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1. Emergency protocol for acute respiratory failure at the workplace or a remote site

Author

Descatha, A., Chanu, S., Jenkins, M., Savary, D, Lentz, T., Havette, P., Baer, M., Institut de recherche en santé, environnement et travail (Irset), Université d'Angers (UA)-Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), United Nations = Organisation des Nations unies (ONU), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and La poste

Subjects
Respiratoire, Procedure, [SDV]Life Sciences [q-bio], Emergency, Respiratory, Professionnel, Urgence, Procédure, Occupational
Abstract

International audience; [No abstract available]

Published
2023
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2. Protocole d'urgence en santé au travail ou milieu isolé. Généralités et mise à jour

Author

Descatha, A., Chanu, S., Jenkins, Jon, Savary, D, Lentz, T., Havette, P., Baer, M., École des Hautes Études en Santé Publique [EHESP] (EHESP), Institut de recherche en santé, environnement et travail (Irset), Université d'Angers (UA)-Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Hôpital Raymond Poincaré [Garches], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and Le travail a bénéficié du soutien dans le cadre du projet TEC-TOP, de la région Pays-de-la-Loire, d’Angers Loire Métropole, de l’Université d’Angers et du CHU d’Angers.

Subjects
Procedure, [SDV]Life Sciences [q-bio], Emergency, Protocol, Protocole, Professionnel, Urgence, Procédure, Travail, Occupational work
Abstract

National audience; Le protocole d’urgence doit être adapté au contexte. Il doit être simple, court, exhaustif et facile à mémoriser. Il résume la conduite à tenir en cas d’urgence.Le protocole d’urgence est établi par le médecin du travail et validé par l’équipe notamment l’infirmier(ère) en santé au travail sous la responsabilité du médecin du travail. Il sera régulièrement actualisé en fonction de nouvelles connaissances et/ou de la situation locale.Deux types de protocoles sont à établir en fonction de la présence ou de l’absence de professionnel de Santé.Le protocole de gestion d’une urgence médicale en l’absence de professionnel de Santé est une procédure d’appel aux secouristes disponibles. L’objectif étant de déclencher les services d’urgence médicale en agissant de façon rationnelle.Le protocole d’urgences destiné au professionnel de Santé est basé sur le symptôme. Il permet de hiérarchiser l’urgence. Il se doit d’être ergonomique, adapté, traçable et (ré)évaluable.Cette mise au point est une mise à jour après la période COVID-19 à partir des généralités de l’ouvrage « Mémento et Protocoles » [1] et de l’article « six principes des protocoles de prise en charge des urgences en milieu de travail » [2]. L’objectif est de proposer un récapitulatif des principes permettant d’élaborer et d’appliquer un protocole pour l’équipe de santé au travail, en l’ouvrant à toute situation où le professionnel de santé en milieu isolé doit gérer les premières urgences avec peu de moyens. La principale différence entre le milieu de travail en France et un milieu isolé est le recours à la structure qui poursuivra la prise en charge, qui ne sera pas le SAMU mais une structure d’urgence et/ou d’évacuation.Après une brève introduction, nous rappellerons les bases du raisonnement de gestion des urgences en milieu de travail ou isolé, afin de poser les bases des protocoles dans ce cadre.

Published
2023
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3. Traumatisme et température

Author

Lapostolle, F., Savary, D, Marqueurs cardiovasculaires en situation de stress (MASCOT (UMR_S_942 / U942)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Institut de recherche en santé, environnement et travail (Irset), and Université d'Angers (UA)-Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )

Subjects
Perfusion, Hemostasis, [SDV]Life Sciences [q-bio], Temperature, Hypothermia, Warming, Trauma
Abstract

National audience; Le patient traumatisé est exposé à l’hypothermie. La mortalité des traumatisés hypothermes est multipliée par quatre ou cinq. Les interactions de l’hypothermie avec l’hémostase et le système cardiovasculaire sont délétères. Les effets sur la coagulation sont multiples et concourent directement à la surmortalité faisant de l’hypothermie une composante majeure de la « triade létale ». Les causes d’hypothermie chez le patient traumatisé sont multiples : 1) environnementales, le risque augmente quand la température ambiante diminue ; 2) cliniques, le risque augmente avec la gravité ; et aussi 3) thérapeutiques, par exemple par la perfusion de solutés à température ambiante. Une prise en charge optimale repose sur une mesure précoce et un monitorage continu de la température corporelle. L’objectif thérapeutique est de maintenir une température corporelle au moins égale à 36 °C. Limiter le déshabillage du patient, le protéger du froid avec une couverture de survie, l’installer rapidement dans une ambulance chauffée, recourir à des dispositifs de réchauffement actifs, perfuser des solutés réchauffés sont les éléments fondamentaux de la prise en charge d’un patient traumatisé, potentiellement hypotherme.

