Emergency Departments In Italy Research Articles

Infectious Risk in Pediatric Emergency Departments in Italy: A Survey by the Italian Society for Pediatric Emergency and Urgent Medicine (SIMEUP) on Available Preventive and Diagnostic Tools.

Background/Objectives: The COVID-19 pandemic has emphasized the importance of preparedness in preventing the spread of infectious diseases, especially in Emergency Departments (EDs), where initial patient assessments and triage occur. This study aims to evaluate the current practices and available tools for infection control in Pediatric EDs across Italy, focusing on the differences between various hospital types and regional settings. Methods: A cross-sectional national survey was conducted in February 2022, targeting healthcare workers in Pediatric EDs across Italy. The survey, distributed via the Italian Society for Pediatric Emergency and Urgent Medicine (SIMEUP) mailing list, collected data on infection control measures, including the availability of hand hygiene stations, personal protective equipment, disinfection protocols, and the use of rapid diagnostic tests. Results: A total of 80 questionnaires were completed from 119 (67.2%) different ERs. The majority of respondents were from Northern Italy (47.5%) and worked in hospitals with 24 h pediatric assistance (48.8%). Less than half of non-pediatric hospitals had separate access for children, potentially exposing them to adult pathogens. Across all settings, basic infection control measures, such as providing masks and hand gel, were widely implemented. However, significant differences were observed in the availability of social distancing, informational materials, and dedicated pediatric pathways, with I level assistance hospitals less likely to have these resources. Rapid diagnostic tests were available in most settings, but the focus was predominantly on SARS-CoV-2, despite other respiratory pathogens' relevance in pediatric care. Conclusions: Strengthening preparations for future pandemics will be crucial in enhancing the resilience of healthcare systems and ensuring the safety of both patients and healthcare workers in the face of emerging infectious threats.

Sex differences in in-hospital management and outcomes of patients with acute pulmonary embolism

Abstract Background Acute pulmonary embolism (PE) is a life-threatening disease with specific risk factors among women. Systematic evaluation of contemporary quality of care and outcomes in women hospitalized with acute PE is needed. Methods The COPE Registry (COntemporary management of acute Pulmonary Embolism) is a nationwide registry that was run in Internal Medicine, Cardiology and Emergency Departments in Italy. Using data from the COPE Registry, we evaluated sex differences in acute management, medical therapies, in-hospital and 30-day mortality and major bleeding in 5,213 patients admitted for acute PE at 182 hospitals in Italy from 2018 to 2020. Results Women (n=2,728) were older than men (71.2 versus 66.6 years, P<0.001) and had different distribution of comorbidities, with dementia and severe renal failure being more prevalent (13.6 vs 6.4% and 6.1 vs 3.0%, respectively) and cancer, COPD and recent bed-rest less prevalent (15.2 vs 18.5% and 11.1 vs 14.5% and 23.5 vs 20.2%) in women than men. At presentation, PE was more severe in women than men in terms of hemodynamic instability (4.1 vs 2.7%), prevalence of right ventricle overload at echocardiography (64.5 vs 57%) and prevalence of sPESI=0 (29.4 vs 38.5%). Concerning the likelihood to receive evidence-based acute treatments for PE, women were more likely than men to receive reperfusion in the case of hemodynamic compromise at presentation after adjusting for age and dementia (63.1 vs 50.0%; OR 1.934, 95% CI 1.01-3.71), and to receive direct oral anticoagulants during hospitalization after adjusting for age, dementia and severe renal failure (50.9 vs 48.6%; OR 1.14, 95% CI 1.01-1.28); similar proportions of low-risk women and men were managed as outpatients or by short hospital stay (1.4% vs 1.4% and 8.6 vs 6.0%, respectively). In-hospital and 30-day mortality rates were not different in women and in men (3.7% versus 3.1% and 5.5 vs 4.8%), but PE-related mortality was higher in women than in men (2.1 vs 1.3%). The sex difference in PE-related mortality was no longer observed in after adjusting for age, hemodynamic instability and dementia (adjusted HR 1.20; 95% CI 0.77-1.88; P=0.415). Similar rates of early and delayed major bleedings occurred in women and in men, both at univariate analysis and after adjusting for age, creatinine clearance and use of thrombolysis. None of 22 pregnant women and 1 out of 204 women with estro-progestin associated PE died or experienced major bleeding. Conclusions Women hospitalized for acute PE in Italy received evidence-based acute treatments more commonly than men. The observed sex differences in PE-related mortality were mainly attributable to worse clinical profiles and older age. Women with sex-related risk factor for PE had favorable prognosis.

