Appropriateness of frequent use of emergency departments: A retrospective analysis in Rome, Italy.

Background: Frequent users (FUs) are patients who repeatedly and inappropriately visit the emergency department (ED) for low-grade symptoms that could be treated outside the hospital setting. This study aimed to investigate the phenomenon of the FU in Rome by profiling such users and analyzing ED attendance by FUs. Methods: The analysis was carried out for attendance in 2021 at 15 EDs in the Local Health Authority Roma 1 geographical area. A digital app collected data, including information on the following variables: number of attendance, demographic characteristics, emergency medical service (EMS) usage, triage code, and appropriateness of attendance. COVID-19 diagnosis was also studied to analyze any possible influence on ED attendance. Differences between FUs and non-FUs were investigated statistically by t-test and chi-square test. Univariate analysis and multivariable logistic regression were performed to analyze the associated factors. Results: A total of 122,762 ED attendance and 89,036 users were registered. The FU category represented 2.9% of all users, comprising 11.9% of total ED attendance. There was a three times higher frequency of non-urgent codes in attendance of FU patients (FU: 9.7%; non-FU: 3.2%). FUs were slightly more likely to have used the EMS (13.6% vs. 11.4%) and had a lower frequency of appropriate ED attendance (23.8% vs. 27.0%). Multivariate logistic analysis confirmed a significant effect of triage code, gender, age, EMS usage, and COVID-19 diagnosis for the appropriateness of attendance. The results were statistically significant (p < 0.001). Conclusion: The FU profile describes mostly non-urgent and inappropriate attendance at the ED, including during the COVID-19 pandemic. This study represents an important tool for strengthening preventive policies outside the hospital setting. The Italian National Recovery and Resilience Plan represents an excellent opportunity for the development of new strategies to mitigate the phenomenon of FUs.

Morbidity experience in populations residentially exposed to 50 hz magnetic fields: methodology and preliminary findings of a cohort study.

A morbidity study of the population of a district of Rome built in part under a 60 kV electric distribution line, included 345 subjects resident in the study area in any period between 1954 and 2003, excluding those deceased before 1998. Residential magnetic field levels were estimated based on current load, line characteristics, and distance of the dwellings from the power line, and the study area was divided into sub-areas with differing magnetic field levels. Standardized morbidity ratios were computed from hospital discharge records dated 1998-2003. Non statistically significant increases were observed for all and primary cancers; primary cancers were significantly increased among subjects with > 30 years' residence and latency. A significant increase for all, primary, and secondary cancers, and a two-fold increase for ischaemic diseases, was observed in subjects in the sub-area with the highest exposure. No increase was seen in neoplastic haematological diseases.

Agreement between emergency room and discharge diagnoses in a population of injured inpatients: determinants and mortality.

BACKGROUND: Various factors contribute to the quality of care of an injured patient at the emergency room (ER), and a correct diagnosis can improve and accelerate care. The aim of this study was to evaluate the agreement between diagnoses assigned in the ER and those assigned after hospital admission to patients with unintentional injuries. We also tried to determine the factors that influenced the disagreement, and to evaluate if discordant diagnoses were associated with higher mortality risk. METHODS: All ER visits for unintentional injuries that were followed by hospital admission at the 60 emergency departments in the Lazio Region in 2000. Concordant diagnoses (ER/discharge) were established based on the Barell matrix cells. Logistic regression was used to assess the role of individual and ER care factors on the probability of concordance. A logistic regression was performed, where death within 30 days was the outcome and concordance was the determinant. RESULTS: We considered 22,892 ER visits for injury that were followed by hospital admission. In 62.2% of cases, the ER and discharge diagnoses were concordant. Higher concordance was found for older patients and less urgent cases. Factors influencing concordance were the hour of the visit, ER specialization degree, initial outcome, and length of hospital stay. Patients who had disconcordant diagnoses had a 30% higher probability of death. CONCLUSIONS: A correct diagnosis (i.e. confirmed at hospital discharge) at first contact with the emergency room is associated with lower mortality. Comparing administrative ER and hospital discharge data can be useful in emergency department management studies.

[Mortality and hospital admissions in the industrial area of Civitavecchia, 1997-2004]. / Mortalità e ricoveri ospedalieri nell'area industriale di Civitavecchia, anni 1997-2004.

OBJECTIVE: the industrial area of Civitavecchia (central Italy) has been object of concern because of several sources of environmental contamination potentially affecting the residential communities: a harbor, a cement factory and several power plans are present in the area. A coal power plant is currently under construction. The aim of the study is to evaluate the health of residents in the area, through the analysis of the mortality registry and the hospital discharge records. DESIGN: cause and gender specific indirect Standardized Mortality (1997-2001) and Hospitalization (1997-2000 and 2001-2004) Ratios were computed, with 95% Confidence Intervals, using regional population as reference. RESULTS: mortality and morbidity excesses for cancer were observed, in particular an increased mortality for lung cancer (observed 134, SMR= 120) and for malignant neoplasm of pleura (observed 8, SMR= 516) were detected among men. An increased frequency of hospital admissions for asthma was observed among children aged 0-14 (period 1997-2000: males, observed 73, SHR= 177; females, observed 40, SHR= 157). Finally an significantly increased incidence of renal diseases was recorded by the Lazio Dialysis Registry in the period 2001-2004 (observed 28, SHR= 156). CONCLUSION: in view of the environmental changes of the area, the excesses observed in this study suggest the need for epidemiologic monitoring found in excess (lung and pleural cancer, respiratory diseases among children, renal diseases) in the area.