Published
2022
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4. Outpatient Management of Patients With COVID-19: Multicenter Prospective Validation of the Hospitalization or Outpatient Management of Patients With SARS-CoV-2 Infection Rule to Discharge Patients Safely

Author

Douillet, Delphine, Penaloza, A, Mahieu, R, Morin, F, Chauvin, A, Gennai, S, Schotte, T, Montassier, E, Thiebaud, P-C, Ghuysen, A, Dall’acqua, D, Benhammouda, K, Bissokele, P, Violeau, M, Joly, L-M, Andrianjafy, H, Soulie, C, Savary, D, Riou, J, Roy, P-M, Université d'Angers (UA), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Physiopathologie Cardiovasculaire et Mitochondriale (MITOVASC), Université d'Angers (UA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Cliniques Universitaires Saint-Luc [Bruxelles], Centre de Recherche en Cancérologie et Immunologie Nantes-Angers (CRCINA), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Centre National de la Recherche Scientifique (CNRS)-Université d'Angers (UA), Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital universitaire Robert Debré [Reims], Centre Hospitalier Le Mans (CH Le Mans), Centre hospitalier universitaire de Nantes (CHU Nantes), CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier Universitaire de Liège (CHU-Liège), CH Vichy, CH Colmar, Centre Hospitalier Libourne, Centre Hospitalier Georges Renon [Niort] (CH Georges Renon Niort), CHU Rouen, Normandie Université (NU), Groupe Hospitalier Nord Essonne [Longjumeau], CH Cholet, Institut de recherche en santé, environnement et travail (Irset), Université d'Angers (UA)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), École des Hautes Études en Santé Publique [EHESP] (EHESP), Micro et Nanomédecines Translationnelles (MINT), Université d'Angers (UA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS), None, MitoVasc - Physiopathologie Cardiovasculaire et Mitochondriale (MITOVASC), Université d'Angers (UA)-Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Centre hospitalier universitaire de Nantes (CHU Nantes), Université d'Angers (UA)-Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), and Chard-Hutchinson, Xavier

Subjects
[SDV] Life Sciences [q-bio], clinical support decision tool, expert consensus, [SDV]Life Sciences [q-bio], outpatient, rule-based decision-making, COVID-19, rule validation, hospitalization
Abstract

International audience; BACKGROUND: The Hospitalization or Outpatient Management of Patients With SARS-CoV-2 Infection (HOME-CoV) rule is a checklist of eligibility criteria for home treatment of patients with COVID-19, defined using a Delphi method. RESEARCH QUESTION: Is the HOME-CoV rule reliable for identifying a subgroup of COVID-19 patients with a low risk of adverse outcomes who can be treated at home safely? STUDY DESIGN AND METHODS: We aimed to validate the HOME-CoV rule in a prospective, multicenter study before and after trial of patients with probable or confirmed COVID-19 who sought treatment at the ED of 34 hospitals. The main outcome was an adverse evolution, that is, invasive ventilation or death, occurring within the 7 days after patient admission. The performance of the rule was assessed by the false-negative rate. The impact of the rule implementation was assessed by the absolute differences in the rate of patients who required invasive ventilation or who died and in the rate of patients treated at home, between an observational and an interventional period after implementation of the HOME-CoV rule, with propensity score adjustment. RESULTS: Among 3,000 prospectively enrolled patients, 1,239 (41.3%) demonstrated a negative HOME-CoV rule finding. The false-negative rate of the HOME-CoV rule was 4 in 1,239 (0.32%; 95% CI, 0.13%-0.84%), and its area under the receiver operating characteristic curve was 80.9 (95% CI, 76.5-85.2). On the adjusted populations, 25 of 1,274 patients (1.95%) experienced an adverse evolution during the observational period vs 12 of 1,274 patients (0.95%) during the interventional period: -1.00 (95% CI, -1.86 to -0.15). During the observational period, 858 patients (67.35%) were treated at home vs 871 patients (68.37%) during the interventional period: -1.02 (95% CI, -4.46 to 2.26). INTERPRETATION: A large proportion of patients treated in the ED with probable or confirmed COVID-19 have a negative HOME-CoV rule finding and can be treated safely at home with a very low risk of complications. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT04338841; URL: www.clinicaltrials.gov.

