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A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Clinical Diagnosis and Prognosis".

Deadline for manuscript submissions: 31 December 2025 | Viewed by 6869

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Special Issue Editor

Dr. Nin-Chieh Hsu

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Guest Editor

1. Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei 10051, Taiwan
2. Division of Hospital Medicine, Department of Internal Medicine, Taipei City Hospital Zhongxing Branch, Taipei 103212, Taiwan
Interests: health policy; healthcare service; palliative care; hospital medicine; internal medicine; emergency medicine; general medicine; point-of-care ultrasound; clinical reasoning

Special Issue Information

Dear Colleagues,

We are pleased to invite you to submit your original contributions to this Special Issue “Clinical Diagnosis and Management in Emergency and Hospital Medicine”.

With the advent of new disciplines and technologies providing high-quality, high-value care for patients, we are entering a new era in emergency and hospital medicine. However, challenges to generalists persist because both emergency care and hospitalizations involve managing complex patients in diverse situations. Clinical diagnosis and management of these patients require a comprehensive process design, quality improvement, competent training and skills, and the integration of the entire healthcare system.

Although most randomized clinical trials enroll participants in emergency and inpatient settings, the primary outcomes are usually tracked outside the hospital. More research is needed to improve evidence-based practice in the field of emergency and hospital medicine so that we can improve the quality of care in the hospital. Highlighting key interventions during the early admission timeframe is necessary. Outcomes assessed during hospitalization or shortly after discharge are crucial, alongside long-term outcomes. We welcome research papers on any aspect related to this theme, including diagnosis, treatment, management, decision making, transitional care, palliative care, and quality improvement.

Dr. Nin-Chieh Hsu
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

diagnosis
treatment
management
hospital medicine
emergency medicine
point-of-care ultrasound
decision making
transitional care
palliative care
quality improvement

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Published Papers (6 papers)

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Research

Jump to: Review

16 pages, 934 KB

Open AccessArticle

Association Between Early Point-of-Care Ultrasound and Emergency Department Outcomes in Admitted Patients with Non-Traumatic Abdominal Pain: A Propensity Score-Weighted Cohort Analysis

by Meng-Feng Tsai, Fen-Wei Huang, Te-Fa Chiu, Tse-Chyuan Wong, Sheng-Yao Hung, Wei-Jun Lin and Shih-Hao Wu

Diagnostics 2025, 15(24), 3182; https://doi.org/10.3390/diagnostics15243182 - 12 Dec 2025

Viewed by 375

Abstract

Background: To evaluate the association of point-of-care ultrasound (PoCUS) performed within one hour of emergency department (ED) arrival with ED length of stay (LOS) and healthcare costs in admitted ED patients with non-traumatic abdominal pain. Methods: This retrospective, inverse probability of treatment weighting (IPTW) cohort study was conducted at a tertiary medical center in Taiwan. This study analyzed data from 2021–2023, focusing on adult patients admitted to an ordinary ward with non-traumatic abdominal pain. Patients discharged from the ED, admitted to the ICU, or receiving PoCUS > 1 h (N = 864) were excluded. The final cohort of 6866 patients comprised those receiving PoCUS within 1 h (N = 1542) and those receiving no PoCUS (N = 5324). Primary and secondary outcomes (ED LOS, costs) were adjusted for age, gender, triage, vital signs, BMI, and comorbidities using generalized linear models with a Gamma distribution. Results: After IPTW adjustment in 6866 admitted abdominal pain patients, PoCUS within one hour was associated with a 14% shorter ED LOS (RM 0.86, 95% CI 0.83–0.89). A notable finding was that PoCUS performed within one hour was associated with 44% higher odds of CT utilization (OR 1.44, 95% CI 1.25–1.65) and 5% lower total healthcare costs (RM 0.95, 95% CI 0.91–0.99). Stratification by CT use revealed distinct patterns underlying these associations: in the non-CT subgroup, PoCUS was associated with 12% lower ED costs (RM 0.88, 95% CI 0.83–0.94), whereas in the CT subgroup, it was associated with 9% lower admission costs (RM 0.91, 95% CI 0.86–0.96). Conclusions: In admitted patients, PoCUS performed within one hour was associated with shorter ED LOS and lower total costs, despite a concurrent association with higher CT utilization. These findings are consistent with a dual, context-dependent role for PoCUS: associated with reduced ED costs in non-CT pathways and lower admission costs in CT pathways. However, as this is an observational study, these results represent associations rather than causal effects and may be influenced by unmeasured confounding. Prospective trials are required to validate these findings. Full article

