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While there is evidence of high use of wide-spectrum antibiotics in children evaluated in the pediatric emergency departments, determinants of this behavior are still unclear. This study was aimed at defining the demographic, social, clinical, and laboratory factors that affect antibiotic prescriptions in children discharged from the emergency department. We performed a retrospective observational study of children aged younger than 18 years discharged from a pediatric university hospital between Jan. 1, 2015 and Dec. 31, 2020. We determined the proportion and type of antibiotic prescription according to demographic, social, clinical, laboratory, and imaging data, as well as doctor’s expertise. Fifty-one thousand six hundred thirty-three children were included, and 13,167 (25.5%) received an antibiotic prescription. Amoxicilline/clavulanate (Am/Cl) was the most prescribed antibiotic (8453, 64.2% of all prescriptions). Factors independently associated with an antibiotic prescription were older age (OR = 1.62 [1.53–1.73] for age 2–5 years, OR = 1.77 [1.64–1.91] for age 6–10 years, OR = 1.36 [1.25–1.49] for age 11–18 years, p < 0.001 for all groups); being evaluated by a physician with > 3 years of pediatric expertise (OR = 1.22 [1.13–1.31], p < 0.001); fever peak higher than 40 °C (OR = 1.37 [1.21–1.54], p < 0.001); abnormal findings on auscultation (OR = 1.95 [1.75–2.17], p < 0.001), CRP values (OR = 1.63 [1.26–2.10] for CRP < 50 mg/L, and OR = 3.78 (2.75–5.21) for CRP ≥ 50 mg/L with respect to CRP not requested; p < 0.01); CXR results whatever positive (OR = 4.47 [3.62–5.52], p < 0.001) or negative (1.82 [1.62–2.04], p < 0.001); being diagnosed with upper respiratory tract infections (OR = 4.27 [4.04–4.51], p < 0.001), lower respiratory tract infections (OR = 5.35 [4.88–5.85]; p < 0.001), and UTI (OR = 9.33 [8.14–10.71], p < 0.001). Conclusions: Overprescription of antibiotics, including Am/Cl, is relevant in pediatric emergency departments. Factors associated with overprescription are not limited to the clinical characteristics of the treated patients. These findings highlight the need for a new and comprehensive approach to ensure successful antibiotic stewardship initiatives in the emergency departments.What is Known:• Antibiotic resistance is a growing problem in medical practice, including in pediatrics.• Antibiotics are overprescribed in children assessed in the emergency department, but comprehensive and large studies are lacking.What is New:• Factors associated with overprescription are not limited to the clinical characteristics of the patients.• Non-clinical factors such as environmental variables, doctor’s expertise, and attitudes to laboratory and radiological examinations affect prescription.

Background: Psychotropic medications are frequently prescribed to elderly patients in emergency settings, yet their potential to induce electrocardiographic (ECG) abnormalities, particularly QTc interval prolongation, raises safety concerns. Older adults may be especially vulnerable due to polypharmacy, age-related cardiac changes, and comorbidities. Methods: We conducted a retrospective observational study on patients aged ≥65 years who underwent psychiatric evaluation in the Emergency Department (ED) of a tertiary hospital between 2015 and 2023. Data was extracted on demographics, psychiatric symptoms, psychotropic drug use, and ECG findings. The primary outcome was the prevalence of major ECG abnormalities (QTc or QRS prolongation), and secondary analyses explored associations with drug class and hospitalization. Results: Seventy-seven patients were included (62.3% female, median age 74 years). Overall, 22.1% exhibited ECG abnormalities, with QTc prolongation in 16.9% and QRS widening in 5.2%. ECG alterations were more common among patients receiving psychotropic drugs (30.7% vs. 13.2%; p = 0.046). Multivariate analysis confirmed psychotropic therapy as an independent predictor of ECG abnormalities (OR 2.84; 95% CI: 1.01–7.98; p = 0.049). No significant sex-related differences were observed. Conclusions: ECG abnormalities are common in elderly patients undergoing psychiatric assessment in the ED and seem associated with psychotropic medication use. However, non-pharmacological factors also contribute significantly to risk. Integrated multidisciplinary evaluation is essential to ensure both psychiatric and cardiovascular safety in this fragile population.

