Mustapha Sebbane

Dans ce travail, nous décrivons les conséquences physiologiques et physiopathologiques de l'obésité, ainsi que les difficultés techniques et logistiques de la prise en charge clinique. Puis, nous étudions les caractéristiques de la prise en charge des patients obèses et obèses morbides aux urgences, au bloc opératoire et en réanimation, ainsi que les modifications de la fonction respiratoire liées à l'obésité morbide et à la perte de poids. Aux urgences, nous démontrons que les patients obèses (IMC et#8805; 30 kg/m²) ont un capital veineux moins accessible et sont plus difficiles à perfuser que les non obèses. En physiologie clinique, nous avons pu confirmer l'absence de variation de la CRF en position couchée et démontrer pour la première fois l'effet de la perte de poids et de la position couchée sur les variations de la CRF. Au bloc opératoire, nous montrons que la préoxygénation des obèses morbides est optimisée par la ventilation non invasive (VNI), qui permet une augmentation rapide et importante de la fraction expirée en oxygène (FEo2) que la préoxygénation classique. Nous montrons aussi que la position assise à 45° associée à la VNI n'améliore pas la préoxygénation chez l'obèse morbide comparé à la VNI seule. Enfin, nous rapportons que les patients obèses médicaux en réanimation se caractérisent par une surmortalité, qui persiste un an après la sortie de l'hôpital, alors que les patients obèses chirurgicaux bénéficient d'un effet protecteur qui persiste jusqu'à un an. Nos travaux proposent la mise en place de nouvelles techniques afin d'optimiser les conditions de prise en charge spécifiques des patients obèses aux urgences, au bloc opératoire et en réanimation.

Telephone triage, performed in Emergency Medical Communication Centers is the complex task of gathering key medical information in order to identify life-threatening emergencies and ensure timely and appropriate service deployment. This decision-making process is particularly challenging when the caller is in emotional distress. To determine the association between the caller’s emotional state, as prospectively measured by the emergency dispatcher using the Emotional Content and Cooperation Score (ECCS), and patient outcomes, and to evaluate the predictive performance of ECCS. Prospective, observational study conducted from February 15^th to May 1^st 2023 in a French Emergency Communication Center. Calls managed by emergency physicians following initial prioritization by emergency dispatchers were included. Emergency dispatchers prospectively assessed callers’ emotional state using the ECCS, without influencing subsequent management. The primary endpoint was the frequency of severe outcomes (death or ICU admission) based on the callers’ ECCS. The association between ECCS and patient outcomes was analyzed using Cochran-Armitage trend test. Secondary endpoints included standard call prioritization by emergency dispatchers (P0–4 codes), graded response by emergency physicians (R1–4 codes), and final severity assessment (B0–3 codes), as well as the ECCS performance in predicting patient outcomes. Of 1134 calls assessed, 805 were analyzed. Twenty-seven emergency dispatchers participated in the ECCS assessment; 63% were female, median experience was 3 years (Q1; Q3: 1; 8). Most callers were rated as calm: ECCS1 (n = 515, 64%) and ECCS2 (n = 228, 28%); distressed callers were less frequent: ECCS3 (n = 48, 6%) and ECCS4 (n = 14, 2%). Severe outcomes occurred in 25 patients (3% of calls), and were significantly associated with higher perceived emotional distress (p = 0.0007). ECCS was also significantly associated with initial call prioritization by emergency dispatchers (P codes) and with the graded response deployed (R codes). ECCS≥2 showed 68% sensitivity (95%CI: 50; 87), 65% specificity (95%CI: 62; 68) and 98% NPV (95%CI: 97; 99) in predicting severe outcomes. This study provides real-world evidence that dispatchers’ assessments of callers’ emotional states, assessed prior to medical management, are associated with patient outcomes. These findings support integrating emotional state assessment into emergency call triage to optimize timely and appropriate care. The online version contains supplementary material available at 10.1186/s12873-025-01446-y.

