Journal of Clinical Medicine最新文献

{"title":"Global Lessons from COVID-19: Regional Variations in the Management of Hospital-Acquired Infections During and Post-Pandemic.","authors":"Corina Voinea, Elena Mocanu, Cristian Opariuc-Dan, Elena Dantes, Alexandra-Cristina Gache, Sorin Rugina","doi":"10.3390/jcm14186654","DOIUrl":"10.3390/jcm14186654","url":null,"abstract":"<p><p><b>Background/Objectives</b>: The COVID-19 pandemic has significantly disrupted healthcare systems worldwide, exposing longstanding weaknesses, particularly in the prevention and control of healthcare-associated infections (HAIs). Regional disparities in infection prevention and control (IPC) strategies offered valuable lessons for improving public health preparedness. This systematic review aims to identify and compare regional IPC approaches adopted during and after the pandemic, highlighting best practices to strengthen healthcare resilience. <b>Methods</b>: The review was conducted in line with PRISMA guidelines and registered in the PROSPERO database (CRD420251032525). Articles published between 1 January 2020 and 31 March 2025, were retrieved from PubMed, Scopus, and Web of Science. Only full-text studies in English were included. The risk of bias was assessed using the ROBINS-I tool. <b>Results</b>: Of the 63 articles initially identified, 8 met the inclusion criteria. The selected studies demonstrated substantial variability in the implementation of IPC. The availability of infrastructure, funding, coordination capacity, and training of medical staff had a significant impact on outcomes. In regions with well-defined protocols and a solid infrastructure, there was a significant decrease in HAIs, while in resource-poor areas, there was a significant increase. Effective measures included continuous monitoring, regular staff training, provision of adequate equipment, expansion of testing capacity, reorganisation of hospitals, and introduction of technological innovations in healthcare. <b>Conclusions</b>: COVID-19 emphasised the importance of adaptable IPC frameworks. Strengthening health systems requires context-specific standards, sustained investment in infrastructure, continuous training, and increased international cooperation to better prepare for future health emergencies.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 18","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12470883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145175793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative Opioid Use Disorder Predicts Prolonged Ventilation, Central Line Placement, and Major Anesthesiology Complications After ACDF Surgery: A Big Data Analysis of 180,000 Cases.","authors":"David Maman, Maneesh Nandakumar, Yaniv Steinfeld, Yaron Berkovich","doi":"10.3390/jcm14186661","DOIUrl":"10.3390/jcm14186661","url":null,"abstract":"<p><p><b>Background:</b> Opioid use disorder (OUD) has emerged as a growing public health challenge, increasingly affecting surgical populations. While anterior cervical discectomy and fusion (ACDF) is a common spinal procedure with known perioperative risks, the specific impact of preoperative OUD on anesthesia-related complications in ACDF remains poorly studied. <b>Methods:</b> We analyzed adult patients undergoing elective single-level ACDF between 2016 and 2022 using the Nationwide Inpatient Sample (NIS) database. Patients with and without OUD were identified using ICD-10 codes. Propensity score matching was applied to adjust for baseline differences. Primary outcomes included prolonged ventilation, central line placement, and major anesthesiology complications. Secondary outcomes included total charges, length of stay, and number of procedures. A cost-effectiveness analysis of universal preoperative urine drug screening was also performed. <b>Results:</b> Among 178,215 patients undergoing ACDF, 1.5% had documented OUD. Following propensity matching, OUD patients had a significantly increased risk of prolonged ventilation (>24 h and >96 h), central line placement, blood transfusion, feeding tube insertion, and major anesthesiology complications. OUD patients experienced longer hospital stays (7.9 vs. 2.7 days), more procedures (4.2 vs. 3.0), and higher total charges ($139,207 vs. $82,179; all <i>p</i> < 0.01). The estimated excess cost attributable to OUD per surgical patient was $855, compared to a $75 screening cost. <b>Conclusions:</b> Preoperative OUD is associated with significantly increased perioperative risk, ICU-level intervention, and healthcare costs in ACDF patients. These findings support systematic preoperative screening and multidisciplinary management for patients with OUD undergoing spine surgery.