The Prognostic Accuracy of Get With The Guidelines-Heart Failure Score Alone and with Lactate Among Acute Symptomatic Heart Failure Patients: A Retrospective Cohort Study.

BACKGROUND: To evaluate the prognostic accuracy of the Get With The Guidelines-Heart Failure (GWTG-HF) score, Shock Index (SI), Modified Shock Index (MSI), and Age Shock Index (Age-SI) alone and with lactate in patients with acute symptomatic heart failure (HF). METHODS: A retrospective cohort study was conducted in the emergency department of a tertiary hospital between January 1, 2019, and December 31, 2019. Patients aged >18 years and diagnosed with acute symptomatic HF were consecutively included in the study. Patients referred from another center and missing medical records were excluded. Arrival type, vital parameters, demographic characteristics, comorbid diseases, consciousness status, laboratory results, and outcomes of the patients were recorded. The primary endpoint of the study was in-hospital mortality. RESULTS: A total of 368 patients were included in the final analysis. The in-hospital mortality rate of the patients was 7.6%. The GWTG-HF score outperformed other scores in predicting in-hospital, 24-hour, and 30-day mortality (area under the curve (AUC) = 0.807, 0.844, and 0.765, P <.001, respectively). The overall performance of the GWTG-HF score with lactate (GWTG-HF+L) was better in predicting in-hospital, 24-hour, and 30-day mortality than the original GWTG-HF score (AUC = 0.872, 0.936, and 0.801, P <.001, respectively). Adding lactate values to the SI, MSI, and Age-SI improved their overall performance for all 3 outcomes. CONCLUSION: Both the GWTG-HF and GWTG-HF+L scores have acceptable discriminatory power in patients with acute symptomatic HF. The GWTG-HF score, SI, MSI, and Age-SI can be used together with lactate to predict mortality in patients with acute HF.

The Utilization of Emergency Department and Outpatient Clinics among Evacuated Victims after the 2023 Turkey Earthquake.

BACKGROUND: After the 2023 Turkey earthquake, thousands of people evacuated to different fields. Earthquake victims still need health care in the evacuation location. This study aims to determine the emergency department (ED) and outpatient clinic utilization characteristics of the evacuated earthquake victims outside the earthquake zone and to provide suggestions for planning the health care facilities in the regions where the evacuated earthquake victims will be placed. METHODS: This retrospective, observational study was conducted in a tertiary university hospital from February 7, 2023 through February 20, 2023. All evacuated earthquake victims who presented to the study hospital were included in the study. Non-victim patients were included as the control group. Missing medical records were excluded. Demographic characteristics of the patients, outpatient clinics, International Statistical Classification of Diseases and Related Health Problems-10th Revision (ICD-10) codes, and outcomes were recorded. RESULTS: A total of 15,128 patients were included in the final analysis. Six-hundred-nine (4.0%) of the patients were evacuated victims. Three-hundred forty-six (56.8%) evacuated victims used the ED. One-hundred fifty-six (25.6%) earthquake victims were in the pediatric age group. Earthquake victims used the ED more than the control group in adult and pediatric age groups (22.5% versus 51.7% and 30.2% versus 71.8%; P <.001, respectively). Earthquake victims frequently presented to the hospital during night shifts in both age groups (P <.05). Pediatric victims were more hospitalized than the control group (4.8% versus 10.9%; P = .001). Diseases of the respiratory system were the most common emergency diagnosis of the victims in both age groups (26.5% and 57.1%, respectively). The most frequently used outpatient clinic was ophthalmology in both age groups (14.6% and 20.5%, respectively). CONCLUSIONS: Evacuated victims, especially pediatric victims, used the ED more than other outpatient clinics. Diseases of the respiratory system were the most common emergency diagnosis of the victims, and the most frequently preferred outpatient clinic was ophthalmology. The most common diseases and frequently preferred clinics should be considered in planning health care for the evacuated earthquake victims.

Prevalence and associated risk factors of post-traumatic stress disorder among survivors of the 2023 Turkey earthquake.

