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New Tools and Technologies in Emergency Medicine and Critical Care
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New Tools and Technologies in Emergency Medicine and Critical Care

A Special Issue of Healthcare (ISSN 2227-9032) belonging to the section "Clinical Care".

Deadline for manuscript submissions: 30 April 2027 | Viewed by 5649

Editor

Dr. Daniele Orso

E-Mail Website
Guest Editor
Anesthesia and Intensive Care Clinic, Department of Emergency, University-Hospital of Udine, ASUFC, 33100 Udine, Italy
Interests: anesthesia; intensive care; resuscitation; emergency medicine; sepsis; ultrasound; liver transplantation
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Emergency medicine and emergency critical care represent a dynamic synergy in modern healthcare, where rapid diagnosis and decisive intervention meet to manage critically ill patients. In the fast-paced environment of the emergency department, clinicians employ state-of-the-art techniques to stabilize patients, seamlessly integrating advanced critical care methods when necessary. This interconnected approach not only ensures timely interventions during the initial resuscitation phase but also paves the way for a smooth transition into ongoing intensive care. The evolution of these fields has led to the development of specialized protocols and multidisciplinary strategies that significantly improve patient outcomes in high-stake, time-sensitive situations.

Recent breakthroughs in technology are revolutionizing emergency medicine and critical care, enabling faster, more accurate diagnoses and tailored interventions. Point-of-care ultrasound and portable imaging devices now offer immediate insights at a patient's bedside, while telemedicine solutions expand expert consultation to remote and resource-limited settings. Additionally, artificial intelligence and machine learning algorithms are being integrated to predict patient deterioration and guide critical decision-making, optimizing treatment protocols in real time. Wearable sensors and advanced monitoring systems provide ongoing, real-time data that help clinical teams respond proactively. Collectively, these innovations not only streamline workflow and improve patient outcomes but also pave the way for a more adaptable, technology-driven model in emergency and critical care settings.

As the Editor of this Special Issue, I am excited to invite new scientific contributions on the evolving frontiers of emergency medicine and critical care. We are particularly interested in manuscripts that explore innovative technologies and novel tools in these fields. Whether your research focuses on breakthrough point-of-care devices, wearable monitoring systems, or the integration of artificial intelligence for real-time clinical decision-making, we welcome studies that challenge traditional models and offer fresh, evidence-based insights into patient management in critical and time-sensitive settings. We look forward to receiving your contributions and to fostering a dynamic exchange of ideas that will help shape the future of emergency and critical care practices.

Dr. Daniele Orso
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-anonymized peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare 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 2700 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
  • emergency critical care
  • new medical technologies
  • telemedicine
  • artificial intelligence

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Published Papers (6 papers)