(This article belongs to the Special Issue Clinical Diagnosis and Management in Emergency and Hospital Medicine)

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12 pages, 915 KB

Open AccessArticle

Soluble Urokinase Plasminogen Activator Receptor (suPAR) Predicts 28-Day and 90-Day Mortality in Emergency Department Patients with Chest Pain, Dyspnoea, or Abdominal Pain

by Francesco Gavelli, Francesca Maria Giolitti, Matteo Vidali, Marta Montersino, Matteo Bertoli, Luca Molinari, Marco Baldrighi, Michela Beltrame, Pier Paolo Sainaghi, Mattia Bellan, Filippo Patrucco, Gian Carlo Avanzi and Luigi Mario Castello

Diagnostics 2025, 15(22), 2851; https://doi.org/10.3390/diagnostics15222851 - 11 Nov 2025

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Abstract

Background: Early stratification of patients at emergency department (ED) admission is crucial. The soluble urokinase plasminogen activator receptor (suPAR) has emerged as a promising biomarker to identify the worsening of different clinical conditions. We aimed at evaluating whether baseline suPAR values predict 28-day and 90-day mortality in patients presenting to the ED with different conditions. Methods: In this prospective observational study, we enrolled patients with dyspnoea (D), chest pain (CP), and abdominal pain (AP). suPAR levels, together with clinical and laboratory data, were recorded at ED admission. The data collected included 28-day and 90-day mortality data, as well as 28-day and 90-day hospital readmission; and their correlation with suPAR values was assessed. Results: We enrolled 298 consecutive patients (CP 23.8%, D 31.9%, AP 44.3%). suPAR was significantly higher in patients with dyspnoea, compared to both patients with chest and abdominal pain (5.50 [3.50–8.60], 3.20 [2.30–4.10], 3.20 [2.33–4.48] ng/mL, respectively; p < 0.001). suPAR plasmatic levels were also higher in patients admitted to semi-intensive or intensive care units compared to other patients (4.10 [3.15–8.05] vs. 3.50 [2.55–5.50] ng/mL, respectively; p = 0.049). suPAR levels were significantly higher in patients dead at 28 days than in survivors (12.65 [9.83–18.53] vs. 3.60 [2.60–5.48] ng/mL, respectively; p < 0.001). Using the stepwise logistic regression analysis, only suPAR emerged as an independent predictor of 28-day mortality with an odds ratio of 1.31 (95% CI 1.10–1.56). Conclusions: Baseline suPAR levels are an independent predictor of mortality in ED patients with chest pain, dyspnoea, or abdominal pain. Full article

(This article belongs to the Special Issue Clinical Diagnosis and Management in Emergency and Hospital Medicine)

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11 pages, 1979 KB

Open AccessArticle

Need for Routine Brain Magnetic Resonance Imaging for Unilateral Facial Palsy in Emergency Department

by Hanna Park, Youn-Jung Kim and Won Young Kim

Diagnostics 2025, 15(17), 2135; https://doi.org/10.3390/diagnostics15172135 - 24 Aug 2025

