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Article ; Online: Identifying traumatic significant haemorrhage is challenging for patient with low and intermediate risk, not when bleeding is obvious.

Darioli, Vincent / Ageron, François-Xavier

Scandinavian journal of trauma, resuscitation and emergency medicine

2023 Volume 31, Issue 1, Page(s) 32

MeSH term(s)	Humans ; Hemorrhage/diagnosis ; Hemorrhage/etiology
Language	English
Publishing date	2023-06-26
Publishing country	England
Document type	Letter
ZDB-ID	2455990-8
ISSN	1757-7241 ; 1757-7241
ISSN (online)	1757-7241
ISSN	1757-7241
DOI	10.1186/s13049-023-01096-8
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Article ; Online: Comment to 'Choosing the right score and threshold to identify low-risk patients with an upper gastrointestinal bleeding is critical'.

Ageron, Francois-Xavier / Rivieri, Sirio

European journal of emergency medicine : official journal of the European Society for Emergency Medicine

2023 Volume 30, Issue 2, Page(s) 147

MeSH term(s)	Humans ; Gastrointestinal Hemorrhage ; Risk Assessment
Language	English
Publishing date	2023-02-21
Publishing country	England
Document type	Journal Article ; Comment
ZDB-ID	1233544-7
ISSN	1473-5695 ; 0969-9546
ISSN (online)	1473-5695
ISSN	0969-9546
DOI	10.1097/MEJ.0000000000000999
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Article ; Online: The role of tranexamic acid in trauma - a life-saving drug with proven benefit.

Roberts, Ian / Ageron, Francois-Xavier

Nature reviews. Disease primers

2022 Volume 8, Issue 1, Page(s) 34

MeSH term(s)	Antifibrinolytic Agents/pharmacology ; Antifibrinolytic Agents/therapeutic use ; Hemorrhage ; Humans ; Tranexamic Acid/therapeutic use
Chemical Substances	Antifibrinolytic Agents ; Tranexamic Acid (6T84R30KC1)
Language	English
Publishing date	2022-05-26
Publishing country	England
Document type	Letter ; Comment
ISSN	2056-676X
ISSN (online)	2056-676X
DOI	10.1038/s41572-022-00367-5
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Article ; Online: The use of whole body computed tomography does not lead to increased 24-h mortality in severely injured patients in circulatory shock.

Hanzalova, Ivana / Bourgeat, Mylène / Demartines, Nicolas / Ageron, François-Xavier / Zingg, Tobias

Scientific reports

2024 Volume 14, Issue 1, Page(s) 2169

Abstract: The Advanced Trauma Life Support (ATLS) approach is generally accepted as the standard of care for the initial management of severely injured patients. While whole body computed tomography (WBCT) is still considered a contraindication in haemodynamically ...

Abstract	The Advanced Trauma Life Support (ATLS) approach is generally accepted as the standard of care for the initial management of severely injured patients. While whole body computed tomography (WBCT) is still considered a contraindication in haemodynamically unstable trauma patients, there is a growing amount of data indicating the absence of harm from cross sectional imaging in this patient group. Our study aimed to compare the early mortality of unstable trauma patients undergoing a WBCT during the initial workup with those who did not. Single-center retrospective observational study based on the local trauma registry including 3525 patients with an ISS > 15 from January 2008 to June 2020. We compared the 24-h mortality of injured patients in circulatory shock undergoing WBCT with a control group undergoing standard workup only. Inclusion criteria were the simultaneous presence of a systolic blood pressure < 100 mmHg, lactate > 2.2 mmol/l and base excess < - 2 mmol/l as surrogate markers for circulatory shock. To control for confounding, a propensity score matched analysis with conditional logistic regression for adjustment of residual confounders and a sensitivity analysis using inverse probability weighting (IPW) with and without adjustment were performed. Of the 3525 patients, 161 (4.6%) fulfilled all inclusion criteria. Of these, 132 (82%) underwent WBCT and 29 (18%) standard work-up only. In crude and matched analyses, no difference in early (24 h) mortality was observed (WBCT, 23 (17.4%) and no-WBCT, 8 (27.6%); p = 0.21). After matching and adjustment for main confounders, the odds ratio for the event of death at 24 h in the WBCT group was 0.36 (95% CI 0.07-1.73); p = 0.20. In the present study, WBCT did not increase the risk of death at 24 h among injured patients in shock. This adds to the growing data indicating that WBCT may be offered to trauma patients in circulatory shock without jeopardizing early survival.
MeSH term(s)	Humans ; Whole Body Imaging/methods ; Injury Severity Score ; Retrospective Studies ; Tomography, X-Ray Computed/methods ; Shock/diagnostic imaging ; Lactic Acid
Chemical Substances	Lactic Acid (33X04XA5AT)
Language	English
Publishing date	2024-01-25
Publishing country	England
Document type	Observational Study ; Journal Article
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-024-52657-5
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Article ; Online: Effects of tranexamic acid treatment in severely and non-severely injured trauma patients.

