Diagnostic, Prognostic, and Therapeutic Pathways in Emergency Medicine and Critical Care

A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Critical Care".

Deadline for manuscript submissions: 16 July 2024 | Viewed by 14251

Special Issue Editor


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Guest Editor
Department of Emergency Medicine, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
Interests: critical care; decision making; diagnostic test approval; emergency medical services; emergency medicine; epidemiology; evidence-based medicine; health care quality, access, and evaluation; health services research; intensive care; meta-analysis; prognosis; research design

Special Issue Information

Dear Colleagues,

As healthcare providers in emergency medicine and critical care, we are faced with numerous questions every day: How can we make fast and well-informed clinical decisions? How can we make sure patients are treated at the right place in a timely manner? What tools and information are needed by patients and providers to improve acute healthcare? 

These questions lay the framework for research on diagnostic, prognostic and therapeutic pathways in emergency medicine and critical care. The last decade was characterized by an impressive increase not only in the quantity, but also in the quality of research in our field. Beginning with robust randomized controlled trials on interventions, we saw the development of innovative methods for observational, diagnostic and prognostic research. 

For this Special Issue of Healthcare, I’d like to invite you to submit original research as well as systematic reviews (including scoping and mapping reviews) on diagnostic, prognostic and therapeutic pathways in acute healthcare. This includes traditional interventional studies, as well as those on diagnostic and prognostic research. Both clinical- and health services research-oriented contributions are welcome.    

Prof. Dr. Dominik Roth
Guest Editor

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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
  • critical care
  • diagnostic and prognostic research
  • health services research

Published Papers (9 papers)

