Claessens Yann-Erick

Princess Grace Hospital Centre | PGHC · emergency medicine

Purpose: To investigate the prevalence of neuro-functional disability and its determinants 12 months after community-acquired bacterial meningitis (CABM) in adult patients. Methods: In a prospective multicenter cohort study (COMBAT), all consecutive cases of CABM were enrolled and followed up for 12 months. Neuro-functional disability at 12 mont...

Purpose[18F]-2-Fluoro-2-deoxy-D-glucose PET/CT (FDG PET/CT) is a sensitive and quantitative technic for detecting inflammatory process. Glucose uptake is correlated with an increased anaerobic glycolysis seen in activated inflammatory cells such as monocytes, lymphocytes, and granulocytes. The aim of the study was to assess the inflammatory status...

Objective: To assess the proportion of patients meeting the 2010 SPILF-AFSSAPS guiding criteria for Streptococcus pneumoniae in patients consulting at the emergency departments of four French university hospitals for acute community-acquired pneumonia (CAP) suspicion. Patients and methods: The PACSCAN study prospectively included 319 patients. M...

Background To investigate whether routine biomarkers and blood leucocytes count could assist diagnosis of COVID-19-associated pneumonia in adult patients visiting the emergency department (ED). Methods This monocentre retrospective study enrolled 254 patients with nasopharyngeal RT-PCR for SARS-COV-2, routine biomarkers (D-dimers, fibrinogen, C-rea...

Background Community-acquired pneumonia (CAP) guidelines have improved the management and outcomes of patients with CAP, primarily by standardization of initial empiric therapy. But current society-published guidelines exclude immunocompromised patients. Research Question There is no concensus regarding the initial management of immunocompromised...

Riassunto La polmonite acuta comunitaria dell’adulto è un problema di salute pubblica a causa della sua frequenza, della sua gravità e dei costi generati. La diagnosi, che si basa sulla combinazione di segni clinici e radiologici, è difficile, spesso posta per eccesso, a volte misconosciuta. La gestione in urgenza si basa su una valutazione della g...

L’acidose métabolique est un trouble fréquemment rencontré en médecine d’urgence et en médecine intensive réanimation. La littérature s’étant enrichie de nouvelles données concernant la prise en charge de l’acidose métabolique, la Société de Réanimation de Langue Française (SRLF) et la Société Française de Médecine d’Urgence (SFMU) ont élaboré des...

L’acidose métabolique est un trouble fréquemment rencontré en médecine d’urgence et en médecine intensive réanimation. La littérature s’étant enrichie de nouvelles données concernant la prise en charge de l’acidose métabolique, la Société de Réanimation de Langue Française (SRLF) et la Société Française de Médecine d’Urgence (SFMU) ont élaboré des...

Abstract Metabolic acidosis is a disorder frequently encountered in emergency medicine and intensive care medicine. As literature has been enriched with new data concerning the management of metabolic acidosis, the French Intensive Care Society (Société de Réanimation de Langue Française [SRLF]) and the French Emergency Medicine Society (Société Fr...

p>In the publication of this article [1], there are two errors in contributing author affiliations. This has now been included in this correction article. The error in affiliation 20: Gibraltar Health Authority, St Bernard's Hospital, Gibraltar, Spain Should instead read: Gibraltar Health Authority, St Bernard's Hospital, Gibraltar, UK The error: t...

Objective: The aim was to create and validate a community-acquired pneumonia (CAP) diagnostic algorithm to facilitate diagnosis and guide chest computed tomography (CT) scan indication in patients with CAP suspicion in Emergency Departments (ED). Methods: We performed an analysis of CAP suspected patients enrolled in the ESCAPED study who had un...

Objectives To determine whether the impact of a thoracic CT scan on community-acquired pneumonia (CAP) diagnosis and patient management varies according to emergency physician’s experience (≤10 vs >10 years). Methods Early thoracic CT Scan for Community-Acquired Pneumonia at the Emergency Department is an interventional study conducted from Novemb...

Abstract Background There is a lack of validated tools to assess potential disease progression and hospitalisation decisions in patients presenting to the emergency department (ED) with a suspected infection. This study aimed to identify suitable blood biomarkers (MR-proADM, PCT, lactate and CRP) or clinical scores (SIRS, SOFA, qSOFA, NEWS and CRB-...

p>Background: There is a lack of validated tools to assess potential disease progression and hospitalisation decisions in patients presenting to the emergency department (ED) with a suspected infection. This study aimed to identify suitable blood biomarkers (MR-proADM, PCT, lactate and CRP) or clinical scores (SIRS, SOFA, qSOFA, NEWS and CRB-65) to...

