Marc Sabbe
Research interests
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InterestsEmergency Medical Services, Prehospital Care, Disaster Planning, Trauma, Disaster Preparedness
Publications
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1.28Impact points
The long-term outcome after severe trauma of children in Flanders (Belgium): a population-based cohort study using the International Classification of Functioning--related outcome score.
European journal of pediatrics. 01/2011; 170(1):65-73.
Important long-term health problems have been described after severe paediatric trauma. The International Classification of Functioning (ICF) was developed as a universal framework to describe that health. We evaluated outcome in children after 'severe' trauma (defined as: hospitalised >4... [more] Important long-term health problems have been described after severe paediatric trauma. The International Classification of Functioning (ICF) was developed as a universal framework to describe that health. We evaluated outcome in children after 'severe' trauma (defined as: hospitalised >48 h) by means of a questionnaire based on this ICF construct (IROS). Questionnaires were sent to children; one year after this trauma and to 'control' children without any previous 'severe' trauma. We created propensity score-matched pairs (n = 133) and evaluated differences in health perception. IROS characteristics were investigated by means of Item Response Theory models. We then estimated the health state of each individual based on his/her response pattern (factor score z01) and investigated the effect of selected covariates with simple linear regression. Significant odds ratios for differences between matched groups (p < 0.05) were observed for among others emotional problems, mobility, societal life and family burden, but not for chronic pain. Children in the trauma group showed, e.g. significant more physician (estimated relative risk R' 1.7) and psychologist (R' 3.5) visits. IROS primarily provides information from medium to high health burden levels and factor scores ranged from 0.41 (lowest) to 0.967 (highest burden). A significant impact on health burden could only be proven for the 'state at discharge' (p = 0.015), although there was a tendency towards worse factor scores for children that were older, had a higher Injury Severity Score or after traffic injury. In conclusion, we showed that the burden of health problems for children and families after severe trauma is still high and physical, as well as psychosocial in nature. The health state at discharge seems to predict long-term outcome, which might be of importance in view of, e.g. trajectory assistance. IROS may provide an improved scoring system to evaluate outcome after (paediatric) injury or critical illness.
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2.80Impact points
Pharmacist- versus physician-acquired medication history: a prospective study at the emergency department.
Quality & safety in health care. 10/2010; 19(5):371-5.
Recent literature revealed that medication histories obtained by physicians and nurses are often incomplete. However, the number of patients included was often low. Study objective In this study, the authors compare medication histories obtained in the Emergency Department (ED) by pharmacists versus... [more] Recent literature revealed that medication histories obtained by physicians and nurses are often incomplete. However, the number of patients included was often low. Study objective In this study, the authors compare medication histories obtained in the Emergency Department (ED) by pharmacists versus physicians and identify characteristics contributing to discrepancies. Medication histories were acquired by the pharmacist from patients admitted to the ED, planned to be hospitalised. A structured form was used to guide the pharmacist or technician to ensure a standardised approach. Discrepancies, defined as any difference between the pharmacist-acquired medication history and that obtained by the physician, were analysed. 3594 medication histories were acquired by pharmacy staff. 59% (95% CI 58.2% to 59.8%) of medication histories recorded by physicians were different from those obtained by the pharmacy staff. Within these inaccurate medication histories, 5963 discrepancies were identified. The most common type of error was omission of a drug (61%; 95% CI 60.4% to 61.6%), followed by omission of dose (18%; 95% CI 17.6% to 18.4%). Drugs belonging to the class of psycholeptics, acid suppressors and beta blocking agents were related to the highest discrepancy rate. Acetylsalicylic acid, omeprazole and zolpidem were most commonly forgotten. This large prospective study demonstrates that medication history acquisition is very often incomplete in the ED. A structured form and a standardised method is necessary. Pharmacists are especially suited to acquire and supervise accurate medication histories, as they are educated and familiar with commonly used drugs.
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1.26Impact points
Screening for risk of unplanned readmission in older patients admitted to hospital: predictive accuracy of three instruments.
