Transcutaneous Electrical Nerve Stimulation (TENS) for the Treatment of Renal Colic in the ED: A Randomized, Double-Blind, Placebo-Controlled Trial.

STUDY OBJECTIVE: To determine the analgesic efficacy of TENS treatment in patients with renal colic in the emergency department (ED). METHODS: This double-blind, randomized controlled trial was conducted in a tertiary care ED. Patients with a definitive diagnosis of renal colic were assigned (1:1) as randomized to receive the real TENS with frequency 100 Hz, pulse width 200 microseconds, voltage 2 mA, or placebo with sham TENS. Pain intensity was measured using visual analog scales (VAS) at baseline, after 15 and 30th minutes. RESULTS: A total of 100 patients were included in the final analysis: 50 patients treated with real TENS and 50 patients treated with sham TENS. VAS scores in both groups were similar at baseline. The mean reduction in VAS score at 15 min was 33.3 ± 17.6 (95% Confidence interval (CI): 28.3 to 38.3) for the real TENS group and 14.9 ± 11.6 (95% CI 11.6 to 18.2) for the sham TENS group (mean difference: 18.4 (95% CI: 12.5 to 24.4, P < 0.0001). The mean reduction in VAS score at 30 min was 63.7 ± 21.1 (95% CI: 57.7 to 69.7) for the real TENS group and 14.9 ± 16.2 (95% CI: 19.5 to 10.3) for the sham TENS group (mean difference: 48.8, 95% CI: 41.4 to 56.3, P < 0.0001). Four patients (8%) in the real TENS group and 24 patients (48%) in the sham TENS group required the rescue medication after 30th minutes. CONCLUSIONS: TENS is effective for acute pain treatment in renal colic patients in the ED. TENS therapy could be a treatment option for renal colic.

Effectiveness of the rapid emergency medicine score and the rapid acute physiology score in prognosticating mortality in patients presenting to the emergency department with COVID-19 symptoms.

OBJECTIVE: We investigated the effectiveness of the Rapid Emergency Medicine Score and the Rapid Acute Physiology Score in identifying critical patients among those presenting to the emergency department with COVID-19 symptoms. MATERIAL AND METHODS: This prospective, observational, cohort study included patients with COVID-19 symptoms presenting to the emergency department over a two-month period. Demographics, clinical characteristics, and the data of all-cause mortality within 30 days after admission were noted, and the Rapid Emergency Medicine Score and the Rapid Acute Physiology Score were calculated by the researchers. The receiver operating characteristic curve analysis was performed to determine the discriminative ability of the scores. RESULTS: A total of 555 patients with a mean of age of 49.4 ± 16.8 years were included in the study. The rate of 30-day mortality was 3.9% for the whole study cohort, 7.2% for the patients with a positive rt-PCR test result for SARS-CoV-2, and 1.2% for those with a negative rt-PCR test result for SARS-CoV-2. In the group of patients with COVID-19 symptoms, according to the best Youden's index, the cut-off value for the Rapid Emergency Medicine Score was determined as 3.5 (sensitivity: 81.82%, specificity: 73.08%), and the area under curve (AUC) value was 0.840 (95% confidence interval 0.768-0.913). In the same group, according to the best Youden's index, the cut-off value for the Rapid Acute Physiology Score was 2.5 (sensitivity: 90.9%, specificity: 97.38%), and the AUC value was 0.519 (95% confidence interval 0.393-0.646). CONCLUSION: REMS is able to predict patients with COVID-19-like symptoms without positive rt-PCR for SARS-CoV-2 that are at a high-risk of 30-day mortality. Prospective multicenter cohort studies are needed to provide best scoring system for triage in pandemic clinics.

Treatment of migraine attacks by transcutaneous electrical nerve stimulation in emergency department: A randomize controlled trial.

