Evaluation of the patients with flank pain in the emergency department by modified STONE score.

BACKGROUND/AIM: Computed tomography (CT) is generally used for ureteral stone diagnosis. Unnecessary imaging use should be reduced to prevent increased radiation exposure and lower costs. For this reason, scoring systems that evaluate the risk of ureteral stones have been developed. In this study, we aimed to investigate the diagnostic accuracy of the modified STONE score (MSS) and its ability to predict ureteral stones. MATERIALS AND METHODS: The research was conducted as a multi-center, prospective and observational study. Patients aged 18 and over who presented to EDs with complaints of flank pain and who received a CT were included. Patients were divided into two groups based on the presence or absence of stones, and the categories of the MSS were determined. The ability of the MSS to predict the ureteral stone and its diagnostic accuracy were calculated. RESULTS: The median age (min/max) of the 367 study patients was 37 (18/91), and 244 (66.5%) were male. A ureteral stone was present in 228 (73.0%) patients. Male gender, previous stone history, duration of pain less than 6 h, presence of hematuria, and CRP value below 0.5 mg/dL were significantly more common in the group with stones. The prevalence of ureter stones in the MSS high-risk group was 96.0%. The area under the receiver operating characteristic curve and sensitivity of the MSS was 0.903 and 0.81, respectively. CONCLUSION: The modified STONE score has high diagnostic performance in suspected urinary stone cases. This scoring system can assist clinicians with radiation reducing decision-making.

A novel biochemical marker for community-acquired pneumonia: Ischemia-modified albumin.

INTRODUCTION: Community-acquired pneumonia (CAP) is a frequent cause of hospitalization and a leading cause of mortality worldwide. Early diagnosis and the initiation of appropriate antibiotic therapy are essential to reduce pneumonia-related morbidity and mortality. CRP is a well-established biomarker in many clinical settings, but has been traditionally considered not specific enough to be a useful guide in the diagnostic process of pneumonia. There is still a need for more specific and practical markers in CAP for diagnosis. The aim of this study was to investigate the diagnostic value of ischemia-modified albumin (IMA) levels in the diagnosis of CAP in the Emergency Department. METHODS: The study included 81 patients admitted with CAP and 81 control patients. Initial hour levels of IMA and CRP were measured. The IMA mean levels were compared between the study and control group. Correlation analyses were performed to investigate the association of serum IMA levels with CRP. RESULTS: Mean levels of IMA were 0.532±0.117IU/ml in the study group and 0.345±0.082IU/ml in the control group. IMA levels were significantly higher in the study group compared to the control group. The IMA level of 0.442IU/ml had sensitivity of 75.3% and specificity of 91.3% and was positively correlated with CRP levels (r=0.506; p<0.05). CONCLUSION: Blood IMA levels significantly increase in adult patients presenting with CAP. IMA may be considered as a novel biomarker in the diagnosis of CAP.

The comparison of modified early warning score with rapid emergency medicine score: a prospective multicentre observational cohort study on medical and surgical patients presenting to emergency department.

OBJECTIVE: There are a few scoring systems in emergency departments (ED) to establish critically ill patients quickly and properly and to predict hospitalisation. We aim to compare the efficacy of Modified Early Warning Score (MEWS) and Rapid Emergency Medicine Score (REMS) on in-hospital mortality, and as predictor of hospitalisation in general medical and surgical patients admitted to ED. METHODS: This is a prospective, multicentre and observational cohort study. The study included general medical and surgical patients admitted to the EDs of three education and research hospitals during a period of 6 months. The primary outcome of the study is the admission of the patient to a ward/an intensive care unit (ICU)/high dependency unit (HDU) and in-hospital mortality. Receiver operating characteristics (ROC) curve analysis was performed to evaluate and compare the performances of two scores. RESULTS: Total patients were 2000 (51.95% male, 48.05% female). The mean age was 61.41±18.92. Median MEWS and REMS values of the patients admitted to the ICU/HDU from ED were 1 and 6, respectively; and there was a significant difference in terms of REMS values, compared with patients discharged from ED. REMS (area under the curve (AUC): 0.642) was found to have a better predictive strength than MEWS (AUC: 0.568) in discriminating in-patients and discharged patients. Additionally, REMS (0.707) was superior to MEWS (AUC 0.630) in terms of predicting in-hospital mortality of patients presenting to ED. CONCLUSIONS: The efficiency of REMS was found to be superior to MEWS as a predictor of in-hospital mortality and hospitalisation in medical and surgical patients admitted to ED.

