The Effect of Out-of-Hours Admission on Mortality in Patients Who Underwent Thrombectomy Due to Ischemic Stroke.

Background: It is important to investigate the factors that may delay the diagnosis and treatment process of ischemic stroke. The aim of this study was to investigate whether in-hospital mortality increased in patients who presented to the emergency department out-of-hours and underwent thrombectomy. Methods: A total of 59 patients who applied to the emergency department between January 1, 2018 and November 1, 2021 and underwent thrombectomy due to ischemic stroke were included in the study. Patient age, gender, thrombectomy success (successful recanalization), in-hospital mortality status, intracranial hemorrhage status after thrombectomy, and out-of-hours admission status were recorded and compared according to out-of-hours admission status. Results: Twenty-seven (45.8%) patients were male, and the median age was 74 (61-81) years. Forty-two (71.2%) patients applied to the emergency department out-of-hours. In-hospital mortality occurred in 27 (45.8%) patients. There was no statistically significant difference in out-of-hours admission status between the non-survivor group and the survivor group (non-survivor: 24 [75%]; survivor: 18 [66.7%], p = 0.481). Nor was a statistically significant difference found in the intracranial hemorrhage complication rate of the patients admitted out-of-hours compared to the patients admitted during working hours (out-of-hours: 17 [40.5%]; during working hours: 6 [35.3%], p = 0.712). Conclusion: No statistically significant difference was found in the rate of in-hospital mortality and intracranial bleeding complications in patients who underwent thrombectomy out of working hours compared to during working hours.

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 Procalcitonin/Albumin Ratio and CRP/Albumin Ratio in Predicting In-hospital Mortality in COVID-19 Patients.

Background: Hospitalized coronavirus disease 2019 (COVID-19) patients have higher mortality rates. Parameters to predict mortality are needed. Therefore, we investigated the power of procalcitonin/albumin ratio (PAR) and C-reactive protein/albumin ratio (CAR) to predict in-hospital mortality in hospitalized COVID-19 patients. Methods: In this study, 855 patients were included. Patients' PAR and CAR values were recorded from the hospital information management system. The patients were evaluated in two groups according to their in-hospital mortality status. Results: In-hospital mortality was observed in 163 patients (19.1%). The median PAR and CAR values of patients in the non-survivor group were statistically significantly higher than those of patients in the survivor group, PAR (median: 0.07, interquartile range [IQR]: 0.03-0.33 vs. median: 0.02, IQR: 0.01-0.04, respectively; p < 0.001); CAR (median: 27.60, IQR: 12.49-44.91 vs. median: 7.47, IQR: 2.66-18.93, respectively; p < 0.001). The area under the curve (AUC) and odds ratio (OR) values obtained by PAR to predict in-hospital mortality were higher than the values obtained by procalcitonin, CAR, albumin, and CRP (AUCs of PAR, procalcitonin, CAR, albumin, and CRP: 0.804, 0.792, 0.762, 0.755, and 0.748, respectively; OR: PAR > 0.04, procalcitonin > 0.14, CAR > 20.59, albumin < 4.02, and CRP > 63; 8.215, 7.134, 5.842, 6.073, and 5.07, respectively). Patients with concurrent PAR > 0.04 and CAR > 20.59 had an OR of 15.681 compared to patients with concurrent PAR < 0.04 and CAR < 20.59. Conclusions: In this study, PAR was found to be more valuable for predicting in-hospital COVID-19 mortality than all other parameters. In addition, concurrent high levels of PAR and CAR were found to be more valuable than a high level of PAR or CAR alone.

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).

The initial analysis of pediatric fractures according to the AO/OTA fracture classification and mechanisms of injuries.