Frequency and type of domestic injuries among children during COVID-19 lockdown: what changes from the past? An Italian multicentre cohort study

Accidents are the main cause of injury in children, more than half events happen at home. Aims of this study were to assess if SARS-CoV-2 lockdown influence emergency department (ED) visits due to children domestic accident (DAs) and to identify factors associated with hospitalization. This was a multicentre, observational, and retrospective cohort study involving 16 EDs in Italy and enrolling children (3–13 years) receiving a visit in ED during March–June 2019 and March–June 2020. Risk factors for hospitalization were identified by logistic regression models. In total, 8860 ED visits due to domestic accidents in children occurred before (4380) and during (4480) lockdown, with a mean incidence of DA of 5.6% in 2019 and 17.9% in 2020 (p < 0.001) (IRR: 3.16; p < 0.001). The risk of hospitalization was influenced by the type of occurred accident, with fourfold higher for poisoning and twofold lower risk for stab-wound ones. In addition, a higher risk was reported for lockdown period vs 2019 (OR: 1.9; p < 0.001), males (OR: 1.4; p < 0.001), and it increased with age (OR: 1.1; p < 0.001). Conclusions: The main limitation of this study is the retrospective collection of data, available only for patients who presented at the hospital. This does highlight possible differences in the total number of incidents that truly occurred. In any case, the COVID-19 lockdown had a high impact on the frequency of DAs and on hospitalization. A public health campaign aimed at caregivers would be necessary to minimize possible risks at home.What is Known:• In Italy, domestic accidents are the second leading cause of paediatric mortality after cancer.• During the first SARS-CoV-2 lockdown in 2020, a sharp decrease in the total number of Emergency Departments visits for all causes was observed, both in children and in adults.What is New:• During the first SARS-CoV-2 lockdown in 2020, domestic accidents involving children increased threefold from the previous year.• Higher risk of hospitalization was showed in minors accessing during 2020 vs 2019, in males than in females and it increased with advancing age. Considering the type of injury, a significant higher risk of hospitalization for poisoning was observed.

Time for implementing high-sensitivity cardiac troponin assays in emergency departments in Italy.

Time for implementing high-sensitivity cardiac troponin assays in emergency departments in Italy.

The impact of the COVID-19 pandemic on the use of Emergency Departments in Italy.

During 2020, COVID-19 had a diversified distribution in Italy, the first nation in Europe to experience the outbreak of the epidemic. This was linked to geographical differences in population density and distribution of healthcare facilities, including Emergency Departments (EDs). This study aims to assess the impact of the pandemic on ED utilization in 2020 across different subpopulations and geographical locations in Italy. We used anonymized data from a survey conducted by the Italian National Institute of Statistics on 25,000 families to analyze the yearly rate of people who used EDs from 2015 to 2020. The rate of persons who accessed ED services in 2020 per 1,000 population was compared with those of the previous non-pandemic years. The number of people accessing EDs in 2020 was 32.3% lower, although this reduction was not uniform across the 21 regions / autonomous provinces. People aged 0-14 years experienced the highest reduction in ED visits. In 2020, low educational level people exhibited a steeper reduction in the use of EDs. This study shows a significant drop in EDs use especially by children; the population section mostly affected by the effects of the pandemic. This study also confirms that education and socio-economic status are important determinants of ED use. The heterogeneous reduction in ED use across the regions of Italy highlights the need to further investigate the impact of this pattern on the health of the population, as well as to define adequate preparedness strategies to face future emergencies.

