Search Results (272)

Background: Use of high-flow nasal cannula (HFNC) expanded from ICUs to internal medicine/respiratory wards during and after the COVID-19 pandemic, but safety and effectiveness in non-ICU settings remain uncertain. Methods: We performed a systematic review and meta-analysis of adults (≥18 years) initiated on HFNC in non-ICU wards. Primary outcomes were in-hospital (or 28-day) mortality and ICU transfer; where available, we compared mortality for HFNC vs. conventional oxygen therapy (COT) in do-not-intubate (DNI) cohorts. Observational studies and trials were eligible. Random-effects models synthesized proportions and risk ratios; risk of bias (ROBINS-I/RoB 2) and certainty (GRADE) were assessed. Results: Ten studies met the inclusion criteria for any-ward HFNC; subsets contributed data to pooled analyses. Across all non-ICU wards (general wards plus step-up IMCU/HDU), pooled mortality was 14.0% (95% CI 4.6–35.5; I² ≈ 92%). Pooled ICU transfer after ward/step-up HFNC start was 20.0% (95% CI 6.3–48.1; I² ≈ 97%). Restricted to internal medicine/respiratory wards, pooled mortality was 19.8% (95% CI 7.1–44.2; I² ≈ 95%) and ICU transfer 31.2% (95% CI 9.9–65.0; I² ≈ 97%). In step-up units (IMCU/HDU), ICU transfer appeared lower and less variable (22.0% [95% CI 16.5–28.8]; I² ≈ 10%), suggesting environment-dependent outcomes. In a multicenter DNI COVID-19 cohort, HFNC vs. COT showed no clear mortality difference (RR ≈ 0.90, 95% CI 0.75–1.08; adjusted OR ≈ 0.72, 95% CI 0.34–1.54). Certainty of evidence for all critical outcomes was very low due to observational design, high inconsistency, and imprecision. Conclusions: HFNC outside the ICU is feasible, but it is related to nontrivial mortality and frequent escalation—particularly on general wards—while step-up units demonstrate more reproducible trajectories. Outcomes appear strongly conditioned by care environment, staffing, monitoring, and escalation pathways. Given very low certainty and substantial heterogeneity, institutions should pair ward HFNC with protocolized reassessment and rapid response/ICU outreach, and future research should prospectively compare ward HFNC pathways against optimized COT/NIV using standardized outcomes. Full article

Background/Objectives: Thirdhand smoke (THS), residual tobacco pollutants persisting on surfaces, dust, and fabrics, poses specific risks to infants and children, yet its implications for nursing remain underexplored. This scoping review mapped existing evidence on THS in neonatal and pediatric contexts and synthesized nursing implications, focusing on nurses’ knowledge, unintentional environmental contamination, and educational roles. Methods: Following JBI methodology and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a three-step search was performed across MEDLINE, CINAHL, Scopus, Web of Science, Cochrane Library, Google Scholar, and OpenGrey. Studies were included if they addressed (1) nurses’ knowledge, beliefs, and attitudes toward THS-related risks in infants and children; (2) nurses’ contribution to unintentional environmental THS contamination; or (3) nurse-led educational or preventive interventions targeting parents or communities. Results: Among 563 records, 8 met inclusion criteria. Four investigated nurses’ awareness and perceptions, revealing limited understanding of THS despite recognition of its harmfulness. One study examined contamination, detecting nicotine residues on nurses’ fingers, suggesting possible in-hospital transmission. No nurse-led interventions specifically targeting THS were found, though broader smoke-exposure education programs showed benefits when supported by nursing staff. Conclusions: Evidence is scarce but underscores significant gaps in nurses’ knowledge, clinical guidance, and educational initiatives concerning THS. Strengthening nursing education and research is essential to mitigate THS exposure in neonatal and pediatric settings and enhance nurses’ preventive and advocacy roles. Full article