BACKGROUND: The epidemiology of pediatric fractures has been changing timely, in a multifactorial fashion. The aim of this study was to put forward a recent 5-year epidemiological analysis of pediatric fractures, according to the current AO/OTA fracture classification, in the current decade of action for road safety. METHODS: A total of 3261 pediatric patients who were diagnosed with at least one fracture related with orthopedics and traumatology in a level-one trauma center were included in this retrospective and epidemiological descriptive study. The patients were grouped according to their ages as follows; <2, 2-5.9, 6-9.9, and 10-17.9. The fractures were examined according to the AO/OTA classification. RESULTS: A total of 3396 fractures were present in 3261 patients. The mean age of the patients was 9.8±4.6 (1-17). The number of patients according to the age groups was as follows; 28 (0.008%), 735 (22.53%), 863 (26.47%), and 1635 (50.99%), respectively. The most frequent three fractures according to the AO/OTA fracture classification were; 23 (radius/ulna distal 22.9%), 13 (humerus distal, 13.3%), and 7 (hand/carpal, 12%). About 68.8% and 31.2% of the patients were treated non-surgically and surgically, respectively. Overall mortality rate was 0.1%. CONCLUSION: To the best of our knowledge, this study represents the first analysis of pediatric fractures according to the AO/OTA classification, over a 5-year period. As a future prospect, further multicentric epidemiological studies are warranted to constitute a sustainable action plan for the prevention of major traumas.

The Role of NEWS2 + Lactate + D-Dimer in Predicting Intensive Care Unit Admission and In-Hospital Mortality of COVID-19 Patients.

Background: We investigated the parameters of National Early Warning Score 2 (NEWS2) + lactate + D-dimer in predicting the intensive care unit (ICU) admission and in-hospital mortality in patients hospitalized with COVID-19. Methods: Patients, who applied to the emergency department of a tertiary university hospital and were taken to the COVID-19 zone with suspected COVID-19 between March 2020 and June 2020, were retrospectively examined. In this study, 244 patients, who were hospitalized and had positive polymerase chain reaction test results, were included. NEWS2, lactate, and D-dimer levels of the patients were recorded. Patients were grouped by the states of in-hospital mortality and ICU admission. Results: Of 244 patients who were included in the study, 122 (50%) were male, while their mean age was 53.76 ± 17.36 years. 28 (11.5%) patients were admitted to the ICU, while in-hospital mortality was seen in 14 (5.7%) patients. The levels of D-dimer, NEWS2, NEWS2 + lactate, NEWS2 + D-dimer, NEWS2 + lactate + D-dimer were statistically significantly higher in patients with in-hospital mortality and admitted to ICU ( p < 0.05). The area under the curve (AUC) values of D-dimer, lactate, NEWS2, NEWS2 + lactate, NEWS2 + D-dimer, NEWS2 + lactate + D-dimer in predicting ICU admission were as 0.745 (0.658-0.832), 0.589 (0.469-0.710), 0.760 (0.675-0.845), 0.774 (0.690-0.859), 0.776 (0.692-0.860), and 0.778 (0.694-0.862), respectively; while the AUC values of these parameters in predicting in-hospital mortality were found to be as 0.768 (0.671-0.865), 0.695 (0.563-0.827), 0.735 (0.634-0.836), 0.757 (0.647-0.867), 0.752 (0.656-0.848), and 0.764 (0.655-0.873), respectively. Conclusions: Compared to using the NEWS2 value alone, a combination of NEWS2, lactate, and D-dimer was found to be more valuable in predicting in-hospital mortality and ICU admission.

The epidemiology of adult fractures according to the AO/OTA fracture classification.