EE177 A Budget Impact Analysis of a Novel Diagnostic Test to Differentiate Viral/Bacterial Etiology for Community-Acquired Pneumonia Patients Presenting to the Emergency Departments in Italy

EE177 A Budget Impact Analysis of a Novel Diagnostic Test to Differentiate Viral/Bacterial Etiology for Community-Acquired Pneumonia Patients Presenting to the Emergency Departments in Italy

The PAWPER tape as a tool for rapid weight assessment in a Paediatric Emergency Department: Validation study and comparison with parents’ estimation and Broselow tape

AimTo validate the PAWPER tape and assess its inter-observer reliability in children accessing a Paediatric Emergency Department (PED). As secondary outcome we compared the accuracy of the PAWPER tape with that of parents’ estimation, the Broselow tape and the European Paediatric Life Support (EPLS) formula. MethodsThis was a cross-sectional study of children (0–12 years) enrolled in a tertiary Paediatric Emergency Department in Italy. Children’s weight was estimated by parents and by trained healthcare providers using the PAWPER tape, the Broselow tape and the EPLS formula. The root mean squared percentage error (RMSPE) for the estimation of precision was calculated. Overall accuracy was evaluated using the percentage of weight estimation falling within 10% (PW10) and 20% (PW20) of real weight. ResultsThe study included 2060 children. Parental estimation was the most accurate and precise method. The PAWPER tape was accurate throughout all habitus sizes except for extreme underweight and overweight categories. Furthermore, it was more accurate and more precise than the Broselow tape and the EPLS formula (p adjusted <0.001). ConclusionsThe PAWPER tape served as an accurate method for weight estimation in children accessing a Paediatric Emergency Department, with excellent inter-rater reliability. It performed significantly better than other length or age-based tools, showing good accuracy and precision except for very extreme weights. Whilst parents’ estimation yielded to be the most accurate and precise method, the age-based EPLS formula was not reliable for estimating weight in all subcategories of habitus.

Clinical, Paraclinical Characteristics and Relative Risk Factors of Severe Degree in Children with COVID-19: Systematic Review