PURPOSE: The primary purpose of this trial is to evaluate the effectiveness of Transcutaneous Electrical Nerve Stimulation (TENS) therapy application in the emergency department. METHODS: The patients were divided into 2 groups: a sham group, and a verum group. Patients in the verum group include those who use the device for the first time. Both groups were connected to visually indistinguishable devices. Both groups underwent therapy for a total of 20 min. Using the Visual Analog Scale (VAS), the patients' perceived changes in pain intensity were recorded at the 20th and 120th minutes after initiation therapy. After the 120th minute, patients' individual needs for additional treatment were assessed. Additionally, their self-reported well-being was assessed using a Likert-type verbal scale. RESULTS: In total 151 patients that were admitted to the emergency ward were assessed, with the sham and verum group being assigned 39 patients each from this pool. For the verum group the VAS change from 0 to 120 min was -65 ± 25 and for the sham group it was -9 ± 2 (p < 0.001). Verbal scores in the 120th minute were found to be 1.2 for sham group and 4.5 in the verum group (p < 0.001). Thirty patients (76.92%) in the sham group and 1 (2%) in the verum group had additional analgesic requirement after 120 min. CONCLUSION: TENS therapy is a fast-acting, effective therapy for the treatment of acute migraine in the emergency department.

Early predictors of mortality for moderate to severely ill patients with Covid-19.

BACKGROUND: Determining the factors affecting the mortality and clinical conditions of the patients with Covid-19 are indispensable needs in developing patient treatment algorithms. We aimed to determine the parameters that can predict the mortality of moderate to severely ill patients with laboratory confirmed Covid-19. METHODS: Moderate to severely ill, Covid-19 patients older than 18 years were included. Mild Covid-19 patients and the ones with negative polymerase chain reaction test results were excluded from the study. The primary outcome of the study was 30-day mortality rate and we aimed to determine the factors affecting mortality in moderate to severely ill Covid-19 patients. RESULTS: 168 patient results were analyzed. Median age of the patients was 59.5 (48.3 to 76) and 90 (53.6%) were male. According to multivariate regression analysis results, the presence of any comorbid disease (p = 0.027, HR = 26.11 (95%CI: 1.45 to 471.31)), elevated C-reactive protein levels (CRP) (p < 0.001, HR = 1.24 (95%CI: 1.11 to 1.38)) and presence of dyspnea (p = 0.026, HR = 4.26 ((95%CI: 1.19 to 15.28)) were found to significantly increase the mortality, while high pulse O 2 saturation level (p < 0.001, HR = 0.90 (95%CI: 0.82 to 0.99) was found to decrease. When receiver operating characteristic curve was created for laboratory tests, it was determined that white blood cell counts, neutrophil counts, CRP levels and neutrophil/lymphocyte ratio predicted mortality while Lymphocyte levels did not. CONCLUSION: Dyspnea, the presence of any comorbid disease, elevated CRP levels, and low pulse O 2 saturation levels predict mortality in moderate to severely ill Covid-19 patients.

Relationship between serum Pentraxin 3 and pro-adrenomedullin levels with acute cholecystitis.

OBJECTIVES: The perforation of the gallbladder (GP) is one of the most significant complications of acute cholecystitis. A biochemical marker indicating the GP has not been determined fully to date. Pentraxin 3 and pro-adrenomedullin (Pro-ADM) proteins are novel acute phase reactants. We aimed to investigate the relationship between serum Pentraxin 3 and Pro-ADM and the GP in patients with acute cholecystitis. METHODS: This prospective cross-sectional study was conducted on patients with acute cholecystitis in a tertiary care emergency department during the six-month period. The acute cholecystitis patients were divided into two groups as with GP, and without GP. Additionally, patients with GP were evaluated according to pericholecystic fluid and gallbladder wall thickness. Serum levels of pro-ADM and pentraxin 3, WBC, CRP and sedimentation rate were measured in all patients. RESULTS: A total of 60 patients with acute cholecystitis were included in the study. Pro-ADM and pentraxin 3 levels were significantly higher in patients with GP and the with pericholecystic free fluid (p < 0.0001). There was no significant relationship between serum pentraxin 3 and pro-ADM with gallbladder wall thickness (p > 0.05) According to the ROC analysis, serum Pentraxin 3 levels of ≥4.9 ng/mL could predict GP with a sensitivity of 75% and a specificity of 85% and serum pro-ADM levels of ≥97 nmol/L with sensitivity and specificity of 100% and 95%. CONCLUSION: Our study results reveal that serum Pentraxin 3 and pro-ADM may be novel biochemical parameters in the detection of GP in acute cholecystitis cases.

Clinical usefulness of brain-derived neurotrophic factor and visinin-like protein-1 in early diagnostic tests for acute stroke.

