Prognostic value of systemic immune-inflammation index in the diagnosis of preeclampsia.

Background: Preeclampsia is a serious complication of pregnancy with negative consequences for the mother and fetus. It was aimed to investigate whether the systemic immune inflammation index is a parameter that will facilitate the diagnosis of preeclampsia. Methods: This retrospective and single-center study included patients diagnosed with preeclampsia after admission to the emergency department and those who met the inclusion criteria. Vital parameters, demographic data, medical history, white blood cell count, platelet count, neutrophil count, systemic immune-inflammation index values, biochemical parameters, and gestational weeks were analyzed in each patient. Results: A total of 40 patients with preeclampsia (preeclampsia group) and 40 normal pregnant women (control group) were included. Laboratory tests revealed that the mean WBC, neutrophil, and lymphocyte counts were significantly higher in the preeclampsia group than in the control group, whereas the preeclampsia group had a significantly lower mean platelet count than the control group (p < 0.001). The sensitivity and specificity for the cut-off value of 758.39 × 109/L systemic immune-inflammation index in pregnant patients with preeclampsia was 77.5% and 67.5%, respectively (AUC: 0.705; 95% CI: 0.587-0.823; p = 0.002). No significant difference was observed between the mean neutrophil-to-lymphocyte ratio in preeclampsia diagnosis. Conclusion: The systemic immune-inflammation index may be used as a marker to help in establishing the diagnosis of preeclampsia. We believe that this index is an important prognostic indicator because it concurrently evaluates neutrophil and lymphocyte values-which indicate the inflammation process-and platelet count, i.e., an indicator of coagulopathy.

Evaluation of the Prognosis of Patients With Acute Respiratory Distress Syndrome at the Emergency Department Based on the Lung Ultrasound Score.

OBJECTIVES: Acute respiratory distress syndrome (ARDS) is a respiratory disease characterized by a high rate of mortality. Determining the prognosis of this disease is therefore important. Lung ultrasonography has found increased use, especially in the recent years. This study aimed to score patients diagnosed with ARDS at the emergency department using point-of-care ultrasound (POCUS)-Lung and to investigate the prognosis of patients with ARDS using a scoring system. METHODS: This study was designed as a single-center prospective study. The study was performed in patients admitted to the emergency department and were diagnosed with ARDS pursuant to the Berlin criteria for ARDS and who met the inclusion criteria. The patients underwent lung ultrasonography at the emergency department and were scored (A line: 0; B1 line: 1; B2 line: 2; and C line: 3 points) accordingly. RESULTS: The study included 100 patients with ARDS. The mortality rate was 52% in the patients in the study. The lung ultrasonography score in the mortality group (25.48 ± 3.64) was higher than that in the survivors (8.46 ± 3.61). For a cut-off value of 17.5 for the lung ultrasonography score, the sensitivity and specificity with regard to mortality indicators were 92.8% and 90.9%, respectively (the area under the curve: 0.901; 95% confidence interval: 0.945-0.985: P < .001). CONCLUSION: The findings suggested that scoring based on POCUS-Lung at the time of initial presentation at the emergency department in patients diagnosed with ARDS according to the Berlin criteria could help determine the prognosis. As POCUS-Lung proved to be an important imaging method in investigating the affected alveolar capacity, we recommend its possible use as a prognostic indicator.

Is caval index a sufficient parameter for determining and monitoring dehydration in intoxication patients?

