Hsiu-Lan Li

Background: Emergency department (ED) revisits within 72 h are commonly used as indicators of healthcare quality and have been associated with adverse clinical outcomes. Some patients return with presenting complaints that differ from those reported during the initial ED encounter; however, factors associated with this phenomenon have not been well described. Methods: This retrospective cohort study analyzed electronic health record data from a regional teaching hospital in Taiwan between 2016 and 2023. Adult patients with unscheduled ED revisits within 72 h were included. Documented presenting complaints recorded at the index visit and revisit were compared according to predefined operational definitions and categorized as consistent or changing. Multivariable logistic regression was used to identify factors associated with complaint consistency. Revisit disposition was also examined. Results: A total of 1957 patients met the study criteria, of whom 809 (41.3%) had changing presenting complaints. Compared with patients with consistent presenting complaints, those with changing presenting complaints were older and had lower activities of daily living (ADL) scores. In multivariable analysis, male sex was independently associated with complaint consistency (OR 1.41, p = 0.002), whereas increasing age was associated with a lower likelihood of consistency (OR 0.99 per year, p < 0.001). Higher ADL scores were also associated with complaint consistency (OR 1.04 per point, p = 0.023). Revisit disposition distributions differed significantly between the two groups (p = 0.005). In the unadjusted analysis, patients with changing documented presenting complaints were more frequently hospitalized, transferred, or died during the revisit than patients with consistent documented presenting complaints. Conclusions: Changing documented presenting complaints were associated with older age and poorer functional status. An unadjusted difference in revisit disposition distributions was also observed between the two groups. These findings are hypothesis-generating and require prospective validation before their clinical utility can be determined.

Patients with end-stage kidney disease (ESKD) have a greater risk of comorbidities, including diabetes and anemia, and have higher hospital admission rates than patients with other diseases. The cause of hospital admissions is associated with ESKD prognosis. This retrospective cohort study involved patients with ESKD who received hemodialysis and investigated whether the cause of hospital admission changed before versus after they started hemodialysis. This study recruited 592 patients with ESKD who received hemodialysis at any period between January 2005 and November 2017 and had been assigned the International Classification of Diseases Ninth Revision Clinical Modification (ICD-9-CM) code for ESKD. The patients’ demographic data and hospitalization status one year before and two years after they received hemodialysis were analyzed. A McNemar test was conducted to analyze the diagnostic changes from before to after hemodialysis in patients with ESKD. The study’s sample of patients with ESKD comprised more women (51.86%) than men and had an average age of 67.15 years. The numbers of patients admitted to the hospital for the following conditions all decreased significantly after they received hemodialysis: type 2 (non-insulin-dependent and adult-onset) diabetes; native atherosclerosis; urinary tract infection; gastric ulcer without mention of hemorrhage, perforation, or obstruction; pneumonia; reflux esophagitis; duodenal ulcer without mention of hemorrhage, perforation, or obstruction; and bacteremia. Most patients exhibited one or more of the following comorbidities: diabetes (n = 407, 68.75%), hypertension (n = 491, 82.94%), congestive heart failure (n = 161, 27.20%), ischemic heart disease (n = 125, 21.11%), cerebrovascular accident (n = 93, 15.71%), and gout (n = 96, 16.22%). An analysis of variance (ANOVA) indicated that changes in the ICD-9-CM codes for native atherosclerosis, urinary tract infection, pneumonia, and hyperkalemia were associated with age. Patients who developed pneumonia before or after they received hemodialysis tended to be older (range: 69–70 years old). This study investigated the causes of hospital admission among patients with ESKD one year before and two years after they received hemodialysis. This study’s results revealed hypertension to be the most common comorbidity. Regarding the cause of admission, pneumonia was more prevalent in older than in younger patients. Moreover, changes in the ICD-9-CM codes of native atherosclerosis, urinary tract infection, pneumonia, and hyperkalemia were significantly correlated with age. Therefore, when administering comprehensive nursing care and treatment for ESKD, clinicians should not only focus on comorbidities but also consider factors (e.g., age) that can affect patient prognosis.

Background: Patients with end-stage kidney disease (ESKD) are required to undergo consecutive time-based blood and biochemical tests to determine the progression of the disease according to changes in their blood and biochemical data. This study employed a random intercept model to investigate whether time-based blood and biochemical data present any notable clinical meaning that can be used to track disease progression.Methods: This study conducted a retrospective analysis on the dialytic data of 148 patients with ESKD, who received hemodialysis between January 2005 and December 2015. The patients were all at least 20 years old, and the data used included patient demographic information and results for at least 60 blood and biochemical tests. A random intercept model was used to analyze the relationships among blood and biochemical test results, explanatory variables of patient comorbidities, and time.Results: The age range of patients was between 33 and 98 years, with an average of 66.1 years and those over 65 years old comprising 51.3% (n = 76) of the total. Furthermore, hypertension was found to be the most common comorbidity among patients (87.2%,n = 129), followed by anemia (48.6%,n = 72), diabetes (47.3%,n = 70), dyslipidemia (19.6%,n = 29), and peptic ulcer (19.6%,n = 29). Coronary atherosclerotic heart disease is a comorbidity that can serve as a strong and independent marker for prognosis in patients with ESKD. Serum creatinine level can serve as an alternative indicator because patients with ESKD and comorbid diabetes may exhibit increased creatinine levels.Conclusions: The results of a parameter estimation for longitudinal data analysis suggested that comorbidity and time were critical variables influencing blood and biochemical test results. Furthermore, WBC and HBC, HCT, albumin, protein, and creatinine levels were recognized as variables of critical significance. The results obtained in this study indicate that multimorbidity increases the treatment burden on patients, leading to polypharmacy. For this reason, comprehensive care and treatment of ESKD cannot rely solely on data from one single time point; instead, longitudinal analysis and other data that can affect patient prognosis must also be considered.