Tranexamic Acid in Pediatric Traumatic Brain Injury: A Multicenter Retrospective Observational Study.
Utsumi S, Ohki S, Amagasa S, Ohshimo S, Shime N. | Ann Emerg Med. 2025 Feb;85(2):101-108
DOI: https://doi.org/10.1016/j.annemergmed.2024.07.014
Keywords: Aucun
Pediatrics/original research
Introduction : Tranexamic acid (TXA) can be used after trauma to prevent bleeding. Our goal was to examine the influence of TXA on morbidity and mortality for children with severe traumatic brain injury (TBI).
Méthode : We identified children aged <18 years with a severe TBI (Glasgow Coma Scale score less than 8) presenting to 1 of the 291 hospitals contributing to the Japanese Trauma Data Bank between 2019 and 2023. The primary outcome was inhospital death, and the secondary outcome was poor neurologic outcome defined with Glasgow Outcome Scale (GOS) score of 1 to 3 at hospital discharge. Our primary exposure was any TXA administered in the hospital. Using propensity score-based inverse probability weighting, we used logistic regression to measure the association between TXA administration and death as well as poor neurologic outcome.
Résultats : Of the 342 included patients, 30 (14%) died, and 102/225 (45%) had a GOS score less than 4 at discharge. After inverse propensity weighting, TXA administration was not associated with either mortality (adjusted odds ratio [aOR] 1.25, 95% confidence interval [CI] 0.61 to 2.54) or poor neurologic outcome (aOR 0.86, 95% CI 0.47 to 1.56).
Conclusion : TXA administration was not associated with either death or poor neurologic outcome. Prospective clinical trials of TXA usage in children with severe TBI are needed.
Conclusion (proposition de traduction) : L'administration d'acide tranexamique n'a été associée ni à la mortalité ni à un mauvais résultat neurologique. Des essais cliniques prospectifs sur l'utilisation de l'acide tranexamique chez les enfants présentant un traumatisme crânien grave sont nécessaires.
Development and Evaluation of a Novel Resuscitation Teamwork Model for Out-of-Hospital Cardiac Arrest in the Emergency Department.
Chong KM, Chou EH, Chiang WC, Wang HC, Liu YP, Ko PC, Huang EP, Hsieh MJ, Lin HY, Lien WC, Huang CH, Fang CC, Chen SC, Bhanji F, Yang CW, Ma MH. | Ann Emerg Med. 2025 Feb;85(2):163-178.
DOI: https://doi.org/10.1016/j.annemergmed.2024.09.008
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Keywords: Aucun
Critical care/original research
Introduction : Cardiopulmonary resuscitation (CPR) is critical for out-of-hospital cardiac arrest patients but is prone to rapid changes and errors. Effective teamwork and leadership are essential for high-quality CPR. We aimed to introduce the Airway-Circulation-Leadership-Support (A-C-L-S) teamwork model in the emergency department (ED) to address these challenges.
Méthode : The study comprised 2 phases. The development phase involved reviewing CPR videos, categorizing problems, and formulating strategies using the Systems Engineering Initiative for Patient Safety model. Resuscitation tasks were organized into A-C-L-S domains using hierarchical task analysis. Equipment and environmental deficits were optimized ergonomically with a pit-crew style arrangement. Mnemonics enhanced teamwork and leadership. The evaluation phase assessed postimplementation ED resuscitation team performance, focusing on adherence, timeliness, and quality of A-C-L-S tasks.
Résultats : The development phase produced a structured teamwork model, assigning tasks, tools, mnemonics, and positions based on A-C-L-S domains. The A-team manages the airway and optimizes end-tidal CO2 levels; the C-team focuses on high-quality chest compressions and defibrillation. Leadership coordinates resuscitation efforts using goal-directed mnemonics (DABCD2E3), whereas the S-team handles medications, timekeeping, and recording. The evaluation phase showed improvements in adherence and timeliness of A-C-L-S tasks, with sustained increases in chest compression fraction before mechanical CPR, from 67.2% preimplementation to 83.0% postimplementation, 89.1% after 1 year, and 86.1% after 2 years. Overall, chest compression fraction also improved from 81.7% to 88.6%, peaking at 92.2% after 1 year and maintaining 90.8% after 2 years.
Conclusion : The A-C-L-S teamwork model is feasible, applicable, and effective. Further research is needed to assess its influence on patient outcomes.