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Research

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20 pages, 780 KiB  
Article
EASY-NET Program: Effectiveness of an Audit and Feedback Intervention in the Emergency Care for Acute Conditions in the Lazio Region
by Laura Angelici, Carmen Angioletti, Luigi Pinnarelli, Paola Colais, Antonio Giulio de Belvis, Andriy Melnyk, Emanuele La Gatta, Sara Farchi, Marina Davoli, Nera Agabiti and Anna Acampora
Healthcare 2024, 12(7), 733; https://doi.org/10.3390/healthcare12070733 - 27 Mar 2024
Viewed by 447
Abstract
The EASY-NET network program (NET-2016-02364191)—effectiveness of audit and feedback (A&F) strategies to improve health practice and equity in various clinical and organizational settings), piloted a novel and more structured A&F strategy. This study compared the effectiveness of the novel strategy against the sole [...] Read more.
The EASY-NET network program (NET-2016-02364191)—effectiveness of audit and feedback (A&F) strategies to improve health practice and equity in various clinical and organizational settings), piloted a novel and more structured A&F strategy. This study compared the effectiveness of the novel strategy against the sole periodic dissemination of indicators in enhancing the appropriateness and timeliness of emergency health interventions for patients diagnosed with acute myocardial infarction (AMI) and ischemic stroke in the Lazio Region. The efficacy of the intervention was assessed through a prospective quasi-experimental design employing a pre- and post-intervention (2021–2022) comparison with a control group. Participating hospitals in the Lazio Region, where professional teams voluntarily engaged in the intervention, constituted the exposed group, while the control group exclusively engaged in routine reporting activities. Effectiveness analysis was conducted at the patient level, utilizing regional health information systems to compute process and outcome indicators. The effectiveness of the intervention was evaluated using difference-in-difference models, comparing pre- and post-intervention periods between exposed and control groups. Estimates were calculated in terms of the difference in percentage points (PP) between absolute risks. Sixteen facilities for the AMI pathway and thirteen for the stroke pathway participated in the intervention. The intervention yielded a reduction in the proportion of 30-day readmissions following hospitalization for ischemic stroke by 0.54 pp in the exposed patients demonstrating a significant difference of −3.80 pp (95% CI: −6.57; −1.03; 5453 patients, 63.7% cases) in the exposed group compared to controls. However, no statistically significant differences attributable to the implemented A&F intervention were observed in other indicators considered. These results represent the first evidence in Italy of the impact of A&F interventions in an emergency setting, utilizing aggregated data from hospitals involved in the Lazio Region’s emergency network. Full article
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12 pages, 1489 KiB  
Article
Impact of the COVID-19 Pandemic on Therapy and Outcome of Acute Exacerbations of Chronic Obstructive Lung Disease at the Emergency Department
by Verena Fuhrmann, Bettina Wandl, Anton N. Laggner and Dominik Roth
Healthcare 2024, 12(6), 637; https://doi.org/10.3390/healthcare12060637 - 12 Mar 2024
Viewed by 576
Abstract
This study compared the treatment outcomes of acute exacerbation of COPD (AECOPD) at an academic tertiary care emergency department before and during the COVID-19 pandemic. Analyzing data from 976 patients, our study showed a significant surge in overall respiratory therapy interventions amidst the [...] Read more.
This study compared the treatment outcomes of acute exacerbation of COPD (AECOPD) at an academic tertiary care emergency department before and during the COVID-19 pandemic. Analyzing data from 976 patients, our study showed a significant surge in overall respiratory therapy interventions amidst the noticeable decline in the total number of AECOPD cases during the pandemic. The marked increase in the utilization of non-invasive ventilation (NIV) was particularly important, soaring from 12% to 18% during the pandemic. Interestingly, this heightened reliance on NIV stood in contrast to the stability observed in other therapeutic modalities, including oxygen insufflation alone, high-flow nasal cannulas, and invasive ventilation. This distinctive treatment pattern underscores the adaptability of healthcare providers in the face of novel challenges, with a discernible emphasis on the strategic utilization of NIV. The shift in patient acuity during the pandemic became evident as the data showed a cohort of individuals presenting with AECOPD who were more severely ill. This was reflected in the increased use of NIV and, notably, a statistically significant rise in one-year mortality rates—from 32% before the pandemic to 38% during the pandemic (p = 0.046). These findings underscore the intricate balance healthcare providers must strike in navigating the complexities of patient care during a public health crisis. A closer examination of the longitudinal trajectory revealed a subtle decrease in re-admission rates from 65% to 60%. The increased reliance on NIV, a key finding of this investigation, reflects a strategic response to the unique demands of the pandemic, potentially influenced by both medical considerations and non-medical factors, such as the prevalent “fear of aerosols” and the imperative to navigate transmission risks within the healthcare setting. These insights contribute to understanding the evolving dynamics of AECOPD management during public health crises. Full article
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11 pages, 252 KiB  
Article
HEART Score and Its Implementation in Emergency Medicine Departments in the West Balkan Region—A Pilot Study
by Armin Šljivo, Ahmed Mulać, Amina Džidić-Krivić, Katarina Ivanović, Dragana Radoičić, Amina Selimović, Arian Abdulkhaliq, Nejra Selak, Ilma Dadić, Stefan Veljković, Slobodan Tomić, Leopold Valerian Reiter, Zorana Kovačević and Sanja Tomić
Healthcare 2023, 11(17), 2372; https://doi.org/10.3390/healthcare11172372 - 23 Aug 2023
Cited by 1 | Viewed by 1006
Abstract
Background: Chest pain represents a prevalent complaint in emergency departments (EDs), where the precise differentiation between acute coronary syndrome and alternative conditions assumes paramount significance. This pilot study aimed to assess the HEART score’s implementation in West Balkan EDs. Methods: A retrospective analysis [...] Read more.
Background: Chest pain represents a prevalent complaint in emergency departments (EDs), where the precise differentiation between acute coronary syndrome and alternative conditions assumes paramount significance. This pilot study aimed to assess the HEART score’s implementation in West Balkan EDs. Methods: A retrospective analysis was performed on a prospective cohort comprising patients presenting with chest pain admitted to EDs in Sarajevo, Zenica, and Belgrade between July and December 2022. Results: A total of 303 patients were included, with 128 classified as low-risk based on the HEART score and 175 classified as moderate-to-high-risk. The low-risk patients exhibited younger age and a lower prevalence of cardiovascular risk factors. Laboratory and anamnestic findings revealed higher levels of C-reactive protein, ALT, and creatinine, higher rates of moderately to highly suspicious chest pain history, a greater number of cardiovascular risk factors, and elevated troponin levels in moderate-to-high-risk patients. Comparatively, among patients with a low HEART score, 2.3% experienced MACE, whereas those with a moderate-to high-risk HEART score had a MACE rate of 10.2%. A moderate-to-high-risk HEART score demonstrated a sensitivity of 91.2% (95%CI 90.2–93.4%) and specificity of 46.5% (95%CI 39.9–48.3%) for predicting MACE. Conclusion: This pilot study offers preliminary insights into the integration of the HEART score within the emergency departments of the West Balkan region. Full article
