Recently, validated clinical decision rules have been developed that avoid unnecessary use of computed tomographic pulmonary angiography (CTPA) in patients with suspected pulmonary embolism (PE) in the emergency department (ED). To measure any resulting change in CTPA use for suspected PE. Retrospective analysis. 26 European EDs in 6 countries. Patients with CTPA performed for suspected PE in the ED during the first 7 days of each odd month between January 2015 and December 2019. The primary end points were the CTPAs done for suspected PE in the ED and the number of PEs diagnosed in the ED each year adjusted to an annual census of 100 000 ED visits. Temporal trends were estimated using generalized linear mixed regression models. 8970 CTPAs were included (median age, 63 years; 56% female). Statistically significant temporal trends for more frequent use of CTPA (836 per 100 000 ED visits in 2015 vs. 1112 in 2019; P < 0.001), more diagnosed PEs (138 per 100 000 in 2015 vs. 164 in 2019; P = 0.028), a higher proportion of low-risk PEs (annual percent change [APC], 13.8% [95% CI, 2.6% to 30.1%]) with more ambulatory management (APC, 19.3% [CI, 4.1% to 45.1%]), and a lower proportion of intensive care unit admissions (APC, -8.9% [CI, -17.1% to -0.3%]) were observed. Data were limited to 7 days every 2 months. Despite the recent validation of clinical decision rules to limit the use of CTPA, an increase in the CTPA rate along with more diagnosed PEs and especially low-risk PEs were instead observed. None specific for this study.

Objectives: To assess the impact of an Artificial Intelligence (AI) limb bone fracture diagnosis software (AIS) on emergency department (ED) workflow and diagnostic accuracy. Materials and Methods: A retrospective study was conducted in two phases—without AIS (Period 1: 1 January 2020–30 June 2020) and with AIS (Period 2: 1 January 2021–30 June 2021). Results: Among 3720 patients (1780 in Period 1; 1940 in Period 2), the discrepancy rate decreased by 17% (p = 0.04) after AIS implementation. Clinically relevant discrepancies showed no significant change (−1.8%, p = 0.99). The mean length of stay in the ED was reduced by 9 min (p = 0.03), and expert consultation rates decreased by 1% (p = 0.38). Conclusions: AIS implementation reduced the overall discrepancy rate and slightly decreased ED length of stay, although its impact on clinically relevant discrepancies remains inconclusive. Key Point: After AI software deployment, the rate of radiographic discrepancies decreased by 17% (p = 0.04) but this was not clinically relevant (−2%, p = 0.99). Length of patient stay in the emergency department decreased by 5% with AI (p = 0.03). Bone fracture AI software is effective, but its effectiveness remains to be demonstrated.

Introduction Short peripheral intravenous catheters (PVCs) are the most frequently used invasive medical devices in hospitals. Unfortunately, PVCs often fail before the end of treatment due to the occurrence of mechanical, vascular or infectious complications, which prolongs hospitalisation and increases healthcare costs and mortality. Prevention of these complications is mainly based on the respect of hygiene rules and the use of biocompatible catheters. In critically ill patients, 2% chlorhexidine-alcohol is superior to 5% povidone iodine-alcohol for skin preparation before central venous and arterial catheters; whether this finding can be extended to PVC inserted in the wards remains speculative. Similarly, the use of new technologies such as catheters designed to minimise blood exposure, zero-reflux needleless connectors, disinfecting caps and flushing PVCs before and after each medication administration to maintain catheter patency are of theoretical interest to prevent PVC failure, but little scientific data support their routine use. Methods and analysis The CLEAN 3 study is an open-label, single-centre, randomised, two-by-two factorial trial. One thousand patients visiting our emergency department and requiring hospital admission in the wards will be randomised to one of four strategies according to skin preparation and devices used. The two primary endpoints will be (1) the incidence of infectious complications related to the catheters (colonisation, local infection or bloodstream infection) and (2) the time between catheter insertion and catheter failure defined as any premature removal of PVC before end of treatment, other than for routine replacement. Ethics and dissemination This protocol has been approved by an independent ethics committee and will be carried out according to the principles of the Declaration of Helsinki and the Good Clinical Practice guidelines. The results of this study will be disseminated through presentation at scientific conferences and publication in peer-reviewed journals. Trial registration number EudraCT 2018-A02535-50; NCT03757143.