BACKGROUND: The epidemiology of adult fractures has been changing timely, in a multifactorial fashion. The aim of this study was to put forward a recent 5-year epidemiological analysis of adult fractures, according to the current AO/OTA fracture classification, in the current decade of action for road safety. METHODS: 5324 adult patients who were diagnosed with at least one fracture related with orthopedics and traumatology in a level-one trauma center were included in this retrospective, epidemiological descriptive study. The patients were grouped according to their ages as; 18-35, 36-55, 56-69, and ≥70. The fractures were examined according to the AO/OTA classification. RESULTS: 5865 fractures were present in 5324 patients. The mean age of the patients was 48.6±21.5. The number of patients according to the age groups was as follows; 1947 (36.6%), 1636 (30.7%), 881 (16.5%), and 860 (16.2%), respectively. The most frequent three fractures according to the AO/OTA fracture classification were; 7 (hand 19.6%), 23 (distal forearm, 12.1%), and 8 (foot, 11.8%). About 54.4% and 45.4% of the patients were treated non-surgically and surgically, respectively. About 0.2% of the patients preferred an alternative treatment. Overall mortality rate was 0.4%. CONCLUSION: To the best of our knowledge, this study represents the first analysis of adult fractures according to the AO/OTA classification, over a 5-year period. As a future prospect, further multi-centric epidemiological studies are warranted to constitute a sustainable action plan for the prevention of major traumas.

Comparison of Endotracheal Intubations Performed With Direct Laryngoscopy and Video Laryngoscopy Scenarios With and Without Compression: A Manikin-Simulated Study.

BACKGROUND: Optimal management for trauma-induced coagulopathy (TIC) is a clinical conundrum. In conjunction with the transfusion of fresh-frozen plasma (FFP), additional administration of prothrombin complex concentrate (PCC) was proposed to bring about further coagulative benefit. However, investigations evaluating the efficacy as well as corresponding side effects were scarce and inconsistent. The aim of this study was to systematically review current literature and to perform a meta-analysis comparing FFP+PCC with FFP alone. METHODS: Web search followed by manual interrogation was performed to identify relevant literatures fulfilling the following criteria, subjects as TIC patients taking no baseline anticoagulants, without underlying coagulative disorders, and reported clinical consequences. Those comparing FFP alone with PCC alone were excluded. Comprehensive Meta-analysis software was utilized, and statistical results were delineated with odd ratio (OR), mean difference (MD), and 95% confidence interval (CI). I2 was calculated to determine heterogeneity. The primary endpoint was set as all-cause mortality, while the secondary endpoint consisted of international normalized ratio (INR) correction, transfusion of blood product, and thrombosis rate. RESULTS: One hundred and sixty-four articles were included for preliminary evaluation, 3 of which were qualified for meta-analysis. A total of 840 subjects were pooled for assessment. Minimal heterogeneity was present in the comparisons (I2 < 25%). In the PCC + FFP cohort, reduced mortality rate was observed (OR: 0.631; 95% CI: 0.450-0.884, p = 0.007) after pooling. Meanwhile, INR correction time was shorter under PCC + FFP (MD: -608.300 mins, p < 0.001), whilst the rate showed no difference (p = 0.230). The PCC + FFP group is less likely to mandate transfusion of packed red blood cells (p < 0.001) and plasma (p < 0.001), but not platelet (p = 0.615). The incidence of deep vein thrombosis was comparable in the two groups (p = 0.460). CONCLUSIONS: Compared with FFP only, PCC + FFP demonstrated better survival rate, favorable clinical recovery and no elevation of thromboembolism events after TIC.

Neutrophil-to-lymphocyte ratio is a prognostic predictor in emergency department patients with cutaneous adverse drug reaction.