Background/Objectives: Quantitative computed tomography (CT) metrics are widely used to assess pulmonary involvement and to predict short-term severity in coronavirus disease 2019 (COVID-19). However, it remains unclear whether baseline artificial intelligence (AI)-based quantitative high-resolution computed tomography (HRCT) metrics of pneumonia burden provide incremental prognostic value for in-hospital composite adverse outcomes beyond routine clinical factors, or whether these imaging-derived markers carry any exploratory signal for long-term severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reinfection among hospitalized patients. Most existing imaging studies have focused on diagnosis and acute-phase prognosis, leaving a specific knowledge gap regarding AI-based quantitative HRCT correlates of early deterioration and subsequent reinfection in this population. To evaluate whether combining deep learning-derived, quantitative, HRCT features and clinical factors improve prediction of in-hospital composite adverse events and to explore their association with long-term reinfection in patients with COVID-19 pneumonia. Methods: In this single-center retrospective study, we analyzed 236 reverse-transcription polymerase chain reaction (RT-PCR)-confirmed COVID-19 patients who underwent baseline HRCT. Median follow-up durations were 7.65 days for in-hospital outcomes and 611 days for long-term outcomes. A pre-trained, adaptive, artificial-intelligence-based, prototype model (Siemens Healthineers) was used for pneumonia analysis. Inflammatory lung lesions were automatically segmented, and multiple quantitative metrics were extracted, including opacity score, volume and percentage of opacities and high-attenuation opacities, and mean Hounsfield units (HU) of the total lung and opacity. Patients were stratified based on receiver operating characteristic (ROC)-derived optimal thresholds, and multivariable Cox regression was used to identify predictors of the composite adverse outcome (intensive care unit [ICU] admission or all-cause death) and SARS-CoV-2 reinfection, defined as a second RT-PCR-confirmed episode of COVID-19 occurring ≥90 days after initial infection. Results: The composite adverse outcome occurred in 38 of 236 patients (16.1%). Higher AI-derived opacity burden was significantly associated with poorer outcomes; for example, opacity score cut-off of 5.5 yielded an area under the ROC curve (AUC) of 0.71 (95% confidence interval [CI] 0.62–0.79), and similar performance was observed for the volume and percentage of opacities and high-attenuation opacities (AUCs up to 0.71; all p < 0.05). After adjustment for age and comorbidities, selected HRCT metrics—including opacity score, percentage of opacities, and mean HU of the total lung (cut-off −662.38 HU; AUC 0.64, 95% CI 0.54–0.74)—remained independently associated with adverse events. Individual predictors demonstrated modest discriminatory ability, with C-indices of 0.59 for age, 0.57 for chronic obstructive pulmonary disease (COPD), 0.62 for opacity score, 0.63 for percentage of opacities, and 0.63 for mean total-lung HU, whereas a combined model integrating clinical and imaging variables improved prediction performance (C-index = 0.68, 95% CI: 0.57–0.80). During long-term follow-up, RT-PCR–confirmed reinfection occurred in 18 of 193 patients (9.3%). Higher baseline CT-derived metrics—particularly opacity score and both volume and percentage of high-attenuation opacities (percentage cut-off = 4.94%, AUC 0.69, 95% CI 0.60–0.79)—showed exploratory associations with SARS-CoV-2 reinfection. However, this analysis was constrained by the very small number of events (n = 18) and wide confidence intervals, indicating substantial statistical uncertainty. In this context, individual predictors again showed only modest C-indices (e.g., 0.62 for procalcitonin [PCT], 0.66 for opacity score, 0.66 for the volume and 0.64 for the percentage of high-attenuation opacities), whereas the combined model achieved an apparent C-index of 0.73 (95% CI 0.64–0.83), suggesting moderate discrimination in this underpowered exploratory reinfection sample that requires confirmation in external cohorts. Conclusions: Fully automated, deep learning-derived, quantitative HRCT parameters provide useful prognostic information for early in-hospital deterioration beyond routine clinical factors and offer preliminary, hypothesis-generating insights into long-term reinfection risk. The reinfection-related findings, however, require external validation and should be interpreted with caution given the small number of events and limited precision. In both settings, combining AI-based imaging and clinical variables yields better risk stratification than either modality alone. Full article

