Submit to Special Issue Submit Abstract to Special Issue Review for JCM Propose a Special Issue

Journal Menu

Journal Browser

Current Challenges and Innovations in Emergency Medicine: From Prehospital Care to Critical Decision-Making in the Emergency Department

Print Special Issue Flyer
Special Issue Editors
Special Issue Information
Keywords
Benefits of Publishing in a Special Issue
Published Papers

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Emergency Medicine".

Deadline for manuscript submissions: 20 August 2026 | Viewed by 6583

Share This Special Issue

Special Issue Editors

Dr. Efstratios Karagiannidis

E-Mail Website
Guest Editor

1. Second Department of Cardiology, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
2. Department of Emergency Medicine, AHEPA University Hospital, 54636 Thessaloniki, Greece
Interests: myocardial infarction; heart failure; coronary artery disease; atrial fibrillation; precision medicine
Special Issues, Collections and Topics in MDPI journals

Dr. Barbara P. Fyntanidou

E-Mail Website
Guest Editor

Department of Emergency Medicine, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
Interests: emergency medicine; anesthesia; trauma; cardiopulmonary resuscitation; heart failure
Special Issues, Collections and Topics in MDPI journals

Dr. Aikaterini Apostolopoulou

E-Mail Website
Guest Editor

Department of Emergency Medicine, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
Interests: emergency; cardiac arrest; meta-analysis; clinical epidemiology; primary care medicine
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Emergency medicine plays a vital role in modern healthcare, spanning from prehospital care to complex decision-making in the emergency department (ED). The growing complexity of cases, the demand for rapid diagnosis and intervention, and evolving patient expectations continue to challenge emergency services globally. At the same time, innovations in triage, technology, and interdisciplinary collaboration are transforming how acute care is delivered.

This Special Issue welcomes submissions addressing current challenges and innovations across the emergency care continuum. Topics of interest include, but are not limited to:

Prehospital assessment and triage strategies;
Technological advances such as artificial intelligence, telemedicine, and point-of-care diagnostics;
Innovations in resuscitation and time-sensitive procedures;
Decision-support systems and real-time tools in the ED.

We aim to bring together high-impact research and perspectives to support clinicians and researchers in enhancing emergency care. By addressing both systemic and clinical aspects, this Special Issue will contribute to improving patient outcomes and care delivery in high-pressure environments.

We look forward to your contributions.

Dr. Efstratios Karagiannidis
Dr. Barbara P. Fyntanidou
Dr. Aikaterini Apostolopoulou
Guest Editors

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. Journal of Clinical Medicine 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
prehospital care
triage strategies
acute care
point-of-care diagnostics
artificial intelligence
telemedicine
emergency department
patient flow
healthcare systems
burnout in emergency care

Benefits of Publishing in a Special Issue

Ease of navigation: Grouping papers by topic helps scholars navigate broad scope journals more efficiently.
Greater discoverability: Special Issues support the reach and impact of scientific research. Articles in Special Issues are more discoverable and cited more frequently.
Expansion of research network: Special Issues facilitate connections among authors, fostering scientific collaborations.
External promotion: Articles in Special Issues are often promoted through the journal's social media, increasing their visibility.
Reprint: MDPI Books provides the opportunity to republish successful Special Issues in book format, both online and in print.

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

Published Papers (7 papers)

Download All Papers

Order results

Result details

Show export options Show export options

Select all

Export citation of selected articles as:

Research

Jump to: Review

18 pages, 2172 KB

Open AccessArticle

Relevance of Reversible Causes of Out-of-Hospital Cardiac Arrest: The “REBECCA” Interactive Checklist

by Martina Hermann, Arthur Stoiber, Andreas Schmid, Thomas Hamp, Angelika De Abreu Santos, Daniel Grassmann, Mario Krammel, Josef M. Lintschinger, Stefan Ulbing, Alessa Stria and Christina Hafner

