ORCID Profile
0000-0003-2608-0347
Current Organisation
Charité Universitätsmedizin Berlin
Does something not look right? The information on this page has been harvested from data sources that may not be up to date. We continue to work with information providers to improve coverage and quality. To report an issue, use the Feedback Form.
Publisher: Public Library of Science (PLoS)
Date: 16-02-2021
DOI: 10.1371/JOURNAL.PONE.0246956
Abstract: The COVID-19 pandemic led to the implementation of drastic shutdown measures worldwide. While quarantine, self-isolation and shutdown laws helped to effectively contain and control the spread of SARS-CoV-2, the impact of COVID-19 shutdowns on trauma care in emergency departments (EDs) remains elusive. All ED patient records from the 35-day COVID-19 shutdown (SHUTDOWN) period were retrospectively compared to a calendar-matched control period in 2019 (CTRL) as well as to a pre (PRE)- and post (POST)-shutdown period in an academic Level I Trauma Center in Berlin, Germany. Total patient and orthopedic trauma cases and contacts as well as trauma causes and injury patterns were evaluated during respective periods regarding absolute numbers, incidence rate ratios (IRRs) and risk ratios (RRs). Daily total patient cases (SHUTDOWN vs. CTRL, 106.94 vs. 167.54) and orthopedic trauma cases (SHUTDOWN vs. CTRL, 30.91 vs. 52.06) decreased during the SHUTDOWN compared to the CTRL period with IRRs of 0.64 and 0.59. While absolute numbers decreased for most trauma causes during the SHUTDOWN period, we observed increased incidence proportions of household injuries and bicycle accidents with RRs of 1.31 and 1.68 respectively. An RR of 2.41 was observed for injuries due to domestic violence. We further recorded increased incidence proportions of acute and regular substance abuse during the SHUTDOWN period with RRs of 1.63 and 3.22, respectively. While we observed a relevant decrease in total patient cases, relative proportions of specific trauma causes and injury patterns increased during the COVID-19 shutdown in Berlin, Germany. As government programs offered prompt financial aid during the pandemic to in iduals and businesses, additional social support may be considered for vulnerable domestic environments.
Publisher: Elsevier BV
Date: 04-2011
Publisher: BMJ
Date: 05-2019
DOI: 10.1136/BMJOPEN-2018-024896
Abstract: To investigate the suitability of the German version of the Manchester Triage System (MTS) as a potential tool to redirect emergency department (ED) patients to general practitioner care. Such tools are currently being discussed in the context of reorganisation of emergency care in Germany. Prospective cohort study. Single centre University Hospital Emergency Department. Adult, non-surgical ED patients. A non-urgent triage category was defined as a green or blue triage category according to the German version of the MTS. Surrogate parameters for short-term risk (admission rate, diagnoses, length of hospital stay, admission to the intensive care unit, in-hospital and 30-day mortality) and long-term risk (1-year mortality). A total of 1122 people presenting to the ED participated in the study. Of these, 31.9% (n=358) received a non-urgent triage category and 68.1% (n=764) were urgent. Compared with non-urgent ED presentations, those with an urgent triage category were older (median age 60 vs 56 years, p=0.001), were more likely to require hospital admission (47.8% vs 29.6%) and had higher in-hospital mortality (1.6% vs 0.8%). There was no significant difference observed between non-urgent and urgent triage categories for 30-day mortality (1.2% [n=4] vs 2.2% [n=15] p=0.285) or for 1-year mortality (7.9% [n=26] vs 10.5% [n=72] p=0.190). Urgency was not a significant predictor of 1-year mortality in univariate (HR=1.35 95% CI 0.87 to 2.12 p=0.185) and multivariate regression analyses (HR=1.20 95% CI 0.77 to 1.89 p=0.420). The results of this study suggest the German MTS is unsuitable to safely identify patients for redirection to non-ED based GP care. U1111-1119-7564 Post-results
Publisher: Wiley
Date: 04-04-2021
DOI: 10.1111/IRV.12857
Abstract: Seasonal influenza is a burden for emergency departments (ED). The aim of this study was to investigate whether point‐of‐care (POC) PCR testing can be used to reduce staff sick days and improve diagnostic and therapeutic procedures. The aim of this study was to investigate whether point‐of‐care (POC) PCR testing can be used to reduce staff sick days and improve diagnostic and therapeutic procedures. Using a cross‐over design, the cobas® Liat® Influenza A/B POC PCR test (Liat) was compared with standard clinical practice during the 2019/2020 influenza season. All adult patients (aged ≥ 18 years) with fever (≥38°C) and respiratory symptoms were included. Primary end points were the prevalence of influenza infections in the ED and staff sick days. Secondary end points were frequency of antiviral and antibacterial therapy, time between admission and test result or treatment initiation, patient disposition, ED length of stay (LOS), and for inpatients mortality and LOS. Nurses were interviewed about handling and integration of POC testing. The occurrence of SARS‐CoV‐2 infections coincided with the second half of the study. A total of 828 patients were enrolled in the study. All 375 patients of the intervention group were tested with Liat, and 103 patients of them (27.6%) tested positive. During the intervention period, staff sick days were reduced by 34.4% ( P = .023). Significantly, more patients in the intervention group received antiviral therapy with neuraminidase inhibitors (7.2% vs 3.8%, P = .028) and tested patients received antibiotics more frequently (40.0% vs 31.6%, P = .033). Patients with POC test were transferred to external hospitals significantly more often (5.6% vs 1.3%, P = .01). We conclude that POC testing for influenza is useful in the ED, especially if it is heavily frequented by patients with respiratory symptoms.
Publisher: BMJ
Date: 11-2021
DOI: 10.1136/BMJOPEN-2021-053110
Abstract: Aim of this study was to analyse if subjectively perceived treatment urgency of patients in emergency departments is associated with self-reported health literacy and the willingness to use the general practitioner (GP) as coordinator of treatment. A multicentre, cross-sectional, observational study. Emergency departments in five hospitals. Each hospital was visited 14 times representing two 8-hour shifts on each day of the week. Calendar dates were randomly assigned. All patients of legal age registered at the emergency department or hospital reception desk. Exclusion criteria included immediate or very urgent need of treatment, high level of symptom burden and severe functional impairments in terms of hearing, vision and speech. We conducted standardised personal interviews. Additionally, clinical data were extracted from patient records. Our target variable was subjectively perceived treatment urgency. Predictor variables included age, sex, education, health-related quality of life (EuroQol Five-Dimension Scale, value set UK), anxiety and depression (Hospital Anxiety and Depression Scale), somatic symptoms (Patient Health Questionnaire, 15 items version), self-reported health literacy (European Health Literacy Questionnaire, 16 questions version) and the commitment to the GP (Fragebogen zur Intensität der Hausarztbindung, ‘F-HaBi’). Data were analysed by multilevel, multivariable linear regression adjusted for random effects at the hospital level. Our s le comprised 276 patients with a mean age of 50.1 years and 51.8% women. A low treatment urgency (defined as 0–5 points on a Numerical Rating Scale) was reported by 111 patients (40.2%). In the final model, lower subjective treatment urgency was associated with male sex (β=0.84 95% CI 0.11/1.57, p=0.024), higher health-related quality of life (−2.27 to –3.39/−1.15, p .001), lower somatic symptoms score (0.09, 0.004/0.17, p=0.040), higher anxiety score (−0.13 to –0.24/−0.01, p=0.027) and lower commitment to the GP (0.08, 0.01/0.14, p=0.029). A lower level of subjectively perceived treatment urgency was predicted by a lower willingness to use the GP as coordinator of treatment. Self-reported health literacy did not predict the patients’ urgency rating.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-04-2021
Publisher: MDPI AG
Date: 18-07-2023
DOI: 10.3390/JCM12144750
Abstract: The association between emergency department (ED) length of stay (EDLOS) with in-hospital mortality (IHM) in older patients remains unclear. This retrospective study aims to delineate the relationship between EDLOS and IHM in elderly patients. From the ED patients (n = 383,586) who visited an urban academic tertiary care medical center from January 2010 to December 2016, 78,478 older patients (age ≥60 years) were identified and stratified into three age subgroups: 60–74 (early elderly), 75–89 (late elderly), and ≥90 years (longevous elderly). We applied multiple machine learning approaches to identify the risk correlation trends between EDLOS and IHM, as well as boarding time (BT) and IHM. The incidence of IHM increased with age: 60–74 (2.7%), 75–89 (4.5%), and ≥90 years (6.3%). The best area under the receiver operating characteristic curve was obtained by Light Gradient Boosting Machine model for age groups 60–74, 75–89, and ≥90 years, which were 0.892 (95% CI, 0.870–0.916), 0.886 (95% CI, 0.861–0.911), and 0.838 (95% CI, 0.782–0.887), respectively. Our study showed that EDLOS and BT were statistically correlated with IHM (p 0.001), and a significantly higher risk of IHM was found in low EDLOS and high BT. The flagged rate of quality assurance issues was higher in lower EDLOS ≤1 h (9.96%) vs. higher EDLOS 7 h t≤ 8 h (1.84%). Special attention should be given to patients admitted after a short stay in the ED and a long BT, and new concepts of ED care processes including specific areas and teams dedicated to older patients care could be proposed to policymakers.
Publisher: Informa UK Limited
Date: 02-01-2018
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 31-01-2023
Publisher: Public Library of Science (PLoS)
Date: 23-08-2018
Publisher: Georg Thieme Verlag KG
Date: 15-09-2016
Publisher: MDPI AG
Date: 17-05-2022
Abstract: Mental health conditions are frequent among patients with somatic illnesses, such as cardiac diseases. They often remain undiagnosed and are related to increased utilization of outpatient services, including emergency department care. The objective of this qualitative study was to investigate the significance of the emergency department in the patients’ course of treatment and from the physicians’ perspective. An improved understanding of the subjective needs of this specific patient group should provide hints for targeted treatment. This study is part of the prospective EMASPOT study, which determined the prevalence of mental health conditions in emergency department patients with cardiac ambulatory care sensitive conditions. The study on hand is the qualitative part, in which 20 semi-structured interviews with patients and a focus group with six ED physicians were conducted. Data material was analyzed using the qualitative content analysis technique, a research method for systematically identifying themes or patterns. For interpretation, we used the “typical case approach”. We identified five “typical patient cases” that differ in their cardiac and mental health burden of disease, frequency and significance of emergency department and outpatient care visits: (1) frequent emergency department users with cardiac diseases and mental health conditions, (2) frequent emergency department users without cardiac diseases but with mental health conditions, (3) needs-based emergency department users with cardiac diseases (4) targeted emergency department users as an alternative to specialist care and (5) patients surprised by initial diagnose of cardiac disease in the emergency department. While patients often perceived the emergency department visit itself as a therapeutic benefit, emergency department physicians emphasized that frequent examinations of somatic complaints can worsen mental health conditions. To improve care, they proposed close cooperation with the patients’ primary care providers, access to patients’ medical data and early identification of mental health conditions after cardiac diagnoses, e.g., by an examination tool.
