Publications of Vincenzo D'ORIO
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See detailGestion des admission aux urgences durant la pandémie de COVID-19 au sein du CHU de Liège : Apport d'un centre de tri avancé
GILBERT, Allison ULiege; PIAZZA, Justine ULiege; SZECEL, Julien ULiege et al

in Revue Médicale de Liège (2020), 75(Supplement), 11-17

résumé : La pandémie de COVID-19 a débuté au mois de mars 2020 sur le territoire belge. Elle a contraint nos institu- tions hospitalières à une série de réorganisations singulières soutenues par ... [more ▼]

résumé : La pandémie de COVID-19 a débuté au mois de mars 2020 sur le territoire belge. Elle a contraint nos institu- tions hospitalières à une série de réorganisations singulières soutenues par l’activation du Plan d’Urgence Hospitalier. Cet article a pour objet de décrire l’expérience du Centre Hospitalier Universitaire de Liège (CHU de Liège) durant la pandémie de COVID-19 et de relater l’efficience de la mise en place d’un centre de tri avancé en amont des services d’urgences pour la gestion des admissions hospitalières. Méthodes : dès le 2 Mars 2020, le CHU de Liège a mis en place une infrastructure d’accueil des patients suspects d’infection par le SARS-CoV-2. D’abord initiée au sein de l’institution hospitalière, la nécessité d’une infrastructure indépendante s’est rapidement révélée indispensable et a, dès lors, vu le jour dès la fin du mois de mars, sur les deux sites hospitaliers universitaires. Du 2 mars au 3 mai 2020, l’ensemble des données relatives aux visites au sein des centres de tri avancé ont été collectées (nombre d’ad- missions, motif des visites, examens complémentaires et évolutions cliniques). Résultats : sur la période de l’étude, 3.094 patients ont transité par les centres de tri du CHU de Liège. Cette fréquentation était constituée d’un volume global de 3.431 contacts dont 337 représentaient des réad- missions. La sensibilité et la spécificité des centres de tri en regard de la nécessité d’une hospitalisation étaient, respectivement, de 87,9 % et 93,4 %. Conclusion : notre expérience suggère une efficience optimale des centres de tri avancé, en amont des structures hospitalières tradi- tionnelles, pour orienter de manière appropriée le flux des patients suspects d’infection par le SARS-CoV-2. [less ▲]

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See detailCOVID-19 pneumonia and acute pulmonary embolism: a case report
SZECEL, Julien ULiege; GILBERT, Allison ULiege; GHUYSEN, Alexandre ULiege et al

in International Journal of Medical Reviews and Case Reports (2020)

Since December 2019, a novel coronavirus (SARS-Cov2) disease emerged in China with the evidence of multiple cases of severe pneumonia. Since then, various clinical findings and complications related to ... [more ▼]

Since December 2019, a novel coronavirus (SARS-Cov2) disease emerged in China with the evidence of multiple cases of severe pneumonia. Since then, various clinical findings and complications related to that infection have been described. Recently, studies reported various cases of thrombotic events complicating SARS-Cov2 infections. Particularly, the incidence of pulmonary embolism appears to be higher in patients with the novel coronavirus disease. In the presence of clinical and/or biological evocative findings, pulmonary embolism has to be excluded. Recent arguments tend to prone thromboprophylaxis early in specific populations. [less ▲]

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See detailSALOMON, un modèle coopératif entre la première et la seconde ligne de soins pour les appels d'urgence nocturnes
BRASSEUR, Edmond ULiege; GILBERT, Allison ULiege; Servotte, Jean-Christophe ULiege et al

in Revue Médicale de Liège (2020), 75(2), 83-88

L’objectif de notre étude est d’apporter une réponse originale à la problématique de la permanence médicale de première ligne liée au vieillissement médical et à la charge de travail croissante. Nous ... [more ▼]

