Trends in Geriatric Trauma Emergency Department Admissions During COVID-19.

BACKGROUND: The impact of coronavirus disease-2019 (COVID-19) on geriatric trauma presenting to the emergency department is unknown. OBJECTIVE: To examine geriatric trauma emergency department admission trends during the COVID-19 pandemic. METHODS: This retrospective, observational, comparison study was conducted in an academic emergency department in Turkey. Trauma patients 65 years and older who presented to the emergency department within 1 year of March 12, 2020, were included. Patients admitted in the same date range in the previous year were included as the control group. The characteristics of the patients, injured area, and injury mechanisms were compared. RESULTS: Geriatric trauma admissions decreased (relative risk = 0.71, odds ratio [OR] = 0.69 [95% confidence interval, CI: 0.62, 0.77], p < .001). According to the type of injury, there was no significant difference in admissions to the emergency department (p = .318). During the pandemic, there was an increase in falls and a decrease in stab wounds and gunshot wounds (p = .001). Multiple trauma (OR = 5.56 [95% CI: 3.75, 8.23], p < .001), fall (OR = 2.41 [95% CI: 1.6, 3.73], p < .001), and-assault related injuries (OR = 4.43 [95% CI: 2.06, 9.56], p < .001) were determined as factors that increased the admissions to the emergency department compared with the prepandemic. CONCLUSION: Although geriatric trauma emergency department admissions decreased during the pandemic, those due to falls and assaults increased. Although curfews and social isolation resulted in a decrease in penetrating injuries, assault-related trauma has increased.

Evaluation of patients with rheumatic diseases admitted at emergency department: 5-year analysis in a single centre.

BACKGROUND: Chronic inflammatory diseases can lead to emergency admissions with various acute complications. Unfortunately, there is limited data on emergency admissions because of rheumatological diseases. OBJECTIVES: To evaluate the patients with rheumatic diseases presenting to the emergency department (ED). METHODS: A total of 1788 patients with a diagnosis of inflammatory rheumatic disease admitted to the ED of a tertiary university hospital between March 2016 and March 2021 were included. The patients' socio-demographic and clinical characteristics, diagnosis and treatments in the ED were recorded. Patients' complaints were classified as rheumatological or non-rheumatological. RESULTS: Over 5 years, 1788 patients with an inflammatory rheumatic disease presented to the ED. The mean duration of rheumatological disease was 7 ± 3.4 years, and the mean number of emergency admissions was 4.4 ± 5. The four most common groups attending the ED were patients with rheumatoid arthritis, ankylosing spondylitis, familial Mediterranean fever and vasculitis. Of the complaints of the 1788 ED visitors, 1106 (61.9%) were rheumatological, 681 (38.1%) were non-rheumatological and other acute or chronic conditions. Twenty-three patients (1.3%) had the rheumatic disease and died after admission to the ED. When the univariable model results are examined, the risk of hospitalisation increases 1.024 times with increasing age. The risk of hospitalisation is 2.318 times higher in those with ankylosing spondylitis and 2.722 times in those with rheumatoid arthritis compared with those with a diagnosis of vasculitis. The risk of hospitalisation in patients with comorbid diseases is 1.807 times higher than those without. When the results of the multivariable model are examined, the risk of hospitalisation is 2.227 times higher in those with ankylosing spondylitis and 2.615 times in those with rheumatoid arthritis compared to those with vasculitis. Other risk factors were not statistically significant (P > .050). CONCLUSION: Patients with the rheumatic disease most frequently presented to the ED with musculoskeletal complaints and were discharged from the ED. True rheumatological emergencies are rare, but ED physicians should be aware of serious and life-threatening conditions.

Comparison of Clinical, Laboratory and Demographic Characteristics of Patients Diagnosed with COVID-19 as Symptomatic and Atypical Symptoms.

BACKGROUND: Clinical findings of COVID-19 have been observed with a wide spectrum ranging from asymptomatic disease and mild upper respiratory tract infection to severe viral pneumonia resulting in mortality. While clinical symptoms present in some COVID-19 patients, others have been incidentally identified. The objective of this study was to examine the clinical and laboratory features of patients diagnosed with COVID-19 who were symptomatic or had atypical symptoms and to make a contribution to the literature. METHODS: Patients with the likelihood of having COVID-19 pneumonia were evaluated with RT-PCR samples, other laboratory tests, and chest computed tomography. RESULTS: There were significant differences between these groups in terms of age, dyspnea, saturation, and comor-bidities including hypertension [HT] in 19 patients, cerebrovascular events [CVE] that were classified as other diseases in two patients (intracranial mass in one patient and Alzheimer's disease in one patient), and CRP and platelet counts (PLT) among the laboratory parameters (for all p < 0.05). CONCLUSIONS: Atypical symptoms have increased due to the progression of the outbreak. Infected people with atypical symptoms can act as sources of the infection. Therefore, the epidemiological history of these patients should be sought in detail, and individuals with atypical symptoms in society should be identified as soon as possible in order to control the spreading of the disease.