Evaluation in an emergency department of rapid separator tubes containing thrombin for serum preparation prior to hs-cTnT and CK-MB analyses.

BACKGROUND: In our emergency department, we collect blood in Rapid Serum Tubes (RSTs; Becton Dickinson, Franklin Lakes, NJ), in which clotting times are reduced. We investigated the influence of RST use on cardiac troponin T (hs-cTnT) and creatine kinase-MB (CK-MB) test results, in comparison with the use of tubes featuring a separator gel containing a clotting activator (SSTs; Green-vac, Yongin, Korea). METHODS: Samples from 60 patients were divided into equal aliquots and placed into RSTs and SSTs; hs-cTnT and CK-MB concentrations were determined using an autoanalyzer (Elecsys 2010) running commercial assays (Roche Diagnostics, Penzberg, Germany). Between-tube differences in CK-MB and hs-cTnT values were compared using the paired t-test, and correlations among variables were evaluated by calculation of Spearman correlation coefficients (r values). Deming regression analysis was performed and Bland-Altman plots were constructed. RESULTS: The hs-cTnT and CK-MB test results obtained from samples placed into RSTs and SSTs did not differ (p > 0.1). The correlations between the concentrations of hs-cTnT and CK-MB in samples placed into RSTs and SSTs were good; both r values were unity (p < 0.001). Deming regression analysis yielded the equation: RST [hs-cTnT] = 0.98 SST [hs-cTnT] + 0.69 pg/ml; and RST [CK-MB] = 0.95 SST [CK-MB]-0.09 ng/ml. The biases of 1.4 pg/ml (95% CI: minus 8.1-10.7 pg/ml) for hs-cTnT levels and 0.249 ng/ml (95% CI: minus 0.682-1.681 ng/ml) for CK-MB levels assayed using either tube was acceptable. CONCLUSION: The hs-cTnT and CK-MB test results did not significantly differ when either tube was used. RST tube use was associated with a short clotting time; this was an advantage in an emergency laboratory setting.

The effect of the shock index and scoring systems for predicting mortality among geriatric patients with upper gastrointestinal bleeding: a prospective cohort study.

BACKGROUND: Gastrointestinal (GI) bleeding is an important cause of mortality and morbidity among geriatric patients. OBJECTIVE: To investigate whether the shock index and other scoring systems are effective predictors of mortality and prognosis among geriatric patients presenting to the emergency department with complaints of upper GI bleeding. DESIGN AND SETTING: Prospective cohort study in an emergency department in Bursa, Turkey. METHODS: Patients over 65 years admitted to a single-center, tertiary emergency service between May 8, 2019, and April 30, 2020, and diagnosed with upper GI bleeding were analyzed. 30, 180 and 360-day mortality prediction performances of the shock index and the Rockall, Glasgow-Blatchford and AIMS-65 scores were evaluated. RESULTS: A total of 111 patients who met the criteria were included in the study. The shock index (P < 0.001) and AIMS-65 score (P < 0.05) of the patients who died within the 30-day period were found to be significantly different, while the shock index (P < 0.001), Rockall score (P < 0.001) and AIMS-65 score (P < 0.05) of patients who died within the 180-day and 360-day periods were statistically different. In the receiver operating characteristic (ROC) analysis for predicting 360-day mortality, the area under the curve (AUC) value was found to be 0.988 (95% confidence interval, CI, 0.971-1.000; P < 0.001). CONCLUSION: The shock index measured among geriatric patients with upper GI bleeding at admission seems to be a more effective predictor of prognosis than other scoring systems.

Factors affecting mortality in patients with thorax trauma.