Ageron, Francois-Xavier / Shakur-Still, Haleema / Roberts, Ian

Transfusion

2022 Volume 62 Suppl 1, Page(s) S151–S157

Abstract: Background: Urgent treatment with tranexamic acid (TXA) reduces bleeding deaths but there is disagreement about which patients should be treated. We examine the effects of TXA treatment in severely and non-severely injured trauma patients.: Study ... ...

Abstract	Background: Urgent treatment with tranexamic acid (TXA) reduces bleeding deaths but there is disagreement about which patients should be treated. We examine the effects of TXA treatment in severely and non-severely injured trauma patients. Study design and methods: We did an individual patient data meta-analysis of randomized trials with over 1000 trauma patients that assessed the effects of TXA on survival. We defined the severity of injury according to characteristics at first assessment: systolic blood pressure of less than 90 mm Hg and a heart rate greater than 120 beats per minute or Glasgow Coma Scale score of less than nine or any GCS with one or more fixed dilated pupils. The primary measure was survival on the day of the injury. We examined the effect of TXA on survival in severely and non-severely injured patients and how these effects vary with the time from injury to treatment. Results: We obtained data for 32,944 patients from two randomized trials. Tranexamic acid significantly increased survival on the day of the injury (OR = 1.22, 95% CI 1.11-1.34; p < .01). The effect of tranexamic acid on survival in non-severely injured patients (OR = 1.25, 1.03-1.50) was similar to that in severely injured patients (OR = 1.22, 1.09-1.37) with no significant heterogeneity (p = .87). In severely and non-severely injured pateints, treatment within the first hour after injury was the most effective. Discussion: Early tranexamic acid treatment improves survival in both severely and non-severely injured trauma patients. Its use should not be restricted to the severely injured.
MeSH term(s)	Antifibrinolytic Agents/therapeutic use ; Glasgow Coma Scale ; Hemorrhage/drug therapy ; Humans ; Tranexamic Acid/therapeutic use ; Wounds and Injuries/drug therapy
Chemical Substances	Antifibrinolytic Agents ; Tranexamic Acid (6T84R30KC1)
Language	English
Publishing date	2022-06-24
Publishing country	United States
Document type	Journal Article ; Meta-Analysis ; Research Support, Non-U.S. Gov't
ZDB-ID	208417-x
ISSN	1537-2995 ; 0041-1132
ISSN (online)	1537-2995
ISSN	0041-1132
DOI	10.1111/trf.16954
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Article ; Online: Assessment of diagnostic strategies based on risk stratification for aneurysmal subarachnoid hemorrhage: a retrospective chart review.

Bianchi, Christophe / Ageron, François-Xavier / Carron, Pierre-Nicolas

European journal of emergency medicine : official journal of the European Society for Emergency Medicine

2021 Volume 28, Issue 5, Page(s) 355–362

Abstract: Background and importance: Current guidelines recommend noncontrast computed tomography (NCCT) followed by lumbar puncture for the diagnosis of subarachnoid hemorrhage (SAH). Alternative strategies, including clinical risk stratification and CT ... ...