Aging clinical and experimental research. 08/2010; 22(4):345-51.
Hospital readmission after discharge is an important clinical and health policy issue. We compared the predictive accuracy of the Identification of Seniors at Risk (ISAR), the Flemish version of the Triage Risk Screening Tool (TRST) and Variable Indicative of Placement risk (VIP) in assessing unplan... [more] Hospital readmission after discharge is an important clinical and health policy issue. We compared the predictive accuracy of the Identification of Seniors at Risk (ISAR), the Flemish version of the Triage Risk Screening Tool (TRST) and Variable Indicative of Placement risk (VIP) in assessing unplanned readmissions. We included 213 patients (≥65 years), hospitalized following admission to the emergency department. The ISAR, TRST and VIP were administered at admission. Unplanned readmissions were registered by telephone follow-up 14, 30 and 90 days post-discharge. Unplanned readmission rates were 6.8%, 14.7% and 23.5% after 14, 30, and 90 days, respectively. The ISAR showed low to moderate sensitivity (54%-69%) and a high negative predictive value (≥78%) at all measurement points. Specificity and positive predictive value were low (≤33% and ≤24%, respectively). The TRST had low to moderate sensitivity (42%-67%) and a high negative predictive value (≥82%). Specificity and positive predictive value were low (≤45% and ≤27%, respectively). The VIP had very low sensitivity (≤26%) and high specificity (≥80%). Its negative predictive value was high (≥79%) and its positive predictive value was low (≤22%). Due to their moderate to low sensitivity, and low specificity and positive predictive value, none of the instruments was capable of accurately predicting unplanned readmission in older, hospitalized patients. Overall, reducing or increasing the original cut-off value by one point did not result in improved performance. Our findings suggest that these instruments lack the necessary sophistication to capture the complexity of (unplanned) readmissions.
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3.13Impact points
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0.73Impact points
Prehospital stroke scales in a Belgian prehospital setting: a pilot study.
European journal of emergency medicine : official journal of the European Society for Emergency Medicine. 07/2009;
OBJECTIVE: To compare the diagnostic value of the Cincinnati Prehospital Stroke Scale, the Face Arm Speech Test, the Los Angeles Prehospital Stroke Screen and the Melbourne Ambulance Stroke Screen for identifying patients with an acute stroke in a prehospital setting in Belgium. METHODS: A prospecti... [more] OBJECTIVE: To compare the diagnostic value of the Cincinnati Prehospital Stroke Scale, the Face Arm Speech Test, the Los Angeles Prehospital Stroke Screen and the Melbourne Ambulance Stroke Screen for identifying patients with an acute stroke in a prehospital setting in Belgium. METHODS: A prospective study was performed, using a questionnaire for every primarily transported patient within emergency medial service with relevant neurological complaints. Exclusion criteria were: patients below 18 years, trauma victims, Glasgow Coma Scale of less than 8 or transported to another hospital. The questionnaire is a comprehension of different stroke scales. RESULTS: The Face Arm Speech Test and Cincinnati Prehospital Stroke Scale demonstrate a high sensitivity (95%) but a lower specificity (33%). The sensitivity of the Los Angeles Prehospital Stroke Screen and Melbourne Ambulance Stroke Screen was lower (74%), but the specificity increased (83 and 67%). Items investigating unilateral facial paralysis and unilateral loss/absence of motor response in upper extremities seemed to be most discriminating between the stroke group (68-78%) and the nonstroke group (17%), suggesting that items related to clinical assessment are more important in stroke recognition than history items. Combination of all clinical parameters of the different scores resulted in a sensitivity and specificity of 95 and 83%, respectively. CONCLUSION: The results obtained in this study are comparable with earlier investigations. Given the limitations of the study, we could not identify the most adequate stroke scale. History items seem to be less relevant compared with clinical assessment. Further research is needed to determine the most adequate stroke scale.
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0.73Impact points
Axis or Harris Ring in odontoid fractures, old fashioned but not obsolete.