23 pages, 2288 KiB  
Article
Strategies of Screening and Treating Post-Extubation Dysphagia: An Overview of the Situation in Greek-Cypriot ICUs
by Meropi Mpouzika, Stelios Iordanou, Maria Kyranou, Katerina Iliopoulou, Stelios Parissopoulos, Maria Kalafati, Maria Karanikola and Elizabeth Papathanassoglou
Healthcare 2023, 11(16), 2283; https://doi.org/10.3390/healthcare11162283 - 13 Aug 2023
Cited by 1 | Viewed by 1680
Abstract
Post-extubation dysphagia (PED) can lead to serious health problems in critically ill patients. Contrasting its high incidence rate of 12.4% reported in a recent observational study, many ICUs lack routine bedside screening, likely due to limited awareness. This study aimed to establish baseline [...] Read more.
Post-extubation dysphagia (PED) can lead to serious health problems in critically ill patients. Contrasting its high incidence rate of 12.4% reported in a recent observational study, many ICUs lack routine bedside screening, likely due to limited awareness. This study aimed to establish baseline data on the current approaches and the status of perceived best practices in PED screening and treatment, as well as to assess awareness of PED. A nationwide cross-sectional, online survey was conducted in all fourteen adult ICUs in the Republic of Cyprus in June 2018, with a 100% response rate. Over 85% of ICUs lacked a standard screening protocol for PED. The most commonly reported assessment methods were cough reflex testing and the water swallow test. Treatment approaches included muscle strengthening exercises without swallowing and swallowing exercises. Only 28.6% of ICUs acknowledged PED as a common issue. The study identified significant gaps in awareness and knowledge regarding PED screening and treatment in Greek-Cypriot ICUs. Urgent implementation of comprehensive dysphagia education programs within the units is necessary, and interdisciplinary collaboration among nurses, intensivists, and speech and language therapists is crucial to improve the quality of care provided. Full article
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7 pages, 1204 KiB  
Article
Feasibility of Muscle Endurance Testing in Critically Ill Trauma Patients: A Pilot Study
by Sun Hyun Kim, Ho Jeong Shin, Myung-Jun Shin and Myung Hun Jang
Healthcare 2023, 11(1), 53; https://doi.org/10.3390/healthcare11010053 - 24 Dec 2022
Cited by 1 | Viewed by 2782
Abstract
Intensive care unit-acquired weakness (ICUAW) occurs secondary to patients treated for life-threatening conditions in the ICU being diagnosed based on the Medical Research Council sum score (MRC-SS). However, patients often complain of fatigability and poor endurance, which are not evaluated by muscle strength. [...] Read more.
Intensive care unit-acquired weakness (ICUAW) occurs secondary to patients treated for life-threatening conditions in the ICU being diagnosed based on the Medical Research Council sum score (MRC-SS). However, patients often complain of fatigability and poor endurance, which are not evaluated by muscle strength. In this study, we explored the feasibility of assessing muscle quality and endurance in trauma ICU patients. The modified Functional Index-2 (FI2) testing was applied to evaluate muscle endurance. The maximal voluntary contraction (MVC) was measured when evaluating the MRC-SS using surface electromyography (sEMG), and the fatigue index (FI) was also recorded at the time of endurance testing. The ultrasonic muscle echogenicity by gray-scale analysis of rectus femoris (RF) and tibialis anterior (TA) muscles was evaluated at the initial (<72 h) and end of ICU care. A total of 14 patients were enrolled in this study. Fatigue was induced in eight patients (fatigue group), and six (non-fatigue group) completed endurance testing. All patients except one had an MRC-SS exceeding 48 points. There was no difference in US echogenicity, MRC-SS, and FI between groups. In sEMG, the root mean square (RMS) values of MVC in RF and TA muscles showed a significant difference (p < 0.05). To evaluate and predict the functional activity of ICU patients, measuring muscle strength alone is insufficient, and it is necessary to evaluate muscle endurance. In this respect, the modified FI2 test and sEMG monitoring are considered to be promising procedures for evaluating the muscle condition of critically ill patients even in complex situations in the ICU. Full article
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6 pages, 790 KiB  
Article
Follow-Up Chest X-rays in Minor Chest Trauma with Fewer Than Three Rib Fractures: A Justifiable, Habitual Re-Imaging Industry?
by Amelie Deluca, Susanne Deininger, Florian Wichlas, Valeska Hofmann, Berndt Amelunxen, Julian Diepold, Thomas Freude and Christian Deininger
Healthcare 2022, 10(12), 2471; https://doi.org/10.3390/healthcare10122471 - 07 Dec 2022
Viewed by 1393
Abstract
Objective: We evaluated the necessity of follow-up chest X-rays (CXRs) to exclude a pneumothorax after 1 week of initial hospital presentation in patients with no signs of respiratory distress and fewer than three rib fractures. Materials and Methods: Adult patients with fewer than [...] Read more.
Objective: We evaluated the necessity of follow-up chest X-rays (CXRs) to exclude a pneumothorax after 1 week of initial hospital presentation in patients with no signs of respiratory distress and fewer than three rib fractures. Materials and Methods: Adult patients with fewer than three fractured ribs who presented at our Level I trauma center between 2015 and 2017 were evaluated retrospectively. Patients with sternal fractures, who had suffered a polytrauma, or were primarily treated with a chest tube were excluded. The patients’ and fractures’ characteristics, trauma mechanism, median follow-up time, and the number of required secondary interventions were recorded. Results: This study included 249 patients, 137 (55.0%) of whom were male, with a median age of 64.34 years. In 150 patients (60.2%) one rib was affected, in 99 patients (39.8%) two ribs were affected, with the fractured ribs being true ribs (1–7) in 72 cases (28.9%), false ribs (8–12) in 151 cases (60.6%), and both in 26 cases (10.4%). The affected thorax half was the left side in 124 cases (49.8%) and both thorax halves in 4 cases (1.6%). The median follow-up time was 9 ± 4 days. In the follow-up CXRs, six patients (1.6%) required delayed intervention (tube thoracostomy): one case of hemopneumothorax and five cases of pneumothorax. All of the patients fully recovered. Conclusions: Planned CXR follow-ups revealed only a small number of complications that needed intervention and therefore seem not to be necessary. Symptom-triggered reappearance seems to be more sufficient and economical compared to habitual reimaging. Full article
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Review