Aim: systematic review of studies in the medical literature of children with COVID – 19 in order to provide evidence of clinical, paraclinical characteristics and relative risk factors of severe degree in children with COVID-19. Research subjects: A systematic review of studies on COVID-19 in children published in the international medical literature. Research methods: the information of research reports was selected from information posted on the COVID-19 update reporting portal of the Ministry of Health, PubMed, EMBASE, Cochrane Library, WHO COVID-19 Database, China National Knowledge Infrastructure (CNKI) Database, WanFang Database through system overview. Results: we collected 115 studies related to COVID-19 in children, published from January 2020 to August 2021, and by screening, we selected 21 studies related to clinical, paraclinical characteristics and relative risk factors of severe degree in children with COVID-19.&#x0D; Keywords:&#x0D; Variant Delta, COVID-19 in children, Clinical, Paraclinical Characteristics and risk factors of severe degree.&#x0D; References&#x0D; [1] Minnistry of Health, Dayly Recorded of COVID-19 (in Vietnamese), https://www.moh.gov.vn/ (accessed on: August 31st, 2021).[2] World Health Organization, Clinical Management Severe Acute Respiratory Infection when Novel Coronavirus (2019-nCoV) Infection is Suspected: Interim Guidance, 2020, 28 January 2020, pp. 1-10.[3] CDC (Centers for Disease Control and Prevention), COVID-19 Response Team, Coronavirus Disease 2019 in Children-United States, February 12-April 2, 2020, MMWR Morb Mortal Wkly Rep, 2020, Vol. 69, No, 14, pp. 422-426, https://doi.org/10. 15585/mmwr.mm6914e4.[4] J. F. Ludvigsson, Systematic review of COVID-19 in Children Shows Milder Cases and a Better Prognosis than Adults, Acta Paediatr, 2020 Jun, Vol. 109, No. 6, pp. 1088-1095, https://doi.org/10.1111.[5] CDC (Centers for Disease Control and Prevention), US COVID-19 Cases caused by Variants, Up-to-Date Info: https://www.cdc.gov/coronavirus/2019-nCoV (accessed on: August 31st, 2021).[6] N. Parri, M. L. D. Buonsenso, Children with Covid-19 in Pediatric Emergency Departments in Italy, N Engl J Med, 2020, Vol. 383, No. 2, pp. 187-190, https://doi.org/10.1056/NEJMc2007617, 2020. [7] Q. Lu and Y. Shi, Coronavirus Disease (COVID-19) and Neonate: what Neonatologist Need to Know, J Med Virol, 2020, Vol. 92, No. 6 , pp. 564-567, https://doi.org/10.1002/jmv.25740. [8] H. Tezer and T. B. Demirdrag, Novel Coronavirus Disease (COVID-19) in Children, Turk J Med Sci, 2020, Vol 50, pp. 592-603, https://doi.org/10.3906/sag-2004-17, 2020.[9] L. K. Zeng, X. W. Tao, W. H. Yuan et al., First Case of Neonate Infected with Novel Coronavirus Pneumonia in China. Front. Pediatr, 2020, Vol. 8, pp. 1-8, https://doi.org/10.3389/fped.2020.00287. [10] M. Wei, J. Yuan, Y. Liu et al., Novel Coronavirus Infection in Hospitalized Infants Under 1 Year of Age in China. JAMA, 2020, Vol. 323, No. 13, pp. 1313-1314, https://doi.org /10.1001/jama.2020.2131. [11] D. Wang, X. L. Ju, F. Xie et al., Clinical Analysis of 31 Cases of 2019 Novel Coronavirus Infection in Children from Six Provinces (Autonomous Region) of Northern China, Zhonghua Er Ke Za Zhi, 2020, Vol. 58, No. 4, pp. 269-274, https://doi.org/10.3760/cma.j.cn112140-20200225-00138, 2020. [12] S. Tiana, N. Hub, J. Lou et al., Characteristics of COVID-19 Infection in Beijing, J Infect, 2020, Vol. 80, No. 4, pp. 401-406, https://doi.org/10.1016/j.jinf.2020.02.018. [13] H. Zhu, L. Wang, C. Fang et al., Clinical Analysis of 10 Neonates Born to Mothers with 2019-nCoV Pneumonia. Transl Pediatr, 2020, Vol. 9, pp. 51-60, https://doi.org/10.21037/tp.2020.02.06. [14] Y. Dong, X. Mo, Y. Hu et al., Epidemiological Characteristics of 2143 Pediatric Patients with 2019 Coronavirus Disease in China, J Emerg Med, 2020, Vol . 58, No. 4, pp. 712-713, https://doi.org/1016/j.jemermed.2020.04.006. [15] I. Liguoro, C. Pilotto, M. Bonann et al., SARS-COV-2 Infection in Children and Newborns: A Systematic Review. SARS-COV-2 Infection in Children and Newborns: A Systematic Review, European Journal of Pediatrics, 2020, Vol. 18, 2020, pp. 1-18, https://doi.org/10.1007/s00431-020-03684-7. [16] J. Yasuhara, T. Kuno, H. Takagi, Clinical Characteristics of COVID‐19 in Children: A Systematic Review, Pediatric Pulmonology, 2020, Vol. 55, No. 10, pp. 2565-2575, https://doi.org/10.1002/ppul.24991. [17] T. H. D. Souza, J. A. Nadal, R. J. N. Nogueira et al., Clinical Manifestations of Children with COVID-19: A Systematic Review, Pediatr Pulmonol, 2021, Vol. 55, No. 8, pp. 1892-1899, https://doi.org/ 10.1002/ppul.24885. [18] Q. Shen, W. Guo, T. Guo et al., Novel Coronavirus Infection in Children Outside of Wuhan, China, Pediatr Pulmonol, 2020, Vol. 55, No. 6, pp. 1424-1429, https://doi.org/10.1002/ppul.24762. [19] H. Qiu, J.a Wu, L. Hong et al., Clinical and Epidemiological Features of 36 Children with Coronavirus Disease 2019 (COVID-19) in Zhejiang, China: an Observational Cohort Study, Lancet Infect Dis, 2020, Vol. 20, No. 6, pp. 689-696, https://doi.org/10.1016/S1473-3099(20)30198-5. [20] N. M. Mustafaa, L. A. Selimc, Characterisation of COVID-19 Pandemic in Paediatric Age Group: A Systematic Review and Meta-Analysis, J Clin Virol, 2020, Vol. 128, pp. 1-15, https://doi.org/10.1016/j.jcv.2020.104395. [21] W. Guan, Z. Y. Ni, Y. Hu et al., Clinical Characteristics of 2019 Novel Coronavirus Infection in China, 2020, N Engl J Med, Vol. 382, pp. 1708-1720, https://doi.org/10.1056/NEJMoa2002032.&#x0D;

Adolescents' Utilization of a Tertiary-Level Pediatric Emergency Department in Italy.

