OBJECTIVES: To analyze the multimorbidity patterns and core diseases among hospitalized patients in different age groups and to explore the impacts of multimorbidity patterns on hospitalization costs. METHODS: Electronic medical records of adult inpatients (aged ≥18 years) from Ningbo Medical Center Lihuili Hospital between January 1, 2018, and June 30, 2023 were collected. The multimorbidity status involving 53 specific diseases was analyzed across different age groups. Association rule mining was used to identify common multimorbidity patterns. Complex network analysis was used to identify core diseases within the multimorbidity networks. Generalized estimating equations (GEE) were used to analyze the impact of different multimorbidity patterns on hospitalization costs. RESULTS: The prevalence of multimorbidity among the 359 402 adult inpatients was 38.51%, with higher rates observed in males (43.60%) and elderly patients (58.29%). Association rule mining identified 15 common multimorbidity patterns, which exhibited differences across age groups. The most prevalent multimorbidity pattern overall was "diabetes→hypertension" (support=7.04%, confidence=62.17%, lift=2.17). In the young adult group, the most prevalent pattern was "dyslipidemia→chronic liver disease" (support=1.19%, confidence=53.17%, lift=6.04). In the middle-aged group, it was "diabetes→hypertension" (support=4.84%, confidence=50.28%, lift=2.15). In the elderly group, it was "coronary heart disease, diabetes→hypertension" (support=2.38%, confidence=77.43%, lift=1.63). Complex network analysis revealed that the core diseases within multimorbidity networks differed across age groups. The core disease identified in the young adult group was chronic liver disease (degree centrality=50, betweenness centrality=0.055, closeness centrality=0.963). Core diseases in the middle-aged group included hypertension, chronic liver disease, and diabetes (all with degree centrality=52, betweenness centrality=0.022, closeness centrality=1.000). Core diseases in the elderly group comprised hypertension, diabetes, malignant tumors, chronic liver disease, thyroid disease, anemia, and arrhythmia (all with degree centrality=52, betweenness centrality=0.009, closeness centrality=1.000). Generalized estimating equations analysis indicated that, most multimorbidity patterns were significantly associated with increased hospitalization costs. However, the magnitude of cost increase varied across different multimorbidity patterns. Specifically, hospitalization costs for patients with patterns such as "heart failure→hypertension", "stroke→hypertension", "malignant tumor, diabetes→hypertension", "stroke, diabetes→hypertension", and "diabetes, heart failure→hypertension" were more than double those of patients without any target diseases. CONCLUSIONS Multimorbidity patterns and core diseases among hospitalized patients differ significantly across age groups, and different patterns exert varying impacts on hospitalization costs. These findings underscore the necessity for age-stratified and multimorbidity pattern specific management strategies.
Humans ; Multimorbidity ; Male ; Hospitalization/economics* ; Female ; Aged ; Middle Aged ; Adult ; Age Factors ; Young Adult ; Adolescent ; Diabetes Mellitus/epidemiology* ; Electronic Health Records ; Aged, 80 and over ; Hospital Costs ; China/epidemiology* ; Hypertension/economics* ; Liver Diseases/epidemiology*

OBJECTIVE: To analyze the characteristics of animal-related injuries and summarize the epidemiological features of the affected population using the hospital's emergency department electronic medical record system. METHODS: A retrospective cross-sectional study was conducted, collecting data on animal-related injuries (dogs, cats, rodents, or other animals) as recorded in the outpatient registration system of the emergency department at Tongde Hospital of Zhejiang Province from October 8, 2022, to October 30, 2023. The study variables encompassed patient demographic characteristics (gender, age, occupation, residence, etc.), and injury characteristics (date and location of injury, type of animal inflicting the injury, level of exposure, wound site, number of wounds, vaccination history, etc.). Descriptive statistics and univariate analysis were performed on the collected data. RESULTS: From October 8, 2022, to October 30, 2023, a total of 1 266 cases of animal bites were attended to in our hospital's emergency department. A distinct seasonal pattern was observed in the monthly distribution of animal bite patients, with a consistent presence throughout the year and notable fluctuations. There was a higher incidence during the summer and autumn (July to October), and a lower incidence during the winter and spring (December to the following March), marking a relatively quiescent period. The study included 680 female cases (53.7%) and 586 male cases (46.3%), with a median age of 27 years (range 11 months to 88 years). The majority of patients were clerks or workers (50.2%), followed by students (21.6%), laborers (8.5%), and retirees (3.6%). The majority of patients were local residents (90.6%), and the majority had no history of rabies vaccination (76.9%), with only 3 cases (0.2%) having pre-exposure immunization. Among the four types of animal bites, cat bites predominated (64.5%), followed by dog bites (28.7%), rodent bites (4.9%), and bites from other animals (1.9%). The time from injury to consultation was 0 (0-40) days. Most patients experienced a level III exposure (76.3%), with level II exposure being less common (23.2%), and level I exposure being the least frequent (0.5%). The upper limbs were the most common site of injury (72.1%), followed by the lower limbs (21.2%), and the trunk was the least affected (2.6%). The majority of patients had a single wound (75.8%), and the majority of injuries occurred at home (90.2%). The number of patients who self-cleaned their wounds was comparable to those who sought outpatient treatment. When stratified by age and gender, the age of 18 to 39 years group was identified as the high-incidence demographic for all four types of animal bites. In this age group, except for injuries caused by mice, injuries caused by other animals were more common in females than males. CONCLUSIONS The proportion of injuries caused by cats in animal-related incidents in the emergency department of Hangzhou, Zhejiang Province, is significantly high. The majority of patients lack a history of rabies vaccination and pre-exposure immunization. There is a higher incidence of cases during the summer and autumn months, with a prolonged high-incidence period. The utilization of emergency department data on animal injuries provides a convenient and sustainable method for monitoring animal bites, representing a novel approach to comprehensive surveillance data and serving as a valuable supplement to the existing disease control surveillance system.
Humans ; Retrospective Studies ; Animals ; Bites and Stings/epidemiology* ; Male ; Female ; Middle Aged ; Cross-Sectional Studies ; Emergency Service, Hospital/statistics & numerical data* ; Adult ; Adolescent ; Child ; Aged ; Young Adult ; Child, Preschool ; Electronic Health Records ; Infant ; Cats ; Aged, 80 and over ; Dogs ; China/epidemiology*