Background There is no consensus on the most accurate combination of diagnostic criteria to define community acquired pneumonia (CAP). We describe inclusion criteria in randomized controlled trials (RCT) of CAP and assess their performance for the diagnosis of formally identified CAP. Methods RCTs related to CAP recorded on ClinicalTrials.gov were...

Introduction La suspicion de pneumonie aiguë communautaire (PAC) est un motif de consultation fréquent dans les services d’accueil des urgences (SAU). Le diagnostic de certitude est souvent difficile. La place des nouvelles techniques de biologie moléculaire comme la PCR multiplexe (mPCR) nasopharyngée (recherchant 15 virus respiratoires, 4 bactéri...

Introduction To determine whether a multifacette intervention using a structured interview finishing with open-ended question improves the comprehension of their condition in patients admitted at the emergency observation unit. Methods This multicenter randomized and controlled cluster study was set at the Emergency observation units from 14 emerg...

El shock séptico implica la asociación entre infección e insuficiencia hemodinámica, en algunos casos con falla orgánica. Las definiciones de shock séptico y sepsis grave suelen tener puntos en común, aunque en la última el trastorno hemodinámico es reversible sin vasopresores. Las bases del tratamiento son las medidas que deben aplicarse en el pla...

Chronic obstructive pulmonary disease (COPD) is the chronic respiratory disease with the most important burden on public health in terms of morbidity, mortality and health costs. For patients, COPD is a major source of disability because of dyspnea, restriction in daily activities, exacerbation, risk of chronic respiratory failure and extra-respira...

Introduction Les pneumonies aigues communautaires (PAC) sont une cause frequente de prescription antibiotique chez les patients hospitalises. La plupart des recommandations preconisent 7 a 14 jours de traitement antibiotique, mais cette duree ne repose pas sur des preuves univoques. Nous etudions la possibilite de reduire la duree de traitement de...

Importance An international task force recently redefined the concept of sepsis. This task force recommended the use of the quick Sequential Organ Failure Assessment (qSOFA) score instead of systemic inflammatory response syndrome (SIRS) criteria to identify patients at high risk of mortality. However, these new criteria have not been prospectively...

Ultra-marathons are becoming increasingly popular (1). In 2014 (4(th) to 14(th) April), the 29(th) Sultan Marathon des Sables (MDS) took place in Morocco. Overall, 1100 runners, men and women aged 16 to 80, met this challenge. Their goal was an endurance race of around 250 km in 5 self-sufficient stages in the desert over 6 days. Each runner carrie...

Introduction: Presepsin (sCD14-ST) is an emerging biomarker for infection. We hypothesized that presepsin could specifically increase during acute pyelonephritis and correlate with severity. Methods: We compared presepsin values in patients with acute pyelonephritis and controls, and we assessed its capacity to predict bacteraemia and admission...

Objective: to evaluate the accuracy of PCT, MR-proANP, MR-proADM, copeptin and CT-proET1 for the risk-stratification of severe acute dyspnea patients presenting to the ED. Methods: Multicentre prospective study in adult patients with a chief complaint of acute dyspnea. Pro-hormone type biomarkers concentrations were measured on arrival. Combined...

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Background: Pain management and patient satisfaction were targeted in the emergency department of a Paris university hospital. In 1999, 77.0% of patients complained of pain on arrival and more than half of patients did not experience pain relief at discharge. The purpose of the study was to evaluate the outcomes of the implementation of a team pil...

Presepsin could help for early diagnosis of systemic infection. Little is known regarding its kinetics. We studied presepsin concentration after challenge with bacterial agonist lipopolysaccharide (LPS) stimulation in peripheral mononuclear cells (PMNC) collected from 5 healthy volunteers and in a human cell line of monocytic cells (THP1). In PMNC,...

Community-acquired pneumonia (CAP) requires prompt treatment, but its diagnosis is complex. Improvement of bacterial CAP diagnosis by biomarkers has been evaluated using chest X-ray infiltrate as the CAP gold standard, producing conflicting results. We analyzed the diagnostic accuracy of biomarkers in suspected CAP adults visiting emergency departm...

