Role of Point-of-Care Lung and Inferior Vena Cava Ultrasound in Clinical Decisions for Patients Presenting to the Emergency Department With Symptoms of Acute Decompensated Heart Failure.

OBJECTIVES: This prospective study was performed to evaluate the diagnostic role of point-of-care lung ultrasound (LUS) and inferior vena cava (IVC) ultrasound in patients with acute decompensated heart failure (ADHF). METHODS: A prospective cohort study was conducted between January 2018 and November 2018 on patients with a diagnosis of ADHF in the emergency department (ED). On admission, LUS findings, inspiratory and expiratory IVC diameters, and the inferior vena cava collapsibility index (IVCCI) were obtained. After therapeutic interventions, third-hour changes in LUS and the IVC index and the treatment response were assessed. RESULTS: Eighty patients were enrolled. Forty-six (58%) patients had an ejection fraction (EF) greater than 40%, and 34 (42%) had an EF of less than 40%. Significant differences were detected between the admission and third-hour inspiratory IVC diameter, expiratory IVC diameter, and IVCCI (P = .001). There was no correlation between the EF and inspiratory IVC diameter (r = -0.03; P = .976), expiratory IVC diameter (r = -109; P = .336), or IVCCI (r = -0.72; P = .523) and between the B-type natriuretic peptide level and inspiratory IVC diameter (r = -0.58; P = .610), expiratory IVC diameter (r = -0.33; P = .774), or IVCCI (r = -0.78; P = .493) either. A comparison of admission and third-hour numbers of B-lines on LUS imaging showed a significant decrease in the number of B-lines in all zones at the end of 3 hours (P = .001). A significant difference existed between the hospitalized and discharged patients with respect to IVC diameters and number of B-lines. CONCLUSIONS: In the ED setting, an assessment of B-lines and measurement of IVC diameters are better markers than the B-type natriuretic peptide level, EF, or chest x-ray for diagnosis of ADHF and can be used to make decisions for hospitalization or discharge from the ED.

Prisoners seeking healthcare in emergency department.

OBJECTIVE: To evaluate inmate referrals to emergency department of a tertiary healthcare facility in terms of demographical and clinical characteristics as well as their impact on the department. METHODS: The retrospective cross-sectional study was conducted at Ankara Numune Training and Research Hospital, Ankara, Turkey and comprised data of incarcerated patients who were brought to the emergency department from January 01, 2010, to December 31, 2012. Demographical characteristics, consultations, duration of hospitalisation, recurrent admissions, disposal and mortality rates were noted. The referrals were grouped as surgical conditions, medical disorders, Eye, Ear, Nose, Throat problems, injury and psychiatric disorders. The groups were then subdivided according to diagnosis. SPSS 22 was used for data analysis. RESULTS: Of the 856 patients, 804(93.4%) were men and 52(6.1%) were women. The overall mean age was 37.54±14.81 years (range: 15-83 years). The number of patients was the highest in the medical group 363(42.4%) and the lowest in the Eye, Ear, Nose, Throat group 56(6.5%). Mean age of the surgical group was significantly lower than the medical group (p<0.001) but significantly higher than that of the trauma group (p=0.001). CONCLUSIONS: Functional emergency response units, strict emergency triage of inmates and their rapid care and management in jails can help avoid referring these patients to already overcrowded emergency departments.

Association of optic nerve sheath diameter measurement with hyponatremia in emergency department.

OBJECTIVE: Investigation of association of ONSD with hyponatremia in symptomatic patients. METHODS: 89 patients who were diagnosed to have hyponatremia (Na + <135 mmol/L) were prospectively analyzed and compared with 72 patients who have normal serum sodium levels presented to ED at the same time interval. Subjects' demographic properties including age and sex were recorded, as were admission symptoms, serum Na + level, and pre-treatment and post-treatment optic nerve sheath diameter (ONSD). RESULTS: The mean age of the study population was 62.3 ±â€¯17.6 years, and the control group 55.1 ±â€¯20.0 years (p < 0.05). There was a significant difference between the patient group's pre-treatment and post-treatment OSNDs compared to the controls (p < 0.05). There was a significant negative correlation between the admission sodium level and ONSD in the patient group (p < 0.05). In the pre-treatment period, patients with symptoms had a significantly greater mean ONSD than those without symptoms (0.546 ±â€¯0.068 mm vs 0.448 ±â€¯0.081 mm; p < 0.05). The area under the curve was 0.870; the cut-off level calculated for hyponatremia was 0.49 mm, which had a sensitivity of 81% and a specificity of 81.9%. CONCLUSION: Ultrasonic imaging of ONSD measurement in the emergency department appears to reflect changes consistent with ICP changes in hyponatremia and change in serum sodium.

