Assessing the precision of artificial intelligence in ED triage decisions: Insights from a study with ChatGPT.

BACKGROUND: The rise in emergency department presentations globally poses challenges for efficient patient management. To address this, various strategies aim to expedite patient management. Artificial intelligence's (AI) consistent performance and rapid data interpretation extend its healthcare applications, especially in emergencies. The introduction of a robust AI tool like ChatGPT, based on GPT-4 developed by OpenAI, can benefit patients and healthcare professionals by improving the speed and accuracy of resource allocation. This study examines ChatGPT's capability to predict triage outcomes based on local emergency department rules. METHODS: This study is a single-center prospective observational study. The study population consists of all patients who presented to the emergency department with any symptoms and agreed to participate. The study was conducted on three non-consecutive days for a total of 72 h. Patients' chief complaints, vital parameters, medical history and the area to which they were directed by the triage team in the emergency department were recorded. Concurrently, an emergency medicine physician inputted the same data into previously trained GPT-4, according to local rules. According to this data, the triage decisions made by GPT-4 were recorded. In the same process, an emergency medicine specialist determined where the patient should be directed based on the data collected, and this decision was considered the gold standard. Accuracy rates and reliability for directing patients to specific areas by the triage team and GPT-4 were evaluated using Cohen's kappa test. Furthermore, the accuracy of the patient triage process performed by the triage team and GPT-4 was assessed by receiver operating characteristic (ROC) analysis. Statistical analysis considered a value of p < 0.05 as significant. RESULTS: The study was carried out on 758 patients. Among the participants, 416 (54.9%) were male and 342 (45.1%) were female. Evaluating the primary endpoints of our study - the agreement between the decisions of the triage team, GPT-4 decisions in emergency department triage, and the gold standard - we observed almost perfect agreement both between the triage team and the gold standard and between GPT-4 and the gold standard (Cohen's Kappa 0.893 and 0.899, respectively; p < 0.001 for each). CONCLUSION: Our findings suggest GPT-4 possess outstanding predictive skills in triaging patients in an emergency setting. GPT-4 can serve as an effective tool to support the triage process.

Diagnostic accuracy of apple watch ECG outputs in identifying dysrhythmias: A comparison with 12-Lead ECG in emergency department.

BACKGROUND: Wearable devices, particularly smartwatches like the Apple Watch (AW), can record important cardiac information, such as single­lead electrocardiograms (ECGs). Although they are increasingly used to detect conditions such as atrial fibrillation (AF), research on their effectiveness in detecting a wider range of dysrhythmias and abnormal ECG findings remains limited. The primary objective of this study is to evaluate the accuracy of the AW in detecting various cardiac rhythms by comparing it with standard ECG's lead-I. METHODS: This single-center prospective observational study was conducted in a tertiary care emergency department (ED) between 1.10.2023 and 31.10.2023. The study population consisted of all patients assessed in the critical care areas of the ED, all of whom underwent standard 12­lead ECGs for various clinical reasons. Participants in the study were included consecutively. An AW was attached to patients' wrists and an ECG lead-I printout was obtained. Heart rate, rhythm and abnormal findings were evaluated and compared with the lead-I of standard ECG. Two emergency medicine specialists performed the ECG evaluations. Rhythms were categorized as normal sinus rhythm and abnormal rhythms, while ECG findings were categorized as the presence or absence of abnormal findings. AW and 12­lead ECG outputs were compared using the McNemar test. Predictive performance analyses were also performed for subgroups. Bland-Altman analysis using absolute mean differences and concordance correlation coefficients was used to assess the level of heart rate agreement between devices. RESULTS: The study was carried out on 721 patients. When analyzing ECG rhythms and abnormal findings in lead-I, the effectiveness of AW in distinguishing between normal and abnormal rhythms was similar to standard ECGs (p = 0.52). However, there was a significant difference between AW and standard ECGs in identifying abnormal findings in lead-I (p < 0.05). Using Bland-Altman analysis for heart rate assessment, the absolute mean difference for heart rate was 0.81 ± 6.12 bpm (r = 0.94). There was strong agreement in 658 out of 700 (94%) heart rate measurements. CONCLUSION: Our study indicates that the AW has the potential to detect cardiac rhythms beyond AF. ECG tracings obtained from the AW may help evaluate cardiac rhythms prior to the patient's arrival in the ED. However, further research with a larger patient cohort is essential, especially for specific diagnoses.