Publisher: Georg Thieme Verlag KG
Date: 15-09-2016
Publisher: Elsevier BV
Date: 03-2016
DOI: 10.1016/J.AMJMED.2015.10.016
Abstract: The search for improved strategies for safe and early discharge of patients with suspected acute coronary syndrome in emergency departments is ongoing. This Biomarkers in Cardiology (BIC)-8 biomarker substudy evaluated the usefulness of high-sensitivity troponin T (hsTnT) below or above the limit of detection (LoD) in low-to-intermediate-risk patients with suspected acute coronary syndrome in the emergency department. Patients were categorized into hsTnT ≥ the 99th percentile, between the 99th percentile and LoD, or undetectable hsTnT (<LoD). HsTnT and copeptin were measured at admission, using a copeptin cut-off of 10 pmol/L. The primary endpoint was death and myocardial infarction within 90 days after admission. Of 882 patients with all biomarker results, 577 (65.4%) had detectable hsTnT levels (≥LoD). Among the 305 patients (34.6%) with undetectable hsTnT, no myocardial infarctions or deaths occurred within 90 days. In patients with detectable hsTnT at admission (≥LoD but ≤99th percentile), the combined endpoint occurred in 1.5% (6/410) of the copeptin-negative patients and in 6.3% (6/96) of copeptin-positive patients within 90 days (hazard ratio 4.39 95% confidence interval, 1.42-13.61 P = .01). In patients with an initially elevated hsTnT (≥14 ng/L), 9.7% (3/31) of the copeptin-negative patients and 15.4% (4/26) of the copeptin-positive patients experienced the combined endpoint (hazard ratio 1.61 95% confidence interval, 0.36-7.17 P = .536). In low-to-intermediate-risk patients with suspected acute coronary syndrome, undetectable hsTnT values at admission allow a safe discharge without occurrence of death or myocardial infarction within 90 days.
Publisher: Springer Science and Business Media LLC
Date: 05-08-2022
DOI: 10.1007/S00392-022-02074-3
Abstract: In this retrospective routine data analysis, we investigate the number of emergency department (ED) consultations during the COVID-19 pandemic of 2020 in Germany compared to the previous year with a special focus on numbers of myocardial infarction and acute heart failure. Aggregated case numbers for the two consecutive years 2019 and 2020 were obtained from 24 university hospitals and 9 non-university hospitals in Germany and assessed by age, gender, triage scores, disposition, care level and by ICD-10 codes including the tracer diagnoses myocardial infarction (I21) and heart failure (I50). A total of 2,216,627 ED consultations were analyzed, of which 1,178,470 occurred in 2019 and 1,038,157 in 2020. The median deviation in case numbers between 2019 and 2020 was − 14% [CI (− 11)–(− 16)]. After a marked drop in all cases in the first COVID-19 wave in spring 2020, case numbers normalized during the summer. Thereafter starting in calendar week 39 case numbers constantly declined until the end of the year 2020. The decline in case numbers predominantly concerned younger [− 16% CI (− 13)–(− 19)], less urgent [− 18% CI (− 12)–(− 22)] and non-admitted cases [− 17% CI (− 13)–(− 20)] in particular during the second wave. During the entire observation period admissions for chest pain [− 13% CI (− 21)–2], myocardial infarction [− 2% CI (− 9)–11] and heart failure [− 2% CI (− 10)–6] were less affected and remained comparable to the previous year. ED visits were noticeably reduced during both SARS-CoV-2 pandemic waves in Germany but cardiovascular diagnoses were less affected and no refractory increase was noted. However, long-term effects cannot be ruled out and need to be analysed in future studies.
Publisher: Informa UK Limited
Date: 25-08-2019
Publisher: Public Library of Science (PLoS)
Date: 14-10-2022
DOI: 10.1371/JOURNAL.PONE.0274793
Abstract: Wastewater-based epidemiology (WBE) surveillance as an early warning system (EWS) for monitoring community transmission of SARS-CoV-2 in low- and middle-income country (LMIC) settings, where diagnostic testing capacity is limited, needs further exploration. We explored the feasibility to conduct a WBE surveillance in Indonesia, one of the global epicenters of the COVID-19 pandemic in the middle of 2021, with the fourth largest population in the world where sewer and non-sewered sewage systems are implemented. The feasibility and resource capacity to collect s les on a weekly or fortnightly basis with grab and/or passive s ling methods, as well as to conduct qualitative and quantitative identification of SARS-CoV-2 ribonucleic acid (RNA) using real-time RT-PCR (RT-qPCR) testing of environmental s les were explored. We initiated a routine surveillance of wastewater and environmental s ling at three predetermined districts in Special Region of Yogyakarta Province. Water s les were collected from central and community wastewater treatment plants (WWTPs), including manholes flowing to the central WWTP, and additional soil s les were collected for the near source tracking (NST) locations (i.e., public spaces where people congregate). We began collecting s les in the Delta wave of the COVID-19 pandemic in Indonesia in July 2021. From a 10-week period, 54% (296/544) of wastewater and environmental s les were positive for SARS-CoV-2 RNA. The s le positivity rate decreased in proportion with the reported incidence of COVID-19 clinical cases in the community. The highest positivity rate of 77% in week 1, was obtained for s les collected in July 2021 and decreased to 25% in week 10 by the end of September 2021. A WBE surveillance system for SARS-CoV-2 in Indonesia is feasible to monitor the community burden of infections. Future studies testing the potential of WBE and EWS for signaling early outbreaks of SARS-CoV-2 transmissions in this setting are required.
Publisher: Springer Science and Business Media LLC
Date: 23-06-2016
Publisher: Georg Thieme Verlag KG
Date: 08-2018
Publisher: Springer Science and Business Media LLC
Date: 28-10-2021
DOI: 10.1007/S00063-021-00879-0
Abstract: In Deutschland gibt es bisher keine Gesundheitsberichterstattung zu sektorenübergreifenden Versorgungsverläufen im Kontext einer Notaufnahmeversorgung. Das Projekt INDEED (Inanspruchnahme und sektorenübergreifende Versorgungsmuster von Patienten in Notfallversorgungsstrukturen in Deutschland) erhebt Routinedaten aus 16 Notaufnahmen, die mit ambulanten Abrechnungsdaten der Jahre 2014 bis 2017 personenbezogen zusammengeführt werden. Die methodischen Herausforderungen der Planung der internen Zusammenführung von klinischen und administrativen Routinedaten aus Notaufnahmen in Deutschland bis zur finalen Datenextraktion werden hier gemeinsam mit Lösungsansätzen dargestellt. Die Auswahl der Notaufnahmedaten erfolgte in einem iterativen Prozess unter Berücksichtigung der Forschungsfragen, medizinischen Relevanz und angenommenen Datenverfügbarkeit. Nach einer Vorbereitungsphase zur Klärung der Rahmenbedingungen (u. a. Datenschutz, Ethik), zur Prüfung von Testdaten und ggf. Korrekturen, erfolgte die verschlüsselte und pseudonyme Datenausleitung. Die Daten der 16 kooperierenden Notaufnahmen stammten in der Regel aus dem Notaufnahme- und dem Krankenhausinformationssystem. Die Datenlage war sehr heterogen. Nicht alle Variablen waren in jeder Notaufnahme verfügbar, da sie beispielsweise nicht standardisiert und digital vorlagen oder der Extraktionsaufwand als zu hoch bewertet wurde. Relevante Daten aus Notaufnahmen liegen unterschiedlich strukturiert und in mehreren IT-Systemen vor. Die notwendige Bildung eines klinikübergreifenden vergleichbaren Datensatzes erfordert erhebliche Ressourcen auf Seiten der Kliniken sowie der datenaufbereitenden Stelle. Dies muss für zukünftige Projekte großzügig kalkuliert werden.
Publisher: S. Karger AG
Date: 07-12-2010
DOI: 10.1159/000320763
Abstract: i Background: /i C-reactive protein (CRP) is a possible causative factor of the destructive processes observed during the weeks after myocardial infarction. i Methods: /i We developed a clinically relevant animal model including the removal of CRP from blood plasma utilizing a specific CRP adsorber and the visualization of the infarct scar in the living animal by cardiovascular magnetic resonance imaging as a tool to investigate the impact of CRP after acute myocardial infarction. i Results: /i We describe the facets of this model system and kinetics of clinical blood parameters like CRP and troponin. In addition, we demonstrate the potency of CRP apheresis reducing CRP levels by ∼70% in the established treatment system. i Conclusion: /i We showed for the first time that it is possible to conduct apheresis at the following 2 days after acute myocardial infarction in a porcine infarction model and to analyze the infarct by cardiovascular magnetic resonance imaging at day 1 and 14.
Publisher: Frontiers Media SA
Date: 25-04-2022
DOI: 10.3389/FPUBH.2022.711235
Abstract: Given the scarcity of resources, the increasing use of emergency departments (ED) represents a major challenge for the care of emergency patients. Current health policy interventions focus on restructuring emergency care with the help of patient re-direction into outpatient treatment structures. A precise analysis of ED utilization, taking into account treatment urgency, is essential for demand-oriented adjustments of emergency care structures. Temporal and seasonal trends in the use of EDs were investigated, considering treatment urgency and hospital mortality. Secondary data of 287,119 ED visits between 2015 and 2017 of the two EDs of Charité Universitätsmedizin Berlin, C us Charité Mitte and C us Virchow Klinikum were analyzed. EDs were used significantly more frequently on weekends than on weekdays (Mdn = 290 vs. 245 visits/day p & 0.001). The proportion of less urgent, outpatient emergency visits on weekends was above average. Holiday periods were characterized by at least 6, and at most 176 additional ED visits. In a comparison of different holidays, most ED visits were observed at New Year (+68% above average). In addition, a significant increase in in-hospital mortality on holidays was evident among inpatients admitted to hospital via the ED (3.0 vs. 3.2% p & 0.001), with New Year's Day being particularly striking (5.4%). These results suggest that, in particular, the resource planning of outpatient emergency treatment capacities on weekends and holidays should be adapted to the increased volume of non-urgent visits in EDs. Nevertheless, treatment capacities for the care of urgent, inpatient emergencies should not be disregarded and further research projects are necessary to investigate the causes of increased mortality during holiday periods.
