Search Results (154)

This study presents an approach based on machine learning (ML) techniques to analyze the relationship between emergency room (ER) admissions for cardiorespiratory diseases (CRDs) and environmental factors. The aim of this study is the development and verification of an interpretable machine learning framework applied to environmental and health data to assess the relationship between environmental factors and daily emergency room admissions for cardiorespiratory diseases. The model’s predictive accuracy was evaluated by comparing simulated values with observed historical data, thereby identifying the most influential environmental variables and critical exposure thresholds. This approach supports public health surveillance and healthcare resource management optimization. The health and environmental data, collected through meteorological sensors and air quality monitoring stations, cover eleven years (2013–2023), including meteorological conditions and atmospheric pollutants. Four ML models were compared, with XGBoost showing the best predictive performance (R² = 0.901; MAE = 0.047). A 10-fold cross-validation was applied to improve reliability. Global model interpretability was assessed using SHAP, which highlighted that high levels of carbon monoxide and relative humidity, low atmospheric pressure, and mild temperatures are associated with an increase in CRD cases. The local analysis was further refined using LIME, whose application—followed by experimental verification—allowed for the identification of the critical thresholds beyond which a significant increase in the risk of hospital admission (above the 95th percentile) was observed: CO > 0.84 mg/m³, P_atm ≤ 1006.81 hPa, Tavg ≤ 17.19 °C, and RH > 70.33%. The findings emphasize the potential of interpretable ML models as tools for both epidemiological analysis and prevention support, offering a valuable framework for integrating environmental surveillance with healthcare planning. Full article

Background: Skin and soft tissue infections (SSTIs) are a major cause of emergency room (ER) visits and hospitalizations. Long-acting lipoglycopeptides (LALs), such as dalbavancin and oritavancin, offer potential for early discharge and outpatient management, especially in patients at risk for methicillin-resistant Staphylococcus aureus (MRSA) or with comorbidities. Methods: We conducted a retrospective observational cohort study from March to December 2024 in an Italian tertiary-care hospital. Adult patients treated in the ER with a single dose of dalbavancin (1500 mg) or oritavancin (1200 mg) for SSTIs were included. Demographic, clinical, and laboratory data were collected. Follow-up evaluations were performed at 14 and 30 days post-treatment to assess outcomes. Results: Nineteen patients were enrolled (median age 59 years; 53% female). Most had lower limb involvement and elevated inflammatory markers. Three patients (16%) were septic. Fourteen patients (74%) were discharged without hospital admission; hospitalization in the remaining cases was due to comorbidities rather than SSTI severity. No adverse drug reactions were observed. At 14 days, 84% of patients had clinical resolution; only 10% had recurrence by day 30, with no mortality nor readmission reported. Conclusions: LALs appear effective and well-tolerated in the ER setting, supporting early discharge and reducing healthcare burden. Broader use may require structured care pathways and multidisciplinary coordination. Full article

Background: While Asia contributes 44.3% of traumatic brain injuries (TBI) worldwide, data regarding Asian TBI inpatient rehabilitation length of stay (RLOS) is scarce. A retrospective cohort study was conducted to determine correlates of inpatient RLOS (days) and prolonged RLOS >30 days (PRLOS > 30). (2) Methods: Data extraction of discharged inpatient records was performed from 2018 to 2024. Dependent variables included RLOS (days) and PRLOS > 30. Independent variables included demographic characteristics, TBI severity (emergency-room Glasgow Coma Scale-GCS), admission/discharge Functional Independence Measure (FIM), intra-rehabilitation complications, post-traumatic amnesia (PTA) duration, and discharge placement. (3) Results: Altogether, 289 data sets were analysed, median (IQR) age, 64 (28) years, 78.9% (228/289) males, and 79.6% (230/289) Chinese. Median (IQR) RLOS was 28 (21) days, with PRLOS >30 at 39.8% (115/289); RLOS of 44 (19.5) days. PRLOS > 30 was significantly associated with PTA duration >28 days (OR 4.01, 95% CI 1.90–8.45, p < 0.001), admission FIM ≤ 40/126 (OR 4.71, 95% CI 2.32–9.59, p < 0.001), delayed neurosurgical complications (OR 4.74, 95% CI 1.28–17.6, p = 0.02) and discharge to non-home destination (OR 2.75. 95% CI 1.12–6.76, p = 0.03). (4) Conclusion: PRLOS >30 was significantly associated with longer PTA > 4 weeks, lower admission FIM score, delayed neurosurgical complications, and discharge to a nursing home. Full article