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 18","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12470753/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145175850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined Liquid-Based Cytology and Conventional Smear Provides Better Sensitivity and Adequacy Rates After Endoscopic Ultrasound-Guided Tissue Acquisition of Abdominal Masses: A Systematic Review and Meta-Analysis.","authors":"Marie Anne Engh, Brigitta Teutsch, Alexander Schulze Wenning, Tamás Kói, Péter Hegyi, Bálint Erőss","doi":"10.3390/jcm14186685","DOIUrl":"10.3390/jcm14186685","url":null,"abstract":"<p><p><b>Background and Aims:</b> Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) or biopsy (FNB) is the standard method for diagnosing abdominal masses, but sample inadequacy and diagnostic accuracy remain challenges. Conventional smear (CS) and liquid-based cytology (LBC) are standard processing methods, yet their comparative effectiveness and potential combined benefit remain unclear. We performed a systematic review and meta-analysis to evaluate and compare the diagnostic performance and adequacy of CS, LBC, and their combination. <b>Methods:</b> A systematic search was conducted in Medline, Embase, and CENTRAL on 17 November 2024. Studies comparing CS, LBC, or their combination following EUS-FNA/FNB for abdominal masses were included. Diagnostic parameters, including sensitivity, specificity, accuracy, and inadequacy rates, were extracted and analyzed. Methodological quality was assessed using QUADAS-2. <b>Results</b>: 16 studies (2128 patients) were included. Sensitivity for pancreatic masses was 71.4% (CI: 62.9-78.7) for CS, 74.7% (CI: 64.3-82.8) for LBC, and 86.2% (CI: 82.4-89.3) for combined methods (<i>p</i> = 0.001). For all abdominal masses, sensitivity was 76.3% (CI: 67.9-83.0) for CS, 73.6% (CI: 65.6-80.2) for LBC, and 88.0% (CI: 84.0-91.2) for combined methods (<i>p</i> ≤ 0.006). Specificity was nearly 100%. Inadequacy rates were lowest for combined methods (1.5%, CI: 0-36.2), when compared to LBC (7.7%, CI: 2.7-20.4) and CS (4.4%, CI: 2.4-7.9). Moderate bias risk was noted, primarily due to incorporation bias. Domain 3 (reference standard) of QUADAS was uniformly moderate-risk across studies. <b>Conclusions</b>: Combining CS and LBC methods improves diagnostic sensitivity and reduces sample inadequacy after EUS-guided tissue acquisition for abdominal masses, particularly pancreatic lesions. Clinical guidelines should consider recommending the combined approach to enhance diagnostic yield and clinical outcomes.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 18","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12471235/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145175634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nutritional Status Assessment Using the Patient-Generated Subjective Global Assessment (PG-SGA) in Individuals with Colorectal Cancer Undergoing Chemotherapy Regimens.","authors":"Luis Enrique Sánchez-Diestro, Raquel Macias-Montero, Ana Isabel Ramalho-Galhanas, Ana Maria Aguiar-Frias, María Sandra Paniagua-Vivas, Jorge Guerrero-Martín","doi":"10.3390/jcm14186664","DOIUrl":"10.3390/jcm14186664","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Colorectal cancer (CRC) has high prevalence and mortality, with a high frequency of malnutrition during chemotherapy (60-70%). Malnutrition reduces treatment tolerance, quality of life, and survival. The Patient-Generated Subjective Global Assessment (PG-SGA) is effective in detecting it, but its use is not systematic. This study aims to analyze the prevalence and degrees of malnutrition in CRC patients undergoing active chemotherapy, using the PG-SGA, and to propose its systematic implementation in oncology care protocols. <b>Methods:</b> Observational, cross-sectional, and descriptive study in patients with stage III-IV CRC receiving FOLFOX, XELOX, or irinotecan regimens. Nutritional status was assessed with PG-SGA and body composition by bioimpedance. <b>Results:</b> The study includes 91 patients. A total of 45.05% of patients required intensive nutritional intervention, 39.56% needed dietary and pharmacological measures, 10.99% required health education, and only 4.4% did not require intervention. FOLFOX was significantly associated with taste alterations (<i>p</i> < 0.001), nausea (<i>p</i> = 0.020), unpleasant odors, and eating problems; XELOX with diarrhea (<i>p</i> = 0.009) and xerostomia (<i>p</i> = 0.038). Irinotecan was related to poorer functional capacity (<i>p</i> = 0.042). Oxaliplatin was linked to loss of appetite (<i>p</i> = 0.034) and unpleasant odors (<i>p</i> = 0.035). Older age correlated with a greater need for intensive interventions. <b>Conclusions:</b> The study shows a high nutritional risk in oncology patients, particularly in those with colorectal cancer undergoing FOLFOX treatment, associated with symptoms that impair intake and functional capacity. The systematic implementation of nutritional screening from the onset of treatment, using tools such as the PG-SGA and GLIM criteria, is essential for early detection and individualized management, improving therapy tolerance, clinical outcomes, and quality of life.