BACKGROUND: Cases of intoxication are increasing day by day and these patients are presenting to emergency departments. These patients are usually individuals with poor self-care, inadequate oral intake, and unable to meet their own needs, and may have significant dehydration due to the agents they have taken. The caval index (CI) is a recently used index to determine fluid requirement and response. AIMS: We aimed to evaluate the success of CI in determining and monitoring dehydration in intoxication patients. METHODS: Our study was conducted prospectively in the emergency department of a single tertiary care center. A total of ninety patients were included in the study. Caval index was calculated by measuring inspiratory and expiratory inferior vena cava diameters. Caval index measurements were repeated after 2 and 4 h. RESULTS: Patients who were hospitalized, took multiple drugs, or needed inotropic agents had significantly higher caval index levels. A further increase in caval index levels was observed on second and third caval index evaluations in patients who received inotropic agents along with fluid resuscitation. Levels of systolic blood pressure recorded at admission (0. hour) showed a significant correlation with caval index and shock index. Caval index and the shock index were highly sensitive and specific at predicting mortality. CONCLUSION: In our study, we found that CI can be used as an index to assist emergency clinicians in determining and monitoring fluid requirement in cases of intoxication presenting to the emergency department.

Accuracy of the Apple Watch in measuring oxygen saturation: comparison with pulse oximetry and ABG.

BACKGROUND: Smartwatches have gained tremendous attention in recent years and have become widely accepted by patients, despite not being intended for medical diagnosis. OBJECTIVE: This study aimed to determine the accuracy of Apple Watch oxygen saturation measurement in patients with acute exacerbation of COPD by comparing it with medical-grade pulse oximetry and ABG. METHOD: This single-center, prospective, cross-sectional study involved 167 patients. Patients presenting with cardiac arrest, life-threatening symptoms, severe hypoxia, or obvious jaundice were excluded. Additionally, patients whose SpO2 measurements with the Apple Watch took more than 2 min or required eight attempts were also excluded. Vital signs were measured simultaneously using the IntelliVue MX500 monitor with the Masimo Rainbow Set pulse oximeter and the Apple Watch. Concurrently, arterial blood gas (ABG) samples were drawn. RESULTS: A strong correlation between the Apple Watch 6 and medical-grade pulse oximetry (r = 0.89, ICC = 0.940) was noted. The Bland-Altman analysis revealed a mean error of 0.458% between the Apple Watch 6 and ABG (SD: 2.78, level of agreement: - 5.912 to 4.996). The mean error between pulse oximetry and ABG (SD: 5.086, level of agreement; - 10.983 to 8.953) was 1.015%. There was a correlation between respiratory rate and the number of attempts to measure SpO2 with the Apple Watch 6 (r = 0.75, p < 0.05). CONCLUSION: Apple Watch 6 is an accurate and reliable method for measuring SpO2 levels in emergency patients who presented with acute exacerbation of COPD. However, tachypneic patients may encounter challenges due to the potential need for multiple attempts to measure their oxygen saturation.

Effect of teleconsultation on the application of thrombolytic therapy in stroke patients in the emergency department.

INTRODUCTION: Recently, telemedicine has become a widely used method worldwide for the treatment of patients with acute ischemic stroke in hospitals where neurologists are unavailable. The purpose of this study was to determine the accuracy and reliability of treatment decisions made by remote neurologists via teleconference assisted by emergency physicians in acute stroke cases and to determine whether the use of teleconsultation would lead to any delays in assessment and treatment decisions. METHODS: This single-center and prospective study was performed with 104 patients who met the inclusion criteria. Patients were concurrently assessed by a teleneurologist (TN) experienced in stroke and an on-site neurologist (OS-N). The TN performed their assessment via teleconference and assisted by an emergency physician for test results and physical examination. NIHSS (The National Institutes of Health Stroke Scale) scores, assessment times, treatment decisions by the two neurologists, and patient outcomes were recorded separately. The TN was asked to rate the quality of communication. RESULTS: Of the 104 patients in the study, 59.6% (n = 62) were men and the median age was 66 (interquartile range = 56-78) years. The median duration of assessment by the OS-N was 30 (18-45) min and the median duration of assessment by the TN was 6 (5-8) min; the duration of assessment by the TN was significantly shorter (6.56 min vs. 33.35 min; Z = 8.669; p < 0.001). The median rating assigned by the TN to the quality of teleconsultation was 5.0 (4.25-5.0) (Table 1). The NIHSS scores assigned by both neurologists showed significant correlation (p < 0.001). Analysis of the agreement between the OS-N and TN in their treatment decisions yielded a Kappa value of 74.3% for interrater agreement. CONCLUSIONS: Teleconsultation was a successful and reliable strategy in assessing patients with ischemic stroke and making decisions for IV-tPA. Moreover, patient assessment via teleconsultation was less time consuming. The results of the study are promising for the use of teleconsultation in the future.