European journal of emergency medicine : official journal of the European Society for Emergency Medicine. 04/2009;
Clearing the cervical spine after blunt trauma remains a challenge. Even in the computed tomography era many emergency departments worldwide still use classical X-rays in first evaluation. Low odontoid fractures are frequently missed, especially in unconscious patients where an open mouth view is no... [more] Clearing the cervical spine after blunt trauma remains a challenge. Even in the computed tomography era many emergency departments worldwide still use classical X-rays in first evaluation. Low odontoid fractures are frequently missed, especially in unconscious patients where an open mouth view is not available. Evaluation of the Harris ring in the lateral view can improve identification rate. We studied the diagnostic values of this sign and the educational effect on trainees. Lateral views of 12 computed tomography confirmed low-axis fractures and 13 controls were randomly presented to 17 residents (traumatology, neurosurgery and emergency medicine) and five experienced radiologists. After the residents were taught the use of the axis ring, they had to review the set. Diagnosis was scored with a degree of certitude from 5 to 1. The specificity and sensitivity for the radiologists was 88% (confidence interval 80-96) and 82% (confidence interval 72-91), respectively. The effect of the education on the scores of the residents was evaluated using the Wilcoxon ranking test with a significant effect for the traumatologists (P=0.0008), emergency physicians (P=0.0005) as well for the neurosurgeons (P=0.0087). The axis ring can be a useful diagnostic tool in identifying low odontoid fractures on cross-table cervical spine X-rays. It is easy to teach and should be included in X-ray-based C-spine clearing protocols.
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0.73Impact points
Atlantoaxial rotatory subluxation.
European journal of emergency medicine : official journal of the European Society for Emergency Medicine. 11/2008; 15(5):283-5.
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0.73Impact points
Emergency psychiatry in the 21st century: critical issues for the future.
European journal of emergency medicine : official journal of the European Society for Emergency Medicine. 11/2008; 15(5):276-8.
Throughout decades of deinstitutionalization, the primary purpose of psychiatric emergency facilities has been defined as rapid referral of patients, triaging those who need 'emergent' care for their mental or emotional problems from those who do not. However, a merely triage-based conceptua... [more] Throughout decades of deinstitutionalization, the primary purpose of psychiatric emergency facilities has been defined as rapid referral of patients, triaging those who need 'emergent' care for their mental or emotional problems from those who do not. However, a merely triage-based conceptualization of the psychiatric emergency room does not take into account the ever increasing number of patients, the low accessibility of specialized services, the high need for early recognition of mental problems, or the need toward a more continuous provision of care. In this paper we aim to address some contemporary problems of emergency psychiatry, and then we try to outline some issues that may be of importance in the future of the psychiatric emergency room.
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1.46Impact points
Mercury tissue concentrations in various organs following a fatal intentional poisoning with mercury chloride.
Clinical toxicology (Philadelphia, Pa.). 10/2008; 46(8):783-4.
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2.71Impact points
Closing the knowledge-performance gap: an audit of medical management for severe paediatric trauma in Flanders (Belgium).
Resuscitation. 10/2008; 79(1):67-72.
Considerable variability in (paediatric) trauma care has been reported. We wanted to audit current practice in Flanders (Belgium). The PENTA network prospectively collected data on paediatric trauma patients in a representative sample of Flemish hospitals during 2005. All cases with an ISS>or=13 ... [more] Considerable variability in (paediatric) trauma care has been reported. We wanted to audit current practice in Flanders (Belgium). The PENTA network prospectively collected data on paediatric trauma patients in a representative sample of Flemish hospitals during 2005. All cases with an ISS>or=13 and sufficient data availability were withheld for panel evaluation (n=92). Two trained experts reviewed the medical care provided in the first hours after trauma, based on available evidence and existing universal guidelines. 'Defaults' were only withheld as such if there was 100% consensus. At random, about 25% of cases were also reviewed by two other experts in order to assess interobserver variability. In the 92 cases, 264 defaults were recognised. 25.4% of all defaults were thought to have a direct impact on the individual patient's outcome. Specific difficulties were observed with, e.g. cervical spine management (18/82 relevant cases), pCO2 and global respiratory management (38/92), fluid management (29/92) and analgesia (27/89). The agreement between the two panels was good for defaults identified (crude agreement 74.8%), yet only fair for the presumed impact on outcome (crude agreement 58.3%). We audited paediatric trauma care in Flanders and identified several problem areas (often in basic areas of paediatric life support). The inherent degree of interobserver variability does not diminish the importance of these findings. More performance-based teaching and timely recertification may have a positive impact on the quality of the care delivered.