Background: The diagnosis of Pulmonary Embolism (PE) in the emergency department (ED) is crucial. As emergency physicians fear missing this potential life-threatening condition, PE tends to be over-investigated, exposing patients to unnecessary risks and uncertain benefit in terms of outcome. The Pulmonary Embolism Rule-out Criteria (PERC) is an e...

Objectives: We aimed to evaluate the diagnostic performance of the combination of cardiac troponin (cTn) and copeptin in a population older than 70 years of age to rule out non-ST-elevation myocardial infarction (NSTEMI) at emergency department (ED) presentation. Methods: Among 885 analyzed patients with acute chest pain presenting to the ED, 21...

Clinical decision making relative to community acquired-pneumonia CAP diagnosis is difficult. Chest X-ray is key in establishing parenchymal lung involvement. However, radiological performance may lead to misdiagnosis, rendering questionable the utility of chest CT-scan in patients with clinically-suspected CAP. To assess whether early multidetecto...

Innate immunity is the first barrier to fight off bacteria, and partly relies on the engagement of the membrane coreceptor CD14. A product of cleavage of CD14, the soluble subtype of CD14 (sCD14-ST) or presepsin, is released in circulation after activation of defense mechanisms. Presepsin can be detected by biochemical methods and therefore appears...

TLR2 has a prominent role in host defense against a wide variety of pathogens. Stimulation of TLR2 triggers MyD88-dependent signaling to induce NF-κB translocation, and activates a Rac1-PI 3-kinase dependent pathway that leads to transactivation of NF-κB through phosphorylation of the P65 NF-κB subunit. This transactivation pathway involves tyrosin...

Infectious agents associated with community-acquired pneumonia (CAP) are understudied. This study attempted to identify viruses from the upper respiratory tract in adults visiting emergency departments (ED) for clinically suspected CAP. Adults with suspected CAP enrolled in the ESCAPED study (impact of computed tomography on CAP diagnosis) had pros...

Introduction – objectifs Le diagnostic des pneumopathies communautaires (PAC) de l’adulte vu aux urgences repose essentiellement sur la clinique et la radiologie. Le rôle exact des agents viraux dans ces pneumopathies est mal connu. Objectifs –Identifier les virus circulants chez les patients (pts) suspects de PAC vus aux urgences–étudier la corr...

Introduction – objectifs La faible concordance inter-observateurs dans la lecture de la radiographie thoracique (RT) et la meilleure sensibilité du scanner thoracique (ST) soulève la question de l’utilité du ST dans la prise en charge des patients (pts) suspects de PAC. L’objectif était de déterminer l’impact diagnostique et thérapeutique du ST dan...

Background In several small studies, anticoagulant therapy reduced the incidence of venous thromboembolism (VTE) in patients with isolated lower-limb injuries. Objective: To compare the efficacy and safety of fondaparinux 2.5 mg (1.5 mg in patients with a creatinine clearance between 30 and 50 ml/min) over nadroparin 2,850 antifactor Xa IU. Patient...

Background: The psychological burden suffered by elderly subjects after a fall adds to rehabilitation difficulties. We hypothesised that Post Traumatic Stress Disorder (PTSD) may be at the root of these psychological post-fall problems. The immediate psychological state was examined after 2 months post-fall in order to determine the prevalence of...

The use of biomarkers has changed approach of diagnosis and treatment procedures in emergency medicine, especially in the field of cardiovascular disorders. Effectiveness of new strategies that integrate biomarkers has precluded development and research in novel tools that may improve safety and efficiency at bedside. This mini-review presents curr...

La comparsa di una neutropenia febbrile in un paziente trattato con chemioterapia antineoplastica è un evento importante gravato da una forte morbilità e da una mortalità che dipende dal terreno. La gestione in urgenza si basa su una valutazione scrupolosa che determina l’orientamento e la terapia antibiotica. Questa valutazione è tanto più diffici...

Introduction La douleur thoracique est un motif fréquent de consultation dans les services d’accueil des urgences des pays occidentaux. Bien que ce motif de recours évoque en premier lieu le syndrome coronarien aigu (SCA), il regroupe une grande variété d’étiologies. Notre étude a pour objectif de décrire l’épidémiologie des douleurs thoraciques pr...

Background In several small studies, anticoagulant therapy reduced the incidence of venous thromboembolism (VTE) in patients with isolated lower-limb injuries. Objectives To compare the efficacy and safety of fondaparinux 2.5mg (1.5mg in patients with a creatinine clearance between 30 and 50mLmin(-1)) over nadroparin 2850 anti-factor Xa IU. Patient...