AimDescribe the use of the emergency department of a tertiary-level children's hospital in Italy by adolescents.MethodsThis retrospective study was based on the medical records of patients aged 13 to 17 years, who accessed the emergency department of the Institute for Maternal and Child Health of Trieste, from 1 January to 31 December 2018. The primary outcome was to describe the leading causes of access, diagnoses, rate of hospitalization, and ward of destination among adolescent patients.ResultsDuring the study period, 24,599 patients accessed the department. Among them, 3,062 were adolescents, for a total of 3,895 unscheduled visits. The principal causes of access were trauma (45.3%) and organic diseases (38.8%). Two hundred and forty nine adolescents (6.4%) had mental health problems. One hundred and forty two adolescents (3.6%) Were Admitted to the Hospital, 54 of Whom (38%) to the Neuropsychiatric Ward, for Mental Health Problems.ConclusionsAmong adolescents seen in this Italian tertiary-level children's hospital, mental health problems represented a small proportion of emergency department visits but were the leading cause of urgent hospitalization.

A simulation-based optimization approach for the calibration of a discrete event simulation model of an emergency department

Accurate modeling of the patient flow within an Emergency Department (ED) is required by all studies dealing with the increasing and well-known problem of overcrowding. Since Discrete Event Simulation (DES) models are often adopted with the aim of assessing solutions for reducing the impact of this worldwide phenomenon, an accurate estimation of the service time of the ED processes is necessary to guarantee the reliability of the results. However, simulation models concerning EDs are frequently affected by missing data, thus requiring a proper estimation of some unknown parameters. In this paper, a simulation-based optimization approach is used to estimate the incomplete data in the patient flow within an ED by adopting a model calibration procedure. The objective function of the resulting minimization problem represents the deviation between simulation output and real data, while the constraints ensure that the response of the simulation is sufficiently accurate according to the precision required. Data from a real case study related to a big ED in Italy is used to test the effectiveness of the proposed approach. The experimental results show that the model calibration allows recovering the missing parameters, thus leading to an accurate DES model.

Contemporary clinical management of acute pulmonary embolism: the COPE study

BackgroundNew management, risk stratification and treatment strategies have become available over the last years for patients with acute pulmonary embolism (PE), potentially leading to changes in clinical practice and improvement of patients’ outcome.MethodsThe COntemporary management of Pulmonary Embolism (COPE) is a prospective, non-interventional, multicentre study in patients with acute PE evaluated at internal medicine, cardiology and emergency departments in Italy. The aim of the COPE study is to assess contemporary management strategies in patients with acute, symptomatic, objectively confirmed PE concerning diagnosis, risk stratification, hospitalization and treatment and to assess rates and predictors of in-hospital and 30-day mortality. The composite of death (either overall or PE-related) or clinical deterioration at 30 days from the diagnosis of PE, major bleeding occurring in hospital and up to 30 days from the diagnosis of PE and adherence to guidelines of the European Society of Cardiology (ESC) are secondary study outcomes. Participation in controlled trials on the management of acute PE is the only exclusion criteria. Expecting a 10–15%, 3% and 0.5% incidence of death for patients with high, intermediate or low-risk PE, respectively, it is estimated that 400 patients with high, 2100 patients with intermediate and 2500 with low-risk PE should be included in the study. This will allow to have about 100 deaths in study patients and will empower assessment of independent predictors of death.ConclusionsCOPE will provide contemporary data on in-hospital and 30-day mortality of patients with documented PE as well as information on guidelines adherence and its impact on clinical outcomes.Trail registrationNCT number: NCT03631810.

Patients who leave the Emergency Department without being seen. Has COVID-19 affected this phenomenon?