L’objectif de notre étude est d’apporter une réponse originale à la problématique de la permanence médicale de première ligne liée au vieillissement médical et à la charge de travail croissante. Nous proposons, à cet effet, la mise en place d’une interface de régulation des appels en période critique (nuit profonde) au moyen d’un outil algorithmique original dénommé SALOMON («Sys- tème Algorithmique Liégeois d’Orientation pour la Méde- cine Omnipraticienne Nocturne»). En fonction du degré de gravité supputé, la plateforme propose l’orientation opti- male du patient parmi quatre options possibles : renvoi de la demande vers le centre d’appel unifié 112 et prise en charge par les moyens de l’Aide Médicale Urgente (AMU), orientation du malade vers un service d’urgence spécialisé (SUS) de son choix pour une Mise Au Point Hospitalière (MAPH), mise en Contact avec le Médecin Généraliste de garde (CMG) ou enfin prise en charge par une Visite Diffé- rée (VD) via le médecin de famille. Après une description de l’outil, nous présentons l’étude de faisabilité qui a porté sur une période de 12 mois. Cette étude préliminaire était destinée à vérifier la robustesse de SALOMON avant de prévoir, le cas échéant, sa diffusion au sein d’une zone plus vaste. Les résultats préliminaires suggèrent une grande fiabilité de SALOMON. Nous avons également observé que son utilisation était associée à un réel état de satis- faction de l’ensemble des acteurs impliqués, qu’ils aient été infirmiers dispatcheurs ou médecins généralistes. Sous réserve d’une étude à plus grande échelle, les bénéfices actuellement notés en matière d’épargne de ressources humaines durant la garde de première ligne ont rapidement entraîné la fusion de deux zones de garde. [less ▲]

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See detailLe cas clinique du mois. Complication hémorragique d’une forme sévère de maladie de moyamoya
ANGELOZZI, Valeria ULiege; GERMAY, Caroline ULiege; GILBERT, Allison ULiege et al

in Revue Médicale de Liège (2020), 75(2), 75-77

La maladie de moyamoya est une vasculopathie cérébrale souvent méconnue. Sa découverte est majoritairement brutale dans les suites de la survenue d’un accident vasculaire ischémique ou, dans certains cas ... [more ▼]

La maladie de moyamoya est une vasculopathie cérébrale souvent méconnue. Sa découverte est majoritairement brutale dans les suites de la survenue d’un accident vasculaire ischémique ou, dans certains cas, hémorragique. L’artériographie est l’examen de choix pour confirmer le diagnostic. Différentes approches thérapeutiques ont été proposées, qu’elles soient médicamenteuses, endoscopiques ou chirurgicales. Nous présentons le cas d’une jeune patiente chez qui un diagnostic de maladie de moyamoya a été posé dans le décours d’une hémorragie cérébrale avec altération rapide de l’état de conscience. [less ▲]

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See detailNouvelle approche de régulation de la demande de soins non planifiés: l'application interactive d'auto-triage ODISSEE
GILBERT, Allison ULiege; BRASSEUR, Edmond ULiege; GHUYSEN, Alexandre ULiege et al

in Revue Médicale de Liège (2020)

La régulation de la demande de soins non planifiés fait partie des approches envisagées pour obtenir une meilleure répartition de la demande de soins parmi les différents intervenants de la santé. En ... [more ▼]