Published
2021
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5. Interhospital transport of patients with COVID-19 under high-flow nasal cannula (HFNC)

Author

Morin, F., Dubie, E., Serruys, A., Usseglio, P., Richard, J.-C., Richard, Jean-Christophe, Douillet, D., Savary, D., Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Centre Hospitalier Métropole Savoie [Chambéry], Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé (CREATIS), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Modeling & analysis for medical imaging and Diagnosis (MYRIAD), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), MitoVasc - Physiopathologie Cardiovasculaire et Mitochondriale (MITOVASC), Université d'Angers (UA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Institut de recherche en santé, environnement et travail (Irset), Université d'Angers (UA)-Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Chard-Hutchinson, Xavier, Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), and Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL)

Subjects
Patient Transfer, 2019-20 coronavirus outbreak, Infectious Disease Transmission, Patient-to-Professional, Coronavirus disease 2019 (COVID-19), business.industry, [SDV]Life Sciences [q-bio], Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), COVID-19, General Medicine, medicine.disease_cause, Respiration, Artificial, Article, [SDV] Life Sciences [q-bio], Transportation of Patients, Anesthesia, Emergency Medicine, medicine, Cannula, Humans, High flow, business, Nasal cannula, ComputingMilieux_MISCELLANEOUS
Abstract

International audience; [No abstract available]

Published
2021
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6. Venous Thromboembolic Risk in Patients with Lower Limb Trauma Requiring Immobilization: Towards an Individualized Approach

Author

Douillet, D., Barbere, T., Peintre, M., Moumneh, T., Morin, F., Savary, D., Penaloza, A., Roy, P-M, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Physiopathologie Cardiovasculaire et Mitochondriale (MITOVASC), Université d'Angers (UA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Institut de recherche en santé, environnement et travail (Irset), Université d'Angers (UA)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Université d'Angers (UA), Université Catholique de Louvain = Catholic University of Louvain (UCL), MitoVasc - Physiopathologie Cardiovasculaire et Mitochondriale (MITOVASC), and Université d'Angers (UA)-Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )

Subjects
[SDV]Life Sciences [q-bio], Immobilisation, Thromboprophylaxis, Trauma, Risk stratification, Venous thromboembolism
Abstract

National audience; Lower limb trauma requiring immobilization is a situation at risk of developing venous thromboembolic (VTE) disease. However, recommendations and practices vary significantly from country to country and from center to center. The aims of this narrative review are to describe the epidemiology, prevention, and prediction algorithms for venous thromboembolic disease in patients with lower limb trauma requiring immobilization. The incidence of VTE varies between studies due to the great heterogeneity of the patients included (from ankle sprains to major injuries requiring surgery) and due to the heterogeneity of the evaluation criteria (consideration of asymptomatic proximal or distal or only symptomatic thrombosis). The estimated incidence of symptomatic venous thromboembolic events is 2.0% (95% confidence interval: 1.3 to 2.7). The efficacy of thromboprophylaxis has been confirmed in two meta-analyses that included randomized controlled trials. However, these results had to be carefully interpreted because many trials had methodological flaws. The largest and most recent study showed no benefit of low molecular weight heparin prevention on symptomatic events in an unselected population. These results suggest adopting a personalized strategy, keeping prophylaxis for at-risk patients. Several scores are currently being proposed to assess individual thromboembolic risk. Considering the characteristics of the patient, the trauma, and the immobilization, it is possible to identify a large subgroup of patients in whom prevention seems useless and a subgroup of high-risk patients in whom prevention should be prescribed or even reinforced. In conclusion, in the case of lower limb trauma requiring immobilization, the indication for thromboprophylaxis should be guided by the individual assessment of thrombotic risk.

Published
2021
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7. Outpatient management or hospitalization of patients with proven or suspected SARS-CoV-2 infection: The HOME-CoV rule

Author

Douillet D., Mahieu R., Boiveau V., Vandamme Y.-M., Armand A., Morin F., Savary D., Dubée V., Annweiler C., and Roy P.-M.

Subjects
3. Good health
Abstract

In the context of the COVID-19 pandemic and overloaded hospitals, a central issue is the need to define reliable and consensual criteria for hospitalization or outpatient management in mild cases of COVID-19. Our aim was to define an easy-to-use clinical rule aiming to help emergency physicians in hospitalization or outpatient management decision-making for patients with suspected or confirmed SARS-CoV-2 infection (the HOME-CoV Rule). The Delphi method was used to reach a consensus of a large panel of 51 experts: emergency physicians, geriatricians, infectious disease specialists, and ethical consultants. A preliminary list of eligible criteria was compiled based on a literature review. Four rounds of anonymized expert consultations were performed. The experts were asked to score each item as relevant, possibly relevant and non-relevant, as major or minor, and to choose the cut-off. They were also able make suggestions and remarks. Eight criteria constituting the HOME-CoV were selected: six correspond to the severity of clinical signs, one to the clinical course (clinically significant worsening within the last 24 hours), and the last corresponds to the association of a severe comorbidity and an inadequate living context. Hospitalization is deemed necessary if a patient meets one or more of the criteria. In the end, 94.4% of the experts agreed with the defined rule. Thanks to the Delphi method, an absolute consensus was obtained of a large panel of experts on the HOME-CoV rule, a decision-making support mechanism for clinicians to target patients with suspected or confirmed COVID-19 requiring hospitalization.Trial registration: NCT04338841