Viewed by 1241

Abstract

Objectives: The need for routine brain magnetic resonance imaging (MRI) for patients presenting with unilateral facial palsy in the emergency department (ED) is a subject of ongoing debate. This study aimed to evaluate the diagnostic yield of MRI in this population and to identify clinical risk factors associated with non-idiopathic causes, to inform selective imaging strategies. Methods: This single-center, retrospective study was conducted in the ED of a tertiary-care center in Korea. We analyzed adult patients (aged ≥ 18 years) who presented with facial palsy as the primary symptom between 1 January 2020 and 31 December 2022. Patients with other neurological abnormalities detected during the initial examination or those who did not undergo brain MRI were excluded. The primary outcome was the identification of positive MRI findings, defined as brain lesions (e.g., ischemic stroke, tumor, and hemorrhage) considered causally related to the facial palsy based on anatomical correlation and radiological interpretation. Patients were categorized into positive or negative MRI groups accordingly, and baseline characteristics were compared between the groups. Results: Among the 436 patients who underwent brain MRI, 13 (3.0%) showed positive findings such as brain tumors or stroke that led to diagnoses other than Bell’s palsy, while the remaining 423 (97.0%) were ultimately diagnosed with Bell’s palsy. The proportion of patients with a history of transient ischemic attack/stroke and malignancy was significantly higher in the group with non-idiopathic facial palsy (p = 0.02 and p < 0.001, respectively). Conclusions: In adults presenting to the ED with clinically isolated unilateral facial palsy and no other neurological signs, routine brain MRI had a low diagnostic yield (3%). A history of malignancy or prior TIA/stroke was associated with alternative diagnoses. A selective imaging strategy based on risk factors may improve diagnostic efficiency without compromising safety. Full article

(This article belongs to the Special Issue Clinical Diagnosis and Management in Emergency and Hospital Medicine)

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12 pages, 1464 KB

Open AccessArticle

Improving Prognostic Accuracy of MASCC Score with Lactate and CRP Measurements in Febrile Neutropenic Patients

by Efe Kanter, Ecem Ermete Güler, Süleyman Kırık, Tutku Duman Şahan, Melisa Buse Baygın, Emine Altınöz, Ejder Saylav Bora and Zeynep Karakaya

Diagnostics 2025, 15(15), 1922; https://doi.org/10.3390/diagnostics15151922 - 31 Jul 2025

Viewed by 1394

Abstract

Objectives: Febrile neutropenia is a common oncologic emergency with significant morbidity and mortality. Although the MASCC (Multinational Association for Supportive Care in Cancer) score is widely used for risk stratification, its limited sensitivity and lack of laboratory parameters reduce its prognostic utility. This study aimed to evaluate whether incorporating serum lactate and CRP measurements into the MASCC score enhances its predictive performance for hospital admission and the 30-day mortality. Methods: This retrospective diagnostic accuracy study included adult patients diagnosed with febrile neutropenia in the emergency department of a tertiary care hospital between January 2021 and December 2024. The original MASCC score was calculated, and three modified models were derived: the MASCC-L (lactate/MASCC), MASCC-C (CRP/MASCC) and MASCC-LC models (CRP × lactate/MASCC). The predictive accuracy for hospital admission and the 30-day all-cause mortality was assessed using ROC analysis. Results: A total of 269 patients (mean age: 67.6 ± 12.4 years) were included; the 30-day mortality was 3.0%. The MASCC-LC model demonstrated the highest discriminative ability for mortality prediction (area under the curve (AUC): 0.995; sensitivity: 100%; specificity: 98%). For hospital admission prediction, the MASCC-C model had the highest specificity (81%), while the MASCC-LC model showed the best balance of sensitivity and specificity (both 73%). All the modified models outperformed the original MASCC score regarding both endpoints. Conclusions: Integrating lactate and CRP measurements into the MASCC score significantly improves its prognostic accuracy for both mortality and hospital admission in febrile neutropenic patients. The MASCC-LC model, relying on only three objective parameters, may serve as a practical and efficient tool for early risk stratification in emergency settings. Full article

(This article belongs to the Special Issue Clinical Diagnosis and Management in Emergency and Hospital Medicine)