J. Clin. Med. 2026, 15(6), 2422; https://doi.org/10.3390/jcm15062422 - 21 Mar 2026

Viewed by 650

Abstract

Background/Objectives: Adequate cardiopulmonary resuscitation (CPR), defibrillation, and treatment of reversible causes are essential for improving the survival of patients suffering from out-of-hospital cardiac arrests (OHCAs). The Advanced Life Support (ALS) algorithm includes reversible causes for cardiac arrest. This study aimed to develop an interactive mobile checklist to identify reversible causes of OHCA (REBECCA) and evaluate their usability and usefulness among emergency physicians. Methods: This mixed-methods study was conducted at the Emergency Medical Service Vienna, Austria. All participants were emergency physicians from the Medical University of Vienna. An interactive mobile checklist was developed using a participatory design approach involving a focus group of 10 emergency physicians. Usability and applicability were assessed using structured questionnaires. Descriptive statistics were used to summarize participant characteristics and evaluation outcomes. Results: Among the included participants, 70% were specialists with a median prehospital experience of 2.0 (1.0–4.3) years. Although most participants were confident about their level of professional experience with OHCA, 85% still found the checklist to be helpful. The majority of the participants preferred the digital checklist over the paper-based checklist and appreciated its integration with the point-of-care ultrasound (POCUS) application. Although the participants did not communicate a significant need for further details on most causes, a small majority favored more information on intoxication and electrolyte disorders. Conclusions: The majority of the included emergency physicians found the REBECCA checklist helpful regardless of training level, whereas almost no physician needed further detailed information on the reversible causes. Our findings underscore the potential importance of future investigations aiming to reduce the cognitive load of emergency physicians during OHCA scenarios. Full article

(This article belongs to the Special Issue Current Challenges and Innovations in Emergency Medicine: From Prehospital Care to Critical Decision-Making in the Emergency Department)

► Show Figures

Figure 1

15 pages, 425 KB

Open AccessArticle

Altered Level of Consciousness in a Tertiary Emergency Department: Etiologies, Mortality, and Outcomes

by Keun Tae Kim and Yong Won Cho

J. Clin. Med. 2026, 15(5), 2037; https://doi.org/10.3390/jcm15052037 - 7 Mar 2026

Viewed by 481

Abstract

Background/Objectives: Altered level of consciousness (ALC) is a common emergency department (ED) presentation with high mortality. We evaluated etiologies and early ED-course prognostic markers for mortality. Methods: We retrospectively identified adult ED visits with ALC (September 2023–August 2025) and classified etiologies using the ALC-10 framework. Patients transferred directly to other hospitals were excluded because post-transfer outcomes were unavailable; sensitivity analyses were performed. Overall mortality was ED death or in-hospital death, and ED mortality was death during the ED stay. Nested logistic models were prespecified: overall-mortality Model A included age, initial Glasgow Coma Scale (GCS), etiologic category, and ICU admission, and Model B added vasopressor use and mechanical ventilation within 1 h; ED-mortality Model A included age and initial GCS, and Model B added vasopressor use and mechanical ventilation. Results: ALC accounted for 2.85% (2194/76,957) of adult ED visits; 1932 patients were analyzed after excluding 262 transfer-outs. Systemic infection (25.8%) and metabolic causes (23.7%) were most frequent. Observed overall mortality was 23.6% (455/1932), including ED mortality of 6.4% (124/1932); model-based sensitivity analysis estimated adjusted overall mortality to be 23.2% (95% uncertainty interval, 22.9–23.7) among all ALC visits. In adjusted models, older age, lower initial GCS, and vasopressor use were associated with higher odds of both outcomes, while ICU admission and mechanical ventilation were associated with overall mortality. Model B showed improved discrimination (AUC 0.795 overall; 0.869 ED). Conclusions: These findings highlight the prognostic significance of age, initial neurologic status, and etiology. This study may assist in risk stratification and early resource allocation. Full article

(This article belongs to the Special Issue Current Challenges and Innovations in Emergency Medicine: From Prehospital Care to Critical Decision-Making in the Emergency Department)