The most practical diagnostic imaging for detecting body packers during the drug trafficking: Ultrasonography.

INTRODUCTION: Body packing is one of the most common methods used in the transboundary trafficking of illicit drugs. These drugs are packaged in capsules and taken orally or inserted into the rectum or vagina. Its diagnosis is, therefore, difficult. Methods like x-ray, ultrasonography, and computed tomography (CT) are usually used to diagnose body packers. This study aimed to evaluate the diagnostic power and feasibility of ultrasonography as a diagnostic tool in patients who have a suspicion of being body packers. METHODS: This study is designed as a prospective and single-centered case-control study in the emergency department of a training and research hospital. Cases admitted to the emergency department with suspicion of being a body packer were included in the study. The data obtained was recorded on the study form. p < 0.05 was accepted as statistically significant. RESULTS: One hundred and one patients were included in the study; 76.2% (n = 77) were male. Packages were detected in 56.5% (n = 57) of the cases. Ultrasonography was found to be significantly useful in evaluating the presence of intra-abdominal packages. Ultrasonography had 92.4% sensitivity and 97.8% specificity in evaluating the presence of packs. CONCLUSION: CT is frequently used to diagnose patients admitted to the emergency departments with suspected body packing. In our study, ultrasonography is an advantageous imaging method, given its success rate, radiation-free nature, and low cost. We have found ultrasonography to be a successful imaging modality in examining patients suspected of being body packers for the presence of packs, and it can replace CT in clinics.

Composite graft repair in distal finger injuries: emergency room or operating room?

BACKGROUND: Fingertip amputations are common injuries presenting to the emergency room. However, all amputations do not have a chance of replantation, and composite graft is among the salvage treatments in this case. This treatment is both easy to apply and economical. Our study compares the success and cost of composite grafting in the emergency and operating rooms. METHODS: Thirty-six patients who met the criteria were included in the study. The decision on the repair site was made by the sur-geon according to patient compliance and the intensity of the emergency clinic. Demographic and disease information of the patients were recorded. P<0.05 was accepted as the significance level. RESULTS: Twenty-two cases were pediatric patients. Eighteen cases of crush injuries and 22 cases were treated in the emergency room. There was no significant difference in terms of complications, need for additional intervention, and short fingers related to interventions performed in the emergency room and operating room. Interventions in the emergency department were significantly lower in cost and shorter hospitalization times. There was no significant difference in terms of patient satisfaction. CONCLUSION: Composite grafting is a simple and reliable method in fingertip injuries and gives satisfactory results in terms of patient satisfaction. In addition, composite graft application in fingertip injuries in the emergency department will both reduce the cost and prevent hospital infections that may occur due to the reduction in hospitalization.

Is optic nerve sheath diameter diagnostic in methanol intoxication?