Conclusion (proposition de traduction) : Le modèle de travail en équipe A-C-L-S est réalisable, applicable et efficace. Des recherches supplémentaires sont nécessaires pour évaluer son influence sur les résultats pour les patients.
In-hospital stay of anemic patients in the ED with/without transfusion: a single-center propensity-matched study.
Coisy F, Anselme C, Goulabchand R, Grau-Mercier L, Markarian T, Bobbia X, Genre-Grandpierre R. | BMC Emerg Med. 2025 Feb 23;25(1):29
DOI: https://doi.org/10.1186/s12873-025-01187-y
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Keywords: Anemia; Blood transfusion; Emergency Department; Hospital; Length of stay.
Research
Introduction : Anemia affects up to 25% of emergency department (ED) patients. Restrictive red blood cell (RBC) transfusion strategies are recommended for stable patients, but ED transfusion practices often remain liberal. Benefits of ED transfusion remains unclear.
Méthode : To evaluate the impact of ED transfusion on death-adjusted in-hospital length of stay (LOS) in stable anemic patients requiring hospitalization.
Methods: This single-center retrospective propensity-matched study included patients ≥ 18 years admitted to the ED of Nîmes University Hospital in 2022 with hemoglobin levels between 70 and 90 g.L-1. Patients with hemorrhagic shock or requiring emergent hemostatic procedures were excluded. Propensity score matching was conducted on variables including age, comorbidities, hemoglobin levels, and diastolic blood pressure. Primary outcome was adjusted in-hospital LOS. Secondary outcomes included ED LOS and RBC transfusion volumes.
Résultats : Among 564 patients, 118 (21%) were propensity-matched: 59 (50%) ED-transfused, 59 (50%) non-ED-transfused. Adjusted in-hospital LOS 13 [8-32] for ED-transfused patients and 12 [6-24] days for non-ED-transfused patients (median difference = 0; 95%CI: -10-7; p = 0.52). Median difference in ED LOS was 7:13 (95%CI: 1:00-11:25; p < 0.001) between ED transfused and non-ED-transfused patients. Median difference in number of RBC transfused during in hospital stay was 2 (95%CI: 1-3); p < 0.01) between ED transfused and non-ED-transfused patients.
Conclusion : In stable anemic patients with 70 to 90 g.L-1 hemoglobin level, ED transfusion did not reduce adjusted in-hospital LOS but prolonged ED LOS. Identifying patients who may safely defer transfusion could improve ED efficiency and safety.
Conclusion (proposition de traduction) : Chez les patients présentant une anémie modérée avec un taux d'hémoglobine compris entre 70 et 90 g.L- 1, la transfusion en salle d'urgence n'a pas réduit la durée d'hospitalisation ajustée, mais a prolongé la durée d'hospitalisation en salle d'urgence. L'identification des patients qui peuvent sûrement différer la transfusion pourrait améliorer l'efficacité et la sécurité des services d'urgence.
Effective strategies for reducing patient length of stay in the emergency department: a systematic review and meta-analysis.
Devia Jaramillo G, Esmeral Zuluaga N, Velandia Avellaneda VA. | BMC Emerg Med. 2025 Feb 20;25(1):25
DOI: https://doi.org/10.1186/s12873-024-01163-y
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Keywords: Emergency services; Fast-track; Length of stay; POCT; Triage.
Systematic Review
Introduction : Overcrowding is a common issue in emergency departments worldwide. One condition associated with overcrowding is the Emergency Department Length of Stay(EDLOS). Prolonged EDLOS is linked to increased hospitalization costs, worsening clinical outcomes, and deterioration in patient-reported outcomes. Consequently, there is a need to reduce EDLOS, and the scientific literature reports multiple strategies aimed at this goal. Therefore, the objective of this study was to determine strategies statistically significant in reducing the EDLOS.
Méthode : A systematic search was conducted in PubMed, Scopus, the Latin American and Caribbean Health Sciences Literature (LILACS) database, and Google Scholar from January 2000 to January 2024. Studies that included patient care strategies in emergency departments to reduce EDLOS, in adults or pediatric populations, and observational or experimental studies were included. The quality of the studies was assessed using the Cochrane Collaboration's Risk of Bias tool for Interventional Studies, and the certainty of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation criteria. A mean difference analysis in minutes was performed using a random-effects model.