Published
2020
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8. Relationship Between Arterial Access and Outcomes in ST‐Elevation Myocardial Infarction With a Pharmacoinvasive Versus Primary Percutaneous Coronary Intervention Strategy: Insights From the STrategic Reperfusion Early After Myocardial Infarction (STREAM) Study

Author

Shavadia, Jay, Welsh, Robert, Gershlick, Anthony, Zheng, Yinggan, Huber, Kurt, Halvorsen, Sigrun, Steg, Phillipe G., Van de Werf, Frans, Armstrong, Paul W., Kaff, A., Malzer, R., Sebald, D., Glogar, D., Gyöngyösi, M., Weidinger, F., Weber, H., Gaul, G., Chmelizek, F., Seidl, S., Pichler, M., Pretsch, I., Vergion, M., Herssens, M., Van Haesendonck, C., Saraiva, J. F K, Sparenberg, A. L F, Souza, J. A., Moraes, J. B M, Sant'anna, F. M., Tarkieltaub, E., Hansen, J. R., Oliveira, E. M., Leonhard, O., Cantor, W., Senaratne, M., Aptecar, E., Asseman, P., Belle, L., Belliard, O., Berland, J., Berthier, A., Besnard, C., Bonneau, A., Bonnefoy, E., Brami, M., Canu, G., Capellier, G., Cattan, S., Champagnac, D., Chapon, P., Cheval, B., Claudel, J., Cohen Tenoudji, P., Coste, P., Debierre, V., Domergue, R., Echahed, K., El Khoury, C., Ferrari, E., Garrot, P., Henry, P., Jardel, B., Jilwan, R., Julie, V., Ketelers, R., Lapostolle, F., Le Tarnec, J., Livarek, B., Mann, Y., Marchand, X., Pajot, F., Perret, T., Petit, P., Probst, V., Ricard Hibon, A., Robin, C., Salama, A., Salengro, E., Savary, D., Schiele, F., Soulat, L., Tabone, X., Taboulet, P., Thicoïpe, M., Torres, J., Tron, C., Vanzetto, G., Villain-Coquet, L., Piper, S., Mochmann, H. C., Nibbe, L., Schniedermeier, U., Heuer, H., Marx, F., Schöls, W., Lepper, W., Grahl, R., Muth, G., Lappas, G., Mantas, I., Skoumbourdis, E., Dilanas, C., Kaprinis, I., Vogiatzis, I., Zarifis, I., Spyromitros, G., Konstantinides, S., Symeonides, D., Rossi, G. P., Bermano, F., Ferlito, S., Paolini, P., Valagussa, L., Della Rovere, F., Miccoli, F., Chiti, M., Vergoni, W., Comeglio, M., Percoco, G., Valgimigli, M., Berget, K., Skjetne, O., Schartum-Hansen, H., Andersen, K., Rolstad, O. J., Aguirre Zurita, O. N., Castillo León, R. P., Villar Quiroz, A. C., Glowka, A., Kulus, P., Kalinina, S., Bushuev, A., Barbarash, O., Tarasov, N., Fomin, I., Makarov, E., Markov, V., Danilenko, A., Volkova, E., Frolenkov, A., Burova, N., Yakovlev, A., Elchinskaya, L., Boldueva, S., Klein, G., Kolosova, I., Ovcharenko, E., Fairushin, R., Andjelic, S., Vukcevic, V., Neskovic, A., Krotin, M., Rajkovic, T., Pavlovic, M., Perunicic, J., Kovacevic, S., Petrovic, V., Mitov, V., Ruiz, A., García-Alcántara, A., Martínez, M., Díaz, J., Paz, M. A., Manzano, F. L., Martín, C., Macaya, C., Corral, E., Fernández, J. J., Martín, F., García, R., Siriwardena, N., Rawstorne, O., Baumbach, A., Manoharan, G., Menown, I., McHechan, S., and Morgan, D.

