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Diagnostics
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Diagnostic Tool and Healthcare in Emergency Medicine
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Diagnostic Tool and Healthcare in Emergency Medicine

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

Deadline for manuscript submissions: 31 July 2025 | Viewed by 2812

Special Issue Editor

Dr. Arian Zaboli

E-Mail Website
Guest Editor
Innovation, Research and Teaching Service (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Via A. Volta 5, 39049 Bolzano, Italy
Interests: triage; risk stratification; risk prediction; sepsis; infection; emergency medicine; chest pain

Special Issue Information

Dear Colleagues,

Emergency medicine is a dynamic and high-stakes field requiring swift decision making and precise strategies to ensure optimal patient outcomes. Recent advancements in diagnostic methods, risk stratification tools, and operational management models have transformed the approach to care delivery in the emergency department, addressing both clinical and logistical challenges. From innovative scoring systems for risk prediction to structured models for optimizing workloads and improving efficiency, these advancements are reshaping emergency medicine.

This Special Issue aims to gather contributions from all professionals working in the emergency department, highlighting the multidisciplinary collaboration essential to this field. Topics of interest include new systems for risk stratification across various pathologies, biomarkers for identifying critical conditions, advancements in safely excluding low-risk patients, and models to streamline workflows and enhance patient safety.

Our goal is to provide a comprehensive platform to showcase cutting-edge research and practical insights that support the evolving needs of emergency medicine. We encourage submissions enriched by clear illustrations, real-world applications, and multidisciplinary perspectives.

Dr. Arian Zaboli
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 100 words) can be sent to the Editorial Office for announcement on this website.

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

  • emergency medicine
  • risk stratification
  • scoring systems
  • emergency care innovation
  • low-risk patient exclusion
  • patients safety in acute care
  • critical condition biomarkers
  • triage
  • decision support system

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Further information on MDPI's Special Issue policies can be found here.

Published Papers (3 papers)