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9 pages, 992 KB  
Article
The Copetti Sign in Suspected Renal Colic: Association with Distal Ureteral Stones in a Prospective Pilot Cohort
by Carmine Cristiano Di Gioia, Daniele Orso, Alice Alame, Jessica Vella, Michela D’Apolito, Gianmarco Sicuranza, Eli Ollari, Lorenzo Bianchi and Marcello Boccardi
Healthcare 2026, 14(12), 1663; https://doi.org/10.3390/healthcare14121663 - 11 Jun 2026
Viewed by 1654
Abstract
Background: Renal colic is a common emergency department (ED) presentation requiring rapid and accurate diagnosis. Point-of-care ultrasound (POCUS) is a fast, radiation-free alternative to CT. The Copetti sign—a rhythmic anteroposterior oscillation of the affected kidney—has been proposed as a dynamic sonographic marker [...] Read more.
Background: Renal colic is a common emergency department (ED) presentation requiring rapid and accurate diagnosis. Point-of-care ultrasound (POCUS) is a fast, radiation-free alternative to CT. The Copetti sign—a rhythmic anteroposterior oscillation of the affected kidney—has been proposed as a dynamic sonographic marker of distal ureteral stones. Methods: In this prospective observational study (June–September 2025), 44 adult patients with suspected renal colic were enrolled at a single-center ED in Baggiovara, Modena, Italy. All underwent standardized POCUS to detect the Copetti sign prior to confirmatory imaging. Clinical, laboratory, and sonographic variables were collected. Associations between the Copetti sign, stone location, stone size, hydronephrosis, urinoma, and management strategy were explored. Associations with conservative management were considered exploratory. Results: The Copetti sign was identified in 70.5% of patients and was significantly associated with distal ureteral stones (74.2% vs. 25.8%, p = 0.005). Copetti-positive patients were more often managed conservatively (77.4% vs. 38.5%, p = 0.019), although this likely reflects the underlying clinical-imaging phenotype and local treatment decisions rather than a validated prognostic endpoint. Conclusions: In this prospective pilot cohort, the Copetti sign was frequently observed and was strongly associated with distal ureteral stone location. Copetti-positive patients were also more often managed conservatively, although this should be interpreted as an exploratory association reflecting clinical decision-making rather than a validated prognostic endpoint. Full article
(This article belongs to the Special Issue New Tools and Technologies in Emergency Medicine and Critical Care)
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14 pages, 499 KB  
Article
Risk Factors, Clinical Outcomes, and Medical Costs of Pelvic Infection After Open Pelvic Fractures: A 7-Year Retrospective Observational Study at a Single Trauma Center
by Donghwan Choi, Jungsub So, Won Tae Cho, Hyung Keun Song and Kyoungwon Jung
Healthcare 2026, 14(10), 1328; https://doi.org/10.3390/healthcare14101328 - 13 May 2026
Viewed by 563
Abstract
Background/Objectives: Patients with unstable pelvic fractures typically die of hemorrhagic shock, whereas those with open pelvic fractures (OPF) more commonly die of pelvic infections (PIs) and pelvic sepsis (PS). We examined the clinical outcomes of PI in patients with OPFs. Methods: Patients with [...] Read more.
Background/Objectives: Patients with unstable pelvic fractures typically die of hemorrhagic shock, whereas those with open pelvic fractures (OPF) more commonly die of pelvic infections (PIs) and pelvic sepsis (PS). We examined the clinical outcomes of PI in patients with OPFs. Methods: Patients with OPFs treated at our hospital between March 2016 and February 2023 were retrospectively reviewed. Factors associated with PI were identified using logistic regression analysis. Results: A total of 44 patients with OPFs were included, of whom 22 developed PIs. The number of patients with Gustilo–Anderson grade III was higher in the PI group than in the non-PI group (n = 18 vs. 8, p = 0.008). Similarly, anorectal injury was more frequent in the PI group than in the non-PI group (n = 15 vs. 3, p = 0.001). Multivariate logistic regression identified age (odds ratio 1.082 [95% confidence interval 1.020–1.148], p = 0.009), serum lactate level (1.319 [0.992–1.755], p = 0.018), presence of Gustilo–Anderson grade III (7.467 [0.987–56.517], p = 0.052), and anorectal injury (36.468 [3.107–427.991], p = 0.004) as independent risk factors for PI. Hospital length of stay, overall medical costs, and number of surgeries were 2.8 (84.0 vs. 30.5 days, p = 0.002), 2.9 (95,812 vs. 33,224 USD, p = 0.001), and 2.9 (13.0 vs. 4.5, p < 0.001) times higher in the PI group than in the non-PI group, respectively. Conclusions: Age and anorectal injury were significantly associated with pelvic infection. Serum lactate level and Gustilo–Anderson grade III injury showed possible associations, although statistical precision was limited. PIs were associated with high medical costs. Early wound management, precise antibiotic therapy, and multidisciplinary approaches are necessary to treat PIs. Full article
(This article belongs to the Special Issue New Tools and Technologies in Emergency Medicine and Critical Care)
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12 pages, 1380 KB  
Article
Unsupervised Clustering of 41,728 Emergency Department Visits: Insights into Patient Profiles and KTAS Reliability
by Jongsun Kim, EunChul Jang, SoonChan Kwon and MyoungJe Song
Healthcare 2025, 13(23), 3073; https://doi.org/10.3390/healthcare13233073 - 26 Nov 2025
Cited by 2 | Viewed by 801
Abstract