Subjects
Male, Epidemiology, medicine.medical_treatment, 030204 cardiovascular system & hematology, Coronary Angiography, 0302 clinical medicine, Recurrence, Odds Ratio, Thrombolytic Therapy, 030212 general & internal medicine, Myocardial infarction, Original Research, Primary percutaneous coronary intervention, Shock, Thrombolysis, Middle Aged, Clopidogrel, Femoral Artery, Tissue Plasminogen Activator, Radial Artery, Cardiology, Female, Cardiology and Cardiovascular Medicine, medicine.medical_specialty, Ticlopidine, Arterial access, Hemorrhage, 03 medical and health sciences, Percutaneous Coronary Intervention, Fibrinolytic Agents, Internal medicine, Catheterization, Peripheral, ST‐segment elevation myocardial infarction, Journal Article, medicine, Humans, Enoxaparin, Mortality, Aged, Heart Failure, Pharmacoinvasive strategy, Aspirin, business.industry, Percutaneous coronary intervention, Odds ratio, medicine.disease, ST-segment elevation myocardial infarction, Clinical trial, Blood pressure, Heart failure, Multivariate Analysis, Conventional PCI, Tenecteplase, ST Elevation Myocardial Infarction, business, Acute Coronary Syndromes, Platelet Aggregation Inhibitors
Abstract

Background The effectiveness of radial access ( RA ) in ST ‐elevation myocardial infarction ( STEMI ) has been predominantly established in primary percutaneous coronary intervention ( pPCI ) with limited exploration of this issue in the early postfibrinolytic patient. The purpose of this study was to compare the effectiveness and safety of RA versus femoral ( FA ) access in STEMI undergoing either a pharmacoinvasive ( PI ) strategy or pPCI . Methods and Results Within ST rategic Reperfusion Early After Myocardial Infarction ( STREAM ), we evaluated the relationship between arterial access site and primary outcome (30‐day composite of death, shock, congestive heart failure, or reinfarction) and major bleeding according to the treatment strategy received. A total of 1820 STEMI patients were included: 895 PI (49.2%; rescue PCI [n=379; 42.3%], scheduled PCI [n=516; 57.7%]) and 925 pPCI (50.8%). Irrespective of treatment strategy, there was comparable utilization of either access site ( FA : PI 53.4% and pPCI 57.6%). FA STEMI patients were younger, had lower presenting systolic blood pressure, lesser Thrombolysis In Myocardial Infarction risk, and more ∑ ST ‐elevation at baseline. The primary composite endpoint occurred in 8.9% RA versus 15.7% FA patients ( P RA persisted (adjusted odds ratio [ OR ], 0.59; 95% CI , 0.44–0.78; P pPCI (adjusted OR , 0.63; 95% CI , 0.43–0.92) and PI cohorts (adjusted OR , 0.57 95% CI , 0.37–0.86; P interaction=0.730). There was no difference in nonintracranial major bleeding with either access group ( RA vs FA , 5.2% vs 6.0%; P =0.489). Conclusions Regardless of the application of a PI or pPCI strategy, RA was associated with improved clinical outcomes, supporting current STEMI evidence in favor of RA in PCI . Clinical Trial Registration URL : https://www.clinicaltrials.gov/ . Unique identifier: NCT 00623623.

Published
2016
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9. Prehospital high-dose tirofiban in patients undergoing primary percutaneous intervention. The AGIR-2 study

Author

El Khoury, C., Dubien, P-Y., Belle, L., Debaty, G., Capel, O., Perret, T., Savary, D., Serre, P., Bonnefoy-Cudraz, E., Bissery, A., Ecochard, René, Plattner, V., Mercier, Catherine, Département biostatistiques et modélisation pour la santé et l'environnement [LBBE], Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS), and Hospices Civils de Lyon (HCL)

Subjects
Male, Emergency Medical Services, Time Factors, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Inhibiteur du glycoprotéine IIb/IIIa, Ambulances, Myocardial Infarction, Coronary Angiography, Medicine, Myocardial infarction, Angioplasty, Balloon, Coronary, Creatine Kinase, ComputingMilieux_MISCELLANEOUS, Angioplastie primaire, General Medicine, Tirofiban, Clopidogrel, Treatment Outcome, Soins préhospitalier, Anesthesia, Platelet aggregation inhibitor, Drug Therapy, Combination, Female, France, Cardiology and Cardiovascular Medicine, TIMI, medicine.drug, medicine.medical_specialty, Ticlopidine, Glycoprotein IIb/IIIa inhibitor, Infarctus du myocarde, Acute myocardial infarction, Loading dose, Prehospital care, Drug Administration Schedule, Angioplasty, Coronary Circulation, Humans, Primary angioplasty, business.industry, Troponin I, Percutaneous coronary intervention, medicine.disease, Surgery, Tyrosine, business, Biomarkers, Platelet Aggregation Inhibitors
Abstract