OBJECTIVE: We aimed to evaluate the prognostic value of neutrophil-to-lymphocyte ratio (NLR) in emergency department (ED) patients with cutaneous adverse drug reactions to identify the severe patients at an early stage. METHODS: In this retrospective study, patients aged 18 and over who admitted to the ED of a university hospital with the diagnosis of cutaneous adverse drug reaction were included. For included patients, clinical findings and ED admission complete blood count results were recorded. The primary outcome was hospitalization and the secondary outcome was the type of drug reaction. RESULTS: A total of 135 patients were included in the study. The median age of patients was 50 (36-64) years. There was no significant difference between the patients hospitalized and discharged from the ED in terms of age and gender (p = 0.340 and p = 0.762, respectively). There was no significant difference between hospitalized and discharged patients in terms of complete blood count parameters (p > 0.05, for all). The median NLR of hospitalized patients was significantly higher than that of patients discharged from the ED (6.13 vs. 3.69, p = 0.006). The median NLR of the patients with erythema multiform/Steven Johnson syndrome/toxic epidermal necrosis was significantly higher than the NLR of the patients with maculopapular and fixed drug eruptions (p = 0.022 and p = 0.015, respectively). The area under the curve value of NLR in predicting hospitalization was 0.640 (0.546-0.734). For 8.4 of NLR cutoff value, specificity was 83.9%. CONCLUSION: NLR is a useful and simple prognostic parameter as an indicator of systemic inflammatory involvement in ED patients with cutaneous adverse drug reactions. NLR is a useful parameter for deciding which patient will be admitted to the hospital in that patient group.

The role of the BUN/albumin ratio in predicting mortality in COVID-19 patients in the emergency department.

INTRODUCTION: Due to the high mortality and spread rates of coronavirus disease 2019 (COVID-19), there are currently serious challenges in emergency department management. As such, we investigated whether the blood urea nitrogen (BUN)/albumin ratio (BAR) predicts mortality in the COVID-19 patients in the emergency department. METHODS: A total of 602 COVID-19 patients who were brought to the emergency department within the period from March to September 2020 were included in the study. The BUN level, albumin level, BAR, age, gender, and in-hospital mortality status of the patients were recorded. The patients were grouped by in-hospital mortality. Statistical comparison was conducted between the groups. RESULTS: Of the patients who were included in the study, 312(51.8%) were male, and their median age was 63 years (49-73). There was in-hospital mortality in 96(15.9%) patients. The median BUN and BAR values of the patients in the non-survivor group were significantly higher than those in the survivor group (BUN: 24.76 [17.38-38.31] and 14.43 [10.84-20.42], respectively [p < 0.001]; BAR: 6.7 [4.7-10.1] and 3.4 [2.5-5.2], respectively [p < 0.001]). The mean albumin value in the non-survivor group was significantly lower than that in the survivor group (3.60 ± 0.58 and 4.13 ± 0.51, respectively; p < 0.001). The area-under-the-curve (AUC) and odds ratio values obtained by BAR to predict in-hospital COVID-19 mortality were higher than the values obtained by BUN and albumin (AUC of BAR, BUN, and albumin: 0.809, 0.771, and 0.765, respectively; odds ratio of BAR>3.9, BUN>16.05, and albumin<4.01: 10.448, 7.048, and 6.482, respectively). CONCLUSION: The BUN, albumin, and BAR levels were found to be reliable predictors of in-hospital mortality in COVID-19 patients, but BAR was found to be a more reliable predictor than the BUN and albumin levels.

Bag-Valve-Mask versus Laryngeal Mask Airway Ventilation in Cardiopulmonary Resuscitation with Continuous Compressions: A Simulation Study.

