Wen-Chun Tsai

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.

Background/Objectives: Extracorporeal membrane oxygenation (ECMO) use has increased worldwide, yet in-hospital mortality among adult recipients remains substantial. Large-scale evidence examining patient- and treatment-related factors associated with mortality in real-world settings is still limited. This study aimed to quantify in-hospital mortality and identify factors associated with mortality among adults receiving ECMO using a nationwide cohort in Taiwan. Methods: We conducted a retrospective nationwide cohort study using Taiwan’s National Health Insurance Research Database, including adults (≥18 years) who received ECMO during hospitalization between 2011 and 2020. ECMO indication groups were defined using ICD-9-CM (before 2016) and ICD-10-CM (2016 onward) codes and further classified into four mutually exclusive categories. Multivariable logistic regression was used to examine factors associated with in-hospital mortality. Results: Among 15,151 adults treated with ECMO, 9657 (63.7%) died during hospitalization. In multivariable analyses, higher odds of in-hospital mortality were associated with older age, higher comorbidity burden (Charlson Comorbidity Index ≥3), and use of multiple ECMO machines (≥2). Compared with patients without cardiopulmonary indications, those classified as cardiogenic shock alone or combined respiratory failure and cardiogenic shock had lower adjusted odds of in-hospital mortality. Longer hospital length of stay was inversely associated with in-hospital mortality, reflecting differing care trajectories among ECMO recipients. Conclusions: In this nationwide real-world cohort of adult ECMO recipients, in-hospital mortality was high, and mortality risk was associated with patient age, comorbidity burden, ECMO treatment complexity, and diagnosis-based indication classification. These findings provide population-level insight into mortality patterns and may inform risk communication and system-level planning for ECMO care.