Summary Background Compared with administration in the catheterization laboratory, early treatment with glycoprotein IIb/IIIa inhibitors provides benefits to patients with ST-segment elevation myocardial infarction who undergo primary percutaneous intervention. Whether this benefit is maintained on top of a 600 mg loading dose of clopidogrel is unknown. Methods In a multicentre, controlled, randomized study, 320 patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention received a high-dose bolus of tirofiban given either in the ambulance (prehospital group) or in the catheterization laboratory. The primary endpoint was a TIMI flow grade 2–3 of the infarct-related vessel at initial angiography. Secondary endpoints included ST-segment resolution 1 h after percutaneous coronary intervention and peak serum troponin I concentration. Results Tirofiban was administered 48 (95% confidence interval 21.4–75.0) min earlier in the prehospital group. At initial angiography, the combined incidence of TIMI 2–3 flow was 39.7% in the catheterization-laboratory group and 44.2% in the prehospital group ( p = 0.45). No difference was found on postpercutaneous intervention angiography or peak troponin concentration. Complete ST-segment resolution 60 min after the start of intervention was 55.4% in the catheterization-laboratory group and 52.6% in the prehospital group ( p = 0.32). Conclusion Prehospital initiation of high-dose bolus tirofiban did not improve significantly initial TIMI 2 or 3 flow of the infarct-related artery or complete ST-segment resolution after coronary intervention compared with initiation of tirofiban in the catheterization laboratory ( NCT00538317 ).

Published
2010
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10. [Evolution of strategies of revascularisation in acute coronary syndromes with ST elevation. Analysis of the data of RESURCOR]

Author

Guillaume Debaty, Belle, L., José Labarere, Fourny, M., Torres, J. P., Savary, D., Usseglio, P., Menthonnex, E., Guenot, O., Vanzetto, G., ThEMAS, Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble, and Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-CHU Grenoble

Subjects
Male, MESH: Angioplasty, Transluminal, Percutaneous Coronary, Time Factors, MESH: Registries, Myocardial Infarction, MESH: Myocardial Revascularization, Electrocardiography, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Myocardial Revascularization, Humans, Thrombolytic Therapy, Prospective Studies, Registries, Angioplasty, Balloon, Coronary, Aged, MESH: Aged, MESH: Thrombolytic Therapy, MESH: Humans, MESH: Middle Aged, MESH: Time Factors, Middle Aged, MESH: Male, MESH: Prospective Studies, MESH: Electrocardiography, MESH: Myocardial Infarction, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Female, MESH: Female
Abstract

National audience; The aim of this study was to describe the changes in strategy of revascularisation in acute coronary syndromes with ST elevation (ACS ST+) since setting up a health care network. The authors analysed the incidence of coronary angioplasty and of intravenous thrombolysis from a prospective permanent hospital register of patients with ACS ST+ in the three Northern Alps departments from october 1st 2002 to december 31st 2004. Respectively, 171 patients were enrolled in 2002 and 675 in 2003, and 588 in 2004. The use of percutaneous coronary intervention increased (57, 69, and 78% in 2002, 2003, 2004, p< 0.01) in relation to the increased use of immediate secondary percutaneous coronary intervention (27, 36, 43%, p< 0.01) although the use of primary percutaneous coronary intervention did not changed (30, 33, 35%, p= 0.17). These results were observed in hospitals with and without Percutaneous Coronary Intervention facilities. An increase in prehospital (49, 67, 68%, p= 0.02) and hospital thrombolysis (48, 68, 73%, p= 0.03) was only observed in patients managed in institutions without Percutaneous Coronary Intervention facilities. The average delay to arterial punction (120. 124, 100 minutes, p< 0.01) and to intravenous thrombolysis (40, 30, 25 minutes, p< 0.01) decreased during the same period. Patients with ACS ST+ more commonly benefit from coronary revascularisation at increasingly shorter intervals to treatment. This would seem to be related to the better coordination of practitioners after the implantation of a health care network.

Published
2007

11. [Comparison of mortality according to the revascularisation strategies and the symptom-to-management delay in ST-segment elevation myocardial infarction]

Author

Ferrier, C., Belle, L., José Labarere, Fourny, M., Vanzetto, G., Guenot, O., Guillaume Debaty, Savary, D., Machecourt, J., Patrice François, ThEMAS, Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-CHU Grenoble, Techniques pour l'Evaluation et la Modélisation des Actions de la Santé (TIMC-IMAG-ThEMAS), and VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)