BACKGROUND AND AIM: Methyl alcohol intoxication causes severe morbidity and mortality, especially in developing countries. Formic acid is formed as a result of methanol metabolism. Formic acid accumulation and inhibition of adenosine triphosphate synthesis result in ophthalmic issues. This study aimed to demonstrate that the optic nerve sheath diameter (ONSD) measurement is an accurate prognostic marker and can be helpful in the diagnosis of methanol intoxication. MATERIALS AND METHODS: This prospective study was conducted with 52 patients who were admitted to the emergency department after alcohol consumption and agreed to participate in the study. Age, gender, comorbid diseases, vital signs, ONSD ultrasonography measurements, hospitalization and discharge status, in-hospital mortality status, dialysis need, presence of visual impairment, blood gas parameters, respiratory status, time since alcohol intake, ethanol levels, urea levels, and creatinine levels were analyzed. RESULTS: ROC curve analysis was performed to evaluate the predictive power of ONSD to diagnose methanol intoxication. The area under the curve was 0.857 for the cut-off value of 5.05 mm (95 % CI: 0.728-0.985; p < 0.001), with a sensitivity of 80.8 % and a specificity of 100 %. In the regression analysis performed to determine the prognostic value of the parameters in estimating mortality in methanol intoxication cases, an increase in ONSD (OR: 3.619; 95 % CI: 0.057-0.199; p = 0.001), an increase in lactate levels (OR: 5.653; 95 % CI: 0.040-0.085; p < 0.001), and increased duration after alcohol intake (OR: 2558; 95 % CI: 0.004-0.034; p = 0.014) were identified as independent predictors of mortality, but pH, HCO3, and base deficit levels were not significant predictors. CONCLUSIONS: We believe that ONSD can be helpful for the differential diagnosis and prognosis of patients with suspected methanol toxicity who presented with alcohol intake.

Lactate for Predicting the Prognosis of Multi-Drug Poisoned Patients.

Background: We aimed to compare serum lactate levels of multi-drug poisoned patients to determine whether knowing the level may help emergency clinicians in predicting the patients' prognoses. Methods: The patients were divided into two groups according to the number of kinds of drugs taken (Group 1: patients took 2 kinds of drugs; Group 2: patients took 3 or more kinds of drugs). The groups' initial venous lactate levels, lactate levels before discharge, lengths of stay in the emergency department, hospitalisation units, clinics, and outcomes were recorded on the study form. These findings of the patient groups were then compared. Results: When we evaluated the first lactate levels and lengths of stay in the emergency department, we found that 72% of the patients with initial lactate levels ≥13.5 mg/dL stayed more than 12 hours in the emergency department. Twenty-five (30.86%) patients in the second group stayed ≥12 hours in the emergency department, and their mean initial serum lactate level was significantly related (p=0.02, AUC=071). The mean initial serum lactate levels of both groups were positively related with their lengths of stay in the emergency department. The mean initial lactate levels of patients who stayed ≥12 hours and those who stayed <12 hours in the second group were statistically significant, and the mean lactate level of the patients who stayed ≥12 hours in the second group was lower. Conclusions: Serum lactate levels may be helpful in determining a patient's length of stay in the emergency department in the case of multi-drug poisoning.

Humoral responses to the CoronoVac vaccine in healthcare workers.

BACKGROUND: This study aimed to assess the immunoglobulin G (IgG) antibody response rate in emergency department (ED) healthcare workers (HCWs) and potential adverse effects after CoronaVac vaccination. METHODS: All included HCWs were grouped based on the previous history of coronavirus disease 2019 (COVID-19) and the number of vaccinations. Furthermore, the IgG antibody response was evaluated based on the sex and smoking status of HCWs. Those with a cut-off index of ≥1.00 after vaccination with CoronaVac were considered to have had COVID-19 and had an adequate humoral response. RESULTS: Among 224 ED HCWs, 18% experienced the adverse effects of CoronaVac vaccine, the most prevalent being pain in the injection site. The IgG antibody response rate was 20% after the first dose of vaccine, while the response rate increased to 90% after the second dose. Female HCWs had higher IgG response rates compared with male HCWs (53.8 [15.9-147.0] vs 31.2 [4.5-124.0]). Non-smokers had higher IgG response rate compared with smokers (49.0 [11.5-160.5] vs 23.1 [7.4-98.5]). CONCLUSION: A single dose of CoronaVac does not produce a sufficient antibody response; hence, two doses are recommended. Men have a lower IgG response compared with women. Smokers had a lower IgG response rate compared with non-smokers. Therefore, it may be necessary to carefully assess the humoral responses of men and smokers when implementing a community vaccination program.