Publisher: Clinical Laboratory Publications
Date: 2017
Publisher: Springer Science and Business Media LLC
Date: 09-2021
DOI: 10.1007/S00063-021-00860-X
Abstract: Das Sachverständigengutachten zur bedarfsgerechten Steuerung der Gesundheitsversorgung 2018 empfiehlt zur Entlastung der klinischen Notfallversorgung unter anderem, dem Rettungsdienst die Option einzuräumen, geeignete Patienten direkt in eine Praxis zur fachärztlichen Versorgung zu transportieren. Quantifizierung von Patienten, die mit dem Rettungswagen (RTW) in der Notaufnahme vorgestellt wurden und sicher und sinnvoll zur Behandlung primär in eine Praxis transportiert hätten werden können. Retrospektive Auswertung prähospitaler und klinischer Daten von erwachsenen Patienten, die innerhalb von 2 Monaten mit einem RTW in die Notaufnahme eines universitären Maximalversorgers eingeliefert wurden. Anhand einer durch Rettungsassistenten durchgeführten, 5‑stufigen Dringlichkeitseinschätzung erfolgte durch die Autoren zunächst die Kategorisierung in „dringliche“ (Arztkontakt innerhalb von maximal 30 min notwendig) und „weniger dringliche“ Fälle (Arztkontakt nicht in weniger als 30 min notwendig, maximal in 120 min). In der Gruppe der „weniger dringlichen“ Fälle wurden aus den klinischen Behandlungsdaten diejenigen mit ambulanter Weiterbehandlung diskriminiert sowie folgend die Fälle, deren administrative Notaufnahme von Montag bis Freitag (Feiertage ausgeschlossen) jeweils zwischen 08.00 und 19.00 Uhr stattfand (praxistaugliche Fälle). Außerdem erfolgte eine medizinisch-inhaltliche Differenzierung dieser Fälle und ein Vergleich mit der Dringlichkeitseinschätzung in der Notaufnahme (Manchester Triage System, MTS). Es wurden n = 1260 Patienten mit dem RTW in die Notaufnahme disponiert (Gesamtbehandlungszahl n = 11.506). Bei n = 894 war eine prähospitale Dringlichkeitseinschätzung dokumentiert, auf deren Grundlage n = 477 (53,4 %) als „weniger dringliche“ Fälle kategorisiert und n = 317 (66,5 %) ambulant weiterbehandelt wurden, n = 114 (23,9 %) zu üblichen Praxisöffnungszeiten. Das entspricht 1 % aller im Beobachtungszeitraum behandelten Patienten. 70 Fälle dieser praxistauglichen Gruppe (63,6 % von n = 110 mit dokumentierter MTS) wurden in der Notaufnahme dringlicher eingestuft. Die prähospital dokumentierten Beschwerdebilder und die in der Klinik erhobenen Hauptdiagnosen lassen den Einsatz relevanter diagnostischer Ressourcen bei einer Vielzahl der praxistauglichen Fälle vermuten. Die Notaufnahmen könnten im Zeitfenster üblicher Praxisöffnungszeiten bei primärer Disposition der weniger dringlichen, ambulant behandelten Fälle in eine Praxis von ungefähr jedem zehnten mit dem RTW disponierten Patienten und 1 % ihrer Gesamtpatientenzahl entlastet werden. Unter dem Aspekt der Patientensicherheit ist dieses Vorgehen mit 60 % möglicher Untertriage kritisch zu bewerten. Für die Diagnostik und Behandlung müssten entsprechende Ressourcen in der Praxis vorhanden und dem Rettungsdienst bekannt sein. Die primäre Disposition in eine Praxis erscheint bezogen auf die mögliche Entlastung einer großstädtischen Notaufnahme unbedeutend, ist potenziell patientengefährdend und mit einem enormen logistischen Aufwand verbunden.
Publisher: Hindawi Limited
Date: 2015
DOI: 10.1155/2015/768401
Abstract: Background . Stroke can be a challenging diagnosis in an emergency-setting. We sought to determine whether copeptin may be a useful biomarker to differentiate between ischemic stroke (IS), transient ischemic attack (TIA), and stroke-mimics. Methods . In patients with suspected stroke arriving within 4.5 hours of symptom-onset, copeptin-levels were measured in initial blood-s les. The final diagnosis was adjudicated by vascular neurologists blinded to copeptin-values. Results . Of all 36 patients with available copeptin-values (median age 71 years, IQR: 54–76 44% female), 20 patients (56%) were diagnosed with IS, no patient was diagnosed with hemorrhagic stroke, nine patients (25%) were diagnosed with TIA, and seven patients (19%) were stroke-mimics. Copeptin-levels (in pmol/L) tended to be higher in patients with IS [19.1 (11.2–48.5)] compared to TIA [9.4 (5.4–13.8)]. In stroke-mimics the range of values was extremely broad [33.3 (7.57–255.7)]. The diagnostic accuracy of copeptin for IS was 63% with a sensitivity of 80% and a positive predictive value of 64%. Conclusion . In this cohort of patients copeptin-levels within 4.5 hours of symptom onset were higher in patients with IS compared to TIA but the broad range of values in stroke-mimics limits diagnostic accuracy. This trial is registered with UTN: U1111-1119-7602.
Publisher: Springer Science and Business Media LLC
Date: 06-06-2023
DOI: 10.1186/S12873-023-00838-2
Abstract: It has not yet been possible to ascertain the exact proportion, characterization or impact of low-acuity emergency department (ED) attendances on the German Health Care System since valid and robust definitions to be applied in German ED routine data are missing. Internationally used methods and parameters to identify low-acuity ED attendances were identified, analyzed and then applied to routine ED data from two EDs of the tertiary care hospitals Charité—Universitätsmedizin Berlin, C us Mitte (CCM) and C us Virchow (CVK). Based on the three routinely available parameters `disposition´, `transport to the ED´ and `triage´ 33.2% ( n = 30 676) out of 92 477 presentations to the two EDs of Charité—Universitätsmedizin Berlin (CVK, CCM) in 2016 could be classified as low-acuity presentations. This study provides a reliable and replicable means of retrospective identification and quantification of low-acuity attendances in German ED routine data. This enables both intra-national and international comparisons of figures across future studies and health care monitoring.
Publisher: MDPI AG
Date: 19-12-2022
DOI: 10.3390/JPM12122085
Abstract: Background: Our aim is to describe and compare the profile and outcome of patients attending the ED with a confirmed COVID-19 infection with patients with a suspected COVID-19 infection. Methods: We conducted a multicentric retrospective study including adults who were seen in 21 European emergency departments (ED) with suspected COVID-19 between 9 March and 8 April 2020. Patients with either a clinical suspicion of COVID-19 or confirmed COVID-19, detected using either a RT-PCR or a chest CT scan, formed the C+ group. Patients with non-confirmed COVID-19 (C− group) were defined as patients with a clinical presentation in the ED suggestive of COVID-19, but if tests were performed, they showed a negative RT-PCR and/or a negative chest CT scan. Results: A total of 7432 patients were included in the analysis: 1764 (23.7%) in the C+ group and 5668 (76.3%) in the C− group. The population was older (63.8 y.o. ±17.5 vs. 51.8 y.o. +/− 21.1, p 0.01), with more males (54.6% vs. 46.1%, p 0.01) in the C+ group. Patients in the C+ group had more chronic diseases. Half of the patients (n = 998, 56.6%) in the C+ group needed oxygen, compared to only 15% in the C− group (n = 877). Two-thirds of patients from the C+ group were hospitalized in ward (n = 1128, 63.9%), whereas two-thirds of patients in the C− group were discharged after their ED visit (n = 3883, 68.5%). Conclusion: Our study was the first in Europe to examine the emergency department’s perspective on the management of patients with a suspected COVID-19 infection. We showed an overall more critical clinical situation group of patients with a confirmed COVID-19 infection.
Publisher: Hindawi Limited
Date: 2018
DOI: 10.1155/2018/7307154
Abstract: Background . Traumatic Pneumothorax (PTX) is a potentially life-threatening injury. It requires a fast and accurate diagnosis and treatment, but diagnostic tools are limited. A new point-of-care device (PneumoScan) based on micropower impulse radar (MIR) promises to diagnose a PTX within seconds. In this study, we compare standard diagnostics with PneumoScan during shock-trauma-room management. Patients and Methods . Patients with blunt or penetrating chest trauma were consecutively included in the study. All patients were examined including clinical examination with auscultation (CE) and supine chest radiography (CXR). In addition, PneumoScan-readings and thoracic ultrasound scan (US) were performed. Computed tomography (CT) served as gold standard. Results . CT scan revealed PTX in 11 patients. PneumoScan detected two PTX correctly but missed nine. 15 false-positive results were found by PneumoScan, leading to a sensitivity of 20% and specificity of 80%. Six PTX were detected through CE (sensitivity: 54,5%). CXR detected four (sensitivity: 27,3%) and thoracic US two PTX correctly (sensitivity: 25%). Conclusion . The unblinded PneumoScan prototype did not confirm the promising results of previous studies. The examined standard diagnostics and thoracic US showed rather weak sensitivity as well. Until now, there is no appropriate point-of-care tool to rule out PTX.
Publisher: Walter de Gruyter GmbH
Date: 09-11-2016
DOI: 10.1515/DX-2016-0026
Abstract: Security standards of our times largely exclude a discharge of patients with chest pain from the emergency departments (EDs) based on clinical assessment alone. Given the increasing use and consequently crowding of EDs worldwide and the large proportion of patients who present to the EDs with, however vague, signs and symptoms of acute coronary syndrome, there is a strong clinical and public health need to achieve a faster but safe rule-in and rule-out of acute myocardial infarction (AMI) to direct patients onto the correct management pathway. A number of approaches for a faster rule-in and rule-out of AMI are currently under research and evaluation and some have already been integrated into current guidelines and/or implemented into the clinical routine in selected centers. This article summarizes these different diagnostic strategies for patients with suspected AMI, using cardiac troponin alone or in combination with copeptin.