Abstract	Background and importance: Current guidelines recommend noncontrast computed tomography (NCCT) followed by lumbar puncture for the diagnosis of subarachnoid hemorrhage (SAH). Alternative strategies, including clinical risk stratification and CT angiography (CTA), are emerging. Objective: To evaluate alternative strategies to current guidelines through clinical risk stratification. Design, setting and participants: Single-site, retrospective observational study of patients with SAH suspicion, from 2011 to 2016. We combined results of each investigation (NCCT, CTA and lumbar puncture) with a clinical risk assessment, including Ottawa score. Exposure: Comparing the current strategy (NCCT ± lumbar puncture if negative CT) to alternative strategies (NCCT + CTA ± lumbar puncture if high clinical risk or negative CT and onset of headache ≥12 h o dds ratio ≥24 h). Outcome measure and analysis: Main outcome was diagnosis of SAH at hospital discharge. Secondary outcomes were death from all causes and need for invasive procedures at 28 days. We used sensitivity, specificity, positive predictive value and negative predictive value (NPV) to evaluate the diagnostic performance of three strategies. Main results: 310 patients were included. SAH was diagnosed in 8 cases (2.6%), none died and 7 (2.2%) had a surgical procedure. Performances of different strategies were not statistically different. NPVs were 99.7% [95% Confidence interval (CI), 98.2-100%] for strategy 1 and 100% (95% CI, 98.8-100%) for strategies 2 and 3. More than 4000 lumbar punctures are needed to diagnose one SAH when CTA is performed within 24 h of symptoms' onset and absence of high-risk criteria. Conclusion: Clinical risk stratification and CTA strategy are well-tolerated and effective for diagnosis of SAH, avoiding systematic use of lumbar puncture.
MeSH term(s)	Emergency Service, Hospital ; Humans ; Retrospective Studies ; Risk Assessment ; Spinal Puncture ; Subarachnoid Hemorrhage/diagnostic imaging
Language	English
Publishing date	2021-03-04
Publishing country	England
Document type	Journal Article ; Observational Study
ZDB-ID	1233544-7
ISSN	1473-5695 ; 0969-9546
ISSN (online)	1473-5695
ISSN	0969-9546
DOI	10.1097/MEJ.0000000000000804
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Article ; Online: External validation and comparison of the Glasgow-Blatchford score, modified Glasgow-Blatchford score, Rockall score and AIMS65 score in patients with upper gastrointestinal bleeding: a cross-sectional observational study in Western Switzerland.

Rivieri, Sirio / Carron, Pierre-Nicolas / Schoepfer, Alain / Ageron, Francois-Xavier

European journal of emergency medicine : official journal of the European Society for Emergency Medicine

2022 Volume 30, Issue 1, Page(s) 32–39

Abstract: Upper gastrointestinal bleeding (UGIB) presents a high incidence in an emergency department (ED) and requires careful evaluation of the patient's risk level to ensure optimal management. The primary aim of this study was to externally validate and ... ...

