Predictors of prolonged hospitalization in patients with mild and moderate pancreatitis presenting to the emergency department.

BACKGROUND: Patients with acute pancreatitis often present to the emergency department (ED) and usually require hospital admission. The aim of this study was to determine predictors of prolonged hospital stays in patients with mild forms of acute pancreatitis. METHODS: This retrospective cohort study was conducted in patients diagnosed in the ED with mild and moderate acute pancreatitis according to the revised Atlanta classification. Patients with available data between 2007 and 2017 were included and were divided based on their admission duration. Eight days or more was considered a long hospitalization. A multivariate logistic regression model was constructed to determine the independent predictors of prolonged hospital stays. RESULTS: Of the 485 evaluated patients, 335 were included in the analysis. Baseline characteristics, determined by vital signs and laboratory parameters, were similar between the short and long hospitalization groups. However, the long hospitalization group received more intravenous crystalloid in the ED, and this group used more diuretics and more angiotensin-converting enzyme inhibitor and angiotensin-receptor blocker (ACEI/ARB) drugs than the other group. Diuretic use was present in 8 patients (4.8%) in the short hospital length of stay group and in 26 patients (15.3%) in the long hospital length of stay group. Age, gender, ACEI/ARB use, diuretic use, total amount of intravenous crystalloid administered in the ED, aPTT, BUN, creatinine, and presence of biliary pathology were included in the multivariate analysis. Regarding the final analysis, diuretic use was an independent predictor of prolonged hospitalization (odds ratio 2.89, 95% confidence interval 1.05-8.00, p = 0.041). CONCLUSION: Diuretic use is an independent predictor of long hospitalization in patients with mild and moderate pancreatitis. Drugs affecting total volume balance may prolong hospital stays in these patients.

Role of Electrocardiographic Manifestations in Admission Decision in Patients with Chronic Obstructive Pulmonary Disease Exacerbation.

OBJECTIVE: To determine the ECG manifestations of COPD exacerbations and their roles in the decision making process in admission. STUDY DESIGN: A descriptive cross-sectional study. PLACE AND DURATION OF STUDY: Emergency Department (ED) of Kocaeli University, Turkey, from November 2016 to December 2017. METHODOLOGY: All COPD patients who presented with exacerbation symptoms and agreed to participate in the study were enrolled, and the exacerbation characteristics were recorded in the standardised charts. Patients were excluded if they refused to participate in the study, if they presented repetitively to the ED with the same presentation, and if the ECG strip at the presentation could not be obtained. A binary logistic regression model was constructed to assess the factors predicting hospital admission, including the ECG features. RESULTS: A total of 146 patients were included in the final analysis. Upon presentation, 122 patients (83.6%) exhibited sinus rhythm, 21 exhibited atrial fibrillation (14.4%), and 3 of them were multifocal atrial tachycardia and junctional rhythm. Thirty-four admitted patients (41.0%) and 22 of the discharged patients (34.9%) exhibited ST and T wave changes in their ECGs (p=0.457). No statistically significant differences were found regarding the rhythms, axes, P wave characteristics, PR interval durations, QRS interval durations, corrected QT(QTc) durations, and bundle branch block occurrences between the admitted and discharged patients. Although the QTc dispersion was more prominent in the admitted group in the univariate analysis (p=0.035), the multivariate analysis revealed that only hypoxemia, older age, increased dyspnea scores, and sputum purulence were independent predictors of hospital admission. CONCLUSION: None of the ECG findings were determined to be successful in predicting the admission needs in COPD exacerbations.

Intravenous metoclopramide in the treatment of acute migraines: A randomized, placebo-controlled trial.

OBJECTIVES: The present study aimed to evaluate the efficacy and safety of intravenous metoclopramide for acute migraine treatment. MATERIALS AND METHODS: A double-blind, randomized, parallel-group, placebo-controlled trial was carried out in an academic emergency department. After the patients were assessed for eligibility via the International Headache Society criteria for migraines, they were randomized into 10 mg intravenous metoclopramide and normal saline groups. The headache intensity was evaluated using an 11-point numeric rating scale (NRS) score. The primary outcome measure was determined as the median between-group change in the score at the 30th minute. The secondary outcome measures were rescue medication needs, adverse events, and emergency department (ED) revisits after discharge. RESULTS: A total of 148 patients were randomized into two equal groups with similar baseline characteristics, including the baseline NRS scores (8 points). The median reduction in the NRS scores at the 30th minute was 4 [interquartile range (IQR): 2-6)] in the metoclopramide group and 3 (IQR: 1-4) in the normal saline group [median difference: -1.0, 95% confidence interval (CI): -2.1 to 0.1]. No serious adverse events were observed, and the rescue medication needs were similar in both groups. CONCLUSION: No difference was found between intravenous metoclopramide and placebo regarding efficacy and safety in patients with acute migraines.