Exploring ChatGPT's abilities in medical article writing and peer review.

AIM: To evaluate the quality of ChatGPT-generated case reports and assess the ability of ChatGPT to peer review medical articles. METHODS: This study was conducted from February to April 2023. First, ChatGPT 3.0 was used to generate 15 case reports, which were then peer-reviewed by expert human reviewers. Second, ChatGPT 4.0 was employed to peer review 15 published short articles. RESULTS: ChatGPT was capable of generating case reports, but these reports exhibited inaccuracies, particularly when it came to referencing. The case reports received mixed ratings from peer reviewers, with 33.3% of professionals recommending rejection. The reports' overall merit score was 4.9±1.8 out of 10. The review capabilities of ChatGPT were weaker than its text generation abilities. The AI as a peer reviewer did not recognize major inconsistencies in articles that had undergone significant content changes. CONCLUSION: While ChatGPT demonstrated proficiency in generating case reports, there were limitations in terms of consistency and accuracy, especially in referencing.

Diagnostic accuracy of venous system ultrasound for subtypes of acute kidney injury.

BACKGROUND: Management of acute kidney injury (AKI) in the ED can be difficult due to uncertainty regarding the aetiology. This study investigated the diagnostic value of venous system ultrasound for determining the aetiological subtypes of AKI in the ED. METHODS: This multidisciplinary prospective cohort study was conducted in a single academic ED over the course of a year. Adult patients with AKI were evaluated using the venous excess ultrasound (VExUS) score, which is a four-step ultrasound protocol. The protocol begins with the inferior vena cava (IVC) measurement and examines organ flow patterns, including portal, hepatic and renal veins in the presence of dilated IVC. The AKI subtypes (hypovolaemia, cardiorenal, systemic vasodilatation and renal) were adjudicated by nephrologists and emergency physicians, considering data that became available during the hospitalisation. We determined the diagnostic test characteristics of VExUS for identifying each of the four AKI aetiological subtypes. RESULTS: 150 patients with AKI were included in the study. Hypovolaemia was the most frequent finally adjudicated cause of AKI (66%), followed by cardiorenal (18%), systemic vasodilatation (8.7%) and renal (7.3%). In diagnosing the cardiorenal subtype, the area under the curve (AUC) for VExUS grade >0 was 0.819, with 77.8% sensitivity and 80.5% specificity, and the AUC for IVC maximum diameter >20.4 mm was 0.865, with 74.1% sensitivity and 86.2% specificity. For the hypovolaemia subtype, the AUC for VExUS grade ≤0 was 0.711, with 83.8% sensitivity and 56.9% specificity, and the AUC for IVC maximum diameter ≤16.8 mm was 0.736, with 73.7% sensitivity and 68.6% specificity. None of the parameters achieved adequate test characteristics for renal and systemic vasodilatation subtypes. CONCLUSION: The VExUS score has good diagnostic accuracy for cardiorenal AKI and fair accuracy for hypovolaemic AKI but cannot identify renal and systemic vasodilatation subtypes. It should not therefore be used in isolation to determine the cause of AKI in the ED. TRIAL REGISTRATION NUMBER: NCT04948710.

The value of venous system ultrasound in predicting the need for emergency haemodialysis in haemodialysis patients.

BACKGROUND: Emergency haemodialysis (HD) is a therapeutic procedure performed in serious clinical situations. This study investigated venous Doppler ultrasound parameters for predicting emergency HD in patients on routine HD treatment for end-stage renal disease in the emergency department (ED). METHOD: Adult patients on a routine HD program in a tertiary care ED between April and December 2022 were enrolled in the study. Inferior vena cava, hepatic, and portal vein flow parameters and the venous excess ultrasound (VExUS) score calculated from these parameters were noted in order to predict emergency HD indications. Hyperkalaemia, hypervolemia, missing more than one session, uremic findings, and metabolic acidosis were regarded as emergency HD indications. RESULTS: One hundred twenty-nine venous ultrasound examinations were performed on 43 patients with routine HD during the study period. The rate of emergency HD was 30.2%. The most common indication of it was hypervolemia (76.9%), followed by missing more than one session (23.1%). Only the portal vein had an AUC value of 0.714, with a sensitivity of 61.5% and specificity of 83.3% for predicting emergency HD. Other parameters including the IVC, hepatic vein, and VExUS score were of no diagnostic value. CONCLUSION: The findings of this study show that only the portal vein Doppler flow parameter has very limited diagnostic value for emergency HD in patients on a routine HD program in the ED. This study can serve as a guide to further research.