Metal Accumulations in Water, Sediment, Crab (Callinectes sapidus) and Two Fish Species (Mugil cephalus and Anguilla anguilla) from the Köycegiz Lagoon System-Turkey: An Index Analysis Approach.

The concentrations of six metals (Hg, Cd, Cu, Pb, Cr and Zn) individual total metal load (IMBI) values and its relation to condition index were determined in water, sediment and tissues of crab (Callinectes sapidus) and two fish species (Mugil cephalus and Anguilla anguilla) inhabiting Köycegiz Lagoon System. The average distribution of the IMBI values ranged from 0.033 to 0.265. Distribution patterns of IMBI in species follow the sequence: A. anguilla > M. cephalus > C. sapidus. Results showed that there are positive relationships between species sizes and metal levels in most cases. The concentrations of Pb in muscle in the three studied species were in all cases considerably higher than the maximum levels set by law. Average Cd, Cu and Zn values in M. cephalus were also higher than the limits proposed for fish by FAO/WHO, EC and TFC. Therefore, the human consumption of all analysed species is not recommended.

The comparison of bedside point-of-care ultrasound and computed tomography in elbow injuries.

OBJECTIVE: The objective of the study was to compare the efficacy of point-of-care ultrasound (POCUS) and computed tomography (CT) in the diagnosis of the fracture of the bones that form the elbow joint and the determination of treatment method in elbow injuries. METHODS: Forty-nine patients aged 5 to 65 years, who were admitted with low-energy elbow injuries, had at least 1 fracture of the elbow joint bones, and underwent CT scanning, were included in this study. Before the initiation of the study, orthopedic surgeons and emergency physicians determined a common treatment based on the fracture characteristics. Patients were first evaluated with direct radiography, and then with POCUS by trained emergency physicians. Emergency physicians made treatment decisions based on the ultrasonography results. Then, CT scans were performed. The CT images were interpreted by radiologists. Orthopedic surgeons made treatment decisions based on the CT interpretations. RESULTS: Forty-nine patients with elbow injury were included in the study. Eighteen (37%) patients were women, and 31 (63%) were men. The mean age was 21 ± 15 years. Compared with CT, sensitivity, specificity, positive predictive value, and negative predictive value of POCUS in fracture detection were 97%, 88%, 94%, and 93%, respectively. Although the sensitivity and specificity of POCUS in the decision for reduction were 95% and 100%, respectively, it was 93% and 100% in the decision for surgery. CONCLUSION: In conclusion, POCUS was shown to be successfully applied in the diagnosis and management of elbow injuries, in which direct radiography was inefficient and CT scans were required.

Bedside sonographic measurement of optic nerve sheath diameter as a predictor of intracranial pressure in ED.

BACKGROUND: Ocular ultrasonography of optic nerve sheath diameter (ONSD) to determine intracranial pressure (ICP) has become favorable in recent years. OBJECTIVE: To demonstrate the efficacy of ONSD measurement in determining the ICP increase due to nontraumatic events in the emergency department. METHODS: A total of 100 patients with suspected nontraumatic intracranial event were enrolled in this prospective study. Patients were divided equally into 2 groups including 50 patients as group I with pathology on cranial computed tomography (CT) and group II with normal cranial CT. Prior to CT scans, patients underwent ONSD measurement by a radiologist using 11- and 14-MHz transducers. RESULTS: The ONSD values of groups I and II were 5.4±1.1and 4.1±0.5mm, respectively. Optic nerve sheath diameter was found to be larger on the side of lesion in patients with a lesion (P<.05). The cutoff value of the difference between ONSD values of both eyes in the presence of pathology was determined as 0.45 (sensitivity, 80%; specificity, 60%; the area under the curve, 0.794; 95% confidence interval, 0.705-0.883). The between-ONSD and midline shift size was statistically significant (r=0.366, P=.009). The cutoff value of ONSD for the detection of midline shift was determined as 5.3mm (sensitivity, 70%; specificity, 74%; the area under the curve, 0.728; 95% confidence interval, 0.585-0.871). CONCLUSION: Optic nerve sheath diameter measurement via bedside ocular ultrasonography in patients with suspected intracranial event in the emergency department is a useful method to determine ICP increase and its severity.