La régulation de la demande de soins non planifiés fait partie des approches envisagées pour obtenir une meilleure répartition de la demande de soins parmi les différents intervenants de la santé. En effet, tant la première ligne de soins que les services d’urgence font face à des flux de patients conséquents, saturant fréquemment les ressources qu’ils possèdent pour y répondre. L’apparition de nouvelles technologies et l’entrée dans la pratique courante de la diffusion de l’information médicale se sont révélées être des précurseurs de nouvelles stratégies adaptatives, mais également de nouveaux défis quotidiens. La création d’une application interactive permettant l’auto-triage du patient vers la ligne de soins la plus appropriée fait intervenir ces différents concepts. Nous avons donc développé une plateforme interactive, l’application ODISSEE (Outil Décisionnel et Informatif des Structures de Soins Efficientes Existantes), permettant au patient d’autoévaluer la gravité de son problème et de bénéficier d’un conseil avisé sur le niveau de soins à envisager. Les protocoles utilisés sont directement issus d’un outil créé précédemment dans notre institution et ayant fait ses preuves durant 5 années d’utilisation, l’outil SALOMON (Système Algorithmique Liégeois d’Orientation pour la Médecine Omnipraticienne Nocturne). La création d’un système interactif d’auto-triage du patient le guidant vers le niveau de soins le plus approprié pourrait être une méthode prometteuse pour la régulation de la demande de soins non planifiés. [less ▲]

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See detailImmersion in an emergency department triage center during the Covid-19 outbreak: first report of the Liège University hospital experience
GILBERT, Allison ULiege; BRASSEUR, Edmond ULiege; PETIT, Meredith ULiege et al

in Acta Clinica Belgica (2020)

Objectives: Since the beginning of the novel coronavirus outbreak, different strategies have been explored to stem the spread of the disease and appropriately manage patient flow. Triage, an effective ... [more ▼]

Objectives: Since the beginning of the novel coronavirus outbreak, different strategies have been explored to stem the spread of the disease and appropriately manage patient flow. Triage, an effective solution proposed in disaster medicine, also works well to manage Emergency Department (ED) flow. The aim of this study was to describe the role of an ED Triage Center for patients with suspected novel coronavirus disease (Covid-19) and character- ize the patient flow. Methods: In March 2020, we established a Covid-19 triage center close to the Liège University EDs. From March 2 to March 23, we planned to analyze the specific flow of patients admitted to this triage zone and their characteristics in terms of inner specificities, work-up and manage- ment. During this period, all patients presented to the ED with symptoms suggestive of Covid- 19 were included in the study. Results: A total amount of 1071 patients presented to the triage center during the study period. 41.50% of the patients presented with flu-like symptoms. In 82.00% of the cases, no risk factor of virus transmission was found. The SARS-Cov2 positive patients represented 29.26% of the screened patients. 83.00% of patients were discharged home while 17.00% were admitted to the hospital. Conclusion: Our experience suggests that triage centers for the assessment and management of Covid-19 suspected patients is an essential key strategy to prevent the spread of the disease among non-symptomatic patients who present to the EDs for care. This allows for a disease- centered work-up and safer diversion of Covid-19 patients to specific hospital units. [less ▲]

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See detailEmergency Department Crowding: why do patients walk-in?
BRASSEUR, Edmond ULiege; GILBERT, Allison ULiege; Servotte, Jean-Christophe ULiege et al

in Acta Clinica Belgica (2019)

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See detailErythema ab igne and its association with cannabinoid hyperemesis syndrome : a case report
Sime Sidieu, Delphine; GILBERT, Allison ULiege; BRASSEUR, Edmond ULiege et al

in International Journal of Medical Reviews and Case Reports (2019)

The erythema ab igne is an uncommon skin disorder related to repeated heat exposure such as open fires or heating pads. Cannabinoid hyperemesis syndrome is an entity including several symptoms such as ... [more ▼]

The erythema ab igne is an uncommon skin disorder related to repeated heat exposure such as open fires or heating pads. Cannabinoid hyperemesis syndrome is an entity including several symptoms such as nausea, vomiting or frequent abdominal pain following marijuana use. Most of those symptoms can be relieved by hot showering or baths. Recently in the literature, erythema ab igne has been associated with cannabinoid hyperemesis syndrome because cannabis users tend to resort to heating pads to relieve persistent abdominal pain. We report the case of a patient with recurrent vomiting and abdominal pain attributed to cannabinoid hyperemesis syndrome, whose physical examination revealed an erythema ab igne. [less ▲]