Publisher: Frontiers Media SA
Date: 16-04-2021
DOI: 10.3389/FPUBH.2021.616857
Abstract: Introduction: The crowding of emergency departments (ED) has been a growing problem for years, putting the care of critically ill patients increasingly at risk. The INDEED project's overall aim is to get a better understanding of ED utilization and to evaluate corresponding primary health care use patterns before and after an ED visit while driving forward processes and methods of cross-sectoral data merging. We aim to identify adequate utilization of EDs and potentially avoidable patient contacts as well as subgroups and clusters of patients with similar care profiles. Methods: INDEED is a joint endeavor bringing together research institutions and hospitals with EDs in Germany. It is headed by the Charité–Universitätsmedizin Berlin, collaborating with Otto von Guericke University Magdeburg, Technische Universität Berlin, the Central Research Institute of Ambulatory/Outpatient Health Care in Germany (Zi), and the AOK Research Institute as part of the Federal Association of AOK, as well as experts in the technological, legal, and regulatory aspects of medical research (TMF). The Institute for Information Technology (OFFIS) was involved as the trusted third party of the project. INDEED is a retrospective study of approximately 400,000 adult patients with statutory health insurance who visited the ED of one of 16 participating hospitals in 2016. The routine hospital data contain information about treatment in the ED and, if applicable, about the subsequent hospital stay. After merging the patients' hospital data from 2016 with their outpatient billing data from 2 years before to 1 year after the ED visit (years 2014–2017), a harmonized dataset will be generated for data analyses. Due to the complex data protection challenges involved, first results will be available in 2021. Discussion: INDEED will provide knowledge on extracting and harmonizing large scale data from varying routine ED and hospital information systems in Germany. Merging these data with the corresponding outpatient care data of patients offers the opportunity to characterize the patient's treatment in outpatient care before and after ED use. With this knowledge, appropriate interventions may be developed to ensure adequate patient care and to avoid adverse events such as ED crowding.
Publisher: Cambridge University Press (CUP)
Date: 04-09-2019
DOI: 10.1017/S1368980019002258
Abstract: To investigate the prevalence of folic acid deficiency in Queensland-wide data of routine laboratory measurements, especially in high-risk sub-populations. Secondary health data analysis. Analysis of routine folic acid tests conducted by Pathology Queensland (AUSLAB). Female and male persons aged 0–117 years with routine folic acid testing between 1 January 2004 and 31 December 2015. If repeat tests on the same person were conducted, only the initial test was analysed ( n 291 908). Overall the prevalence of folic acid deficiency declined from 7·5 % before (2004–2008) to 1·1 % after mandatory folic acid fortification (2010–2015 P 0·001) reflecting a relative reduction of 85 %. Levels of erythrocyte folate increased significantly from a median (interquartile range) of 820 (580–1180) nmol/l in 2008 before fortification to 1020 (780–1350) nmol/l in 2010 ( P 0·001) after fortification. The prevalence of folic acid deficiency in the Indigenous population (14 792 s les) declined by 93 % (17·4 v . 1·3 % P 0·001) and by 84 % in non-Indigenous residents (7·0 v . 1·1 % P 0·001). In a logistic regression model the observed decrease of folic acid deficiency between 2008 and 2010 was found independent of gender, age and ethnicity (OR crude = 0·20 95 % CI 0·18, 0·23 P 0·001 OR adjusted = 0·21 95 % CI 0·18, 0·23 P 0·001). While voluntary folic acid fortification, introduced in 1995, failed especially in high-risk subgroups, the 2009 mandatory folic acid fortification programme coincided with a substantial decrease of folic acid deficiency in the entire population.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-09-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-09-2022
Publisher: Elsevier BV
Date: 04-2023
Publisher: Oxford University Press (OUP)
Date: 15-10-2014
Abstract: Combined testing of copeptin and troponin at presentation to the emergency department (ED) has been shown to possess a high negative predictive value (NPV) for ruling out acute myocardial infarction (AMI) in patients with suspected acute coronary syndrome. The aim of this study was to evaluate the diagnostic performance of the combination of copeptin and troponin for the exclusion of AMI in emergency patients with acute cardiac chief complaints and to assess diagnoses and outcome in copeptin-positive patients. In this prospective study, 537 consecutive patients with cardiac chief complaints were recruited from the ED. Blood s les were collected at admission. The overall incidence of AMI in the study s le was 14.2% (n=76). In troponin-negative patients, copeptin showed a sensitivity of 76.9% (95% confidence interval (CI) 46.2-95.0), a specificity of 64.2% (95% CI 59.2-69.0), a positive predictive value (PPV) of 6.9% (95% CI 3.3-12.2) and an NPV of 98.8% (95% CI 96.5-99.8). The highest copeptin values were observed in patients with chronic heart failure, followed by ST-elevation myocardial infarction (STEMI), acute heart failure (AHF), pneumonia and non-STEMI (NSTEMI). A copeptin-value of above 10 pmol/l increased the risk of death within three months significantly (hazard ratio (HR)=5.42 (1.81-16.21) p=0.003). Copeptin seems to be a promising biomarker for the initial evaluation of emergency patients with cardiac chief complaints. The study adds to the evidence that a single copeptin and troponin test at admission achieves a high NPV for ruling-out NSTEMI early in low-to-intermediate risk patients and thus--in combination with the clinical evaluation--seems to be of considerable relevance in emergency medicine.
Publisher: Elsevier BV
Date: 03-2010
Publisher: MDPI AG
Date: 21-12-2022
DOI: 10.3390/JCM12010032
Abstract: The effect of emergency department (ED) length of stay (EDLOS) on in-hospital mortality (IHM) remains unclear. The aim of this systematic review and meta-analysis was to determine the association between EDLOS and IHM. We searched the PubMed, Medline, Embase, Web of Science, Cochrane Controlled Register of Trials, CINAHL, PsycInfo, and Scopus databases from their inception until 14–15 January 2022. We included studies reporting the association between EDLOS and IHM. A total of 11,337 references were identified, and 52 studies (total of 1,718,518 ED patients) were included in the systematic review and 33 in the meta-analysis. A statistically significant association between EDLOS and IHM was observed for EDLOS over 24 h in patients admitted to an intensive care unit (ICU) (OR = 1.396, 95% confidence interval [CI]: 1.147 to 1.701 p 0.001, I2 = 0%) and for low EDLOS in non-ICU-admitted patients (OR = 0.583, 95% CI: 0.453 to 0.745 p 0.001, I2 = 0%). No associations were detected for the other cut-offs. Our findings suggest that there is an association between IHM low EDLOS and EDLOS exceeding 24 h and IHM. Long stays in the ED should not be allowed and special attention should be given to patients admitted after a short stay in the ED.
Publisher: Georg Thieme Verlag KG
Date: 08-2018
Publisher: JMIR Publications Inc.
Date: 14-07-2023
Abstract: espite the relative longevity of Germany’s non-emergency number 116 117, evidence suggests that awareness of this service remains limited. In light of this, this study turns to the often overlooked medium of primary care practitioner (PCP) websites to promote this service. While these websites may have previously functioned as little more than “electronic nameplates”, as the use of primary care online services, such as online appointment booking, continues to grow so too does their potential to promote and reinforce beneficial health seeking behaviours through the provision of information. he aim of this research is to quantify the availability of “out of hours” (OOH) service information currently provided on PCP websites in Berlin, Germany. o quantify availability of the above a two-stage approach was utilized. In the first stage, the google search site operator was utilized to search the entire website for mention of Germany’s non-emergency number. In the second stage, manual close reading of each PCP website’s homepage (“Startseite”) was conducted alongside use of the find command (ctrl +F) to identify the variables of interest. Homepages were included for further analysis as these are often a website’s default-loading page and provide service users with immediate information and helps them navigate the website. n total, the s ling frame contained details of 4508 physicians working in Berlin and Brandenburg (N = 4508). Search of the entire website for presence of 116 117 indicated that 75 websites featured references to the non-emergency number (32%). 26 featured this information on their homepage (11%). Information on opening hours was more common: 179 websites featured information and/or a link to practice opening hours on their homepage (76%). Overall 13 websites provided information about what to do outside of working hours on their homepage (5%) and all did so with reference to 116 117, explicitly connecting out of hours care with the non-emergency number. he results of this study indicate that a substantial number of physicians are not providing adequate and accessible OOH service information on their websites.
Publisher: Georg Thieme Verlag KG
Date: 10-09-2015
Publisher: BMJ
Date: 09-09-2012
DOI: 10.1136/EMERMED-2012-201530
Abstract: To assess the value of mid-regional pro-adrenomedullin (MR-proADM) in guiding patient disposition from the emergency department (ED), as one of the key factors of hospital resource utilisation, in undifferentiated patients with acute dyspnoea. We used clinical and outcome data from a large international biomarker study (BACH trial) and analysed data of all 1557 patients of the European and US sites presenting with acute dyspnoea. Patients were discharged or transferred from the ED to different levels of care (general ward, monitoring unit, intensive care unit). This original patient disposition was compared with the hypothetical disposition based on an adapted method of net reclassification improvement (NRI), which upgraded or downgraded patients from one level of care to the other based on the MR-proADM test result. MR-pro-ADM was significantly higher in patients who died during the follow-up than in survivors (p<0.0001). When applying the adapted NRI model, 30 additional patients from the European Union (EU) and 55 additional patients from USA were theoretically discharged (increase of 16.5%) if MR-proADM had been used for patient management. The overall NRI, adding up the rates of upgrades and downgrades, in the EU was 16.0% (95% CI 8.2% to 23.9%). A total of n=72 (9.9%) patients changed disposition when adding MR-pro ADM. In the USA, the overall NRI was 12.0% (5.7%-18.4%) and a total of n=81 (11.2%) patients changed disposition. MR-proADM has the potential to guide initial disposition of undifferentiated ED patients with acute dyspnoea and might therefore be helpful to improve resource utilisation and patient care.
