AI Article Synopsis
- The study investigates how the initial misclassification of undifferentiated hypotension (UH) in the emergency department (ED) impacts patients' clinical outcomes.
- It included 270 adult patients who presented with UH, categorizing them into groups based on whether their initial and final shock diagnoses matched.
- Findings showed that misclassified patients had higher hospitalization rates and lower discharge rates from the ED, but surprisingly, survival to discharge was not affected by the misclassification.
Article Abstract
Managing shock, a life-threatening emergency, is challenging. The influence of the initial misclassification of undifferentiated hypotension (UH) in the emergency department (ED) on patients' outcomes remains uninvestigated. The aim of this study was to investigate whether the initial misclassification of UH in the ED affects patients' clinical outcomes. This prospective observational study enrolled 270 non-traumatic adult patients with UH who had visited the ED of National Taiwan University Hospital between July 2020 and January 2022. The patients were divided into same-diagnosis and different-diagnosis groups, depending on the consistency between the initial and final classifications of shock. The outcome was survival to discharge. The clinical variables, management, and outcomes were compared between the groups. A total of 39 of 270 patients (14.4%) were in the different-diagnosis group. Most misclassified patients were initially diagnosed as having hypovolemic shock (HS, = 29) but finally diagnosed as having distributive shock (DS, = 28) or cardiogenic shock ( = 1). When compared with the same-diagnosis group, the different-diagnosis group had higher hospitalization (94.9% vs. 81.4%, = 0.023) but lower ED discharge (5.1% vs. 16.5%, = 0.046) rates. Logistic regression analysis showed that the HS initially diagnosed was associated with an increased risk of misclassification (odds ratio [OR] = 14.731, 95% confidence interval [CI] = 3.572-60.749, < 0.001). However, the survival to discharge did not differ between the two groups. DS, when finally diagnosed instead of the initial misclassification, was associated with in-hospital mortality (OR = 0.317, 95%CI = 0.124-0.810, = 0.016). The misclassification of UH in the ED is not rare, particularly in patients with DS, who are likely to be initially misdiagnosed with HS. Although misclassification may increase hospitalization and decrease ED discharge, it does not affect survival to discharge.
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11396653 | PMC |
| http://dx.doi.org/10.3390/jcm13175293 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Low- and High-Volume Disease in Metastatic Hormone-Sensitive Prostate Cancer: From CHAARTED to PSMA PET-An International Multicenter Retrospective Study.
J Nucl Med
January 2025
Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, UCLA, Los Angeles, California.
Article Synopsis
- The study compares the definitions of high-volume disease (HVD) and low-volume disease (LVD) in metastatic hormone-sensitive prostate cancer (mHSPC) patients using both conventional imaging (CI) and prostate-specific membrane antigen (PSMA) PET imaging, highlighting the need for more accurate definitions for treatment decisions.
- Researchers analyzed data from 67 mHSPC patients across five international sites who had both PSMA PET and CI scans within a specific timeframe, assessing how many were classified as HVD or LVD based on each imaging method.
- Results showed a significant discrepancy in classification: 25.4% of patients were identified as HVD using CI, while 40.3% were identified as HVD using
The necessity of validity diagnostics when drawing causal inferences from observational data: lessons from a multi-database evaluation of the risk of non-infectious uveitis among patients exposed to Remicade.
BMC Med Res Methodol
December 2024
Janssen Research & Development LLC, Global Epidemiology Organization, Raritan, NJ, USA.
Background: Autoimmune disorders have primary manifestations such as joint pain and bowel inflammation but can also have secondary manifestations such as non-infectious uveitis (NIU). A regulatory health authority raised concerns after receiving spontaneous reports for NIU following exposure to Remicade, a biologic therapy with multiple indications for which alternative therapies are available. In assessment of this clinical question, we applied validity diagnostics to support observational data causal inferences.
View Article and Find Full Text PDFRisks of grade reclassification among patients with Gleason grade group 1 prostate cancer and PI-RADS 5 findings on prostate MRI.
Urol Oncol
December 2024
Department of Urology, Yale School of Medicine, New Haven, CT; Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT; Yale Cancer Outcomes, Public Policy and Effectiveness Research Center, New Haven, CT. Electronic address:
Background And Objective: As most Prostate Imaging Reporting and Data System (PI-RADS) 5 lesions on MRI harbor Gleason grade (GG) group ≥2 disease on biopsy, optimal management of patients with imaging-biopsy discordance remains unclear. To estimate grade misclassification, we evaluated the incidence of Gleason upgrading among patients with GG1 disease in the setting of a PI-RADS 5 lesion.
Methods: We conducted a single-institution retrospective analysis to identify patients with GG1 prostate cancer on fusion biopsy with MRI demonstrating ≥1 PI-RADS 5 lesion.
Attacking medical images with minimal noise: exploiting vulnerabilities in medical deep-learning systems.
Quant Imaging Med Surg
December 2024
College of Computer Science and Technology, Guizhou University, Guiyang, China.
Background: A change in the output of deep neural networks (DNNs) via the perturbation of a few pixels of an image is referred to as an adversarial attack, and these perturbed images are known as adversarial samples. This study examined strategies for compromising the integrity of DNNs under stringent conditions, specifically by inducing the misclassification of medical images of disease with minimal pixel modifications.
Methods: This study used the following three publicly available datasets: the chest radiograph of emphysema (cxr) dataset, the melanocytic lesion (derm) dataset, and the Kaggle diabetic retinopathy (dr) dataset.
Combined pulmonary fibrosis and emphysema and lung transplantation: current evidence and future directions.
J Thorac Dis
November 2024
Division of Pulmonology, University Hospital Zurich, Zurich, Switzerland.
Background: Combined pulmonary fibrosis and emphysema (CPFE) patients generally have a poorer prognosis compared to those with either pulmonary fibrosis or chronic obstructive pulmonary disease (COPD)/emphysema alone, as demonstrated by several studies. Our study aimed to identify undiagnosed CPFE cases within a lung transplantation cohort initially diagnosed with interstitial lung fibrosis or COPD/emphysema. It was hypothesized that the patient cohort might contain overlooked CPFE cases, and CPFE patients would exhibit a higher incidence of pre-transplant pulmonary hypertension and post-transplant chronic lung allograft dysfunction (CLAD).
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!