Management of epistaxis associated with oral antithrombotic drugs in emergency department and impact on prescription thereafter.

Objectives: To describe management, and to assess factors associated with antithrombotic prescription thereafter in patients who had epistaxis referred to emergency department (ED).

Design: Prospective cohort study. From EDs, clinical, biological and hospital data were collected.

Clinical use of low-dose parenteral anticoagulation, incidence of major bleeding and mortality: a multi-centre cohort study using the French national health data system.

Purpose: Low-dose parenteral anticoagulation has demonstrated its efficacy for venous thromboembolism prophylaxis in randomized trials. However, current practice is not widely documented. In ambulatory settings, we aimed to provide an overview of the clinical use of low-dose parenteral anticoagulation in France and to assess the incidence of major bleeding and death rates.

Ground-level falls among nonagenarians: the impact of pre-injury antithrombotic therapy.

Among nonagenarians admitted to our emergency department (ED) for ground-level falls, we assessed the impact of pre-injury antithrombotic (AT) treatment on the post-traumatic consequences, and identified risk factors for 1-month mortality. All eligible patients were consecutively included over an 18-month period. Head trauma was attested by reliable medical history, witnesses or recent external signs.

Acute, major muscular hematoma associated with antithrombotic agents: A multicenter real-world cohort.

Background: There is little data on major muscular hematomas and the little there is has mainly focused on patients exposed to oral anticoagulants.

Objective: To describe the clinical characteristics, management and outcomes of patients admitted to emergency department (ED) for major muscular hematoma associated with an antithrombotic agent, and to identify predictors of in-hospital mortality.

Patients And Methods: Over a three-year period, all consecutive cases of adult patients admitted to the ED of 5 tertiary care hospitals for major muscular hematoma while exposed to an antithrombotic agent were prospectively collected and medically validated.

Major gastrointestinal bleeding and antithrombotics: Characteristics and management.

Background: There are few reports on major gastrointestinal (GI) bleeding among patients receiving an antithrombotic.

Aim: To describe clinical characteristics, bleeding locations, management and in-hospital mortality related to these events.

Methods: Over a three-year period, we prospectively identified 1080 consecutive adult patients admitted in two tertiary care hospitals between January 1, 2013 and December 31, 2015 for major GI bleeding while receiving an antithrombotic.

Analgesic consumption evolution at the emergency department of a university hospital (2006-2017): a defined daily doses based analysis.

Objective: Pain management in the emergency department (ED) is a key issue that must be regularly evaluated. Practice evaluation gold standard remains patient file analysis, but is highly time consuming. The aim of this study is to evaluate the interest of a defined daily dose (DDD) based analysis in the evaluation of pain management in the ED.

Major bleeding risk and mortality associated with antiplatelet drugs in real-world clinical practice. A prospective cohort study.

Background: Major bleedings other than gastrointestinal (GI) and intracranial (ICH) and mortality rates associated with antiplatelet drugs in real-world clinical practice are unknown. The objective was to estimate major bleeding risk and mortality among new users of antiplatelet drugs in real-world clinical practice.

Methods And Findings: A population-based prospective cohort using the French national health data system (SNIIRAM), identified 69,911 adults living within five well-defined geographical areas, who were new users of antiplatelet drugs in 2013-2015 and who had not received any antithrombotics in 2012.

Major bleeding risk associated with oral anticoagulant in real clinical practice. A multicentre 3-year period population-based prospective cohort study.

Aims: The objective was to compare major bleeding risk of direct oral anticoagulants (DOACs; per type and dose) with vitamin K antagonists (VKAs), irrespective of indication, using real-world data.

Methods: A population-based prospective cohort study, using the French national health data system (SNIIRAM), identified 47 469 adults living within 5 well-defined geographical areas, who were new users of oral anticoagulants in the period 2013-2015: 20 205 VKA users, 19 579 rivaroxaban users, 4225 dabigatran users and 3460 apixaban users. From all emergency departments within these areas, clinical data for all adults referred for bleeding was collected and medically validated.