Background: The yearly number of left ventricular assist device (LVAD) implantations is approximately twice the number of heart transplantations (HTX) in Germany. As the number of patients with an LVAD installed grows, so does the likelihood of their presentation to the emergency room (ER). Due to uneasiness in identifying their primary complaint, ER personnel are often likely to overlook important clues in the treatment of patients with an LVAD. Methods: To assess the urgency of patients’ conditions and their relationship with LVADs, we retrospectively examined the ER admissions of patients with HeartMate 3^TM (HM 3) LVADs installed between 2014 and 2024 at our university medical center. We counted referrals to the peripheral ward (minor) and to the intensive care unit (ICU, major). Relation to LVAD relation was also recorded. The survival was analyzed with respect to the severity of the cause of admission (minor/major) and the relationship to the LVAD therapy. Results: We observed 100 presentations to the emergency department. Of these, 77 were minor and 23 were major. The majority (92) was not related to the LVAD. Of the eight admissions related to the LVAD, two were major adverse events, accounting only for 2% of the total cases. Conclusions: An ER presentation of a patient with an HM 3 is very likely to have a medical cause not related to the LVAD. LVAD-related causes were mostly minor and could be treated on the ward. Full article

Background: Chronic obstructive pulmonary disease (COPD) is a progressive respiratory condition characterised by frequent exacerbations, which contribute to increased healthcare utilisation and reduced quality of life. Knowledge about the disease is generally associated with better outcomes. This study examined the association between COPD knowledge levels and healthcare utilisation (including hospital readmissions) in patients hospitalised for acute exacerbations. Methods: This prospective observational study included 78 patients hospitalised for COPD exacerbations and classified as Group D according to the updated GOLD criteria 2021. The Bristol COPD Knowledge Questionnaire (BCKQ) was administered prior to discharge to evaluate patients’ knowledge levels. Data were collected about emergency department visits, hospitalisations, and intensive care unit (ICU) admissions for a six-month follow-up period. Statistical analyses assessed the relationships between BCKQ scores, patient outcomes, and risk factors influencing hospital readmissions. Results: The median BCKQ total score was 23 (6–40). A strong correlation was found between higher BCKQ scores and more visits to the emergency room (p = 0.005), especially in the subdomains of epidemiology (p = 0.010), aetiology (p = 0.033), and dyspnoea (p = 0.042). Higher antibiotic knowledge scores were associated with ICU admissions (p = 0.019). Logistic regression analysis revealed that domiciliary NIV use (OR = 2.60, p = 0.041) and higher BCKQ scores (OR = 1.10, p = 0.010) were significant predictors of hospital readmissions. However, no significant relationship was found between survival and BCKQ or mCCI scores (p > 0.05). Conclusions: This study indicates that while increased COPD knowledge is associated with greater healthcare utilisation, it does not directly translate into improved clinical outcomes. These findings underscore the importance of integrating practical skills and behaviour management into educational programmes to help patients effectively apply their knowledge. Further research is needed to explore long-term implications and strategies to optimise knowledge-based interventions. Full article