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0.73Impact points
Methanol poisoning: the duality between 'fast and cheap' and 'slow and expensive'.
European journal of emergency medicine : official journal of the European Society for Emergency Medicine. 05/2008; 15(2):107-9.
The management of methanol poisoning includes early antidote therapy to inhibit the metabolism of methanol to formate. Ethanol and fomepizole are both effective, but recently fomepizole has been preferred, although there is no scientific evidence that the use of fomepizole is a superior therapeutic ... [more] The management of methanol poisoning includes early antidote therapy to inhibit the metabolism of methanol to formate. Ethanol and fomepizole are both effective, but recently fomepizole has been preferred, although there is no scientific evidence that the use of fomepizole is a superior therapeutic strategy compared with the use of ethanol combined with haemodialysis. The same patient was admitted twice to our emergency department with methanol poisoning. The first time (methanol 3.24 g/l), she was treated with fomepizole without dialysis owing to the absence of acidosis. The second time (methanol 5.5 g/l), she received ethanol as an antidote and dialysis was started. For both therapeutic strategies, hospital length of stay, observation unit length of stay and costs are compared. In the Belgian healthcare system, we found that fomepizole treatment was three times as expensive as ethanol treatment, and the majority of costs are not reimbursed. Fomepizole antidote therapy, compared with ethanol, has fewer reported side effects, but is more expensive. In hospitals where dialysis is easily available, ethanol antidote therapy should still be considered, especially if similar cost differences exist within the healthcare system one is working in.
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1.46Impact points
Mercury tissue concentrations in various organs following a fatal intentional poisoning with mercury chloride.
Clinical toxicology (Philadelphia, Pa.). 04/2008;
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2.71Impact points
Assessing the level of consciousness in children: a plea for the Glasgow Coma Motor subscore.
Resuscitation. 03/2008; 76(2):175-9.
AIM: The Glasgow Coma Scale (GCS) is not always easy to score and its reliability has been questioned. In adults the GCS Motor score has proven a valuable alternative, as it is easier to assess yet shows similar predictive capacity for outcome. We wanted to test the non-inferiority of the Glasgow Co... [more] AIM: The Glasgow Coma Scale (GCS) is not always easy to score and its reliability has been questioned. In adults the GCS Motor score has proven a valuable alternative, as it is easier to assess yet shows similar predictive capacity for outcome. We wanted to test the non-inferiority of the Glasgow Coma Motor score GCS-M versus the Total score GCS-T for predicting outcome in children. MATERIALS AND METHODS: As part of the Flemish paediatric trauma registry (PENTA) we collected data on 96 consecutive children (0-18 years) with moderate to severe traumatic brain injury. Outcome was evaluated using a three level ordinal scale: [normal to mild disability, moderate to severe disability and death]. A number of proportional odds models were fitted for various choices of predictive variables (GCS-T, GCS-M, age, sex, and injury severity score ISS). For each model we calculated Somers'D(xy) rank correlation and NagelKerke's R(2)N index, both measures of the predictive performance of the model. RESULTS: All children had an injury to the brain that resulted in a hospital stay of more than 48h. Half of them had a "best" initial GCS of 15; 60%, a Motor score of 6. The median Injury Severity Score ISS was 16. Outcome was 'normal to mild' in 79 children, 'moderate to severe' in 7, and 'death' in 10. D(xy) values were 0.983 for the model with the Motor score and 0.972 for that with the total GCS, indicating excellent predictive performance for both. R(2)N indices were 0.862 and 0.813, respectively. Overall the difference between all models was small. CONCLUSION: The GCS Motor subscore was shown to have at least the same predictive ability for outcome as the total GCS. It is our opinion that the total GCS is unnecessarily complicated (especially in children). Using the Motor score alone will improve scoring compliance and statistical performance. We do not believe that the reduction in number of potential scores from 13 to 6 would decrease the descriptive capacity significantly, since clinical algorithms typically group values of the total GCS into five or fewer ranges.