Background The HOME-CoV (Hospitalisation or Outpatient ManagEment of patients with SARS-CoV-2 infection) score is a validated list of uniquely clinical criteria indicating which patients with probable or proven COVID-19 can be treated at home. The aim of this study was to optimise the score to improve its ability to discriminate between patients who do and do not need admission. Methods A revised HOME-CoV score was derived using data from a previous prospective multicentre study which evaluated the original Home-CoV score. Patients with proven or probable COVID-19 attending 34 EDs in France, Monaco and Belgium between April and May 2020 were included. The population was split into a derivation and validation sample corresponding to the observational and interventional phases of the original study. The main outcome was non-invasive or invasive ventilation or all-cause death within 7 days following inclusion. Two threshold values were defined using a sensitivity of >0.9 and a specificity of >0.9 to identify low-risk and high-risk patients, respectively. The revised HOME-CoV score was then validated by retrospectively applying it to patients in the same EDs with proven or probable COVID-19 during the interventional phase. The revised HOME-CoV score was also tested against original HOME-CoV, qCSI, qSOFA, CRB65 and SMART-COP in this validation cohort. Results There were 1696 patients in the derivation cohort, of whom 65 (3.8%) required non-invasive ventilation or mechanical ventilation or died within 7 days and 1304 patients in the validation cohort, of whom 22 (1.7%) had a progression of illness. The revised score included seven clinical criteria. The area under the curve (AUC) was 87.6 (95% CI 84.7 to 90.6). The cut-offs to define low-risk and high-risk patients were 3, respectively. In the validation cohort, the AUC was 85.8 (95% CI 80.6 to 91.0). A score of Conclusion The revised HOME-CoV score, which does not require laboratory testing, may allow accurate risk stratification and safely qualify a significant proportion of patients with probable or proven COVID-19 for home treatment.

Faced with the pandemic viral circulation of SARS-CoV-2, healthcare establishments have had to maintain an effective screening strategy in order to prevent nosocomial clusters. Automated antigenic tests appear to be a reliable and complementary alternative to RT-PCR (reverse transcriptase polymerase chain reaction) in order to optimize patient care in the emergency department. We report our experience of the deployment of the LumiraDx antigen tests on the LumiraDx platform, as well as the comparison of these tests’ results with the RT-PCR results on a population of patients sampled in the emergency department.

(1) Incomplete or wrong medication histories can lead to missed diagnoses of Adverse Drug Effects (ADEs). We aimed to evaluate pharmacist-identified ED errors in the medication histories obtained by physicians, and their consequences for ADE detection. (2) This prospective monocentric study was carried out in an ED of a university hospital. We included adult patients presenting with an ADE detected in the ED. The best possible medication histories collected by pharmacists were used to identify errors in the medication histories obtained by physicians. We described these errors, and identified those related to medications involved in ADEs. We also identified the ADEs that could not have been detected without the pharmacists’ interventions. (3) Of 735 patients presenting with an ADE, 93.1% had at least one error on the medication list obtained by physicians. Of the 1047 medications involved in ADEs, 51.3% were associated with an error in the medication history. In total, 23.1% of the medications involved in ADEs were missing in the physicians’ medication histories and were corrected by the pharmacists. (4) Medication histories obtained by ED physicians were often incomplete, and half the medications involved in ADEs were not identified, or were incorrectly characterized in the physicians’ medication histories.

Adverse drug events (ADEs) are a major public health concern, given their consequences in terms of morbi-mortality and associated healthcare costs. Many studies have focused on the elderly, who are considered particularly vulnerable in this respect. We aimed to determine and compare the frequency, characteristics, and predictive factors of ADEs according to age in an adult population. A prospective seven-year cross-sectional study was conducted in a university hospital emergency department. Structured medication reviews and ADE detection were performed. Patient data and ADE characteristics were collected. Descriptive statistics and logistic regression were performed in two age groups: Group 1 (age < 65 years) and 2 (age ≥ 65 years). Among the 13,653 patients included, 18.4% in Group 1 and 22.6% in Group 2 experienced an ADE. Differences were identified in terms of the ADE type (more ADEs due to noncompliance in Group 1) and ADE symptoms (greater bleeding in Group 2). In the multivariable analysis, several specific predictive factors were identified, including kidney failure and antidiabetic drug use in Group 1 and inappropriate prescription and antithrombotic treatment in Group 2. Analysis by age provided a more refined vision of ADEs as we identified distinct profiles of iatrogenesis. These results will lead to a better detection of ADEs.