INTRODUCTION: The 2017 International Liaison Committee on Resuscitation (ILCOR) guideline recommends that Emergency Medical Service (EMS) providers can perform cardiopulmonary resuscitation (CPR) with synchronous or asynchronous ventilation until an advanced airway has been placed. In the current literature, limited data on CPR performed with continuous compressions and asynchronous ventilation with bag-valve-mask (BVM) are available. STUDY OBJECTIVE: In this study, researchers aimed to compare the effectiveness of asynchronous BVM and laryngeal mask airway (LMA) ventilation during CPR with continuous chest compressions. METHODS: Emergency medicine residents and interns were included in the study. The participants were randomly assigned to resuscitation teams with two rescuers. The cross-over simulation study was conducted on two CPR scenarios: asynchronous ventilation via BVM during a continuous chest compression and asynchronous ventilation via LMA during a continuous chest compression in cardiac arrest patient with asystole. The primary endpoints were the ventilation-related measurements. RESULTS: A total of 92 volunteers were included in the study and 46 CPRs were performed in each group. The mean rate of ventilations of the LMA group was significantly higher than that of the BVM group (13.7 [11.7-15.7] versus 8.9 [7.5-10.3] breaths/minute; P <.001). The mean volume of ventilations of the LMA group was significantly higher than that of the BVM group (358.4 [342.3-374.4] ml versus 321.5 [303.9-339.0] ml; P = .002). The mean minute ventilation volume of the LMA group was significantly higher than that of the BVM group (4.88 [4.15-5.61] versus 2.99 [2.41-3.57] L/minute; P <.001). Ventilations exceeding the maximum volume limit occurred in two (4.3%) CPRs in the BVM group and in 11 (23.9%) CPRs in the LMA group (P = .008). CONCLUSION: The results of this study show that asynchronous BVM ventilation with continuous chest compressions is a reliable and effective strategy during CPR under simulation conditions. The clinical impact of these findings in actual cardiac arrest patients should be evaluated with further studies at real-life scenes.

NLR and CRP to albumin ratio as a predictor of in-hospital mortality in the geriatric ED patients.

INTRODUCTION: We aimed to investigate the role of neutrophil to lymphocyte ratio (NLR) and the C-Reactive Protein/Albumin Ratio (CAR), which are obtained from the first laboratory values of the elderly patients at admission to the emergency department (ED), in predicting in-hospital mortality. METHODS: This retrospective observational study includes the patients aged 65 and above who applied to the emergency department for two months. The patients' neutrophil, lymphocyte, C-reactive protein (CRP), albumin, NLR and CAR values were recorded. Statistical analysis of NLR and CAR values was performed according to in-hospital mortality and ED outcome. RESULTS: 784 patients were included in the statistical analysis of the study. Increased NLR (8.82 (4.16-16.63), 4.76 (2.62-8.56), p˂0.001) and increased CAR (21.39 (6.02-55.07), 4.82 (1.17-17.03), p < 0.001) values were found to be statistically significant in the group with mortality compared to the group without mortality. Increased NLR (AUC: 0.642) and increased CAR (AUC: 0.723) were a predictor of in-hospital mortality. It was found that in-hospital mortality risk in patients with concurrent high NLR and CAR values (CAR˃12.3, NLR˃7.1) was 9.87 times more than the patients with concurrent low NLR and CAR values (CAR<12.3, NLR < 7.1). NLR and CAR values of the patients hospitalized in intensive care and service (NLR 7.21 (4.07-13.36), 5.77 (3.45-11.22); CAR 12.65 (2.79-36.8), 9.56 (1.74-33.97)) were found to be statistically significantly higher than those who were discharged (NLR 3.64 (2.26-7.02); CAR 2.88 (0.9-10.59)). CONCLUSION: According to our results, the concurrent high levels of NLR and CAR values were found to be more effective in predicting in-hospital mortality compared to a separate evaluation.

Blood urea nitrogen to albumin ratio is a predictor of in-hospital mortality in older emergency department patients.