Introduction: In the emergency room, it is essential to quickly and accurately classify the patients’ various severities. However, existing five-stage classification systems, such as the Korean Emergency Patient Classification Tool (KTAS), do not sufficiently reflect the physiological and clinical heterogeneity of all patients, [...] Read more.
Introduction: In the emergency room, it is essential to quickly and accurately classify the patients’ various severities. However, existing five-stage classification systems, such as the Korean Emergency Patient Classification Tool (KTAS), do not sufficiently reflect the physiological and clinical heterogeneity of all patients, so there is a possibility of under-classification in some age groups or specific symptom groups. Methods: A retrospective cross-sectional study was conducted using KTAS and the physiological and clinical data of 41,728 patients who visited the emergency room of a university hospital in Incheon in 2022. K-prototypes unsupervised cluster analysis incorporating demographic, physiological, and clinical variables was applied, and the number of clusters was determined as the optimal value through the Silhouette, Dunn, and Davies–Bouldin indicators. Dimension reduction was performed by UMAP, and differences between clusters were compared by t-test, Mann–Whitney U, and chi-square test. Results: Two different clusters were identified. Cluster 0 was a stable patient group with a mean age of 58 years and an average arterial pressure of 104 mmHg. On the other hand, Cluster 1 was a young but physiologically unstable patient group with an average age of 46 years and an average arterial pressure of 90 mmHg. There were significant differences in age, MAP, heart rate, respiratory rate, body temperature, and pain scores between clusters (p < 0.001), and a moderate association was observed between KTAS classification and clusters (Cramer’s V = 0.208). Discussion: This study suggested the possibility of early identification of high-risk groups in the emergency room and efficient resource allocation by identifying potential patient heterogeneity that KTAS cannot detect through unsupervised learning. This approach can be used as a basis for precision triage and patient-centered emergency medical policy establishment by supplementing rather than replacing the existing classification system. Full article
(This article belongs to the Special Issue New Tools and Technologies in Emergency Medicine and Critical Care)
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17 pages, 1178 KB  
Article
Hemodynamic Heterogeneity in Community-Acquired Sepsis at Intermediate Care Admission: A Prospective Pilot Study Using Impedance Cardiography
by Gianni Turcato, Arian Zaboli, Lucia Filippi, Fabrizio Lucente, Michael Maggi, Alessandro Cipriano, Massimo Marchetti, Daniela Milazzo, Christian J. Wiedermann and Lorenzo Ghiadoni
Healthcare 2025, 13(21), 2686; https://doi.org/10.3390/healthcare13212686 - 23 Oct 2025
Cited by 2 | Viewed by 1038
Abstract
Background: Sepsis is a heterogeneous syndrome in which patients with similar clinical presentations at admission may exhibit markedly different treatment responses and outcomes, suggesting that comparable macroscopic features can conceal profoundly distinct perfusion and hemodynamic states. Aim: This study aimed to [...] Read more.
Background: Sepsis is a heterogeneous syndrome in which patients with similar clinical presentations at admission may exhibit markedly different treatment responses and outcomes, suggesting that comparable macroscopic features can conceal profoundly distinct perfusion and hemodynamic states. Aim: This study aimed to characterize the hemodynamic profile of patients with community-acquired sepsis, assess its correlation with macro-hemodynamic indices, compare fluid responders with non-responders, and explore the prognostic value of early identification of a feature consistent with distributive shock. Methods: A prospective observational pilot study was conducted in the Intermediate Medical Care Unit (IMCU) of Ospedale Alto Vicentino (Santorso, Italy), September 2024–May 2025. 115 consecutive adults with community-acquired sepsis underwent NICaS® bioimpedance assessment at IMCU admission. Sepsis was diagnosed at IMCU admission as suspected/confirmed infection plus an acute increase in total Sequential Organ Failure Assessment (SOFA) ≥ 2 points. Hemodynamic indices were analyzed in relation to the Sequential Organ Failure Assessment (SOFA) score and mean arterial pressure (MAP), fluid responsiveness, and 30-day mortality. Results: Hemodynamics were heterogeneous across patients and within SOFA strata. SOFA showed no correlation with SV, SI, CO, or CI; weak inverse associations for TPR (r = −0.198, p = 0.034) and TPRI (r = −0.241, p = 0.009) were observed. MAP did not correlate with SV, SI, CO, or CI, but correlated positively with TPR (r = 0.461) and TPRI (r = 0.547) and with CPI (ρ = 0.550), all p < 0.001. A distributive profile was present in 21.7% (25/115), increasing with higher SOFA (p = 0.033); only 20% of those with this profile had MAP < 65 mmHg at admission. Fluid non-responders (27.8%) had lower resistance and higher CI (4.1 vs. 3.4 L/min/m2; p = 0.015). The distributive profile was not associated with 30-day mortality (log-rank p = 0.808). Conclusions: In IMCU patients with community-acquired sepsis, macro-indices (SOFA, MAP) correlate poorly with the underlying hemodynamic state. Early noninvasive profiling reveals within-SOFA circulatory heterogeneity and may support operational, individualized resuscitation strategies; these pilot findings are hypothesis-generating and warrant prospective interventional testing. Full article