BACKGROUND: Earthquakes can cause psychological trauma among survivors as well as physical trauma. This study aims to determine the prevalence of post-traumatic stress disorder (PTSD) and identify associated risk factors among earthquake survivors after the 2023 Turkey earthquake. METHODS: This prospective cross-sectional study was conducted in the emergency department of a tertiary university hospital between May 6, 2023, and May 16, 2023. An online questionnaire was sent to the participants. The questionnaire form consisted of three parts. In the first part, the sociodemographic characteristics of the participants were included. In the second part, the participants were asked about their experiences with the earthquake. In the third part, the post-traumatic stress disorder checklist for the Diagnostic and Statistical Manual of Mental Disorders, which screens PTSD among the participants, was included. Participants who did not complete all the questions and had severe communication disorders were excluded. RESULTS: The prevalence of probable PTSD among the participants was 51.4% (n = 197). Age (OR: 0.96 95% CI: 0.93-99), female gender (OR: 4.54 95% CI: 2.39-8.61), being the head of the family (OR: 2.00 95% CI: 1.04-3.82), bereavement (OR: 1.71 95% CI: 1.03-2.82), lost loved ones (OR: 3.15 95% CI: 1.67-5.92), low social support (OR: 1.80 95% CI: 1.12-2.90) and receiving emergency care at the field (OR: 6.67 95% CI: 1.03-43.2) were the associated risk factors of PTSD among earthquake survivors. CONCLUSIONS: The prevalence of PTSD among survivors three months after the 2023 Turkey earthquake is over half of the survivors. Younger age, female gender, being the head of the family, bereavement, lost loved ones, low social support, and receiving emergency care in the field were the associated risk factors of PTSD among earthquake survivors. Considering survivors may visit EDs until other outpatient clinics are re-established and the high rate of PTSD, rapid psychological evaluations can be performed in emergency departments. Emergency physicians should be aware of possible risk factors and high rate of PTSD.

The prognostic value of rapid risk scores among patients with community-acquired pneumonia : A retrospective cohort study.

BACKGROUND: Community-acquired pneumonia (CAP) is a frequent reason for emergency department (ED) presentations. Various risk scores have been validated in the management of CAP and are recommended for daily practice. OBJECTIVE: The aim of the study was to evaluate the performance of the rapid risk scores (the rapid acute physiology score (RAPS), the rapid emergency medicine score (REMS), the Worthing physiological scoring system (WPS), CURB-65 and CRB-65) among patients with CAP. METHODS: This retrospective cohort study was conducted in the ED of a tertiary hospital between 1 January 2019 and 31 December 2019. Patients aged ≥ 18 years and diagnosed with CAP were included. Patients who were transferred from another center or with missing records were excluded. Demographic information, vital signs, level of consciousness, laboratory results, and outcomes were recorded. RESULTS: A total of 2057 patients were included in the final analysis. The 30-day mortality of the patients was 15.2% (n = 312). The WPS achieved the most successful results for all three outcomes, 30-day mortality, intensive care unit (ICU) admission and mechanical ventilation (MV) needs (area under the curve, AUC 0.810, 0.918, and 0.910, respectively; p < 0.001). In the prediction of mortality, RAPS, REMS, CURB-65, and CRB-65 had a moderate overall performance (AUC 0.648, 0.752, 0.778, and 0.739, respectively). In the prediction of ICU admission and MV needs, RAPS, REMS, CURB-65, and CRB-65 had moderate to good overall performance (AUC at ICU admission 0.793, 0.873, 0.829, and 0.810; AUC for MV needs 0.759, 0.892, 0.754, and 0.738, respectively). Advanced age, lower levels of mean arterial pressure and peripheral oxygen saturation, presence of active malignancy and cerebrovascular disease, and ICU admission were associated with mortality (p < 0.05). CONCLUSION: The WPS outperformed other risk scores in patients with CAP and can be used safely. The CRB-65 can be used to discriminate critically ill patients with CAP due to its high specificity. The overall performances of the scores were satisfactory for all three outcomes.

Relationships of the frailty index and geriatric trauma outcome score with mortality in geriatric trauma patients.