► Show Figures

Figure 1

15 pages, 1240 KB

Open AccessArticle

Prognostic Value of Stress-Induced Hyperglycemia in High-Acuity Emergency Department Patients

by Aikaterini Apostolopoulou, Christos Kofos, Marios G. Bantidos, Sofia-Chrysovalantou Zagalioti, Sofia Gkarmiri, Anna Drokou, Christina Kaltsidou, Nikolaos Koumianakis, Aikaterini Letsiou, Eleni Panayi, Grigorios Voulgaris, Paraskevi Katrana, Alexandra Arvanitaki, Vasileios Grosomanidis, Efstratios Karagiannidis and Barbara Fyntanidou

J. Clin. Med. 2026, 15(4), 1618; https://doi.org/10.3390/jcm15041618 - 19 Feb 2026

Viewed by 643

Abstract

Background/Objectives: Stress-induced hyperglycemia (SIH) is frequently observed in critically ill patients and has been associated with adverse outcomes in individuals both with and without known diabetes mellitus (DM). However, evidence regarding its prognostic utility for in-hospital mortality in high-acuity emergency department (ED) populations remains limited. Methods: We conducted a retrospective observational cohort study of consecutive adult ED patients classified as Emergency Severity Index (ESI) triage level 1. SIH was defined a priori as an admission serum glucose > 140 mg/dL, a pragmatic cutoff widely applied in clinical practice despite ongoing debate regarding optimal pathophysiological thresholds. Associations with in-hospital mortality were assessed using logistic regression in the overall cohort and stratified by DM status. Additional analyses assessed the prognostic performance of admission glucose as a continuous variable. Results: Of 470 included patients, 435 had complete mortality data; 247 (56.8%) died during hospitalization. SIH was present in 258/435 (59.3%)and known DM in 114/435 (26.2%). SIH was associated with higher in-hospital mortality in univariate analysis (OR 2.90, 95% CI 1.91–4.43; p < 0.001) and remained independently associated after adjustment (adjusted OR 2.22, 95% CI 1.41–3.51; p < 0.001). The association between SIH and mortality persisted in both non-DM and DM subgroups, with no significant interaction by DM status. SIH alone showed modest discrimination for mortality (AUC 0.625, 95% CI 0.572–0.669), whereas continuous admission glucose performed better. Discrimination improved in the multivariable model (AUC 0.728, 95% CI 0.677–0.779). Restricted cubic spline analysis demonstrated a strong overall association between admission glucose and mortality without evidence of nonlinearity, indicating an approximately linear risk increase across the observed glucose range. Conclusions: Regarding severely ill ED patients, classified as ESI triage 1, SIH is an independent predictor of in-hospital mortality irrespective of DM status. Admission glucose may improve early risk stratification when incorporated into clinical models. Full article

(This article belongs to the Special Issue Current Challenges and Innovations in Emergency Medicine: From Prehospital Care to Critical Decision-Making in the Emergency Department)

► Show Figures

Figure 1

12 pages, 2513 KB

Open AccessArticle

Missing Data in OHCA Registries: How Multiple Imputation Methods Affect Research Conclusions—Paper II

by Stella Jinran Zhan, Seyed Ehsan Saffari, Marcus Eng Hock Ong and Fahad Javaid Siddiqui