Résultats : A total of 3410 studies were identified using the search strategy with a total of 245,404 patients were analyzed. Three types of strategies were identified with results in reducing EDLOS. Interventions performed by physicians in the triage area (liaison, supervision, and advanced triage) showed a significant reduction of -21.87 min (95% CI -28.35; -15.38). The second intervention was the use of Point-of-Care Testing, which showed a reduction of -41.98 min (95% CI -98.13; 14.15). The third intervention was the creation of fast-track strategies, which documented a reduction of -21.81 min (95% CI -41.79; -1.83). Most of the studies were of the before-and-after type. The certainty of the evidence for the first intervention was moderate, while for the other two groups, it was considered low.
Conclusion : The presence of a physician in the triage team demonstrated a reduction in patient EDLOS, although with high heterogeneity among the analyzed studies. Similarly, the use of fast-track strategies is also significantly useful in reducing EDLOS, while POCT reduces EDLOS but not significantly.
Conclusion (proposition de traduction) : La présence d'un médecin dans l'équipe de tri a permis de réduire la durée du séjour des patients aux urgences, bien qu'avec une grande hétérogénéité entre les études analysées. De même, l'utilisation de stratégies accélérées est également très utile pour réduire la durée du séjour aux urgences, tandis que le POCT (point-of-care testing) la réduit, mais de manière non significative.
Wake up!: a novel, cadaver-based approach to training emergency physicians in awake intubation.
Parks A, Law JA, Kovacs G. | CJEM. 2025 Feb;27(2):107-110.
DOI: https://doi.org/10.1007/s43678-024-00831-z
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Keywords: Airway; Awake tracheal intubation; Emergency medicine; Medical education; Training
Educational Innovation
Editorial : Bien que l’intubation trachéale en éveil soit considérée comme la méthode d’intubation la plus sûre pour les patients dont les voies respiratoires sont prédites difficiles, il existe peu de données probantes et une faible disponibilité des interventions de formation pour aider les médecins urgentistes à acquérir des compétences dans cette technique. Nous décrivons ici un cours novateur, basé sur des cadavres, pour les médecins urgentistes afin qu’ils acquièrent des compétences en intubation trachéale éveillée. Un échantillon de 15 médecins urgentistes de partout au Canada a participé à ce cours pilote. Les données du questionnaire concernant l’utilité du cours et la confiance des participants dans l’intubation trachéale en éveil ont été recueillies. Les 15 participants ont suivi le cours et les données du questionnaire montrent que les participants ont trouvé le cours utile et changeant leur pratique. Trois médecins ont déclaré avoir effectué avec succès une intubation trachéale éveillée dans le service des urgences pendant la période de suivi de 3 à 6 mois. L’élargissement de cours similaires pourrait aider les médecins urgentistes à acquérir les compétences nécessaires pour effectuer en toute sécurité une intubation trachéale éveillée. Les études futures devraient se concentrer sur l’optimisation des protocoles de formation, en mettant l’accent sur les méthodes pratiques pour améliorer la rétention des compétences à long terme.
Conclusion : This study presents a novel, cadaver-based training intervention to assist emergency medicine physicians improve their skills and knowledge in awake tracheal intubation. The intervention was looked upon favorably by participants, seemed to improve self-perceived confidence in awake tracheal intubation, and appeared to have an effect on behavior change.
Conclusion (proposition de traduction) : Cette étude présente une nouvelle intervention de formation basée sur l'utilisation de cadavres pour aider les urgentistes à améliorer leurs compétences et leurs connaissances en matière d'intubation trachéale éveillée. L'intervention a été bien accueillie par les participants, semble avoir amélioré la confiance en soi dans l'intubation trachéale éveillée et semble avoir eu un effet sur le changement de comportement.
2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.
Rao SV, O'Donoghue ML, Ruel M, Rab T, Tamis-Holland JE, Alexander JH, Baber U, Baker H, Cohen MG, Cruz-Ruiz M, Davis LL, de Lemos JA, DeWald TA, Elgendy IY, Feldman DN, Goyal A, Isiadinso I, Menon V, Morrow DA, Mukherjee D, Platz E, Promes SB, Sandner S, Sandoval Y, Schunder R, Shah B, Stopyra JP, Talbot AW, Taub PR, Williams MS. | Circulation. 2025 Feb 27
DOI: https://doi.org/10.1161/cir.0000000000001309
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Keywords: AHA Scientific Statements; EMS; ST-segment elevation myocardial infarction; acute coronary syndrome(s); angina, unstable; anticoagulants; aspirin; atrial fibrillation; cardiovascular diseases; coronary artery disease; coronary syndrome; emergency medical services; fibrinolytic agents; hemorrhage; major adverse cardiovascular events; morphine; myocardial infarction; non–ST-segment elevation myocardial infarction; percutaneous coronary intervention; prehospital; revascularization; risk; time factors; treatment outcome.