BACKGROUND: We aimed to determine the relationships of the trauma-specific frailty index (TSFI) and the geriatric trauma out-come score (GTOS) with 30-day mortality among geriatric trauma patients aged 65 and older. METHODS: This prospective observational study included 382 patients aged 65 years and older who were admitted to a training and research hospital due to blunt trauma. Informed consent was obtained from them and/or their relatives. In addition to patients' vital signs, information about chronic diseases and drug use was obtained on admission to the emergency service and the results of labo-ratory examinations, radiological imaging, blood replacements, length of stay in the emergency room and hospital, and mortality were recorded in case forms. Glasgow coma scale, injury severity score, GTOS, TSFI, and body mass index (BMI) values were calculated by the researchers. Outcome information was obtained from the patient and/or relatives by phone 30 days later. RESULTS: When the patients who died and those who survived were compared at the 30th day after trauma, no significant difference was found in terms of BMI or TSFI (p>0.05). It was determined that patients with a GTOS of ≥95 at admission would have higher 30-day mortality (the sensitivity was 76%, and the specificity was 72.27% (p<0.001)). When correlations were evaluated according to mortality, a correlation was found between the presence of two or more comorbid diseases and mortality (p=0.001). CONCLUSION: We think that a more reliable frailty score can be obtained using these parameters as we have determined that the TSFI as calculated at admission to the emergency department is not sufficient on its own, while the lactate, GTOS, and the length of hospital stay are also effective in mortality. We suggest that it would be appropriate to use the GTOS in long-term follow-up as well as for predictive power for mortality within 24 h.

The predictive value of modified risk scores in patients with acute exacerbation of COPD: a retrospective cohort study.

This study aims to evaluate the performance of CREWS (Chronic Respiratory Early Warning Score), S-NEWS (Salford-National Early Warning Score), qNEWS (Quick National Early Warning Score), NEWS (National Early Warning Score), and qSOFA (Quick Sequential Organ Failure Assessment) scores in predicting mortality, intensive care unit (ICU) admission and the need for mechanical ventilation (MV) of patients presented with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). This retrospective cohort study was conducted in the emergency department of a tertiary hospital between January 1 and December 31, 2019. The patients with AECOPD and aged ≥ 18 were included. Patients who were transferred from another center and whose data could not be reached were excluded. Demographic information, comorbid diseases, variables of the scores, laboratory results, and outcomes were recorded. A total of 575 consecutive patients were included. The 30-day mortality, ICU admission, and MV need rate were 5.7% (n = 33), 9.6% (n = 55), and 13.7% (n = 79), respectively. Each score had moderate-to-excellent performance in predicting MV need and ICU admission, while their performance in predicting mortality was poor. CREWS is the most successful score in predicting 30-day mortality (AUC 0.695), ICU admission (AUC 0.841), and MV need (AUC 0.924). ICU admission, age, and creatinine levels were associated with mortality (p < 0.05). All scores have better performance in predicting ICU admission and MV need than mortality. ICU admission, age, and creatinine levels may be the predictors of mortality among AECOPD patients.

COVID-19 outbreak impact on emergency trauma visits and trauma surgery in a level 3 trauma center.

BACKGROUND: This study aims to compare emergency trauma visits' severity, emergency surgical needs, and characteristics between the pandemic and pre-pandemic periods. METHODS: This retrospective observational study was conducted in a tertiary training and research hospital between 1 and 30 April 2020 (pandemic group) and compared with the previous year's same dates (pre-pandemic group). Trauma patients aged 18 and over were included in the study. Emergency Severity Index (ESI) levels, trauma surgery needs, and injury characteristics were compared. RESULTS: A total of 2097 patients (592 pandemic and 1505 pre-pandemic) were included. There was an approximately 60% reduction in total and daily visits. ESI levels 1 (0.2% vs. 1.4%) and 2 (0.8% vs. 1.9%) patients increased during pandemic period. Trauma surgery needs (1.6% vs. 2.2%), intensive care unit (ICU) admission (0.4% vs. 0.2%), and ward admission (6.3% vs. 7.9%) did not change during pandemic period. CONCLUSION: Despite the decrease in the visit frequency of adult trauma patients during the pandemic period, the needs for trauma surgery, ICU, and ward admission did not change. Trauma teams should continue their duties during the pandemic period.

Secondary traumatic stress, anxiety, and depression among emergency healthcare workers in the middle of the COVID-19 outbreak: A cross-sectional study.