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11 pages, 1043 KiB  
Review
Pulmonary Fat Embolism Following Liposuction and Fat Grafting: A Review of Published Cases
by Yu-Ming Kao, Kuo-Tai Chen, Kuo-Chang Lee, Chien-Chin Hsu and Yeh-Cheng Chien
Healthcare 2023, 11(10), 1391; https://doi.org/10.3390/healthcare11101391 - 11 May 2023
Cited by 4 | Viewed by 2078
Abstract
Background: One of the most severe complications of liposuction and fat grafting is pulmonary fat embolism (PFE). However, most healthcare workers are not familiar with PFE. We performed a systematic review to describe the details of PFE. Methods: PubMed, EMBASE, and Google Scholar [...] Read more.
Background: One of the most severe complications of liposuction and fat grafting is pulmonary fat embolism (PFE). However, most healthcare workers are not familiar with PFE. We performed a systematic review to describe the details of PFE. Methods: PubMed, EMBASE, and Google Scholar were searched up to October 2022. Further analysis focused on clinical, diagnostic, and outcome parameters. Results: A total of 40 patients from 19 countries were included. Chest computed tomography (CT) yielded 100% accuracy in the diagnosis of PFE. More than 90% of the deceased died within 5 days after surgery, and in 69% of patients, onset of symptoms occurred within 24 h after surgery. The proportions of patients who required mechanical ventilation, had a cardiac arrest event, or died among all patients and among those whose onset of symptoms occurred within 24 h after surgery were 76%, 38%, and 34% versus 86%, 56%, and 54%, respectively. Conclusions: The earlier the onset of symptoms was, the more severe the clinical course was. Once a patient presents with PFE-related symptoms, surgery should be halted, supportive care initiated, and chest CT used to diagnose PFE. According to our review results, if a patient with PFE survives the initial episode without permanent sequelae, a complete recovery can be anticipated. Full article
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24 pages, 3604 KiB  
Review
Strategies of Predictive Schemes and Clinical Diagnosis for Prognosis Using MIMIC-III: A Systematic Review
by Sarika R. Khope and Susan Elias
Healthcare 2023, 11(5), 710; https://doi.org/10.3390/healthcare11050710 - 27 Feb 2023
Viewed by 2250
Abstract
The prime purpose of the proposed study is to construct a novel predictive scheme for assisting in the prognosis of criticality using the MIMIC-III dataset. With the adoption of various analytics and advanced computing in the healthcare system, there is an increasing trend [...] Read more.
The prime purpose of the proposed study is to construct a novel predictive scheme for assisting in the prognosis of criticality using the MIMIC-III dataset. With the adoption of various analytics and advanced computing in the healthcare system, there is an increasing trend toward developing an effective prognostication mechanism. Predictive-based modeling is the best alternative to work in this direction. This paper discusses various scientific contributions using desk research methodology towards the Medical Information Mart for Intensive Care (MIMIC-III). This open-access dataset is meant to help predict patient trajectories for various purposes ranging from mortality forecasting to treatment planning. With a dominant machine learning approach in this perspective, there is a need to discover the effectiveness of existing predictive methods. The resultant outcome of this paper offers an inclusive discussion about various available predictive schemes and clinical diagnoses using MIMIC-III in order to contribute toward better information associated with its strengths and weaknesses. Therefore, the paper provides a clear visualization of existing schemes for clinical diagnosis using a systematic review approach. Full article
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Other