CLINICAL PRACTICE GUIDELINES
Introduction : The "2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes" incorporates new evidence since the "2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction" and the corresponding "2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes" and the "2015 ACC/AHA/SCAI Focused Update on Primary Percutaneous Coronary Intervention for Patients With ST-Elevation Myocardial Infarction." The "2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes" and the "2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization" retire and replace, respectively, the "2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease."
Méthode : A comprehensive literature search was conducted from July 2023 to April 2024. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline.
Conclusion : Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.
Conclusion (proposition de traduction) : De nombreuses recommandations issues de recommandations publiées antérieurement ont été mises à jour à la lumière de nouvelles données, et de nouvelles recommandations ont été formulées lorsqu'elles étaient étayées par des données déjà publiées.
Update on management of cerebral venous thrombosis.
Rosa S, Fragata I, Aguiar de Sousa D. | Curr Opin Neurol. 2025 Feb 1;38(1):18-28
DOI: https://doi.org/10.1097/wco.0000000000001329
Keywords: Aucun
Cerebrovascular disease
Introduction : This review intends to systematize the diagnostic and treatment approach to cerebral venous thrombosis (CVT), highlighting key studies that have been recently published.
Résultats : In light of the recent pandemic, new risk factors for CVT have emerged. Contrast-enhanced MRI and susceptibility-weighted imaging have been shown to offer increased sensitivity for detecting cortical vein thrombosis.Dabigatran seems to be as effective and well tolerated as warfarin for long-term anticoagulation. Partial venous recanalization often occurs in patients treated with anticoagulation only, as early as 8 days after treatment onset. For patients with CVT and impending brain herniation, two-thirds of those who undergo decompressive craniectomy survive, with one-third being functionally independent 6 months after diagnosis.
Conclusion : CVT is an unusual type of cerebrovascular disease that mostly affects women of fertile age. Risk factors should be identified and addressed. Diagnosis relies on confirmation of venous sinus and/or vein thrombosis, usually by CT venography or MRI. Anticoagulation is the cornerstone of treatment. Despite the lack of high-quality evidence, endovascular treatment is often considered in severe cases. Special populations require tailored approaches. About 80% achieve mRS 0-1, but residual symptoms often affect quality of life and the ability to return to work.
Conclusion (proposition de traduction) : La thrombose veineuse cérébrale est un type inhabituel de maladie cérébrovasculaire qui touche principalement les femmes en âge de procréer. Les facteurs de risque doivent être identifiés et traités. Le diagnostic repose sur la confirmation de la présence d'un sinus veineux et/ou d'une thrombose veineuse, généralement par tomodensitométrie ou IRM. L'anticoagulation est la pierre angulaire du traitement. Malgré l'absence de preuves de haute qualité, le traitement endovasculaire est souvent envisagé dans les cas graves. Les populations particulières nécessitent des approches adaptées. Environ 80 % des patients atteignent un score de 0-1 sur l'échelle de Rankin modifiée (mRS), mais les symptômes résiduels affectent souvent la qualité de vie et la capacité à reprendre le travail.
Commentaire : L'échelle de Rankin modifiée est une échelle d'évaluation globale de handicap, réalisée en 5 minutes. Échelle à six niveaux et fiable, sa sensibilité n'a pas été testée.
Calcul du Echelle de Rankin modifiée en ligne
2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.
Rao SV, O'Donoghue ML, Ruel M, Rab T, Tamis-Holland JE, Alexander JH, Baber U, Baker H, Cohen MG, Cruz-Ruiz M, Davis LL, de Lemos JA, DeWald TA, Elgendy IY, Feldman DN, Goyal A, Isiadinso I, Menon V, Morrow DA, Mukherjee D, Platz E, Promes SB, Sandner S, Sandoval Y, Schunder R, Shah B, Stopyra JP, Talbot AW, Taub PR, Williams MS; Peer Review Committee Members. | J Am Coll Cardiol. 2025 Feb 27:S0735-1097(24)10424-X
DOI: https://doi.org/10.1016/j.jacc.2024.11.009
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Keywords: ACC/AHA clinical practice guideline; EMS; ST-segment elevation myocardial infarction; acute coronary syndrome(s); angina; anticoagulants; aspirin; atrial fibrillation; cardiovascular diseases; coronary artery disease; coronary syndrome; emergency medical services; fibrinolytic agents; hemorrhage; major adverse cardiovascular events; morphine; myocardial infarction; non–ST-segment elevation myocardial infarction; percutaneous coronary intervention; prehospital; revascularization; risk; time factors; treatment outcome; unstable.
