This study found a high diagnostic accuracy and a faster time to result of B·R·A·H·M·S PCT direct in the ED setting, allowing shortening time to therapy and a more wide-spread use of PCT.

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ObjectivesWe aimed to compare the use of nine different cardiac troponin (cTn) assays (2 cTnT and 7 cTnI) for the diagnosis of NSTEMI in a single multi-centre population.Design and methodsOne hundred and fifty-eight patients were included (mean age 60 years, SD 17 years), including 23 patients (14%) with NSTEMI.ResultsThe analytical comparison highlighted a large heterogeneity of cTn assays, as reflected by percentages of patients with detectable cTn, correlation coefficients, Passing-Bablok comparisons and concordance coefficients. Correlations within cTnI assays were good and correlation within cTnT assays was excellent. Diagnostic performances demonstrated that each cTn assay has specific threshold values. Furthermore, some assays (HS-cTnI and T, cTnI-Pathfast and cTnI-Centaur) indicated high sensitivity and negative predictive value using the limit of detection (LoD) diagnostic strategy. For the latter assays, a significant increase in specificity was found when using the 99th percentile or the H0-H3 strategies, in comparison to the LoD strategy. When applying the European Society of Cardiology H0-H3 algorithm, comparable diagnostic performances were obtained.ConclusionAll 9 cTn assays indicated overall good diagnostic performances for the diagnosis of NSTEMI in emergency departments when the recommended algorithm based on the variation of cTn value between two measurements at admission and 3 h later was used.

Évolution dans la prise en charge des accidents hémorragiques liés aux antivitamines K et traités par du concentré de complexes prothrombiniques : la gestion du traitement médicamenteux par les urgentistes s'est-elle améliorée au fil du temps ?Has the management of bleeding related to VKA, and treated with prothrombin complex concentrate, improved over time in emergency departments?Abstract Aims: Bleeding is a serious and potentially fatal complication of VKA, and represents in France, the main cause of hospitalisations for severe iatrogenic accidents. The aim of our study was to assess the compliance of the French guidelines for the management of patients, treated with prothrombin complex concentrate (PCC) for severe hemorrhage associated with VKA, over time in emergency departments (ED). Procedure: This was a two-center observational and retrospective study. Patients who consulted in the ED in 2006, 2009 and 2012 for severe bleeding due to VKA, and who underwent reversal with PCC (centralized orders from the pharmacy), were included. Results: A total of 58 patients met the inclusion criteria. The mean age was 77 years. The leading cause of oral anticoagulation was atrial fibrillation. The main sites of bleeding were abdominal (37%) and intracranial (19%). The average time for PCC prescription was estimated to 146 minutes without any significant change over the time (138 in 2006, concomitantly with PCC in 40 of the 58 included patients (43% in 2006, 80% in 2009 and 68% in 2012). Conclusion: Our results showed no improvement for the management of severe hemorrhage in VKA treated patients over time.