Presepsin is elevated in patients developing infections, and increase in a severity-dependent manner. We aimed to evaluate circulating values of this new biomarker in a population free of any acute infectious disorder. We recruited 144 consecutive patients presenting at the emergency department (ED) without acute infection or acute/unstable disorde...

La réponse immunitaire innée, première barrière de l’organisme contre l’infection, repose sur la reconnaissance des antigènes microbiens par des récepteurs spécifiques associés au corécepteur membranaire CD14. Après reconnaissance du pathogène et activation des voies de signalisation intracellulaire des mécanismes de défense, le CD14 est libéré dan...

Pochi studi si sono interessati all’anemia in Pronto Soccorso, mentre questo problema è pluriquotidiano al letto del paziente per ogni urgentista. L’anemia può essere la causa del sintomo che conduce il paziente a visita e l’oggetto stesso della visita o essere scoperta al momento della presa in carico del paziente. La presenza di un’anemia pone nu...

Phase III clinical trials on severe sepsis and septic shock published during the past decade have failed to reveal the superiority of any therapeutic intervention on mortality compared with evolving standards of care, with the exception of the Early-Goal Directed Therapy reported in 2001. This viewpoint paper presents an analysis of these studies i...

Introduction Guidelines dealing with severe sepsis and septic shock mostly rely on randomized controlled trials (RCTs) to ensure the best standards of care for patients. However, patients included in high-quality studies may differ from the routine population and alter external validity of recommendations. We aimed to determine to what extent non-i...

Objectives: Biomarkers have been developed in emergency medicine to improve decision at bedside using Bayesian approach. We intend to determine the cognitive process actually utilised by emergency physicians to incorporate biomarkers in clinical reasoning. Design: We invited eight emergency physicians to answer eight script concordance tests. In...

Concerns have been raised about the performance of highly sensitive cardiac troponin assays to accurately detect acute myocardial infarction (AMI), particularly in non-ST segment elevation (NSTEMI), in elderly patients, and in patients with renal failure. We evaluated whether increased age and low estimated glomerular filtration rate (eGFR) alter d...

Background: In Europe, including France, a measles outbreak has been ongoing since 2008. Unprotected healthcare workers (HCWs) may contract and spread the infection to patients. Aim: The objective of this study was to evaluate HCWs' measles immunity and vaccine acceptance in our setting. Methods: In a survey-based study conducted in three univ...

Comprehension is poor in patients admitted in the emergency observation unit. Teamwork communication gaps could contribute to patients' misunderstanding of their health condition. To determine in patients admitted in the emergency observation unit whether comprehension of diagnosis, prognosis, and management depended on nurses' comprehension, the a...

Although numerous diagnostic and/or prognostic biomarkers are proposed in the literature, only a limited number of them are finally used in daily practice. The necessary steps to prove their clinical interest include: 1) an exhaustive clinical and statistical evaluation demonstrating not only the added value of the marker with regard to the existin...

L’utilisation des biomarqueurs a considérablement modifié l’approche diagnostique des pathologies cardiovasculaires et infectieuses en médecine d’urgence. L’utilisation de stratégies combinées incluant des biomarqueurs a sensiblement amélioré la qualité de la prise en charge des patients souffrant de pathologies courantes. Le besoin de nouveaux out...

La médecine d’urgence a pour spécificité d’assurer l’accueil et la prise en charge d’un très grand nombre de malades. Les pathologies communautaires et circonstancielles qui constituent les grands problèmes de santé publique forment le plus important contingent de patients. Cependant, le service d’urgence est par essence un lieu privilégié pour ren...

1147 Background D-dimer levels below a well defined cut-off level enable to safely rule out VTE in patients with a low or intermediate pre-test probability (PTP), with a high negative predictive value (NPV). As ageing is associated with increased concentrations of coagulation activation markers, including D-dimer, the question was raised of their...

In October 2009 the French National Authority for Health recommended that HIV testing be proposed at least once to all persons aged 15 to 70 years in all healthcare settings. We examined whether routine HIV screening with a rapid test in emergency departments (EDs) was feasible without dedicated staff, and whether newly diagnosed persons could be l...

Results of a 12 month routine HIV screening program with a rapid test after written inform consent in non eligible patients at 6 university hospital emergency departments (EDs) in Paris area (2009–2011). (DOC)

Objectives: The Risk of Early Admission to the Intensive Care Unit (REA-ICU) index is a clinical prediction model that was derived based on 4,593 patients with community-acquired pneumonia (CAP) for predicting early admission to the intensive care unit (ICU; i.e., within 3 days following emergency department [ED] presentation). This study aimed to...