Correlation of CAT Score With Peak Expiratory Flow in Acute Exacerbation of COPD Patients.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) leads to physical activity limitation and a significant reduction in quality of life. This study aimed to investigate the correlation between The COPD Assessment Test (CAT) score and peak expiratory flow (PEF), and the factors effecting hospital admission rates of patients with COPD. METHODS: This observational study was conducted prospectively. CAT score was calculated and PEF measured at the time of emergency department admission. Descriptive statistics were expressed as number (n), percentage (%), and mean ± standard deviation. Chi-Square and correlation tests were used for statistical analyses. A p value of less than 0.05 was considered statistically significant. RESULTS: Of 123 patients included in the study, 85 (69.1%) were male and 38 (30.9%) were female. Pulse pressure, pH, blood urea nitrogen, oxygen saturation measured by pulse oximetry (SpO2), PO2, PCO2, and SpO2 values on arterial blood gas analysis, and PEF value were significantly correlated to CAT score (p < 0.05). CONCLUSION: High CAT score and low PEF value can be used to make the decision of hospitalization from emergency department in acute exacerbations of COPD.

Retroperitoneal Haematom due to Spontaneous Rupture and Haemorrhage of Adrenal Cyst Presenting with Grey Turner's Sign.

Spontaneous retroperitoneal haemorrhage is a rare entity and a potentially life-threatening condition. A 41-year-old woman presented to our emergency department with left flank pain and dysuria. Her physical examination disclosed left abdominal and costovertebral angle tenderness, left flank ecchymosis (Grey Turner sign). Abdominal computerised tomography revealed spontaneous retroperitoneal haemorrhage. She was discharged after 10 days with recommendation of urology follow-up.

Bedside heart type fatty acid binding protein (H-FABP): Is an early predictive marker of cardiac syncope.

OBJECTIVE: To determine the value of bedside heart-type fatty acid binding protein in diagnosis of cardiac syncope in patients presenting with syncope or presyncope. METHODS: The prospective study was conducted at Ankara Numune Training and Research Hospital, Ankara, Turkey, between September 1, 2010, and January 1, 2011, and comprised patients aged over 18 years who presented with syncope or presyncope. Patients presenting to emergency department within 4 hours of syncope or presyncope underwent a bedside heart-type fatty acid binding protein test measurement. SPSS 16 was used for statistical analysis. RESULTS: Of the 100 patients evaluated, 22(22%) were diagnosed with cardiac syncope. Of them, 13(59.1%) patients had a positive and 9(40.9%) had a negative heart-type fatty acid binding protein result. Consequently, the test result was 12.64 times more positive in patients with cardiac syncope compared to those without. CONCLUSIONS: Bedside heart-type fatty acid binding protein, particularly at early phase of myocardial injury, reduces diagnostic and therapeutic uncertainity of cardiac origin in syncope patients.

A case presented with fever enlightened by cardiac auscultation: Sarcoma originated in pulmonary artery.

In the emergency department, there are many symptoms patients present. One of the major symptoms is fever which could be the only symptom, as our patient had. Not only do infections, drugs, trauma, etc., cause fever, but also undetermined cancer types do. In this case, we are presenting a 28-year-old male coming with a 3-week duration of fever and being admitted with the diagnosis of pulmonary artery intimal sarcoma as generally misconceived with pulmonary thromboembolism, to raise awareness of this fatal cancer.

Prospective, multicenter, Turkish out-of-hospital cardiac arrest study: TROHCA.