OBJECTIVES: Lack of a rapid biochemical test for acute stroke is a limitation in the diagnosis and management of acute stroke. The aim of this study is to evaluate the efficacy of BDNF and VILIP-1 as diagnostic markers in acute ischemic stroke and as predictors of mortality. METHODS: The study included 75 patients with acute ischemic stroke older than 18 years. During the same period, 28 normal controls were recruited from the hospital ED. Blood samples were collected from all patients at admission to determine the levels of VILIP-1 and BDNF. RESULTS: The mean VILIP-1 levels in the study and control groups were 0.547 ±â€¯0.081 and 0.515 ±â€¯0.035 ng/mL, respectively, and the difference was not significant (p = 0.071). The mean BDNF levels in the study and control groups were 3.89 ±â€¯2.05 ng/mL and 14.9 ±â€¯4.7 ng/mL, respectively, and the level was significantly (p < 0.0001) lower in the stroke patients. CONCLUSION: The BDNF level showed a significant ability to discriminate stroke and control patients but did not predict mortality. The VILIP-1 level showed insignificant ability to discriminate stroke patients and again did not predict mortality.

Prevalence of attention deficit hyperactivity disorder (ADHD) in children presenting with foreign body ingestion.

BACKGROUND: Foreign body ingestion is a common condition in children. We aimed to compare the incidence of attention deficit hyperactivity disorder (ADHD) symptoms in children that ingested foreign bodies with healthy children. METHODS: The study group consisted of 3- to 17-year-old pediatric patients admitted to the emergency department after foreign body ingestion, and the control group was formed with children having similar demographic and cultural characteristics that presented to the same department for non-traumatic causes. After initial intervention and stabilization, we administered the Conners' Parent Rating Scales-Revised (CPRS-R) to both groups. RESULTS: The study group consisted of 53 patients with a mean age of 7.83 ±â€¯4.36 and the control group comprised 47 children with a mean age of 7.72 ±â€¯3.48 years. There were no statistically significant differences between the study and control groups in terms of age, gender, and parental education levels (p > 0.05 for each). The foreign objects most ingested by children were coins (32.1%), followed by needles (15.1%) and beads (9.4%), and all the patients recovered without complications and were discharged. All the CPRS-R subscale scores were significantly higher in the study group than in the control group (p < 0.001). The parental education levels of the study group were not significantly correlated with DSM-IV hyperactivity-impulsivity and DSM-IV total. CONCLUSION: We found that the incidence of ADHD symptoms may be high in children referred to emergency services after accidentally ingesting foreign bodies.

The role of radiologic, clinical and biochemical parameters in prediction of stroke mortality.

OBJECTIVE: To assess National Institutes of Health Stroke Scale (NIHSS), stroke volume, biochemical, and blood parameters for the prediction of one-month mortality in stroke patients. METHODS: The study had retrospective design and 75 patients were involved that presented to a hospital Emergency Department between January 2016 and December 2017 in Adiyaman, Turkey diagnosed with acute ischemic cerebral infarction. The patients were divided into 2 groups according to whether mortality occurred within one month. Values for NIHSS, stroke volume, Glasgow Coma Scale, and blood parameters were compared between the groups. RESULTS: Values for Glasgow Coma Scale p=0.002, NIHSS p=0.001, stroke volume p=0.003, monocyte/HDL ratio p=0.047, neutrophils p=0.01, white blood cell p=0.007, calcium p=0.016, and albumin p=0.027 were statistically significant for the prediction of one-month mortality. There were no significant differences between the groups for other parameters. CONCLUSION: The clinical, laboratory, and radiological findings individually provide significant support for the short-term prognosis of stroke. The evaluation of these results together can provide a clearer advance understanding of a prognosis to better manage the course of the disease and prevent death.

Femoral artery pseudoaneurysm due to a gunshot injury.

Femoral artery pseudoaneurysms are commonly iatrogenic due to increasing use of the artery for arterial interventions. Other reasons of pseudoaneurysm formation are intravenous drug use and penetrating trauma. Here, we have discussed the management strategy of a femoral artery pseuodoaneursym and the modalities for preventing the misdiagnoses of the pseudoaneurysm in the emergency department. A 50-year-old male patient was referred to our emergency department (ED) with claudication and severe local swelling. Ten days earlier, he had been referred to another ED immediately after a gunshot injury to the left inguinal zone. Duplex ultrasound and CT angiography of the left lower extremity revealed a 4 cm sac of pseudoaneurysm on the distal part of posterofemoral branch of deep femoral artery and a 9*10 cm haematoma on the posteromedial part of pseudoaneurysm. The patient underwent open repair surgery due to co-existing large haematoma and risk of infection. The patient was discharged after three days hospitalization. Pain, extremity oedema, pulsatile mass, femoral bruit, palpable thrill, and compressive neuropathy should alert the physician to possible femoral artery pseudoaneurysm. Duplex ultrasound and CT angiography are important diagnostic steps to reveal a possible life-threatening vascular injury.

