Journal of Clinical Medicine最新文献

{"title":"Trends of Pediatric Anterior Cruciate Ligament Reconstruction Surgery in Korea: Nationwide Population-Based Study.","authors":"Jihyun Hwang, Young-Min Kwon, Collin Lee, Sung Jae Kim, Young-Jin Seo","doi":"10.3390/jcm14041389","DOIUrl":"https://doi.org/10.3390/jcm14041389","url":null,"abstract":"<p><p><b>Background</b>/<b>Objective</b>: The rise in sports participation among children and adolescents has led to an increase in ACL injuries in skeletally immature individuals. This study analyzed nationwide trends in the anterior cruciate ligament (ACL) reconstruction surgeries in pediatric and adolescent populations, addressing concerns about growth plate disturbances with surgery and risks of secondary injuries with nonoperative treatment. <b>Methods</b>: We conducted a retrospective population-based cohort study using the National Health Insurance Corporation database in South Korea, analyzing ACL reconstruction trends from 2011 to 2018. Patients were categorized into four age groups (≤12 years, 13-15 years, 16-17 years, and ≥18 years). The Chi-square linear-by-linear association test was used to analyze trends in procedural volumes, age groups, and regions. Poisson regression was used to examine whether differences over time were statistically significant by modeling count data and estimating incidence rate ratios (IRRs) with 95% confidence intervals (CIs). It also evaluates the statistical differences by age, gender, and hospital location. <b>Results</b>: A total of 83,132 patients underwent ACL reconstruction during the study period. The ≤12-year-old group accounted for a stable, low percentage of surgeries (16.6% in 2011 to 23.7% in 2018) with no significant trends observed (IRR = 0.99, <i>p</i> = 0.683). Conversely, significant increases were noted in patients aged 13-15 years (IRR = 1.04, <i>p <</i> 0.001), 16-17 years (IRR = 1.03, <i>p <</i> 0.001), and aged ≥18 years (IRR = 1.03, <i>p <</i> 0.001). Male patients and urban hospital locations were associated with higher surgical rates. <b>Conclusions</b>: During the study period, ACL reconstruction is rare in children ≤12 years old due to concerns about growth disturbances, while adolescents 13-17 years old show increased surgical rates due to evolving practices supporting early intervention. These findings emphasize the need for individualized treatment balancing early benefits and growth plate risks.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 4","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Benefits and Pitfalls of Uraemic Toxin Measurement in Peritoneal Dialysis.","authors":"Aruni Malaweera, Louis Huang, Lawrence McMahon","doi":"10.3390/jcm14041395","DOIUrl":"https://doi.org/10.3390/jcm14041395","url":null,"abstract":"<p><p>Chronic kidney disease is a global health burden with a rising incidence and prevalence in developed and developing nations. Once established, it results in a progressive accumulation of a myriad of uraemic toxins. Peritoneal dialysis (PD) uses the body's peritoneal membrane to remove these toxins across a semipermeable membrane to restore and maintain homeostasis. Traditionally, dialysis adequacy has been measured through clearance of urea and creatinine. However, numerous studies have shown marginal links comparing the clearance of urea and creatinine with clinical outcomes reflected in the recent changes to the ISPD guidelines on dialysis adequacy. Instead, attention has focused on protein-bound uraemic toxins (PBTs). Produced by gut bacteria, these molecules are highly protein-bound and poorly removed by either dialysis or absorptive agents. Elevated concentrations of molecules such as p-cresyl sulfate and indoxyl sulfate have been associated with abnormal cellular function and poor patient outcomes. However, widespread use of these measures to determine dialysis adequacy has been limited by the need for specialized techniques required for measurement. Altering the gut microbiome to reduce generation of PBTs through increased dietary fiber might be an alternate approach to better patient outcomes, with some initial positive reports. This report explores advantages and limitations of measuring uraemic toxins in PD, now and in the foreseeable future.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 4","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143500725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lateralization and Distalization Shoulder Angles in Reverse Shoulder Arthroplasty: Are They Still Reliable and Accurate in All Patients and for All Prosthetic Designs?","authors":"Koray Şahin, Hakan Batuhan Kaya, Christos Koukos, Mehmet Kapıcıoğlu, Kerem Bilsel","doi":"10.3390/jcm14041393","DOIUrl":"https://doi.org/10.3390/jcm14041393","url":null,"abstract":"<p><p><b>Background:</b> Recently, the lateralization shoulder angle (LSA) and distalization shoulder angle (DSA) have been proposed to assess lateralization and distalization in reverse shoulder arthroplasty (RSA). However, there is insufficient evidence about the influence of patient anatomy and prosthesis design on these measurements. This study aims to investigate the impact of patient anatomy and implant design on LSA and DSA measurements and to assess the validity of the previously reported \"optimal\" ranges for these parameters. <b>Methods:</b> Patients who underwent the RSA procedure using four different prosthetic designs between April 2014 and