Publisher: Elsevier BV
Date: 05-2015
DOI: 10.1016/J.IJCARD.2015.03.261
Abstract: Current guidelines recommend troponin as the preferred biomarker to diagnose acute myocardial infarction (AMI) irrespective of the patient's sex. Recent reports have shown that sex-specific cut-offs should be considered but studies investigating sex-differences in the diagnostic accuracy of cardiac troponins are sparse. To evaluate whether the diagnostic performance of cardiac troponin at admission (cTn) under routine conditions is influenced by patient's sex. Between 15th of February 2009 and 15th of February 2010, women (n=1648) and men (n=2305) who presented to the emergency department with chest pain (n=3954) were enrolled. The diagnostic performance of the routine, contemporary sensitive cTn assays (TnI Stratus® CS, Siemens and TnT Roche Diagnostics) at baseline for the diagnosis of non-ST-elevation myocardial infarction (NSTEMI) was analyzed. NSTEMI was diagnosed in 7.3% (n=287) of all patients. Men were more likely to be diagnosed with NSTEMI (8.8% n=202) as compared to women (5.2% n=85 p<0.001). Sensitivity was 56.1% (95% CI: 44.7-67.0%) in women and 70.1% (95% CI: 63.1-76.4%) in men. Specificity was 96.8% (95% CI: 95.6-97.7%) in women and 94.5% (95% CI: 93.3-95.6%) in men. This resulted in a lower positive predictive value (PPV) for women (53.5% 95% CI: 42.4-64.3) as compared to men (60.8% 95% CI: 54.1-67.2) and a slightly higher negative predictive value (NPV) for women: 97.1% (95% CI: 96.0-97.9) vs. 96.3% (95% CI: 95.2-97.2) in men. The findings of this study underline that the performance of cTn for the diagnosis of NSTEMI depends on a patient's sex, with a lower sensitivity and NPV in women. The definition and implementation of sex-specific cut-off values for cTn into clinical routine seems to be highly recommendable.
Publisher: Elsevier BV
Date: 04-2022
Publisher: Elsevier BV
Date: 10-2015
DOI: 10.1016/J.AMJCARD.2015.07.017
Abstract: In the Providing Regional Observations to Study Predictors of Events in the Coronary Tree (PROSPECT) study, plaque burden, plaque composition, and minimal luminal area were associated with an increased risk of adverse cardiovascular events arising from untreated atherosclerotic lesions (vulnerable plaques) in patients with acute coronary syndromes (ACS). We sought to evaluate the utility of biomarker profiling and clinical risk factors to predict 3-year all-cause and nonculprit lesion-related major adverse cardiac events (MACEs). Of 697 patients who underwent successful percutaneous coronary intervention (PCI) for ACS, an array of 28 baseline biomarkers was analyzed. Median follow-up was 3.4 years. Beta2-microglobulin displayed the strongest predictive power of all variables assessed for all-cause and nonculprit lesion-related MACE. In a classification and regression tree analysis, patients with beta2-microglobulin >1.92 mg/L had an estimated 28.7% 3-year incidence of all-cause MACE C-peptide 1.92 mg/L identified a cohort with a 3-year rate of 18.5%, and C-peptide <2.22 ng/ml was associated with a further increase to 25.5%. By multivariable analysis, beta2-microglobulin was the strongest predictor of all-cause and nonculprit MACE during follow-up. High-density lipoprotein (HDL), transferrin, and history of angina pectoris were also independent predictors of all-cause MACE, and HDL was an independent predictor of nonculprit MACE. In conclusion, in the PROSPECT study, beta2-microglobulin strongly predicted all-cause and nonculprit lesion-related MACE within 3 years after PCI in ACS. C-peptide and HDL provided further risk stratification to identify angiographically mild nonculprit lesions prone to future MACE.
Publisher: Public Library of Science (PLoS)
Date: 15-04-2020
Publisher: Informa UK Limited
Date: 03-10-2012
Publisher: F1000 Research Ltd
Date: 11-05-2020
DOI: 10.12688/GATESOPENRES.13122.1
Abstract: Background: Ae. aegypti mosquitoes stably transfected with the intracellular bacterium Wolbachia pipientis ( w Mel strain) have been deployed for biocontrol of dengue and related arboviral diseases in multiple countries. Field releases in northern Australia have previously demonstrated near elimination of local dengue transmission from Wolbachia -treated communities, and pilot studies in Indonesia have demonstrated the feasibility and acceptability of the method. We conducted a quasi-experimental trial to evaluate the impact of scaled Wolbachia releases on dengue incidence in an endemic setting in Indonesia. Methods: In Yogyakarta City, Indonesia, following extensive community engagement, w Mel Wolbachia -carrying mosquitoes were released every two weeks for 13–15 rounds over seven months in 2016–17, in a contiguous 5 km 2 area (population 65,000). A 3 km 2 area (population 34,000) on the opposite side of the city was selected a priori as an untreated control area. Passive surveillance data on notified hospitalised dengue patients was used to evaluate the epidemiological impact of Wolbachia deployments, using controlled interrupted time-series analysis. Results: Rapid and sustained introgression of w Mel Wolbachia into local Ae. aegypti populations was achieved. Thirty-four dengue cases were notified from the intervention area and 53 from the control area (incidence 26 vs 79 per 100,000 person-years) during 24 months following Wolbachia deployment. This corresponded in the regression model to a 73% reduction in dengue incidence (95% confidence interval 49%,86%) associated with the Wolbachia intervention. Exploratory analysis including 6 months additional post-intervention observations showed a small strengthening of this effect (30 vs 115 per 100,000 person-years 76% reduction in incidence, 95%CI 60%,86%). Conclusions: We demonstrate a significant reduction in dengue incidence following successful introgression of Wolbachia into local Ae. aegypti populations in an endemic setting in Indonesia. These findings are consistent with previous field trials in northern Australia, and support the effectiveness of this novel approach for dengue control.
Publisher: Springer Science and Business Media LLC
Date: 20-12-2021
DOI: 10.1007/S00063-021-00887-0
Abstract: Patient*innen mit atraumatischen Bauchschmerzen (aBS) sind in der Notaufnahme (NA) häufig und haben bei einem sehr weiten Spektrum verschiedener ursächlicher Diagnosen eine relativ hohe Krankenhaussterblichkeit. Eine schnelle, zielführende Diagnostik ist in diesem Zusammenhang essenziell. In einem Delphi-Verfahren mit Vertreter*innen verschiedener Fachrichtungen wurde ein diagnostischer Behandlungspfad entworfen, der als „Abdominal Pain Unit“ (APU) bezeichnet wird. Der Behandlungspfad wurde als erweiterte Ereignisprozesskette dargestellt und die jeweiligen Entscheidungsfelder mit Dokumenten für ein standardisiertes Vorgehen hinterlegt. Der APU-Behandlungspfad etabliert eine konsistente Versorgungsstruktur für Bauchschmerzpatient*innen. Er hat das Potenzial die Versorgungsqualität zu verbessern und die intrahospitale Mortalität langfristig zu senken.
Publisher: MDPI AG
Date: 28-08-2021
DOI: 10.3390/JCM10173869
Abstract: Infectious biomarkers such as procalcitonin (PCT) can help overcome the lack of sensitivity of the quick Sequential Organ Failure Assessment (qSOFA) score for early identification of sepsis in emergency departments (EDs) and thus might be beneficial as point-of-care biomarkers in EDs. Our primary aim was to investigate the diagnostic performance of PCT for the early identification of septic patients and patients likely to develop sepsis within 96 h of admission to an ED among a prospectively selected patient population with elevated qSOFA score. In a large multi-centre prospective cohort study, we included all adult patients (n = 742) with a qSOFA score of at least 1 who presented to the ED. PCT levels were measured upon admission. Of the study population 27.3% (n = 202) were diagnosed with sepsis within the first 96 h. The area under the curve for PCT for the identification of septic patients in EDs was 0.86 (95% confidence interval (CI): 0.83–0.89). The resultant sensitivity for PCT at a cut-off of 0.5 µg/L was 63.4% (95% CI: 56.3–70.0). Furthermore, specificity was 89.2% (95% CI: 86.3–91.7), the positive predictive value was 68.8% (95% CI: 62.9–74.2), and the negative predictive value was 86.7% (95% CI: 84.4–88.7). The early measurement of PCT in a patient population with elevated qSOFA score served as an effective tool for the early identification of sepsis in ED patients.
Publisher: Springer Science and Business Media LLC
Date: 04-09-2015
Publisher: Wiley
Date: 05-07-2014
DOI: 10.1002/JCA.21344
Abstract: There is substantial evidence that C-reactive protein (CRP) mediates secondary damage of the myocardium after acute myocardial infarction (AMI). The aim of this animal trial in pigs was to specifically deplete CRP from porcine plasma after AMI and to study possible beneficial effects of the reduced CRP concentration on the infarcted area. Ten pigs received balloon catheter-induced myocardial infarction. CRP was depleted from five animals utilizing a new specific CRP-adsorber, five animals served as controls. The area of infarction was analyzed by cardiovascular magnetic resonance imaging on day 1 and day 14 after AMI. Porcine CRP levels were determined by ELISA. CRP-apheresis resulted in a mean reduction of the CRP levels up to 48.3%. The area of infarction was significantly reduced by 30 ± 6% (P = 0.003) within 14 days in the treatment group, whereas it increased by 19 ± 11% (P = 0.260) in the controls. Fourteen days after infarction, the infarcted area revealed compact, transmural scars in the controls, whereas animals receiving CRP-apheresis showed spotted scar morphology. In the interventional group, a significantly higher left ventricular ejection fraction (LVEF) was observed after 14 days as compared to the controls (57.6 ± 2.4% vs. 46.4 ± 2.7% P = 0.007). In a pig model for AMI, we observed that selective CRP-apheresis significantly reduces CRP levels and the volume of the infarction zone after AMI. Additionally, it changes the morphology of the scars and preserves cardiac output (LVEF).
Publisher: BMJ
Date: 07-2019
DOI: 10.1136/BMJOPEN-2018-028311
Abstract: There is sparse information on the safety of early primary discharge from the emergency department (ED) after rule-out of myocardial infarction in suspected acute coronary syndrome (ACS). This prospective registry aimed to confirm randomised study results in patients at low-to-intermediate risk, with a broader spectrum of symptoms, across different institutional standards and with a range of local troponin assays including high-sensitivity cTn (hs-cTn), cardiac troponin (cTn) and point-of-care troponin (POC Tn). Prospective, multicentre European registry. 18 emergency departments in nine European countries (Germany, Austria, Switzerland, France, Spain, UK, Turkey, Lithuania and Hungary) The final study cohort consisted of 2294 patients (57.2% males, median age 57 years) with suspected ACS. Using the new dual markers strategy, 1477 patients were eligible for direct discharge, which was realised in 974 (42.5%) of patients. The primary endpoint was all-cause mortality at 30 days. Compared with conventional workup after dual marker measurement, the median length of ED stay was 60 min shorter (228 min, 95% CI: 219 to 239 min vs 288 min, 95% CI: 279 to 300 min) in the primary dual marker strategy (DMS) discharge group. All-cause mortality was 0.1% (95% CI: 0% to 0.6%) in the primary DMS discharge group versus 1.1% (95% CI: 0.6% to 1.8%) in the conventional workup group after dual marker measurement. Conventional workup instead of discharge despite negative DMS biomarkers was observed in 503 patients (21.9%) and associated with higher prevalence of ACS (17.1% vs 0.9%, p .001), cardiac diagnoses (55.2% vs 23.5%, p .001) and risk factors (p .01), but with a similar all-cause mortality of 0.2% (95% CI: 0% to 1.1%) versus primary DMS discharge (p=0.64). Copeptin on top of cardiac troponin supports safe discharge in patients with chest pain or other symptoms suggestive of ACS under routine conditions with the use of a broad spectrum of local standard POC, conventional and high-sensitivity troponin assays. NCT02490969 .