BACKGROUND: The purpose of this study was to define the epidemiologic properties and correlation of physiological and anatomical risk factors with the mortality rate among patients with thorax trauma and to ensure early prediction of severe trauma. METHODS: Files of 371 cases were retrospectively examined. Their initial state in the emergency department was analyzed in terms of mortality development. Age, gender, trauma mechanism, systolic blood pressure and respiration type on admission, accompanying injuries, thorax pathology, trauma scores, and treatment approaches in exitus and surviving cases were compared. Survival probabilities and unexpected mortality rates were computed using the Trauma Revised Score-Injury Severity Score (TRISS). RESULTS: Age, hypotension, pathologic respiration, blunt injury, accompanying injury, abdominal trauma, high Injury Severity Score (ISS), and low Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), and TRISS were the factors affecting mortality, and presence of blunt injuries, TRISS <85, ISS >22 and GCS <13 were found to be independent prognostic factors. The strongest factor indicating mortality was TRISS. Thirty-four of 307 cases with survival probability of over 50% died. CONCLUSION: In the presence of factors affecting mortality, patients with thorax trauma should be evaluated as being in a high-risk group and treatment strategies must be aggressive. Case analysis based on the TRISS model would further reveal the mistakes and may improve patient care.

Comparison of trauma scoring systems for predicting mortality in firearm injuries.

BACKGROUND: Prediction of mortality in trauma patients is an important part of trauma care. Trauma scoring systems are the current methods used for prediction of mortality. We aimed to evaluate and compare the performances of Injury Severity Score (ISS) and New Injury Severity Score (NISS) in firearm injuries. METHODS: Records of 135 firearm-injured patients who applied to Uludag University Emergency Department between January 2001 and December 2005 were analyzed retrospectively. All patients' data, including age, gender, cause of injury, initial vital signs, injury region, Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), mortality, operation data, and final diagnosis, were collected, and ISS, NISS and Trauma and Injury Severity Score (TRISS) were calculated. RESULTS: Mortality rate was 12.6%. The patients' mean GCS, RTS, ISS, NISS, and TRISS scores were 13.41 +/- 0.31, 10.65 +/- 0.26, 17.04 +/-1.20, 21.94 +/- 1.45, and 9.52 +/- 2.37, respectively. The patients were divided into two groups as ISS = NISS (53.3%) and ISS < NISS (46.7%). CONCLUSION: ISS and NISS both performed well in mortality prediction of firearm injuries. NISS demonstrated no superiority to ISS for prediction of mortality in these patients.

Assessing prognosis with modified early warning score, rapid emergency medicine score and worthing physiological scoring system in patients admitted to intensive care unit from emergency department.

INTRODUCTION: In this study our purpose is to examine the effectiveness and reliability of MEWS (Modified Early Warning Score), REMS (Rapid Emergency Medicine Score) and WPS (Worthing Physiological Scoring System) scoring systems for prediction of the prognosis and mortality rate of critically ill patients scheduled to be admitted to intensive care unit (ICU) among emergency department (ED) patients. METHODS: This single-centered retrospective study was performed on medical, surgical and trauma patients referred to the ED and admitted to ICU of University Hospital between 23 July 2013 and 26 November 2015. RESULTS: Mortality and the duration of stay in ICU were significantly correlated with systolic blood pressure (SBP) and WPS score compared to other variables (p = 0.014, p = 0.010 respectively). The decrease in SBP increased the mortality by 2 (OR: %95 CI 1.1-3.5) fold and the increase in WPS increased the mortality by 2.4 (OR: %95 CI 1.2-4.5) fold. CONCLUSIONS: In our study, there was a more significant correlation between WPS score and mortality and duration of stay in ICU compared to other scores.

MR imaging in the detection of diffuse axonal injury with mild traumatic brain injury.

PURPOSE: To evaluate the occurrence and distribution of mild traumatic brain injury (MTBI) caused by diffuse axonal injury (DAI) using magnetic resonance (MR) imaging and to attempt to correlate MR findings with post-concussion symptoms (PCS). PATIENTS AND METHODS: Forty MTBI patients (mean age: 32.5 years) with normal cranial computed tomography (CT) findings were examined with standard MR protocol including T(1)-weighted, T(2)-weighted, fluid attenuated inversion recovery (FLAIR), gradient echo (GRE) and diffusion-weighted (DW) sequences. MR imaging was performed within 24 hours of injury. The lesions were classified as DAI based on their location and morphologic appearance. RESULTS: In MR imaging of five (12.5%) of the patients, the lesions compatible with DAI were observed. Four patients (10%) had the foci of low signal intensity compatible with hemorrhagic shear injury on the GRE sequence, and five (12.5%) patients had high signal intensity on FLAIR and DW sequence. CONCLUSION: MR imaging can be helpful in revealing DAI lesions in patients with normal CT scan findings after MTBI. FLAIR, GRE and DW sequences are superior to conventional spin-echo images in detecting DAI lesions.