June 2023 were retrospectively evaluated. Postoperative LSA and DSA measurements were compared according to implant design, preoperative glenoid morphology (Favard classification), and the Hamada grade. The correlation of LSA and DSA with preoperative shoulder anatomy (critical shoulder angle, CSA, and acromial index, AI) was also assessed. <b>Results:</b> In total, 135 shoulders were included in the study, with a mean age of 71.7 ± 7.9 years. The mean LSA was 88.4 ± 11.8° and mean DSA was 40.6 ± 12.5°. According to prosthetic design, both mean LSA and DSA values differed significantly (<i>p</i> < 0.05). Lateralized designs (Groups I and IV) had significantly higher mean LSA values. The Favard classification and Hamada grade of shoulders did not show a significant influence on LSA and DSA measurements (<i>p</i> > 0.05). DSA was observed to be significantly correlated with CSA and AI (<i>p</i> < 0.05; r = -0.27 and -0.189, respectively). <b>Conclusions:</b> Prosthetic design and preoperative shoulder anatomy had a significant influence on LSA and DSA measurements in RSA. Optimal LSA and DSA values may lack validity and reliability and should not be applied to all patients.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 4","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adaptation and Linguistic Validation of Angioedema PROMs in Latvian for Assessing Recurrent Angioedema.","authors":"Lāsma Lapiņa, Adīne Kaņepa, Maksims Zolovs, Thomas Buttgereit, Nataļja Kurjāne","doi":"10.3390/jcm14041375","DOIUrl":"https://doi.org/10.3390/jcm14041375","url":null,"abstract":"<p><p><b>Background:</b> Angioedema (AE) is a localized, non-pitting swelling affecting subcutaneous and/or submucosal tissues. Despite varying underlying mechanisms, AE significantly impacts patients' quality of life (QoL), which is closely linked to disease activity and control. <b>Objectives:</b> This study aimed to translate and linguistically validate the angioedema activity score (AAS), angioedema control test (AECT), and angioedema quality of life (AE-QoL) questionnaires into Latvian, and to use these validated tools to assess disease activity, control, and quality of life within the study population. <b>Methods:</b> PROMs, including the AECT, AAS, and AE-QoL, underwent a standardized linguistic validation process. Patients with hereditary angioedema (HAE), mast cell-mediated angioedema (AE-MC), and angioedema of unknown origin (AE-UNK) were recruited from two separate studies conducted at Riga Stradiņš University. <b>Results:</b> We enrolled 41 participants (90.2% women) with a mean age of 46.3 years. AE-MC was the most common (63.4%), followed by HAE (19.5%) and AE-UNK (17.1%). The mean AAS score was 15.8, with no significant differences regarding AE type, gender, or age. The mean AECT score was 8.29, revealing significant gender differences (women: 7, men: 13.5). The AE-QoL total score was 45.5, with significant gender differences in most domains. Strong correlations were found between AE-QoL scores and both AAS and AECT, highlighting the impact of both disease activity and control on QoL. <b>Conclusions:</b> The Latvian adaptation of the AAS, AECT, and AE-QoL questionnaires effectively assesses AE activity, control, and disease-related QoL. Our study reveals poor disease control, underscoring the need for tailored interventions and regular PROM evaluations, with the Latvian version of the AE-QoL questionnaire identifying five distinct domains compared to four in the original version.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 4","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143500860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in Respiratory Viruses' Activity in Children During the COVID-19 Pandemic: A Systematic Review.","authors":"Marco Maglione, Vincenzo Tipo, Emiliano Barbieri, Roberta Ragucci, Agnese Sara Ciccarelli, Chiara Esposito, Ludovica Carangelo, Antonietta Giannattasio","doi":"10.3390/jcm14041387","DOIUrl":"https://doi.org/10.3390/jcm14041387","url":null,"abstract":"<p><p><b>Background/Objectives</b>: The impact of the coronavirus disease 2019 (COVID-19) pandemic on health was significant worldwide. The measures adopted to limit the spread of the virus had an indirect effect on the epidemiology of other infectious diseases with similar mechanisms of inter-human transmission. The present literature review analyzed the scenario of pediatric acute respiratory infections in the post-lockdown period compared to the pre-pandemic and lockdown periods. The different patterns of viruses' outbreaks were evaluated according to the type of local COVID-19 restrictive measures and to the type of pathogen. <b>Methods</b>: Relevant scientific literature published between March 2020 and November 2024 was identified by means of electronic keyword searches in the PubMed, Scopus, and Cochrane Library databases. <b>Results</b>: Worldwide implementation of non-pharmacological public health interventions aimed at limiting the COVID-19 pandemic resulted in a measurable effect on the circulation of other common respiratory viruses, significantly affecting their usual seasonality. Most viruses significantly reduced their activity during the lockdown period but returned to or exceeded historical levels after discontinuation of preventive non-pharmacological measures. For many respiratory viruses, particularly respiratory syncytial virus, an off-season increase was reported. <b>Conclusions</b>: The non-pharmacological interventions, which effectively helped limit the COVID-19 pandemic, resulted in relevant epidemiologic changes in most common respiratory viruses. Given the different seasonality and clinical severity observed for some pathogens after lockdown, possible future off-season or more severe epidemics should be expected.