Background and aim of the work:Patients who present to an Emergency Department (ED) and leave without being seen by a physician represent a safety concern because they may become severely ill and experience adverse events as a result of lacking or delayed ED treatment. Prior to the COVID-19 outbreak, the increasing number of patients accessing care through the ED in Italy and throughout the world has had implications for health policies.Methods:A retrospective cohort study that included all ED visits from 1st January 2013 to 31st December 2018 in the Perugia University Hospital has been carried out.Results:During the 5 years investigated 26,344 out of 300,372 (8.77%) patients who attended the ED left the triage area before being seen with an average of 439 patients per month. The same phenomenon has been analysed from February to October 2020. During these 9 months there were a total of 1,824 out of 30,990 (5.88%) patients who left the ED without being seen with an average of 202 per month. The latter value is one third lower than the one related to the period investigated prior to the COVID-19 outbreak.Conclusions:Such investigation could help to differentiate actual essential demand from non-essential demand within the ED, which could inform quality-improvement policies. Several strategies could be implemented to lower the proportion of patients who leave the department without being seen. Reorganising the activities in the ED with different paths should be implemented with the aim of reducing waiting times and in turn patients’ satisfaction. (www.actabiomedica.it)

Use of high-sensitivity cardiac troponins in the emergency department for the early rule-in and rule-out of acute myocardial infarction without persistent ST-segment elevation (NSTEMI) in Italy.

Serial measurements of cardiac troponin are recommended by international guidelines to diagnose myocardial infarction (MI) since 2000. However, some relevant differences exist between the three different international guidelines published between 2020 and 2021 for the management of patients with chest pain and no ST-segment elevation. In particular, there is no agreement on the cut-offs or absolute change values to diagnose non-ST-segment elevation MI (NSTEMI). Other controversial issues concern the diagnostic accuracy and cost-effectiveness of cut-off values for the most rapid algorithms (0h/1h or 0h/2h) to rule-in and rule-out NSTEMI. Finally, another important point is the possible differences between demographic and clinical characteristics of patients enrolled in multicenter trials compared to those routinely admitted to the Emergency Department in Italy. The Study Group of Cardiac Biomarkers, supported by the Italian Scientific Societies Società Italiana di Biochimica Clinica, Italian Society of the European Ligand Assay Society, and Società Italiana di Patolgia Clinica e Medicina di Laboratorio decided to revise the document previously published in 2013 about the management of patients with suspected NSTEMI, and to provide some suggestions for the use of these biomarkers in clinical practice, with a particular focus on the Italian setting.

CARDIOVASCULAR RISK AND OUTCOME IN PATIENTS WITH HYPERTENSIVE EMERGENCIES AND URGENCIES IN AN EMERGENCY DEPARTMENT. AN ITALIAN GREEK COLLABORATION

Objective: Background: at present, few data are available on the prognosis of hypertensive emergencies and urgencies admitted to Emergency Departments (ED). The aim of our study was to evaluate the incidence of total and cardiovascular events during follow-up in hypertensive patients admitted in 2 ED in Italy and Greece with hypertensive emergencies or urgencies. Design and method: Methods: medical records of patients aged &gt; 18 yrs, admitted to the ED with blood pressure values &gt; = 180 mmHg (SBP) and/or &gt; = 120 mmHg (DBP) were collected and analysed (24% of patients were classified as “hypertensive emergency” and 76 % as “hypertensive urgency”). Data in 1218 patients (556 men and 662 women, mean age 70 + 13 years) were analysed; the mean duration of follow-up after admission to the ED was 19.5 + 7 months years. Results: Results: During the follow-up cardiovascular events occurred in 148 patients (69 cardiac events, 43 cerebrovascular events). In 272 pts (22 %) a new episode of acute BP rise was recorded. A total of 87 deaths was recorded during follow-up (in 28 patients for cardiovascular causes). All cause and CV mortality were greater in patients with a previous hypertensive emergency (14.7 vs 4.7 %, chisquare p = 0.0001 and 5.8 vs 1.2% chisquare p &lt; 0.0001 for all-cause and for CV mortality, respectively). The incidence of non fatal cardiovascular events was 10,11 and 2,11 per 100 patient-years in patients with hypertensive emergency and urgency, respectively and similar results were obtained when we considered separately the occurrence of cerebrovascular events. Conclusions: Conclusions: admission to the ED for hypertensive emergencies identifies hypertensive patients at increased risk for fatal and non fatal cardiovascular events. Our results underline the need for an accurate follow-up in patients with hypertensive emergencies and urgencies.