Diagnostic value of systemic immune inflammation index in acute appendicitis.

OBJECTIVE: Clinical diagnosis of acute appendicitis is often difficult and involves a synthesis of clinical, laboratory, and radiological findings. The aim of this study was to investigate whether the systemic immune inflammation index can be used as an effective parameter in the diagnosis of acute appendicitis and its reliability in the differentiation of complicated vs. non-complicated appendicitis. METHODS: The study was conducted retrospectively with patients admitted to the emergency department with abdominal pain and diagnosed with acute appendicitis. In total, 150 patients and 150 control cases were included in the study. Demographic data, medical history, white blood cell count, platelet count, neutrophil count, systemic immune inflammation index values, Alvarado score, adult appendicitis score, and pathology result of appendectomy material were retrieved from the hospital automation system and recorded in the data form. RESULTS: Neutrophil-lymphocyte ratio and systemic immune inflammation index were significantly higher, and platelet-neutrophil ratio and lymphocyte-neutrophil ratio were significantly lower in the patient group compared to the control group (p<0.001). Receiver operating characteristic analysis revealed that the sensitivity and specificity of systemic immune inflammation index with a cutoff value of 840.13 was 82 and 66.7%, respectively, for the diagnosis of acute appendicitis. Correlation analysis revealed that systemic immune inflammation index, Alvarado score, and adult appendicitis score were positively correlated, and this correlation was statistically significant. CONCLUSION: Systemic immune inflammation index may be used to promote the diagnosis of acute appendicitis and may reduce the need for radiation exposure and diagnostic imaging tests such as contrast-enhanced abdominal computed tomography. It can also be used to differentiate between complicated and non-complicated acute appendicitis cases.

Revised Trauma Score and CRAMS better predicted mortality in high-energy-trauma patients than Early-Warning Score.

BACKGROUND: Trauma is one of the common reasons for emergency department (ED) presentations. Specifically, severe-trauma patients often present with mortal complications, including traumatic shock or respiratory or multiorgan failure/dysfunction, and these situations cause high-mortality risk. Scoring systems in the triage of trauma patients can help determine the injury's severity and the patient's prognosis. AIM: In this study, we aimed to compare Early-Warning Score (EWS), Revised Trauma Score (RTS), and CRAMS to predict the severity and prognosis of damage among high-energy-trauma patients. METHODS: This retrospective study included adult high-energy-trauma patients (> 18 years of age) assessed in our emergency department (ED) from April 1, 2020, to September 31, 2020. We included a total of 177 high-energy-trauma patients in the study. We compared the effectiveness of EWS; RTS; and circulation, respiration, abdomen, motor, and speech (CRAMS) in predicting mortality. The primary outcome of this study was mortality. RESULTS: We included 67 females and 110 males with a mean age of 39.2 in our study. Of those patients, 6 died during ICU hospitalization and 104 were discharged from the ward. RTS (AUC: 0.978, CI: 0.945-0.994, p < 0.001) and CRAMS (AUC: 0.978, CI: 0.944-0.994, p < 0.001) had the same AUC values, but the AUC value of EWS (AUC: 0.966, CI: 0.927-0.987, p < 0.001) was lower. Sensitivity of EWS was 93.1 (CI: 77.2-99.2%), and sensitivity of RTS was 96.55 (CI: 82.2-99.9) and CRAMS' sensivity was 96.55% (CI: 82.2-99.9). RTS showed the highest specivity level (96.62%, CI: 92.3-98.9). CONCLUSION: In conclusion, RTS and CRAMS better predicted mortality in high-energy-trauma patients than EWS.

Accuracy of emergency physician bedside ultrasonography compared with private teleradiologist for acute appendicitis diagnosis.

