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The Complicated UroLithiasis and Alternative Diagnoses (CLAD) score was derived from a retrospective cohort to predict the likelihood of surgery within 7 days following emergency department (ED) presentation for renal colic. The objective of this study was to prospectively refine and validate the CLAD score. This was a prospective observational study conducted in five French EDs between July 6, 2021, and July 6, 2023. Patients aged 18 years and older who presented to the ED with renal colic were included. The primary outcome was surgical intervention within 7 days of the ED visit. Logistic regression was used to identify risk factors associated with the need for surgery. Six hundred and two were analyzed including 60 (10 %) that required 7 days surgery. The CLAD – Modified with Biology (CLAD – MB) included: age > 45 years (OR = 1.64; + 1 point), an history of urological surgery (OR = 2.03; + 1 point), a pain score > 7/10 (OR = 2.16; + 1 point), a temperature > 37.8 °C (OR = 4.2; + 2 points), a negative dipstick for blood (OR = 1.53; + 1 point), a CRP ≥ 50 mg/mL (OR = 2.8; + 1 point), a leucocytes count ≥12 G/L (OR = 1.72; + 1 point) and an elevated creatinine (OR = 5.46; + 2 points). A CLAD – MB threshold of <1 had high sensitivity (98 % [91–100]) and low negative likelihood ratio (0.12 [0.02–0.83]). CLAD – MB has good prognostic ability for identify patients at low risk of 7-day surgery. •Renal colic may be caused by conditions that require urgent surgical intervention.•Criteria to identify patients needing CT during ED visits remain debated.•The CLAD-MB score includes 8 easily assessable clinical and biological predictors.•The CLAD-MB score predicts the risk of surgery within 7 days.•It may assist clinicians in deciding whether to perform a CT scan during the ED visit.

The sensitivity of reverse transcriptase polymerase chain reaction (RT-PCR) has been questioned due to negative results in some patients who were strongly suspected of having coronavirus disease 2019 (COVID-19). The aim of our study was to analyze the prognosis of infected patients with initial negative RT-PCR in the emergency department (ED) during the COVID-19 outbreak. This study included two cohorts of adult inpatients admitted into the ED. All patients who were suspected to be infected with SARS-CoV-2 and who underwent a typical chest CT imaging were included. Thus, we studied two distinct cohorts: patients with positive RT-PCR (PCR+) and those with negative initial RT-PCR (PCR–). The data were analyzed using Bayesian methods. We included 66 patients in the PCR– group and 198 in the PCR+ group. The baseline characteristics did not differ except in terms of a proportion of lower chronic respiratory disease in the PCR– group. We noted a less severe clinical presentation in the PCR– group (lower respiratory rate, lower oxygen need and mechanical ventilation requirement). Hospital mortality (9.1% vs. 9.6%) did not differ between the two groups. Despite an initially less serious clinical presentation, the mortality of patients infected by SARS-CoV-2 with a negative RT-PCR did not differ from those with positive RT-PCR.

Objective: Correct and timely identification of SARS-CoV-2-positive patients is critical in the emergency department (ED) prior to admission to medical wards. Antigen-detecting rapid diagnostic tests (Ag-RDTs) are a rapid alternative to Reverse-transcriptase polymerase chain reaction (RT-PCR) for the diagnosis of COVID-19 but have lower sensitivity. Methods: We evaluated the performance in real-life conditions of a strategy combining Ag-RDT and chest computed tomography (CT) to rule out COVID-19 infection in 1015 patients presenting in the ED between 16 November 2020 and 18 January 2021 in order to allow non-COVID-19 patients to be hospitalized in dedicated units directly. The combined strategy performed in the ED for patients with COVID-19 symptoms was assessed and compared with RT-PCR. Results: Compared with RT-PCR, the negative predictive value was 96.7% for Ag-RDT alone, 98.5% for Ag-RDT/CT combined, and increased to 100% for patients with low viral load. Conclusion: A strategy combining Ag-RDT and chest CT is effective in ruling out COVID-19 in ED patients with high precision.