A nationwide analysis of emergency medicine residents' CT interpretation in trauma: The Tract-EM study.

OBJECTIVE: To evaluate the accuracy and determine the factors influencing trauma CT interpretation proficiency among emergency medicine (EM) residents in Turkey through the TraCT-EM study (Interpretation of Trauma CT by EMergency Physicians). METHODS: This nationwide, multicenter, cross-sectional study was conducted in 29 academic emergency departments (EDs) from April 2023 to March 2024. A total of 401 senior EM residents participated in the study, each interpreting a standardized set of 42 trauma CT series (cranial, maxillofacial, and cervical) derived from seven patients. Interpretation accuracy was assessed, and factors predicting interpretation failure were analyzed using univariate and multivariate regression models. RESULTS: The median accuracy rate of residents was 64.9 %, with higher accuracy in normal CT findings. Using the Angoff method, 14 % of residents scored below the passing threshold. Factors associated with interpretation failure included shorter interpretation times (OR, 0.97; 95 % CI, 0.95-0.99), lower self-confidence in detecting serious pathologies (OR, 2.50; 95 % CI, 1.42-4.42), reliance on in-hospital radiology department reports (OR, 3.45; 95 % CI, 1.47-8.05), and receiving final radiology reports for CT scans (OR, 3.30; 95 % CI, 1.67-6.52), and lack of in-department training programs (OR, 2.51; 95 % CI, 1.34-4.70). CONCLUSION: The TraCT-EM study highlighted a 65 % accuracy rate for senior EM residents in trauma CT interpretation, with specific predictors of failure identified. These findings suggest a need for tailored radiology education strategies to enhance training and competency in trauma CT interpretation for EM residents. Further optimization of educational programs could address these gaps, ultimately improving patient outcomes in trauma care.

Smart watch detected ventricular bigeminy during chest palpitations.

Smart watches, which are a rapidly developing technology that can record and store personal health data such as heart rate, oxygen saturation, ECG, and sports activities. We presented a patient who applied to the emergency department due to palpitation and he recorded an ECG output with a smart watch before admission. In this case, we emphasized that the use of smart watches in the prehospital period can help the diagnosis process of dysrhythmias in the hospital setting.

Simulation-Based Drone Assisted Search Operations in a River.

INTRODUCTION: Drones can transmit live video and geographic coordinates during the planning stages for search and rescue operations and the operations themselves. There are few simulation studies in which drones provided rescue support. However, the literature does not contain any simulation studies involving the use of drones to locate lost "victims" represented by dummies in rivers. We developed a simulation model to compare the first visual contact times for drone-assisted search techniques (DAST) and classic search techniques (CST). METHODS: In this prospective experimental simulation study, we used both DAST and CST to perform a series of river searches for unconscious victims (represented by dummies). We calculated the first visual contact times, total scanned area, scanned area per minute, flight-walking distances, and flight-walking speeds and compared the results between both groups. The data are presented as mean±SD. RESULTS: We performed 20 search and rescue operations, 10 with the CST and 10 with the DAST. The time to reach the victim was 823±177 s using CST and 80±14 s using DAST. The area scanned by unit time was 3091±54 m2·min-1 using CST and 22,640±1622 m2·min-1 using DAST. CONCLUSIONS: The drone-assisted search technique located a simulated victim drifting in a river faster than the classic search technique. The use of drones in search and rescue operations could improve the time to find victims.

Examination of the Effects of 4-Hour Nonvalved Filtering Facepiece Respirator Use on Blood Gas Values of Health Care Professionals: A Before and After Study.