BACKGROUND: Acute appendicitis (AA) is a common cause of abdominal pain resulting in admission to the emergency room. Imaging methods such as ultrasonography and CT are usually used for diagnosing acute appendicitis. Reports regarding CT scans conducted during night shifts are prepared by private teleradiologists. AIMS: The aim of this study was to compare the accuracy of point-of-care ultrasound performed by an emergency medicine specialist and private teleradiologists in the diagnosis of AA. METHODS: This study was conducted prospectively and in a single center in the emergency department of a tertiary hospital. Patients who were admitted to the study between 15.09.2020 and 15.09.2021 and were diagnosed with AA who met the study criteria were included. A total of 134 patients diagnosed with AA, who met the inclusion criteria, out of 158 operated patients were included in the study. RESULTS: In the study, 77 were male and 57 were female. The mean age of patients with histopathologically positive AA was 31 and 31.5 in negative patients. The sensitivity and specificity of POCUS performed by the emergency physician and private teleradiology for the diagnosis of AA were 78.4% and 59.3% and 58.8% and 53.1%, respectively. CONCLUSIONS: POCUS performed by an emergency medicine specialist showed a higher sensitivity for the diagnosis of AA compared with private teleradiology. Hence, POCUS is more successful in diagnosing AA than private teleradiology. In conclusion, we recommend the concurrent use of AS and POCUS in emergency departments rather than private teleradiology for the diagnosis of AA.

Humoral responses to the CoronoVac vaccine in healthcare workers

ABSTRACT Background: This study aimed to assess the immunoglobulin G (IgG) antibody response rate in emergency department (ED) healthcare workers (HCWs) and potential adverse effects after CoronaVac vaccination. Methods: All included HCWs were grouped based on the previous history of coronavirus disease 2019 (COVID-19) and the number of vaccinations. Furthermore, the IgG antibody response was evaluated based on the sex and smoking status of HCWs. Those with a cut-off index of ≥1.00 after vaccination with CoronaVac were considered to have had COVID-19 and had an adequate humoral response. Results: Among 224 ED HCWs, 18% experienced the adverse effects of CoronaVac vaccine, the most prevalent being pain in the injection site. The IgG antibody response rate was 20% after the first dose of vaccine, while the response rate increased to 90% after the second dose. Female HCWs had higher IgG response rates compared with male HCWs (53.8 [15.9-147.0] vs 31.2 [4.5-124.0]). Non-smokers had higher IgG response rate compared with smokers (49.0 [11.5-160.5] vs 23.1 [7.4-98.5]). Conclusion: A single dose of CoronaVac does not produce a sufficient antibody response; hence, two doses are recommended. Men have a lower IgG response compared with women. Smokers had a lower IgG response rate compared with non-smokers. Therefore, it may be necessary to carefully assess the humoral responses of men and smokers when implementing a community vaccination program.

Resistant Lactic Acidemia Due to Accidental Cheese Starter Culture Ingestion.

Lactic acid is the end-product of anaerobic glycolysis. It is generally believed that elevated blood lactate levels are associated with poor patient outcomes. Literature reports that lactic acidosis can be related to supplementary food intake in the pediatric age group however, in adult patients, it is not common to see lactic acidosis due to oral ingestion unless the patient has a history of short bowel syndrome or jejunoileal bypass surgery. With the current case presentation, we report an accidental cheese starter culture intake that resulted in resistant lactic acidosis with no signs of critical illnesses.

Check the diastolic blood pressure twice in aortic dissection as it is associated with prognosis.

