scholarly journals Academy of Emergency Medicine and Care-Society of Clinical Biochemistry and Clinical Molecular Biology consensus recommendations for clinical use of sepsis biomarkers in the emergency department

2017 ◽  
Vol 13 (2) ◽  
Author(s):  
Giuseppe Lippi ◽  
Martina Montagnana ◽  
Fiamma Balboni ◽  
Andrea Bellone ◽  
Ivo Casagranda ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Clinical Biochemistry ◽  
Clinical Information ◽  
Clinical Value ◽  
Suspected Sepsis ◽  
Consensus Document ◽  
Diagnostic Threshold ◽  
High Negative Predictive Value ◽  
Routine Assessment

Increasing evidence is emerging that the measurement of circulating biomarkers may be clinically useful for diagnosing and monitoring sepsis. Eight members of AcEMC (Academy of Emergency Medicine and Care) and eight members of SIBioC (Italian Society of Clinical Biochemistry and Laboratory Medicine) were identified by the two scientific societies for producing a consensus document aimed to define practical recommendations about the use of biomarkers for diagnosing of sepsis and managing antibiotic therapy in the emergency department (ED). The cumulative opinions allowed defining three grade A recommendations (i.e., highly recommended indications), entailing ordering modality (biomarkers always available on prescription), practical use (results should be interpreted according to clinical information) and test ordering defined according to biomarker kinetics. Additional grade B recommendations (i.e., potentially valuable indications) entailed general agreement that biomarkers assessment may be of clinical value in the diagnostic approach of ED patients with suspected sepsis, suggestion for combined assessment of procalcitonin (PCT) and Creactive protein (CRP), free availability of the selected biomarker(s) on prescription, adoption of diagnostic threshold prioritizing high negative predictive value, preference for more analytically sensitive techniques, along with potential clinical usefulness of measuring PCT for monitoring antibiotic treatment, with serial testing defined according to biomarker kinetics. PCT and CRP were the two biomarkers that received the largest consensus as sepsis biomarkers (grade B recommendation), and a grade B recommendation was also reached for routine assessment of blood lactate. The assessment of biomarkers other than PCT and CRP was discouraged, with exception of presepsin for which substantial uncertainty in favor or against remained.

scholarly journals Laboratory testing in the emergency department: an Italian Society of Clinical Biochemistry and Clinical Molecular Biology (SIBioC) and Academy of Emergency Medicine and Care (AcEMC) consensus report

2018 ◽  
Vol 56 (10) ◽  
pp. 1655-1659 ◽  
Author(s):  
Giuseppe Lippi ◽  
Mauro Panteghini ◽  
Sergio Bernardini ◽  
Laura Bonfanti ◽  
Paolo Carraro ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Molecular Biology ◽  
Laboratory Testing ◽  
Clinical Biochemistry ◽  
National Level ◽  
Mean Value ◽  
Italian Society ◽  
Emergency Setting ◽  
Consensus Document ◽  
The Mean

Abstract Background: The mainstay of patient-oriented laboratory testing in emergency settings entails selecting a number and the type of tests according to valid criteria of appropriateness. Since the pattern of urgent tests requesting is variable across different institutions, we designed a joined survey between the Academy of Emergency Medicine and Care (AcEMC) and the Italian Society of Clinical Biochemistry and Clinical Molecular Biology (SIBioC) for reaching tentative consensus about the most informative diagnostic tests in emergency settings. Methods: A survey, containing the most commonly ordered urgent laboratory tests and the relative clinical indications, was disseminated to eight relevant members of AcEMC and eight relevant members of SIBioC. All contributors were asked to provide numerical scores for the different laboratory parameters, where 1 indicated “strongly recommended”, 2 “recommended in specific circumstances”, and 3 “strongly discouraged”. The mean results of the survey were presented as the mean of responders’ values, and the parameters were finally classified as “strongly recommended” (mean value, 1.00–1.49), “weakly recommended” (mean value, 1.50–1.99), “discouraged” (mean value, 2.00–2.49) and “strongly discouraged” (mean value, 2.50–3.00). Results: The results of the survey allowed defining a hierarchy of priority, wherein 24 tests were “strongly recommended”. The use of five common tests was instead “strongly discouraged”. For 16 additional parameters in the list, the consensus ranged between “weakly recommended” and “discouraged”. Conclusions: We hope that results presented in this joint AcEMC-SIBioC consensus document may help harmonizing panel of tests and requesting patterns in emergency setting, at least at a national level.