Subjects
Male, Time Factors, Myocardial Infarction, MESH: Myocardial Revascularization, Cohort Studies, Electrocardiography, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Myocardial Revascularization, Humans, MESH: Patient Selection, Hospital Mortality, MESH: Hospital Mortality, MESH: Cohort Studies, Aged, MESH: Aged, MESH: Humans, MESH: Middle Aged, Patient Selection, MESH: Time Factors, Middle Aged, MESH: Male, MESH: Electrocardiography, MESH: France, MESH: Myocardial Infarction, Female, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, France, MESH: Female
Abstract

National audience; The aim of this study was to compare the mortality associated to primary angioplasty and thrombolysis in patients managed for an elevated ST-segment acute coronary syndrome in less than or more than 3 hours after the onset of symptoms. We analyzed the in-hospital mortality of 846 patients (including 276 [33%] treated by primary angioplasty, 511 [60%] by thrombolysis, and 59 [7%] without revascularisation) included from October 2002 to December 2003 in a registry of patients with an elevated ST-segment acute coronary syndrome managed in less than 12 hours in Northern Alps districts. The overall in-hospital mortality was at 6.0% (51/846). For the 631 managed in 3 hours. These results are in line with randomized trials conclusions and confirm the international guidelines suggesting primary angioplasty for patients with a chest pain >3 hours and either angioplasty or thrombolysis in case of chest pain < 3 hours.

Published
2007

12. [Analysis of the accuracy of a coronary syndrome register]

Author

Fourny, M., Belle, L., José Labarère, Senee, D., Savary, D., Guillaume Debaty, Vanzetto, G., Patrice François, ThEMAS, Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-CHU Grenoble, Techniques pour l'Evaluation et la Modélisation des Actions de la Santé (TIMC-IMAG-ThEMAS), and VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)

Subjects
Male, Clinical Trials as Topic, MESH: Humans, MESH: Clinical Trials as Topic, MESH: Registries, Data Collection, Myocardial Infarction, MESH: Retrospective Studies, MESH: Male, MESH: Angina, Unstable, MESH: France, MESH: Myocardial Infarction, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Humans, Female, MESH: Data Collection, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Angina, Unstable, France, Registries, MESH: Female, Retrospective Studies
Abstract

National audience; Registers of the management of infarction can complement information obtained from randomised trials evaluating the methods and practice of treatment. In order to do this, the quality of the registers must be assured, and in particular the accuracy of the recorded cases. The objective of this study was to evaluate the accuracy of a register for the in-hospital and pre-hospital management of acute coronary syndromes with ST segment elevation of less than 12 hours' duration. Using a capture-recapture method, the study compared cases in the register with eligible cases present in the hospital and emergency ambulance service databases at two establishments, giving a recruitment rate of 61%. The rate of accuracy was estimated at 84% (95% CI [82 ; 86]).The independent factors associated with failure of notification were female sex (ORa=6.65 [2.04-21.69]), presentation at nights, weekends or bank holidays (ORa=4.13 [1.33-12.85]), direct admission to hospital without passing by the emergency ambulance service (ORa=2.85 [1.03-7.69]), primary angioplasty (ORa=6.18 [1.60-23.79]) and the absence of reperfusion (ORa=40.38 [6.21-262.40]). With more than 80% accuracy, the results produced by the register are robust. The selection bias linked to the under-representation of certain subgroups, while real, has only a marginal impact on estimates derived from the register. Factors associated with failure of notification should be taken into account when operating such a register.

Published
2006

15. Association of helicopter transportation and improved mortality for patients with major trauma in the northern French Alps trauma system: an observational study based on the TRENAU registry

Author

Ageron, Francois-Xavier, Debaty, Guillaume, Savary, Dominique, Champly, Frederic, Albasini, Francois, Usseglio, Pascal, Vallot, Cécile, Galvagno, Samuel, Bouzat, Pierre, TRENAU Group, TRENAU Group, Ageron, F.X., Bouzat, P., Albasini, F., Champly, F., Chapiteau, L., Haller, E., Hoareau, C., Levrat, A., Rancurel, E., Savary, D., Thouret, J.M., Usseglio, P., Muller, S., Vallenet, C., Vallot, C., and Venchiarutti, D.

Subjects
Adult, Male, medicine.medical_specialty, Aircraft, Transport time, Crew, Trauma registry, Critical Care and Intensive Care Medicine, Logistic regression, Trauma, Helicopter, Trauma Centers, Emergency medical services, medicine, Humans, Registries, Mortality, Original Research, business.industry, Major trauma, lcsh:Medical emergencies. Critical care. Intensive care. First aid, lcsh:RC86-88.9, Air Ambulances, medicine.disease, Triage, Survival Rate, Emergency medicine, Emergency Medicine, Wounds and Injuries, Observational study, Female, France, business
Abstract