INTRODUCTION: The use of personal protective equipment increased rapidly during the COVID-19 pandemic that began in 2019. The purpose of this study was to examine the effects of uninterrupted 4-hour use of internationally certified nonvalved filtering facepiece respirators on venous blood gas in health care workers during the COVID-19 pandemic. METHODS: A before-after design included venous blood gas analyses collected at the beginning of shifts before nonvalved filtering facepiece respirator had been put on and after 4-hour uninterrupted use of nonvalved filtering facepiece respirator. RESULTS: In this study, 33 volunteer health care workers took part. In terms of blood gas values, mean pCO2 values were 47.63 (SD = 5.16) before and 47.01 (SD = 5.07) after nonvalved filtering facepiece respirator use, mean HCO3 values were 23.68 (SD = 1.10) in first blood gas analysis and 24.06 (SD = 1.31) in second blood gas analysis, and no significant difference was observed between before and after the use of nonvalved filtering facepiece respirator (t = 0.67, P = .50, t = -2.0, P = .054, respectively). The only significant difference in parameters investigated between the groups was in pH levels, at pH = 7.35 (SD = 0.29) before and pH = 7.36 (SD = 0.20) after nonvalved filtering facepiece respirator use (t = -2.26, P = .03). CONCLUSION: Continuous nonvalved filtering facepiece respirator use for 4 hours was not associated with clinician impairment in blood gas and peripheral SpO2 levels during nonexertional clinical ED work.

Acute effects of the electromagnetic waves emitted by mobile phones on attention in emergency physicians.

STUDY OBJECTIVE: The purpose of this study was to investigate the acute effects of the electromagnetic waves (EMW) emitted by mobile phones on attention in emergency physicians. METHODS: This single-center, prospective, randomized, double-blinded clinical study was performed among emergency physicians in a tertiary hospital. Thirty emergency physicians were enrolled in the study. Initial d2 test was applied in the evaluation of attention and concentration of all the physicians, who were randomly assigned into one of two groups. The control group members hold mobile phones in 'off' mode to their left ears for 15min. The members of the intervention group hold mobile phones in 'on' mode to their left ears for 15min, thus exposing them to 900-1800MHz EMW. The d2 test was re-applied to both groups after this procedure. Differences in attention and concentration levels between the groups were compared. RESULTS: Difference between initial and final d2 test in total performance (TN-E, p=0.319), in total number of figures marked (TN, p=0.177), in test performance percentile (PR, p=0.619) and in attention fluctuation (FR, p=0.083) were similar between the groups. However, difference in the number of figures missed (E1 selective attention, p=0.025), difference between numbers of incorrectly marked figures (E2, p=0,018) and difference in focus levels (E, p=0.016) were significantly in favor of the intervention group. CONCLUSION: According to our study findings, the EMW emitted by mobile phones has no deleterious effect on the attention and concentration levels of emergency physicians, and even has a positive impact on selective attention levels.

A retrospective analysis of nebulized versus intravenous fentanyl for renal colic.

STUDY OBJECTIVE: To assess the effectiveness of nebulized fentanyl used for analgesia in renal colic. MATERIALS/METHODS: This research was planned as a randomized, blinded study in which prospectively collected data were analyzed retrospectively to compare nebulized and intravenous (iv) fentanyl therapies. Patients with renal colic with 'moderate' or worse pain on a four-point verbal pain score (VPS) or with pain of 20mm or above on a 100-mm visual analogue score (VAS) at time of presentation were randomized into iv fentanyl (n=62) or nebulized fentanyl (n=53) study groups. Decreases in VAS and VPS scores at 15 and 30min compared to baseline, rescue analgesia requirements and side-effects between the groups were compared. RESULTS: Both iv fentanyl and nebulized fentanyl provided effective analgesia in renal colic patients at the end of 30min. However, iv fentanyl provided more rapid and more effective analgesia than nebulized fentanyl. Patients receiving iv fentanyl had lower rescue analgesia requirements than those receiving nebulized fentanyl (37.1% vs 54.7%), although the difference was not statistically significant (p=0.058). In addition, side-effects were more common in the iv fentanyl group compared to the nebulized fentanyl group (22.1% vs 9.4%), although the difference was also not significant (p=0.058). CONCLUSION: Nebulized fentanyl provides effective analgesia in patients with renal colic. However, iv fentanyl exhibits more rapid and more powerful analgesic effects than nebulized fentanyl. Nonetheless, due to its ease of use and few potential risks and side-effects the nebulized form can be used as an alternative in renal colic.

A dangerous tradition: retrospective analysis of celebratory gunfire-related injuries in three tertiary hospitals.

