Explore the vast range of titles available.

The aim of this study was to assess the variation in the use of head computed tomography (CT) scan in patients attending EDs with ground-level fall-related minor head injury. Secondary objectives were: i) to measure the prescription rate of appropriate head CT scan, ii) to identify patients' and EDs characteristics associated with head CT scan prescription iii) to explore potential correlation between head CT scan use and traumatic intracranial hemorrhage (ICH) yield rate in this population. This research was a planned sub-analysis of a cross-sectional prospective multicentric study performed in 63 EDs in France (EPI-TC study). Patients sustaining ground-level fall-related with minor head injury were included in this sub-analysis. The main outcome was head CT scan performed during ED stay. Variations in the use of head CT scan were described depending on each ED and French region. Multiple fixed effects mixed logistic regression model was performed to identify factors associated with head CT scan. A total of 631 patients admitted for head injury after ground-level fall were included. Median age was 79 [63-88] years. A head CT scan was performed in 409 patients (64.8%, CI95% 61.0-68.5); 19.6% (CI95% 15.8-23.7) of them were appropriated; and 29 (7.1%, CI95% 4.8-10.0) showed a traumatic ICH. At regional level, head CT scan prescription rate ranged from 45.5% (CI95%: 24.4-67.8) to 84.6% (CI95% 54.5-98.1). Head CT scan use was not correlated with the yield rate of traumatic ICH. In multivariable analysis, preinjury antiplatelets (OR 29.2, CI95%: 12.2-69.9), anticoagulants (OR 69.9, CI95%: 20.0-243.9), syncope (OR 6.9, CI95%: 2.0-24.2), post-trauma amnesia (3.2, CI95%: 1.0-10.5) and post-trauma loss of consciousness (OR 5.6, CI95%: 2.0-15.9) were associated with head CT scan use. Head CT scan use in patient presenting to EDs with head injuries after ground-level falls is highly variable. High rate of head CT scan use is not correlated with high traumatic intracranial hemorrhage yield rate. The use of a clinical decision rule dedicated to this population would be suitable for harmonizing our practices.

IntroductionDyspnea is a common chief complaint leading to emergency department (ED) visits. Multiple conditions may cause or be associated with dyspnoea, including bacterial pneumonia, acute heart failure (AHF), exacerbation of chronic obstructive pulmonary disease (COPD) or asthma and pulmonary embolism. Each of these diagnoses has a specific treatment recommended by international guidelines. Inappropriate treatment in the ED is more frequent among elderly patients and is independently associated with in-hospital mortality. Point-of-care ultrasound is immediately available at the bedside. Lung and cardiac ultrasound (LuCUS) offers excellent diagnostic accuracy for bacterial pneumonia, AHF and COPD exacerbations, even in elderly patients. The primary objective of the LUC REED trial is to evaluate the impact of a LuCUS-guided strategy versus standard care on reducing inappropriate treatment of dyspnoea in elderly ED patients.Methods and analysisThe LUC REED trial is a prospective, interventional, multicentre, stepped-wedge randomised controlled trial designed to assess the superiority of a LuCUS-guided strategy over standard care in ensuring treatment appropriateness for dyspnoea in elderly ED patients. The study will include 504 patients over 2 years. Patients aged >65 years presenting with acute dyspnoea and signs of severity (respiratory rate ≥22 and SpO2 <92% on room air) will be enrolled. Each ED (cluster) will start with a control phase. Every 3 months, one centre will transition to the intervention phase (LuCUS-guided strategy). The primary outcome is treatment inappropriateness within the first hour after inclusion, assessed by comparing administered treatment to the final diagnosis adjudicated by two experts.Ethics and disseminationEthics final approval was obtained from the Institutional Review Board of France—Est IV on 4 April 2025 (2024-A01678-39). Results will be published in peer-reviewed international journals.Trial registration numberNCT06807983.

Background During simulation training, the confederate is a member of the pedagogical team. Its role is to facilitate the interaction between participants and the environment, and is thought to increase realism and immersion. Its influence on participants' performance in full-scale simulation remains however unknown. The purpose of this study was to observe the effect of the presence of confederates on the participants’ performance during full-scale simulation of crisis medical situations. Methods This was a prospective, randomized study comparing 2 parallel groups. Participants were emergency medicine residents engaging in a simulation session, with or without confederates. Participants were then evaluated on their Crisis Resource Management performance (CRM). The overall performance score on the Ottawa Global Rating Scale was assessed as primary outcome and the 5 non-technical CRM skills as secondary outcomes. Results A total of 63 simulation sessions, including 63 residents, were included for statistical analysis ( n  = 32 for Control group and 31 for Confederate group). The mean Overall Performance score was 3.9 ± 0.8 in the Control group and 4.0 ± 1.1 in the Confederate group, 95% confidence interval of the difference [-0.6; 0.4], p  = 0.60. No significant differences between the two groups were observed on each CRM items (leadership, situational awareness, communication, problem solving, resource utilization) Conclusion In this randomized and controlled study, the presence of confederates during full-scale simulated practice of crisis medical situations does not seem to influence the CRM skills performance of Emergency medicine residents. Trial registration This study does not need to be registered on Clintrial as it does not report a health care intervention on human participants.