BACKGROUND: For decades, trauma has been recognized globally as a major cause of death. Reducing the mortality of patients with trauma is an extremely pressing issue, particularly for those with severe trauma. An early and accurate assessment of the risk of mortality among patients with severe trauma is important for improving patient outcomes.METHODS: We performed a retrospective medical record review of 582 patients with severe trauma admitted to the emergency department between July 2011 and June 2016. We analyzed the associations of in-hospital mortality with the baseline characteristics and initial biochemical markers of patients with severe trauma on admission.RESULTS: The overall in-hospital mortality rate was 14.9%. Multivariate logistic regression analysis showed that the patient’s Rapid Emergency Medicine Score (REMS; odds ratio [OR], 1.186; 95% confidence interval [CI], 1.018–1.383; p=0.029), Emergency Trauma Score (EMTRAS; OR, 2.168; 95% CI, 1.570–2.994; p<0.001), serum lactate levels (SLL; OR, 1.298; 95% CI, 1.118–1.507; p<0.001), and Injury Severity Score (ISS; OR, 1.038; 95% CI, 1.010–1.130; p=0.021) were significantly associated with in-hospital mortality.CONCLUSION: The REMS, EMTRAS, and SLL can easily and rapidly be used as alternatives to the injury severity score to predict in-hospital mortality for patients who present to the emergency department with severe trauma.
Biomarkers ; Cause of Death ; Emergencies ; Emergency Medicine ; Emergency Service, Hospital ; Hospital Mortality ; Humans ; Injury Severity Score ; Lactic Acid ; Logistic Models ; Medical Records ; Mortality ; Odds Ratio ; Retrospective Studies ; Risk Factors ; Wounds and Injuries

BACKGROUND: We evaluated the timing and route of arrival of patients with cancer referred to a hospital near their residence for end-of-life care.METHODS: The medical records of patients with cancer receiving palliative systemic treatment at other hospitals who were transferred to our hospital for terminal care were reviewed retrospectively.RESULTS: Records of 60 patients (mean age, 57.4 years) were reviewed. The median survival after transfer was 40 days; 56.3% and 43.3% of the patients were referred to the outpatient and emergency departments of our hospital, respectively. Only 45% of the patients were enrolled in the hospice palliative care system. The most common reason for not enrolling was rejection of the patients or their families for hospice palliative care.CONCLUSION: For end-of-life care, the time from the referral to death was short, and many patients were transferred to the emergency department of our hospital.
Emergency Service, Hospital ; Hospices ; Humans ; Medical Records ; Outpatients ; Palliative Care ; Referral and Consultation ; Retrospective Studies ; Terminal Care