Publisher: Springer Science and Business Media LLC
Date: 13-06-2019
DOI: 10.1007/S00063-019-0589-0
Abstract: "Triage" means the primary assessment of a previously unknown patient with an acute health disorder, initially considered a medical emergency. The initial triage is part of the primary assessment, which also includes the registration of administrative data and patient's mode of arrival. The aim of the work is to provide an overview of frequently used structured primary assessment tools and the underlying evidence for their use in the emergency room. Based on a systematic literature search in PubMed, 41 articles were selected according to predefined criteria. The most frequently used primary assessment systems in Germany are the Emergency Severity Index (ESI) and the Manchester Triage System (MTS). Scientific evidence exists for the accuracy and reliability of the primary assessment with these instruments. However, there are no gold standards for measuring urgency, so that separate criteria must be defined. Sufficient data to determine a treatment sector or the necessary staffing levels are lacking. Structured primary assessment using formalized systems alone is inadequate to categorize the urgency of emergency and acute patients. In fact, a combination of different measures in an interprofessional team is required. Primary assessment systems and processes generally do not allow patients to be referred to downstream structures without a thorough medical examination.
Publisher: Springer Science and Business Media LLC
Date: 05-05-2015
Publisher: Georg Thieme Verlag KG
Date: 09-10-2019
DOI: 10.1055/A-0996-8371
Abstract: Hintergrund Nicht nur im Kontext der Neuordnung der Notfallversorgung in Deutschland besteht derzeit ein hoher Bedarf an Daten aus Notaufnahmen. Für die Versorgungsforschung bieten sich Daten an, welche auf gesetzlicher Grundlage generiert werden. Unterschiedliche Kostenträger und Abrechnungsmodi stellen eigene Anforderungen an die Dokumentation dieser Routinedaten. Methodische Herausforderungen Aufgrund der sektoralen Trennung gibt es keinen Datensatz oder Datenhalter, der Auskunft über alle Notaufnahmebehandlungen geben kann. Aus administrativer Sicht gilt die gesamte Notaufnahmebehandlung als ambulant oder stationär, tatsächlich wird die Entscheidung darüber erst während der Versorgung getroffen. Für die stationäre Versorgung existiert ein administratives Notfallkennzeichen, allerdings kein direktes Merkmal für Notaufnahmebehandlungen. Bei Abrechnung ambulanter Fälle über die kassenärztlichen Vereinigungen ist mindestens eine Diagnose (ICD-10-Kode) zu erfassen, versehen mit einem Kennzeichen zur Diagnosesicherheit. Es können mehrere ICD-10-Kodes ohne Hierarchie angegeben werden. Bei stationär behandelten Patienten ist eine Aufnahmediagnose und nach Behandlungsende die Hauptdiagnose und ggf. Nebendiagose(n) an die zuständige Krankenkasse zu übermitteln. Die gesetzliche Unfallversicherung hat eigene Dokumentationsanforderungen. Lösungsansätze Je nach Forschungsfrage und Studiendesign sind unterschiedliche Vorgehensweisen erforderlich. Stammen die Daten unmittelbar aus Notaufnahmen bzw. Kliniken ist eine Information über den Kostenträger und den Abrechnungsmodus hilfreich. Bei Nutzung von Krankenkassendaten muss die Identifikation von stationär behandelten Patienten in einer Notaufnahme aktuell indirekt erfolgen. Dazu können unter anderem die Parameter Aufnahmegrund und definierte „eindeutige“ Notfall-Diagnosen herangezogen werden. Die fallpauschalenbezogene Krankenhausstatistik hat eigene Limitationen, enthält dafür aber die stationären Fälle aller Kostenträger. Diskussion Die ergierenden Anforderungen an die administrative Dokumentation verursachen einen hohen Aufwand in den Kliniken. Perspektivisch ist eine Vereinheitlichung der Leistungserfassung und Dokumentation von Notfallbehandlungen aller Kostenarten auch zur Generierung von validen, vergleichbaren und repräsentativen Daten für die Versorgungsforschung erstrebenswert. Die Einführung eines eigenen Fachabteilungsschlüssels würde zur Identifikation von Notaufnahmebehandlungen beitragen.
Publisher: Massachusetts Medical Society
Date: 10-06-2021
Publisher: Hindawi Limited
Date: 2015
DOI: 10.1155/2015/490947
Abstract: Background . Medical histories are a crucially important diagnostic tool. Elderly patients represent a large and increasing group of emergency patients. Due to cognitive deficits, taking a reliable medical history in this patient group can be difficult. We sought to evaluate the medical history-taking in emergency patients above 75 years of age with respect to duration and completeness. Methods . Anonymous data of consecutive patients were recorded. Times for the defined basic medical history-taking were documented, as were the availability of other sources and times to assess these. Results . Data of 104 patients were included in the analysis. In a quarter of patients (25%, n = 26 ) no complete basic medical history could be obtained. In the group of patients where complete data could be gathered, only 16 patients were able to provide all necessary information on their own. Including other sources like relatives or GPs prolonged the time until complete medical history from 7.3 minutes (patient only) to 26.4 (+relatives) and 56.3 (+GP) minutes. Conclusions . Medical histories are important diagnostic tools in the emergency setting and are prolonged in the elderly, especially if additional documentation and third parties need to be involved. New technologies like emergency medical cards might help to improve the availability of important patient data but implementation of these technologies is costly and faces data protection issues.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2011
DOI: 10.1161/ATVBAHA.111.237784
Abstract: Soluble fms-like tyrosine kinase 1 (sFlt1) is involved in the pathophysiology of preecl sia and coronary artery disease. Because sFlt1 has a heparin-binding site, we investigated whether or not heparin releases sFlt1 from the extracellular matrix. We measured sFlt1 before and after heparin administration in 135 patients undergoing coronary angiography, percutanous coronary intervention, or both. sFlt1 was increased directly after heparin administration (from 254 to 13 440 pg/mL) and returned to baseline within 10 hours. Umbilical veins and endothelial cells treated with heparin released sFlt1. Heparinase I and III also increased sFlt1. Mice treated with heparin had elevated sFlt1 serum levels. Their serum inhibited endothelial tube formation. Heparin releases sFlt1 by displacing the sFlt1 heparin-binding site from heparan sulfate proteoglycans. Heparin could induce an antiangiogenic state.
Publisher: Oxford University Press (OUP)
Date: 10-2015
DOI: 10.1373/CLINCHEM.2015.240580
Abstract: The release pattern of copeptin during the initial 36 h of spontaneous acute myocardial infarction (AMI) has received relatively little investigation but may provide important information on optimal timing of diagnostic measurements. We investigated the release pattern of copeptin and cardiac troponin T in patients with suspected acute coronary syndrome (ACS). Blood s les were collected in the ambulance, at admission, and after 2, 4, 6, and 12–36 h. Copeptin and high-sensitivity cardiac troponin T (hs-cTnT) were measured in heparin plasma s les. Of 93 patients studied, 37 (39.8%) had ST-elevation myocardial infarction (STEMI), 20 (21.5%) non-STEMI, 20 (21.5%) unstable angina pectoris (UAP), and 16 (17.2%) non-ACS diagnoses. Peak copeptin concentrations were detected during ambulance transport for NSTEMI patients [median 94.0 pmol/L, interquartile range (IQR) 53.3–302.1 pmol/L] and at admission for patients with STEMI (70.0 pmol/L, 22.0–144.8 pmol/L). In patients with AMI, copeptin decreased significantly over time (P & 0.0001). This was true for patients with STEMI (P = 0.005) and non-STEMI (P = 0.021). The diagnostic performance during ambulance transport was similar for hs-cTnT (area under the ROC curve 0.75, 95% CI 0.62–0.88) and copeptin (0.81, 0.69–0.92). In early presenters (n = 52), no patient with AMI was initially (in ambulance or at admission) negative for copeptin, resulting in an area under the ROC curve of 0.963 for ambulance values and a negative predictive value of 100%. In late presenters, the negative predictive value of copeptin was 50% in ambulance and at admission. Our analysis is the first to show a consistent early increase in copeptin at first medical contact in the ambulance and a decrease to routine values within 12–36 h in patients presenting early with spontaneous AMI.
Publisher: BMJ
Date: 07-06-2021
DOI: 10.1136/EMERMED-2020-210268
Abstract: E-scooters have emerged as a frequently used vehicle in German cities due to their high availability and easy access. However, investigations about the causes and mechanisms of E-scooter incidents and their trauma-specific consequences are rare. We analysed all patients involved in E-scooter incidents from June to December 2019 who presented to four inner-city EDs in Berlin. The prospective data included patient-related and incident-related data, information on injury patterns and therapy, responses in a voluntary questionnaire concerning E-scooter use and general traffic experience. 248 patients (129 males median age 29 years (5–81)) were included: 41% were tourists and 4% were children. Most incidents (71%) occurred between July and September 2019, the majority occurring at weekends (58%). The injury pattern was mostly multifocal, affecting the lower (42%) and upper limbs (37%) and the head (40%). Traumatic brain injury was associated with alcohol consumption. Inpatient admission was recorded in 25%, surgery in 23%. This study has defined the incidence of injury related to E-scooter use in a major European city. Stricter laws governing the use of E-scooters, the wearing of helmets and technical modifications to the E-scooter platforms might decrease E-scooter-associated incidents and resulting injuries in the future. German Clinical Trials Registry (DRKS00018061).