Sensitivity and specificity of an algorithm based on medico-administrative data to identify hospitalized patients with major bleeding presenting to an emergency department.

Background: Validation studies on an ICD-10-based algorithm to identify major bleeding events are scarce, and mostly focused on positive predictive values.

Objective: To evaluate the sensitivity and specificity of an ICD-10-based algorithm in adult patients referred to hospital.

Methods: This was a cross-sectional, retrospective analysis.

Pain intensity and imaging at the initial phase of acute pyelonephritis.

Objective: To identify predictive factors of urological complication on imaging findings in women with pyelonephritis aged 18 to 65 years.

Methods: We performed an observational, retrospective, single-center study. The medical charts of women diagnosed with pyelonephritis at the emergency department from 2010 to 2015 were reviewed.

Guideline-Based Clinical Assessment Versus Procalcitonin-Guided Antibiotic Use in Pneumonia: A Pragmatic Randomized Trial.

Study Objective: Efforts to reduce unnecessary and unnecessarily long antibiotic treatment for community-acquired pneumonia have been attempted through use of procalcitonin and through guidelines based on serial clinical assessment. Our aim is to compare guideline-based clinical assessment- and procalcitonin algorithm-guided antibiotic use among patients with community-acquired pneumonia.

Methods: We performed a pragmatic, randomized, multicenter trial from November 2012 to April 2015 at 12 French hospitals.

Major bleeding with antithrombotic agents: a 2012-2015 study using the French nationwide Health Insurance database linked to emergency department records within five areas - rationale and design of SACHA study.

Bleeding represents the most recognized and feared complications of antithrombotic drugs including oral anticoagulants. Previous studies showed inconsistent results on the safety profile. Among explanations, bleeding definition could vary and classification bias exists related to the lack of medical evaluation.

Determination of risk factors for herpesvirus outbreak in oysters using a broad-scale spatial epidemiology framework.

Marine diseases have major impacts on ecosystems and economic consequences for aquaculture and fisheries. Understanding origin, spread and risk factors of disease is crucial for management, but data in the ocean are limited compared to the terrestrial environment. Here we investigated how the marine environment drives the spread of viral disease outbreak affecting The Pacific oyster worldwide by using a spatial epidemiology framework.

Pulmonary embolism rule-out criteria (PERC) rule in European patients with low implicit clinical probability (PERCEPIC): a multicentre, prospective, observational study.

Background: The ability of the pulmonary embolism rule-out criteria (PERC) to exclude pulmonary embolism without further testing remains debated outside the USA, especially in the population with suspected pulmonary embolism who have a high prevalence of the condition. Our main objective was to prospectively assess the predictive value of negative PERC to rule out pulmonary embolism among European patients with low implicit clinical probability.

Methods: We did a multicentre, prospective, observational study in 12 emergency departments in France and Belgium.

Safety of Fixed Dose of Antihypertensive Drug Combinations Compared to (Single Pill) Free-Combinations: A Nested Matched Case-Control Analysis.

To compare serious adverse events of fixed-dose dual antihypertensive drug combination (FIXED) to component-based free-combination (FREE).A population-based nationwide cohort from the French Health Insurance System included subjects over 50 years with first time claims (new user) in the second half of 2009 for a calcium-channel blocker or a thiazide-like diuretic in combination with either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker as FREE or FIXED. We designed a nested matched case-control analysis with 304 cases, hospitalized for hypotension, syncope, or collapse (n = 224), renal failure (n = 19), hyponatremia, hyper- or hypokalemia (n = 61) and 1394 controls matched for gender, age, date of inclusion in the cohort, and administrative county.

Emergency admissions for major haemorrhage associated with direct oral anticoagulants.

Introduction: To describe the population admitted in an emergency department of a teaching hospital for severe bleeding associated with direct oral anticoagulants (DOAC).