Background/Objectives: Hypertension, diabetes, and cancer are three prevalent chronic conditions with distinct etiologies and significant global health impacts. This study aimed to explore the diverse impacts of different chronic illnesses on health behaviors and psychological well-being, with a focus on identifying and addressing the unique challenges faced by individuals with hypertension, diabetes, and cancer. It was hypothesized that health behaviors and psychological well-being would differ significantly among individuals with hypertension, diabetes, and cancer, reflecting the distinct demands and psychosocial impacts of each condition. Methods: The database of Americans’ Changing Lives, Wave 6, including 767 participants, was used (56.1% hypertension, 20.8% diabetes, and 19.9% cancer cases). Variables concerning physical and mental health issues were chosen. Descriptive statistics summarized the data. Chi-squared and t-tests assessed associations and group differences, with effect sizes reported. Logistic regression examined predictors of hypertension, diabetes, and cancer. Sensitivity analyses excluded outliers. Results: Hypertensive individuals are more likely to show cognitive impairment and unhealthy behaviors, including poor self-rated health, higher BMI, lower physical activity, and altered alcohol use. Risk increases with age, widowhood, retirement, hospital admissions, and poor mental health, while more emergency room or doctor visits slightly reduce it. People with diabetes experience greater depressive symptoms, hopelessness, and financial stress. They also tend to have poorer self-rated health, higher BMI, and less physical activity. Risk is higher for separated individuals and lower for females. Psychological distress is a key factor, while age, employment, and healthcare use show minimal influence. Cancer is linked to chronic stress, poorer perceived health, and mental health challenges. Risk is higher among older adults and those who keep house. Poor self-rated health, high BMI, low fruit and vegetable intake, and psychological distress increase risk, but healthcare use is not a strong predictor. Conclusions: While different chronic illnesses present distinct challenges to health behaviors and psychological well-being, they also share common features-such as increased stress and lifestyle disruptions-underscoring the importance of both tailored and cross-cutting interventions to effectively support individuals across conditions. Full article

Background: Patient motion poses significant challenges for the accurate delivery of radiotherapy. In children undergoing proton beam therapy (PBT), up to 30 treatments under general anesthesia may be required over a period of 6 to 8 weeks. To date, the impact of this many iterative anesthetic exposures on patient outcomes remains unclear. Objective: The primary objective of this study was to assess the impact of iterative anesthesia with propofol-based total intravenous anesthesia (propofol-TIVA) on overall survival. The secondary objective was to assess the association between propofol-TIVA and the occurrence of an unplanned admission or emergency room visit within 30 days of treatment start. Methods: This was a retrospective study of children (≤19 years) who had undergone PBT (with or without anesthesia) for central nervous system disease. The Log-rank test and Cox proportional hazards models were used for analysis. Propensity score matching and E-value analyses were used to adjust for selection bias. Results: The average age of the 461 children included was 9.0 years (SD ± 4.9). The majority, 261/461 (56.6%), were male, and 267/461 (57.9%) had undergone PBT without anesthesia. The group who underwent PBT with propofol-TIVA were younger (4.7 years vs. 12.2 years, p < 0.001) and had higher proportions of patients with treatment interruptions (111/194 [57.2%] vs. 118/267 [44.2%], p = 0.006), chemotherapy history (64/194 [33.0%] vs. 18/267 [6.7%], p < 0.001), concurrent chemotherapy (37/194 [19.1%] vs. 27/267 [10.1%], p = 0.006), and unplanned admissions/emergency room visits (26/194 [13.4%] vs. 1/267 [0.4%], p < 0.001). Overall survival rates (propofol-TIVA vs. no anesthesia) at 1yr (94% vs. 96%), 2 years (88% vs. 90%), and 3 years (88% vs. 89%) were similar between patient groups (p = 0.558). In the multivariable analysis, PBT with propofol-TIVA was associated with increased odds of an unplanned admission/emergency room visit before (OR, 38.311; 95%CI, 5.139–285.580; p < 0.001) and after (OR, 42.012; 95% CI, 5.322–331.632; p < 0.001; E-value = 83.52) propensity score matching. Conclusions: In this retrospective study of children undergoing PBT for central nervous system disease, there was no association between anesthesia exposure with propofol-based total intravenous anesthesia and overall survival. However, PBT with propofol-based total intravenous anesthesia was associated with an increased risk of an unplanned admission/emergency room visit within 30 days of treatment start. Full article