The relationship between upper extremity functional performance and anthropometric features and the quality criteria of cardiopulmonary resuscitation.

Objectives: This study aims to examine the effect of upper extremity performance using the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST) on cardiopulmonary resuscitation (CPR) quality criteria according to the European Resuscitation Council (ERC) Guidelines for Resuscitation 2015, including chest compression rate, depth, and recoil. Patients and methods: This simulation-based study included 105 paramedic students (43 males, 62 females; median age: 19 years; range, 18 to 20 years) attending a two-year paramedic program between February 2018 and April 2018. The CKCUEST was used to determine upper extremity performance scores, including the touch number, normalized, and power score of the paramedic students. A TrueCPR® feedback device was used to measure CPR quality criteria throughout the study. The characteristics of the providers, such as height, weight, body mass index (BMI), and fat-free mass were also analyzed. Results: Adequate compression depth had a positive correlation with body fat-free mass (r=0.397, p<0.001), power score (r=0.326, p=0.001), height (r=0.326, p=0.001), weight (r=0.314, p=0.001), and BMI (r=0.204, p=0.037). Full chest recoil had a negative correlation with the power score (r=-0.249, p=0.010) and height (r=-0.219, p=0.025). None of the variables were significantly different between the groups with and without the correct compression rate. In the receiver operating characteristic curve analysis for power score and correct compression depth as 100%, the area under the curve was 0.845 (p<0.001). Conclusion: The power score combination of upper extremity functionality and the rescuer's weight is the main factor affecting chest compression depth. However, this score is negatively correlated with full chest recoil.

The characteristics of assaulted victims presented to a university emergency department: Can head trauma in male patients be considered a clue for assaults?

BACKGROUND: Violence is a common issue without an exact number worldwide. The types are interpersonal, spousal, or domestic violence. We aim to reveal the demographic characteristics of cases involving violence, mechanisms of injury, and their relationship with head and face trauma. METHODS: The files of patients presented to our University Hospital Adult Emergency Department (ED) between January 2018 and December 2020 after an assault were reviewed retrospectively. The data were analyzed with SPSS 20.0. The demographic findings, injury mechanisms, and affected areas were reported. The Chi-square test tested the differences between the groups, and p<0.05 was considered significant. RESULTS: Among the 1280 patients presented after an assault, 71% were male with a median age of 32 (IQR 25-43). In 84% of the cases, the perpetrators were unknown, while their spouses were the perpetrators in 9% of the cases. The place was most noted as home (11%). The methods used were struggling (43%) and punching (42%). The most common affected area was the head (70%) and diagnosis for nasal fracture (4%); two patients had epidural bleeding, and one had a pneumothorax. Males were more common in the 20-40 age groups (χ2, p=0.003). Most of the female victims were battered by their spouses (χ2, p<0.001). Head injury was found in 83% of patients with high blood alcohol levels (χ2, p<0.001) and 75% of male patients had head injuries (χ2, p<0.001). CONCLUSION: Assault is a common problem predominantly among young males. The most commonly affected body part was the head, and nasal fractures were the diagnosis. Most of the patients with high blood levels were among the male victims. The perpetrator of the female victims was their spouses. In the ED, male patients who presented with head trauma were considered as assault victims.

Delirium, dementia, and depression (3D) assessment of older patients in the emergency department: 5-year survival analysis.