Management involves organizing, planning, coordinating, and scheduling tasks. Emergency departments (EDs) face organizational challenges due to their specific activities, interprofessional collaboration within the team, and coordination with both intra- and extra-hospital partners. To address these challenges, the French Society of Emergency Medicine (FSEM) sought to bring together experts working in EDs, along with academic researchers and educators, to develop evidence-based guidelines for ED management. While managers must be recognized for their medical skills, they must also develop their leadership skills through dedicated training. These skills will enable them to adapt their leadership style to different situations and teams to encourage team motivation and commitment. Serving as the interface between frontline teams, management, and institutional partners, their role should be to promote dialogue and ensure team security. The manager’s role and resources need to be formalized in collaboration with senior leadership, in particular regarding access to information, so that the manager can convey a strategic vision to teams and partners. Projects should be implemented and meetings should be organized within the framework of an effective strategy. To achieve this, setting out and sharing clearly defined objectives and operating rules, as well as involving staff in decision-making, are effective tools for reducing resistance to change and encouraging the co-construction of organizational transformation. Skills development through individual and group training creates opportunities for the meaningful exchanges needed to support professionals to flourish, strengthen motivation, and build shared values. Certain factors are directly associated with the attractiveness of an ED, such as the working environment, the variety of activities, and individualized career management. The organizational structures put in place must ensure psychological safety and effective interprofessional collaboration to improve both the quality of work life and the quality of care. Communication and crisis management must be carefully thought out and methodically organized to build an ED in which every team member can fully engage and feel valued. Experts agree that managing an ED should be a structured activity, requiring specific tools and skills. This role must be recognized by the teams, leadership, and partners.

Introduction: The COVID-19 outbreak had a major impact on healthcare systems worldwide. Our study aims to describe the characteristics and therapeutic emergency mobile service (EMS) management of patients with vital distress due to COVID-19, their in-hospital care pathway and their in-hospital outcome. Methods: This retrospective and multicentric study was conducted in the six main centers of the French Greater East region, an area heavily impacted by the pandemic. All patients requiring EMS dispatch and who were admitted straight to the intensive care unit (ICU) were included. Clinical data from their pre-hospital and hospital management were retrieved. Results: We included a total of 103 patients (78.6% male, median age 68). In the initial stage, patients were in a critical condition (median oxygen saturation was 72% (60–80%)). In the field, 77.7% (CI 95%: 71.8–88.3%) were intubated. Almost half of our population (45.6%, CI 95%: 37.1–56.9%) had clinical Phenotype 1 (silent hypoxemia), while the remaining half presented Phenotype 2 (acute respiratory failure). In the ICU, a great number had ARDS (77.7%, CI 95% 71.8–88.3% with a PaO2/FiO2 < 200). In-hospital mortality was 33% (CI 95%: 24.6–43.3%). The two phenotypes showed clinical and radiological differences (respiratory rate, OR = 0.98, p = 0.02; CT scan lesion extension >50%, OR = 0.76, p < 0.03). However, no difference was found in terms of overall in-hospital mortality (OR = 1.07, p = 0.74). Conclusion: The clinical phenotypes appear to be very distinguishable in the pre-hospital field, yet no difference was found in terms of mortality. This leads us to recommend an identical management in the initial phase, despite the two distinct presentations.

IntroductionThis study describes patients admitted to an urban emergency service in France during the 2003 heat wave. Patients with heat-related illnesses were studied and comparison was made between those who died and survivors.MethodsA retrospective study of about 760 records concerning 726 patients aged over 65 years admitted during August 2003 to a French emergency department.ResultsAfter review of the medical records, 42 patients had heat-related illnesses. Heat-related illnesses were not diagnosed by the treating physician in any of the patients. The patients were more likely to live in institutional care and used more psychotropic medications. Hyperthermia and acute cognitive impairment were the main reasons for admission to the emergency department. The patients had a higher heart rate and body temperature and more dyspnoea and central nervous system dysfunction than those without heat-related illnesses. Twelve patients (28.6%) with heat-related illnesses died in the emergency unit or after admission to hospital. Temperature, heart rate and plasma creatinine levels were higher in those who died than in survivors with heat-related illnesses.ConclusionHeat-related illnesses are a group of underestimated and underdiagnosed conditions with high morbidity and mortality rates.