The influence of COVID-19 lockdowns on presentation with spontaneous posterior vitreous detachment to the emergency department in Italy.

The purpose of the study was to analyze the frequency of the spontaneous posterior vitreous detachment (PVD) in patients admitted to an Emergency Eye Department in Italy (EED) during the COVID-19 pandemic national lockdown in 2020 compared with the similar time period in 2019. In this retrospective observational study, patient records for ophthalmology EED patients in the month of April 2020 during the COVID-19 Italian national lockdown, were compared with those for an equivalent one-month period in 2019. Diagnoses, gender, and age were assessed. Unpaired Student t-tests were used for continuous variables. Poisson regression was used for count analysis to compare categorical variables. Chi-square test was applied to asses proportion differences. In comparison with the 2019 equivalent period, there was a significant decrease in the overall number of EED visits and in the number of patients presenting with a spontaneous PVD during the 2020 lockdown (-41.6% and -49%, respectively). During the 2020 lockdown, all diagnostic categories showed less patient admittance, however, the proportions remained stable when considering the entire cohort. The proportion of urgent visits was 90% in 2020 and 86% in 2019 (p = 0.66). The proportion of EED patients affected by spontaneous PVD was comparable between the two study periods (8.4% in 2020 vs. 9.6% in 2019, p = 0.34). Patients presenting with spontaneous PVD in both periods were significantly older when compared to patients with other pathologies (mean age of 63years in 2020 and 64years in 2019, p < 0.001). There was a significant bias in female gender (61.2% in 2019 and 60% in 2020, p < 0.05). There was a significant decrease of accesses to the EED during COVID-19 2020 lockdown. Patients affected by spontaneous PVD were about 50% less compared with the same period of 2019. Risk factors for the development of spontaneous PVD were older age and female gender. PVD represents a potentially visual function threatening condition because it can cause retinal ruptures and retinal detachment. Patients need to be educated to get urgent ophthalmic assessments in the presence of important acute signs and symptoms, like floaters and flashes, even in the presence of a lockdown.

Children with special health care needs attending emergency department in Italy: analysis of 3479 cases

BackgroundAlthough children with special health care needs (CSHCN) represent a minority of the population, they go through more hospitalizations, more admissions to the Emergency Department (ED), and receive a major number of medical prescriptions, in comparison to general pediatric population. Objectives of the study were to determine the reasons for admission to the ED in Italian CSHCN, and to describe the association between patient’s demographic data, clinical history, and health services requirements.MethodsAd hoc web site was created to collect retrospective data of 3479 visits of CSHCN to the ED in 58 Italian Hospitals.ResultsSeventy-two percent of patients admitted to ED were affected by a previously defined medical condition. Most of the ED admissions were children with syndromic conditions (54%). 44.2% of the ED admissions were registered during the night-time and/or at the weekends. The hospitalization rate was of 45.6% among patients admitted to the ED. The most common reason for admission to the ED was the presence of respiratory symptoms (26.6%), followed by gastrointestinal problems (21.3%) and neurological disorders (18.2%). 51.4% of the access were classified as ‘urgent’, with a red/yellow triage code. Considering the type of ED, 61.9% of the visits were conducted at the Pediatric EDs (PedEDs), 33.5% at the Functional EDs (FunEDs) and 4.6% at the Dedicated EDs (DedEDs). Patients with more complex clinical presentation were more likely to be evaluated at the PedEDs. CSHCN underwent to a higher number of medical procedures at the PedEDs, more in comparison to other EDs. Children with medical devices were directed to a PedED quite exclusively when in need for medical attention. Subjects under multiple anti-epileptic drug therapy attended to PedEDs or FunEDs generally. Patients affected by metabolic diseases were more likely to look for medical attention at FunEDs. Syndromic patients mostly required medical attention at the DedEDs.ConclusionsAccess of CSHCN to an ED is not infrequent. For this reason, it is fundamental for pediatricians working in any kind of ED to increase their general knowledge about CHSCN and to gain expertise in the management of such patients and their related medical complexity.