BACKGROUND: While physicians tend to emphasize on physical medical problems, behavioral and cognitive disorders of geriatric patients are usually missed, especially in emergency settings. The aim of the study was to determine the prevalence of delirium, dementia, and depression (3D) among older patients (≥65 years old) in the Emergency Department (ED) and to evaluate the effect of geriatric 3D on the 6-month and 5-year mortality. METHODS: This was a prospective, observational cohort study, including 415 patients from eligible 512 consecutive older patients, who are 65 years of age or older, presenting to the ED of a tertiary care university hospital. Geriatric delirium, dementia, and depression were prospectively evaluated using Confusion Assessment Method, Quick Confusion Scale, and Geriatric Depression Scale-15, respectively. Premorbid functional status was determined by Barthel Index. The Charlson Comorbidity Index was used to measure the comorbid burden. After enrollment, patients were screened for 6-month and 5-year survival rates via the Government Death Reporting System records. The Kaplan-Meier method and Cox proportional hazards analysis was used for survival analysis. RESULTS: Among the study population, the prevalence of geriatric 3D was found as 10.6% (n = 44/415) for delirium, 45.6% (n = 160/351) for dementia, and 35.1% (n = 123/350) for depression. Delirium, dementia, and depression all had higher mortality rates among older ED patients covering the 5-year period. However, only delirium was predictive of both 6-month and 5-year mortality rates. DISCUSSION: Aside from the medical and surgical issues of geriatric patients, the prevalences of dementia and depression are much higher than expected in the emergency department. Delirium was a predictor for 6-month and 5-year mortality. We suggest that EDs should have screening tools for geriatric 3D mental health disorders to increase the quality of life for the geriatric population.

Accuracy of Multi-organ Point-of-Care Ultrasound for Acute Kidney Injury Etiologies.

This study investigated the diagnostic performance of point-of-care ultrasound (POCUS) for acute kidney injury (AKI) etiological subgroups in emergency department (ED) patients. Multi-organ POCUS including kidney, bladder, inferior vena cava (IVC), lung and cardiac examinations were used to identify five AKI subgroups: hypovolemia, reduced cardiac output, systemic vasodilatation and renal vasomodulation, renal and post-renal. One hundred sixty-five AKI patients were included in the study. The most diagnostic parameter in the post-renal group was the presence of any hydronephrosis, with a sensitivity of 93.3% (95% confidence interval [CI]: 68.1-99.8) and specificity of 85.9% (95% CI: 79.3-91.1). For the reduced cardiac output group, the most diagnostic parameter was IVC maximum diameter >17 mm with a sensitivity of 100% (95% CI: 83.2-100) and specificity of 70.2% (95% CI: 61.6-77.7). For the hypovolemia group, the most diagnostic parameter was IVC maximum diameter ≤17.9 mm with a sensitivity of 81.2% (95% CI: 71.2-88.8) and specificity of 56.5% (95% CI: 44-68.4). For the systemic vasodilatation and renal vasomodulation group, the most diagnostic parameter was diffuse ascites with a sensitivity of 56.3% (95% CI: 29.9-80.2) and specificity of 89.9% (95% CI: 83.8-94.2). None of the parameters were significant for the renal group. We concluded that multi-organ POCUS is of diagnostic value for AKI subgroups.

Diagnostic Accuracy of Early Systolic Notching in Pulmonary Embolism.

OBJECTIVE: Recently, a cardiac sonography finding, early systolic notching (ESN), was reported with high sensitivity and specificity for the diagnosis of pulmonary embolism (PE) in a limited population. The aim of this study was to determine the diagnostic accuracy of ESN finding for PE in emergency department (ED) patients. METHOD: This prospective multicenter study was conducted in 4 academic EDs. All patients who underwent computed tomography angiography for suspected PE were included in the study. After inclusion, cardiac ultrasound including the right ventricular outflow tract Doppler signal was performed. The diagnostic tests of ESN finding were used for PE and its subgroups. RESULTS: In the study, 183 of 201 patients met the study criteria. Of all patients, 52.5% had PE (n = 96), and 19.7% (n = 36) had ESN finding. In all ED patients, the sensitivity of ESN for PE was 34% (95% CI 25-45), and the specificity was 97% (95% CI 90-99). In the subgroup analysis, the sensitivity of ESN for PE with high or intermediate-high risk was 69% (95% CI 49-85), and the specificity was 90% (95% CI 84-94). Inter-rater reliability for ESN finding between the cardiologist and emergency physician was strong with a kappa statistic of 0.87. CONCLUSION: The pulmonary Doppler flow of ESN was moderate to high specific but low sensitive for PE in all ED patients. In the subgroup analysis, this finding was moderate specific and low sensitive.

Effects of metronome use on cardiopulmonary resuscitation quality.

