INTRODUCTION Idiopathic intracranial hypertension (IIH) is a rare disorder requiring coordinated interdisciplinary management. The Austrian Network for IIH (AN4IH) has developed consensus-based recommendations to standardize its diagnosis, treatment, and monitoring; however, their uptake in clinical practice remains unassessed. METHODS Between October 2025 and January 2026, all 1460 members of the Austrian Neurological Society (ÖGN) were invited to complete an anonymized online survey on diagnostic and therapeutic practices and AN4IH recommendation awareness, with a response rate of 3.7%. Associations between categorical variables were assessed using Fisher's exact test. RESULTS Of the 54 respondents 64.8% worked in a hospital setting. Nearly 80% treated 5 or fewer IIH patients per year. Low confidence in IIH management was reported by 33.3%, with a tendency toward greater confidence in hospital-based physicians (odds ratio, OR 2.55, 95% confidence interval, CI 0.68-9.86) and those treating 6 or more patients annually (OR 2.62, 95% CI 0.46-27.96). Interdisciplinary pathways were lacking in 55.6% of settings. Routine diagnostics included brain magnetic resonance imaging (MRI, 98.1%), neurological examination (94.4%), ophthalmological assessment (85.2%), and lumbar puncture (77.8%). Venous MR angiography (53.7%), perimetry (46.3%), optical coherence tomography (31.5%), and optic nerve sonography (14.8%) were used less consistently. Acetazolamide (98.1%) and weight reduction (90.7%) were the dominant treatment strategies. The AN4IH recommendations were partially known to 44.5% of respondents. Of those, 95.8% perceived them as a valuable clinical resource. DISCUSSION Substantial practice variation in IIH management was observed among survey respondents. The AN4IH recommendations are widely perceived as supportive and may help standardize care. Yet implementation requires broader interdisciplinary structures in specialized settings.
Background Appropriate emergency medical dispatch aims to balance rapid deployment of physician-staffed emergency medical services against unnecessary utilization of limited prehospital resources. Data on physician dispatch appropriateness in Austrian emergency medical services remain scarce. This study evaluated overtriage of a physician-staffed emergency medical response vehicle in Lower Austria. Patients and methods This single-center retrospective study included all primary dispatches of a physician-staffed emergency medical response vehicle between January and December 2022. Dispatches were retrospectively classified as appropriately triaged or overtriaged based on predefined criteria. Secondary objectives were overtriage across the 10 most frequent dispatch codes and the association between priority level and dispatch appropriateness. Results Overall, 3454 primary dispatches were analyzed and 2629 dispatches were classified as overtriage (76.1%; 95% confidence interval, CI 74.7-77.5%). Of these, 38.4% represented dispatches without patient contact and 37.7% were classified as low acuity overtriage, while only 23.9% (95% CI 22.5-25.3%) were retrospectively classified as appropriately triaged. The 10 most frequent dispatch codes accounted for 41.8% of all dispatches and demonstrated a combined overtriage rate of 77.1% (95% CI 74.8-79.2%). Priority level was not associated with physician dispatch appropriateness (rho = -0.002, p = 0.92). Conclusion In this study, over three quarters of physician-staffed emergency medical service dispatches did not meet the predefined retrospective criteria for physician involvement, although about half of these overtriaged cases were cancelled before physician-patient contact. Among cases with patient contact, 61% did not meet the predefined criteria for physician-level care. These findings highlight substantial potential to refine emergency physician-dispatch criteria.
Background Early antibiotic administration is crucial in the treatment of sepsis. The impact of prehospital sepsis recognition remains unclear. We investigated whether an emergency medical services (EMS) suspicion of sepsis was associated with earlier antibiotic administration after patients arrived at the emergency department (ED). Methods We conducted a retrospective, single-center observational cohort study involving adult patients (>= 18 years) admitted via EMS between January 2022 and June 2025 with a sepsis diagnosis made in the ED. Prehospital sepsis recognition was defined as documentation of the term "sepsis" in the EMS protocol. The primary outcome was the percentage of patients who received antibiotic treatment within 1 h of ED admission. Logistic regression was used to adjust for age, sex, and illness severity (quick sequential organ failure assessment [qSOFA]). Results We included 134 patients (43% female; mean age 71 +/- 15 years). The EMS suspected sepsis in 30 patients (22%). Among these, 63.3% received antibiotics within 1 h of ED admission, compared with 19.2% of patients without an EMS suspicion (p < 0.001). The median time to antibiotic administration was shorter in the EMS suspected group (32.0 min, interquartile range, IQR 16.5-76.8 min versus 124.5 min, IQR 72.5-211.5 min; p < 0.001). Prehospital sepsis suspicion was independently associated with antibiotic administration within 1h (adjusted odds ratio, OR 5.77, 95% confidence interval, CI 2.14-16.4; p < 0.001). Conclusion Prehospital recognition of sepsis by EMS was strongly associated with earlier antibiotic treatment after ED admission. This highlights the potential of systematic sepsis detection in prehospital settings.
Background Acute-on-chronic liver failure (ACLF) frequently requires intensive care unit (ICU) management, yet real-world data on dynamic disease course, organ support and mortality predictors in critically ill ACLF patients remain scarce. Methods All ACLF patients admitted to a tertiary care hepatology ICU between 2013 and 2023 were analyzed in this retrospective single-center study for ACLF grade trajectories, organ support, and independent predictors of 90-day mortality. Results Among 209 patients (228 admissions), 54.4% had ACLF grade 3 at ICU admission (median CLIF-C ACLF 56). Most patients required vasopressors (86.8%), invasive mechanical ventilation (59.6%), and renal replacement therapy (53.5%). The ICU and 90-day survival were 56.1% and 34.2%, respectively. One third of the patients (33.3%) showed improvement in ACLF grade during the ICU stay, including grade 3 patients, indicating meaningful reversibility under comprehensive organ support. The CLIF-C ACLF score (OR: 1.07, 95% CI: 1.03-1.11, p < 0.001) and the peak noradrenaline dose (OR: 13.5, 95% CI: 3.18-69.7, p < 0.001) were identified as independent predictors of 90-day mortality. Conclusion Critically ill ACLF patients retain potential for partial recovery under full organ support, justifying ICU escalation even in grade 3 disease. Peak noradrenaline dose, alongside the established prognostic scores, provides a readily available parameter to guide individualized decision-making regarding full organ support or timely de-escalation.