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10 pages, 3976 KiB  
Case Report
Rare or Overlooked Cases of Acute Acalculous Cholecystitis in Young Patients with Central Nervous System Lesion
by Seong-Hun Kim, Min-Gyu Lim, Jun-Sang Han, Chang-Hwan Ahn and Tae-Du Jung
Healthcare 2023, 11(10), 1378; https://doi.org/10.3390/healthcare11101378 - 11 May 2023
Viewed by 1345
Abstract
This case series presents two cases of acute acalculous cholecystitis (AAC)—a rare condition—in young women with central nervous system (CNS) lesions. Both patients had significant neurologic deficits and no well-known risk factors or presence of comorbidities (such as diabetes or a history of [...] Read more.
This case series presents two cases of acute acalculous cholecystitis (AAC)—a rare condition—in young women with central nervous system (CNS) lesions. Both patients had significant neurologic deficits and no well-known risk factors or presence of comorbidities (such as diabetes or a history of cardiovascular or cerebrovascular disease). Early diagnosis is important in cases of AAC owing to its high mortality rate; however, due to neurological deficits in our cases, accurate medical and physical examinations were limited, thereby leading to a delay in the diagnosis. The first case was of a 33-year-old woman with multiple fractures and hypovolemic shock due to a traumatic accident; she was diagnosed with hypoxic brain injury. The second case was of a 32-year-old woman with bipolar disorder and early-onset cerebellar ataxia who developed symptoms of impaired cognition and psychosis; she was later diagnosed with autoimmune encephalopathy. In the first case, the duration between symptom onset and diagnosis was 1 day, but in the second case, it was 4 days from diagnosis based on the occurrence of high fever. We emphasize that if a young woman presents with high fever, the possibility of AAC should be considered, particularly if a CNS lesion is present because it may pose difficulty in the evaluation of typical symptoms of AAC. Careful attention is thus required in such cases. Full article
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