scholarly journals Laboratory testing in the emergency department: An Italian Society of Clinical Biochemistry and Clinical Molecular Biology (SIBioC) and Academy of Emergency Medicine and Care (AcEMC) consensus report

2017 ◽  
Vol 13 (1) ◽  
Author(s):  
Giuseppe Lippi ◽  
Mauro Panteghini ◽  
Sergio Bernardini ◽  
Laura Bonfanti ◽  
Paolo Carraro ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Molecular Biology ◽  
Laboratory Testing ◽  
Clinical Biochemistry ◽  
National Level ◽  
Mean Value ◽  
Italian Society ◽  
Emergency Setting ◽  
Consensus Document ◽  
The Mean

The mainstay of patient-oriented laboratory testing in emergency settings entails selecting number and type of tests according to valid criteria of appropriateness. Since the pattern of urgent tests requesting is variable across different institutions, we designed a joined survey between the Academy of Emergency Medicine and Care (AcEMC) and the Italian Society of Clinical Biochemistry and Clinical Molecular Biology (SIBioC) for reaching tentative consensus about the most informative diagnostic tests in emergency settings. A survey, containing the most commonly performed urgent laboratory tests and the relative clinical indications, was disseminated to eight relevant members of AcEMC and eight relevant members of SIBioC. All contributors were asked to provide numerical scores for the different laboratory parameters, where 1 indicated <em>strongly recommended</em>, 2 <em>recommended in specific circumstances</em>, and 3 <em>strongly discouraged</em>. The mean results of the survey were presented as the mean of responders’ values, and the parameters were finally classified as <em>strongly recommended</em> (mean value, 1.0-1.5), <em>somehow recommended</em> (mean value, 1.5-2.0), <em>discouraged</em> (mean value, 2.0-2.5) and <em>strongly discouraged</em> (mean value, 2.5-3.0). The results of the survey allowed defining a hierarchy of priority, wherein 24 tests were <em>strongly recommended</em>. The use of 5 common tests was instead <em>strongly discouraged</em>. For 16 additional parameters in the list, the consensus ranged between <em>somehow recommended</em> and <em>discouraged</em>. We hope that results presented in this joint AcEMC-SIBioC consensus document may help harmonizing panel of tests and requesting patters in emergency setting, at least at a national level.

scholarly journals Emergency medicine airway leads: a rapid response distributed educational model for emergency department COVID-19 airway management

CJEM ◽  
2021 ◽  
Author(s):  
Adam Harris ◽  
Lorri Beatty ◽  
Nicholas Sowers ◽  
Sam G. Campbell ◽  
David Petrie ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Airway Management ◽  
Rapid Response ◽  
Educational Model

scholarly journals Predictive factors for prolonged hospitalisation in acute pyelonephritis patients admitted to the emergency medicine ward

2021 ◽  
pp. 102490792110009
Author(s):  
Howard Tat Chun Chan ◽  
Ling Yan Leung ◽  
Alex Kwok Keung Law ◽  
Chi Hung Cheng ◽  
Colin A Graham
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Length Of Stay ◽  
Acute Pyelonephritis ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Prolonged Length ◽  
Reactive Protein ◽  
Prolonged Hospital ◽  
Emergency Medicine Ward

Background: Acute pyelonephritis is a bacterial infection of the upper urinary tract. Patients can be admitted to a variety of wards for treatment. However, at the Prince of Wales Hospital in Hong Kong, they are managed initially in the emergency medicine ward. The aim of the study is to identify the risk factors that are associated with a prolonged hospital length of stay. Methods: This was a retrospective cohort study conducted in Prince of Wales Hospital. The study recruited patients who were admitted to the emergency medicine ward between 1 January 2014 and 31 December 2017. These patients presented with clinical features of pyelonephritis, received antibiotic treatment and had a discharge diagnosis of pyelonephritis. The length of stay was measured and any length of stay over 72 h was considered to be prolonged. Results: There were 271 patients admitted to the emergency medicine ward, and 118 (44%) had a prolonged hospital length of stay. Univariate and multivariate analyses showed that the only statistically significant predictor of prolonged length of stay was a raised C-reactive protein (odds ratio 1.01; 95% confidence 1.01–1.02; p < 0.0001). Out of 271 patients, 261 received antibiotics in the emergency department. All 10 patients (8.5%) who did not receive antibiotics in emergency department had a prolonged length of stay (p = 0.0002). Conclusion: In this series of acute pyelonephritis treated in the emergency medicine ward, raised C-reactive protein levels were predictive for prolonged length of stay. Patients who did not receive antibiotics in the emergency department prior to emergency medicine ward admission had prolonged length of stay.