BackgroundMild traumatic brain injury (TBI) in anticoagulated patients is a common challenge for emergency departments because of lack of appropriate epidemiological data and huge management variability for those under oral anticoagulation therapy.Given the discrepancies between guidelines, the aim of the present study was to quantify the association between oral anticoagulant therapy (either vitamin K antagonist (VKA) or direct oral anticoagulant (DOAC)) and the post-traumatic intracranial hemorrhage worsening compared to admission CT scan.MethodsWe included all consecutive records of patients admitted to our emergency department for mild TBI as chief complaint and with a positive admission CT scan. After statistical univariate comparison, cause-specific hazard ratio (HR) and 95% confidence interval (CI) were determined with the use of Cox proportional hazard model.ResultsIn the study period, 4667 patients had a CT scan for mild TBI; 439 (9.4%) were found to have intracranial hemorrhage. Among these patients, 299 (68.1%) were prescribed observation and control CT: 46 (15.38%) were on anticoagulant therapy, 23 (50%) on VKA, and 23 (50%) on DOAC. In multivariate analysis, only oral anticoagulation therapy was significantly associated to an increased risk of intracranial hemorrhage progression (HR 2.58; 95% CI 1.411–4.703; p = .002 and HR 1.9; 95% CI 1.004–3.735; p = .0048 for VKA and DOAC, respectively). Surgery was due to isolated subdural hematoma in 87.5% of cases, to subdural hematoma associated with intraparenchymal hemorrhage in 9.38% and to intraparenchymal hemorrhage only in 3.12%; 13 cases (4.35%) deceased in intensive care unit.ConclusionsIn our series, anticoagulation was associated to a significant increase in intracranial progression, leaving the question open as to what this implies in current clinical practice; subdural hematoma was the major finding associated to evolution and surgery. Against this background, further studies are needed to clarify patients’ management and DOAC safety profile compared to VKA in mild TBI.

Psychiatric conditions, such as depression, anxiety, bipolar disorder, and schizophrenia, are increasingly recognized as significant risk factors for cardiovascular disease (CVD). This review systematically analyzes evidence from various databases to provide a comprehensive understanding of the impact of psychiatric illnesses on the incidence, management, and prognosis of CVD. Key findings suggest a bidirectional relationship between psychiatric disorders and CVD, indicating that mental health conditions can predispose individuals to CVD, while CVD can exacerbate or trigger psychiatric symptoms. The review explores the underlying mechanisms of these associations, including behavioral factors, stress responses, and medication side effects. It also examines the challenges in managing CVD patients with comorbid psychiatric conditions, emphasizing the importance for integrated care approaches. This review underscores the necessity of considering mental health as an integral component of cardiovascular care and calls for further research to develop tailored management strategies for these complex conditions, ultimately aiming to improve patient outcomes and quality of life. This comprehensive analysis provides valuable insights for future investigations and guides clinicians in optimizing care for patients with both psychiatric and cardiovascular conditions.

Background and Objectives: Fever is one of the most common presenting complaints in the Emergency Department (ED). The role of serum procalcitonin (PCT) determination in the ED evaluation of adults presenting with fever is still debated. The aim of this study was to evaluate if, in adults presenting to the ED with fever and then hospitalized, the early PCT determination could improve prognosis. Materials and Methods. This is a retrospective, mono-centric study, conducted over a 10-year period (2009–2018). We analyzed consecutive patients ≥18 years admitted to ED with fever and then hospitalized. According to quick sequential organ failure assessment (qSOFA) at admission, we compared patients that had a PCT determination vs. controls. Primary endpoint was overall in-hospital mortality; secondary endpoints were in-hospital length of stay, and mortality in patients with bloodstream infection and acute respiratory infections. Results. The sample included 12,062 patients, median age was 71 years and 55.1% were men. In patients with qSOFA ≥ 2 overall mortality was significantly lower if they had a PCT-guided management in ED, (20.5% vs. 26.5%; p = 0.046). In the qSOFA < 2 group the mortality was not significantly different in PCT patients, except for those with a final diagnosis of bloodstream infection. Conclusions. Among adults hospitalized with fever, the PCT evaluation at ED admission was not associated with better outcomes, with the possible exception of patients affected by bloodstream infections. However, in febrile patients presenting to the ED with qSOFA ≥ 2, the early PCT evaluation could improve the overall in-hospital survival.