Mesenteric volvulus in children: two autopsy cases and review of the literature.

Small bowel mesenteric volvulus when compared with mesocolonic volvulus, have not high incidence. Two autopsy cases of small bowel mesenteric volvulus in infants, highlighting the importance of a suspicion in early recognition of this rare but potentially fatal intra-abdominal emergency are reported. We also review the literature on possible aetiologies and mechanism of small bowel mesenteric volvulus, as well as its management.

Should the New Injury Severity Score replace the Injury Severity Score in the Trauma and Injury Severity Score?

BACKGROUND: This study was performed to compare the efficacies of Injury Severity Score (ISS) and New Injury Severity Score (NISS), and to investigate whether replacing ISS with NISS in Trauma and Injury Severity Score (TRISS) changes the predictive power for mortality. METHODS: We retrospectively analyzed 550 patients aged over 16 years seen in our center over a period of four years who had injuries in at least two organ systems. The ISS, NISS and TRISS were calculated for each patient. TRISS was calculated in two ways: TRISS 1 with age, Revised Trauma Score (RTS) and ISS, and TRISS 2 with age, RTS and NISS. The cut-off values for TRISS 1, TRISS 2, ISS and NISS were determined by ROC analysis. RESULTS: The ideal cut-off values for the prediction of mortality were 21.0 (AUC: 0.907) for ISS and 25.0 (AUC: 0.914) for NISS. There was no statistically significant difference between the ROC curves of ISS and NISS. The ideal cut-off values for predicting mortality were 90 (AUC: 0.934) for TRISS 1 and 86 (AUC: 0.935) for TRISS 2. There was no statistically significant difference between the ROC curves of TRISS 1 and TRISS 2. CONCLUSION: Use of NISS instead of ISS in the TRISS model demonstrated no significant difference, and it can thus be recommended for use.

The effect of the shock index and scoring systems for predicting mortality among geriatric patients with upper gastrointestinal bleeding: a prospective cohort study

ABSTRACT BACKGROUND: Gastrointestinal (GI) bleeding is an important cause of mortality and morbidity among geriatric patients. OBJECTIVE: To investigate whether the shock index and other scoring systems are effective predictors of mortality and prognosis among geriatric patients presenting to the emergency department with complaints of upper GI bleeding. DESIGN AND SETTING: Prospective cohort study in an emergency department in Bursa, Turkey. METHODS: Patients over 65 years admitted to a single-center, tertiary emergency service between May 8, 2019, and April 30, 2020, and diagnosed with upper GI bleeding were analyzed. 30, 180 and 360-day mortality prediction performances of the shock index and the Rockall, Glasgow-Blatchford and AIMS-65 scores were evaluated. RESULTS: A total of 111 patients who met the criteria were included in the study. The shock index (P < 0.001) and AIMS-65 score (P < 0.05) of the patients who died within the 30-day period were found to be significantly different, while the shock index (P < 0.001), Rockall score (P < 0.001) and AIMS-65 score (P < 0.05) of patients who died within the 180-day and 360-day periods were statistically different. In the receiver operating characteristic (ROC) analysis for predicting 360-day mortality, the area under the curve (AUC) value was found to be 0.988 (95% confidence interval, CI, 0.971-1.000; P < 0.001). CONCLUSION: The shock index measured among geriatric patients with upper GI bleeding at admission seems to be a more effective predictor of prognosis than other scoring systems.

A case report of fatal oral ingestion of resorcinol.