Background: Community-acquired pneumonia (CAP) remains one of the leading causes of infectious mortality worldwide. Variability in diagnosis and management can significantly influence outcomes. Objective: To assess the association between the implementation of a standardized hospital protocol and clinical outcomes in patients hospitalized for bacterial CAP and to identify factors associated with in-hospital and 30-day mortality. Methods: An ambispective before–after study was conducted at Hospital San Juan de Dios del Aljarafe (Seville, Spain), including a retrospective phase (2019) and a prospective intervention period (2022–2023). The intervention consisted of a standardized clinical protocol supported by training sessions and a 9-item checklist. Adults (≥18 years) with clinically and radiologically confirmed bacterial CAP were included. Mortality, length of stay, and empirical and targeted antibiotic adequacy were compared between periods. In the prospective cohort (n = 169), mortality-associated factors were analyzed using multivariate logistic regression. Results: A total of 1610 patients were analyzed: 634 in the pre-intervention period and 976 during the intervention period. Hospital mortality was lower during the intervention (11.3% [95% CI 9.3–13.2] vs. 16.6%; [95% CI 13.7–19.5] p = 0.002) with an absolute risk difference of 5.3%, corresponding to an approximate number needed to treat (NNT) of 19. Median length of stay decreased slightly (8.1 vs. 7.9 days; p < 0.001). In the prospective cohort, in-hospital mortality was 7.7% and 30-day mortality 16.6%. The therapeutic effort limitation (aOR 9.10, 95% CI 1.36–121.57; p = 0.021) and lower SaO₂/FiO₂ (aOR per unit 0.98, 95% CI 0.97–0.99; p < 0.001) were independently associated with in-hospital mortality. The ARDS (aOR 4.29, 95% CI 1.05–19.93; p = 0.043), lower SaO₂/FiO₂ (aOR 0.99 per unit, 95% CI 0.98–1.00; p = 0.005), older age (aOR 1.06 per year, 95% CI 1.02–1.12; p = 0.005), and lower Barthel Index (aOR 0.97 per point, 95% CI 0.94–0.99; p < 0.001) were associated with higher 30-day mortality. Conclusions: Implementation of a standardized CAP protocol was associated with lower mortality and high antibiotic adequacy in the intervention cohort. While causal inference is limited by the non-contemporaneous before–after design, these findings support the integration of structured, multidisciplinary, protocol-driven strategies—together with periodic audit and feedback cycles—to strengthen CAP management in community hospital settings. Full article

Background/Objectives: Oral hygiene is an essential component of overall health, but is often neglected during hospital stays, particularly among patients who rely on healthcare providers for daily care. Poor oral hygiene may lead to discomfort, infections, and complications such as hospital-acquired pneumonia. The objective of this study was to assess the oral hygiene practices of hospitalized patients in Al-Ahsa, Saudi Arabia. Methods: A hospital-based cross-sectional study was conducted among patients in public and private hospitals. Since no prior studies existed for this population, a pilot study with 60 participants was used to estimate the population proportion for sample size calculation. Based on the pilot findings, a proportion of 80% was assumed, with a 95% confidence level, 5% margin of error, and 80% power. Patients were recruited through non-probability convenience sampling. Data were collected via structured face-to-face interviews and analyzed using SPSS version 27. Descriptive statistics, chi-square tests, and logistic regression were applied, with significance set at 0.05. Results: Regular toothbrushing declined from 69.6% before admission to 29.8% during hospitalization. Only 29.8% of patients received oral hygiene supplies, and 79.2% received no assistance. In-hospital toothbrushing was significantly associated with being female (AOR = 2.52; 95% CI: 1.17–5.43), non-Saudi (AOR = 3.91; 95% CI: 1.22–12.55), and having a Bachelor’s degree or higher (AOR = 5.66; 95% CI: 1.53–20.88). Conclusions: Oral hygiene among hospitalized patients in Al-Ahsa was inadequate, particularly in public hospitals where essential supplies were lacking. Hospitals should adopt clear oral care policies, ensure supply availability, train staff, and integrate dental professionals to improve patient safety and prevent complications. Full article