Factors affecting seizure recurrence in the emergency department.

Background: Information on Emergency Department (ED) follow-up of patients presenting with epileptic seizures is limited. Objectives: It was planned to investigate the factors affecting the recurrence of epileptic seizures in the follow-up of patients presenting to the ED with the complaint of epileptic seizures. Materials and methods: This prospective, observational, single-center study was carried out in an adult population presenting to the ED. The study included patients older than 18 years of age presenting to the ED with the complaint of epileptic seizures. Results: Of the 205 patients included in the study, 68 (33.2%) had seizure recurrence during the 6 h. In the univariable analysis, advanced age, prolonged post-ictal duration, increased seizure duration, generalized tonic clonic seizure, alcohol consumption within past 24 h, hypertension, coronary artery disease, Alzheimer's disease, prior ischemic cerebrovascular disease, low Glascow Coma Scale (GCS), high glucose, high C-Reactive Protein, high phosphorus, low potassium, high blood urea nitrogen, high lactate, increased anion gap, high osmolarity were statistically significant in predicting recurrent seizure recurrence within 6 h. According to the logistic regression, postictal duration, GCS score, and age were independent predictors in our model. The cut-off value of postictal duration in predicting seizure recurrence at the highest sensitivity (66.2%) and specificity (89.8%) was 22.5 min. Conclusion: A prolonged postictal state, low GCS score, advanced age may be an indication of seizure recurrence. Therefore, patients with a long postictal duration, low GCS score, advanced age should be followed up more carefully in terms of recurrent seizures in the ED.

Investigating the association between various platelet indices and different clinical sub-groups of severe malaria.

Aim: To evaluate the ability of platelet count, mean platelet volume, platelet distribution width, and platelet mass index to predict the severity of malaria. Materials and Methods: This study was conducted as a retrospective cohort study at a tertiary hospital in Somali. Patients grouped as severe and non-severe malaria. We compared groups in terms of platelet count, mean platelet volume, platelet distribution width, and platelet mass index. Results: A total of 131 patients were included in the final analysis. Of the patients, 77 (58.7%) had non-severe malaria, and 54 (41.3%) had severe malaria. The multivariate analysis revealed that there was no significant difference between the groups in terms of platelet count, mean platelet volume, platelet distribution width, and platelet mass index (p: 0.183, 0.323, 0.204, and 0.139, respectively). In the receiver operating characteristic analysis, the area under the curve values for platelet count, mean platelet volume, platelet distribution width, and platelet mass index were 0.699, 0.619, 0.504, and 0.675, respectively. Conclusion: Of the platelet indices, platelet count, mean platelet volume, platelet distribution width, and platelet mass index were not clinically significant markers that could be used to predict the severity of malaria.

Characteristics of School Injuries Presenting to the Emergency Department.

Background School injuries account for approximately one-fifth of pediatric injuries. We aimed to investigate the frequency and severity of school injuries among school-aged children and determine clinical diagnoses and surgery requirement data. Methods In this prospective study, children who were admitted to the emergency department due to school accidents over a 5-month period were included. Demographics, activity during trauma, mechanism of trauma, nature, severity, emergency department outcomes, and surgery requirement were evaluated. Results The study included a total of 504 school-aged children, of whom 327 (64.9%) were male and 177 (35.1%) were female. Of the children, 426 (84.5%) had no evidence of injury or minor injury, while 78 (15.5%) had moderate or severe injury. There was a statistically significant difference between these two groups in terms of gender ( p = 0.031). Of the 78 children with moderate or severe injuries, 45 had extremity fractures, 18 had lacerations, 5 had maxillofacial injuries, 4 had cerebral contusion, 1 had lung contusion, and 1 had cervical soft-tissue damage. Two patients with fractures and two with eyelid lacerations were treated surgically, and four patients with brain contusion were hospitalized for a close follow-up. Conclusion This study revealed that the most common moderate or severe injuries in school accidents referred to emergency department were distal radius fractures and lacerations.