OBJECTIVE: Whether the use of metronome affects the quality of cardiopulmonary resuscitation (CPR) remains unclear. In this study, we investigated the effect of metronome use on CPR quality. METHODS: This was a prospective, simulation-based CPR manikin study. There were two phases: without and with metronome use. Chest compression was performed for 2 min, and three CPR quality criteria including chest compression depth, recoil, and rate were recorded with TrueCPR Feedback Device in both phases. RESULTS: In all, 102 resident physicians were included. The achievement of optimal chest compression depth and complete recoil was better with metronome use than without (83% and 77% vs. 78% and 39%, P ≤ 0.001, respectively). Optimal chest compression rate was also reached with metronome use because the range of the compression rate was closer to the normal limits than those without metronome use (110 [interquartile range (IQR) 109-113] vs. 120 [IQR 109-129], P ≤ 0.001). Of all the participants, 70.6% stated that metronome use had a positive effect on their performance during the CPR application and 66.7% stated that they wished to use the metronome in their daily practice. CONCLUSION: Using a metronome during simulation-based CPR improved the compression depth and recoil by fixing chest compression rate. We suggested that metronome should be used in CPR trainings of health-care professionals.

The factors predicting pneumonia in COVID-19 patients: preliminary results from a university hospital in Turkey

Background/aim: Pneumonia is the most serious clinical presentation of COVID-19. This study aimed to determine the demographic, clinical, and laboratory findings that can properly predict COVID-19 pneumonia. Materials and methods: This study was conducted in the Gazi University hospital. All hospitalized patients with confirmed and suspected SARS-CoV-2 infection between 16 March 2020 and 30 April 2020 were analyzed retrospectively. COVID-19 patients were separated into two groups, pneumonia and nonpneumonia, and then compared to determine predicting factors for COVID-19 pneumonia. Variables that had a P-value of less than 0.20 and were not correlated with each other were included in the logistic regression model. Results: Of the 247 patients included in the study 58% were female, and the median age was 40. COVID-19 was confirmed in 70.9% of these patients. Among the confirmed COVID-19 cases, 21.4% had pneumonia. In the multivariate analysis male sex (P = 0.028), hypertension (P = 0.022), and shortness of breath on hospital admission (P = 0.025) were significant factors predicting COVID-19 pneumonia. Conclusion: Shortness of breath, male sex, and hypertension were significant for predicting COVID-19 pneumonia on admission. Patients with these factors should be evaluated more carefully for diagnostic procedures, such as thorax CT.

Trends in medical students' career choice of emergency medicine: A 14-year study.

INTRODUCTION: The long-term trends of medical students' choice for emergency medicine (EM) in Turkey are unclear. With this background, we aimed to determine the change in the rate of EM preferences of students over the years. METHODS: This was a cross-sectional study originated from 6th-year medical students' feedback forms, to examine trends of EM carrier preferences between 2005 and 2018 in a tertiary care academic emergency department. There are two main questions containing "would you choose EM as a specialty?" and "why?" as open-ended questions in the form. The answers to the open-ended question were classified as six main factors, which were perception of work, lifestyle, nature of work, personal job preference, mentorship/department experiences, and income. RESULTS: During the study, 2957 forms (80.6% of 3668) were completed by 6th-year medical students. Of the students, 26.5% (n = 784) responded "yes" to the question, which was "would you choose EM as a specialty?," 6.1% (n = 181) responded "do not know," and 67.4% (n = 1992) responded "no." In 2005, 15% of students stated that they would choose EM, while this rate increased to 29% in 2018 (χ 2: 9.67; P trend = 0.003). Perception of work was the most common reason for "yes" (46.3%), "no" (46%), and "do not know" answers. CONCLUSION: The rate of EM choice of medical students doubled during the study, and approximately one in three students stated that they could choose EM as their future career in the past year. Perception of work was the main factor for choosing or rejecting to EM.

The use of emergency department and outpatient clinics by Syrian refugees.

