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Background: Chest pain is a common symptom that presents to the emergency department (ED), and its causes range from minor illnesses to serious diseases such as acute coronary syndrome. Accurate and timely diagnosis is essential for the efficient management and treatment of these patients., Objective: This study aims to expand on a model previously developed by the Chi Mei Medical Group (CMMG) Emergency Department in 2020 to predict adverse cardiac events in patients with chest pain. The main goal is to evaluate the accuracy and generalizability of the model through external validation using data from other hospitals., Methods: The initial model for this study was developed using data from three CMMG-affiliated hospitals in southern Taiwan. We utilized four supervised machine learning algorithms, namely random forest, logistic regression, support-vector clustering, and K-nearest neighbor, to predict the risk of acute myocardial infarction within a one month for emergency chest pain patients. The study used the model with the best area under the curve (AUC), recall and precision for external validation. The external validated data source was data collected from three hospitals associated with Taipei Medical University (TMU) in northern Taiwan., Results: The original best model constructed by CMMG exhibited an AUC of 0.822, an accuracy of 0.740, a recall of 0.741, a precision of 0.566, a specificity of 0.740, and an NPV of 0.861. Subsequently, during the external validation phase, CMMG's top-performing model demonstrated acceptable validation result with TMU's data, achieving an AUC of 0.63, an accuracy of 0.661, a recall of 0.593, a precision of 0.243, a specificity of 0.691, and an NPV of 0.900. While the results indicate that the model's performance varied across different datasets and are not outstanding, the model is still acceptable for clinical application as a preliminary decision-support tool., Conclusion: This study highlights the importance of external validation to confirm the applicability of the previously developed predictive model in other hospital settings. Although the model shows potential in assessing chest pain patients in the ED, its broad clinical application requires further validation to ensure it can improve patient outcomes and optimize healthcare resource allocation., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: [Jason C. Hsu reports financial support was provided by Chi Mei Medical Group and Taipei Medical University Academic Collaborative Research Project. Jason C. Hsu reports financial support was provided by Taiwan Ministry of Science and Technology Council. Jason C. Hsu reports financial support was provided by Industry-Academia Collaboration between Taipei Medical University and AstraZeneca. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper]., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Abstract: Objective: The purpose of this study was to determine the etiologies of altered mental status (AMS) in an emergency department (ED) and the associated contributing factors. Materials and Methods: A retrospective chart review of the medical records was performed from January 2006 through December 2006 in a medical center in eastern Taiwan among the ED patients with AMS. Data collected included sex, age, date of ED visit, chief complaint, disposition, admission diagnosis, date of admission, location admitted to (ordinary ward or intensive care unit), diagnosis at discharge, and date of discharge from hospital. Results: Of the 595 patients analyzed during the study period, which accounted for 1.3% of total ED census, the mean age was 51.55 years. The three leading etiologies of AMS were trauma, hypoglycemia, and stroke. Among them, trauma had higher incidences in the summer and winter; hypoglycemia had increased tendencies in the spring; the population of stroke patients increased in the summer and fall. Of the cases studied, 51.3% were admitted with a mean length of stay of 13.54 days; incidence of death was 12.4%. Other conditions with admission rate > 50% were hypoxia and stroke. The diagnoses with the lowest admission rate were psychosis, trauma and alcohol abuse. One third of AMS patients was younger than 40 years and the other one third was older than 70 years Conclusion: It is important for ED physicians to be knowledgeable about the etiologies of patients with AMS in general, special subgroups, and the etiologic tendencies during the different seasons. Ranking results for the different etiologies of AMS in our study differed from the results of previous studies due to differences of local culture and residents in eastern Taiwan. [Copyright &y& Elsevier]

Introduction: The health benefits of entering methadone maintenance treatment (MMT) for opioid-dependent persons may not be merely limited to therapy of opioid use disorder. We aimed to compare the healthcare utilization of MMT patients before and after MMT., Methods: A retrospective analysis was performed using the Taiwan Illicit Drug Issue Database and the National Health Insurance Research Database (NHIRD) between 2014 and 2016. We included 1255 newly enrolled MMT patients in 2015 and randomly selected 5020 patients from NHIRD matched by age and gender as the comparison group. Changes in healthcare utilization 1 year before and 1 year after the date of the index date (MMT initiation) were compared within and between MMT and comparison groups., Results: During the 1-year period following MMT, the hospitalization length was considerably decreased, while the number of outpatient visits, emergency department (ED) visits, and ED expenditure significantly increased in MMT patients. Multivariable linear regression with the difference-in-difference approach revealed that all the categories of healthcare utilization increased, except for a minor increase of outpatient expenditure and a slight decrease of hospitalization length for the MMT group relative to the comparison group. Increases in utilization of the departments of psychiatry and infectious diseases of the MMT patients were considerable., Conclusion: MMT is associated with increased healthcare utilization, and departments of psychiatry and infectious diseases play substantial roles. Policy-makers should warrant access for all who need healthcare by ensuring the availability of the treatment for drug dependence.