Objectifs La contamination bactérienne des stéthoscopes est reconnue comme une source potentielle de transmission d’agents pathogènes. Nous avons observé auprès des médecins l’impact d’une procédure multifacette incluant une formation sur les bonnes pratiques de désinfection des stéthoscopes dans un service d’urgence. Matériel et méthodes Étude pr...

Background: Whether proadrenomedullin (ProADM) improves the performance of the Risk of Early Admission to ICU (REA-ICU) score in predicting early, severe community-acquired pneumonia (ESCAP) has not been demonstrated. Methods: Secondary analysis was completed of the original data from 877 consecutive patients with community-acquired pneumonia (C...

Diagnosis of sepsis in elderly is challenging. Objectives: We investigated whether procalcitonin concentrations in elderly differed from values for the general population. Procalcitonin measurement was assessed prospectively in 307 apyretic patients ≥75 years visiting the emergency department. Median age was 86 years [IQR81-90] and 222 (72%) were f...

The main objective of this multicentric study was to evaluate the additional value of copeptin to conventional cardiac troponin (cTn) for a rapid ruling out of acute myocardial infarction (AMI) in patients with acute chest pain and a previous history of coronary artery disease (CAD). Patients with a previous history of CAD presenting in the emergen...

BACKGROUND: Newer assays (high-sensitivity troponin T, HsTnT) and biomarkers (copeptin) have recently improved the management of chest pain in the Emergency Department. OBJECTIVES: To assess the negative predictive value (NPV) of the combination of HsTnT and copeptin for the diagnosis of acute myocardial infarction (AMI). METHODS: In consecutive pa...

Le terme « biomarqueur » est un néologisme récemment intégré dans le jargon médical. Ce barbarisme d’origine anglo-saxonne se doit de correspondre à une définition opérationnelle. Il est couramment accepté qu’un biomarqueur ait une caractéristique biologique mesurable liée à un processus normal ou non et il est possible d’utiliser des biomarqueurs...

Les peptides natriurétiques de type B sont parmi les plus étudiés et les plus utilisés des biomarqueurs actuellement à la disposition du clinicien. Un récent regain d’intérêt pour le peptide natriurétique atrial (ou Atrial Natriuretic Peptide, ANP) a soulevé la question de la place potentielle de ce marqueur dans léarsenal diagnostique de l’insuffi...

La douleur abdominale aiguë représente 5 % des motifs de recours aux urgences. Elle représente le type même de symptôme où l’urgentiste est amené à gérer un processus diagnostique dans l’incertitude, dans la mesure où aucun élément clinique ou biologique n’est pathognomonique. Le médecin urgentiste est confronté à cette gestion diagnostique à chaqu...

L’adrénomédulline (ADM) est une hormone découverte au début des années 1990, qui connaît un regain d’intérêt dans le domaine d’application des biomarqueurs. Initialement caractérisée dans les glandes surrénales, l’ADM a été détectée dans de nombreux autres tissus et la circulation systémique. Son activité biologique dépend de sa forme mature. Les p...

Les biomarqueurs ou marqueurs biologiques appliqués à la médecine d'urgence sont en plein essor. Ils correspondent à des dosages biologiques spécifiques d’organes, témoignant de dysfonctions ou de souffrance de systèmes. Le développement de stratégies associant ces biomarqueurs aux données traditionnelles – au premier rang duquel se situe le raison...

In combination with cardiac troponin, heart-type fatty acid binding protein (h-FABP)-a biomarker of myocardial necrosis-offers the possibility of rapidly eliminating the diagnosis of acute myocardial infarction (AMI). The main objective of this study was to assess the incremental value of h-FABP to cardiac troponin for a rapid elimination of AMI, a...

Mid-regional pro-atrial natriuretic peptide (MR-proANP) increases with severity in community-acquired pneumonia (CAP). We investigated whether changes of MR-proANP correlated to bacteremia. 392 adult patients with CAP visiting emergency department from a prospective observational multicenter study. MR-proANP levels increased in patients with positi...

Background: Copeptin, in combination with conventional troponin (cTn), has been suggested as a means of rapid rule out of the diagnosis of acute myocardial infarction (AMI). This study aims to assess the value of copeptin for rule out of AMI, according to the pre-test probability (PTP). Methods: In a prospective multicentric study, we enrolled p...