BACKGROUND: Several studies have evaluated risk factors for falls; however, the risk factors for recurrent falls are poorly understood. Therefore, this study evaluated the prevalence and factors associated with recurrent falls.METHODS: This study included 250 patients aged over 65 years, all of whom visited the emergency department (ED) at Seoul Medical Center following a fall from January 2016 to December 2017. We reviewed the patients' medical records for demographic data and medical history. Previous fall history, use of gait-aids, residence type, and fall recurrence were assessed via individual telephone calls.RESULTS: During the follow-up period, 21.6% (n=54) of the 250 subjects experienced recurrent falls. Logistic regression analyses showed that fall recurrence was significantly associated with a previous fall history and the residence type. Subjects who lived in basement-level residences had a significantly higher risk of fall recurrence compared to those who lived in ground-level residences (odds ratio, 8.910; 95% confidence interval, 1.082–73.366).CONCLUSION: This study revealed a high incidence of fall recurrence in older adults who visited the ED due to falls. Our results suggest that careful evaluation and intervention are essential, especially in elderly individuals with fall histories and those who live in residences associated with ncreased risk of falls.
Accidental Falls ; Adult ; Aged ; Emergencies ; Emergency Service, Hospital ; Follow-Up Studies ; Housing for the Elderly ; Humans ; Incidence ; Logistic Models ; Medical Records ; Prevalence ; Recurrence ; Risk Factors ; Seoul ; Telephone

OBJECTIVES: Most of the studies on the effect of heat stress on preterm birth (PTB) are conducted in temperate climates. Evidence on this effect in hot and arid countries with low and middle income is limited. This paper describes the short-term effect of exposure to the hot and cold environment on a daily number of PTB in Iran. METHODS: The daily number of PTB was obtained from all hospitals of the city. Meteorological and air pollution data from 2011 to 2017 were obtained from a metrological station in the city. A semi-parametric generalized additive model following a quasi-Poisson distribution with the distributed lag non-linear model was selected as a modeling framework for time-series analysis to simultaneously model the short-term and lagged effect of heat stress on PTB in the Sabzevar city. RESULTS: The minimum and maximum daily temperature were - 11.2 and 45.4 °C respectively. The highest risk estimate at extreme cold temperature was found for apparent temperature (relative risk (RR) 1.83; 95% CI 1.61: 2.09). This pattern was seen for both models. For extreme hot temperatures, the model with mean temperature showed the highest risk increase for both the main model and air pollution adjusted model (RR 1.36; 95% CI 1.25: 1.49). The lowest risk estimate in extremely cold conditions was found in the model with mean temperature. However, for extremely hot temperature conditions, the lowest risk estimate was found for both maximum and apparent temperature. CONCLUSION Obstetricians working in semi-arid areas should be aware of the influence of environmental extreme temperature on the incidence of PTB.
Air Pollutants ; analysis ; Climate ; Cold Temperature ; adverse effects ; Environmental Exposure ; adverse effects ; Environmental Monitoring ; methods ; Female ; Hospital Records ; Hot Temperature ; adverse effects ; Humans ; Infant, Newborn ; Iran ; epidemiology ; Poisson Distribution ; Pregnancy ; Premature Birth ; etiology ; Risk Factors

OBJECTIVE: To determine the factors associated with unmet needs in immigrant patients complaining of abdominal pain, by analyzing those associated with the time from symptom onset to emergency room visit.METHODS: We retrospectively reviewed the medical records of immigrants with abdominal pain who visited a tertiary hospital emergency department from January to December 2016. The dependent variable was the time from symptom onset to emergency room visit. The independent variables were age, sex, vital signs, disposition, health insurance status, date of visit, time of visit, level of education, employment status, economic satisfaction, marital status, living with family, duration of residence, having a native spouse, and subjective proficiency in Korean. We analyzed the association of the dependent variable with each independent variable.RESULTS: In total, 102 immigrant patients with abdominal pain were enrolled in this study. The patients who had earlier visits had good subjective proficiency in Korean, high economic satisfaction, longer durations of residence, a tendency to have a native spouse, and a high employment rate. After linear regression analysis, the time from symptom onset to emergency room visit was negatively associated with employment (adjusted odds ratio, -13.67; 95% confidence interval, -23.25 to -4.09; P=0.006) and having a native spouse (adjusted odds ratio, -11.7; 95% confidence interval, -20.61 to -2.8; P=0.011).CONCLUSION: The factors influencing the time from symptom onset to emergency room visit in immigrant patients with abdominal pain are associated with social capital, which improves access to emergency care. Policies that improve immigrant access to emergency care should be considered.
Abdominal Pain ; Adult ; Education ; Emergencies ; Emergency Medical Services ; Emergency Service, Hospital ; Emigrants and Immigrants ; Employment ; Health Services Needs and Demand ; Humans ; Insurance, Health ; Korea ; Linear Models ; Marital Status ; Medical Records ; Odds Ratio ; Retrospective Studies ; Social Capital ; Spouses ; Tertiary Care Centers ; Vital Signs