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12 pages, 854 KB

Open AccessArticle

Forensic Cases in the Emergency Department: Associations Between Life-Threatening Risk, Medical Treatability, and Patient Outcomes

by Harun Yildirim and Murtaza Kaya

Diagnostics 2025, 15(11), 1416; https://doi.org/10.3390/diagnostics15111416 - 2 Jun 2025

Cited by 1 | Viewed by 959

Abstract

Background: This study aimed to evaluate the clinical and forensic characteristics of cases admitted to a high-volume tertiary emergency department, focusing on severity-based classification using treatability with simple medical intervention (SMI) and life-threatening status. Methods: We retrospectively analyzed 3014 forensic cases over one year. Patients were classified based on injury severity, anatomical region, and clinical outcomes. Documentation practices and report types were also reviewed. Results: Among all the cases, 60.4% were treatable with SMI, and 10.5% were identified as life threatening. Notably, all patients who died (1.3% mortality) were in the life-threatening group, and none of the SMI-treated patients died, underscoring the accuracy of early triage and alignment between documentation and outcomes. Road traffic accidents were the leading cause of life-threatening injury and hospitalization, while assault cases were predominantly minor and managed conservatively. Seasonal variation peaked in July, and sex-based differences revealed a higher SMI eligibility among female patients. Final forensic reports were more frequently issued in SMI cases, while preliminary reports were predominant in severe trauma. Conclusions: Severity-based classification using SMI and life-threatening categories offers valuable insight for clinical decision-making and forensic documentation. Integrating structured triage, anatomical injury mapping, and standardized report templates can enhance both patient safety and legal reliability. Full article

(This article belongs to the Special Issue Clinical Diagnosis and Management in Emergency and Hospital Medicine)

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Review

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14 pages, 2185 KB

Open AccessReview

Ten Questions on Using Lung Ultrasonography to Diagnose and Manage Pneumonia in Hospital-at-Home Model: Part II—Confounders and Mimickers

by Nin-Chieh Hsu, Yu-Feng Lin, Hung-Bin Tsai, Charles Liao and Chia-Hao Hsu

Diagnostics 2025, 15(10), 1200; https://doi.org/10.3390/diagnostics15101200 - 9 May 2025

Cited by 1 | Viewed by 1743

Abstract

The hospital-at-home (HaH) model offers hospital-level care within patients’ homes and has proven effective for managing conditions such as pneumonia. The point-of-care ultrasonography (PoCUS) is a key diagnostic tool in this model, especially when traditional imaging modalities are unavailable. This review explores how PoCUS can be optimized to manage pneumonia in HaH settings, focusing on its diagnostic accuracy in patients with comorbidities, differentiation from mimickers, and role in assessing disease severity. Pulmonary comorbidities, such as heart failure and interstitial lung disease (ILD), can complicate lung ultrasound (LUS) interpretation. In heart failure, combining lung, cardiac, and venous assessments (e.g., IVC collapsibility, VExUS score) improves diagnostic clarity. In ILD, distinguishing chronic changes from acute infections requires attention to B-line patterns and pleural abnormalities. PoCUS must differentiate pneumonia from conditions such as atelectasis, lung contusion, cryptogenic organizing pneumonia, eosinophilic pneumonia, and neoplastic lesions—many of which present with similar sonographic features. Serial LUS scoring provides useful information on pneumonia severity and disease progression. Studies, particularly during the COVID-19 pandemic, show correlations between worsening LUS scores and poor outcomes, including increased ventilator dependency and mortality. Furthermore, LUS scores correlate with inflammatory markers and gas exchange metrics, supporting their prognostic value. In conclusion, PoCUS in HaH care requires clinicians to integrate multi-organ ultrasound findings, clinical context, and serial monitoring to enhance diagnostic accuracy and patient outcomes. Mastery of LUS interpretation in complex scenarios is crucial to delivering personalized, high-quality care in the home setting. Full article

(This article belongs to the Special Issue Clinical Diagnosis and Management in Emergency and Hospital Medicine)

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