Indicators of breast cancer severity and appropriateness of surgery based on hospital administrative data in the Lazio Region, Italy.

BACKGROUND: Administrative data can serve as an easily available source for epidemiological and evaluation studies. The aim of this study is to evaluate the use of hospital administrative data to determine breast cancer severity and the appropriateness of surgical treatment. METHODS: the study population consisted of 398 patients randomly selected from a cohort of women hospitalized for first-time breast cancer surgery in the Lazio Region, Italy. Tumor severity was defined in three different ways: 1) tumor size; 2) clinical stage (TNM); 3) severity indicator based on HIS data (SI). Sensitivity, specificity, and positive predictive value (PPV) of the severity indicator in evaluating appropriateness of surgery were calculated. The accuracy of HIS data was measured using Kappa statistic. RESULTS: Most of 387 cases were classified as T1 and T2 (tumor size), more than 70% were in stage I or II and the SI classified 60% of cases in medium-low category. Variation from guidelines indications identified under and over treatments. The accuracy of the SI to predict under-treatment was relatively good (58% of all procedures classified as under-treatment using pT where also classified as such using SI), and even greater predicting over-treatment (88.2% of all procedures classified as over treatment using pT where also classified as such using SI). Agreement between clinical chart and hospital discharge reports was K = 0.35. CONCLUSION: Our findings suggest that administrative data need to be used with caution when evaluating surgical appropriateness, mainly because of the limited ability of SI to predict tumor size and the questionable quality of HIS data as observed in other studies.

Determinants of hospitalization in a cohort of chronic dialysis patients in central Italy.

BACKGROUND: Few studies linking hospital discharge records with the population register of chronic dialysis (CD) patients are available. This study aimed to evaluate the frequency and the determinants of hospitalization, taking into account the demographic, clinical and biochemical data. METHODS: We conducted a retrospective cohort study in 3411 patients starting dialysis from 1996-2000, reported to the Lazio Dialysis Registry (RDL) (Italy). These patients were linked with the hospital information system from 1996-2002. Hospital admission probability was calculated using the Kaplan-Meier method. To evaluate the determinants of hospitalization risk we used Cox's proportional hazards for the first admission and a marginal model considering competitive effect of mortality, the Wei-Lin-Weissfeld model, for any admission. RESULTS: We found 7530 hospital admissions, referring to 1711 patients (50.7%), with a rate of 63/100 person-years. The most prevalent diagnoses were "diseases of the genitourinary system", (37.4%), and "diseases of the circulatory system", among secondary diagnoses (46.6%). Hospitalization probability was 34.4% at 1 yr after starting dialysis. The risk of first and any hospital admission was higher (p<0.05) for patients having more than one comorbid disease, hematocrit (Hct) level <30%, serum albumin level <3.5 g/dL, and a low degree of self-sufficiency. CONCLUSIONS: Hospitalization frequency, mainly during the first months of dialysis, suggests the need to improve the early management of chronic renal failure and indicates the importance of preventing complications and maximizing functional status among the dialysis population.

[Monitoring microbiological safety of small systems of water distribution. Comparison of two sampling programs in a town in central Italy]. / Monitoraggio di potabilità dell'acqua in piccoli sistemi di distribuzione. Confronto tra due programmi di campionamento in una cittadina dell'Italia centrale.

OBJECTIVE: To determine the frequency of sampling in small water distribution systems (<5,000 inhabitants) and compare the results according to different hypotheses in bacteria distribution. DESIGN AND SETTING: We carried out two sampling programs to monitor the water distribution system in a town in Central Italy between July and September 1992; the Poisson distribution assumption implied 4 water samples, the assumption of negative binomial distribution implied 21 samples. Coliform organisms were used as indicators of water safety. The network consisted of two pipe rings and two wells fed by the same water source. The number of summer customers varied considerably from 3,000 to 20,000. RESULTS: The mean density was 2.33 coliforms/100 ml (sd= 5.29) for 21 samples and 3 coliforms/100 ml (sd= 6) for four samples. However the hypothesis of homogeneity was rejected (p-value <0.001) and the probability of II type error with the assumption of heterogeneity was higher with 4 samples (beta= 0.24) than with 21 (beta= 0.05). CONCLUSION: For this small network, determining the samples' size according to heterogeneity hypothesis strengthens the statement that water is drinkable compared with homogeneity assumption.