Aims: The role of diuretics in patients with intermediate-risk pulmonary embolism (PE) is controversial. In this multicentre, double-blind trial, we randomly assigned normotensive patients with intermediate-risk PE to receive either a single 80 mg bolus of furosemide or a placebo. Methods and results: Eligible patients had at least a simplified PE Severity Index (sPESI) ≥1 with right ventricular dysfunction. The primary efficacy endpoint assessed 24 h after randomization included (i) absence of oligo-anuria and (ii) normalization of all sPESI items. Safety outcomes were worsening renal function and major adverse outcomes at 48 hours defined by death, cardiac arrest, mechanical ventilation, or need of catecholamine. A total of 276 patients underwent randomization; 135 were assigned to receive the diuretic, and 141 to receive the placebo. The primary outcome occurred in 68/132 patients (51.5%) in the diuretic and in 49/132 (37.1%) in the placebo group (relative risk = 1.30, 95% confidence interval 1.04–1.61; P = 0.021). Major adverse outcome at 48 h occurred in 1 (0.8%) patients in the diuretic group and 4 patients (2.9%) in the placebo group (P = 0.19). Increase in serum creatinine level was greater in diuretic than placebo group [+4 µM/L (−2; 14) vs. −1 µM/L (−11; 6), P < 0.001]. Conclusion: In normotensive patients with intermediate-risk PE, a single bolus of furosemide improved the primary efficacy outcome at 24 h and maintained stable renal function. In the furosemide group, urine output increased, without a demonstrable improvement in heart rate, systolic blood pressure, or arterial oxygenation. ClinicalTrials.gov identifier NCT02268903.

The aim of this study is to compare the Hestia rule vs. the simplified Pulmonary Embolism Severity Index (sPESI) for triaging patients with acute pulmonary embolism (PE) for home treatment. Normotensive patients with PE of 26 hospitals from France, Belgium, the Netherlands, and Switzerland were randomized to either triaging with Hestia or sPESI. They were designated for home treatment if the triaging tool was negative and if the physician-in-charge, taking into account the patient’s opinion, did not consider that hospitalization was required. The main outcomes were the 30-day composite of recurrent venous thrombo-embolism, major bleeding or all-cause death (non-inferiority analysis with 2.5% absolute risk difference as margin), and the rate of patients discharged home within 24 h after randomization (NCT02811237). From January 2017 through July 2019, 1975 patients were included. In the per-protocol population, the primary outcome occurred in 3.82% (34/891) in the Hestia arm and 3.57% (32/896) in the sPESI arm (P = 0.004 for non-inferiority). In the intention-to-treat population, 38.4% of the Hestia patients (378/984) were treated at home vs. 36.6% (361/986) of the sPESI patients (P = 0.41 for superiority), with a 30-day composite outcome rate of 1.33% (5/375) and 1.11% (4/359), respectively. No recurrent or fatal PE occurred in either home treatment arm. For triaging PE patients, the strategy based on the Hestia rule and the strategy based on sPESI had similar safety and effectiveness. With either tool complemented by the overruling of the physician-in-charge, more than a third of patients were treated at home with a low incidence of complications. The international randomized HOME-PE study demonstrates that, for triaging patients with acute pulmonary embolism for home treatment, the Hestia rule and the simplified Pulmonary Embolism Severity Index, complemented by the physician's overruling, are equally safe and efficient.

Background: Adverse drug events (ADE) represent one of the main causes of admission to emergency department (ED). Their detection, documentation, and reporting are essential to avoid readmission.We hypothesize that a pharmacist-initiated multidisciplinary transition of care program combining ED pharmacist contribution and medications’ data transfer between inpatient and outpatient caregivers will reduce emergency visits related to ADEMethod/design: This is a prospective, open-label, randomized controlled trial. The primary aim of the study is 6-month ED readmission related to the same ADE. Three hundred forty-six adult patients with an ADE detected by a binomial pharmacist-physician will be recruited from the ED of an University Hospital and will be randomized in two groups: [1] experimental group (multidisciplinary transition of care program and medications’ data transfer between inpatient and outpatient caregivers) and [2] control group (usual care). Patients will be followed up over a period of 6 months. Endpoints will be carried out blindly of the randomization arm. The primary endpoint is the rate of patients who had at least one readmission in the ED for the same reason at 6 months (data collected during a phone call with the patient and the general practitioner). Trials registered NCT03725046.Discussion: The trial results will have implications for the role of the clinical pharmacist in an emergency department. If successful, the intervention could be considered for implementation across other hospitals.Trial registration: ClinicalTrials.gov NCT03725046. Registered on 30 October 2018