J. Clin. Med. 2026, 15(2), 732; https://doi.org/10.3390/jcm15020732 - 16 Jan 2026

Viewed by 502

Abstract

Background/Objectives: Missing data in clinical observational studies, such as out-of-hospital cardiac arrest (OHCA) registries, can compromise statistical validity. Single imputation methods are simple alternatives to complete-case analysis (CCA) but do not account for imputation uncertainty. Multiple imputation (MI) is the standard for handling missing-at-random (MAR) data, yet its implementation remains challenging. This study evaluated the performance of MI in association analysis compared with CCA and single imputation methods. Methods: Using a simulation framework with real-world Singapore OHCA registry data (N = 13,274 complete cases), we artificially introduced 20%, 30%, and 40% missingness under MAR. MI was implemented using predictive mean matching (PMM), random forest (RF), and classification and regression trees (CART) algorithms, with 5–20 imputations. Performance was assessed based on bias and precision in a logistic regression model evaluating the association between alert issuance and bystander CPR. Results: CART outperformed PMM, providing more accurate β coefficients and stable CIs across missingness levels. Although K-Nearest Neighbours (KNN) produced similar point estimates, it underestimated imputation uncertainty. PMM showed larger bias, wider and less stable CIs, and in some settings performed similarly to CCA. MI methods produced wider CIs than single imputation, appropriately capturing imputation uncertainty. Increasing the number of imputations had minimal impact on point estimates but modestly narrowed CIs. Conclusions: MI performance depends strongly on the chosen algorithm. CART and RF methods offered the most robust and consistent results for OHCA data, whereas PMM may not be optimal and should be selected with caution. MI using tree-based methods (CART/RF) remains the preferred strategy for generating reliable conclusions in OHCA research. Full article

(This article belongs to the Special Issue Current Challenges and Innovations in Emergency Medicine: From Prehospital Care to Critical Decision-Making in the Emergency Department)

► Show Figures

Figure 1

13 pages, 1434 KB

Open AccessArticle

Early Prognostication After Out-of-Hospital Cardiac Arrest: Modified rCAST Score Incorporating Age and Brainstem Reflexes

by Youn-Jung Kim, Yonghun Jung, Byung Kook Lee, Chun Song Youn and Won Young Kim

J. Clin. Med. 2025, 14(19), 6830; https://doi.org/10.3390/jcm14196830 - 26 Sep 2025

Viewed by 884

Abstract

Background: Out-of-hospital cardiac arrest (OHCA) survivors demonstrate wide variation in neurological outcomes due to hypoxic–ischemic brain injury. Early prognostic stratification in the emergency department is essential to inform clinical decisions. This study aimed to improve the revised Cardiac Arrest Syndrome for Therapeutic hypothermia (rCAST) score by incorporating additional clinical variables and to evaluate its ability to predict poor neurological outcomes. Methods: This multicenter observational study analyzed OHCA survivors treated with targeted temperature management (TTM) between October 2015 and December 2018 at 22 university-affiliated hospitals participating in the Korean Hypothermia Network prospective registry. The primary outcome was poor neurological status at one month, defined as a Cerebral Performance Category (CPC) score of 3–5. Independent predictors were identified using multivariable logistic regression and incorporated into a modified rCAST (mCAST) score. Results: Among 881 included patients, age > 65 years (odds ratio [OR], 13.87; 95% confidence interval [CI], 7.38–26.08) and absence of brainstem reflexes (OR, 2.31; 95% CI, 1.29–4.12) were identified as independent predictors and added to the mCAST score. The mCAST demonstrated higher prognostic accuracy than the original rCAST (area under the curve [AUC], 0.849 vs. 0.823; p < 0.001). In the high-severity group, the mCAST identified a higher poor outcome rate (95.1% vs. 90.9%) while reducing the proportion of patients in this group (20.7% vs. 31.3%). Conclusions: The mCAST score improves early prognostic accuracy during the immediate post-cardiac arrest period by incorporating age and brainstem reflexes and may offer refined risk stratification without compromising clinical feasibility. Full article

(This article belongs to the Special Issue Current Challenges and Innovations in Emergency Medicine: From Prehospital Care to Critical Decision-Making in the Emergency Department)

► Show Figures

Figure 1

Review

Jump to: Research

14 pages, 3947 KB

Open AccessReview

Point-of-Care Transcranial Doppler Sonography at the Intensive Care Unit—A Practical Review of the Fundamentals

by Péter Siró, Zsófia Fülesdi, Csilla Molnár, Róbert Almási, László Csiba and Béla Fülesdi