(This article belongs to the Special Issue New Tools and Technologies in Emergency Medicine and Critical Care)
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11 pages, 5812 KB  
Brief Report
Baseline Predictors of Adverse Outcome and Survival in Adults Hospitalized with Invasive Pneumococcal Disease
by Sergio Venturini, Ingrid Reffo, Mariateresa Casarotto, Maria Teresa Bortolin, Giancarlo Basaglia, Francesco Cugini, Giovanni Del Fabro, Agnese Zanus-Fortes, Camilla Negri, Astrid Callegari, Federico Giovagnorio, Lucia Corich, Stefano Tavano and Umberto Zuccon
Healthcare 2026, 14(14), 2057; https://doi.org/10.3390/healthcare14142057 - 9 Jul 2026
Viewed by 333
Abstract
Background/Objectives: Invasive pneumococcal disease (IPD) remains associated with substantial mortality. We evaluated whether routinely available baseline variables were associated with 65-day all-cause mortality among adults hospitalized with IPD. Methods: We conducted a retrospective cohort study of 195 adults hospitalized with IPD. The primary [...] Read more.
Background/Objectives: Invasive pneumococcal disease (IPD) remains associated with substantial mortality. We evaluated whether routinely available baseline variables were associated with 65-day all-cause mortality among adults hospitalized with IPD. Methods: We conducted a retrospective cohort study of 195 adults hospitalized with IPD. The primary endpoint was 65-day all-cause mortality, with hospital admission as the time origin and administrative censoring at day 65. Logistic regression and Cox proportional hazards models were fitted with a prespecified adjustment set that included age, sex, invasive mechanical ventilation, procalcitonin, and pH. Results: Overall, 42 patients died during follow-up. Non-survivors had lower admission pH, higher procalcitonin concentrations, and more frequent invasive mechanical ventilation. In the adjusted logistic model, lower pH showed a directionally consistent but non-significant association with mortality (OR per 0.05-unit decrease, 1.45; 95% CI, 0.96–2.20; p = 0.080). In the adjusted Cox model, lower pH was associated with a higher mortality hazard (HR per 0.05-unit decrease, 1.31; 95% CI, 1.03–1.65; p = 0.026). When lower pH was correctly oriented as the risk marker, its AUC was 0.729. The apparent AUC of the multivariable model was 0.831, and the bootstrap optimism-corrected AUC was 0.785. Conclusions: In adults hospitalized with IPD, lower admission pH, higher procalcitonin levels, and invasive mechanical ventilation were associated with worse outcomes. Lower pH showed the most consistent prognostic signal, particularly in time-to-event analysis, but estimates were imprecise and should be interpreted as exploratory. These findings support the potential bedside value of early acid–base assessment for risk stratification in IPD. Full article
(This article belongs to the Special Issue New Tools and Technologies in Emergency Medicine and Critical Care)
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8 pages, 3782 KB  
Case Report
Septic Shock, Infective Endocarditis, Septic Embolization and Disseminated Intravascular Coagulation Caused by a Toxigenic C. diphtheriae Strain: A Case Report
by Matteo Fabris, Ivan Martinello and Flavio Bassi
Healthcare 2026, 14(13), 1890; https://doi.org/10.3390/healthcare14131890 - 29 Jun 2026
Viewed by 366
Abstract
Background: Diphtheria is an acute infectious disease caused by Corynebacterium diphtheriae. Despite several worldwide outbreaks, it is now considered a rare disease by industrialized countries. Clinical manifestations usually account for oropharyngeal lesions, but rare cases of systemic involvement (mainly endocarditis) have been [...] Read more.
Background: Diphtheria is an acute infectious disease caused by Corynebacterium diphtheriae. Despite several worldwide outbreaks, it is now considered a rare disease by industrialized countries. Clinical manifestations usually account for oropharyngeal lesions, but rare cases of systemic involvement (mainly endocarditis) have been described among non-toxigenic strains. Case description: We report the case of a patient who experienced septic shock, disseminated intravascular coagulation and multiorgan failure due to Corynebacterium diphtheriae infection. The pathogen was further characterized as a highly toxigenic strain. Infective endocarditis with mitral and aortic valve vegetations led to early multiorgan septic embolization. Major stroke, liver function impairment, heart failure and acute kidney injury were the main findings. Unlike the typical forms of infection caused by this pathogen, there was no evidence of airway or skin involvement. Furthermore, apart from hemocultures, none of the other investigations (pharyngeal swabs, bronchoalveolar lavages, urine culture) ever tested positive for the bacteria. Conclusions: The report we present describes a case of C. diphtheriae infection with many atypical characteristics: (i) lack of any pathognomonic signs or symptoms; (ii) extensive endocarditic process (very uncommon for toxigenic strains); (iii) early septic emboli development, with rapid evolution to multiorgan failure; (iv) detection of disseminated intravascular coagulation. Despite disseminated intravascular coagulation being a known complication of septic shock, regardless of the etiological agent, according to our literature research, this is the second known case driven by C. diphtheriae infection in an adult. Full article
(This article belongs to the Special Issue New Tools and Technologies in Emergency Medicine and Critical Care)
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