Background Spontaneous pneumomediastinum (SPM) is rare, and most existing knowledge comes from small case series. Although usually benign, SPM often leads to hospital admission and substantial healthcare resource use. This study aimed to characterize SPM and recurrent spontaneous pneumomediastinum (RSPM) in a large cohort and to explore factors associated with recurrence. Methods Patients with SPM hospitalized at Putian First Hospital between September 2011 and September 2023 were included. Clinical data were extracted from electronic medical records. Follow‐up was performed to identify RSPM. Patients were divided into nonrecurrence and recurrence groups, and risk factors for recurrence were evaluated using univariate logistic regression. Results A total of 135 patients with SPM were included. Most patients were male (78.1%), with a median age of 20 years (interquartile range [IQR]: 17–32). A bimodal age distribution was observed, with peaks at 15–19 and 50–54 years. The most common symptom was chest pain (51.9%), and 54.0% of the patients had no identifiable trigger. Among the 9 patients with RSPM (6.7%), median age at recurrence was 25 years (IQR: 16–56) and median interval to recurrence was 6.5 months (range: 1–16.5). Dyspnea was the most common symptom at recurrence (66.7%), and 44.4% of the patients showed greater clinical and radiological severity than at initial presentation. Univariate analysis suggested that a history of bronchitis was associated with RSPM (OR: 11.71, 95% CI: 1.68–81.89); other potential factors included silicosis, pneumonia, and upper respiratory infection as a trigger. Conclusion SPM predominantly affects young males and generally follows a benign course. Although recurrence is uncommon (6.7%), it may be more severe than the initial episode in nearly half of the cases. A history of bronchitis may be associated with recurrence, but this finding is exploratory. Age‐specific preventive strategies and careful exclusion of secondary pneumomediastinum are essential.
Aim We aimed to conduct an exploratory investigation on the association between bowel diameter on early‐phase abdominal computed tomography (CT) and neurological outcomes in patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR) for out‐of‐hospital cardiac arrest (OHCA). Methods This observational study included patients who underwent ECPR for OHCA and abdominal CT before intensive care unit admission between January 2015 and December 2021 at a tertiary emergency medical center. Maximum bowel diameter was measured with a picture archiving and communication system by an investigator blinded to outcomes. The primary endpoint was unfavorable neurological outcomes at 1 month, defined as Cerebral Performance Category 3–5. The discriminatory ability of bowel diameter was assessed using the area under the receiver operating characteristic curve (AUC). Results Data from 181 patients were analyzed (median age, 57 years; 84.5% male). Bowel diameter demonstrated a weak ability to predict unfavorable neurological outcomes, with an AUC of 0.58 (95% confidence interval [CI], 0.47–0.70). However, higher discriminatory performance was observed in subgroups of patients aged ≥ 65 years (AUC, 0.83; 95% CI, 0.69–0.96) and those with initial nonshockable rhythms (AUC, 0.69; 95% CI, 0.47–0.91). Conclusion The results of this exploratory investigation suggest that bowel diameter may represent a potential adjunctive marker associated with functional outcomes post‐ECPR for OHCA.
Background Emergency department (ED) length of stay (LOS) is an important indicator of healthcare efficiency and patient flow. The duration of ED stay is influenced by a complex interaction of patient‐related, clinical and system‐level factors. Prolonged LOS (> 4 h) contributes to ED overcrowding and adverse patient outcomes. However, limited data exist regarding factors influencing ED LOS in Nepal. Method A descriptive cross‐sectional study was conducted in the ED of KIST Medical College and Teaching Hospital (MCTH), a tertiary care hospital in Lalitpur, Nepal, from May 15, 2025, to May 30, 2025. All patients presenting to the ED during the study period were eligible for inclusion. Consecutive patient records were reviewed. ED LOS was defined as the time from patient arrival to ED exit. LOS was summarized using median and interquartile range (IQR). Group differences were assessed using the Mann–Whitney U and Kruskal–Wallis tests. Variables with p < 0.20 in univariate analysis were entered into a multivariable logistic regression model to identify factors independently associated with prolonged ED LOS (> 4 h). Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were reported. Results A total of 395 patients were included. The median ED LOS was 3.58 h (IQR 2.42–5.00). A total of 161 (40.8%) experienced prolonged ED LOS, while 234 (59.2%) had a LOS of ≤ 4 h. In univariate analysis, age, triage category, number of specialty consultations, payment method and requirement for advanced investigations were significantly associated with prolonged ED LOS ( p < 0.05). On multivariable logistic regression analysis, increasing age, time of presentation and number of specialty consultations were independent predictors of prolonged ED LOS. Patients requiring single specialty consultation had higher odds of prolonged LOS (aOR 3.12; 95% CI 1.34–7.28), while those requiring multiple consultations had markedly higher odds (aOR 13.41; 95% CI 4.47–40.20). Presentation during night shift was associated with lower odds of prolonged LOS compared with morning shift (aOR 0.29; 95% CI 0.16–0.52). Conclusions ED LOS in this tertiary care hospital was primarily influenced by patient age, time of presentation, consultation processes and administrative factors. Strengthening interdepartmental consultation processes and improving ED workflow efficiency may help reduce prolonged ED stay and overcrowding.
Background: Type B acute aortic dissection (BAAD) is associated with significant morbidity and mortality. Early identification of high-risk patients remains challenging. This study aimed to investigate whether the ratio of red cell distribution width to red blood cell count (RRR) could serve as a novel prognostic biomarker for 30-day mortality in patients with BAAD. Methods: This retrospective cohort study enrolled 126 BAAD patients between 2017 and 2019. The primary outcome was 30-day mortality. To mitigate overfitting and identify robust predictors from a comprehensive panel of laboratory parameters, we employed the Boruta algorithm for feature selection, followed by variance inflation factor (VIF) analysis to assess multicollinearity. Variables with VIF > 5 were excluded. An optimal RRR cutoff was determined using receiver operating characteristic (ROC) analysis. The Boruta algorithm and multivariate logistic regression were used to identify independent predictors. Results: During the 30-day follow-up period, 16 deaths (12.7%) were recorded. Comparative analysis showed that nonsurvivors had significantly lower RBC counts and hemoglobin, higher RDW, and markedly elevated RRR compared to survivors (all p < 0.05). The AUC for RRR was 0.774 (95% CI: 0.672-0.876) (RBC AUC = 0.741; RDW AUC = 0.684). However, the prognostic performance of RRR was not statistically superior to that of RDW alone (DeLong's test, p = 0.155) or RBC alone (DeLong's test, p = 0.335). After Boruta selection and VIF-based exclusion of collinear variables (AST and RBC, both VIF > 5), the final multivariable logistic regression model included RRR, ALT, PLT, and CREA. In multivariate analysis, only RRR remained independently associated with mortality within this model (OR = 3.059, 95% CI: 1.431-6.540, p = 0.004). Conclusion: The RRR, a simple index derived from routine blood tests, was independently associated with 30-day mortality within our laboratory-based model in patients with BAAD. Given this association, the RRR warrants prospective validation as a prognostic tool.