Background: Wireless Vital Parameter Continuous Monitoring (WVPCM) allows the continuous tracking of patient physiological parameters, facilitating the earlier detection of clinical deterioration, especially in low-intensity care settings. The aim of this study is to evaluate the effectiveness of using WVPCM compared to the usual monitoring of critically ill patients hospitalized in Internal Medicine wards. An investigation of the attitude of health professionals towards the use of new technologies in daily practice to improve patient management was also carried out. Methods: The LIght Monitor Study (LIMS) is a prospective, open-label, randomized, multi-center pilot trial comparing WVPCM and conventional nurse monitoring during the first 72 h of hospitalization. A central randomization unit used computer-generated tables to allocate patients to two different types of monitoring. The main outcome was the occurrence of major complications. The study planned to enroll 296 critically ill patients with a Modified Early Warning Score (MEWS) ≥ 3 and/or National Early Warning Score (NEWS) ≥ 5 across two Internal Medicine (IM) Units in Italy. The investigation of the attitude of nurses towards the use of WVPCM was carried out by using a questionnaire and a qualitative survey. Results: Due to the COVID-19 outbreak, the study was interrupted early and only 135 patients (WVPCM = 68; standard care = 67) were randomized. One patient in the control group was excluded from analysis because of drop-out, leaving 134 patients for intention to treat analysis. No statistically significant differences between standard care and WVPCM were observed in terms of major complications (37.5%, vs. 31.2% p = 0.475), in-hospital mortality (17.5% vs. 11.1%, p = 0.309), and median hospital length of stay (9 vs. 10 days, p = 0.463). WVPCM decreased nursing workload compared to the control, as the average time spent by nurses on the detection of vital signs per patient was 0 min per patient per day compared to 24.4 min (p < 0.001) observed in the control group. Twenty-two percent of patients in the WVPCM group (15/68) experienced discomfort with the device, resulting in its removal. The investigation of nurses involved 16 out of 18 people participating in the study. Opinions on the wireless device for patient monitoring were particularly favorable; most of them considered remote monitoring clearly superior to traditional in-person visits and easy to use after a brief practice period. All participants recognized the safety benefits of the system. Conclusions: The reduced sample size of this pilot study does not allow us to draw any conclusions on the superiority of WVPCM compared to standard care in terms of clinical outcomes. However, we observed a positive trend in the reduction of major complications. Full article

Background/Objectives: Abnormal vital signs often precede in-hospital clinical deterioration, but little is known about how nurses decide when to recheck vital signs. We examined how nurse characteristics relate to the next vital sign observation interval after detecting abnormal values and how this decision could be used as a learning objective in simulation-based education. Methods: In this prospective exploratory observational study at a university hospital in Japan, twenty-seven nurses used a full-body patient simulator across three scenarios: normal, low-urgency, and moderate-risk (moderately abnormal vital signs according to National Early Warning Score 2 [NEWS2] risk bands). After each assessment, participants specified in hours the interval they considered appropriate for the next vital sign observation. Nurse characteristics included years of clinical experience, advanced life support (ALS) training, and prior experiences recognizing or responding to deterioration. Mann–Whitney U tests and multiple regression were used to explore univariate and adjusted associations. Results: In the low-urgency scenario, ALS training was associated with shorter intervals (median 1 h vs. 3 h; p = 0.04). In the moderate-risk scenario, univariate analyses showed shorter intervals among nurses with greater experience and among those with ALS training (both p < 0.01). In adjusted models for the moderate-risk scenario, years of experience and prior experiences of recognizing and responding to deterioration were independently associated with shorter intervals (all p < 0.05), whereas ALS training was not. Conclusions: The decision to shorten observation intervals appears to reflect experiential aspects of clinical judgment. Integrating “setting the next observation interval” as an explicit learning objective in simulation may help strengthen nurses’ clinical judgment for early recognition of deterioration. As an exploratory, single-center study with a small sample and fixed scenario order, these findings should be interpreted cautiously and used to guide larger confirmatory studies and curricular design. This study was not registered. Full article

Background: Chronic total occlusion percutaneous coronary intervention (CTO PCI) is a complex revascularization procedure requiring advanced techniques to ensure procedural success and safety. Hybrid strategies combining antegrade dissection/re-entry (ADR) and retrograde approaches have become increasingly adopted in contemporary practice. Objectives: To systematically review and synthesize evidence comparing outcomes of ADR and retrograde CTO PCI techniques, with pooled estimates of success rates and adverse events. Methods: This review followed PRISMA 2020 guidelines. We searched PubMed, Cochrane CENTRAL, and Google Scholar for studies published between January 2015 and June 2025. Eligible studies included randomized controlled trials and observational studies reporting outcomes of ADR and/or retrograde CTO PCI. Data extraction was performed by two independent reviewers. Risk of bias was assessed using the Newcastle–Ottawa Scale and the Cochrane RoB 2.0 tool. A random-effects meta-analysis was conducted for consistently reported outcomes. Results: Twenty studies encompassing over 87,000 CTO PCI procedures were included. Pooled analysis of 16 studies demonstrated a technical success rate of 83.4% and a procedural success rate of 84.6%. The in-hospital major adverse cardiac event (MACE) rate was 3.3%. Hybrid strategies integrating ADR and retrograde approaches yielded the highest success rates (86–91%) with acceptable safety profiles. Use of adjunctive tools such as IVUS, dual arterial access, and re-entry devices was associated with improved outcomes. Discussion: Hybrid CTO PCI techniques are safe, effective, and reproducible across diverse clinical settings. When performed by experienced operators using modern adjuncts, these strategies provide durable benefits and should be considered standard for complex occlusions. Limitations include variation in study quality, heterogeneous procedural definitions, and lack of long-term data in several cohorts. Full article