Cardiovascular risk and outcome in patients with hypertensive emergencies and urgencies in an emergency department. an italian greek collaboration

Abstract Background At present, few data are available on the prognosis of hypertensive emergencies and urgencies admitted to Emergency Departments (ED). The aim of our study was to evaluate the incidence of total and cardiovascular events during follow-up in hypertensive patients admitted in 2 ED in Italy and Greece with hypertensive emergencies or urgencies. Methods Medical records of patients aged &amp;gt;18 yrs, admitted to the ED with blood pressure values ≥180 mmHg (SBP) and/or ≥120 mmHg (DBP) were collected and analysed (24% of patients were classified as “hypertensive emergency” and 76% as “hypertensive urgency”). Data in 1218 patients (556 men and 662 women, mean age 70±13 years) were analysed; the mean duration of follow-up after admission to the ED was 19.5±7 months years. Results During the follow-up cardiovascular events occurred in 148 patients (69 cardiac events, 43 cerebrovascular events). In 272 pts (22%) a new episode of acute BP rise was recorded. A total of 87 deaths was recorded during follow-up (in 28 patients for cardiovascular causes). All cause and CV mortality were greater in patients with a previous hypertensive emergency (14.7 vs 4.7%, chi-square p=0.0001 and 5.8 vs 1.2% chisquare p&amp;lt;0.0001 for all-cause and for CV mortality, respectively). The incidence of non fatal cardiovascular events was 10,11 and 2,11 per 100 patient-years in patients with hypertensive emergency and urgency, respectively and similar results were obtained when we considered separately the occurrence of cerebrovascular events. Conclusions Admission to the ED for hypertensive emergencies identifies hypertensive patients at increased risk for fatal and non fatal cardiovascular events. Our results underline the need for an accurate follow-up in patients with hypertensive emergencies and urgencies. Funding Acknowledgement Type of funding source: None

Pain management in the emergency department: results from an observational longitudinal prospective study in a second-level urban hospital

Although a correct assessment of pain and an adequate analgesia represent a priority in the setting of emergency care, many studies documented an inadequate pain control. The purpose of our study is to characterize the present status of a second level Emergency Department in Italy in terms of pain assessment and treatment. Our survey investigates the multidimensional aspects of pain, the accomplishment of appropriate pain evaluation by the medical and nursing staff and the effectiveness of the treatment, in terms of pain reduction and also of customer satisfaction.

Impact of the COVID-19 pandemic on urological practice in emergency departments in Italy.

None declared.

The development of a Consensus Conference on Pediatric Procedural Sedation in the Emergency Department in Italy: from here where to?

BackgroundIn Italy, as in many European countries, Pediatric Emergency Medicine is not formally recognized as a pediatric subspecialty, hindering nation-wide adoption of standards of care, especially in the field of procedural sedation and analgesia (PSA) in the Emergency Department (ED). For this reason PSA in Italy is mostly neglected or performed very heterogeneously and by different providers, with no reference standard. We aimed to describe the procedures and results of the first multidisciplinary and multi-professional Consensus Conference in Italy on safe and effective pediatric PSA in Italian EDs.MethodsThe preparation, organization and conduct of the Consensus Conference, held in Florence in 2017, followed the recommended National methodological standards. Professionals from different specialties across the country were invited to participate.ResultsOverall 86 recommendations covering 8 themes (pre-sedation evaluation, pharmacologic agents, monitoring, equipment and discharge checklists, training, non-pharmacologic techniques, the adult ED setting, impact on hospitalizations) were developed, taking into account the Italian training system and healthcare organization characteristics.ConclusionThe results of the first multidisciplinary and multi-professional Consensus Conference in Italy are meant to provide up-to-date national guidance to improve the standard of care of children undergoing painful and stressful procedures in the ED. The recommendations will be periodically updated as new relevant evidence is published.