Emergency Departments

The Emergency Department represents the main entry point to the hospital and a key setting for the management of urgent healthcare needs in the population. To date, the assessment of care quality has mainly focused on organizational aspects, with limited structured tools to systematically measure clinical and care processes. Overcrowding and limited resources make dedicated data collection unsustainable; therefore, it is necessary to rely on data already available from routine healthcare information systems. In this context, the study aims to assess the feasibility of using these data to construct quality indicators, as well as to evaluate their availability and reliability across participating centers. The study will also analyze variability in indicators among participating Emergency Departments, with the goal of identifying differences in care processes and potential areas for improvement.

Mild TBI is one of the main causes of admission to the Emergency Department (ED). Brain computed tomography (CT) is one of the most widely used diagnostic tools to assess the presence of intracranial lesions. However, in Western countries, 85-95% of CT scans performed in the ED for mild TBI are negative. It is therefore conceivable that a significant number of CTs could be avoided by a more careful use of this exam. On the other hand, excessive use of CT exposes patients to unnecessary radiation, increases healthcare costs and slows down the management of patients in the ED. This study aims to analyze the variability in the use of CT in mild TBI in Italian EDs, validate the scores designed to help the physician decide when to use it and develop a model that predicts the medium-term outcome of patients with mild head trauma.

A geriatric patient is defined as a patient aged 75 and over who meets certain medical or social vulnerability criteria and is characterised by coexisting physical and/or psychological dependence. The proportion of patients with a geriatric profile in the general population is growing. The average time spent in the emergency department by the elderly population is about 3 hours longer than for patients under 75 years old in France, which is associated with the risk of decompensation of chronic conditions, confusion, falls or agitation. An overnight stay in the emergency department for these patients increases the risk of mortality and the length of hospital stay. Several prognostic scores for hospitalization have been studied in adult populations. The most widely used scores are the Sydney Triage to Admission Risk Tool (START), the Ambulatory (AMB) and the Glasgow Admission Prediction Score (GAPS). Studies have compared these three scores and demonstrated the greater robustness of GAPS. The CalcuLation of the Elderly Admission Risk in the Emergency Department (CLEARED) tool, developed for the elderly population, has lower performance than GAPS. A systematic review of the literature studied the power of GAPS for the geriatric population and highlighted the need for validation in the target population. No validated hospitalization prognostic score was found in France for this population. The research hypothesis is that GAPS would detect hight probability of admission at the time of triage for the patients aged 75 and over in emergency department in France. The primary objective of this monocentric study is to evaluate the prognostic performance of GAPS for the target population (on the group 1). The secondary objectives consist of developing and internally validating a new score (PROFACTHOS) (on the group 2), then performing a temporal validation of PROFACTHOS with comparison to the GAPS (on the group 1), and finally to determine the threshold for classifying patients with a high probability of hospitalization for the score with the strongest discriminatory performance among GAPS or PROFACTHOS. Group 1: Patients aged 75 and over admitted to emergency department from 10/01/2024 to 09/30/2025. Group 2 : Patients aged 75 and over admitted to emergency department from 10/01/2022 to 09/30/2023