To determine whether patient-to-doctor transmission of measles occurred in an emergency department (ED) despite isolation precautions and full personal protective equipment (PPE) during the COVID-19 pandemic, an epidemiological and molecular investigation was carried out following the identification of two subsequent cases. The N fragment was used to identify the closest whole measles genome present in the GenBank nr database and, subsequently, this was used as a reference for the reconstruction of the entire MeV sequence in the two cases studied. Seven measles-susceptible healthcare workers were on duty the day of admission of the patient, wearing full PPE. The infected doctor neither visited the patient nor entered the isolation room. The patient wore a facial respirator. No breaches in infection control procedures, or other cases among contacts, patients and healthcare workers were identified. Molecular analysis provided evidence of patient-to-worker transmission: the two B3 genome sequences showed only one mutation and no sequences of other countries were identified as phylogenetically related. Isolation precautions and full PPE were widely implemented in the ED during the COVID-19 pandemic; however, this did not prevent nosocomial transmission of measles. Vaccination of healthcare workers and enhanced ventilation should complement other preventive measures to protect workers and patients. Full article

It is crucial to assess health impacts of PM_2.5, especially from wildfire smoke, to ensure proper planning for healthcare services. Studies often focus on respiratory conditions; fewer estimate the additional burden of cardiovascular complications. This study aims to extend previous work on the impacts of wildfire smoke and associated PM_2.5 on health in Southern Oregon by expanding study areas and timeframes, including cardiovascular conditions, and applying improved and novel air quality measurement data. This study adopts a case-crossover approach using conditional Poisson regression to analyze time stratified patient counts while controlling for mean temperature. Every 10 μg/m³ increase in PM_2.5 is associated with a 1.6% increase in same-day hospital or emergency room admission rates for respiratory conditions (OR = 1.0157; 95% CI: 1.0024–1.0287) and no significant increase in admission rates for cardiovascular conditions. A 10 μg/m³ increase in PM_2.5 lasting fifteen days is associated with a 6.5% increase in hospital or emergency room admission rates for respiratory conditions (OR = 1.0645; 95% CI: 1.0400–1.0894) and a 4.9% increase in hospital or emergency room admission rates for cardiovascular conditions (OR = 1.0493; 95% CI: 1.0265–1.0723). As the duration of poor air quality increases, the risk of negative respiratory and cardiovascular health outcomes increases. Full article

Background/Objectives: Although nursing complexity and health literacy (HL) are critical determinants of patient outcomes, their combined impact on mortality, hospital re-admissions, and emergency department (ED) visits remains poorly understood. This study aims to measure nursing complexity and HL in hospitalized patients, examine their interaction, and analyze their impacts on mortality, hospital re-admissions, and ED visits over a one-year follow-up period. Methods: Adult patients from two hospital centers were enrolled, excluding those with stays under two days or cognitive impairments. Data were collected at baseline to assess nursing complexity (measured according to the number of nursing diagnoses assigned to patients within 24 h from hospital admission) and HL (assessed using the Single-Item Literacy Screener, SILS). Patients were followed during a 12-month follow-up period to track mortality, hospital re-admissions, and ED visits. Latent class analysis classified patients into distinct nursing complexity and HL profiles. Survival analyses and Cox proportional hazard models were used to evaluate the relationships between variables. Results: At baseline, among the 2667 enrolled patients, 55.9% were classified as having high nursing complexity, and 32% had inadequate HL. High nursing complexity was associated with lower HL (r = 0.384; p < 0.001). During follow-up, 387 patients (14.5%) were lost. Of the remaining sample, mortality occurred in 8.3% of the patients, hospital re-admissions in 27.2%, and ED visits in 16.8%. Nursing complexity was significantly associated with higher mortality (HR: 1.84, adjusted HR: 1.81), but not with hospital re-admissions or ED visits. The patients with inadequate HL (32%) had increased risks of mortality (HR: 11.21, adjusted HR: 7.75), hospital re-admissions (HR: 3.61, adjusted HR: 3.58), and ED visits (HR: 20.78, adjusted HR: 14.45). The patients with both high nursing complexity and inadequate HL had the highest mortality risk and the lowest 12-month survival rate (75%; 95% CI: 71.1–79.1%; p < 0.001). Conclusions: This study demonstrates that both high nursing complexity and inadequate HL independently and jointly contribute to adverse patient outcomes. Interventions targeting HL and supporting patients with high nursing complexity could reduce risks, enhance care, and improve patient survival. While these findings underscore the critical role of both factors in patient outcomes, the limitations include this study’s single-country setting and reliance on a single-item HL measure. Future research should validate these findings in broader healthcare contexts and integrate multidimensional HL assessments for a more comprehensive evaluation. Full article