Abstract	Upper gastrointestinal bleeding (UGIB) presents a high incidence in an emergency department (ED) and requires careful evaluation of the patient's risk level to ensure optimal management. The primary aim of this study was to externally validate and compare the performance of the Rockall score, Glasgow-Blatchford score (GBS), modified GBS and AIMS65 score to predict death and the need for an intervention among patients with UGIB. This was a cross-sectional observational study of patients consulting the ED of a Swiss tertiary care hospital with UGIB. Primary outcomes were the inhospital need for an intervention, including transfusion, or an endoscopic procedure or surgery or inhospital death. The secondary outcome was inhospital death. We included 1521 patients with UGIB, median age, 68 (52-81) years; 940 (62%) were men. Melena or hematemesis were the most common complaints in 1020 (73%) patients. Among 422 (28%) patients who needed an intervention or died, 76 (5%) died in the hospital. Accuracy of the scoring systems assessed by receiver operating characteristic curves showed that the Glasgow-Blatchford bleeding and modified GBSs had the highest discriminatory capacity to determine inhospital death or the need of an intervention [AUC, 0.77 (95% CI, 0.75-0.80) and 0.78 (95% CI, 0.76-0.81), respectively]. AIMS65 and the pre-endoscopic Rockall score showed a lower discrimination [AUC, 0.68 (95% CI, 0.66-0.71) and 0.65 (95% CI, 0.62-0.68), respectively]. For a GBS of 0, only one patient (0.8%) needed an endoscopic intervention. The modified Glasgow-Blatchford and Glasgow-Blatchford bleeding scores appear to be the most accurate scores to predict the need for intervention or inhospital death.
MeSH term(s)	Male ; Humans ; Aged ; Female ; Switzerland ; Cross-Sectional Studies ; Gastrointestinal Hemorrhage/diagnosis ; Gastrointestinal Hemorrhage/therapy ; Gastrointestinal Hemorrhage/etiology ; ROC Curve ; Hospitals ; Risk Assessment/methods ; Severity of Illness Index ; Prognosis
Language	English
Publishing date	2022-11-10
Publishing country	England
Document type	Observational Study ; Journal Article
ZDB-ID	1233544-7
ISSN	1473-5695 ; 0969-9546
ISSN (online)	1473-5695
ISSN	0969-9546
DOI	10.1097/MEJ.0000000000000983
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Article: Performance Assessment of Out-of-Hospital Use of Pelvic Circumferential Compression Devices for Severely Injured Patients in Switzerland: A Nationwide Retrospective Cross-Sectional Study.

Balet, Lionel / Ageron, François-Xavier / Pasquier, Mathieu / Zingg, Tobias / The Swiss Trauma Registry

Journal of clinical medicine

2023 Volume 12, Issue 17

Abstract: Background: Patients with severe pelvic fractures carry a greater risk of severe bleeding, and pelvic compression devices (PCCD) are used to stabilize the pelvis on the pre-hospital scene. The aim of this study was to describe the use of PCCD in the pre- ...

Abstract	Background: Patients with severe pelvic fractures carry a greater risk of severe bleeding, and pelvic compression devices (PCCD) are used to stabilize the pelvis on the pre-hospital scene. The aim of this study was to describe the use of PCCD in the pre-hospital setting on a nationwide scale (Switzerland) and determine the sensitivity, specificity and rates of over- and under-triage of the current application practices. The secondary objective was to identify pre-hospital factors associated with unstable pelvic fractures. Methods: Retrospective cross-sectional study using anonymized patient data (1 January 2015-31 December 2020) from the Swiss Trauma Registry (STR). Based on AIS scores, patients were assigned a unique principal diagnosis among three categories (unstable pelvic fracture-stable pelvic fracture-other) and assessed for use or not of PCCD. Secondarily, patient characteristics, initial pre-hospital vital signs, means of pre-hospital transport and trauma mechanism were also extracted from the database. Results: 2790 patients were included for analysis. A PCCD was used in 387 (13.9%) patients. In the PCCD group, 176 (45.5%) had an unstable pelvic fracture, 52 (13.4%) a stable pelvic fracture and 159 (41.1%) an injury unrelated to the pelvic region. In the group who did not receive a PCCD, 214 (8.9%) had an unstable pelvic fracture, 182 (7.6%) a stable pelvic fracture and 2007 (83.5%) an injury unrelated to the pelvic region. The nationwide sensitivity of PCCD application was 45.1% (95% CI 40.1-50.2), the specificity 91.2% (95% CI 90-92.3), with both over- and under-triage rates of 55%. The prevalence of unstable fractures in our population was 14% (390/2790). We identified female sex, younger age, lower systolic blood pressure, higher shock index, pedestrian hit and fall ≥3 m as possible risk factors for an unstable pelvic fracture. Conclusions: Our results demonstrate a nationwide both over- and under-triage rate of 55% for out-of-hospital PCCD application. Female gender, younger age, lower blood pressure, higher shock index, pedestrian hit and fall >3 m are possible risk factors for unstable pelvic fracture, but it remains unclear if those parameters are relevant clinically to perform pre-hospital triage.
Language	English
Publishing date	2023-08-24
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm12175509
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Article ; Online: Étude de l’exposition médicamenteuse aux cardiotropes des sujets âgés consultant aux urgences pour chute avec malaise en Rhône-Alpes.