BACKGROUND: Displacement after a war or an armed conflict always leads to unexpected health problems, both among migrating people and in places to which new people have migrated. This study aimed to determine the health care needs and trends of Syrian patients. METHODS: This retrospective study was conducted in a secondary care hospital in the city of Nevsehir, in central Turkey, between January 2013 and December 2017. All Syrian patients who visited the outpatient clinics and emergency department (ED) were enrolled in the study. RESULTS: Over a span of five years, 41 723 Syrian patients visited the hospital's outpatient clinics and ED. The patients' median age was 23 (inter-quartile range (IQR) = 7-34), and 57.7% of them were female. In 2017, one-third of the Syrian patients visited the ED, a rate that was higher than that found among local patients (30.3% vs 25.0%, P < 0.001, respectively). The rate of pediatric clinic admissions among Syrian patients was about four times greater than the rate of local patients (20.1% vs 5.2%, P < 0.001, respectively), and Syrians' rate of admission to the obstetrics and gynecology clinic was about three times greater than the rate of local patients' admissions (12.3% vs 4.3%, P < 0.001, respectively). CONCLUSIONS: This study showed that Syrian patients' visits to the hospital, and especially the ED, are increasing. Further, the needs and expectations of these patients in terms of health care are different from local demands. New approaches should be applied to provide an appropriate use of health care facilities.

Revisits of forensic cases to the emergency department.

OBJECTIVE: The data of forensic cases who revisited to the emergency department (ED) more than once, remain uncertain. In this study, it was aimed that to determine characteristics of these cases and to investigate factors associated with forensic revisits. METHODS: All forensic cases who presented to emergency department of a secondary care hospital in Turkey were evaluated between July 2017 and June 2018, retrospectively. During a year study period, 7580 visits were performed by 5870 forensic cases in the ED. Characteristics of cases which were gender, age, injury patterns, number of revisits, outcomes, and total cost were noted. Factors associated with forensic revisits were identified by multivariate logistic regression analysis. RESULTS: During a year study period, 985 forensic cases had multiple ED visits (a total of 2692). Median revisit number was 2 (IQR 2-3). In logistic regression analysis, male gender (Odds ratio [OR], 1.76; 95% confidence interval [CI]: 1.47-2.10), physical assault (OR, 2.70; 95% CI: 1.40-5.20), and fall (OR, 0.21; 95% CI: 0.07-0.64) were associated with forensic revisits. Revisited group had lower hospitalization rate and hospital cost than those of non-revisited group (2.6% and 7.4%; 15.5 TL (interquartile range [IQR] 15.5-15.5) and 15.5 TL (IQR 15.5-107.8), respectively) (χ2; P < .001). CONCLUSION: One-sixth of all forensic cases revisited to the ED multiple times. Physical assault and male gender were the most important factors associated with forensic revisits in this study. Further, these revisits were often composed of simple reasons requiring less hospitalization and less cost.

Hot-Air Balloon Tour Accidents in the Cappadocia Region.

BACKGROUND: The incidence of hot-air balloon tour accidents in Turkey is not clear, as published data are scarce. This study aimed to determine the rate of such accidents, including passenger fatalities and injuries, across all flight hours and to also compare these types of accidents to those of other commercial air tour crashes.METHODS: Hot-air balloon tour accident reports in the Cappadocia region were analyzed for 1,415,943 passengers during 81,112 flight hours undertaken between August 2013 and July 2017. The flight and accident data were obtained from the Accident Investigation Board and the Directorate General of Civil Aviation.RESULTS: There were 12 accidents which occurred during the flight hours examined (a rate of 14.8 accidents per 100,000 h). There were 33 individuals seriously injured, 3 fatally in all passengers (3.7 fatalities per 100,000 h in these flights). The majority of accidents that produced serious and fatal injuries occurred during the last year of the study. The most common cause of accidents was a hard landing (58.3%). All accidents occurred during the landing phase of the flight. Seven patients experienced multiple traumas and lower extremity injuries constituted the majority of cases (N = 21).DISCUSSION: The fatality rate of commercial balloon rides was lower than that for lighter-than-air craft, which include balloons and blimps (sports aviation flights), and the crash rate of hot-air balloons was higher than those of aircraft (airplanes and helicopters) tour flights. However, there is still insufficient information in the literature to properly compare this activity with commercial motorized aircraft tours and other hot-air balloon flights.Aslaner MA. Hot-air balloon tour accidents in the Cappadocia region. Aerosp Med Hum Perform. 2019; 90(2):123-127.

Emergency medicine physicians' perspectives on subspecialty training: A national survey.