Resorcinol is a pharmaceutical agent used topically in dermatological treatments for acne, eczema, psoriasis and related skin conditions. Although there are a few studies that indicate chronic toxic effects of resorcinol on humans after topical application, information on the effects of resorcinol in acute poisoning after oral ingestion is limited. Thus, we wish to report the clinical and laboratory findings of a patient who was admitted to our emergency department (ED) after inadvertent oral ingestion of resorcinol and later died, as well as the patient's autopsy findings. The major clinical and laboratory findings were unconsciousness, respiratory failure that required mechanical ventilation, generalized tonic-clonic seizures, leukocytosis and severe metabolic acidosis. In the blood sample taken at the autopsy, a high level of methemoglobin was found. In the serum, resorcinol was revealed by gas chromatography-mass spectrometry. It can be concluded that the basic approach to patients with resorcinol poisoning should include initial stabilization of the patient by supporting the airway, respiration and circulation, and treating complications such as seizures or metabolic acidosis in the ED, as soon as possible after oral ingestion.

Trauma in the elderly patients in Bursa.

BACKGROUND: The aim of this study was to determine the epidemiology and clinical features of the trauma in elderly patients, to investigate the factors influencing mortality and morbidity and to make a contribution to the national trauma data. METHODS: We retrospectively investigated the medical records of three hundred seventy-one trauma patients (231 males (62,3%); 140 females (37,7%); mean age 71,9), aged 65 and older presenting to our hospital. Patients' census data, diagnosis, dispositions, prognosis, trauma scores (GCS (Glasgow Coma Score), RTS (Adult Trauma Score), ISS (Injury Severity Score)), sites of injury were analyzed. RESULTS: During the study period 187.326 patients were admitted to our emergency department (ED). A total of 9.520 patients were trauma patients. There were 371 patients 65 years and older. Mean GCS, mean RTS and mean ISS were 13,6, 11,3, and 9,3 respectively. A total of 213 patients were hospitalized. Mean length of stay was 7,9 days. Sixty-six patients were discharged from the ED. Mortality rate was 10,2% (38/371). The mechanism of injury, injury severity, increasing age were predictors of mortality (p<0.001). Major injuries included head trauma (36,4%), extremity trauma (36,4%), and thoracic trauma (18%). Head trauma and abdominal trauma were significantly more frequent in the nonsurvivors (p<0.001 and p=0.02 respectively). CONCLUSION: Injury severity and increasing age were the predictors of mortality. Also pedestrian- vehicle collision patients were high mortality rate than the other trauma mechanisms. The most common injured organs were head and extremities.

Acute poisoning in adults in the years 1996-2001 treated in the Uludag University Hospital, Marmara Region, Turkey.

BACKGROUND: Acute poisonings are frequent causes of admission to emergency departments and these cases may have hazardous outcomes. METHODS: In the present study, medical records of 1818 poisoned patients admitted to Uludag University Medical School's Emergency Department between January 1996 and December 2001 were investigated. The age, sex, outcomes of the patients, and type of poisoning are described. RESULTS: . The mean age for females (63% of the patients) was 27 years, whilst the mean age of male patients was 31 years. The major types of poisonings were ingestions of medications (59.6%), mushrooms (3.3%), corrosives (2.5%), organophosphates (3.2%), and methyl alcohol (0.4%). Carbon monoxide accounted for 6.9% of intoxications. Approximately 65% of the patients survived, while the methyl alcohol and corrosive ingestions led to the highest fatality averages (100% and 14.8%, respectively). CONCLUSIONS: The demographic and diagnostic features of acute poisoning cases treated in our hospital are similar to those reported in the literature. Adults and women are in a high-risk group for acute poisonings and medicine poisoning, which is the most common type of poisoning.

[Traumatic aortic rupture: a case report]. / Travmatik aort yirtigi: olgu sunumu.

Aortic injuries can easily be missed in polytraumatized patients due to either associated injuries or vagueness of physical examination findings. Especially in young adults without associated injuries, relatively low atherosclerotic changes may limit the dissection of traumatic descending aortic injuries. We present a 34-year-old male patient who only had a complaint of back pain following a traffic accident. Upon detection of no abnormalities on plain X-ray films, he was discharged home with analgesics. One week later, he presented with dypsnea and dysphagia. Aortography showed rupture of the aorta and a pseudoaneurysm near the isthmus. Following surgical excision of the pseudoaneurysm and aortic repair with a Dacron graft interposition he was discharged with complete relief of symptoms. This case emphasizes the need for a high index of clinical suspicion in timely diagnosis and prompt treatment of traumatic aortic ruptures.