Hélias, Gaëlle / Garnier, Virginie / Enzinger, Lukas / Eymaron, Maeva / Ageron, Francois-Xavier / Couturier, Pascal

Geriatrie et psychologie neuropsychiatrie du vieillissement

2023 Volume 21, Issue 2, Page(s) 173–184

Abstract: Study of cardiovascular drugs usage, among elderly subjects admitted to the emergency department for syncopal falls in Rhône-Alpes region. Polypharmacy and cardiovascular medication usage are risk factors for falls in the elderly. This study included ... ...

Title translation	Study of cardiovascular drugs usage, among elderly subjects admitted to the emergency department for syncopal falls in Rhône-Alpes region.
Abstract	Study of cardiovascular drugs usage, among elderly subjects admitted to the emergency department for syncopal falls in Rhône-Alpes region. Polypharmacy and cardiovascular medication usage are risk factors for falls in the elderly. This study included subjects aged 75 and over, admitted in the emergency department for falls, based on evaluation data of professional practices carried out in the Nord Alpine region by the French Network of North-Alps Emergency Departments (Réseau Nord Alpin des Urgences, RENAU). The patients included were divided into 4 groups: "syncope", "accidental falls", "repeated falls" and "other types of fall". From the emergency room admission prescriptions, we studied the consumption of cardiovascular drugs in number and quality in the "syncope" group compared to other types of falls. The main objective in this study was to highlight higher cardiovascular drug usage among the elderly patients admitted to the emergency department for syncopal falls, in comparison with other types of falls. We included 1,476 patients among whom 262 patients came for "syncopal falls". We found superior usage of cardiovascular medication among syncopal falls compared to other type of falls (p < 0,01). However, there is no statistically significant association between inappropriate cardiovascular drug prescriptions, and the type of falls. The "standardized" fall assessment whose orthostatic hypotension investigation, is not always exhaustive in the emergency room. Orthostatic hypotension diagnostic is insufficiently sought in the emergency room. This study highlights a significantly higher usage of diuretic medication within the syncope group, in comparison to the other groups, and especially loop diuretic. Antihypertensive drugs (angiotensin-converting enzyme inhibitor, angiotensin II receptor blockers, calcium inhibitor) are also recurrent within the syncope group compared to the others. A careful supervising of these prescriptions among elderly patients seems required. These data prompt to revise prescriptions during fall related hospitalizations, and then with the primary-care physician, or with the cardiologist.
MeSH term(s)	Aged ; Humans ; Hypotension, Orthostatic/complications ; Hypotension, Orthostatic/diagnosis ; Accidental Falls ; Cardiovascular Agents/adverse effects ; Syncope/epidemiology ; Hospitalization ; Emergency Service, Hospital
Chemical Substances	Cardiovascular Agents
Language	French
Publishing date	2023-07-31
Publishing country	France
Document type	English Abstract ; Journal Article
ISSN	2115-7863
ISSN (online)	2115-7863
DOI	10.1684/pnv.2023.1107
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Article ; Online: Problems With Clinical Application of Low-Dose Vasopressin for Traumatic Hemorrhagic Shock.

Gauss, Tobias / Bouzat, Pierre / Ageron, Francois-Xavier

JAMA surgery

2020 Volume 155, Issue 4, Page(s) 363

MeSH term(s)	Arginine Vasopressin ; Dietary Supplements ; Humans ; Shock, Hemorrhagic/drug therapy ; Shock, Hemorrhagic/etiology ; Vasopressins
Chemical Substances	Vasopressins (11000-17-2) ; Arginine Vasopressin (113-79-1)
Language	English
Publishing date	2020-01-15
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	2701841-6
ISSN	2168-6262 ; 2168-6254
ISSN (online)	2168-6262
ISSN	2168-6254
DOI	10.1001/jamasurg.2019.5433
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