European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Comparative Study Observational Study
Management of chest pain in the French emergency healthcare system: the prospective observational EPIDOULTHO study.
The aim of this paper was to describe the epidemiology, and diagnostic and therapeutic strategies that emergency physicians use to manage patients presenting with chest pain at all three levels of the French emergency medical system - that is, dispatch centres (SAMUs: the medical emergency system), which operate the mobile intensive care units (MICUs), and hospitals' emergency departments (EDs), with a focus on acute coronary syndrome (ACS). ⋯ Management of chest pain at the three levels of the French medical emergency system is mainly oriented towards ruling out ACS. The strategy of diagnostic management is based on minimizing missed diagnoses of ACS.
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This study presents an analysis of clinical data of the circumstances and outcome of paediatric (0-16 years) out-of-hospital cardiac arrests (p-OHCA) in Belgium. ⋯ p-OHCA remains rare. Typically, Belgian MUGs each encounter less than two p-OHCA yearly, thus inducing a risk of being insufficiently prepared. Compared with other countries, cardiopulmonary resuscitation was not started in more cases. Even so, in many other cases, children were transported from scene to be proclaimed 'dead' very soon after, pointing to a practice of 'slow code'. This study provides 'real-life' data on p-OHCA in Belgium. As it is based on an administrative registry, it lacks information on individual cases. Large population-based registries are needed to further guide our decision making.
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Multicenter Study
Applying the Ottawa subarachnoid haemorrhage rule on a cohort of emergency department patients with headache.
The Ottawa subarachnoid haemorrhage (SAH) rule suggests that alert patients older than 15 years with a severe nontraumatic headache reaching maximum intensity within 1 h and absence of high-risk variables effectively have a SAH ruled out. We aimed to determine the proportion of emergency department (ED) patients with any headache fulfilling the entry criteria for the Ottawa SAH rule. ⋯ In this descriptive observational study, the majority of ED patients presenting with a headache did not fulfil the entry criteria for the Ottawa SAH rule. Less than 5% of the patients in this cohort could have SAH excluded on the basis of the rule. More definitive studies are needed to determine an accepted benchmark for the proportion of patients receiving further work-up (computed tomographic brain) after fulfilling the entry criteria for the Ottawa SAH rule.