Predictive Ability of the MEWS, REMS, and RAPS in Geriatric Patients With SARS-CoV-2 Infection in the Emergency Department.

BACKGROUND: The aim of this study was to compare the ability of the Modified Early Warning Score (MEWS), Rapid Emergency Medicine Score (REMS), and Rapid Acute Physiology Score (RAPS) to predict 30-d mortality in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection aged 65 y and over. METHODS: This prospective, single-center, observational study was carried out with 122 volunteers aged 65 y and over with patients confirmed to have SARS-CoV-2 infection according to the reverse transcriptase-polymerase chain reaction (RT-PCR) test, who presented to the emergency department between March 1, 2020, and May 1, 2020. Demographic data, comorbidities, vital parameters, hematological parameters, and MEWS, REMS, and RAPS values of the patients were recorded prospectively. RESULTS: Among the 122 patients included in the study, the median age was 71 (25th-75th quartile: 67-79) y. The rate of 30-d mortality was 10.7% for the study cohort. The area under the receiver operating characteristic curve values for MEWS, RAPS, and REMS were 0.512 (95% confidence interval [CI]: 0.420-0.604; P = 0.910), 0.500 (95% CI: 0.408-0.592; P = 0.996), and 0.675 (95% CI: 0.585-0.757; P = 0.014), respectively. The odds ratios of MEWS (≥2), RAPS (>2), and REMS (>5) for 30-d mortality were 0.374 (95% CI: 0.089-1.568; P = 0.179), 1.696 (95% CI: 0.090-31.815; P = 0.724), and 1.008 (95% CI: 0.257-3.948; P = 0.991), respectively. CONCLUSIONS: REMS, RAPS, and MEWS do not seem to be useful in predicting 30-d mortality in geriatric patients with SARS-CoV-2 infection presenting to the emergency department.

Effect of the COVID-19 Pandemic on Emergency Department Presentations with Mushroom Poisoning: A Report from Turkey.

Background In this study, we investigated the effect of the coronavirus disease 2019 (COVID-19) pandemic on emergency department admissions with mushroom poisoning in a tertiary hospital in Turkey. Materials and Methods This study was conducted as a retrospective cohort study to evaluate the data of patients admitted to the emergency department between January 1, 2018, and December 31, 2020. The patients diagnosed with the International Classification of Diseases-10 code T62.0 concerning the toxic effect of ingested mushrooms were identified through the computerized medical and laboratory record system of the hospital. The patients' demographic data, presentation seasons, laboratory findings, emergency department outcomes, and mortality due to mushroom poisoning were obtained. To reveal the effect of COVID-19 pandemic on emergency department presentations with mushroom poisoning, the means of the pre-pandemic period (2018-2019) and the pandemic period (2020) were compared. Results The data of a total of 171 patients were included in the final analysis. The number of patients diagnosed with the toxic effect of ingested mushrooms was 96 in 2018, 61 in 2019, and 14 in 2020. There was a 5.6-fold decrease during pandemic period in the number of patients presenting to the emergency department with mushroom poisoning. Conclusion The decrease in mushroom poisoning cases may be related to the changes in the eating habits of individuals during the pandemic and our study being conducted in a metropolitan city. We recommend that multicenter studies be performed to verify the data obtained from our study and increase their generalizability.

Can 1st and 6th month pulmonary function test follow-ups give an idea about the long-term respiratory effects of COVID-19 pneumonia?

OBJECTIVE: The aim of this study was to ascertain the long-term respiratory effects of COVID-19 pneumonia through pulmonary function tests in follow-ups at 1 and 6 months. METHODS: Our study was conducted between August 1, 2020 and April 30, 2021. At 1 month after discharge, follow-up evaluations, PFTs, and lung imaging were performed on patients aged above 18 years who had been diagnosed with COVID-19 pneumonia. In the 6th month, the PFTs were repeated for those with pulmonary dysfunction. RESULTS: A total of 219 patients (mean age, 49±11.9 years) were included. Pathological PFT results were noted in the 1st month for 80 patients and in the 6th month for 46 (7 had obstructive disorder, 15 had restrictive disorder, and 28 had small airway obstruction) patients. A significant difference was found between abnormal PFT results and patient-described dyspnea in the 1st month of follow-up. The 6-month PFT values (especially those for forced vital capacity) were statistically significantly lower in the patients for whom imaging did not indicate complete radiological improvement at the 1-month follow-up. No statistically significant difference was found between the severity of the first computed tomography findings or clinical condition on emergency admission and pulmonary dysfunction (Pearson's chi-square test, P=0.904; Fisher's exact test, P=0.727). CONCLUSION: It is important that patients with COVID-19 pneumonia be followed up for at least 1 month after discharge to be monitored for potential long-term lung damage. PFTs should be administered to those in whom ongoing dyspnea, which started with COVID-19, and/or full recovery were not identified in pulmonary imaging.