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1.28Impact points
Paediatric trauma and trauma care in Flanders (Belgium). Methodology and first descriptive results of the PENTA registry.
European journal of pediatrics. 02/2008;
Paediatric injury surveillance and prevention are definite priorities for the European, Belgian, and Flemish authorities. Current available data for Flanders (Belgium) are fragmentary and out-of-date. The PENTA registry (PaEdiatric Network around TraumA) was therefore set up to obtain recent populat... [more] Paediatric injury surveillance and prevention are definite priorities for the European, Belgian, and Flemish authorities. Current available data for Flanders (Belgium) are fragmentary and out-of-date. The PENTA registry (PaEdiatric Network around TraumA) was therefore set up to obtain recent population-based data on trauma and trauma care in children and youngsters in Flanders. Data were collected prospectively in a representative sample (n = 18) of Flemish emergency departments (ED). All children (age 0-17 years) who presented at the ED in 2005 or died prehospital due to trauma were included. The registry was split into two levels. The basic A registry ('all' trauma) consisted of 30 variables, and the more exhaustive B registry ('severe trauma', defined as length of hospitalisation >48 hours, including all nonsurvivors) collected data on 291 variables. The incidence for paediatric trauma presenting at Flemish ED was approximately 119/1000/year. Further data were collected in a random sample of 7,879 cases (21.9% of 35,900 eligible patients). Of all cases, 0.8% were considered 'severe' and included in the B registry. In conclusion, the 'burden' of injury in Flanders is still enormous. PENTA provides the first population-based data about the circumstances and the extent of injury in children and youngsters for the Flemish region. In this article we present in detail the surplus value of the methods used, the difficulties encountered, and the most relevant epidemiological findings from the registry.
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0.73Impact points
Screening for risk of readmission of patients aged 65 years and above after discharge from the emergency department: predictive value of four instruments.
European journal of emergency medicine : official journal of the European Society for Emergency Medicine. 01/2008; 14(6):315-23.
OBJECTIVES: To compare the abilities of four different screening tools to predict return visits of older persons after they have been discharged from the emergency department (ED). METHODS: We assessed 83 short-term (discharged within 24 h) patients (aged 65 years and above) who visited the ED of th... [more] OBJECTIVES: To compare the abilities of four different screening tools to predict return visits of older persons after they have been discharged from the emergency department (ED). METHODS: We assessed 83 short-term (discharged within 24 h) patients (aged 65 years and above) who visited the ED of the University Hospitals Leuven, Belgium, from 15 October 2005 to 24 December 2005. The Identification of Seniors at Risk (ISAR), the Triage Risk Screening Tool (TRST), the eight-item questionnaire of Runciman, and the seven-item questionnaire of Rowland were administered at admission to screen the patients for risk factors of future ED readmission. By telephone follow-up 14, 30, and 90 days after discharge from the ED, we asked the patients (or their families) whether readmission had occurred since their initial discharge from the ED. RESULTS: Readmission rates were 10%, 15.8%, and 32.5% after 14, 30, and 90 days, respectively. When using three or more positive answers as the cutoff scores, the Rowland questionnaire proved to be the most accurate predictive tool with a sensitivity of 88%, specificity of 72%, and negative predictive value of 98% at 14 days after discharge. Thirty days after discharge, the sensitivity was 73%, specificity was 75%, and negative predictive value was 92%. CONCLUSION: Repeat visits in older persons admitted to an ED seemed to be most accurately predicted by using the Rowland questionnaire, with an acceptable number of false positives. This instrument can be easily integrated into the standard nursing assessment.
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2.71Impact points
European first aid guidelines.