Publisher: Oxford University Press (OUP)
Date: 30-04-2014
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2020
Publisher: Georg Thieme Verlag KG
Date: 05-06-2013
Publisher: Springer Science and Business Media LLC
Date: 04-10-2021
Publisher: Georg Thieme Verlag KG
Date: 08-2017
Publisher: Elsevier BV
Date: 03-2019
DOI: 10.1016/J.JTEMB.2019.01.005
Abstract: Selenium-binding protein 1 (SELENBP1) is an intracellular protein with variable expression in response to cellular stress. As the selenium (Se) status is affected by inflammation and hypoxia, we hypothesized that SELENBP1 contributes to disease-specific Se metabolism. To test this hypothesis, a quantitative assay was developed and used to monitor SELENBP1 in patients with acute coronary syndrome (ACS). SELENBP1 was expressed, antibodies were generated and a luminometric immuno assay (LIA) was established and characterized. Serum s les were collected from controls (n = 37) and patients (n = 85) admitted to the Chest Pain Unit with suspected ACS. Blood s les were available from time of first medical contact in the ambulance, at admission to hospital, and after 2, 4, 6 and 12-36 h. Circulating SELENBP1 was close to limit of detection in healthy controls and elevated in patients with suspected ACS. SELENBP1 was unrelated to other biomarkers of myocardial damage such as troponin T or aspartate aminotransferase. Serum SELENBP1 enabled a categorization of patients on first medical contact as either high-risk or low-risk for major adverse cardiac events (MACE) or death, when using 0.8 nmol/l as threshold. The odds-ratios (OR) for MACE and death were OR = 11 (95% CI: 2-49, p = 0.0022) and OR = 12 (2-74, p = 0.014), respectively. Until now, SELENBP1 was mainly considered as an intracellular protein involved in Se metabolism and redox control. Our data indicate that SELENBP1 constitutes a circulating biomarker for cardiac events categorizing patients with suspected ACS at first medical contact into high-risk or low-risk for MACE and death, independent from and complimentary to current biomarkers.
Publisher: Springer Science and Business Media LLC
Date: 12-09-2017
DOI: 10.1007/S00063-017-0345-2
Abstract: For several years, Emergency Departments (ED) in Germany have observed increasing patient numbers, resulting in ED crowding. This leads to the question of whether patients with nonurgent conditions could also receive adequate treatment in primary care. Our objective was to develop a quantitative questionnaire to investigate in a larger patient group the reasons for this and to describe the implications for a patient survey in the ED. The development of the questionnaire was based on a literature search and the results of the qualitative EPICS-2 study. Two pretest surveys were conducted in three EDs at the Charité - Universitätsmedizin Berlin. We included patients aged ≥ 18 years with outpatient treatment and the categories blue (nonurgent), green (standard), or yellow (urgent) according to the Manchester Triage System (MTS). In total, 189 patients were recruited in two surveys (pretest 1: n = 89, pretest 2 n = 100). The final questionnaire includes 24 items, which were evaluated and adapted during both pretests. The items evaluate basic clinical characteristics, reasons for choosing the ED, prior contacts in primary care, utilization of primary care after-hours services as well as sociodemographic characteristics. Data from the hospital information system were used to link the survey data with clinical characteristics. The questionnaire is based on reasons for ED utilization. We recommend the written, self-applied questionnaire for patient surveys with plausibility checks conducted by staff. It is necessary to consider the heterogenic study surroundings in the ED, which requires a lot of flexibility during data collection.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2013
Publisher: Springer Science and Business Media LLC
Date: 09-2021
DOI: 10.1007/S00063-021-00859-4
Abstract: Die aktuelle COVID-19-Pandemie stellt, trotz der Verfügbarkeit von Schnelltests und des Starts der Impfk agne, die Notaufnahme weiterhin vor große Herausforderungen. Die strukturierte Erfassung von demographischen, klinischen sowie therapiebezogenen Daten stellt die Grundlage für die Erstellung evidenzbasierter Prozesse und Behandlungskonzepte dar. Darstellung der systematischen Erfassung klinischer Parameter bei Patienten mit COVID-19-Verdacht im Notaufnahmeregister ReCovER ( Registry for COVID-19 in the Emergency Room ) sowie deskriptive Darstellung der ersten 1000 Patienten. In zentralen Notaufnahmen (ZNA) von 6 Universitätskliniken werden kontinuierlich Daten von Patienten mit COVID-19-Verdacht, unabhängig vom Nachweis einer SARS-CoV-2-Infektion, in ein webbasiertes, anonymisiertes Register eingegeben. Zwischen dem 19.05.2020 und dem 13.01.2021 wurden 1000 Patienten in das Register eingegeben, hiervon waren 594 Patienten (59,4 %) in der SARS-CoV-2-positiven (PG) und 406 Patienten (40,6 %) in der negativen Gruppe (NG). Patienten der PG hatten signifikant weniger Vorerkrankungen und eine deutlich längere Latenz zwischen Symptombeginn und Vorstellung in der ZNA (Median 5 vs. 3 Tage), litten häufiger unter Husten, Myalgien, Fatigue sowie Geruchs/Geschmacksverlust und hatten einen signifikant höheren Sauerstoffbedarf als die NG-Patienten. Die Rate von schweren Krankheitsverläufen war in der PG signifikant erhöht und es bestanden nach Entlassung häufiger persistierende Symptome (11,1 vs. 4,6 %). Durch die multizentrische Erfassung von umfangreichen klinischen Daten zu COVID-19-Verdachtsfällen in der Notaufnahme können insbesondere auch für die Situation in Deutschland spezifische Aspekte analysiert werden. Dies ist essenziell für eine gezielte Überprüfung und Adaption international publizierter Strategien.
Publisher: Georg Thieme Verlag KG
Date: 22-04-2016
Abstract: Einleitung: Die steigende Inanspruchnahme von Zentralen Notaufnahmen (ZNA) durch Patientinnen und Patienten mit akut-, aber nicht notfallmedizinischem Versorgungsbedarf trägt zur Überfüllung der Notaufnahmen bei. Ziel dieser Arbeit ist die Exploration der subjektiven Motive zum Aufsuchen der ZNA durch Menschen mit nichtdringlichem Behandlungsbedarf. Methode: In einer qualitativen Studie wurden 40 leitfadengestützte Interviews mit ambulanten Patientinnen und Patienten ohne dringlichen Handlungsbedarf an 2 ZNA der Charité Berlin durchgeführt und mit der Qualitativen Inhaltsanalyse ausgewertet. Ergebnis: Neben der Substitution nicht oder spät verfügbarer Haus- oder Facharzttermine gaben die Befragten als Hauptmotive Zeitautonomie, den Qualitätsstandard eines universitären Krankenhauses sowie die Möglichkeit multidisziplinärer Untersuchungen während eines Termins an. Die Bemühungen um eine Terminfindung im ambulanten Bereich erschienen durch die allzeitige Verfügbarkeit der ZNA teilweise wenig konsequent. Schlussfolgerung: Die Interviewdaten zeigen eine eigenständige Funktion der ZNA für ambulante Behandlungen auf. Es ist anzunehmen, dass auch eine konsequentere Wahrnehmung des Sicherstellungsauftrages der KV die Anforderungen an die ZNA nicht auf die Versorgung medizinischer Notfälle zurückführen könnte. Zur dauerhaften Sicherstellung der medizinischen Qualität für Patientinnen und Patienten aller Dringlichkeitsstufen ist eine den Anforderungen entsprechende Ausstattung der ZNA erforderlich.
Publisher: American Society of Tropical Medicine and Hygiene
Date: 07-11-2018
Publisher: Informa UK Limited
Date: 08-11-2016
Publisher: Wiley
Date: 12-12-2019
DOI: 10.1002/EJHF.1667
Abstract: To determine whether initiation of antibiotic therapy (ABX) by procalcitonin (PCT) within 8 h of admission in patients presenting to the emergency department with symptoms and signs of acute heart failure (AHF) and elevated natriuretic peptides would improve clinical outcomes. The study was a randomized multicentre clinical trial conducted at 16 sites in Europe. Patients were randomized to either a PCT-guided strategy or standard care. Patients with PCT-guided strategy (n = 370) had ABX initiated if PCT was > 0.2 μg/L. Patients with standard care (n = 372) had AHF care in accordance with published guidelines without PCT. The primary endpoint was 90-day all-cause mortality. Pre-specified secondary endpoints included 30-day all-cause mortality and readmission and rate of pneumonia. The Data Safety and Review Committee recommended stopping the study for futility when 762 of the planned 792 patients had been enrolled. A total of 742 patients could be analysed. Patients were elderly (median age: 77 years), 38% were women, and had typical signs and symptoms of AHF. All-cause mortality at 90 days was 10.3% in the PCT-guided group vs. 8.2% in standard care (P = 0.316). Thirty-day readmission was significantly higher in the PCT-guided group vs. standard care but the difference vanished until day 90. The rate of pneumonia was overall low (7.5%) and not different between groups. In patients with AHF, a strategy of PCT-guided initiation of ABX was not more effective than a standard care strategy in improving clinical outcomes.
Publisher: BMJ
Date: 11-2016
Publisher: Informa UK Limited
Date: 18-04-2018
Publisher: Georg Thieme Verlag KG
Date: 08-2018
Publisher: Georg Thieme Verlag KG
Date: 29-03-2017
Publisher: BMJ
Date: 03-2021
DOI: 10.1136/BMJOPEN-2020-044853
Abstract: One major goal of the emergency department (ED) is to decide, whether patients need to be hospitalised or can be sent home safely. We aim at providing criteria for these decisions without knowing the SARS-CoV-2 test result in suspected cases. Tertiary emergency medicine. All patients were treated at the ED of the Charité during the pandemic peak and underwent SARS-CoV-2 testing. Patients with positive test results were characterised in detail and underwent a 14-day-follow-up. Logistic regression and classification and regression tree (CART) analyses were performed to identify predictors (primary endpoint), which confirm safe discharge. The clinical endpoint was all-cause mortality or need for mechanical ventilation during index stay or after readmission. The primary test population of suspected COVID-19 consisted of n=1255 cases, 45.2% were women (n=567). Of these, n=110 tested positive for SARS-CoV-2 (8.8%). The median age of SARS-CoV-2-positive cases was 45 years (IQR: 33–66 years), whereas the median age of the group tested negative for SARS-CoV-2 was 42 years (IQR: 30–60 years) (p=0.096). 43.6% were directly admitted to hospital care. CART analysis identified the variables oxygen saturation ( %), dyspnoea and history of cardiovascular (CV) disease to distinguish between high and low-risk groups. If all three variables were negative, most patients were discharged from ED, and the incidence of the clinical endpoint was 0%. The validation cohort confirmed the safety of discharge using these variables and revealed an incidence of the clinical endpoint from 14.3% in patients with CV disease, 9.4% in patients with dyspnoea and 18.2% in patients with O 2 satuaration below 95%. Based on easily available variables like dyspnoea, oxygen saturation, history of CV disease, approximately 25% of patients subsequently confirmed with COVID-19 can be identified for safe discharge. DRKS00023117.