IntroductionThe decisions of withholding or withdrawing life-sustaining treatments are difficult to make in the context of emergency departments (EDs) because most patients are unable to communicate. Relatives are thus asked to participate in the decision‐making process, although they are unprepared to face such situations. We therefore aimed to develop a standardised intervention for announcing decisions of withholding or withdrawing life-sustaining treatments in EDs and assess the efficacy of the intervention on the stress of relatives.Methods and analysisThe DISCUSS trial is a multicentre stepped-wedge cluster randomised study and will be conducted at nine EDs in France. A standardised intervention based on human simulation will be codesigned with partner families and implemented at three levels: the relatives, the healthcare professionals (HCP) and the EDs. The intervention will be compared with a control based on treatment as usual. A total of 538 families are planned to be included: 269 in the intervention group and 269 in the control group. The primary endpoint will be the symptoms of post-traumatic stress disorder (PTSD) at 90 days. The secondary endpoints will be symptoms of PTSD at 7 and 30 days, diagnosis of PTSD at 90 days and anxiety and depression scores at 7, 30 and 90 days. Satisfaction regarding the training, the assertiveness in communication and real-life stress of HCPs will be measured at 90 days.Ethics and disseminationThis study was approved by the ethics committee Est III from Nancy and the French national data protection authority. All relatives and HCPs will be informed regarding the study objectives and data confidentiality. Written informed consent will be obtained from participants, as required by French law for this study type. The results from this study will be disseminated at conferences and in a peer-reviewed journal.Trial registration numberNCT06071078.

Background Mild traumatic brain injury is the leading cause of arrivals to emergency department due to trauma in the 65-year-old population and over. Recent studies conducted in ED suggested a low intracranial lesion prevalence. The objectives of this study were to assess the prevalence and risk factors of intracranial lesion in older patients admitted to emergency department for mild traumatic brain injury by reporting in the emergency department the precise anamnesis of injury and clinical findings. Methods Patients of 65 years old and over admitted in emergency department were prospectively included in this monocentric study. The primary outcome was the prevalence of intracranial lesion threw neuroimaging. Results Between January and June 2019, 365 patients were included and 66.8% were women. Mean age was 86.5 years old (SD = 8.5). Ground-level fall was the most common cause of mild traumatic brain injury and occurred in 335 patients (91.8%). Overall, 26 out of 365 (7.2%) patients had an intracranial lesion. Compared with cutaneous frontal impact (medium risk group), the relative risk of intracranial lesion was 2.54 (95% CI 1.20 to 5.42) for patients with temporoparietal or occipital impact (high risk group) and 0.12 (95% CI 0.01 to 0.93) for patients with facial impact or no cutaneous impact (low risk group). There was not statistical increase in risk of intracranial injury with patients receiving antiplatelets (RR = 1.43; 95% CI 0.68 to 2.99) or anticoagulants (RR = 0.98; 95% CI 0.45 to 2.14). Conclusion Among patients of 65 years old and over, the prevalence of intracranial lesion after a mild traumatic brain injury was similar to the younger adult population. The cutaneous impact location on clinical examination at the emergency department may identify older patients with low, medium and high risk for intracranial lesion.

Key summary points Aim We aimed to identify factors associated with potentially inappropriate resident transfers from the nursing home to emergency department requested by an emergency medical dispatcher. Findings Onsite medical examination before transfer and prompt available psychiatric advice was associated with a low rate whereas the presence of a Special Care Unit in Nursing was associated with a high rate of potentially inappropriate transfer. Message Promoting onsite examination and partnership thanks to available geriatrician’s advice may help the emergency medical dispatcher to improve the appropriateness of residents’ transfer from the nursing home to the emergency department. Purpose In the last decades, the amount of emergency department (ED) transfers of nursing home (NH) residents has disproportionally increased in western countries. The main role of emergency medical dispatcher (EMD) among this population is to refer residents to EDs in the most appropriate way. The aim of this study was to assess risk factors of inappropriate transfers from NH to ED after EMD request. Methods This research was a secondary analysis of a prospective observational multicenter study carried out in 17 EDs entitled FINE aimed to assess potentially inappropriate transfer prevalence among this population. Inappropriate transfers were determined in the FINE study threw a standardized approach by a unique expert team. Results Overall, 572/1037 (55.2%) of residents were transferred to the ED after an EMD’s decision. Among them, 92/572 (16.1%) transfers was defined as inappropriate. The average age was 87.3 years old (SD = 0.3). The main reason for ED transfer were falls (217/572, 37.9%). In multivariate analysis, the presence of a Special Care Unit in NH was significantly associated with a high rate of inappropriate transfer (OR 1.78; 95 CI [1.07–2.93]; p  = 0.02) whereas a medical examination by a general practitioner before the transfer (OR 0.55; 95 CI [0.33–0.83]; p  = 0.02) and a prompt access to psychiatric advice (OR 0.54; 95 CI [0.33–0.84]; p  = 0.007) were associated with a low rate of potentially inappropriate transfer. Conclusion Promoting onsite medical assessment and partnership thanks to available geriatrician’s advice may help the emergency medical dispatcher to improve the appropriateness of residents’ transfer from Nursing Home to the emergency department.