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 18","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12470535/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145175857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic Outcomes and Inflammatory Marker Correlation in Adult Patients with Corrosive Substance Ingestion.","authors":"Seymur Aslanov, Ali Senkaya, Nalan Gulsen Unal, Cengiz Karahanlı, Idris Kurt, Ferit Celik, Alper Uysal, Ozan Fatih Sarıkaya, Ahmet Omer Ozutemiz","doi":"10.3390/jcm14186663","DOIUrl":"10.3390/jcm14186663","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Corrosive substance intake remains a significant public health concern due to its potential for severe gastrointestinal (GI) injury and associated morbidity. Early risk stratification is crucial for appropriate management, yet there is a lack of reliable non-invasive predictors of injury severity. This study aimed to evaluate the clinical characteristics of adult patients with corrosive ingestion and to investigate the correlation between inflammatory markers and endoscopic injury severity. <b>Methods:</b> In this retrospective study, 83 adult patients who underwent esophagogastroduodenoscopy (EGD) following corrosive ingestion between January 2017 and January 2021 were analyzed. Endoscopic injuries were graded using the Zargar classification and categorized as mild (grades 0-2a) or severe (grades 2b-4). Demographic, clinical, endoscopic, and laboratory data, including neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) levels, were recorded. The correlation between inflammatory markers and injury severity was assessed, and receiver operating characteristic (ROC) analysis was performed to determine diagnostic accuracy. <b>Results:</b> Among the patients, 55.4% were female with a mean age of 41.5 ± 17.3 years. Most ingestions were accidental (74.7%), with bleach being the most common agent (41%). Endoscopic injury was detected in 55.4% of patients, predominantly in the stomach and esophagus. Severe injuries were associated with longer intensive care and hospital stays, increased complication rates, and more frequent organ involvement (<i>p</i> < 0.001). A weak but statistically significant correlation was found between injury severity and both NLR (r = 0.357, <i>p</i> = 0.001) and CRP (r = 0.247, <i>p</i> = 0.024). ROC analysis revealed an NLR cut-off of 2.95 (AUC = 0.804) and CRP cut-off of 2.5 (AUC = 0.706) for predicting severe injury. <b>Conclusions:</b> Early endoscopic evaluation remains essential for assessing corrosive injury severity. However, NLR and CRP may serve as useful, non-invasive indicators in predicting injury severity, potentially aiding clinical decision-making, especially in settings where endoscopy is not readily available or is contraindicated.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 18","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12470495/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145175859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sequential AI-ECG Diagnostic Protocol for Opportunistic Atrial Fibrillation Screening: A Retrospective Single-Center Study.","authors":"Ji-Hoon Choi, Sung-Hee Song, Jongwoo Kim, JaeHu Jeon, KyungChang Woo, Soo Jin Cho, Seung-Jung Park, Young Keun On, Ju Youn Kim, Kyoung-Min Park","doi":"10.3390/jcm14186675","DOIUrl":"10.3390/jcm14186675","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Atrial fibrillation (AF) often occurs in episodes that are sudden and go unnoticed, reducing the chances of anticoagulation. We evaluated a two-stage AI ECG screening protocol that uses a single ECG model at initial screening and, if necessary, a serial ECG model after short interval follow-up to enhance accuracy while saving monitoring resources. <b>Methods</b>: We analyzed 248,612 12-lead ECGs from 164,793 adults (AF, <i>n</i> = 10,735) for model development and assessed the protocol in 11,349 eligible patients with longitudinal ECGs. The proposed algorithm first applied a single-ECG AI model at the initial visit, followed by a serial-ECG AI model three months later if AF was not initially detected. The model's performance