BACKGROUND: Firing guns into the air during celebrations is a tradition that poses significant risks to public safety. These falling bullets, often referred to as tired bullets, can attain high velocities during their descent and have the potential to cause serious injury or death to people and animals, or significant damage to property upon impact. METHODS: This study aimed to retrospectively detect and analyze incidents of celebratory gunfire-related injuries (CGRI) that were admitted to three different hospitals in two cities in Turkey over a 10-year period from 2014 to 2023. RESULTS: Data collected from Trabzon Kanuni Training and Research Hospital, Karadeniz Technical University Faculty of Medicine Farabi Hospital, and Yeditepe University Kozyatagi Hospital revealed 48 cases of injuries attributed to celebratory gunfire. Of these cases, 64.6% involved male victims. Children aged 0-17 years were the most affected demographic, with the head, neck, and face being the most frequently injured areas. The majority of incidents occurred in rural areas. Eight cases (16.7%) resulted in fatalities. The reasons for gunfire in 43.8% of the cases could not be determined. CONCLUSION: Sociologically, gun ownership is often associated with prestige and can trigger the use of firearms in celebrations, such as weddings, in some societies. However, this tradition can result in tragic consequences worldwide. Stricter regulations and legal frameworks are necessary to prevent the use of unlicensed weapons. Collaborative efforts are crucial for effectively addressing the societal normalization of celebratory gunfire. Future prospective studies can comprehensively evaluate the incidence of CGRI and identify effective preventive strategies to safeguard public health.

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.

Diagnostic value of serum signal peptide-CUB-EGF-like domain-containing protein 1 levels in patients with acute appendicitis.

OBJECTIVE: Acute appendicitis is one of the most common surgical causes of an acute abdomen among patients admitted to the emergency room due to abdominal pain. The clinical diagnosis of acute appendicitis is usually difficult and is made by evaluating the clinical, laboratory, and radiological findings together. The aim of this study was to investigate the diagnostic potential of signal peptide-CUB-EGF-like domain-containing protein 1 as a biomarker for acute appendicitis. METHODS: A total of 67 adult patients without any comorbidities who presented to the emergency department with abdominal pain and were clinically diagnosed with acute appendicitis were included in the case group. The patients included in the study were classified into the negative appendectomy group and the acute appendicitis group according to their histopathological final diagnosis. In addition, 48 healthy volunteers without comorbidities were included in the control group. Signal peptide-CUB-EGF-like domain-containing protein 1 levels of patients and the control group were measured. RESULTS: According to postoperative histopathological examinations of the patients, 7 (10.4%) patients were diagnosed with negative appendectomy, and 60 (89.6%) patients were diagnosed with acute appendicitis. Signal peptide-CUB-EGF-like domain-containing protein 1 levels were higher in the patients with acute appendicitis than in negative appendectomy patients (p=0.012). Signal peptide-CUB-EGF-like domain-containing protein 1 levels were also higher in the case group compared to the control group (p=0.001). CONCLUSION: The admission signal peptide-CUB-EGF-like domain-containing protein 1 level was significantly higher in adults with acute appendicitis. The SCUBE1 level is a novel but promising biomarker that aids in the diagnosis of acute appendicitis.

Potential therapeutic effects of ethyl pyruvate and N-acetyl cysteine in an experimental rat model of corrosive esophageal.

BACKGROUND AND STUDY AIMS: Esophageal burns due to ingestion of corrosive substances are frequently seen in both children and adults. However, there is no standard method of treatment to prevent associated mortality and morbidity. Therefore, this study aimed to evaluate the effects of known antioxidants, namely N-acetyl cysteine and ethyl pyruvate, on esophageal damage due to sodium hydroxide-induced corrosive burns. MATERIALS AND METHODS: Thirty-five female rats were randomly assigned to five equal groups. Group 1 was the sham group, while Group 2 was the control group. Group 3 received N-acetyl cysteine, Group 4 received ethyl pyruvate, and Group 5 received both N-acetyl cysteine and ethyl pyruvate. Rats in the "burn" groups were gavage-fed with 0.2mL of 25% NaOH. All esophagi were extracted on day 4 for histopathological evaluation. RESULTS: Total histopathological damage scores were evaluated at the end of the study. Groups 3 and 5 were significantly different from the control group in terms of total histopathological scores (p = 0.001), while no significant difference was seen with Group 4. Stenosis index results in groups 3 and 5 were similar to those seen with total histopathological scores (p = 0.004). CONCLUSION: N-acetyl cysteine, alone or in combination with ethyl pyruvate, may be useful in the treatment of esophageal damage associated with corrosive substances and in achieving histopathological improvement in an experimental setting.