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 4","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-Effectiveness of Routine X-Rays After Central Venous Catheter Removal: A Value-Based Analysis of Post-Removal Complications.","authors":"Martin Breitwieser, Teresa Wiesner, Vanessa Moore, Florian Wichlas, Christian Deininger","doi":"10.3390/jcm14041397","DOIUrl":"https://doi.org/10.3390/jcm14041397","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Background&lt;/b&gt;: Healthcare systems worldwide are increasingly burdened by rising costs, growing patient demand, and limited resources. In this context, cost-effectiveness analysis (CEA) plays a vital role in evaluating the clinical value of medical interventions relative to their costs. Despite the lack of evidence supporting their necessity, routine post-removal chest X-rays for central venous catheters (CVCs) are still performed in some hospitals due to persistent misconceptions about their benefits. This study seeks to address these misconceptions by examining the costs of routine imaging through a cost analysis of complication detection rates in a large inpatient cohort, with the aim of highlighting the inefficiencies of this practice and promoting evidence-based approaches. &lt;b&gt;Methods&lt;/b&gt;: A retrospective cohort analysis was performed across four university hospitals in Salzburg, Austria, including 984 CVC removals conducted between 2012 and 2021. Comparisons were made between X-rays after primary catheter insertion and post-removal X-rays to isolate complications specifically associated with CVC removal. A simple cost-per-outcome analysis, a subtype of CEA, was chosen to determine the cost per complication detected. The approach incorporated activity-based costing, adjusted to 2024 price levels via the Austrian Consumer Price Index (CPI), to capture real-world resource utilization. &lt;b&gt;Results&lt;/b&gt;: Complications related to CVC removal were identified in five cases (0.5%), including one catheter rupture due to self-removal, two failed removals, one hemothorax, and one case of intrathoracic bleeding. Of these, three complications were detected on X-rays, including a retained catheter fragment, signs of intrathoracic bleeding, and a hemothorax. Additionally, one asymptomatic patient had a likely incidental finding of a small pneumothorax, which required no intervention. The cost of routine X-rays was calculated at EUR 38.20 per X-ray, resulting in a total expenditure of EUR 37,588.80 for 984 X-rays. This corresponds to EUR 7517.76 per detected complication (&lt;i&gt;n&lt;/i&gt; = 4). The odds of detecting a complication on an X-ray were 193 times higher in symptomatic patients than in asymptomatic patients (&lt;i&gt;p&lt;/i&gt; &lt; 0.001). &lt;b&gt;Conclusions&lt;/b&gt;: This study confirms that complications following CVC removal are rare with only five detected cases. Routine imaging did not improve clinical decision-making, as complications were significantly more likely to be identified in symptomatic patients through clinical evaluation alone. Given the high financial cost (EUR 37,588.80 for 984 X-rays, EUR 7517.76 per detected complication), routine post-removal X-rays are unnecessary in asymptomatic patients and should be reserved for symptomatic cases based on clinical judgment. Adopting a symptom-based imaging approach would reduce unnecessary healthcare costs, minimize patient radiation exposure, and optimize resource allocation in high-volume procedures such as ","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 4","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Care Delivery in Chest Pain Patients Without an Acute Coronary Syndrome-A Retrospective Cohort Study.","authors":"Anas Alrefaee, Sherif Eltawansy, Abbas Alshami, Paweł Łajczak, Ndausung Udongwo, George Ayob, Jeffrey Selan","doi":"10.3390/jcm14041372","DOIUrl":"https://doi.org/10.3390/jcm14041372","url":null,"abstract":"<p><p><b>Background:</b> Chest pain is a prevalent and critical complaint among patients in emergency departments (EDs) across the United States. Professional societies have refined clinical guidelines to establish the most effective diagnostic pathways for identifying obstructive coronary artery disease. However, many healthcare systems do not adhere to the guideline-validated clinical pathways and instead order repeat diagnostic testing. This study evaluated the efficiency of care delivered to chest pain patients in our tertiary medical center. <b>Methods:</b> We performed a retrospective chart review of patients presenting to our ED with acute chest pain between November and December 2022, collecting information about chest pain, the testing received, and their outcomes. The data were then reviewed to determine clinical practice patterns. <b>Results:</b> We included 342 patients, with a mean age of 54 years; 54.7% of study participants were females. Patients who were eventually admitted from the ED (46.5%, <i>n</i> = 159) were either under observation or inpatient status. Furthermore, 16.6%, <i>n</i> = 57, of patients had an