Clinical Practice Guideline
Introduction : The "2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes" incorporates new evidence since the "2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction" and the corresponding "2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes" and the "2015 ACC/AHA/SCAI Focused Update on Primary Percutaneous Coronary Intervention for Patients With ST-Elevation Myocardial Infarction." The "2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes" and the "2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization" retire and replace, respectively, the "2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease."
Méthode : A comprehensive literature search was conducted from July 2023 to April 2024. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline.
Conclusion : Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.
Conclusion (proposition de traduction) : De nombreuses recommandations issues de lignes directrices publiées antérieurement ont été mises à jour à la lumière de nouvelles données, et de nouvelles recommandations ont été créées lorsqu'elles étaient étayées par des données publiées.
Commentaire : Cette mise à jour des recommandations intègre les dernières données concernant la prise en charge des syndromes coronariens aigus (SCA), y compris les infarctus du myocarde avec ou sans élévation du segment ST. Elle aborde les stratégies de traitement pharmacologique, les indications pour les interventions invasives, et les considérations spécifiques pour les soins en phase aiguë.
Is Topical Tranexamic Acid Effective in Treating Epistaxis?.
Munroe KM, Sowerby LJ, Chin CJ. | Laryngoscope. 2025 Feb;135(2):488-490
DOI: https://doi.org/10.1002/lary.31900
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Keywords: Aucun
Best practice
Editorial : L'acide tranexamique topique peut être utilisé dans le traitement de l'épistaxis. Nous avons examiné les preuves de cette utilisation et avons constaté, sur la base de la littérature actuelle, qu'il peut être utilisé comme traitement complémentaire dans la prise en charge de l'épistaxis.
Conclusion : Review of relevant literature suggests that topical TXA could potentially be a useful adjunct in the management of anterior epistaxis. However, the current evidence is somewhat flawed and multiple limitations have been identified. Further study is warranted to ascer- tain the role of topical TXA in the management of epistaxis.
Conclusion (proposition de traduction) : L'examen de la littérature pertinente suggère que l'acide tranexamique en traitement local pourrait potentiellement être un complément utile dans la prise en charge de l'épistaxis antérieur. Cependant, les preuves actuelles sont quelque peu lacunaires et de multiples limites ont été identifiées. D'autres études sont nécessaires pour déterminer le rôle de l'acide tranexamique en traitement local dans la prise en charge de l'épistaxis. Les preuves de cette revue comprennent quatre essais contrôlés randomisés (niveau 1) et une revue systématique et une méta-analyse (niveau 1).
Commentaire : Les études n’ont pas comparé les mêmes utilisations. Toutefois, il semble que l'acide tranexamique en tamponnement local (tampon imbibé de 1000 mg d'acide tranexamique) associé à la compression nasale est aussi efficace que le tamponnement nasal par Merocel dans l'épistaxis antérieure et pourrait diminuer la durée de séjour aux urgences, surtout chez les patient traités par un AAP, notamment dans les dix premières minutes.
Références complémentaires choisies.
1. Prise en charge des épistaxis de l’adulte. Recommandation pour la pratique clinique. Société Française d’Oto-Rhino-Laryngologie et de Chirurgie de la Face et du Cou. Juin 2017.
2. Joseph J, Martinez-Devesa P and al. Tranexamic acid for patients with nasal haemorrhage (epistaxis). Cochrane Database Syst Rev. 2018 Dec 31;12(12):CD004328.
3. Arikan C, Akyol PY. Appropriate dose of tranexamic acid in the topical treatment of anterior epistaxis, 500 mg vs 1000 mg: A double-blind randomized controlled trial. Sci Prog. 2024 Oct-Dec;107(4):368504241264993.
Comparison of supination/flexion maneuver to hyperpronation maneuver in the reduction of radial head subluxations: A randomized clinical trial.
İşlek OM, Ademoğlu E, Eroğlu SE, Satıcı MO, Özdemir S. | Am J Emerg Med. 2025 Feb;88:29-33
DOI: https://doi.org/10.1016/j.ajem.2024.11.026
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Keywords: Emergency medicine; Hyperpronation; Nursemaid's elbow; Pediatric; Pulled elbow; Radial head subluxation; Supination-flexion.