Background: Intra-abdominal infection (IAI) is a challenging condition that needs both medical and surgical treatment and it is still associated with high morbidity and mortality rates. Fosfomycin is approved for use in combination therapy for IAIs. The aim of this study was to evaluate the impact of intravenous fosfomycin addition in a combination regimen for IAI treatment in an intensive care setting. Methods: We performed a retrospective, observational, monocentric study. We enrolled patients admitted to the ICU with IAIs from April 2022 to June 2024. Patients were divided into two groups: Group A, standard treatment; and Group B, combination therapy including fosfomycin. Primary endpoints were clinical response at 7 days and in-hospital mortality; moreover, a risk factor analysis for mortality was also performed. Results: In total, 104 patients were enrolled, 85 in Group A, and 19 in Group B. Groups were homogenous in regard to demographics, but clinical condition was slightly worst in Group B. Source control < 24 h was performed in 69.6% and 33.3% cases in Group A and Group B, respectively (p = 0.017). Clinical response on day 7 (81.2% vs. 73.7%, p = 0.675) and in-hospital mortality (27.1% vs. 47.2%, p = 0.145) were comparable. Univariate and multivariate analysis highlighted Charlson Comorbidity Index (CCI) (p = 0.04) and septic shock (p = 0.029) as risk factors, and effective empirical therapy (p = 0.04) as the protective factor; fosfomycin was not directly associated with outcome improvement. Conclusions: The outcome was comparable between groups; clinicians preferred to administer a combination regimen including fosfomycin in patients with statistically significant greater severity of illness and without early source control. Full article

Background: Age is a well-established determinant of sepsis outcomes, often integrated into severity scoring systems. However, most studies focus on critically ill patients in intensive care units (ICUs), with limited insight into how age influences mortality in non-ICU settings, particularly across the full adult lifespan. Objective: To investigate the relationship between age and in-hospital mortality in patients with sepsis hospitalized in internal medicine wards, using age-stratified logistic and spline regression models. Methods: We conducted a retrospective, multicenter cohort study involving 4300 adult patients admitted to internal medicine wards at eight academic hospitals affiliated with Clalit Health Services in Israel between December 2001 and October 2020. All patients were diagnosed with sepsis during hospitalization and died during their hospital stay. Patients were stratified into seven age groups (18–34, 35–44, 45–54, 55–64, 65–74, 75–84, >85 years). Logistic regression identified age-specific comorbidities associated with mortality. Adjusted spline regression models were used to estimate mortality probabilities across age ranges. Results: The cohort had a mean age at death of 78.84 years, and 51.7% were female. Mortality probability increased with age but demonstrated non-linear trends. Sharp fluctuations in predicted mortality were observed in middle-aged groups (especially ages 45–54), with peaks not captured in conventional binary or linear models. Hematologic and solid neoplasms were strongly associated with mortality in younger groups, while cardiovascular comorbidities such as heart failure and atrial fibrillation were more prominent in older adults. Conclusions: Age is a major determinant of in-hospital mortality in septic patients on internal medicine wards, but its effect is non-linear and age-specific. Our findings highlight a unique population of patients with severe sepsis not managed in critical care settings and underscore the need for more nuanced, age-stratified risk assessment models outside of the ICU. Full article