OBJECTIVES: There is no sufficient data to provide a clear picture of out-of-hospital cardiac arrest (OHCA) across Türkiye. This study is the first to present the prognostic outcomes of OHCA cases and the factors associated with these outcomes. MATERIALS AND METHODS: The study was conducted in a prospective, observational, multicenter design under the leadership of the Emergency Medicine Association of Turkey Resuscitation Study Group. OHCA cases aged 18 years and over who were admitted to 28 centers from Türkiye were included in the study. Survived event, return of spontaneous circulation (ROSC), survival to hospital discharge, and neurological outcome at discharge were investigated as primary outcomes. RESULTS: One thousand and three patients were included in the final analysis. 61.1% of the patients were male, and the average age was 67.0 ± 15.2. Cardiopulmonary resuscitation (CPR) was performed on 86.5% of the patients in the prehospital period by emergency medical service, and bystander CPR was performed on only 2.9% by nonhealth-care providers. As a result, the survived event rate was found to be 6.9%. The survival rate upon hospital discharge was 4.4%, with 2.7% of patients achieving a good neurological outcome upon discharge. In addition, the overall ROSC and sustained ROSC rates were 45.2% and 33.4%, respectively. In the multiple logistic regression analysis, male gender, initial shockable rhythm, a shorter prehospital duration of CPR, and the lack of CPR requirement in the emergency department were determined to be independent predictors for the survival to hospital discharge. CONCLUSION: Compared to global data, survival to hospital discharge and good neurological outcome rates appear to be lower in our study. We conclude that this result is related to low bystander CPR rates. Although not the focus of this study, inadequate postresuscitative care and intensive care support should also be discussed in this regard. It is obvious that this issue should be carefully addressed through political moves in the health and social fields.

Efficacy of bedside optic nerve sheath diameter measurement in differentiating provoked seizure from unprovoked seizure in the emergency department.

BACKGROUND: Emergency departments (EDs) are typically the first medical contact for seizure patients, and early diagnosis and treatment is primarily the responsibility of emergency physicians. OBJECTIVES: Demonstrate the efficacy of bedside ocular ultrasonography for optic nerve sheath diameter (ONSD) measurement in differentiating provoked seizure from unprovoked seizure in the ED. DESIGN: Prospective observational study SETTINGS: Tertiary care hospital PATIENTS AND METHODS: Patients presenting to the ED with seizure were divided into two groups according to medical history, physical examination, laboratory results, cranial computed tomography findings and electroencephalography results. Patients with seizures that did not have a specific cause (unprovoked) were compared with patients who had seizures caused by underlying pathology (provoked). The measurement of the ONSD was taken at the bedside within 30 minutes of arrival. The study compared the ONSD values, age, sex, type of seizure, and Glasgow Coma Score between the two groups. MAIN OUTCOME MEASURE: Efficacy of ONSD to distinguish between provoked and unprovoked seizures. SAMPLE SIZE: 210 patients RESULTS: One hundred and fourteen (54.3%) patients were in the provoked seizure group and 96 (45.7%) were in the unprovoked seizure group. The ONSD measurements were significantly higher in the provoked seizure group compared with the unprovoked seizure group (median 6.1 mm vs. 5.2 mm, P<.001). The cut-off value of ONSD higher than 5.61 was significantly associated with the prediction of the provoked seizure (P<.001). The area under the curve value was 0.882 (95% CI: 0.830-0.922) with a sensitivity of 86.5 and specificity of 78.9%. CONCLUSIONS: Bedside ONSD measurement by means of ocular ultrasound is an effective method for differentiating provoked seizure from unprovoked seizure. LIMITATIONS: Statistical significance of age on ONSD and exclusion of pediatric patients. CONFLICT OF INTEREST: None.

Ultrasonographically detected hepatosteatosis independently predicts the presence and severity of coronary artery disease.

Background: Nonalcoholic fatty liver disease (NAFLD) has shown to be associated with coronary artery disease (CAD). Objectives: The aim of our study was to evaluate the association between the presence and severity of CAD and NAFLD. Methods: The study group consisted of 153 patients who underwent coronary angiographies. Patients were categorized into CAD and non-CAD groups. CAD severity was determined by the number of CAD-involved arteries and the vessel score multiplied by Gensini score, the latter judging CAD severity. Fatty liver was diagnosed by abdominal ultrasonography (USG), with the patients being categorized by the degree of hepatosteatosis, as Grade 0, Grade 1, and Grade 2-3. Results: Among the whole study population, 47.1% of patients (n=72) were female and 52.9% of patients (n=81) were male. Forty-three patients had normal coronary arteries; 27 patients had non-critical CAD and side branch disease; and 83 patients had clinically significant CAD (stenosis>50%). The rate of CAD and Gensini score were significantly different between Grade 0, 1 and 2-3 hepatosteatosis groups (p<0.05). Patients with CAD had a significantly higher AST level than those without (p< 0.05). Conclusions: Ultrasonographically detected hepatosteatosis independently predicts the presence and severity of CAD.

Subcutaneous Emphysema, Pneumomediastinum and Spinal Epidural Emphysema As Complications of Violent Coughing: A Case Report.