Diagnostic Value of Plasma Pentraxin-3 in Acute Appendicitis.

PURPOSE: To measure serum PTX3 levels in patients admitted with right lower quadrant pain to emergency department and to investigate whether this parameter will be helpful for the diagnosis of acute appendicitis. MATERIALS AND METHODS: This study was conducted with a group of 89 patients over 17 years of age who were admitted with the complaint of right lower quadrant pain to ED and had a preliminary diagnosis of acute appendicitis clinically and the control group of 31 healthy volunteers in a tertiary university hospital for 3 months. RESULTS: Median PTX3 levels were 3.28 (1.08-30.24) ng/mL in the acute appendicitis groups and 0.97 (0.34-2.62) ng/mL in the control group. A significant difference was observed between acute appendicitis groups and the control group (p < 0.05). CONCLUSION: PTX3 was found to be significantly higher in patient with acute appendicitis compared to the control group and the patients with non-specific abdominal pain. PTX3 can be used as an aid in the diagnosis of acute appendicitis.

Endoplasmic reticulum stress markers are of no value in predicting cardiopulmonary resuscitation success and survival in out-of hospital cardiac arrest: A nested case-control study.

OBJECTIVES: The purpose of this study was to determine the value of the endoplasmic reticulum (ER) stress markers glucose-regulated protein 78 (GRP78), C/EBP homologous protein (CHOP) and PERK in predicting the success of cardiopulmonary resuscitation (CPR) or post-CPR survival. MATERIALS AND METHODS: Non-traumatic out-of-hospital CA patients were included in this prospective, nested case-control study. Standard CPR and post-resuscitative care were applied. Levels of ER stress markers were measured at presentation and were investigated to determine whether they might constitute a marker predicting return of spontaneous circulation (ROSC) or sustained ROSC, and of 24-h, and 1 and 3-month survival. RESULTS: Fifty-two out of 99 non-traumatic CA patients were enrolled. ROSC was determined at a level of 25%, sustained ROSC at 23%, 24-h survival at 7%, and 1- and 3-month survival at 4.6%. No difference was determined in terms of ER stress markers between patients with and without ROSC or sustained ROSC. Only PERK levels were higher in surviving patients than non-surviving subjects in terms of 24-h survival (p = 0.01). Otherwise, no stress markers differed between surviving and non-surviving patients at any survival time point. CONCLUSION: ER stress markers are of no value in determining establishment of ROSC or sustained ROSC, success of CPR, or survival. Only PERK levels may be valuable in terms of 24-h survival.

A novel method for improving chest tube insertion skills among medical interns. Using biomaterial-covered mannequin.

OBJECTIVES: To develop a low-cost biomaterial-covered chest tube simulation model and assess its possible usefulness for developing the chest tube insertion skills among medical interns. Methods: This mannequin-based interventional study was performed in a University hospital setting. We included 63 physicians performing emergency medicine internship at the Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey, between January 2015 and March 2015. A dummy was prepared for training simulation using a display mannequin. Medical interns received instruction concerning pneumothorax and the chest tube procedure. A total of 63 medical interns participating in this interventional study were asked to insert a chest tube in a biomaterial-covered mannequin. A senior trainee scored their performance using a check list and the mean of the total scores was calculated (21 items; total score, 42). Results: The mean procedural score was 40.9 ± 1.3 of a possible 42. The maximum score of 42 was achieved by 39.7% of the medical interns, while another 33.3% achieved a score of 41. Of the participants, 85% succeeded in inserting the tube via an appropriate technique, achieving a score of 40 or more. Conclusion: Our results indicated that this model could be useful for effective training of medical interns for chest tube insertion, which is an important skill in emergency medicine. This biomaterial-covered model is inexpensive and its use can potentially be widened to improve training methods without significant financial demand.