The study of the effects of climate change and air pollution on human health is an interesting topic for wellbeing projects in urban areas. We present a method for highlighting how adverse weather and environmental conditions affect human health and influence emergency room admissions during the summer in an urban area. Daily apparent temperature, a biometeorological index, was used to characterize thermal discomfort while atmospheric concentrations of PM10 and NOX were used as indicators of unfavorable environmental conditions. We analyzed how the above parameters influence the emergency room access, considering all the different pathologies. Over the four years analyzed, we identified the periods during which environmental conditions (both thermal discomfort and pollutant concentrations) were unfavorable, the persistence of these conditions, and verified that during these days, the average daily number of emergency room visits increased. Visits for ENT and dermatological disorders also showed significant increases. Our analysis showed that emergency room access is useful in evaluating the impact of unfavorable climatic and environmental conditions on human health during the summer period; vice versa, our results could be used to optimize resource management in emergency rooms during this specific period of the year. Full article

Background/Objectives: Dyspnea, the subjective experience of breathing discomfort, accounts for approximately 5% of emergency department (ED) presentations, 10% of general ward admissions, and 20% of intensive care unit (ICU) admissions. Despite its prevalence, dyspnea remains a challenging clinical manifestation for physicians. To the best of our knowledge, there are no international guidelines for the assessment and management of patients with dyspnea coming to the ED. In this study, we aim to evaluate how dyspnea cases are assessed and managed at Cantonal Hospital Baselland in Liestal (KSBL) and to audit these practices. Methods: We conducted a retrospective, observational study of hospital records from KSBL, including all patients presenting to the ED with dyspnea as their primary symptom who were subsequently admitted to the internal medicine ward for at least one night between January and December 2022. Data on assessment and management practices were compared using the medStandards algorithm. Results: A total of 823 cases were included. The median age at admission was 76 years (with a range of 15–99), and 57% of the patients were male. Blood pressure and heart rate were documented in 93.8% of the cases, respiratory rate in 61.4%, oxygen saturation in 96.1%, and body temperature in 86.3%. The patient’s subjective dyspnea description was recorded in 14.8% of the cases, while the temporal onset (timing of symptoms) was documented in 98.8%, and the intensity of effort triggering dyspnea was noted in 36.2% of cases. A dyspnea index scale was used in 7.8% and smoking status was documented in 41.1% of the cases. Lung percussion was performed in 2.6% of the cases, while a lung auscultation was performed in 94.4% and a heart auscultation was performed in 85.3% of cases. A complete blood count with a basic metabolic panel and TSH test was collected in 86.9% of the cases, while a blood gas analysis was collected in 34.0% of the cases. An ECG was reported in 87.5% of the cases. From the 337 patients who should have received an emergency ultrasound, 10.1% received one. The three most frequent final diagnoses were decompensated heart failure (28.4%), pneumonia (26.4%), and COVID-19 (17.0%). None of the three patients with a known neuromuscular disease were admitted to the shock room. Conclusions: Our findings reveal that the medStandards algorithm was only partially followed at the ED in KSBL Liestal, highlighting gaps in detailed history taking, respiratory rate measurement, lung percussion, and emergency ultrasound use. Given the frequency of dyspnea-related presentations, systematic improvements in the adherence to assessment protocols are urgently needed to enhance patient outcomes. Full article