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Research

11 pages, 1016 KiB  
Article
Diagnostic and Prognostic Value of Lung Ultrasound Performed by Non-Expert Staff in Patients with Acute Dyspnea
by Greta Barbieri, Chiara Del Carlo, Gennaro D’Angelo, Chiara Deri, Alessandro Cipriano, Paolo De Carlo, Massimo Santini and Lorenzo Ghiadoni
Diagnostics 2025, 15(14), 1765; https://doi.org/10.3390/diagnostics15141765 - 13 Jul 2025
Viewed by 284
Abstract
Background/Objectives: Dyspnea is one of the main causes of visits to the Emergency Department (ED) and hospitalization, with its differential diagnosis representing a challenge for the clinician. Lung ultrasound (LUS) is a widely used tool in ED. The objective of this study [...] Read more.
Background/Objectives: Dyspnea is one of the main causes of visits to the Emergency Department (ED) and hospitalization, with its differential diagnosis representing a challenge for the clinician. Lung ultrasound (LUS) is a widely used tool in ED. The objective of this study was to evaluate the impact of LUS, performed by a non-expert operator, in determining diagnosis and prognosis of patients with dyspnea. Methods: A total of 60 patients presenting with dyspnea at the ED were prospectively enrolled and underwent LUS examination by a medical student, after brief training, within 3 h of triage. LUS findings were classified into four patterns: N.1, absence of notable ultrasound findings, attributable to COPD/ASMA exacerbation; N.2, bilateral interstitial syndrome, suggestive of acute heart failure; N.3, subpleural changes/parenchymal consolidations, suggestive of pneumoniae; and N.4, isolate polygonal triangular consolidation, attributable to infarction in the context of pulmonary thromboembolism. Results: The diagnostic hypothesis formulated after LUS was compared with the final diagnosis after further investigations in the ED, showing agreement in 90% of cases. The mean LUS score value was higher in patterns N.2 (18.4 ± 8.5) and N.3 (17 ± 6.6), compared to patterns N.1 and N.4 (9.8± 6.7 and 11.5 ± 2.1). Given the high prevalence of pattern N.2, the diagnostic accuracy of LUS in this context was further evaluated, showing a sensitivity of 82% and specificity of 100%. In terms of the prognostic value of LUS, hospitalized patients had a higher LUS score compared to those discharged (17.3 ± 8.1 vs. 8.5 ± 6.8, p value 0.004). A similar trend was obtained in the subgroup of patients requiring non-invasive ventilation (NIV), who present a higher LUS score (21.1 ± 6.6 vs. 13.1 ± 8.1, p value 0.002). When considering a combined outcome (death and NIV), patients with worse outcomes more often had a LUS score > 15 (p value < 0.001). Conclusions: In conclusion, this study confirms that LUS is a very useful tool in the ED, assisting the clinical evaluation for diagnosis, treatment decision, and determination of the appropriate care setting for patients with acute dyspnea. Its short learning curve allows even non-expert staff to use it effectively. Full article
(This article belongs to the Special Issue Diagnostic Tool and Healthcare in Emergency Medicine)
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11 pages, 946 KiB  
Article
Pupillary Responses and Vital Signs in Hypoglycemic Patients with Impaired Consciousness During Prehospital Care: A Retrospective Observational Study
by Junko Yamaguchi, Kosaku Kinoshita, Umefumi Iguchi and Tsukasa Kuwana
Diagnostics 2025, 15(12), 1487; https://doi.org/10.3390/diagnostics15121487 - 11 Jun 2025
Viewed by 915
Abstract
Background/Objectives: Impaired consciousness has various causes. One such cause includes hypoglycemia, which may be symptomatic or asymptomatic and is associated with high mortality. Autonomic abnormalities are also common in hypoglycemic patients. Early detection is critical for improving prognosis. In this study, we evaluated [...] Read more.
Background/Objectives: Impaired consciousness has various causes. One such cause includes hypoglycemia, which may be symptomatic or asymptomatic and is associated with high mortality. Autonomic abnormalities are also common in hypoglycemic patients. Early detection is critical for improving prognosis. In this study, we evaluated changes in vital signs and pupillary responses before and after glucose administration in patients with hypoglycemia managed in a prehospital emergency setting. Methods: This retrospective observational study included 583 adult patients from the Tokyo Fire Department database. All patients were suspected by emergency medical technicians (EMTs) to have hypoglycemia-related impaired consciousness and showed improved consciousness after receiving intravenous glucose infusion at the scene. Vital signs, level of consciousness, and pupillary responses were assessed before and after glucose administration. Results: The mean patient age was 58.9 years, and approximately 90% had comorbid diabetes mellitus. Tachypnea was common at the scene, with 27% showing tachycardia, while blood pressure remained normal. Miosis and abnormal pupillary light reflexes were observed in 68% and 84% of cases, respectively. Anisocoria occurred in 7.6% of the patients. After glucose administration, both abnormal reflexes and anisocoria significantly decreased (both p < 0.0001). Although vital signs did not consistently reflect autonomic responses, changes in pupillary findings were prominent. Conclusions: Altered pupillary responses are common in hypoglycemic coma. Findings such as miosis and anisocoria can result from various causes, including central nervous system disorders and cholinergic toxicity; thus, careful differential diagnosis is essential. Normal blood pressure may help to distinguish hypoglycemic coma during prehospital care. Full article
(This article belongs to the Special Issue Diagnostic Tool and Healthcare in Emergency Medicine)
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12 pages, 1112 KiB  
Article
Comparing the National Early Warning Score and the Manchester Triage System in Emergency Department Triage: A Multi-Outcome Performance Evaluation
by Arian Zaboli, Serena Sibilio, Gloria Brigiari, Magdalena Massar, Norbert Pfeifer, Francesco Brigo and Gianni Turcato
Diagnostics 2025, 15(9), 1055; https://doi.org/10.3390/diagnostics15091055 - 22 Apr 2025
Cited by 1 | Viewed by 1206
Abstract
Background: Emergency department (ED) triage systems aim to prioritize patients based on clinical severity, ensuring timely intervention for high-risk cases. Recently, the National Early Warning Score (NEWS) has been proposed as an alternative to traditional triage systems, but its efficacy across multiple clinical [...] Read more.
Background: Emergency department (ED) triage systems aim to prioritize patients based on clinical severity, ensuring timely intervention for high-risk cases. Recently, the National Early Warning Score (NEWS) has been proposed as an alternative to traditional triage systems, but its efficacy across multiple clinical outcomes remains unclear. This study aimed to compare the predictive performance of the NEWS and the Manchester Triage System (MTS) across multiple clinical outcomes. Methods: We conducted a retrospective, single-center study at Merano Hospital, Italy, from 1 June 2022 to 30 June 2023, comparing the performance of the NEWS and the Manchester Triage System (MTS). All adult ED patients (≥18 years) were included, while exclusions applied to those on fast-track pathways, non-residents, and pregnant patients. Primary outcomes included 30-day mortality, hospitalization, and ICU admission. A random 5% subgroup was analyzed for secondary outcomes, including the need for life-saving interventions (LSIs), physician-defined clinical priority, and severity. Predictive performance was assessed using Receiver Operating Characteristic (ROC) curves, area under the ROC curve (AUROC) comparisons, and Decision Curve Analysis (DCA). Results: Among 27,238 patients, the NEWS predicted 30-day mortality more accurately than the MTS (AUROC 0.745 vs. 0.701, p < 0.001). However, the MTS outperformed the NEWS for hospitalization (AUROC 0.733 vs. 0.609, p < 0.001), ICU admission (AUROC 0.862 vs. 0.672, p < 0.001), and all secondary outcomes. DCA further confirmed MTS’s superiority across clinically relevant ED probability thresholds (20–40%). Conclusions: The NEWS, while effective for predicting mortality, it is inadequate in comprehensive triage decision-making. The MTS remains the superior system for prioritizing high-risk patients based on clinical severity. Rather than replacing triage with the NEWS, efforts should focus on refining existing systems to improve risk stratification. Future multi-center prospective studies are necessary to validate these findings. Full article
(This article belongs to the Special Issue Diagnostic Tool and Healthcare in Emergency Medicine)
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