ischemic evaluation within the preceding year. Physicians documented a HEART score in 24.6%, <i>n</i> = 84 of the patients. While HEART score is a considerable factor utilized by admitting physicians to triage incoming patients, 39%, <i>n</i> = 62, of all admitted patients had a low HEART score (<3) and a negative ischemic evaluation within the past year. <b>Conclusions:</b> This single-center retrospective analysis of care delivery for non-ACS (acute coronary syndrome) chest pain patients demonstrated that the HEART score was not thoroughly documented in the study population. This resulted in an overperformance of inpatient ischemic testing, with an increased length of stay and costs for the institution and healthcare system. This study serves as a quality improvement initiative to explore similar data within their institutions and as a reminder of the importance of utilizing validated clinical pathways to streamline clinical care and reduce healthcare costs.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 4","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decoding Prejudice: Understanding Patterns of Adolescent Mental Health Stigma.","authors":"Sara Albuquerque, Ana Carvalho, Bárbara de Sousa, Leonor Pereira da Costa, Ana Beato","doi":"10.3390/jcm14041394","DOIUrl":"https://doi.org/10.3390/jcm14041394","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Mental health problems are a major cause of disability, impacting nearly 20% of adolescents. Nevertheless, they are hesitant to seek help because of stigma and fear of being labelled. Adolescents often have low mental health literacy and perceive mental health problems as personal failures. To address it, our study aimed to identify subgroups within the adolescent population based on mental health knowledge, social stigma, experiences of intergroup anxiety, and endorsement of stereotypes. <b>Methods</b>: This cross-sectional study included 182 adolescents (50.6% male) aged 10 to 17 years (M = 13.8, SD = 2.4). Participants completed an online survey comprising the Mental Health Knowledge Schedule, Attribution Questionnaire (AQ-8-C), Intergroup Anxiety Scale, and a scale regarding stereotypes towards people with mental health problems. Cluster analysis was used to identify the subgroups. <b>Results</b>: We identified three subgroups: (1) \"Potential Advocates\", showing high mental health knowledge, low social stigma, low intergroup anxiety, and moderate endorsement of stereotypes; (2) \"Ambivalents\", manifesting high mental health knowledge, moderate social stigma, heightened intergroup anxiety, and low endorsement of stereotypes; and (3) \"Stigmatizers\", revealing low mental health knowledge, pronounced social stigma, moderate intergroup anxiety, and tendency to endorse stereotypes. <b>Conclusions</b>: The results highlight the multiplicity of perceptions regarding mental health and the pivotal role of knowledge, stigma, intergroup dynamics, and stereotypes in shaping attitudes. Implications for interventions targeting mental health stigma and fostering positive attitudes among adolescents are discussed, underscoring the importance of customised strategies to address the multiple needs and experiences characteristic of this developmental stage.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 4","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Simultaneous Medullary and Papillary Thyroid Carcinomas: Personal Experience Report and Literature Review.","authors":"Nadia De Falco, Massimo Agresti, Massimo De Falco, Pasquale Sperlongano, Giancarlo Moccia, Pasquale Luongo, Alessio Cece, Francesco Bove, Francesco Miele, Alfredo Allaria, Francesco Torelli, Paola Bassi, Antonella Sciarra, Stefano Avenia, Paola Della Monica, Federica Colapietra, Marina Di Domenico, Ludovico Docimo, Domenico Parmeggiani","doi":"10.3390/jcm14041382","DOIUrl":"https://doi.org/10.3390/jcm14041382","url":null,"abstract":"<p><p>While the frequency of papillary thyroid carcinoma (PTC) has increased in recent decades, both due to improvements in diagnostic procedures and a real, effective percentage increase in cases, the frequency of medullary thyroid carcinoma (MTC), however, has remained almost unchanged, representing 3-5% of thyroid cancer cases. Our experience relates to the observation of cases with the synchronous presence of PTC and MTC, also in chronic autoimmune thyroiditis, and this led us to carry out a brief review of the literature on the subject, with the aim above all of identifying the most correct postoperative therapeutic process.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 4","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dyspnea Management in Patients Presenting to the Emergency Department at Cantonal Hospital Baselland-A Retrospective Observational Study and Medical Audit.","authors":"Emanuele Debernardi, Fabienne Jaun, Maria Boesing, Joerg Daniel Leuppi, Giorgia Lüthi-Corridori","doi":"10.3390/jcm14041378","DOIUrl":"https://doi.org/10.3390/jcm14041378","url":null,"abstract":"<p><p><b>Background/Objectives:</b> 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. <b>Methods:</b> 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. <b>Results:</b> 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. <b>Conclusions:</b> 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.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 4","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}