Background Prompt prehospital triage and transportation are essential in an organised trauma system. The benefits of helicopter transportation on mortality in a physician-staffed pre-hospital trauma system remains unknown. The aim of the study was to assess the impact of helicopter transportation on mortality and prehospital triage. Methods Data collection was based on trauma registry for all consecutive major trauma patients transported by helicopter or ground ambulance in the Northern French Alps Trauma system between 2009 and 2017. The primary endpoint was in-hospital death. We performed multivariate logistic regression to compare death between helicopter and ground ambulance. Results Overall, 9458 major trauma patients were included. 37% (n = 3524) were transported by helicopter, and 56% (n = 5253) by ground ambulance. Prehospital time from the first call to the arrival at hospital was longer in the helicopter group compared to the ground ambulance group, respectively median time 95 [72–124] minutes and 85 [63–113] minutes (P P = 0.01) and with reduced undertriage (OR 0.69 95% CI, 0.60–0.80; P Conclusion Helicopter was associated with reduced in-hospital death and undertriage by one third. It did not decrease prehospital and transport times in a system with the same crew using both helicopter or ground ambulance. The mortality and undertriage benefits observed suggest that the helicopter is the proper mode for long-distant transport to a regional trauma centre.

Published
2020

16. A regional trauma system to optimize the pre-hospital triage of trauma patients

Author

Bouzat, Pierre, Ageron, François-Xavier, Brun, Julien, Levrat, Albrice, Berthet, Marion, Rancurel, Elisabeth, Thouret, Jean-Marc, Thony, Frédéric, Arvieux, Catherine, Payen, Jean-François, Debaty, Guillaume, Neuro-imagerie fonctionnelle et métabolique (ANTE-INSERM U836, équipe 5), Grenoble Institut des Neurosciences (GIN), Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM), Initiatives de Recherche aux Urgences [Paris, France], Société Française de Médecine d'Urgence [Paris, France], Service d'anesthésie-réanimation, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Hôpital Michallon, Centre Hospitalier Annecy-Genevois [Saint-Julien-en-Genevois], Université Grenoble Alpes - UFR Médecine (UGA UFRM), Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Service central de radiologie et d'imagerie médicale, CHU Grenoble-Hôpital Michallon, CHU Grenoble, Physiologie cardio-Respiratoire Expérimentale Théorique et Appliquée (TIMC-IMAG-PRETA), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF), TRENAU group, Albasini, F., Champly, F., Danel, V., Debaty, G., Grailles, F., Habold, D., Hoareau, C., Peribois, G., Savary, D., and Vallenet, C.

Subjects
Adult, Male, Emergency Medical Services, medicine.medical_specialty, Female, France/epidemiology, Humans, Injury Severity Score, Registries, Sensitivity and Specificity, Trauma Centers, Triage/methods, Wounds and Injuries/mortality, Poison control, Critical Care and Intensive Care Medicine, 03 medical and health sciences, 0302 clinical medicine, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Emergency medical services, medicine, 030212 general & internal medicine, ComputingMilieux_MISCELLANEOUS, business.industry, Research, Mortality rate, Trauma center, 030208 emergency & critical care medicine, Triage, Confidence interval, 3. Good health, Relative risk, Emergency medicine, Wounds and Injuries, France, business
Abstract

Introduction Pre-hospital triage is a key element in a trauma system that aims to admit patients to the most suitable trauma center, and may decrease intra-hospital mortality. We evaluated the performance of a pre-hospital procedure in a regional trauma system through measurements of the quality of pre-hospital medical assessment and the efficacy of a triage protocol. Methods Our regional trauma system included 13 hospitals categorized as Level I, II or III trauma centers according to their technical facilities. Each patient was graded A, B or C by an emergency physician, according to the seriousness of their injuries at presentation on scene. The triage was performed according to this grading and the categorization of centers. This study is a registry analysis of a three-year period (2009 to 2011). Results Of the 3,428 studied patients, 2,572 were graded using the pre-hospital grading system (Graded group). The pre-hospital gradation was closely related with injury severity score (ISS) and intra-hospital mortality rate. The triage protocol had a sensitivity of 92% (95% confidence interval (CI) 90% to 93%) and a specificity of 41% (95% CI 39% to 44%) to predict adequate admission of patients with ISS more than 15. A total of 856 patients were not graded at the scene (Non-graded group). Undertriage rate was significantly reduced in the Graded group compared with the Non-graded group, with a relative risk of 0.47 (95% CI 0.40 to 0.56) according to the definition of the American College of Surgeons Committee on Trauma (P P Conclusions Implementation of a regional trauma system with a pre-hospital triage procedure was effective in detecting severe trauma patients and in lowering the rate of pre-hospital undertriage. A beneficial effect on outcome of such an organization is suggested.

Published
2015
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