Resuscitation. 03/2007; 72(2):240-51.
AIM: Our objectives were to determine the most effective, safe, and feasible first aid (FA) techniques and procedures, and to formulate valid recommendations for training. We focussed on emergencies involving few casualties, where emergency medical services or healthcare professionals are not immedi... [more] AIM: Our objectives were to determine the most effective, safe, and feasible first aid (FA) techniques and procedures, and to formulate valid recommendations for training. We focussed on emergencies involving few casualties, where emergency medical services or healthcare professionals are not immediately present at the scene, but are available within a short space of time. Due to time and resource constraints, we limited ourselves to safety, emergency removal, psychosocial FA, traumatology, and poisoning. Cardiopulmonary resuscitation (CPR) was not included because guidelines are already available from the European Resuscitation Council (ERC). The FA guidelines are intended to provide guidance to authors of FA handbooks and those responsible for FA programmes. These guidelines, together with the ERC resuscitation guidelines, will be integrated into a European FA Reference Guide and a European FA Manual. METHODS: To create these guidelines we used an evidence-based guideline development process, based on the methodology of the Scottish Intercollegiate Guidelines Network (SIGN). RESULTS: The recommendations cover FA for bleeding, wounds, burns, spinal and head trauma, musculoskeletal trauma, and poisoning, as well as safety and psychosocial FA. CONCLUSIONS: Where good evidence was available, we were able to turn science into practice. Where evidence was lacking, the recommendations were consensus-based. These guidelines provide systematically developed recommendations and justifications for the procedures and techniques that should be included in FA manuals and training programmes.
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2.05Impact points
Who visits the psychiatric emergency room for the first time?
Social psychiatry and psychiatric epidemiology. 07/2006; 41(7):580-6.
OBJECTIVE: To examine patient and system characteristics of first-time ("incident") vs. recurrent ("recurrent") use of a psychiatric emergency room (PER). METHODS: Data on demographic and clinical characteristics and health service utilization were collected for incident and recu... [more] OBJECTIVE: To examine patient and system characteristics of first-time ("incident") vs. recurrent ("recurrent") use of a psychiatric emergency room (PER). METHODS: Data on demographic and clinical characteristics and health service utilization were collected for incident and recurrent users (n=3,719) who visited the PER of the university hospital in Leuven, Belgium, between March 2000 and March 2002. RESULTS: About 64% (n=2,368) were incident and 36% (n=1,351) were recurrent users. The PER was the first treatment setting ever for 50% of the incident users. Incident users were most likely over 69 years (OR=2.84, P<0.001), employed (OR=2.21, P<0.001), or referred by a health care professional (OR=1.72, P<0.001). They were less likely to have a personality disorder (OR=0.40, P<0.001) or to have used inpatient or outpatient services in the past (OR's 0.11 and 0.65, respectively, P<0.001). About 44% were admitted, 38% referred for outpatient treatment, 9% referred to the outpatient crisis-intervention program, and 9% refused any follow-up. CONCLUSIONS: The PER was a first treatment setting ever for 1 in 3 patients. Incident and recurrent users differed in sociodemographic characteristics, pathways to care, service use, and the presence of a personality disorder. They did not differ in axis 1 disorders, comorbid mental disorders, or pathways after care.
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0.73Impact points
Aetiology of unsuccessful prehospital witnessed cardiac arrest of unclear origin.
European journal of emergency medicine : official journal of the European Society for Emergency Medicine. 07/2006; 13(3):144-7.