Mucormycosis (MCM) is an opportunistic fungal infection in immunocompromised hosts, most commonly associated with poorly controlled diabetes mellitus (DM). We conducted a retrospective review of 45 MCM cases diagnosed between 2010 and 2023 at a referral center in Central California, a region with high DM prevalence and significant healthcare disparities. Clinical features, histopathology, microbiology, treatment, and outcomes were analyzed. Ninety-six percent of patients had DM, and 69% had no other predisposing condition. Glycemic control was markedly poor: 36% had HbA1c > 10%, and 61% had HbA1c > 8%. Diabetic ketoacidosis (DKA) was present in 19% of patients and associated with 100% mortality. Rhino-orbito-cerebral mucormycosis (ROCM) accounted for 60% of cases and carried a 70% mortality rate. Angioinvasion, confirmed in 62% of biopsied cases, significantly increased mortality (69% vs. 28%, p = 0.015). In-hospital mortality remained high at 58%, consistent with outcomes reported in other high-burden settings. Over 60% of patients identified as Hispanic. ZIP code–based analyses revealed that 75% of individuals lived in neighborhoods with Healthy Places Index (HPI) scores below the 25th percentile, and 64% resided in areas with a Social Deprivation Index (SDI) of 85 or higher, indicating entrenched structural disadvantage. Our findings highlight that MCM in Central California disproportionately affects individuals with uncontrolled DM living in socially deprived areas. These data underscore the need for early diagnosis, targeted antifungal therapy, and upstream public health interventions addressing diabetes management and healthcare access. Full article

Introduction: Timely detection of clinical deterioration in hospitalized patients remains a challenge, often limited by intermittent vital signs (VS) monitoring and delayed escalation. Remote patient monitoring (RPM) offers a medium of high-frequency surveillance of patient VS and may facilitate earlier recognition of deterioration. This study evaluated whether RPM integration into rapid response workflows improves clinical outcomes among patients requiring clinical emergency response team (CERT) activation and subsequent intensive care unit (ICU) transfer. Methods: A retrospective study was conducted to assess the impact of RPM implementation on severity of illness and mortality in adult patients who experienced CERT activation followed by ICU transfer. The primary outcomes were severity of illness at ICU admission and in-hospital mortality. We hypothesized that patients in the post-intervention group would demonstrate better outcomes compared to pre-intervention. Results: A total of 1120 patients were included (PRE: n = 656; POST: n = 464). The POST group, which received continuous monitoring via the BioButton^® device and augmented workflows, demonstrated a lower mean APACHE-IV score at ICU transfer (83.96 vs. 90.01; p = 0.0016 and reduced in-hospital mortality (7.75% vs. 11.48%; p = 0.084). Median ICU stay in the PRE group was 5.85 (3.00–11.58) and 5.07 (2.59–9.22) in the POST group (p: 0.0565). Total LOS was 11.95 (6.57–20.40) and 10.50 (6.01–18.17), respectively [p = 0.0278]. Conclusions: Integration of RPM into hospital care pathways was associated with earlier recognition of clinical deterioration, reduced illness severity at ICU admission, and lower in-hospital mortality. These findings may support the utility of RPM as part of a comprehensive, multicomponent, rapid response model to recognize early physiological deterioration and may improve patient safety and outcomes in acute care settings. Full article

Pesticide poisoning remains a significant public health issue, characterized by high morbidity and mortality, particularly among patients presenting to the emergency department. This study aimed to develop a 14-day in-hospital mortality prediction model for patients with acute pesticide poisoning using early clinical and laboratory data. This retrospective cohort study included 1056 patients who visited Soonchunhyang University Cheonan Hospital between January 2015 and December 2020. The cohort was randomly divided into train (n = 739) and test (n = 317) sets using stratification by pesticide type and outcome. Candidate predictors were selected based on univariate Cox regression, LASSO regularization, random forest feature importance, and clinical relevance derived from established prognostic scoring systems. Logistic regression models were constructed using six distinct feature sets. The best-performing model combined LASSO-selected and clinically curated features (AUC 0.926 [0.890–0.957]), while the final model—selected for interpretability—used only LASSO-selected features (AUC 0.923 [0.884–0.955]; balanced accuracy 0.835; sensitivity 0.843; specificity 0.857; F1.5 score 0.714 at threshold 0.450). SHapley Additive exPlanations (SHAP) analysis identified paraquat ingestion, Glasgow Coma Scale, bicarbonate level, base excess, and alcohol history as major mortality predictors. The proposed model outperformed the APACHE II score (AUC 0.835 [0.781–0.888]) and may serve as a valuable tool for early risk stratification and clinical decision making in pesticide-poisoned patients. Full article