was evaluated using several metrics, including the area under the receiver operating characteristic curve (AUROC), sensitivity, specificity, accuracy, and F1 score. <b>Results</b>: The protocol achieved an AUROC of 0.908 with a sensitivity of 88.1%, specificity of 78.7%, positive predictive value (PPV) of 30.2%, negative predictive value (NPV) of 98.4%, accuracy of 79.6%, and an F1 score of 0.450. Among patients with a history of stroke (<i>n</i> = 551), 84.9% were correctly identified as AF-positive under the protocol. <b>Conclusions</b>: A sequential AI ECG strategy maintains high NPV at entry and improves PPV with longitudinal confirmation. This approach can prioritize ambulatory monitoring for those most likely to benefit and merits prospective, multi-center validation and cost-effectiveness assessment.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 18","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12470484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145175728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Ocular Wavefront in Seated and Supine Positions Using a Hand-Held Hartmann-Shack Aberrometer.","authors":"Noh Eun Kwon, Nicolas Brown, Jong Hwa Jun, Seung Pil Bang","doi":"10.3390/jcm14186688","DOIUrl":"10.3390/jcm14186688","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Intraoperative aberrometry has gained clinical relevance in correcting aberrations during cataract and corneal refractive surgeries. As wavefront aberrations are typically measured with patients seated, while surgeries are performed supine, this study aimed to compare ocular aberrations between seated and supine positions, using a hand-held Hartmann-Shack aberrometer. <b>Methods</b>: Total ocular wavefront aberrations were measured five times consecutively from cyclopledged eyes for a 6 mm pupil, under three conditions: (1) seated with a holder-fixed mode (reference), (2) seated with a hand-held mode, and (3) supine with a hand-held mode. Condition 2 was included to assess potential measurement errors from the hand-held mode. Repeatability was assessed using the standard deviation of repeated measurements (Srm) and the intraclass correlation coefficient (ICC). Differences among the three conditions were analyzed to evaluate the effects of positional change and hand-held stability on ocular wavefront aberration measurements. <b>Results</b>: Eighteen healthy subjects (36 eyes) were enrolled. The Srms for the sphere were 0.37, 0.38, and 0.40 diopters (D); and for the cylinder, 0.10, 0.10, and 0.11 D, with no significant differences across conditions. ICC values exceeded 0.9 for both lower-order aberrations (LOAs) and higher-order aberrations (HOAs), indicating excellent repeatability. The mean root mean square HOAs (HOA_RMS) were 0.48, 0.49, and 0.45 µm, with no statistically significant differences by position (<i>p</i> = 0.913) or measurement mode (<i>p</i> = 0.966). <b>Conclusions</b>: The hand-held Hartmann-Shack aberrometer demonstrated satisfactory repeatability for LOAs and HOAs. Supine measurements did not differ from seated, supporting the feasibility of extending preoperative results to intraoperative aberrometry, regardless of positional differences.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 18","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12470436/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145175818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Textbook Outcomes of Totally Robotic Versus Totally Laparoscopic Pancreaticoduodenectomy for Periampullary Neoplasm: A Propensity Score-Matched Cohort Study.","authors":"Boram Lee, Ho-Seong Han, Yoo-Seok Yoon, Jun Suh Lee","doi":"10.3390/jcm14186687","DOIUrl":"10.3390/jcm14186687","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Textbook outcome (TO) is a composite quality measure in surgery, but few studies have compared TO between robotic pancreaticoduodenectomy (RPD) and laparoscopic pancreaticoduodenectomy (LPD). This study aimed to evaluate and compare TO following RPD and LPD for periampullary neoplasms. <b>Methods</b>: We retrospectively analyzed 322 patients who underwent minimally invasive PD between 2010 and 2023 (RPD, <i>n</i> = 60; LPD, <i>n</i> = 262). LPD was first introduced in 2004, but only cases performed since 2010 were included, while RPD has been performed since 2019. Propensity score matching (1:2) yielded 48 RPD and 96 LPD patients. TO was defined as the absence of pancreatic fistula, bile leak, post-pancreatectomy hemorrhage, severe complications (Clavien-Dindo ≥ III), readmission, and in-hospital or 30-day mortality. <b>Results</b>: In the entire cohort, 240 of 322 patients (74.5%) achieved TO. After matching, TO rates were 64.6% in RPD and 76.9% in LPD (<i>p</i> = 0.656). Perioperative outcomes, including operative time, blood loss, transfusion, hospital stay, and major complications, were comparable, although RPD showed a higher incidence of hemorrhage (<i>p</i> = 0.032). Multivariate analysis identified body mass index < 25 kg/m² as an independent predictor of achieving TO (OR 3.13, <i>p</i> = 0.008). <b>Conclusions</b>: RPD and LPD achieved comparable textbook outcomes in periampullary surgery. Both approaches are feasible when performed by experienced surgeons, but larger studies with long-term follow-up are needed to validate these findings.