Objective Hip fractures in elderly patients are a major public health concern, associated with high morbidity and mortality. Early identification of high‐risk patients is crucial to guide clinical decision‐making, optimize resource allocation, and improve outcomes. However, existing risk prediction models, such as the Nottingham Hip Fracture Score (NHFS) and the Charlson Comorbidity Index (CCI), require laboratory or postoperative data, delaying risk stratification. This study aims to develop and validate the FPG score, a novel and simplified tool for predicting intrahospital mortality in elderly patients undergoing surgery for proximal femur fractures, using only admission data available at triage. Materials and Methods This single‐center, observational cohort study was conducted in two phases: a retrospective derivation phase (2015–2019) and a prospective validation phase (2020–2022). Patients aged ≥ 65 years with proximal femur fractures (AO 31A, 31B) undergoing surgical treatment were included. Exclusions involved pathological, periprosthetic, and femoral head fractures (31C). Data on demographics, comorbidities, vital signs, and laboratory values were collected at Emergency Unit triage. The primary outcome was intrahospital mortality. Univariate and multivariate logistic regression identified predictors, and ROC analysis assessed the FPG score's predictive performance, with AUC, sensitivity, and specificity evaluated using SPSS v25 and MedCalc v18. Results In the retrospective phase, 1984 patients (median age: 83.5 years, 28.7% male) were analyzed, with an observed intrahospital mortality of 3.8% (77 patients). The FPG score demonstrated an AUC of 0.79, outperforming NHFS and CCI. A score > 2 was associated with a > 50% mortality risk, with 61% sensitivity and 80% specificity. In the validation cohort (752 patients, 4.8% mortality), the FPG score maintained strong predictive performance (AUC = 0.751). Conclusion The FPG score provides a rapid, objective, and clinically applicable tool for mortality risk assessment in elderly patients with hip fractures, allowing for immediate triage‐based decision‐making. Unlike NHFS and CCI, it does not require laboratory or post‐admission data, making it particularly useful in emergency settings. Its integration into clinical practice may enhance patient management, improve resource allocation, and facilitate early intervention. While the score has been validated in a single‐center study, further multicenter validation is needed to confirm its broader applicability. Future research should explore the integration of frailty indices and laboratory markers to refine its predictive accuracy. Development and validation of the FPG score, a novel tool for predicting intrahospital mortality in elderly patients with hip fractures. This score provides clinicians with a reliable method for early risk stratification, facilitating targeted interventions and improving patient outcomes.

Background. Acute diarrhea is one of the leading causes of Emergency Department (ED) access. The search for the causative pathogen cannot be routinely performed since conventional methods, like stool cultures, are time-consuming, requiring days for growth and delaying diagnosis and the start of therapy. In this large sample retrospective study, we evaluated the prognostic role of serum procalcitonin (PCT) for adult patients with acute diarrhea in the ED. Methods. In a retrospective, mono-centric study, we enrolled all patients visiting our ED complaining of acute diarrhea and then hospitalized over five years. Final diagnosis of an infective (including bacterial) diarrhea, any other infection, and a bloodstream infection (BSI) was collected by clinical records, according to the International Disease Classification 10th edition. Procalcitonin determination was obtained upon request of the ED physician at the admission visit based on patient evaluation and clinical judgment. Results. Of a total of 1910 patients, early PCT values (cut-off of 0.5 ng/mL) did not show a significant predictive value for infective diarrhea (OR 0.554 [0.395–0.778]), nor for bacterial diarrhea (OR 0.596 [0.405–0.875]). Conversely, PCT levels at ED admission showed a significant predictive value for a final diagnosis of any infection (OR 1.793 [1.362–2.362]) and, above all, of bloodstream infection (BSI) (OR 6.694 [4.869–9.202]). Conclusions. Our data suggest that in ED, where the complexity and heterogeneity of patients are very high, indiscriminate PCT-guided management of patients with diarrhea is not indicated. Conversely, in patients with diarrhea but also clinical suspicion of BSI, PCT determination remains a useful instrument, possibly improving clinical management.