Method: During a three-year period (2012-2014) patients older than 16 years were prospectively identified by haemorrhagic symptoms from computerised requests. At least one of the following criteria defined major haemorrhage: haemorrhagic shock, unstable haemodynamic, need for transfusion or haemostatic procedure, or a life threatening location.

Emergency admissions for major haemorrhage associated with antithrombotics: a cohort study.

Introduction: to describe antithrombotic-related major haemorrhage, therapeutic management and outcomes in patients admitted to an emergency department of a teaching hospital.

Material And Method: This prospective cohort included patients older than 16years with antithrombotic-related major haemorrhage identified by monthly diagnostic codes computerised requests. Major haemorrhage was defined by at least one the following criteria: unstable hemodynamic, haemorrhagic shock, uncontrollable bleeding, need for transfusion or haemostatic procedure, or a life threatening location.

Frequency and severity of adverse drug reactions due to self-medication: a cross-sectional multicentre survey in emergency departments.

Background: Little is known about the relation of adverse drug reactions (ADRs) to self-use of medications.

Objective: The aim of this study was to determine the frequency and severity of ADRs related to self-medication (ADR-SM) among emergency department (ED) patients and to describe their main characteristics.

Methods: A prospective, cross-sectional, observational study was conducted over a period of 8 weeks (1 March to 20 April 2010), in the ED of 11 French academic hospitals.

[Bacterial meningitis: factors related to the delay before appropriate antibiotic administration in the emergency department].

Objectives: We had for aim to check the appropriateness of our practices according to French guidelines (17th consensus conference, SPILF 2008) and to identify variables associated with the delay before appropriate measures were implemented.

Methods: Our retrospective observational study (2009-2011) focused on acute bacterial meningitis (ABM) in adults. Data was collected on a standardized questionnaire from medical charts and nurse reports.

[Impact of low-dose CT in the diagnosis and treatment of renal colic in emergency department].

Objective: To evaluate the diagnostic performance and the benefit in terms of management of low-dose CT for the imaging assessment of renal colic (CN) emergencies.

Patients And Methods: Two hundred and ninety-one patients admitted to emergency for CN were included in this study. Eighty-seven had a low-dose CT and 40 an ASP and an ultrasound (ASPE).

Managing an emergency department by analysing HIS medical data: a focus on elderly patient clinical pathways.

Introduction: The objective of this paper is to present complementary views of the activity of the emergency department for a specific group of patients. Once validated, these views will be used as decision support tools for better managing the department and providing better care delivery for this population. The views are produced from the data stored in Healthcare Information Systems that correspond potentially to a vast source of information for supporting decisions on management or public health issues.

[Admissions of elderly to French emergency departments related to adverse drug events].

Aims: To investigate the characteristics of adverse drug events (ADE) causing emergency medical admissions in the elderly.

Methods: Data were obtained from two prospective cross sectional studies with similar experimental design which were carried out in seven French emergency departments in 1999 and 2003. The proportion of ADE leading to admission, their severity and preventability were assessed in patients aged > or =70 (group A) and compared to those of patients < 70 years (group B).

Towards a decision support system for optimising clinical pathways of elderly patients in an emergency department.

Unlabelled: Data stored in Healthcare Information Systems correspond potentially to a vast source of information for supporting decisions in management or public health issues. The presented study illustrates clinical data valuation, through the analysis of clinical pathways of elderly patients at the Emergency Department (ED) of Rennes hospital.

Method: Relevant data were extracted from the Emergency Department database.

[Not Available].

Aims: To investigate the characteristics of adverse drug events (ADE) causing emergency medical admissions in the elderly.

Methods: Data were obtained from two prospective cross sectional studies with similar experimental design which were carried out in seven French emergency departments in 1999 and 2003. The proportion of ADE leading to admission, their severity and preventability were assessed in patients aged ≥70 (group A) and compared to those of patients <70years (group B).