Background and Objective: Acute kidney injury (AKI) is a serious condition requiring prompt fluid resuscitation, yet both under- and over-treatment carry risks. Accurate volume assessment is essential, especially in emergency settings. The Inferior Vena Cava Collapsibility Index (IVCCI) is commonly used but has limitations. The Pleth Variability Index (PVI) offers a non-invasive alternative, though its role in AKI remains unclear. To compare the efficacy of the Pleth Variability Index (PVI) and Inferior Vena Cava Collapsibility Index (IVCCI) in assessing fluid responsiveness and predicting in-hospital mortality in patients with acute kidney injury. Materials and Methods: This prospective observational study enrolled 50 adult AKI patients presenting to a tertiary emergency department. All patients received sequential fluid resuscitation with 1000 mL and 2000 mL of isotonic saline. PVI, IVCCI, mean arterial pressure (MAP), peripheral oxygen saturation (SpO₂, perfusion index (PI), and shock index (SI) were recorded at baseline and after each fluid bolus. Changes in these parameters were analyzed to assess their utility in fluid responsiveness. Additionally, the prognostic value of baseline PVI for in-hospital mortality was investigated. Results: PVI demonstrated a significant and dose-responsive decrease following fluid administration, outperforming IVCCI, MAP, PI, SpO₂, and SI in sensitivity (p < 0.001). Baseline PVI values were significantly associated with mortality (AUC: 0.821, p < 0.001), whereas post-resuscitation PVI values showed no prognostic significance. IVCCI and PI showed comparable reliability but were less sensitive to incremental volume changes. Conclusions: PVI is a sensitive, non-invasive marker of fluid responsiveness in non-intubated AKI patients and may also serve as an early prognostic indicator. Its use in emergency departments could support fluid management decisions, but further large-scale, multicenter studies are needed to validate these findings. Full article

Aim: Older adult pedestrians are at greater risk of severe injuries than younger pedestrians due to gradual physical changes and coexisting medical conditions. This leads to longer hospital stays, increased mortality risk, and higher inpatient costs. Focusing on the aging population, this study explores the characteristics and injury profiles of pedestrian crossing accidents in the capital city of Bern, Switzerland. Methods: Our retrospective cohort study comprised adult patients admitted to our ED between 1 January 2013 and 31 December 2023, as crossing (or zebra crossing)-related pedestrian victims. Two cohorts were formed on the basis of age < 65 and ≥65 years and compared according to the setting of the accident, type, pattern of the injury, and clinical outcomes (short-term mortality, ICU/hospital length of stay). Results: Of a total of 124 patients, 31.5% (n = 39) of patients were elderly (65+ group). In contrast to the younger patients, the aging population was predominantly admitted as inpatients (64.1% vs. 35.3%, p = 0.001) and was hospitalised in the intensive care unit (20.5% vs. 6%, p = 0.020). Older patients were more likely to be polytraumatised (41% vs. 11.8%, p = 0.001) and to have been tossed or hurled than patients under 65 years (75% vs. 47.3%, p = 0.016). Fractures of the upper extremities (17.9% vs. 4.7%, p = 0.016), pelvis (30.8% vs. 9.4%, p = 0.003), and thoracic spine (12.8% vs. 2.4%, p = 0.019) were significantly more common in the elderly population. Intracranial haemorrhage (35.9% vs. 17.6%, p = 0.026), abdominal trauma (17.9% vs. 5.9%, p = 0.035), and relevant vessel damage (30.8% vs. 3.5%, p < 0.001) were also significantly higher in geriatric patients. Trauma indices were slightly more increased in the older population than in the younger group (ISS; p = 0.004 and AIS > 2 of chest and thoracic spine; abdomen, pelvic contents, and lumbar spine; extremities & bony pelvis p < 0.05). The 65+ group had a longer length of hospital stay (p = 0.001) and ICU stay (p = 0.002). A hospital stay longer than 7 days was also significantly more common in elderly individuals (p = 0.007). In-hospital (15.4% vs. 1.2%, p = 0.001) and 30-day mortality (17.9% vs. 1.2%, p < 0.001) were significantly higher in patients over 65 years of age. Conclusion: In our study, the impact of pedestrian crossing accidents was more severe in the elderly, as indicated by the severity of injuries, hospitalisation rate, longer length of hospital and ICU stays, and higher mortality rates. These findings underline the importance of developing tailored strategies to reduce crosswalk accidents and to optimise management approaches for these vulnerable patients. Full article