OBJECTIVES: To determine, by means of autopsy, the cause of death following unsuccessful cardiopulmonary resuscitation of patients with a witnessed prehospital cardiac arrest of unclear origin. METHOD: Observational study of all prehospital-witnessed cardiac arrest of unclear origin over a period of... [more] OBJECTIVES: To determine, by means of autopsy, the cause of death following unsuccessful cardiopulmonary resuscitation of patients with a witnessed prehospital cardiac arrest of unclear origin. METHOD: Observational study of all prehospital-witnessed cardiac arrest of unclear origin over a period of 19 months in the emergency medical service region of a tertiary care hospital. RESULTS: During the study period, 211 prehospital cardiopulmonary resuscitation attempts were recorded. In 144 study participants, cardiopulmonary resuscitation was not successful: there was no return of spontaneous circulation. Cardiac arrest of traumatic or other clear origin was not considered, nor were paediatric cases. Thirty out of the 114 remaining patients underwent an autopsy (26.3%). The main aetiology of cardiac arrest in this selected population was ischaemic heart disease in 16 out of 30 patients (53.3%) followed by pulmonary embolism in four patients (13.3%) and vascular disease other than coronary disease in two patients (6.7%). Other causes consisted of hypertrophic obstructive cardiomyopathy (one patient) (3.3%) and poisoning (one patient) (3.3%). The cause of death could not be identified in six cardiac arrest victims (20%). CONCLUSIONS: Ischaemic heart disease and pulmonary embolism account for 66.6% of all witnessed cardiac arrest with no return of spontaneous circulation.
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2.05Impact points
Predicting aftercare in psychiatric emergencies.
Social psychiatry and psychiatric epidemiology. 11/2005; 40(10):829-34.
BACKGROUND: Aftercare dispositions in psychiatric emergencies have often been limited to the classic armamentarium of admission vs nonadmission. It is unknown to what extent there are differences in predicting follow-up after psychiatric emergency room (PER) visits when focusing on a broader scope o... [more] BACKGROUND: Aftercare dispositions in psychiatric emergencies have often been limited to the classic armamentarium of admission vs nonadmission. It is unknown to what extent there are differences in predicting follow-up after psychiatric emergency room (PER) visits when focusing on a broader scope of aftercare possibilities. MATERIAL AND METHODS: This observational study describes and predicts aftercare dispositions after a psychiatric emergency referral: admission, onsite short-term crisis-intervention program (CIP), refusal of any aftercare, and outpatient aftercare. From March 2000 until March 2002, PER patients (N=3,719) of the university hospital were monitored regarding sociodemographic and clinical characteristics, and use of health services. RESULTS: Forty-four percent were admitted, 38% were referred to outpatient treatment, 9% refused any aftercare, and the remainder was referred to the CIP. Psychotic patients were most likely to be admitted [odds ratios (ORs) between 5.98 and 6.52], followed by patients with suicidal symptoms (OR=2.25) and those who reported outpatient service utilization (OR=1.43). Young patients (OR=3.36) or those with anxiety disorders (OR=2.03) were most likely to be referred for outpatient aftercare. Patients diagnosed with a personality disorder were at highest risk of refusing any aftercare (OR=1.81). CONCLUSION: Despite the existence of a short-term onsite CIP, the majority of the patients were admitted after PER referral. We assume that the existence of this program decreased the number of patients who otherwise would refuse all aftercare. More research is needed in order to explain aftercare dispositions more appropriately.
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0.73Impact points
Amphetamine toxicity in the emergency department.
European journal of emergency medicine : official journal of the European Society for Emergency Medicine. 09/2005; 12(4):193-7.
XTC and other amphetamines are considered to be safe by the majority of partying young people who are unaware of (or unwilling to know about) the acute and chronic toxicity of these substances, and these drugs are widespread, illicit stimulants. In this article, we describe four cases of severe acut... [more] XTC and other amphetamines are considered to be safe by the majority of partying young people who are unaware of (or unwilling to know about) the acute and chronic toxicity of these substances, and these drugs are widespread, illicit stimulants. In this article, we describe four cases of severe acute toxicity due to recreational use of amphetamines 3,4-methylene-dioxymethamphetamine, 3,4-methylenedioxyethylamphetamine, 3,4-methylenedioxyamphetamine, 4-methylthioamphetamine or p-methoxyamphetamine, with emphasis on the presenting symptoms and acute treatment in the emergency department.
Following (3)
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Annick De Jaeger
University of Ghent -
Paul A Calle
University of Ghent -
Emmanuel Lesaffre
Erasmus MC
Topics (5)
