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.

An Evaluation of the National Early Warning Score 2 and the Laboratory Data Decision Tree Early Warning Score in Predicting Mortality in Geriatric Patients.

BACKGROUND: Due to the high rate of geriatric patient visits, scoring systems are needed to predict increasing mortality rates. OBJECTIVE: In this study, we aimed to investigate the in-hospital mortality prediction power of the National Early Warning Score 2 (NEWS2) and the Laboratory Data Decision Tree Early Warning Score (LDT-EWS), which consists of frequently performed laboratory parameters. METHODS: We retrospectively analyzed 651 geriatric patients who visited the emergency department (ED), were not discharged on the same day from ED, and were hospitalized. The patients were categorized according to their in-hospital mortality status. The NEWS2 and LDT-EWS values of these patients were calculated and compared on the basis of deceased and living patients. RESULTS: Median (interquartile range [IQR]) NEWS2 and LDT-EWS values of the 127 patients who died were found to be statistically significantly higher than those of the patients who survived (NEWS2: 5 [3-8] vs. 3 [1-5]; p < 0.001; LDT-EWS: 8 [7-10] vs. 6 [5-8]; p < 0.001). In the receiver operating characteristic curve analysis, the NEWS2, LDT-EWS, and NEWS2+LDT-EWS-formed by the sum of the two scoring systems-resulted in 0.717, 0.705, and 0.775 area under curve values, respectively. CONCLUSIONS: The NEWS2 and LDT-EWS were found to be valuable for predicting in-hospital mortality in geriatric patients. The power of the NEWS2 to predict in-hospital mortality increased when used with the LDT-EWS.

The role of the neutrophil-lymphocyte ratio in the diagnosis of cerebral venous sinus thrombosis.

OBJECTIVES: We aimed to assist in the diagnosis of cerebral venous sinus thrombosis (CVST) with the neutrophil-lymphocyte ratio (NLR). BACKGROUND: Diagnosis of CVST is difficult. METHODS: Patients, who visited the emergency department between March 1, 2013 and March 1, 2021 and underwent magnetic resonance (MR) venography were included. The patients' MR venography results, ages, gender, NLR, were collected. The patients were categorized according to their CVST diagnosis status, and NLR were compared. RESULTS: Of the 530 patients included in the study, 366 (69.1 %) were female, and the median age was 40 (31-58) years. CVST was detected in 57 (10.8 %) patients, no pathological diagnosis was detected in 251 (47.4 %) patients. The median NLR of the patients with CVST was statistically significantly higher than in the patients without CVST and in the patients without any diagnosis ((3.94 [2.5-6.47] vs 3.03 [1.93-5.43], p = 0.023) (3.94 [2.5-6.47] vs 2.92 [1.86-4.95], p = 0.009). In the ROC analysis performed with reference to the patients without any diagnosis, NLR obtained 0.612 AUC. CONCLUSION: Significantly higher NLR levels were found in CVST patients compared to the patients, who were not diagnosed with CVST and the patients without any diagnosis (Tab. 5, Fig. 2, Ref. 22).