Trauma patients and whole-body computerized tomography imaging: Location of CT-Scan and factors affecting mortality.

OBJECTIVE: : We aimed to study the factors affecting the mortality of trauma patients who underwent whole-body computerized tomography (CT) on Emergency department (ED) time frames in a developing emergency care system. Materials and Methods: This is a retrospective analysis of adult patients who received WBCT from August to November for two consecutive years (2014 and 2015). Non-parametric statistical methods were used to compare the patients who died and survived. The Backward logistic regression model was used to define factors significantly affecting mortality. RESULTS: : During 2014, 200 patients out of 827 (24.1%) received WBCT. During 2015, 263 patients out of 951 (27.6%) received WBCT. Four hundred sixteen patients were entered into the analysis. The overall mortality was 3.4% (7% in 2014 and 1% in 2015, P = 0.002). Significant factors found in backward logistic regression model defining factors affecting mortality were ISS (p < 0.0001), Glasgow Coma Scale (GCS) (p = 0.001). CT location (outside the ED in 2014, inside the ED in 2015) showed a very strong trend for affecting mortality (p = 0.054). Patients who had WBCT in the ED had lower ISS (p < 0.0001). CT imaging in the ED decreased ED to CT time 15.5 minutes (p < 0.0001), but admission time was 75.5 minutes longer. CONCLUSIONS: ISS and GCS were the main factors predicting mortality in patients who received WBCT. Patients received more WBCT imaging and physicians showed a tendency to order WBCT for less severe patients when the CT located in the ED. CT location did not show a significant effect on mortality, but on some operational time frames.

Searching for mortality predictors in trauma patients: a challenging task.

BACKGROUND: We aimed to study the value of new physiological variables compared with ISS and GCS as predictors for trauma mortality in a high-income developing country having a young population. METHODS: Data of 1008 consecutive trauma patients who were included in Al-Ain City Road Traffic Collision Registry were analyzed. Demography of patients, systolic blood pressure, heart rate, shock index, shock index age (SIA), blood pressure age index (BPAI), Glasgow Coma Scale (GCS), injury severity score (ISS), and in-hospital mortality were analyzed. Univariate analysis was used to compare those who died with those who survived. Significant factors were then entered into a backward logistic regression model to define factors predicting mortality. RESULTS: 80.3% of the patients were males. The median (range) age of patients was 26 (1-78) years. Significant factors that predicted mortality were GCS (p < 0.0001), SIA (p = 0.003), ISS (p = 0.007), and BPAI (p = 0.022). CONCLUSIONS: The physiological variables including GCS and shock index age were better predictors for trauma mortality comparted with ISS in our young population. A large global multi-centric study could possibly define an accurate global formula that uses both anatomical and physiological variables for predicting trauma mortality.

Interrelation between the Poisoning Severity Score, carboxyhaemoglobin levels and in-hospital clinical course of carbon monoxide poisoning.

The aim of the present study is to evaluate the relationship between the Poisoning Severity Score (PSS) and carboxyhaemoglobin (COHb) levels in patients with carbon monoxide poisoning (COP) using outcome as the measure. The study was designed as a retrospective chart review of patients with final diagnosis of COP. Correlation of PSS and COHb levels at presentation was evaluated with collected data. Majority of the cases were grade 1 (minor) PSS (134 cases, 73.6%) and 93.4% of these patients made a complete recovery. There were six deaths (mortality 3.3%) and six in-hospital major complications (IHMCs) (3.3%) (please specify whether the complications were in the patients who died). There is moderate correlation between PSS and outcome (p < 0.001, r = 0.493). Grade 3 (severe) PSS was significantly different from other grades for outcome (six mortalities and three IHMCs). Patients classified as grade 3 and patients who died had a significantly higher mean age (p < 0.05, 41.8 +/- 23.6 and p < 0.01, 60.1 +/- 20.3, respectively). Mean COHb level of grade 3 (33.2 +/- 13.9%) was significantly higher than that of other grades (p < 0.05). COHb levels according to outcome were not different (? within the patients in grade 3). Decreased level of consciousness, acidosis, tachycardia, high glucose and leucocyte levels showed significant relation with higher PSS, COHb level and adverse outcome. We conclude that the PSS is a reliable guide in COP. Value of the PSS in COP may be enhanced if additional factors and investigations are included.

Adverse events associated with aggressive treatment of increased blood pressure.

Patients with severely increased blood pressure often present to the emergency department. Rapid lowering of blood pressure can precipitate or worsen end organ damage. We report two cases that developed cerebrovascular and cardiovascular adverse events associated with aggressive treatment of increased blood pressure by the use of sublingual nifedipine capsule. The first patient had developed ischaemic stroke; the second patient actually had acute left ventricular failure causing deteriorated, and required positive inotropic treatment for persistent hypotension. These cases emphasise that the pseudoemergency may rapidly progress into a real emergency when blood pressure is rapidly and aggressively reduced.

Update on the development of emergency medicine as a specialty in Turkey.

Emergency medical care, both prehospital and hospital-based, is currently provided by general practitioners in over 90% of the emergency departments in Turkey. In the early 1990s, government and university leaders recognized that Turkey needed to improve its emergency medical care system, and they chose to adapt the mature and tested Anglo-American model of emergency medicine (EM). EM was declared to be an independent specialty by the Ministry of Health in 1993. The first paramedic school and the first EM residency programme (36 months in length) were opened at the Dokuz Eylul University in 1993 and 1994, respectively. In 1995, the Emergency Medicine Association of Turkey (EMAT) was established. Today, there are 14 EM residency programmes around the country, and these are trying to design a common curriculum. The connection between departments is improving with annual meetings organized by EMAT. In addition, EMAT is developing international collaboration in the Middle East region. The Turkish government is trying to promote EM specialist physicians and paramedics in the national emergency care system.

[Epidemiological characteristics of trauma patients]. / Travma hastalarinin epidemiyolojik özelliklerinin arastirilmasi.

We have evaluated retrospectively adult trauma patients admitted to the Dokuz Eylul University Hospital Emergency Department (ED) between 1.1.1997-30.6.1997 by the aim of contributing epidemiological data about trauma related injuries of Turkey. Among the 1063 study patients, 626 patients were male, 437 patients were female and mean age of the patients was 40.6 +/- 18. The most common causes of injury was fall. The revised trauma score lesser than 12 was 75 patients. It has been determined that 90.8% of the patients were brought to ED by the vehicles other than the ambulance. Among all patients, 872 patients (82%) were discharged from ED, 118 patients (11.1%) were admitted, 73 patients (6.9%) were referred to another hospitals and 13 patients (1.2%) were died. We have determined the significantly increased hospital admission rate in the subgroups of the penetrating trauma patients, patients older than 65 years old (p = 0.001 and 0.003, respectively) and the significantly increased operative intervention and death in penetrating trauma patients (p = 0.000 and 0.009, respectively).