CP098 - Dyspnée aiguë en pré-hospitalier : Impact de la qualité du diagnostic et de la prise en charge thérapeutique en urgence sur le pronostic: Résultats préliminaires de PARADISE study ?PAthwAy of Dyspneic patIent in Emergency?

Tahar CHOUIHED (1, 2), Yann DELORME (3), Baptiste AGULLES (3), Adrien BASSAND (3), Aurélien BUESSLER (4), Julien JABBOUR (3), Nicolas GIRERD (2)

1. SAMU et Service d'Urgence, CHRU Nancy, Nancy, France 2. CIC-Plurithématique 1433, CHRU Nancy - Institut Louis Mathieu, Nancy, France 3. SAMU-SMUR-SAU Nancy, CHRU Nancy - Hôpital Central, Nancy, France 4. SAMU et Service d'Urgence, CHU Nancy, Nancy, France

Diffusion le 11/05/2017

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Introduction : La dyspnée aiguë non traumatique est un motif fréquent d’appel au Service d’Aide Médicale d’Urgence (SAMU). Les étiologies les plus fréquentes sont : les syndromes d’insuffisance cardiaque aiguë (SICA), l’exacerbation aiguë de BPCO, la pneumopathie et l’embolie pulmonaire. Ce travail souhaite évaluer la mortalité intra-hospitalière des patients pris en charge pour dyspnée aiguë en pré-hospitalier et en fonction du diagnostic porté en pré-hospitalier. Les objectifs secondaires : comparer les caractéristiques cliniques en fonction du diagnostic final et étudier la concordance entre les diagnostics pré-hospitalier et finaux ainsi que la qualité du traitement initié en pré-hospitalier et ces conséquences sur le pronostic.

Matériel et méthode : étude observationnelle rétrospective mono-centrique dans un CHRU sur 2014 et 2015. Les critères d’inclusion : âge > 18 ans, dyspnée aiguë et une prise en charge pré-hospitalière par le SMUR. Les malades étaient répartis en 2 bras : « syndrome insuffisance cardiaque aiguë » (SICA) ou « non syndrome d’insuffisance cardiaque aiguë » (non SICA) sur la base des diagnostics pré-hospitaliers et finaux. CIL: R2016-08 et « clinicaltrials.gov » NCT02800122.

Résultats : 823 premiers patients saisis. Age moyen 79 ans. Le sex-ratio est de 1,38. La mortalité globale intra-hospitalière est de 14.6 % ; pour les SICA final : 8.6% et pour les non SICA final : 16.6 %, (p=0.016). La concordance entre les diagnostics pré-hospitalier et finaux fixait un coefficient Kappa à 0.48 (0.40 – 0.56 ; IC 95 %). Les caractéristiques cliniques révélaient pour les SICA et non SICA, une moyenne de SpO2 de 92% contre 95% (p=0.016), une PAS moyenne de 159 mm Hg contre 142 (p=0.007). On observe une baisse de 5,1 % de la mortalité quand la prise en charge thérapeutique pré-hospitalière est appropriée. Après les urgences, 40 % sont hospitalisés en surveillance continue, quand 10 % regagnent leurs domiciles.

Discussion et Conclusion : la dyspnée aiguë est un symptôme grave dont la mortalité intra-hospitalière toutes causes est élevée (14,6%). La concordance entre diagnostics pré- hospitaliers et finaux était en faveur d’un accord modéré montrant les difficultés diagnostiques face à une dyspnée aigue. Le diagnostic pré-hospitalier est souvent erroné et nécessite de développer d’autres outils diagnostics (Echo. Pulm. ou BNP pré-hospitalier) afin de pouvoir initier le traitement plus rapidement qui permettrait d’améliorer le pronostic des patients.

Tags : Dyspnée Pré-hospitalier Insuffisance Cardiaque Diagnostics Traitements.

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/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Controller/Router/Route/Static.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Date.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Date/DateObject.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Db.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Db/Adapter/Abstract.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Db/Adapter/Pdo/Abstract.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Db/Adapter/Pdo/Mysql.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Db/Expr.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Db/Profiler.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Db/Select.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Db/Statement.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Db/Statement/Interface.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Db/Statement/Pdo.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Db/Table.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Db/Table/Abstract.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Db/Table/Definition.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Exception.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Filter.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Filter/Inflector.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Filter/Interface.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Filter/PregReplace.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Filter/StringToLower.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Filter/Word/CamelCaseToDash.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Filter/Word/CamelCaseToSeparator.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Filter/Word/Separator/Abstract.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Filter/Word/SeparatorToSeparator.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Filter/Word/UnderscoreToSeparator.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Layout.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Layout/Controller/Action/Helper/Layout.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Layout/Controller/Plugin/Layout.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Loader.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Loader/Autoloader.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Loader/PluginLoader.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Loader/PluginLoader/Interface.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Locale.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Locale/Data.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Locale/Format.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Locale/Math.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Log.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Log/FactoryInterface.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Log/Filter/Abstract.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Log/Filter/Interface.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Log/Filter/Priority.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Log/Writer/Abstract.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Registry.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Session.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Session/Abstract.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Session/Exception.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Session/Namespace.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Session/SaveHandler/Interface.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Uri.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Version.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Abstract.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Abstract.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Doctype.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/HeadMeta.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/HeadTitle.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Interface.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Layout.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Placeholder/Container.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Placeholder/Container/Abstract.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Placeholder/Container/Standalone.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Placeholder/Registry.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Url.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Interface.php

ZFDebug Files

/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/Cache.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/Database.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/Exception.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/File.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/Interface.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/Log.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/Log/Writer.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/Text.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/Variables.php