OBJECTIVE: This study was conducted to evaluate the concordance between the underlying causes of death (UCOD) on the death certificates written by three emergency physicians (EPs). We investigated errors on the death certificates committed by each EP.METHODS: This study included 106 patients issued a death certificate in the emergency department of an academic hospital. Three EPs reviewed the medical records retrospectively and completed 106 death certificates independently. The selection of the UCOD on the death certificates by each EP (EP-UCOD) was based on the general principle or selection rules. The gold standard UCOD (GS-UCOD) was determined for each patient by unanimous consent between three EPs. We also compared between the EP-UCOD and the GS-UCOD. In addition, we compared between UCODs of three EPs. The errors on the death certificates were investigated by each EP.RESULTS: The rates of concordance between EP-UCOD and the GS-UCOD were 86%, 81%, and 67% for EP-A, EP-B, and EP-C, respectively. The concordance rates between EP-A and EP-B were the highest overall percent agreement (0.783), and those between EP-A and EP-C were the lowest overall percent agreement (0.651). Although each EP had differences in the errors they committed, none of them listed the mode of dying as UCOD.CONCLUSION: This study confirmed that each EP wrote death certificates indicating different causes of death for the same decedents; however, the three EPs made fewer errors on the patients’ death certificates compared with those reported in previous studies.
Cause of Death ; Death Certificates ; Emergencies ; Emergency Medicine ; Emergency Service, Hospital ; Humans ; Medical Records ; Mortality ; Retrospective Studies

OBJECTIVE: To rapidly and safely identify the risk of developing acute coronary syndrome in patients with chest pain who present to the emergency department, the clinical use of the History, Electrocardiogram, Age, Risk Factors, and Troponin (HEART) scoring has recently been proposed. This study aimed to assess the inter-rater reliability of the HEART score calculated by a large number of Italian emergency physicians.METHODS: The study was conducted in three academic emergency departments using clinical scenarios obtained from medical records of patients with chest pain. Twenty physicians, who took the HEART score course, independently assigned a score to different clinical scenarios, which were randomly administered to the participants, and data were collected and recorded in a spreadsheet by an independent investigator who was blinded to the study’s aim.RESULTS: After applying the exclusion criteria, 53 scenarios were finally included in the analysis. The general inter-rater reliability was good (kappa statistics [κ], 0.63; 95% confidence interval, 0.57 to 0.70), and a good inter-rater agreement for the high- and low-risk classes (HEART score, 7 to 10 and 0 to 3, respectively; κ, 0.60 to 0.73) was observed, whereas a moderate agreement was found for the intermediate-risk class (HEART score, 4 to 6; κ, 0.51). Among the different items of the HEART score, history and electrocardiogram had the worse agreement (κ, 0.37 and 0.42, respectively).CONCLUSION: The HEART score had good inter-rater reliability, particularly among the high- and low-risk classes. The modest agreement for history suggests that major improvements are needed for objectively assessing this component.
Acute Coronary Syndrome ; Chest Pain ; Electrocardiography ; Emergencies ; Emergency Service, Hospital ; Heart ; Humans ; Medical Records ; Observational Study ; Research Personnel ; Risk Factors ; Troponin

OBJECTIVE: Bedside consultation by cardiologists may facilitate safe discharge of selected patients from the emergency department (ED) even when admission is recommended by the History, Electrocardiogram, Age, Risk factors, Troponin (HEART) pathway. If bedside evaluation is unavailable, phone consultation between emergency physicians and cardiologists would be most impactful if the resultant disposition is discordant with the HEART pathway. We therefore evaluate discordance between actual disposition and that suggested by the HEART pathway in patients presenting to the ED with chest pain for whom cardiology consultation occurred exclusively by phone and to assess the impact of phone-consultation on disposition.METHODS: We performed a single-center, retrospective study of adults presenting to the ED with chest pain whose emergency physician had a phone consultation with a cardiologist. Actual disposition was abstracted from the medical record. HEART pathway category (low-risk, discharge; high-risk, admit) was derived from ED documentation. For discharged patients, major adverse cardiac events were assessed at 30 days by chart review and phone follow-up.RESULTS: For the 170 patients that had cardiologist phone consultation, discordance between actual disposition and the HEART pathway was 17%. The HEART pathway recommended admission for nearly 80% of discharged patients. Following cardiologist phone-consultation, 10% of high-risk patients were discharged, with the majority having undergone a functional study recommended by the cardiologist. At 30 days, discharged patients had experienced no episodes of major adverse cardiac events or rehospitalization for cardiac reasons.CONCLUSION: For patients presenting to the ED with chest pain, cardiology phone-consultation has the potential to safely impact disposition, primarily by facilitating functional testing in high-risk individuals.
Acute Coronary Syndrome ; Adult ; Cardiology ; Chest Pain ; Electrocardiography ; Emergencies ; Emergency Service, Hospital ; Follow-Up Studies ; Heart ; Humans ; Medical Records ; Retrospective Studies ; Risk Factors ; Troponin