Mental illnesses can have a significant impact on individuals experiencing acute coronary syndromes (ACS). Mental illnesses are associated with an increased cardiovascular risk profile and early onset of cardiovascular disease. A critical aspect of this interplay is the effect of psychiatric conditions on left ventricular ejection fraction (LVEF), a key parameter in evaluating cardiac function and predicting long-term outcomes in ACS patients. The present single-center, retrospective study investigated the associations between psychiatric conditions and cardiac function, with a focus on LVEF in ACS patients. The inclusion criteria were Italian nationality and 30 years or older. One hundred and sixty-four patients without (Mage = 68.8 ± 10.6, 62 females) and 161 patients with a psychiatric diagnosis (Mage = 68.4 ± 13.7, 63 females) were enrolled. The data collected included sociodemographic variables, psychiatric diagnoses, LVEF, ACS type (STEMI/NSTEMI), smoking status, previous interventions, and pharmacological treatments. Statistical analyses included chi-square, t-tests, ANOVAs, and ANCOVA to assess differences across groups. Findings revealed lower LVEF in patients with a psychiatric diagnosis compared to patients without a psychiatric diagnosis (p = 0.004, d = 0.36). Patients without a psychiatric diagnosis were associated with NSTEMI (p = 0.047, φ = 0.11), hypertension (p = 0.003, φ = −0.16), and dyslipidemia (p = 0.022, φ = −0.13). In contrast, patients with a psychiatric diagnosis were associated with STEMI (p = 0.047, φ = 0.11), neurological dysfunction (p = 0.014, φ = 0.14), and chronic obstructive pulmonary disease (p = 0.010, φ = 0.14). Among psychiatric diagnoses, anxiety disorders were associated with lower LVEF compared to substance abuse disorders (p = 0.012, d = −0.81). The findings underscore the complex relationship between mental illness and cardiac function, emphasising the need to integrate psychiatric evaluations into cardiology care to optimise the management of both mental and cardiovascular health. This study has several limitations, including its design, which prevents causal conclusions, and the use of convenience sampling, which limits the generalizability of the findings.

Acute diarrhea represents a major public health issue, and the management of adult patients admitted to the emergency department (ED) for this problem is still challenging. In a retrospective analysis on more than 20,000 patients visiting a tertiary ED for acute diarrhea and then being discharged home, we found that age > 65 years, onset of symptoms > 24 h since ED admission, refusal of hospitalization, and a history of chronic renal and liver diseases were independently associated with ED readmission for abdominal symptoms within 7 days. In the younger group, the presence of comorbidities significantly impacted on ED readmission, while fever and alteration of serum creatinine were the main determinants in the older group. Antibiotics were prescribed in about 25% of patients, although diarrhea etiology (viral or bacterial) was usually not available. According to international guidelines, fluoroquinolones were the most prescribed class, showing an inverse correlation to ED readmission. However, β-lactams and probiotics were also commonly prescribed; the latter were independently correlated to ED readmission in the elderly group. A comprehensive, guideline-based approach, including a detailed clinical history and laboratory and comorbidity assessment, should be encouraged to support physicians in the management of different age subgroups of adults admitted to the ED for acute diarrhea.

Background: In patients aged 65 years and older who experience severe trauma, their underlying health status significantly influences overall mortality. This study aimed to determine whether computed tomography (CT) evaluation of skeletal muscle quality could serve as an effective risk stratification tool in the emergency department (ED) for this population. Methods: Retrospective observational study conducted between January 2018 and September 2021, including consecutive patients ≥65 years admitted to the ED for a major trauma (defined as having an Injury Severity Score > 15). Muscle quality analysis was made by specific software (Slice-O-Matic v5.0, Tomovision®, Montreal, QC, Canada) on a CT-scan slice at the level of the third lumbar vertebra (L3). Results: A total of 263 patients were included (72.2% males, median age 76 (71–82)), of whom 88 (33.5%) died during hospitalization. The deceased patients had a significantly lower skeletal muscle area density (SMAd) compared with survivors. The multivariate Cox regression analysis confirmed that SMAd <38 at the ED admission was an independent risk for death (adjusted HR 1.68 [1.1–2.7]). The analysis also revealed that, among the survivors after the first week of hospitalization, the patients with low SMAd had an increased risk of death (adjusted HR 3.12 [1.2–7.9]). Conclusions: Skeletal muscle density assessed by a CT scan at ED admission may represent a valuable prognostic marker for risk stratification patients ≥65 years with major trauma. In patients with SMAd <38 HU the in-hospital mortality risk could be particularly increased after the first week of hospitalization.