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 18","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12471001/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145175903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interstitial Lung Disease in 2025-Progress, Challenges, and Hope Ahead.","authors":"Sameep Sehgal, Atul Mehta","doi":"10.3390/jcm14186673","DOIUrl":"10.3390/jcm14186673","url":null,"abstract":"<p><p>Interstitial lung disease (ILD) remains one of the most challenging conditions in respiratory medicine, with outcomes often as poor as those seen in advanced malignancies [...].</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 18","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12471081/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145175943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electrocardiographic Predictors for Early Risk Stratification: 30-Day Mortality in Older Adult Trauma Patients.","authors":"Sedat Ozdemir, Mehmet Murat Oktay, Iffet Tiftikci, Kazim Ersin Altinsoy","doi":"10.3390/jcm14186659","DOIUrl":"10.3390/jcm14186659","url":null,"abstract":"<p><p><b>Objectives:</b> This prospective observational study aimed to assess the prognostic value of electrocardiographic (ECG) findings obtained at emergency department (ED) admission in adult patients presenting with trauma-related fractures, with a focus on their association with 30-day all-cause mortality. <b>Materials and Methods:</b> A total of 391 patients aged ≥18 years with trauma-induced fractures were enrolled at a tertiary emergency center between February and May 2025. Baseline demographic and clinical data, including comorbidities, trauma mechanisms, and 12-lead ECG findings at admission, were recorded. Patients were monitored for 30-day mortality. Logistic regression analysis was used to identify independent predictors of mortality. <b>Results:</b> The mean age of the patients was 73.9 ± 6.7 years, and 50.1% were female. Normal sinus rhythm was the most common ECG finding (31.5%), followed by sinus tachycardia (20.5%) and bundle branch block (15.3%), while atrial fibrillation (AF) was present in 9.5% of cases. Thirty-day mortality occurred in 5.1% of the cohort (n = 20). Non-survivors had significantly higher frequencies of AF (35.0% vs. 8.1%, <i>p</i> = 0.001), head trauma (70.0% vs. 18.1%, <i>p</i> < 0.001), cerebrovascular disease (55.0% vs. 16.4%, <i>p</i> < 0.001), and polypharmacy (100% vs. 62.8%, <i>p</i> = 0.001) compared with survivors. Conversely, low-energy falls were more common among survivors (74.7% vs. 20.0%, <i>p</i> < 0.001), whereas falls from stairs or a bed and high-energy trauma were significantly more frequent among non-survivors (all <i>p</i> < 0.05). In multivariate logistic regression, AF (OR: 6.112; 95% CI: 1.612-23.176; <i>p</i> = 0.008), head trauma (OR: 16.514; 95% CI: 4.925-55.367; <i>p</i> < 0.001), and cerebrovascular disease (OR: 6.725; 95% CI: 2.219-20.385; <i>p</i> = 0.001) emerged as independent predictors of 30-day mortality. Although normal sinus rhythm was associated with survival in univariate analysis (<i>p</i> = 0.034), it did not retain independent significance in multivariate modeling. Patients with AF had significantly lower 30-day survival compared with those without AF (65.0% vs. 96.3%, <i>p</i> = 0.001). <b>Conclusions:</b> This prospective study demonstrates that electrocardiographic abnormalities-especially atrial fibrillation-are strong predictors of 30-day mortality in older adult trauma patients. Their prognostic value was further reinforced when assessed alongside head trauma and cerebrovascular disease. These findings emphasize ECG as a rapid, practical, and noninvasive tool for early risk stratification and clinical decision-making in the emergency care of geriatric fracture patients.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 18","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12470298/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145175800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}