BACKGROUND: Subspecialty training (sST) is an accepted educational model for the branches that have completed the maturation period. At the end of a rapid growth and reaching its limits, we wanted to determine the emergency medicine (EM) physicians' thoughts about subspecialty training in EM in Turkey. METHOD: This is a national cross-sectional survey study conducted in November 2017. Participants were physicians who were receiving or who had completed emergency medicine education. RESULTS: The response rate was 32% (n = 607) in the study. The rate of attending physicians was 45.1%, resident physicians were 40.2%, and academic staff were 14.7%. Among all the EM physicians, 85.2% noted the need for sST, 9.6% were uncertain about the need, and 5.3% found the need unnecessary. The most frequently requested trainings were toxicology (72.5%), traumatology (71.3%), and critical care (67.4%). After sST, 48.9% of EM physicians requested to work both in the emergency department and in the other relevant department, 36.1% requested to work full-time in the emergency department, and 14.9% requested to work full-time in the other relevant department. CONCLUSION: The great majority of EM physicians believed in the need for sST in Turkey. There were two primary reasons for wanting to apply for sST: first, and most frequently, was the contribution to advanced training, and second, was avoiding problems in the daily practice of EM.

Laryngopyocele: A deep neck infection diagnosed by emergency ultrasound.

Laryngopyocele is a rare diagnosis that can cause life-threating conditions such as airway obstruction and even death. Emergency ultrasound (POCUS) can be very helpful during the diagnosis and monitoring of the illness because it is both easy to apply and repeatable. A deep neck infection was diagnosed as laryngopyocele by POCUS in the emergency department; this is the first case in the literature.

Etiologies and delirium rates of elderly ED patients with acutely altered mental status: a multicenter prospective study.

OBJECTIVES: Altered mental status (AMS) is a challenging diagnosis in older patients and has a large range of etiologies. The aim of this study was to investigate the nature of such etiologies for physicians to be better aware of AMS backgrounds and hence improve outcomes and mortality rates. METHODS: This prospective observational study was conducted at 4 emergency departments. Patients 65 years and older who presented to the emergency department with acute AMS (≤1 week), with symptoms ranging from comas and combativeness, were eligible for inclusion in this study. The outcomes, etiologies, Richmond Agitation and Sedation Scale scores, and the presence of delirium were recorded. RESULTS: Among 822 older patients with AMS, infection (39.5%) and neurological diseases (36.5%) were the most common etiologies. The hospital admission and mortality rates were 73.7% (n = 606) and 24.7% (n = 203), respectively. The mortality rate rose if AMS persisted for more than 3 days. Delirium was observed in 55.7% of the patients; these individuals had higher durations of AMS than those without delirium (median, 24 hours; interquartile range, 3-48 hours; median 6 hours, interquartile range, 3-48 hours, respectively; P = .010). Notably, delirium was observed in more than two-thirds of neurological patients. CONCLUSIONS: The most common causes of AMS were infection and neurological diseases. Delirium was associated with AMS in nearly half the patients. Moreover, the rates of hospitalization and mortality remained high.

Admissions of critically ill patients to the ED intensive care unit.

INTRODUCTION: Many emergency departments (EDs) have established units capable of providing critical care because of increasing need for critical care, called as ED intensive care unit (EDICU). However, prolonged critical care leads to crowding, resulting in poor quality of care and high mortality rates. We aimed to determine which type of critically ill patients play a main role for crowding in the EDICU, and how to manage these patients. METHOD: Patients aged older than 18 years who presented to the ED and presented for consultation to the ICU were eligible for inclusion in this study. Patients were classified into 4 priority groups by the Society of Critical Care Medicine. RESULT: Four hundred medical patients were enrolled in the study. Sixty-one patients were not admitted to hospital (15.2% of all patients) and were treated in the EDICU. These patients were older (mean age, 66.6 years) and had a higher percentage belonging to the priority 3 group (82.0%-unstable with reduced likelihood of recovery due to chronic illness) in comparison with other ICUs patients (mean age, 60.4 years and 11.9%, respectively) (P < .05). In priority 3 patients, the length of stay was median 120 hours, and also, length of invasive mechanical ventilations duration was median 19 hours in the EDICU. CONCLUSIONS: Emergency department intensive care unit occupancy appears driven by categorized as "reduced benefit" patients, and these units tend to become alternative dumping grounds for palliative care services. Hospitals and health care administrators should take special care to develop policies for improving the management of these patients.