BACKGROUND: This study aims to determine the secondary traumatic stress (STS), anxiety, and depression levels of the emergency healthcare workers (HCWs) and to identify the factors associated with the mental health of the emergency HCWs. METHODS: This prospective cross-sectional study was performed between April 1 and May 1, 2021. Emergency nurses and auxiliary staff who gave informed consent were included in the study. Participants who answered the questions incompletely were excluded from the study. Demographic information, working and living conditions, STS, anxiety, depression scores, and coping strategies were recorded. RESULTS: A total of 363 HCWs were included in the study. STS was detected in 261 (71.9%) of the participants, anxiety in 148 (40.8%), and depression in 203 (55.9%) participants. Vaccination against COVID-19 was not associated with STS, anxiety, and depression among emergency HCWs (p > 0.05). Having financial difficulties was the most important factor in the development of anxiety, depression, and STS (OR: 3.68 (95% CI 1.96-6.90), p < 0.001; OR: 4.36 (95% CI 2.52-7.53), p < 0.001; OR: 5.35 (95% CI 3.06-9.37), p < 0.001, respectively). We found significantly reduced levels of STS, anxiety, and depression among participants reporting coping strategies that engaging in hobbies, healthy nutrition, and reading books. CONCLUSION: High levels of STS, anxiety, and depression were determined among emergency nurses and auxiliary staff during the pandemic. Poor job satisfaction and financial difficulties were associated with the mental health of emergency HCWs. The mental health of the emergency HCWs should be evaluated regularly. In addition to professional psychological support, social and financial support should be provided as well.

Impact of COVID-19 Outbreak on Emergency Visits and Emergency Consultations: A Cross-Sectional Study.

Background This study aimed to determine the effect of the COVID-19 outbreak on emergency department (ED) visits and emergency consultations according to the triage levels indicating the patients' urgency. Methods A cross-sectional retrospective study was performed in the ED of a tertiary training and research hospital between 1 April and 31 May 2020 in Istanbul, Turkey. The daily count of emergency visits and the count of the emergency consultations during the study period were recorded. The emergency visits and consultations in the same months of the previous year (1 April-31 May 2019) were included as a control group. Results Approximately 50% reduction in ED visits and a 30% reduction in emergency consultations were detected. A significant decrease was detected in all triage levels of visits and emergency consultations (p < 0.001). Within total ED visits, a significant increase was found in the red (4.32% vs. 4.74%) and yellow (21.66% vs. 33.16%) triage levels visit rates, while the green (74.01% vs. 62.1%) level was decreased. Within total emergency consultations, anesthesiology (0.83% vs. 1.56%) and cardiology (3.17% vs. 3.75%) consultation rates increased, neurology (2.22% vs. 1.15%), orthopedics (3.53% vs. 3.01%), and ophthalmology (2.89% vs. 1.57%) consultation rates decreased, internal medicine (2.45% vs. 2.49%), and general surgery (4.46% vs. 4.64%) consultation rates did not change. Conclusions During the COVID-19 pandemic, ED visits at all triage levels decreased. While the rate of critical patient visits increased, non-emergency patient visit rates decreased. The total count of consultations decreased, while the total consultation rates increased. The management of the COVID-19 pandemic will be easier by using or developing appropriate triage scores, as well as establishing good interdisciplinary coordination.

Performance of the Pandemic Medical Early Warning Score (PMEWS), Simple Triage Scoring System (STSS) and Confusion, Uremia, Respiratory rate, Blood pressure and age ≥ 65 (CURB-65) score among patients with COVID-19 pneumonia in an emergency department triage setting: a retrospective study.

BACKGROUND: Healthcare institutions are confronted with large numbers of patient admissions during large-scale or long-term public health emergencies like pandemics. Appropriate and effective triage is needed for effective resource use. OBJECTIVES: To evaluate the effectiveness of the Pandemic Medical Early Warning Score (PMEWS), Simple Triage Scoring System (STSS) and Confusion, Uremia, Respiratory rate, Blood pressure and age ≥ 65 years (CURB-65) score in an emergency department (ED) triage setting. DESIGN AND SETTING: Retrospective study in the ED of a tertiary-care university hospital in Düzce, Turkey. METHODS: PMEWS, STSS and CURB-65 scores of patients diagnosed with COVID-19 pneumonia were calculated. Thirty-day mortality, intensive care unit (ICU) admission, mechanical ventilation (MV) need and outcomes were recorded. The predictive accuracy of the scores was assessed using receiver operating characteristic curve analysis. RESULTS: One hundred patients with COVID-19 pneumonia were included. The 30-day mortality was 6%. PMEWS, STSS and CURB-65 showed high performance for predicting 30-day mortality (area under the curve: 0.968, 0.962 and 0.942, respectively). Age > 65 years, respiratory rate > 20/minute, oxygen saturation (SpO2) < 90% and ED length of stay > 4 hours showed associations with 30-day mortality (P < 0.05). CONCLUSIONS: CURB-65, STSS and PMEWS scores are useful for predicting mortality, ICU admission and MV need among patients diagnosed with COVID-19 pneumonia. Advanced age, increased respiratory rate, low SpO2 and prolonged ED length of stay may increase mortality. Further studies are needed for developing the triage scoring systems, to ensure effective long-term use of healthcare service capacity during pandemics.