Spontaneous pneumomediastinum (SPM) is a rare condition characterized by chest pain of sudden- onset, difficulty breathing, dysphagia, dysphonia, and subcutaneous emphysema, which are some-times -accompanied by pain in the neck or back. This condition typically has a benign character that limits itself, and supportive therapy is all that is needed; however, life-threatening consequences may occur, such as upper respiratory tract obstruction, esophageal injury, and tracheal damage, requiring surgery. We report here a man aged 19 years who coughed vigorously due to acute allergic asthma, which lead to subcutaneous emphysema starting from the neck down to the chest, mediastinum and spinal epidural space. This case report stresses the importance of including SPM in the differential diagnosis of cough and chest pain in the young.

The efficiency of continuous positive airway pressure therapy in carbon monoxide poisoining in the emergency department.

OBJECTIVE: To determine whether oxygen therapy with continuous positive airway pressure (CPAP) is superior to normobaric oxygen therapy in carbon monoxide poisoning. METHODS: The study participants were 43 patients diagnosed with carbon monoxide poisoning between the dates 15 March and 30 June 2016 at the emergency department of an urban teaching hospital. The control group comprised patients who received normobaric oxygen therapy. The case group consisted of patients who underwent one-hour CPAP therapy. The primary outcome was the determination of the half-life of carboxyhemoglobin (COHb) with CPAP treatment. The CPAP and control groups were compared in terms of the reduction in COHb levels after 60 minutes of therapy. RESULTS: The COHb level among patients in the CPAP group was lower in the 30th and 60th minutes. The half-life of COHb was apparently decreased in the CPAP group compared with the control group (control and case groups mean plasma half-life of COHb were 80.26 ± 12.70 and 36.20 ± 4.58 minutes, respectively). CONCLUSION: The results of the present study demonstrate that CPAP therapy may be an effective option for oxygen therapy among patients with carbon monoxide intoxication; this is achieved by decreasing the half-life of COHb.

Analysis of the Patients Who Admitted To A Turkish Emergency Department During COVID-19 Pandemic

BACKGROUND AND AIM: In this study, it was aimed to review patients who presented to a Turkish emergency department (ED) with fever and at least one symptom and finding of acute respiratory infection (cough, shortness of breath) in Sisli Hamidiye Etfal Education and Research Hospital Tertiary Medical Care Center during COVID-19 pandemic. METHODS: This retrospective, descriptive, observational study included patients presented between March 10, 2020 and April 25, 2020. The patients were classified into two groups according to RT-PCR test result: RT-PCR (+) and RT-PCR (-). The demographic characteristics and clinical endpoint-related factors were analyzed in the patients. RESULTS: The study included 840 patients; 461 men (54.9%) and 379 women (45.1%). RT-PCR test was positive in 345 patients (41.0%). The most common comorbidity was hypertension (HT) in 119 patients (34.5%); followed by diabetes mellitus (DM) in 61 patients (18.3%). At time of ED presentation, there was mild clinical manifestation in 72.2%, whereas moderate in 21.7% and severe in 6.1% of patients with positive RT-PCR testing. Of the patients with positive RT-PCR testing, 64 patients (18.6%) were discharged from ED while 255 patients (73.9%) were admitted to COVID clinic and 26 were admitted to COVID intensive care unit (ICU). Of the patients admitted, 299 patients (86.7%) were discharged while 46 patients (13.3%) died due to multi-organ failure (MOF) (50%), acute respiratory distress syndrome (ARDS) (32.6%), acute pulmonary embolism (APE) (10.9%) and acute coronary syndrome (ACS) (6.5%). CONCLUSIONS: The RT-PCR positivity rate seemed lower in our study when compared to literature. In addition, mortality rate was lower in our study when compared to other countries.

Concomitant Substance Use Increases the Toxic Effect of synthetic cannabinoid (Bonsai): A Prospective Study.

