Can ferritin/lymphocyte percentage ratio, a new indicator, predict the clinical course of COVID-19 cases?

OBJECTIVES: COVID-19 maintains its seriousness as a global emergency with its rapid distribution worldwide. Ferritin / lymphocyte percentage ratio (FLPR) may appear as a prognostic value at the initial evaluation stage and thus can be used as a simple, effective, and reliable parameter in critical patient identification with COVID-19. METHODS: In this retrospective cohort study, we evaluated patients over 18 years old, who were hospitalized after being evaluated as COVID-19 and whose PCR results were positive. We calculated FLPRs from complete blood counts taken during emergency department admissions and classified disease severity due to emergency initial evaluation. The relationship between the severity of the thoracic tomography findings, hospitalization, and intensive care needs, and 28-day mortality with the FLPR were evaluated. RESULTS: The difference between the groups classified according to COVID-19 severity and the FLPR means was statistically significant (x2=148.284; SD=3; p=0.000). FLPR levels were found to be high in critical and serious groups. In the ROC analysis for the FLPR level, the area under the curve (AUC) value was found to be 0.909 (95% CI 0.857-0.961). When the cut off value of FLPR was 9.80, the sensitivity was found to be 97.6 %, and the specificity was 65.2 %, whereas, when the cut off value for FLPR was found to be 21.11, the sensitivity was 82.9 % and the specificity was 82.8 %. CONCLUSION: The FLPR, a new parameter, can be used as a significant marker to predict the 28-day mortality in patients (Tab. 5, Fig. 1, Ref. 25).

The prospective evaluation of the effectiveness of scoring systems in the emergency department in cases with suspected ureteral stones: STONE? CHOKAI?

INTRODUCTION: This study evaluates the effectiveness of CHOKAI and STONE scores in patients presenting to the emergency department with ureteral stones. METHODS: Patients over the age of 18 who were admitted to the emergency department with flank pain, groin pain, scrotal pain, and hematuria and who were performed non-contrast abdominal computed tomography (CT) for diagnostic imaging were included. The numeric pain, CHOKAI, and STONE scores of the patients were calculated. The effectiveness of these scoring systems in the presence of stones was examined. RESULTS: A total of 105 patients were included in the study. In the analysis performed to investigate whether there was a difference between the numeric pain, STONE, and CHOKAI scores in terms of the presence of stones on CT, it was seen that the CHOKAI score was significantly different from the others (p < 0.001). A significant positive correlation was found between the CHOKAI score and stone size (r = 0.343, p < 0.001).When the cut-off value of the CHOKAI score was >7, the sensitivity was found to be 60.49%, and specificity was 83.33%. The cut-off value for the STONE score was >8 with a sensitivity of 70.37% and specificity of 58.33%. The corresponding area under curve values for the CHOHAI and STONE scores was 0.788 (p < 0.0001) and 0.615 (p = 0.087). Male sex, the CHOKAI, and STONE scores were the independent risk factors for ureteral stone. A significant positive correlation was found between the CHOKAI score and stone size (r = 0.343, p < 0.001). CONCLUSION: The CHOKAI score has a higher performance than the STONE score in detecting the presence of ureteral stones. NEW KNOWLEDGE ADDED BY THIS STUDY: The CHOKAI score has a higher performance than the STONE score in detecting the presence of ureteral stones. Especially in countries such as Turkey, where there are no specific racial differences, the STONE score may be diagnostically insufficient. The CHOKAI score shows the presence of the patient's stone and positively correlates with the size of the stone and the stone location. IMPLICATION FOR CLINICAL PRACTICE OR POLICY: In the functioning of the emergency department, it is important to make the differential diagnosis of patients quickly and provide effective treatment. The use of diagnostic scoring systems saves time for the emergency physician in the differential diagnosis phase and guides in terms of applying for possible additional imaging methods.

Vaccine hesitancy among healthcare professionals and the general population: Second important step in the fight against COVID-19.

INTRODUCTION: This study aims at finding valuable information for predicting vaccination intentions against COVID-19 to guide future interventions to address hesitation. METHODOLOGY: This observational study consists of 1010 volunteer health workers from the state hospitals in Bursa, and 1111 volunteers from the non-healthcare group, unvaccinated against COVID-19. In the study, the participants were asked about their sociodemographic information and reasons for refusing the COVID-19 vaccine by face-to-face interview. RESULTS: We classified the unvaccinated healthcare worker group as group 1, and the unvaccinated non-health workers group as group 2. Between groups 1 and 2, vaccination refusal, education level, income level, and pregnancy status were statistically significant (p < 0.001). The groups differed in the reasons for vaccine refusal and recommending vaccination to the relatives of those who refused vaccination (p < 0.001). CONCLUSIONS: Healthcare workers have priority among high-risk groups considered candidates for early vaccination. Therefore, it is important to consider health professionals' attitudes towards COVID-19 vaccination to better address barriers to widespread vaccination. The role of healthcare professionals is also important, as it encourages the entire community to be vaccinated with role-modeling behavior and advises patients and communities.

The role of emergency department triage early warning score (TREWS) and modified early warning score (MEWS) to predict in-hospital mortality in COVID-19 patients.