[Does the leukocyte count correlate with the severity of injury?]. / Kan lökosit degeri travmanin siddetini yansitir mi?

BACKGROUND: Injury severity score (ISS), Glasgow coma score (GCS), and revised trauma score (RTS) are the most frequently used methods to evaluate the severity of injury in blunt trauma patients. ISS is too complicated to assess easily and GCS and RTS are easy to assess but somewhat subjective. White blood cell count (WBC) is an easy, quick and objective test. This study was performed to evaluate the significance of the WBC count at presentation in the blunt trauma patients. METHODS: 713 blunt trauma patients, who were admitted to the Uludag University Medical Center Emergency Department between 01.04.2000-31.12.2000, were retrospectively evaluated in terms of ISS, GCS, RTS and white blood cell count at presentation. RESULTS: Statistical analysis revealed that WBC was correlated positively with ISS, but negatively with GCS and RTS. CONCLUSIONS: The leukocyte count at presentation can be used as an adjunct in the evaluation of the severity of injury in blunt trauma patients.

Evaluation of the modified MEDS, MEWS score and Charlson comorbidity index in patients with community acquired sepsis in the emergency department.

Sepsis is one of the most important causes of morbidity and mortality in patients presenting to the emergency department. SIRS criteria that define sepsis are not specific and do not reflect the severity of infection. We aimed to evaluate the ability of the modified mortality in emergency department sepsis (MEDS) score, the modified early warning score (MEWS) and the Charlson comorbidity index (CCI) to predict prognosis in patients who are diagnosed in sepsis. We prospectively investigated the value of the CCI, MEWS and modified MEDS Score in the prediction of 28-day mortality in patients presenting to the emergency department who were diagnosed with sepsis. 230 patients were enrolled in the study. In these patients, the 5-day mortality was 17 % (n = 40) and the 28-day mortality was 32.2 % (n = 74). A significant difference was found between surviving patients and those who died in terms of their modified MEDS, MEWS and Charlson scores for both 5-day mortality (p < 0.001, p = 0.013 and p = 0.006, respectively) and 28-day mortality (p < 0.001, p = 0.008 and p < 0.001, respectively). The area under the curve (AUC) for the modified MEDS score in terms of 28-day mortality was 0.77. The MEDS score had a greater prognostic value compared to the MEWS and CCI scores. The performance of modified MEDS score was better than that of other scoring systems, in our study. Therefore, we believe that the modified MEDS score can be reliably used for the prediction of mortality in sepsis.

Diagnostic accuracy of uriSed automated urine microscopic sediment analyzer and dipstick parameters in predicting urine culture test results.

INTRODUCTION: Urinary tract infection (UTI) is one of the most common types of infection. Currently, diagnosis is primarily based on microbiologic culture, which is time- and labor-consuming. The aim of this study was to assess the diagnostic accuracy of urinalysis results from UriSed (77 Electronica, Budapest, Hungary), an automated microscopic image-based sediment analyzer, in predicting positive urine cultures. MATERIALS AND METHODS: We examined a total of 384 urine specimens from hospitalized patients and outpatients attending our hospital on the same day for urinalysis, dipstick tests and semi-quantitative urine culture. The urinalysis results were compared with those of conventional semiquantitative urine culture. RESULTS: Of 384 urinary specimens, 68 were positive for bacteriuria by culture, and were thus considered true positives. Comparison of these results with those obtained from the UriSed analyzer indicated that the analyzer had a specificity of 91.1%, a sensitivity of 47.0%, a positive predictive value (PPV) of 53.3% (95% confidence interval (CI) = 40.8-65.3), and a negative predictive value (NPV) of 88.8% (95% CI = 85.0-91.8%). The accuracy was 83.3% when the urine leukocyte parameter was used, 76.8% when bacteriuria analysis of urinary sediment was used, and 85.1% when the bacteriuria and leukocyturia parameters were combined. The presence of nitrite was the best indicator of culture positivity (99.3% specificity) but had a negative likelihood ratio of 0.7, indicating that it was not a reliable clinical test. CONCLUSIONS: Although the specificity of the UriSed analyzer was within acceptable limits, the sensitivity value was low. Thus, UriSed urinalysis resuIts do not accurately predict the outcome of culture.