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OBJECTIVE: To assess the prevalence of computed tomography application in out-of-hospital cardiac arrest cases during emergency department processes, its contribution to changes in patient management, and effects on hospital discharge, and its cost-effectiveness. METHODS: The retrospective study was conducted at the Izmir Bakircay University Cigli Training and Research Hospital, Izmir, Turkey, and comprised data of adult out-of-hospital cardiac arrest patients who were brought to the emergency department and survived for at least 24 hours between June 21, 2016, and December 31, 2018. Demographic variables and computed tomography results were collected and analysed. Abnormalities found in computed tomography results that could have changed patient management, discharge results, and the cost of the computed tomography were recorded. RESULTS: Of the 109 patients, 65(59.6%) were men with a mean age of 62.1±14.2 years (range: 28-95 years), and the mean age of the 44(40.3%) female patients was 69.2±15.8 years (range: 18-96 years). Overall, 74(67.9%) patients underwent computed tomography in the emergency department after resuscitation. Acute abnormalities were found in 4(3.6%) scans, and 3(2.7%) abnormal scans resulted in management changes. CONCLUSIONS: Computed tomography of out-of-hospital cardiac arrest patients in the emergency department should not be a matter of routine, and the scan, if necessary, should be done post-admission.
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Reanimación Cardiopulmonar , Servicios Médicos de Urgencia , Paro Cardíaco Extrahospitalario , Adulto , Masculino , Humanos , Femenino , Persona de Mediana Edad , Anciano , Adolescente , Adulto Joven , Anciano de 80 o más Años , Paro Cardíaco Extrahospitalario/diagnóstico por imagen , Paro Cardíaco Extrahospitalario/epidemiología , Paro Cardíaco Extrahospitalario/terapia , Estudios Retrospectivos , Análisis Costo-Beneficio , Retorno de la Circulación Espontánea , Servicio de Urgencia en Hospital , Pronóstico , TomografíaRESUMEN
Background/aim: The aim of our study was to emphasize the importance of routine bedside biliary ultrasonography (USG) for the differential diagnosis of biliary tract disorders in patients admitted with acute isolated epigastric pain. Materials and methods: Adult patients who were admitted to the emergency department with acute isolated epigastric pain were included in the study. Emergency residents (ERs) were asked whether they planned to perform biliary USG during the initial evaluation and following diagnosis/treatment (secondary evaluation) of these patients. Bedside biliary USG examinations were performed by a sonologist and a radiologist evaluated the video recordings. Results: A total of 103 patients were enrolled, 29 of whom were diagnosed with biliary tract disease (BTD). In the 29 patients diagnosed with BTD, 27 had gallstones (biliary colic, 18; acute cholecystitis, 7; acute pancreatitis, 2) and two had biliary sludge. USG was not ordered by the ERs for 44.8% of the 29 patients with a final diagnosis of BTD, 58.8% of 17 patients with normal liver function tests and BTD, and 35.3% of the 17 hospitalized patients. Conclusion: Emergency physicians should routinely use biliary USG along with clinical judgement and laboratory studies in order to rule out BTD in patients with acute isolated epigastric pain.
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Objective. Acute mesenteric ischemia (AMI) is a disease, usually seen in elderly people and accompanied by comorbid diseases. Mean platelet volume (MPV), the significant indicator of platelet activation and function, is associated with AMI. In this study, we considered that we can use MPV as a reliable indicator in the diagnosis of AMI. Methods. This study was conducted among AMI patients with two control groups. Age, gender, MPV, platelet count, concomitant diseases, abdominal computed tomography, and patient outcomes were recorded for evaluation. Control group I contained 41 healthy patients whose ages-genders were matched. Control group II contained 41 patients with no AMI, whose ages-genders-concomitant diseases were matched. Results. Of the total 41 AMI patients, 22 were female and 19 were male. The average age of them was 72.12 ± 13.2 (44-91) years. MPV was significantly increased in the AMI (p = 0.001) and control group II (p < 0.001) in comparison with healthy control groups. In the comparison of the AMI patients with their matched controls for concomitant diseases, no statistical difference was found in the MPV values. Conclusion. MPV may be used as an indicator of AMI only if the patient has no concomitant diseases. The existence of a concomitant disease brings into question the reliability of high MPV values as a suitable indicator.
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Biomarcadores/sangre , Volúmen Plaquetario Medio , Isquemia Mesentérica/sangre , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Isquemia Mesentérica/patología , Persona de Mediana EdadRESUMEN
BACKGROUND: There is no specific laboratory method for the diagnosis of acute mesenteric ischemia (AMI). In this study, we aimed to determine the efficacy of the D-dimer test in selected cases prior to multi-detector angio-CT, which is expensive and has side effects. METHODS: Patients, over 65, with abdominal pain were included in this study. The D-dimer test was applied to 230 (34%) of 676 abdominal pain patients admitted to our emergency service. The D-dimer levels of the patients diagnosed with AMI by angio-CT were compared. RESULTS: In AMI patients sensitivity of the D-dimer test was 84.6% and the specificity was 47.9%. Elevated D-dimer levels and AF were observed in 90.9% of the patients diagnosed with AMI by CT. CONCLUSION: D-dimer levels were elevated in the AMI patients. Patients suspected of having AMI with unclear clinical results and patients with D-dimer levels above 1000 ng/ml and AF should undergo further evaluation.
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Biomarcadores/sangre , Productos de Degradación de Fibrina-Fibrinógeno/metabolismo , Isquemia Mesentérica/diagnóstico , Abdomen Agudo/etiología , Anciano , Anciano de 80 o más Años , Femenino , Evaluación Geriátrica , Servicios de Salud para Ancianos , Humanos , Masculino , Isquemia Mesentérica/sangre , Isquemia Mesentérica/complicaciones , Isquemia Mesentérica/diagnóstico por imagen , Valor Predictivo de las Pruebas , Sensibilidad y Especificidad , Tomografía Computarizada por Rayos XAsunto(s)
Accidentes de Tránsito , Trastorno por Déficit de Atención con Hiperactividad/complicaciones , Accidentes de Tránsito/psicología , Adulto , Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Trastorno por Déficit de Atención con Hiperactividad/psicología , Servicio de Urgencia en Hospital , Femenino , Humanos , MasculinoRESUMEN
The objective of this study was to identify factors that affect overall satisfaction of patients admitted to the emergency department (ED). All consecutive adult patients in the ED during a 14-day period who could communicate well were enrolled into this cross-sectional analytic study. Patients' demographic data, information on care, and level of satisfaction were recorded. Patients were asked to rate specific issues concerning their satisfaction (good and excellent) on a 5-point Likert scale. Response to the survey was obtained from 1019 (91.6%) of 1113 patients for analysis during the study. Satisfaction with physician experience, physician attitude, triage, explanation of health status and treatment, and discharge instructions were found to have significant impact on satisfaction (P < .001 for each). Satisfaction with physician experience level was the most important factor affecting overall satisfaction. Patient perception of the total time spent in the ED as "short" and "very short" was not demonstrated to be significantly related to overall satisfaction (P = .162). Temporal perceptions as "long" and "very long" were shown to be significantly related to overall satisfaction (P < .001). Behavioral characteristics of the healthcare providers and the hospital itself were the factors that had the greatest impact on overall satisfaction of the ED population evaluated.