J. Clin. Med. 2026, 15(4), 1630; https://doi.org/10.3390/jcm15041630 - 20 Feb 2026

Viewed by 996

Abstract

Point-of-care ultrasonography (POCUS) has become an integral part of intensive and emergency care. Despite the widespread use and availability of multipurpose ultrasound devices, the regular assessment of intracranial circulatory conditions has not become a part of daily routine in multidisciplinary intensive care units. This brief narrative review aims to summarize the fundamental knowledge about the transcranial Doppler technique and the most significant clinical areas in which the method can provide valuable assistance in daily diagnostic and therapeutic decision-making. The authors searched the PubMed database for reviews, systematic reviews, and meta-analyses using the keywords “transcranial Doppler sonography; critical care; cerebral vasospasm; brain death diagnosis; non-invasive intracranial pressure monitoring”. We conclude that TCD is a simple, yet skilled, bedside method for assessing intracranial circulation. In everyday practice, it can be used to support clinical decision-making primarily in the areas of intracranial pressure monitoring, diagnosis and follow-up of cerebral vasospasm, and diagnosis of cerebral circulatory arrest. The study of cerebral hemodynamics should be an integral part of the increasingly widespread bedside ultrasound diagnostics in intensive care. Full article

(This article belongs to the Special Issue Current Challenges and Innovations in Emergency Medicine: From Prehospital Care to Critical Decision-Making in the Emergency Department)

► Show Figures

Figure 1

14 pages, 892 KB

Open AccessReview

Recognizing Coagulation Disorders in Sepsis in the Emergency Room: A Narrative Review

by Toshiaki Iba, Tomoki Tanigawa, Hideo Wada, Kenta Kondo, Ricard Ferrer and Jerrold H. Levy

J. Clin. Med. 2026, 15(2), 488; https://doi.org/10.3390/jcm15020488 - 8 Jan 2026

Viewed by 1659

Abstract

Sepsis remains a leading cause of global mortality, and early management in the emergency department (ED) is a key determinant of clinical outcomes. Among the earliest physiological derangements in sepsis are abnormalities in coagulation, which represent not merely laboratory disturbances but fundamental reflections of dysregulated host response, endothelial injury, and evolving microvascular thrombosis. Sepsis-induced coagulopathy (SIC) and disseminated intravascular coagulation (DIC) form a dynamic continuum that frequently begins before shock is clinically apparent. Despite their prognostic value and pathophysiologic significance, these abnormalities are often underrecognized in the ED, where coagulation tests are still commonly interpreted through the narrow lens of bleeding risk rather than as markers of systemic thromboinflammation. This narrative review synthesizes current understanding of the mechanisms linking sepsis, endothelial dysfunction, and coagulation abnormalities; outlines the distinction between SIC and overt DIC; and highlights why early identification of coagulopathy in the ED is essential. We discuss practical bedside approaches, including recommended laboratory testing, pattern recognition, and application of validated scores such as the SIC and ISTH DIC criteria. System-level strategies, such as embedding coagulation testing into sepsis bundles, automating score calculation, and enhancing communication between the ED and ICU teams, are explored as avenues to improve early detection. Evidence suggests that ED recognition of SIC/DIC may refine risk stratification, guide triage decisions, and identify patients who may benefit from targeted anticoagulant strategies once stabilized. Ultimately, recognizing coagulation disorders in the ED reframes sepsis not solely as a hemodynamic crisis but as a complex, thromboinflammatory syndrome in which early intervention may alter trajectory and improve outcomes. Full article

(This article belongs to the Special Issue Current Challenges and Innovations in Emergency Medicine: From Prehospital Care to Critical Decision-Making in the Emergency Department)

► Show Figures

Journal Menu

Journal Browser

Current Challenges and Innovations in Emergency Medicine: From Prehospital Care to Critical Decision-Making in the Emergency Department

Share This Special Issue

Special Issue Editors

Special Issue Information

Keywords

Benefits of Publishing in a Special Issue

Published Papers (7 papers)

Research

Review

Further Information

Guidelines

MDPI Initiatives

Follow MDPI