Embargo: 00.01 hrs CEST on Sunday 17 September 2023

Barcelona, Spain: Half of patients discharged from the emergency department need only five tablets or fewer of morphine 5 mg or an equivalent opioid pain killer, according to new research presented at the European Emergency Medicine Congress today (Sunday).

The recent crisis in opioid abuse has been partly attributed to over-prescription, particularly for chronic pain, and doctors have become cautious about giving these drugs to patients.

However, researchers say it is vital that patients are given sufficient medication to help them recover from pain and injury, and the new study will help emergency medicine doctors to get the balance right.

The research was presented by Professor Raoul Daoust, from the University of Montreal, Canada. He said: “Opioids such as morphine can be very beneficial for patients suffering acute pain, for example when they have injured their neck or broken a bone. However, patients are often prescribed too many opioid tablets and that means unused tablets are available for misuse. On the other hand, since the opioid crisis, the tendency in the USA is to not prescribe opioids at all, leaving some patient in agonising pain.

“With this research I wanted to provide a tailored approach to prescribing opioids so that patients have enough to manage their pain but almost no unused tablets available for misuse.”

Professor Daoust and his colleagues recruited 2,240 adult patients who were treated at one of six hospital emergency departments in Canada for a condition that causes acute pain. All were discharged with an opioid prescription and were asked to complete a pain medication diary for the following two weeks.

Overall, half of patients took five morphine tablets (5mg) or fewer. However, the number of tablets that would be enough for most patients for two weeks varied greatly according to the patient’s painful condition. For example, patients suffering from renal colic or abdominal pain needed only eight tablets and patient with broken bones needed 24 tablets.

Professor Daoust said: “We found that, in general, patients consume few opioids, but this varies depending on the type of painful condition. Our findings make it possible to adapt the quantity of opioids we prescribe according to patient need. We could ask the pharmacist to also provide opioids in small portions, such as five tablets initially, because for half of patients that would be enough to last them for two weeks.”

The researchers now hope to apply their results in the clinic to evaluate whether they have an impact on long-term use and misuse of opioids.

Professor Youri Yordanov from the St Antoine Hospital emergency department (APHP Paris), France, is Chair of the EUSEM 2023 abstract committee and was not involved in the research. He said: “It’s estimated that millions of people around the world are struggling with opioid addiction and more than 100,000 people die of opioid overdose every year. These drugs play an important role in emergency medicine, but we need to ensure they are prescribed wisely.

“This study shows how opioid prescriptions could be adapted to specific acute pain conditions, and how they could be dispensed in relatively small numbers at the pharmacy to lower the chance of misuse. This research could provide a safer way to prescribe opioids that could be applied in emergency departments anywhere in the world.”

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[1] Abstract no: OA077, “Opioids for acute pain: how much to prescribe to minimize unused medication? (OPUM Study)” by Raoul Daoust et al, in the All sorts of pain session, 17:26 hrs CEST, Sunday 17 September, Room 131.

Note: When obtaining outside comment, journalists are requested to ensure that their contacts are aware of the embargo on this release.

Funding: The Canadian Institutes of Health Research Fund (CIHR)

About European Society of Emergency Medicine (EUSEM)

For immediate release on Wednesday 13 September 2023

Barcelona, Spain: The artificial intelligence chatbot ChatGPT performed as well as a trained doctor in suggesting likely diagnoses for patients being assessed in emergency medicine departments, in a pilot study to be presented at the European Emergency Medicine Congress, which starts on Saturday [1].

Researchers say a lot more work is needed, but their findings suggest the technology could one day support doctors working in emergency medicine, potentially leading to shorter waiting times for patients.

The study was by Dr Hidde ten Berg, from the department of emergency medicine and Dr Steef Kurstjens, from the department of clinical chemistry and haematology, both at Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands.

Dr ten Berg told the Congress: “Like a lot of people, we have been trying out ChatGPT and we were intrigued to see how well it worked for examining some complex diagnostic cases. So, we set up a study to assess how well the chatbot worked compared to doctors with a collection of emergency medicine cases from daily practice.”

The research, which is also published this month in the Annals of Emergency Medicine [2], included anonymised details on 30 patients who were treated at Jeroen Bosch Hospital’s emergency department in 2022. The researchers entered physicians’ notes on patients’ signs, symptoms and physical examinations into two versions of ChatGPT (the free 3.5 version and the subscriber 4.0 version). They also provided the chatbot with results of lab tests, such as blood and urine analysis. For each case, they compared the shortlist of likely diagnoses generated by the chatbot to the shortlist made by emergency medicine doctors and to the patient’s correct diagnosis.

They found a large overlap (around 60%) between the shortlists generated by ChatGPT and the doctors. Doctors had the correct diagnosis within their top five likely diagnoses in 87% of the cases, compared to 97% for ChatGPT version 3.5 and 87% for version 4.0.

Dr ten Berg said: “We found that ChatGPT performed well in generating a list of likely diagnoses and suggesting the most likely option. We also found a lot of overlap with the doctors’ lists of likely diagnoses. Simply put, this indicates that ChatGPT was able suggest medical diagnoses much like a human doctor would.

“For example, we included a case of a patient presenting with joint pain that was alleviated with painkillers, but redness, joint pain and swelling always recurred. In the previous days, the patient had a fever and sore throat. A few times there was a discolouration of the fingertips. Based on the physical exam and additional tests, the doctors thought the most likely diagnosis was probably rheumatic fever, but ChatGPT was correct with its most likely diagnosis of vasculitis.

“It’s vital to remember that ChatGPT is not a medical device and there are concerns over privacy when using ChatGPT with medical data. However, there is potential here for saving time and reducing waiting times in the emergency department. The benefit of using artificial intelligence could be in supporting doctors with less experience, or it could help in spotting rare diseases.”

Professor Youri Yordanov from the St Antoine Hospital emergency department (APHP Paris), France, is Chair of the EUSEM 2023 abstract committee and was not involved in the research. He said: “We are a long way from using ChatGPT in the clinic, but it’s vital that we explore new technology and consider how it could be used to help doctors and their patients. People who need to go to the emergency department want to be seen as quickly as possible and to have their problem correctly diagnosed and treated. I look forward to more research in this area and hope that it might ultimately support the work of busy health professionals.”

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[1] Abstract no: OA66, “ChatGPT Effectively Generates Differential Diagnosis Using Emergency Department Physician Notes” by Hidde Ten Berg, in the Out-of-the-hospital and the newest technology session, 09:42 hrs CEST, Tuesday 19 September Room 131.

[2] “ChatGPT and Generating a Differential Diagnosis Early in an Emergency Department Presentation”, by H. ten Berg et al, In press, Annals of Emergency Medicine. DOI: https://doi.org/10.1016/j.annemergmed.2023.08.003

Note: When obtaining outside comment, journalists are requested to ensure that their contacts are aware of the embargo on this release.

Funding: No external funding

About European Society of Emergency Medicine (EUSEM)

We are pleased to support the European Resucitation Council's initiative for International CPR Guidelines that consider economic disparities and diverse realities; based on expert recommendations from various low-, middle-, and high resource settings.

Read the full media release here

We are pleased to announce the results of EUSEM Board Election.

We would like to congratulate Dr Robert Leach elected as President-Elect, Dr Diana Cimpoesu elected as Honorary Treasurer, Dr Niccolò Parri elected as Vice president and Dr Tatjana Rajkovic elected as Honorary Secretary.

The newly elected board members will take their positions following the ratification of the General Assembly on 19 September.