Endogenous Carboxyhemoglobin Concentrations in Predicting Prognosis of Patients with COVID-19 Pneumonia.

BACKGROUND: The coronavirus disease 2019 (COVID-19) outbreak has caused great difficulties in providing healthcare services worldwide. Accurate and useful indicators are needed for the effective use of resources. Carbon monoxide (CO) is also produced endogenously without exogenous exposure. Studies confirm that endogenous CO increases in conditions such as pneumonia, sepsis, and trauma. This study aimed to compare patients diagnosed with COVID-19 pneumonia and healthy people to reveal whether endogenous carboxyhemoglobin (COHb) levels differ. It was also to determine whether it could be a helpful indicator for the clinician in predicting disease severity in combating the COVID-19 pandemic. METHODS: The study included 72 patients admitted to the hospital during the COVID-19 pandemic and diagnosed with COVID-19 pneumonia and a control group of 75 healthy people. The research data was collected retrospectively in a tertiary emergency department. The patients' demographic data, pneumonia severity index (PSI) score, CURB-65 score, 30-day mortality, hospitalization, need for mechanical ventilation (MV), and COHb levels were recorded. RESULTS: While the COHb level was 0.9% (min-max, 0.1 - 4.0) in patients with COVID-19 pneumonia, it was 1% (min-max, 0.1 - 2.6) in the control group. No significant difference was found between the patients and the control group in terms of COHb levels (p = 0.341). Also, there was no correlation between COHb levels and PSI and CURB-65 scores. No significant difference was detected between COHb levels and patients diagnosed with COVID-19 pneumonia in terms of mortality, need for MV, or hospitalization (p > 0.05). CONCLUSIONS: We concluded that COHb levels alone could not be used to diagnose COVID-19 pneumonia or predict disease severity. Besides, in COVID-19 pneumonia, the COHb level was not a useful indicator of mortality, need for MV, or hospitalization decision. Further studies are needed to find useful indicators to assist clinicians in their decision-making process in tackling the COVID-19 pandemic.

The Demographic Analysis of the Probable COVID-19 Cases in Terms of RT-PCR Results and Age.

BACKGROUND: Despite global prevention and quarantine efforts, the incidence of COVID-19 disease continues to increase. As a possible cause, our aim was to investigate which parameters increase the sensitivity or protection against COVID-19 between RT-PCR positive and RT-PCR negative cases in patients admitted to the emergency department. METHODS: In the pandemic process, patients admitted to the hospital with suspicion of COVID-19 were evaluated retrospectively. RT-PCR test was divided into + (for Group 1) and - (Group 2). The gender, age, clinical information, application symptoms, and comorbidity data of the patients were evaluated. RESULTS: One hundred and sixty-seven cases were evaluated in the study. Group 1: 88 cases, M/F ratio: 46/42 and average age 48 ± 17.3 years, Group 2: 79 cases, M/F ratio was approximately 3/2, and the average age was 48.3 ± 19.4 years. When the groups were compared in terms of symptoms, fever, cough, weakness, and headache were prominent in Group 1, whereas the contact was significantly higher in Group 2 (p < 0.05). Among the comorbid diseases, only COPD showed a significant difference between the groups, and it was found significantly higher in Group 2 (p < 0.05). CONCLUSIONS: Cough, headache, and fever were found valuable in the detection of cases. Attention should be paid to contact isolation to circumvent the pandemic process with less damage. Having chronic diseases, especially COPD, increases the risk of infection with SARS-CoV-2. Close monitoring and control of chronic diseases can positively change the course of COVID-19.

Evaluation of elderly patients in adult suicide cases admitted to the emergency department.

The proportion of elderly people in the general population has been increasing in our country. The suicide rate increases by a person's age, and old age appears as one of the life periods with a high suicide incidence. We aimed at investigating the causes and risk factors of suicide attempts and to analyze the sociodemographic and clinical features of the elderly individuals presenting to the emergency department after suicide attempt. Cross-sectional retrospective study was performed.1403 patients were enrolled. The patients were categorized into two age groups of 18-64 years and 65 years or older. The male gender had a greater proportion in both groups. The young group contained more subjects having an educational level of primary school while the illiterate ones in the older group had a greater suicide tendency. The married subjects had a greater suicide tendency in the younger group while widowed/divorced subjects had a greater suicide tendency in the older group. Subjects without any comorbidity or medication use had a greater suicide tendency in the younger group whereas those who had comorbidities or medication use greater suicide tendency. Mood disorders were the most common psychiatric disorder in both groups. Medication intake was the most common method of suicide in both groups; suicide attempts were more common in summer and between 16:00-24:00. Domestic problems as the cause of suicide were more common in the younger group, while communication problems were more common in the older group. Male gender, divorced/widowed, low education and sociocultural level, presence of depression, communication problems have been identified as risk factors for older group.