Dizziness is a frequent reason for visiting emergency departments (EDs). Differentiating stroke from other causes is challenging for physicians. The role of biomarkers has been poorly assessed. We evaluated whether copeptin and S100b protein (PS100b) assessment, alone or in combination, could rule out stroke in patients visiting EDs for dizziness. We included patients 18 years of age or older, visiting the adult ED of a French university hospital for a new episode of dizziness evolving for less than 72 h. All patients underwent standardized physical examination (HINT [Head Impulse test, Nystagmus, test of skew deviation] maneuvers), copeptin and S-100b protein (PS100) measurement and injected brain imaging. Stroke diagnosis involved diffusion-weighted magnetic resonance imaging or, if not available, neurological examination and contrast brain CT scan compatible with the diagnosis. Of the 135 patients participating in the study, 13 (10%) had stroke. The sensitivity, specificity and positive and negative predictive values of copeptin/PS100 combination were 100% (95%CI, 77–100%), 48% (40–57%), 14% (11–27%) and 100% (94–100%), respectively. Values for copeptin alone were 77% (CI95% 0.50–0.91), 50% (CI95% 0.49–0.58), 14% (CI95% 0.08–0.24), 93% (CI95% 0.87–0.98), and for PS100 alone were 54% (CI95% 0.29–0.77), 97% (CI95% 0.92–0.99), 64% (CI95% 0.35–0.84), 95% (CI95% 0.90–0.98). Absence of copeptin and PS100 elevation seems to ruling out the diagnosis of stroke in patients visiting the ED for a new episode of dizziness. These results need to be confirmed in a large-scale study.

Lower respiratory tract infections (LRTIs) place a substantial burden on emergency departments (EDs) during winter outbreaks. Their microbiological diagnosis is currently based on either broad-spectrum molecular techniques performed in laboratory, with turnaround times incompatible with ED workflows, or point-of-care systems, restricted to SARS-CoV-2, influenza A/B, and RSV (quadriplex panel). The Spotfire combines rapid result and syndromic approach (10 respiratory viruses and 4 atypical bacteria), but its added value in EDs remains unassessed. During the 2023 winter, trained nurses collected nasopharyngeal swabs from adult patients with LRTI symptoms and operated the Spotfire in the ED of the Poitiers University Hospital. We described the viral epidemiology and evaluated the impact and efficacy of this rapid broad-spectrum diagnosis by comparing the management of patients with or without respiratory pathogen detected. From 15 December 2023 to 15 March 2024, 1,320 samples were analyzed with Spotfire, with a median turnaround time of 37 min and 10 uninterpretable results. A total of 540 (41%) were positive. Influenza A (30.9%), rhinovirus/enterovirus (21.1%), and SARS-CoV-2 (18.7%) were the main viruses detected, while atypical bacteria represented 8% of all pathogens. Overall, a pathogen not represented on the quadriplex panel was detected in 43% samples. Positive test results were associated with faster medical decision (380 ± 234 vs 431 ± 238 min; P < 0.001), fewer hospital admissions (65% vs 78%; P < 0.001), and shorter hospital stay (10 ± 9 vs 12 ± 14 days; P = 0.006) than negative test results. Antibiotic therapy was administered to 42 of 43 of Mycoplasma pneumoniae -positive patients (98%) compared with 110 of 1,265 (9%) negative patients. This study validated the feasibility of this new diagnostic tool in high-volume EDs improving patient flow, antimicrobial decisions, and isolation strategies. IMPORTANCE: This study provides the first real-world evidence supporting the use of a broad multiplex PCR platform for respiratory pathogens directly at the point of care in a high-volume emergency department. By enabling the simultaneous detection of 14 viruses and atypical bacteria within 20 min, this system bridges a critical gap between laboratory diagnostics and bedside clinical decision-making. Its implementation proved feasible and reliable, improving patient flow, antimicrobial stewardship, and infection control measures. Nearly half of the pathogens identified would have been missed by conventional quadriplex assays, highlighting the added diagnostic value of broader syndromic coverage. These findings are of interest to both clinicians and microbiologists, as they provide pragmatic evidence to guide the integration of advanced molecular diagnostics into acute-care workflows and to optimize patient management during respiratory infection surges.

Background: Handling emergency calls in French emergency medical call centres (EMCCs) can be challenging considering the frequent lack of relevant information. Tele-transmission device use in regular ambulances seems like a good solution to provide the EMCC physician with a more accurate assessment of the scene, particularly for mild traumatic injury (MTI). We measured the impact of ambulance staff tele-transmitted photography on prehospital dispatching optimisation for patients calling the EMCC with MTI.Methods: We conducted a prospective, single-centre, randomised-controlled trial comparing two groups of patients calling the EMCC with MTI who were or were not allocated to photography tele-transmission by ambulance staff. The primary outcome was the proportion of patients referred away from the nearest hospital (left at home for outpatient care; referred to a higher-level hospital; handled by a medical intensive care ambulance for advanced pre-hospital care) used as a marker of better orientation.Results: Between 29 April 2019 and 21 July 2020, 165 patients were randomised and 152 analysed. Photography tele-transmission resulted in better patient dispatching (24/73 [33%] patients in the intervention group vs 9/79 [11%] patients in the control group, OR 3.80 [1.63–8.90];p = 0.03), without increasing the proportion of patients initially left at home for outpatient care and visiting an ED within 10 days for secondary trauma-related care (1/14 [7%] vs 1/4 [25%], OR 0.25 [0.01–24.1];p = 0.41). The proportion of patients unnecessarily referred to an ED was 7% [4/59 patients] in the intervention group vs 16% [12/75 patients] in the control group (OR 0.38 [0.09–1.36];p = 0.10).Conclusion: Photography tele-transmission by regular ambulance staff could improve the dispatching of patients calling French EMCCs with MTI.Trial registrationThe study is registered with Clinicaltrials.gov (NCT04034797).