INTRODUCTION: In this study, we aimed to evaluate the first measured blood urea nitrogen (BUN)/albumin ratio in the emergency department (ED) as a predictor of in-hospital mortality in older ED patients. METHODS: This retrospective observational study was conducted at a university hospital ED. Consecutive patients aged 65 and over who visited the ED in a three-month period were included in the study. The BUN, albumin, creatinine, and estimated glomerular filtration rate (eGFR) of patients were recorded. The primary end point of the study was in-hospital mortality. RESULTS: A total of 1253 patients were included in the statistical analyses of the study. Non-survivors had increased BUN levels (32.9 (23.3-55.4) vs. 20.2 (15.4-28.3) mg/dL, p < 0.001), decreased albumin levels (3.27 (2.74-3.75) vs. 3.96 (3.52-4.25) g/dL, p < 0.001), and increased BUN/albumin ratios (10.19 (6.56-18.94) vs. 5.21 (3.88-7.72) mg/g, p < 0.001) compared to survivors. An increased BUN/albumin ratio was a powerful predictor of in-hospital mortality with an area under the curve of 0.793 (95% CI: 0.753-0.833). Malignancy (OR: 2.39; 95% CI: 1.59-3.74, p < 0.001), albumin level < 3.5 g/dL (OR: 2.75; 95% CI: 1.74-4.36, p < 0.001), and BUN/albumin ratio > 6.25 (OR: 2.82; 95% CI: 1.22-6.50, p < 0.015) were found to be independent predictors of in-hospital mortality in older ED patients. CONCLUSION: According to our findings, older patients with a BUN level > 23 mg/dL, an albumin level < 3.5 g/dL, and a BUN/albumin ratio > 6.25 mg/g in the ED have a higher risk of in-hospital mortality. Additionally, the BUN/albumin ratio is a more powerful independent predictor of in-hospital mortality than the BUN level, albumin level, creatinine level, and eGFR in older ED patients.

Is There a Difference Between the Readabilities of Informed Consent Forms Used for Elective and Emergency Procedures in Turkey?

BACKGROUND: Informed consent is an important aspect of ethical medical practice. In legal terms, making an intervention without informed consent may mean negligence or malpractice and may lead to legal action, maltreatment, and even attack against the doctor. This study aims to evaluate the readability of informed consent forms (ICFs) used for elective (urology and general surgery) and emergency procedures (emergency medicine and intensive care) by comparing through readability formulas. METHOD: Elective and emergency ICFs were accessed through the web sites of national health care associations. A total of 387 consent forms were evaluated and the same forms were included only once. A total of 35 consent forms were evaluated for emergency procedures, while a total of 55 consent forms were evaluated for elective procedures. Atesman and Bezirci-Yilmaz formulas defined for determining the readability level of Turkish texts and Gunning fog and Flesch Kincaid formulas measuring the general readability level were used for calculating the readability level of consent forms. RESULTS: Even though elective ICFs are more readable compared to those of emergency procedures according to Bezirci-Yilmaz formulas, this was statistically insignificant ([Formula: see text]). The readability of elective consent forms was found to be at a significantly more difficult level to read compared to Atesman, Gunning fog, and Flesch Kincaid formulas ([Formula: see text], [Formula: see text], [Formula: see text], respectively). CONCLUSION: Even though the procedure is emergency or elective, a difficult readability level may cause problems for the doctor in legal phases. Readable and understandable consent forms should be available to be able to explain morbidity and mortality and improve prognosis. Education level of our country should also be considered while preparing these consent forms.

Seasonal variations of patients presenting dyspnea to emergency departments in Europe: Results from the EURODEM Study

Background/aim: To describe seasonal variations in epidemiology, management, and short-term outcomes of patients in Europe presenting to an emergency department (ED) with a main complaint of dyspnea. Materials and methods: Anobservational prospective cohort study was performed in 66 European EDs which included consecutive patients presenting to EDs with dyspnea as the main complaint during 3 72-h study periods. Data were collected on demographics, comorbidities, chronic treatment, prehospital treatment, mode of arrival of patient to ED, clinical signs at admission, treatment in the ED, ED diagnosis, discharge from ED, and in-hospital outcome. Results: The study included 2524 patients with a median age of 69 (53­80) years old. Of the patients presented, 991 (39.3%) were in autumn, 849 (33.6%) were in spring, and 48 (27.1%) were in winter. The winter population was significantly older (P < 0.001) and had a lower rate of ambulance arrival to ED (P < 0.001). In the winter period, there was a higher rate for lower respiratory tract infection (35.1%), and patients were more hypertensive, more hypoxic, and more hyper/hypothermic compared to other seasons. The ED mortality was about 1% and, in hospital, mortality for admitted patients was 7.4%. Conclusion: The analytic method and the outcome of this study may help to guide the allocation of ED resources more efficiently and to recommend seasonal ED management protocols based on the seasonal trend of dyspneic patients.