Article
Introduction : This randomized controlled trial aimed to compare the effectiveness of supination/flexion (SF) and hyperpronation (HP) maneuvers in the management of radial head subluxation (RHS) in children ≤6 years old presenting to the emergency department.
Méthode : Patients were randomly allocated to one of two treatment arms. Following the application of the respective reduction maneuver, maneuver success was assessed after 10 min. If unsuccessful, the maneuver was repeated up to three times. Patients failing to achieve reduction after three attempts were classified as experiencing ultimate failure. Treatment failure rates were compared between groups for each reduction attempt. Additionally, procedural pain, side effects, and recurrence within 72 h were compared between treatment groups.
Résultats : In this study involving 119 patients, first attempt failure rates were 9.8 % in the HP group and 24.2 % in the SF group, indicating a statistically significant advantage for HP (Risk ratio 0.41 (95 % confidence interval 0.19 to 0.98)). No statistically significant differences were observed between groups regarding second-attempt success, ultimate failure, procedural pain, side effects, or recurrence rates within 72 h.
Conclusion : Among children ≤6 years old presenting with RHS, the HP maneuver demonstrated significantly superior first-attempt success rates compared to SF. Therefore, we recommend the HP maneuver as the preferred initial treatment option for managing these patients.
Conclusion (proposition de traduction) : Chez les enfants de 6 ans et moins présentant une subluxation de la tête, la manœuvre d'hyperpronation a permis d'obtenir des taux de réussite à la première tentative significativement supérieurs à ceux de la manœuvre de supination/flexion. Par conséquent, nous recommandons la manœuvre d'hyperpronation comme option de traitement initial à privilégier pour la prise en charge de ces patients.
Association of fluoroquinolones with the risk of spontaneous pneumothorax: nationwide case-time-control study.
Bénard-Laribière A, Pambrun E, Kouzan S, Faillie JL, Bezin J, Pariente A. | Thorax. 2025 Feb 17;80(3):159-166
DOI: https://doi.org/10.1136/thorax-2024-221779
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Keywords: Connective tissue disease associated lung disease; Drug induced Lung Disease.
Original research
Introduction : Fluoroquinolones can cause severe collagen-associated adverse effects, potentially impacting the pulmonary connective tissue. We investigated the association between fluoroquinolones and spontaneous pneumothorax.
Méthode : A case-time-control study was performed using the nationwide French reimbursement healthcare system database (SNDS). Cases were adults ≥18 years admitted for spontaneous pneumothorax between 2017 and 2022. For each case, fluoroquinolone use was compared between the risk period immediately preceding the admission date (days -30 to -1), and three earlier reference periods (days -180 to -151, -150 to -121, -120 to -91), adjusting for time-varying confounders. OR estimates were corrected for potential exposure-trend bias using a reference group without the event (matched on age, sex, chronic obstructive pulmonary disease history, calendar time). Amoxicillin use was studied similarly to control for indication bias.
Résultats : Of the 246 pneumothorax cases exposed to fluoroquinolones (63.8% men; mean age, 43.0±18.4 years), 63 were exposed in the 30-day risk period preceding pneumothorax and 128 in the reference periods. Of the 3316 amoxicillin cases (72.9% men; mean age, 39.4±17.6 years), 1210 were exposed in the 30-day risk period and 1603 in the reference ones. OR adjusted for exposure-trend and covariates was 1.59 (95% CI 1.14 to 2.22) for fluoroquinolones and 2.25 (2.07 to 2.45) for amoxicillin.
Conclusion : An increased risk of spontaneous pneumothorax was associated with both fluoroquinolone and amoxicillin use, with an even higher association for amoxicillin. This strongly suggests the role of the underlying infections rather than a causal effect of the individual antibiotics and can be considered reassuring regarding a potential lung connective toxicity of fluoroquinolones.
Conclusion (proposition de traduction) : Un risque accru de pneumothorax spontané a été associé à la fois à l'utilisation de fluoroquinolones et d'amoxicilline, avec une association encore plus forte pour l'amoxicilline. Cela suggère fortement le rôle des infections sous-jacentes plutôt qu'un effet causal des antibiotiques individuels et peut être considéré comme rassurant en ce qui concerne une toxicité potentielle des fluoroquinolones pour le tissu conjonctif pulmonaire.