OBJECTIVE: In this study we aimed to determine the prediction level of admission diastolic blood pressure (DBP) on the prognosis and mortality in aortic dissection patients over 65 years old and under 65 years old. METHODS: We included 72 patients in this retrospective study and study groups were divided into two groups according to 65 age. Demographic data, dissection type (Stanford A-B), DBP, systolic blood pressure (SBP), mean arteriel pressure (MAP), heart rate (/min) main complaints, preoperative length of stay, hospitalisation clinic (clinic/intensive care unit), length of hospitaliisation, complications during hospitalisation (renal failure etc..) and the outcome (death/dischargement) results were noted. Preoperative lenth of stay, hospitalisation length, outcome and complications were compared between groups according to SBP, DBP, MAP and heart rate. RESULTS: Mean blood pressure values of the Stanford type B patients over 65 years old were higher than the other group (p<0.05). Fifty percent of patients under 65 years old were discharged but this ratio was 26.9% in the elder group. DBP was positively correlated with preoperative length of stay and hospitalisation length and negatively correlated with mortality. DBP under 65 mmHg was significantly related with high mortality (p<0.05). When the age and presentation time heart rate is added to each other, the values over 142 were significantly related with high mortality (p<0.05). CONCLUSIONS: The presentation time vital signs especially the DBP may be helpful for emergency clinicians to predict the prognosis and outcome in aortic dissection patients which has high mortality ratio in patients over 65 years of age.

Comparison of high-flow oxygen treatment and standard oxygen treatment in patients with hypertensive pulmonary edema.

OBJECTIVE: The aim compares the blood gases, vital signs, mechanical ventilation requirement, and length of hospitalization in patients with hypertensive pulmonary edema treated with standard oxygen therapy (SOT) and high-flow oxygen therapy (HFOT). METHODS: This prospective observational study was conducted in patients with tachypneic, hypoxemic, hypertensive pulmonary edema. The patients' 0th, 1st, and 2nd hour blood gas results; 0th, 1st, and 2nd hour vital signs; requirement of endotracheal intubation, length of hospitalization, and the prognosis were recorded on the study form. RESULTS: A total of 112 patients were included in this study, of whom 50 underwent SOT and 62 received HFOT. The initial blood gas analysis revealed significantly lower levels of pH, PaO2, and SpO2 and significantly higher levels of PaCO2 in the HFOT group. Patients in the HFOT group had significantly higher respiratory rate and pulse rate and significantly lower SpO2 values. The recovery of vital signs was significantly better in the HFOT group (p<0.05). Similarly, follow-up results of arterial blood gas analysis were better in the HFOT group (p<0.05). Both length of stay in the emergency department (p<0.05) and length of intensive care unit hospitalization s significantly shorter in the HFOT group (p<0.05). CONCLUSION: HFOT can be much more effective in patients with hypertensive pulmonary edema than SOT as it shortens the length of stay both in the emergency service and in the intensive care unit. HFOT also provides better results in terms of blood gas analysis, heart rate, and respiratory rate in the follow-up period.

The prediction levels of emergency clinicians about the outcome of the ambulance patients and outpatients.

AIM: The increased number of emergency clinic patients causes the length of stay in the emergency department, low patient satisfaction and dismiss of real emergency patients. In this study, we aimed to determine the prediction levels of emergency clinicians according to working year on the outcome of the ambulance patients and outpatients presented to the emergency department (ED). MATERIALS & METHODS: This prospective study included patients over 18 years old. The triage of outpatients was made by a senior nurse and patients were divided into three triage categories such as green, yellow and red. Then these patients were evaluated by the emergency physician at the examination areas. Ambulance patients were directly evaluated by the emergency physician. These ambulance patients were noted as yellow or red according to triage categories. The main complaints, triage category, presentation method, vital signs, predicted outcome noted by the clinicians. RESULTS: The correct prediction levels of hospitalisation (clinic/intensive care unit) were higher in clinicians whose working year is between 6 and 10 years (p < 0.05). There was no significant difference between 6-10 year and >10 year group according to prediction level (p > 0.05). Prediction of dischargement was higher in 0-5 year group than 6-10 year (p < 0.05) and >10 year (p < 0.05) group. CONCLUSION: Experienced clinicians can make much more accurate prediction on length of stay and the prognosis of the emergency patients so crowded follow-up areas of the emergency room can be planned much more effectively.