Progressive alteration of DNA methylation of Alu, MGMT, MINT2, and TFPI2 genes in colonic mucosa during colorectal cancer development

2021 ◽  
pp. 1-6
Author(s):  
Ben Kang ◽  
Hyun Seok Lee ◽  
Seong Woo Jeon ◽  
Soo Yeun Park ◽  
Gyu Seog Choi ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Dna Methylation ◽  
Healthy Subjects ◽  
Large Scale ◽  
Methylation Status ◽  
Clinical Information ◽  
Field Cancerization ◽  
Aberrant Methylation ◽  
Clinical Value ◽  
Mortality And Morbidity

BACKGROUND: Colorectal cancer (CRC) is one of the leading causes of mortality and morbidity in the world. It is characterized by different pathways of carcinogenesis and is a heterogeneous disease with diverse molecular landscapes that reflect histopathological and clinical information. Changes in the DNA methylation status of colon epithelial cells have been identified as critical components in CRC development and appear to be emerging biomarkers for the early detection and prognosis of CRC. OBJECTIVE: To explore the underlying disease mechanisms and identify more effective biomarkers of CRC. METHODS: We compared the levels and frequencies of DNA methylation in 11 genes (Alu, APC, DAPK, MGMT, MLH1, MINT1, MINT2, MINT3, p16, RGS6, and TFPI2) in colorectal cancer and its precursor adenomatous polyp with normal tissue of healthy subjects using pyrosequencing and then evaluated the clinical value of these genes. RESULTS: Aberrant methylation of Alu, MGMT, MINT2, and TFPI2 genes was progressively accumulated during the normal-adenoma-carcinoma progression. Additionally, CGI methylation occurred either as an adenoma-associated event for APC, MLH1, MINT1, MINT31, p16, and RGS6 or a tumor-associated event for DAPK. Moreover, relatively high levels and frequencies of DAPK, MGMT, and TFPI2 methylation were detected in the peritumoral nonmalignant mucosa of cancer patients in a field-cancerization manner, as compared to normal mucosa from healthy subjects. CONCLUSION: This study identified several biomarkers associated with the initiation and progression of CRC. As novel findings, they may have important clinical implications for CRC diagnostic and prognostic applications. Further large-scale studies are needed to confirm these findings.

scholarly journals Subarachnoid hemorrhage in the emergency department

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Sima Patel ◽  
Amay Parikh ◽  
Okorie Nduka Okorie
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Subarachnoid Hemorrhage ◽  
Early Management ◽  
Vast Number ◽  
Emergency Medicine Physician ◽  
Medicine Physician ◽  
Diagnostic Modalities ◽  
Poor Outcomes ◽  
Subarachnoid Hemorrhages

Abstract Background Subarachnoid hemorrhage accounts for more than 30,000 cases of stroke annually in North America and encompasses a 4.4% mortality rate. Since a vast number of subarachnoid hemorrhage cases present in a younger population and can range from benign to severe, an accurate diagnosis is imperative to avoid premature morbidity and mortality. Here, we present a straightforward approach to evaluating, risk stratifying, and managing subarachnoid hemorrhages in the emergency department for the emergency medicine physician. Discussion The diversities of symptom presentation should be considered before proceeding with diagnostic modalities for subarachnoid hemorrhage. Once a subarachnoid hemorrhage is suspected, a computed tomography of the head with the assistance of the Ottawa subarachnoid hemorrhage rule should be utilized as an initial diagnostic measure. If further investigation is needed, a CT angiography of the head or a lumbar puncture can be considered keeping risks and limitations in mind. Initiating timely treatment is essential following diagnosis to help mitigate future complications. Risk tools can be used to assess the complications for which the patient is at greatest. Conclusion Subarachnoid hemorrhages are frequently misdiagnosed; therefore, we believe it is imperative to address the diagnosis and initiation of early management in the emergency medicine department to minimize poor outcomes in the future.

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