Lactate and NEWS-L are fair predictors of mortality in critically ill geriatric emergency department patients.

INTRODUCTION: In this study, we aimed to investigate the prognostic power of the first lactate level measured in the emergency department (ED), National Early Warning Score (NEWS), and NEWS-lactate (NEWS-L) on ED admission in critically ill geriatric patients. METHODS: This retrospective observational study was conducted in the ED of a university hospital. Consecutive patients ≥65 years of age admitted to our ED between July 1, 2017, and December 31, 2017, and transferred to the intensive care unit after the ED follow-up period were included in the study. The predictive performances of lactate, NEWS, and NEWS-L in terms of in-hospital mortality were compared. RESULTS: A total of 455 patients were included in the statistical analyses. The in-hospital mortality rate was 22.9%. The mean lactate, NEWS, and NEWS-L of non-survivors was significantly higher than those of survivors (2.9 ±â€¯2.2 vs. 1.9 ±â€¯1.5 mmol/L, 8.9 ±â€¯4.1 vs. 6.1 ±â€¯3.7, and 11.8 ±â€¯5.0 vs. 8.1 ±â€¯4.4, respectively, for all p < 0.001). The AUCs of the lactate, NEWS, and NEWS-L were respectively 0.654 (95% CI 0.594-0.713), 0.686 (95% CI 0.628-0.744), and 0.714 (95% CI 0.658-0.770) in predicting in-hospital mortality. CONCLUSIONS: According to the results of this study, we conclude that ED admission lactate level and NEWS are low-accuracy predictors of in-hospital mortality in critically ill geriatric patients. Although the combination of lactate level with physiological parameters increases the predictive performances of both parameters, NEWS-L is still not a powerful predictor to make definitive clinical decisions for critically ill geriatric ED patients.

Presenting symptoms of older emergency department patients: a single-center experience of 10,692 patients in Turkey.

Objective: In this study, we aimed: (1) to evaluate the presenting symptoms of older emergency department (ED) patients within a 12-month period, (2) to compare the differences in presenting symptoms between three age groups, and (3) to evaluate the seasonal variations in the presenting symptoms. Methods: This retrospective single-centered observational study was conducted at the ED of a university hospital in older ED patients with yellow and red triage code. Consecutive patients aged 65 and older admitted to ED in the study period were included in the study. Results: In our study, 14.0% of all ED admissions were patients aged 65 and older. The mean age of 10,692 patients was 75.3 ± 7.3 years, and 49.2% of them were male. The most common presenting symptoms to ED were dyspnea (18.5%), abdominal pain (12.4%), and chest pain (8.3%). Whereas 6,352 (59.4%) patients had been discharged from the ED (to home), 4,305 (40.3%) were hospitalized. Falls became the third rank presenting symptom in patients aged 85 and older. The hospital admission rate increased from 35% to 53% by age, and the in-hospital mortality rate of patients aged 85 and older was higher than that of the other age groups (p < 0.001). Conclusion: ED physicians should be aware of the common medical problems and life-threatening conditions of older patients. Morbidity and mortality rates increase by age and those patients may need different management strategies and an increased number of resources.

How successful is "pleural sound sign" in the identification of pneumothorax?