Characteristics of injuries among infants who fall from bed.

INTRODUCTION: Accidental falls are the most common causes of injury among infants. Due to their limited ability to move independently, falling from bed or other types of furniture (such as sofas or armchairs) is considered the most common reason for such injury. However, little is known about the frequency and types of injury associated with this type of fall among infants. This study aimed to determine the incidence and characteristics of injury among infants presented at emergency departments (ED) after falling from bed or similar furniture. METHODS: The retrospective analysis of infants under one year old presenting at ED after falling from bed (or similar furniture) was performed over a four-year period (2016-2019). Patient demographics, incidence and patterns of injury, outcomes, and ED resources use were evaluated as part of the study. RESULTS: In total, 1,439 infants were included in the study, of whom 782 (54.3%) were male and 657 (45.7%) female. The median age of the patients was 7 months (interquartile range [IQR]: 6-9 months). More than half the infants (n = 812, 56.4%) had minor injuries, such as abrasions, bruising, contusions, and lacerations. There were significant injuries for 135 (9.4%) infants. The most common fracture was skull fracture (n = 59, 4.1%), followed by proximal fracture of the upper extremities (n = 26, 1.8%). Six (0.4%) patients had radial head subluxation. Traumatic brain injury featured for 30 (2.1%) infants (intracranial hemorrhage/cerebral contusion). While the majority of patients (n = 1352, 94%) were discharged from ED, 86 (6%) infants were hospitalized, all due to head injuries. A neurosurgical intervention was performed with three (0.2% of all patients) of the hospitalized patients. CONCLUSION: Falling from bed causes skull fractures, traumatic brain injury, and long bone fractures among infants. Therefore, campaigns should be organized to raise awareness of these risks among parents and caregivers of infants. In addition, the use of safety equipment (such as bed rails) and creating a safe environment can help prevent significant injuries.

Diagnostic performance of thorax CT in mildly symptomatic COVID-19 patients: The importance of atypical CT findings.

OBJECTIVE: Computed tomography of the thorax (Thorax CT) is frequently used to diagnose viral pneumonia in moderate to severe COVID-19 patients, but its diagnostic performance in mildly symptomatic COVID-19 patients is still unclear. Assessing the diagnostic performance of thorax CT in mildly symptomatic COVID-19 patients was the purpose of our study. METHODS: Mildly symptomatic and clinically stable, suspected COVID-19 patients scanned with Thorax CTs between March 11, 2020, and April 13, 2020, were included in this study. The sensitivity, specificity, positive and negative likelihood ratios, positive and negative predictive values, and the respective accuracies were calculated for diagnostic purposes. RESULTS: Among the 1119 patients enrolled in our study, abnormal thorax CT scans were 527 out of which 363/527 (68.9%) had typical CT features for COVID-19. According to analysis of typical COVID findings, sensitivity, specificity, positive predictive values, negative predictive value, and the accuracy of Thorax CTs with were 51.45%, 86.07%, 78.24%, 64.55%, and 68.99%, respectively. When typical CT findings and atypical CT findings were combined for the statistical analysis, the sensitivity, specificity, and accuracy observed 68.84%, 74%, and 71.49%. CONCLUSION: Diagnosing pneumonia can be challenging in mildly symptomatic COVID-19 patients since the Reverse Transcription Polymerase Chain Reaction test results, when compared with symptoms are not always evident. According to our study, thorax CT sensitivity was higher when atypical COVID-19 CT findings were included compared to those with typical COVID-19 CT findings alone. Our study which included the largest number of patients among all other similar studies indicates that not only typical but also atypical CT findings should be considered for an accured diagnosis of COVID-19 pneumonia.