Publisher: Public Library of Science (PLoS)
Date: 24-08-2022
DOI: 10.1371/JOURNAL.PONE.0273115
Abstract: This study aims to improve emergency department (ED) care for patients suffering from atraumatic abdominal pain. An application-supported pathway for the ED will be implemented, which supports quick, evidence-based, and standardized diagnosis and treatment steps for patients with atraumatic abdominal pain at the ED. A mixed-methods multicentre cluster randomized controlled stepped wedge trial design will be applied. A total of 10 hospitals with EDs (expected n = 2.000 atraumatic abdominal pain patients) will consecutively (every 4 months) be randomized to apply the intervention. Inclusion criteria for patients are a minimum age of 18 years, suffering from atraumatic abdominal pain and being insured with a German statutory health insurance. Primary outcomes: acute pain score at time of discharge from ED, duration of treatment at the ED, patient-reported satisfaction. Secondary endpoints include patient safety and quality of care parameters, process evaluation parameters, and costs and cost-effectiveness parameters. Quantitative data will be gathered from patient-surveys, clinical records, and routine data from hospital information systems as well as from a participating German statutory health insurance. Descriptive and analytic statistical analysis will be performed to provide summaries and associations for primary patient-reported outcomes, process measures, quality measures, and costs. Qualitative data collection consists of participatory patient observations and semi-structured expert interviews, which will be inductively analysed. Findings will be disseminated in publications in peer-reviewed journals, on conferences, as well as via a project website. To ensure data protection, appropriate technical and organisational measures will be taken. Trial registration: DRKS00021052 .
Publisher: Wiley
Date: 26-08-2021
DOI: 10.1111/ACEM.14349
Abstract: This study aimed to (1) examine the proportion of patients presenting to an emergency department (ED) for acute cardiac symptoms with comorbid mental health conditions (MHCs) comprising current depression, generalized anxiety disorder, and panic disorder (2) compare cardiac patients with and without MHCs regarding sociodemographic, medical, and psychological characteristics and (3) examine recognition and treatment rates of MHCs. Multimorbid patients, aged ≥50 years, presenting to an inner‐city ED with acute cardiac symptoms including chest pain, dyspnea, and palpitations, completed validated self‐report instruments assessing MHCs and a questionnaire collecting psychosocial and medical information. In addition, routine medical data were extracted from the electronic health record. A total of 641 patients were included in the study. Mean (±SD) age was 68.8 (±10.8) years and 41.7% were female. Based on screening instruments, 28.4% of patients were affected with comorbid MHCs. Patients reported clinically significant symptoms of depression (23.3% PHQ‐9 ≥10), generalized anxiety disorder (12.2% GAD‐7 ≥10), and panic disorder (4.7% PHQ‐PD). Patients with MHCs were more likely to be younger, female, lower educated, and unemployed. The presence of MHCs was associated with higher cardiac symptom burden and subjective treatment urgency as well as more psychosocial distress (PHQ‐stress) and impaired quality of life (SF‐12v2). Of all patients, 15.6% were identified with new or unrecognized MHCs. MHCs are prevalent in nearly one‐third of patients presenting with cardinal cardiac symptoms. Thus, the ED visit offers an opportunity to identify and refer patients with MHCs to appropriate and timely care after exclusion of life‐threatening conditions.
Publisher: Elsevier BV
Date: 10-2012
Publisher: Springer Science and Business Media LLC
Date: 20-09-2022
DOI: 10.1186/S13063-022-06688-W
Abstract: Due to the increasing use of online health information, symptom checkers have been developed to provide an in idualized assessment of health complaints and provide potential diagnoses and an urgency estimation. It is assumed that they support patient empowerment and have a positive impact on patient-physician interaction and satisfaction with care. Particularly in the emergency department (ED), symptom checkers could be integrated to bridge waiting times in the ED, and patients as well as physicians could take advantage of potential positive effects. Our study therefore aims to assess the impact of symptom assessment application (SAA) usage compared to no SAA usage on the patient-physician interaction in self-referred walk-in patients in the ED population. In this multi-center, 1:1 randomized, controlled, parallel-group superiority trial, 440 self-referred adult walk-in patients with a non-urgent triage category will be recruited in three EDs in Berlin. Eligible participants in the intervention group will use a SAA directly after initial triage. The control group receives standard care without using a SAA. The primary endpoint is patients’ satisfaction with the patient-physician interaction assessed by the Patient Satisfaction Questionnaire. The results of this trial could influence the implementation of SAA into acute care to improve the satisfaction with the patient-physician interaction. German Clinical Trials Registry DRKS00028598 . Registered on 25.03.2022
Publisher: Springer Science and Business Media LLC
Date: 12-12-2017
Publisher: Springer Science and Business Media LLC
Date: 12-01-2023
DOI: 10.1007/S00063-022-00981-X
Abstract: Ziel der Studie ist a) die Prävalenzerfassung psychosozialer Notfälle in der Notaufnahme, b) die Ermittlung des Anteils der nicht als (Neben‑)Diagnose kodierten psychosozialen Fälle (Dunkelziffer) und c) die Charakterisierung identifizierter Patient*innen. In einer retrospektiven Studie wurden psychosoziale Notfälle einer Kalenderwoche aus der Routinedokumentation der zentralen Notaufnahme (ZNA) der Charité – Universitätsmedizin Berlin, Charité C us Mitte (CCM) identifiziert. Nach Ausschluss von geplant aufgenommenen Fällen wurden 862 Patient*innen in die Studie eingeschlossen. Die identifizierten psychosozialen Notfälle wurden hinsichtlich ihrer soziodemografischen und klinischen Merkmale deskriptiv analysiert und mit anderen Notfällen verglichen. Die Prävalenz psychosozialer Notfälle unter Notaufnahmepatient*innen im angegebenen Zeitraum betrug 11,9 % ( n = 103). Ein Großteil der psychosozialen Notfälle war in den Diagnosen nicht (35,9 %) oder nicht vollständig (20,4 %) kodiert. Es gab einen statistisch relevanten Unterschied in der Geschlechterverteilung mit einem signifikant höheren Männeranteil unter den psychosozialen Notfällen (70,9 %) im Vergleich zu anderen Notfällen (50,7 % p 0,0001). Die 2 häufigsten Behandlungsanlässe unter den psychosozialen Notfällen waren Substanzmissbrauch (66,0 %) und Obdachlosigkeit (20,4 %). Diese Studie zeigt einen relevanten Anteil an in den Routinedaten dokumentierten psychosozialen Behandlungsanlässen an allen Behandlungsanlässen in der Notaufnahme und einen hohen Anteil von in den kodierten Diagnosen nicht erfassten Fällen (Dunkelziffer) auf. Notaufnahmen stellen somit eine wichtige Anlaufstelle für vulnerable Patient*innengruppen dar, die dort bisher nicht ausreichend identifiziert werden.
Publisher: Elsevier BV
Date: 03-2017
DOI: 10.1016/J.IJCARD.2016.12.085
Abstract: A point of care test (POCT) for troponin T (TnT) in the Emergency Department (ED) was compared to a high-sensitivity TnT (hsTnT) central laboratory test (CLT) to determine the influence of test system and different cut-off values on the diagnostic performance in patients with suspected acute coronary syndrome (ACS) under routine conditions. All patients with routine TnT testing in the ED were enrolled. Only internal medicine patients without STEMI and with both troponin values were analyzed. TnT was measured with a contemporary sensitive POCT assay in the ED and with a hs-assay in the central laboratory. The diagnostic performance was analyzed at two different cut-off points (99th percentile and conventional rule-in cut-offs). Primary endpoint was the diagnosis of NSTEMI. Of all patients (n=3423), 3.6% had a diagnosis of NSTEMI (n=124). For the hsTnT assay, 28.4% of all values were at or below the lower limit of detection (LOD) as compared to 75.7% of the POC-TnT-values. The area under the receiver operating curves did not differ significantly between the assays (hsTnT: 0.912(95%-CI: 0.884-0.940) POC-TnT: 0.896(95%-CI: 0.859-0.933)). The diagnostic performance was very similar for both assays: the positive predictive value was below 50% for troponin values below 100ng/L and hardly increased for values between 100 and 600ng/L for hs and conventional assays. In our cohort of emergency patients, the diagnostic performance of conventional POC-testing was comparable to hsTnT. A 99th percentile cut-off may be useful for rule-out of NSTEMI, but seems limited for routine rule-in strategies.
Publisher: MDPI AG
Date: 08-01-2022
Abstract: Regarding the management of suspected Non-ST-segment-elevation acute coronary syndrome (ACS), the main Biomarker-in-Cardiology (BIC)-8 randomized controlled trial study had reported non-inferiority for the incidence of major adverse cardiac events at 30 days in the Copeptin group (dual marker strategy of copeptin and hs-cTnT at presentation) compared to the standard process (serial hs-cTnT testing). However, in 349 (38.7%) of the 902 patients, high-sensitivity cardiac troponin was not available for the treating physicians. High sensitivity cardiac troponin T was re-measured from thawed blood s les collected at baseline. This cohort qualified for a re-analysis of the 30-day incidence rate of MACE (death, survived cardiac death, acute myocardial infarction, re-hospitalization for acute coronary syndrome, acute unplanned percutaneous coronary intervention, coronary bypass grafting, or documented life-threatening arrhythmias), or components of the primary endpoint including death or death/MI. After re-measurement of troponin and exclusion of 9 patients with insufficient blood s le volume, 893 patients qualified for re-analysis. A total of 57 cases were detected with high sensitivity cardiac troponin T ≥ 14 ng/L who had been classified as “troponin negative” based on a conventional cardiac troponin T or I 99th percentile upper limit of normal. Major adverse cardiac events rates after exclusion were non-inferior in the Copeptin group compared to the standard group (4.34% (95% confidence intervals 2.60–6.78%) vs. 4.27% (2.55–6.66%)). Rates were 53% lower in the per-protocol analysis (HR 0.47, 95% CI: 0.18–1.15, p = 0.09). No deaths occurred within 30 days in the discharged low risk patients of the Copeptin group. Copeptin combined with high sensitivity cardiac troponin is useful for risk stratification and allows early discharge of low-to-intermediate risk patients with suspected acute coronary syndrome is as safe as a re-testing strategy at 3 h or later.
Publisher: Informa UK Limited
Date: 31-10-2020
No related grants have been discovered for Anna Slagman.