OBJECTIVE: In the present study, in thorax ultrasonography (USG) Doppler images obtained from cases with occult pneumothorax, we investigated the status of pulsatile pleural sounds over the pleural line and called these as the pleural sound sign (PSS). The purpose of the present study was to identify the efficacy of the proposed PSS in diagnosing pneumothorax and to compare it with the other USG findings including the sliding lung sign (SLS) and seashore sign (SSS). METHODS: The present study included 66 consecutive patients who were referred to the emergency unit with a blunt trauma from October 2009 to January 2010 at a tertiary university hospital. RESULTS: Of the 66 patients, 34 were in the patient group, and 32 were in the control group. Males accounted for 66.7% (n=44) of the study population. In predicting pneumothorax, the areas under receiver operating characteristic (ROC) curves of PSSmax and PSSdifference were 0.989 and 0.990, respectively. While the sensitivity of the SLS was 88% and the sensitivity of the SSS was 56%, the specificities of the SLS and SSS were 100%. Based on our findings, accuracy ranking was as follows: PSSmax = PSSdifference > SLS > SSS. CONCLUSION: New applications of thorax USG are rapidly growing. Our findings have to be confirmed in a large patient series. PSS is not a novel method, but it enhanced the importance of USG in the diagnosis of pneumothorax. We can stipulate that it can replace thorax computed tomography imaging particularly for the diagnosis of occult pneumothoraxes.

The role of heparin-binding protein in the diagnosis of acute mesenteric ischemia.

BACKGROUND: Acute mesenteric ischemia (AMI) is associated with a high mortality rate, yet diagnostic difficulties persist. Although many biomarkers have been investigated for diagnostic purposes, as well as imaging methods, a sufficiently specific and sensitive marker has not been identified. This research was designed to examine whether heparin-binding protein (HBP), which has a role in the early phase of inflammation, could be useful in the diagnosis of AMI. METHODS: Serum samples obtained from a previously performed rabbit model of AMI were used in the study. HBP, C-reactive protein (CRP) and interleukin 6 (IL-6) levels were measured in blood samples obtained at baseline and 1, 3, and 6 hours from subjects that were separated into 3 groups: control, sham, and ischemia. The change in each marker over time and comparisons of the groups were evaluated statistically. RESULTS: A significant difference was not detected at the first hour in any of the studied markers. At the third hour, the CRP and IL-6 levels in the ischemia group indicated a significant increase in comparison with the control and sham groups (p<0.001). The HBP values showed a significant increase at the sixth hour in the ischemia group in comparison with the others (p<0.001). CONCLUSION: The HBP level demonstrated a slower increase in a rabbit model of AMI compared with CRP and IL-6. However, it still has the potential to become an early diagnostic biomarker. Diagnostic sensitivity and specificity should be evaluated in further clinical trials.

The role of soluble urokinase plasminogen activator receptor (SuPAR) as an indicator of the severity of acute pancreatitis

Background/aim: Soluble urokinase plasminogen activator receptor (suPAR) has been reported to have a positive correlation with the activation degree of the immune system. This study's aim is to investigate the efficiency of SuPAR serum levels in acute pancreatitis (AP) patients in determining the severity of disease. Materials and methods: This prospective research involves patients who arrived at the emergency service, were over 18 years old, had nontraumatic abdominal pain and diagnosis of AP, and agreed to join the study. Demographic characteristics, contact information, laboratory and imaging test parameters, Ranson's criteria, the Balthazar Severity Index, the Rapid Acute Physiologic Score (RAPS), and the modified Glasgow (Imrie) score of all patients were recorded. Two study groups were created as score of <3 (mild, Group I) and ≥3 (severe, Group II) for pancreatitis according to Ranson's criteria. Results: During the study period, 59 sequential patients with AP were included in the study. It was seen that 79.7% of the study group (n = 47) were in Group I. Etiologically 67.8% (n = 40) cases were biliary and 32.3% (n = 19) were nonbiliary diseases. According to the results, suPAR level was effective in distinguishing the severity of AP (AUC = 0.902, P < 0.001 (95% CI: 0.821­0.984)). With regard to determining severe disease, suPAR had an optimum cutoff value of 6.815 ng/mL, sensitivity of 91.66%, specificity of 82.97%, and negative predictive value of 97.5%. Conclusion: Our study was performed the determine the efficiency of suPAR level in predicting severe disease in AP patients. We found it significant in indicating the severity of disease according to the study results.