Background/Objectives The emergency department transfer (EDT) rate of residents from nursing homes (NHs) to emergency departments is an important public health issue. The purpose of this study was to examine whether organizational and geographical factors were associated with EDT among older adults living in NHs. Design Retrospective analysis using information from patients’ medical charts regarding hospitalization in the last 12 months. Information came from the baseline data of the IQUARE clinical trial. Participants 5926 residents (86.0 years old, standard deviation, SD = 2.9), from 175 NHs with available data on EDT. Outcome measure The EDT rate was estimated for each NH, from the number of residents who were transferred to an emergency department (one transfer or more) in the previous 12 months. Results 1119 (18.9%, SD = 11.5) residents were transferred to an emergency department at least once during the past year. In adjusted multiple linear regression, NHs located in rural areas had an EDT rate significantly lower than those in urban areas (confidence interval, 95% CI − 10.15, − 2.16, p  = 0.003), with an absolute EDT rate of 16.4% (SD = 9.1) versus 20.4% (SD = 12.5); pharmacy for internal use was significantly associated with a lower EDT rate compared with the NHs with no PUI [11.9% (SD = 9.2); 19.1% (SD = 10.1), 95% CI − 16.33, − 3.09, p  = 0.004] and the implementation of a personalized care project in NHs was significantly associated with a lower EDT rate [18.6% (SD = 11.4), 22.4% (SD = 12.4), 95% CI − 11.67, − 0.63, p  = 0.03]. Conclusion Our study suggests that a structured plan of care, a strategy to improve medication and being located in rural areas reduce the EDT rate in NH residents. IQUARE study trial registration number NCT01703689.

AbstractBackgroundFalls among older adults are now the leading cause of traumatic brain injury worldwide. We aimed to identify historical and clinical characteristics including the visible head impact location indicative of significant acute traumatic intracranial hemorrhage in older patients presenting to emergency department with mild traumatic brain injury subsequent to a ground-level fall.Methods and FindingsWe conducted a multicentre prospective cohort study across five university-affiliated emergency departments over a 2-year period (1 July 2023, to 30 June 2025) in Europe. We included patients aged 65 years or older who presented with mild traumatic brain injury (defined as head trauma with a Glasgow Coma Scale score of 13 to 15 upon emergency department presentation) following a ground-level fall and who underwent a computed tomography scan. The primary outcome was significant acute traumatic intracranial hemorrhage, defined as a neuroimaging radiological interpretation system (NIRIS) score > 1. Predictors were identified using logistic regression and recursive partitioning. A predictor was included in the decision rule if its association with the primary outcome and its interobserver reliability were strong. Internal validation was performed using bootstrapping. The study included 1,620 patients (mean age, 84.6 ± 8.5 years). A significant acute traumatic intracranial hemorrhage was identified in 72 patients (4.4%, 95% CI, 3.5–5.6) of which five (0.3%, 95 CI% 0.1–0.7) required neurosurgical intervention, performed within a median delay of 2 days (1–4). Eight criteria were identified as strong and reliable predictors: visible forehead-scalp impact, Glasgow Coma Scale score below baseline, focal neurological deficit, sign of basal skull fracture, acute confusion, vomiting, loss of consciousness, and headache. We then derived two clinical decision rules, which both showed 100% sensitivity (95% CI, 95–100) with specificities ranging from 25.3% (95% CI, 23.2–27.6) to 43.6% (95% CI, 41.1–46.1). Application of either clinical decision rule would have allowed reductions (41.7% or 24.2%) of the numbers of patients sent to the CT scan unit. Internal validation confirmed the strong performance of both rules, based on C-statistics of 0.84 (95% CI, 0.79–0.87) and 0.79 (95% CI, 0.74–0.84).ConclusionOur findings revealed that factors drawn from patient history and physical examination were associated with significant acute traumatic intracranial hemorrhage in older adults after a ground-level fall. Incorporating these factors into decision rules could provide a reliable strategy to stratify risk and reduce unnecessary CT scan. Such rules need to be validated externally and independently for their implementation in clinical practice, but may already be of aid for identifying high-risk patients.