BACKGROUND: It is necessary to identify critical patients requiring hospitalization early due to the rapid increase in the number of COVID-19 cases. AIM: This study aims to evaluate the effectiveness of scoring systems such as emergency department triage early warning score (TREWS) and modified early warning score (MEWS) in predicting mortality in COVID-19 patients. METHODS: In this retrospective cohort study, PCR positive patients evaluated for COVID-19 and decided to be hospitalized were evaluated. During the first evaluation, MEWS and TREWS scores of the patients were calculated. Intensive care needs as well as 24-h and 28-day mortality rates were evaluated. RESULTS: A total of 339 patients were included in the study. While 30 (8.8%) patients were hospitalized in the intensive care unit, 4 (1.2%) died in the emergency. The number of patients who died within 28 days was found to be 57 (16.8%). In 24-h mortality, the median MEWS value was found to be 7 (IQR 25-75) while the TREWS value was 11.5 (IQR 25-75). In the ROC analysis made for the diagnostic value of 28-day mortality of MEWS and TREWS scores, the area under the curve (AUC) for the MEWS score was found to be 0.833 (95% CI 0.777-0.888, p < 0.001) while it was identified as 0.823 (95% CI 0.764-0.882, p < 0.001) for the TREWS. CONCLUSION: MEWS and TREWS calculated at emergency services are effective in predicting 28-day mortality in patients requiring hospitalization due to COVID-19.

Predictive Value of Modified Early Warning Scoring System for Identifying Critical Patients with Malignancy in Emergency Department.

BACKGROUND: Identification of critically ill patient is particularly important in the emergency department (ED). The prolonged duration from hospital admission to delivering intensive care service is related to increased mortality. The aim of this study is to evaluate the effectiveness of Modified Early Warning Score (MEWS) for identifying critical patients with malignancy in ED settings. METHODS: We evaluated patients with malignancy who were admitted to our ED of a tertiary university hospital in Turkey over a three-month period. We evaluated MEWS on admission as MEWS 1. After the initial treatment depending on the patients' health status in ED, at 2 hours after admission, we evaluated MEWS again and recorded as MEWS 2. All patients were followed up for 30 days after the initial admission. RESULTS: Mean age (SD) was 59.2 (13.5) and male/female ratio was 295/206. MEWS1 was higher than MEWS2, (MEWS1: 3.05 ± 3.31, MEWS2: 2.35 ± 3.17, P < 0.001). A total of 362 patients (72.3%) survived and 139 (27.7%) died within 30 days of initial admission. MEWS1/MEWS2 values for alive and dead patients were 1.66/0.87, and 6.67/6.21, respectively, and the difference was significant (P < 0.001). ROC analysis was performed for MEWS 1; the area under curve (AUC) for hospitalization was 0.768 (95% CI 0.729 to 0.804) and for mortality was 0.900 (95% CI 0.870 to 0.924). ROC analysis revealed a cut-off value of 2 for predicting both hospitalization and mortality in these patients. The sensitivity of the presented cut-off was 77.32% (72.1%-82.0%) for hospitalization and 76.24% (95% CI 71.5-80.5) for mortality; the specificity was 69.52 (95% CI 62.8-75.7) for hospitalization and 90.65 (95% CI 84.65-94.9) for mortality. CONCLUSION: We found in our study that MEWS evaluation for patients with malignancy on admission to ED is predictive of mortality in the subsequent 30 days, and it is a valuable tool for identifying the critical group. Also, AVPU scores alone can predict mortality in patients admitted to ED.

Comparison of Fatal Injuries Resulting from Tractor and High Speed Motorcycle Accidents in Turkey: A Multicenter Study.

AIM: Injuries are among the main causes of mortality and morbidity all over the world, and effective initial triage of these patients can determine the thin line between death and life. Tractor accidents and related injuries are significant problems particularly in rural areas. However, major trauma classification systems do not include tractor accidents as a criterion for trauma team activation or transportation of the patients to a trauma center. This study evaluated the general characteristics and outcomes of tractor accidents in comparison to motorcycle accidents, which are considered as a comparison criterion for major trauma. MATERIALS AND METHODS: This is a multicenter study conducted in 6 emergency departments in 4 cities over a six month period. All cases over 18 years of age who were admitted to emergency service due to tractor or motorcycle accidents and meet the criteria were included in the study. The general characteristics and outcomes of both trauma types were compared to determine whether tractor accident should be considered as major traumas. RESULTS: Eighty-eight patients had a tractor accident, and 339 patients had a motorcycle accident. The tractor accident victims were significantly younger (p<0.001), and the proportion of females was higher in this group (p=0.001). Glasgow coma score (p=0.062), revised trauma score (p=0.201), duration from incident to admission (p=0.481), and route of admission (p=0.810) were similar between both accident types. The rates of thoracic traumas (42% versus 23%, p<0.001) and spinal injuries (17% versus 5.9%, p=0.002) were significantly higher in tractor accidents. The hospitalization rates of the patients were significantly higher in tractor accidents (p=0.008). CONCLUSION: The findings of this study support the hypothesis that tractor accidents should be included in the criteria of ATLS major trauma classification system and trauma team activation procedures.