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See detailParsonage-Turner Syndrome as a rare extra hepatic complication of hepatitis E infection
Ngah Njabom, Claude Bérenger ULiege; GILBERT, Allison ULiege; BRASSEUR, Edmond ULiege et al

in European Journal of Case Reports in Internal Medicine (2019)

Parsonage-Turner syndrome, also known as neuralgic amyotrophy, is a rare disorder characterized by painful clinical manifestations mainly involving the upper limbs. This syndrome seems to be triggered ... [more ▼]

Parsonage-Turner syndrome, also known as neuralgic amyotrophy, is a rare disorder characterized by painful clinical manifestations mainly involving the upper limbs. This syndrome seems to be triggered, among other factors, by some viral infections, although its pathophysiology remains unclear. Moreover, it has rarely been related to hepatitis E virus infection. We report the case of a 33-year-old man who was diagnosed with Parsonage-Turner syndrome following acute hepatitis E infection. [less ▲]

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See detailTriage for out-of-hours primary care calls: a reliability study of a new French-language algorithm, the SALOMON rule
BRASSEUR, Edmond ULiege; Servotte, Jean-Christophe ULiege; Donneau, Anne-Françoise ULiege et al

in Scandinavian Journal of Primary Health Care (2019)

Introduction: Triage systems for out-of-hours primary care physician (PCP) calls have been implemented empirically but no triage algorithm has been validated to date. A triage algorithm named SALOMON ... [more ▼]

Introduction: Triage systems for out-of-hours primary care physician (PCP) calls have been implemented empirically but no triage algorithm has been validated to date. A triage algorithm named SALOMON (Syst eme Algorithmique Li egeois d’Orientation pour la M edecine Omnipraticienne Nocturne) was developed to guide triage nurses. This study assessed the performance of the algorithm using simulated PCP calls. Methods: Ten nurses were involved in 130 simulated PCP call scenarios, allowing the determination of SALOMON’s inter-rater agreement by comparing the actual choices of a specific triage flowchart and the level of care selected as compared with reference assignments. Intra-rater agreement was estimated by comparing triage after training (T1) and 3 to 6 months after SALOMON use in clinical practice (T2). Results: Overall selection of flowcharts was accurate for 94 .1% of scenarios at T1 and 98.7% at T2. Level of triage was adequate for 93.4% of scenarios at T1 and 98.5% at T2. Both flowchart and triage level accuracy improved significantly from T1 to T2 (p<0.0001). SALOMON algorithm use is associated with a 0.97/0.99 sensitivity and 0.97/0.99 specificity, at T1/T2 respectively. Conclusions: Results revealed that using the SALOMON algorithm is valid for out-of-hours PCP calls triage by nurses. The criterion validity of this algorithm should be further evaluated through its implementation in a real life setting. [less ▲]

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See detailTime to Embrace Simulation in Vascular Surgical Training: Little Things Matter
Boyle, Jonathan Robert; Ghuysen, Alexandre ULiege; D'Orio, Vincenzo ULiege et al

in European Journal of Vascular and Endovascular Surgery (2019), 58(2), 161-162

[No abstract available]

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See detailImpact of a prehospital discrimination between trauma patients with or without early acute coagulopathy of trauma and the need for damage control resuscitation: rationale and design of a multicenter randomized phase II trial.
TONGLET, Martin ULiege; D'ORIO, Vincenzo ULiege; MOENS, Didier ULiege et al

in Acta Chirurgica Belgica (2019)

BACKGROUND: The evidence of the Trauma Induced Coagulopathy Clinical Score (TICCS) accuracy has been evaluated in several studies but the potential effect of its use on patient outcomes needs to be ... [more ▼]