Background and Clinical Significance: Necrotizing fasciitis (NF) is a rare skin and soft tissue infection that progresses rapidly to necrosis and can be life-threatening. The incidence varies by geographic region but is generally low, with a mortality rate ranging between 11 and 22%. Early diagnosis and treatment are crucial for survival, particularly in patients with underlying conditions such as immune suppression, diabetes, obesity, trauma, recent surgical procedures, or renal pathology. However, the relationship between pregnancy and NF has not been extensively studied. Case Presentation: The case presented involves a 37-year-old, 20-week pregnant woman, who presented to the emergency department with septic shock and left forearm compartment syndrome. She reported no recent trauma or obvious source of contamination. The patient was immediately admitted and taken to the operating room. During admission, she underwent three surgeries, consisting of staged debridement, fasciectomy, and vacuum therapy and skin grafting. The patient was carefully monitored in the intensive care unit and multiple obstetrical consultations were performed to monitor the fetus. The patient was discharged with a fully integrated graft and with the donor area undergoing epithelialization. Conclusions: This case highlights the importance of early diagnosis and treatment of NF, particularly in high-risk patients, and the need for further research into the relationship between pregnancy and NF. Full article

Background: While severe exacerbations are known to worsen the prognosis of patients with chronic obstructive pulmonary disease (COPD), the extent of this impact based on the degree of deterioration is unclear. COPD Assessment Test (CAT) scores increase during exacerbations, reflecting symptom worsening. This study aimed to compare healthcare resource utilisation and mortality among patients with COPD after a severe exacerbation, stratified by changes in CAT scores. Methods: This observational study included patients hospitalised for COPD exacerbation. The CAT questionnaire was administered twice: once referring to the time of admission and once to the stable phase. Patients were divided into tertiles based on symptom worsening. A prospective follow-up was conducted to compare emergency room visits, hospital admissions, and survival rates. Results: This study included 50 patients, of whom 30 (60%) were male. Their mean age was 70.5 years (standard deviation [SD]: 9.6), mean forced expiratory volume in the first second (FEV1) was 46.7% (SD: 0.8) of the predicted value, and median CAT score deterioration was 9 points (interquartile range: 5–15.25). Patients in the third tertile had earlier healthcare utilisation than those in the first tertile (emergency room visits: log-rank = 5.27, p = 0.022; hospitalisations: log-rank = 5.27, p = 0.022). Survival rates did not differ significantly among tertiles. Conclusions: Patients with greater CAT score deterioration experienced earlier COPD-related events, suggesting the need for closer monitoring after severe exacerbation. Full article

Background: Effective pain management is essential to early extubation and recovery in living donor liver transplantation (LDLT). The subcostal transversus abdominis plane (TAP) block has emerged as a potential strategy to address postoperative pain while reducing opioid consumption. This study evaluated the effectiveness of the TAP block in facilitating early extubation in the OR and examined its impact on re-intubation rates, postoperative fentanyl requirements, and pain intensity upon ICU admission to determine its role in perioperative pain management. Methods: This retrospective cohort study included adult patients who underwent LDLT for hepatocellular carcinoma within the Milan criteria. Propensity score matching was performed to compare outcomes between patients who received the subcostal TAP block and those who did not. The primary outcome was the rate of successful extubation in the operating room (OR). Secondary outcomes included re-intubation rates, postoperative fentanyl requirements, and peak numeric rating scale (NRS) pain scores upon ICU admission. Results: The subcostal TAP block was associated with a significantly higher rate of successful OR extubation compared with no TAP block. Multivariable analysis revealed that the TAP block independently increased the likelihood of successful extubation. Patients receiving the TAP block required less fentanyl for pain management and demonstrated lower peak NRS pain scores upon ICU admission. No complications related to the TAP block were observed, underscoring its safety in this high-risk population. Conclusions: The subcostal TAP block facilitates early OR extubation by effectively managing postoperative pain and reducing opioid requirements, promoting smoother recovery without increasing adverse events. These findings support its inclusion in multimodal analgesia protocols for optimizing perioperative outcomes in LDLT patients. Full article