An extremely rare complication of acute pancreatitis: Intraventricular thrombus.

Acute pancreatitis is a frequent reason for emergency admission, which has seen its numbers increase over the years. This condition has systemic, local, and vascular complications. A 73-year-old male patient presented to our emergency department complaining of abdominal pain, nausea, and vomiting. During imaging, intraventricular thrombus was discovered, and following completion of diagnostic testing, he was diagnosed with acute pancreatitis. Herein, we present the first case of intraventricular thrombus related to acute pancreatitis prothrombotic process in the literature.

NEDOCS: is it really useful for detecting emergency department overcrowding today?

The Emergency Department (ED) overcrowding is an ongoing problem all over the world. The scoring systems are available for the detection of this problem. This study aims to test the applicability of the National Emergency Department Overcrowding Study (NEDOCS) scoring system, one of the scoring systems that evaluate the ED overcrowding.In this prospective observational study, the survey was applied on on-duty doctors, nurses, paramedics, intern doctors, and ward persons working in a University Adult Emergency Department and agreed to participate in the study, between certain hours during the day and the NEDOCS score was calculated simultaneously. The demographic characteristics of the on-duty staff, overcrowding of ED, and the number of the on-duty staff members were recorded in the questionnaires.During the study, 153 measurements were performed, and 3221 questionnaires were filled. The NEDOCS mean score was determined as 101.59 and the most reached result was "extremely busy but not overcrowded" (32%). The ED was rated mostly as "busy" (33.7%) by the on-duty staff. A significant difference was found between ED overcrowding and NEDOCS score. There is a significant difference between ED overcrowding and on-duty emergency nurse and intern doctor count.The NEDOCS score is not suitable for evaluating ED overcrowding. Accurate determination of the ED overcrowding is very important to avoid the negative consequences of the ED overcrowding. Increasing emergency nurse and intern doctor count will decrease ED overcrowding. Also, there is an urgent need to constitute local hospitals and also public health policies to satisfy the increasingly ED's presentations.

Novel complication of Flakka: Stevens-Johnson syndrome/Toxic epidermal necrolysis overlap.

Flakka, as the newest member of the synthetic cathinone group, is a substance with serious cardiovascular, neurological, psychiatric, infectious effects and addictive potential. There are only a few case reports and laboratory studies in the literature and there is no dermatological side effects reported yet. We present the first Stevens-Johnson syndrome/Toxic epidermal necrolysis (SJS/TEN) overlap case after Flakka use.

Changing Attitudes of Medical Students Regarding Organ Donation from a University Medical School in Turkey.

BACKGROUND Doctors have an important role in increasing the number of organ donors. This study aimed to investigate the changing attitudes of medical students regarding organ donation, from first-year medical students (FYMS) to sixth-year medical students (SYMS) at a university medical school in Turkey. MATERIAL AND METHODS One hundred first-year medical students and 100 sixth-year medical students participated in the study. A four-part questionnaire was designed for the study, with a response rate of 66.8%. RESULTS Completed study questionnaires showed that organ donation was considered by 46% of first-year medical students and 60% of sixth-year medical students, but an organ donor card was signed by only 8% and 10%, respectively. Information about organ donation had been sought, mainly from social media, by 72% of first-year medical students, and 55% of sixth-year medical students. Regarding their views on organ donation of their relatives, 78% of first-year medical students and 86% of sixth-year medical students were influenced by the opinions of their families and community. When asked about brain death, 50% of first-year medical students and 12% of sixth-year medical students believed it to be a potentially reversible condition, or were uncertain of the definition. CONCLUSIONS During six years of training in a university medical school in Turkey, there was only a slight increase in the number of students who were willing to become organ donors and there was a lack of formal education regarding organ donation. Therefore, urgent improvements are required in the education of doctors and society regarding organ donation.