OBJECTIVE: In this study, we aimed to contribute to the literature by evaluating bonsai and additional drugs. MATERIALS AND METHODS: This prospective study was conducted on 217 patients who admitted to the emergency department (ED) with bonsai intake between December 20, 2014 and January 1, 2016, according to the patient history obtained from the patients. While 168 patients with negative urinary metabolites results were excluded from the study, 49 patients with positive urinary metabolites were included in the study. Patients were divided into two groups. The first group consisted of patients with only bonsai intake and the second group consisted of patients with bonsai and concomitant drug intake. The groups were compared in terms of symptoms, findings, blood gas values, duration of the symptoms, discharge time, hospitalization, and mortality rate. Data were analyzed using the Chi-square, the Fisher's exacttest, the Student t-test, and the Mann-Whitney U test. Data were evaluated at the 95% confidence interval. P<0.05 was considered statistically significant. RESULTS: The mean age of 49 patients included in the study was 26.7±8.9 years and 91.8% (n=45) of the patients were male. Concomittant drug intake was identified in 69.4% of patients. Concomitant drug use was as follows: cocaine (20.4%, n=10), amphetamines (14.3%, n=7), methamphetamines (8,2%, n=4,) tetrahydrocannabinol (32.7%, n=16), opiates (18.4%, n=9) and alcohol (30.6%, n=15). On admission, Glasgow Coma Score (GCS) of the bonsai with additional substance group was significantly higher (p=0,003). The most common symptom was palpitations (tachycardia) (75.5%, n=37). There were no patients hospitalized in Only Bonsai group (p=0,020). The median time to remission of symptoms and median follow-up time of the patients in the emergency room were 3 hours and 6 hours, respectively. Remission time of the symptoms and hospitalization rates were higher in patients with concomittant drug intake (p <0.05) Conclusion: While the bonsai intake alone is not considered mortal to the patients and most of them can be discharged from the ED after signs and symptoms disappear, concomitant drug use can increase the toxic effects of bonsai intake. That is why follow-up of patients taking concomitant drug and the treatment process should be carried out more carefully.

Is Bedside End-Tidal CO2 Measurement a Screening Tool to Exclude Pulmonary Embolism in Emergency Department?

BACKGROUND: Pulmonary embolism (PE) is among the most difficult conditions to diagnose in emergency department. The majority of patients thought to have PE are tested positive for D-dimer and subsequently tested with advanced diagnostic modalities. Novel noninvasive tests capable of excluding PE may obviate the need for advanced imaging tests. We studied the role of combined clinical probability assessment and end-tidal carbon dioxide (ETCO2) measurement for diagnosis of possible PE in emergency department. METHODS: We included 100 consecutive subjects suspected to have PE and a positive D-dimer test to study clinical probability of PE and ETCO2 levels. ETCO2 > 34 mm Hg was found to be the best cut-off point for diagnosing PE. PE was ultimately eliminated or diagnosed by spiral computed tomography (CT). RESULTS: Diagnostic performances of tests were as follows: ETCO2 and D-dimer had a sensitivity of 100% and a negative predictive value (NPV) of 100% at the cut-off levels of 34 mm Hg and 500 ng/mL, respectively; Wells score had a sensitivity of 80% and NPV of 69.7% at a score of 4. CONCLUSIONS: ETCO2 alone cannot reliably exclude PE. Combining it with clinical probability, however, reliably and correctly eliminates or diagnoses PE and prevents further testing to be done.

Is initial optic nerve sheath diameter prognostic of specific head injury in emergency departments?

BACKGROUND: Emergency departments (EDs) are typically the first medical contact for patients with traumatic brain injury (TBI) and early diagnosis and treatment of intracranial pressure (ICP) in patients with neurotrauma primarily falls under the liability of emergency doctors. Monitoring ICP with optic nerve sheath diameter (ONSD) via tools has gained popularity among emergency service doctors. In this study, we aimed to evaluate the predictive value of ONSD for specific head injury on initial cranial tomography. METHODS: CT scans of 176 patients with a known intracranial pathology were retrospectively analyzed and compared with normal control CTs of 182 patients presented to ED at the same time interval. The attending radiologist analyzed all initial brain CT scans and randomly sampled control CTs were similarly assessed by the second senior radiologist whom were blind to the patients' medical histories and circumstances of TBI at the time of measurement. ONSD was measured at a distance of 3 mm behind the eyeball, immediately below the sclera. RESULTS: Right ONSD value was significantly higher in patients with herniation and SAH (p = 0,024 and 0,028, respectively). Left ONSD values was at the level of statistical significance and mean ONSD values was significantly higher in patients with SAH (p = 0.05 and 0.026, respectively). Right-left-mean ONSD values were statistically higher in study group with bilateral lesions on brain CT (p < 0,001). ONSD measurements and patient age were higher in patients who died (p < 0,001). CONCLUSIONS: ONSD measurement on initial brain CT is lesion dependent and indicates mortality.