BACKGROUND: The evidence of the Trauma Induced Coagulopathy Clinical Score (TICCS) accuracy has been evaluated in several studies but the potential effect of its use on patient outcomes needs to be evaluated. The primary objective of this study is to evaluate the impact on mortality of a prehospital discrimination between trauma patients with or without a potential need for damage control resuscitation. METHODS: The trial will be designed as randomized phase II clinical trial with comparison of the experimental protocol against the standard of care. The TICCS will be calculated on the site of injury for the patients of the intervention group and treatment will be guided by the TICCS value. Seven days mortality, 30 days mortality, global use of blood products and global hospital length-of-stay will be compared. DISCUSSION: Many data suggest that a very early flagging of trauma patients in need for DCR would be beneficial but this need to be proved. Do we improve our quality of care by an earlier diagnosis? Does a prehospital discrimination between trauma patients with or without a potential need for DCR has a positive impact? [less ▲]

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See detailThromboelastometry in trauma care: a place in the 2018 Belgian health care system?
TONGLET, Martin ULiege; Poplavsky, Jean Louis; SEIDEL, Laurence ULiege et al

in Acta Clinica Belgica (2018)

Introduction Evidence supporting the use of Thromboelastography (TEG®) and rotational thromboelastometric (ROTEM®) in the trauma setting remains limited. We present the results of a practical evaluation ... [more ▼]

Introduction Evidence supporting the use of Thromboelastography (TEG®) and rotational thromboelastometric (ROTEM®) in the trauma setting remains limited. We present the results of a practical evaluation of the potential interest of ROTEM® in the diagnosis of acute coagulopathy and the need for emergent blood product transfusion in the general trauma population of a non-trauma Belgian emergency department. Methods Extracting a convenience cohort from the initial prospective TICCS study, we performed a retrospective analysis to test the following hypothesis: ROTEM® might be helpful to discriminate trauma patients with or without acute coagulopathy. Fifty patients were included and ROTEM® results were compared to conventional coagulation tests results, blood transfusion need and outcome. Results With a negative predictive value of 97.6% and a positive predictive value of 42.9%, a strictly normal ROTEM® profile at the time of admission seems to be able to exclude the presence of acute coagulopathy. ROTEM® also seems to be accurate in identifying patients without the need for emergent blood product transfusions. Conclusion In a population of trauma patients of a Belgian general emergency department, a strictly normal coagulation profile evaluated by ROTEM® at hospital entry is associated with a normal coagulation profile evaluated by INR and fibrinogen levels and the absence of any indication of blood product transfusion. ROTEM® may be useful for preselection of trauma patients at risk for coagulopathy within the global trauma population. This, however, would need confirmation in further investigations. [less ▲]

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See detailLes urgences cardiaques et vasculaires : du diagnostic au traitement.
Scheen, André ULiege; Lancellotti, Patrizio ULiege; Defraigne, Jean-Olivier ULiege et al

in Revue Médicale de Liège (2018), 73(5-6), 221-223

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See detailLe triage infirmier avancé aux Urgences
Jobe, Jérôme ULiege; Ghuysen, Alexandre ULiege; D'ORIO, Vincenzo ULiege

in Revue Médicale de Liège (2018), 73(5-6), 229-236

To cope with overcrowding, a consequence of their constant growth, emergency departments have implemented operational strategies based on triage systems. Despite its interest, nurse triage has been ... [more ▼]

To cope with overcrowding, a consequence of their constant growth, emergency departments have implemented operational strategies based on triage systems. Despite its interest, nurse triage has been limited by several hindrances, and new strategies are emerging. Among those, advanced nurse triage, allowing a nurse to initiate the diagnostic process just after categorization of the patient, seems to be promising. A study on advanced nurse triage for patients presenting with chest pain has been conducted in the emergency department of the CHU of Liège. The encouraging results obtained following this new system demonstrate a reduction of the delay to management of patients, and a reduction of the total length of stay in the emergency unit mainly during overcrowding periods. Advanced nurse triage, in addition to a conventional triage during overcrowding periods, improves management of patients in terms of time and reduces the total time spent in the emergency department. © 2018 Revue Medicale de Liege. All rights reserved. [less ▲]

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