A nationwide analysis of emergency medicine residents' CT interpretation in trauma: The Tract-EM study.

OBJECTIVE: To evaluate the accuracy and determine the factors influencing trauma CT interpretation proficiency among emergency medicine (EM) residents in Turkey through the TraCT-EM study (Interpretation of Trauma CT by EMergency Physicians). METHODS: This nationwide, multicenter, cross-sectional study was conducted in 29 academic emergency departments (EDs) from April 2023 to March 2024. A total of 401 senior EM residents participated in the study, each interpreting a standardized set of 42 trauma CT series (cranial, maxillofacial, and cervical) derived from seven patients. Interpretation accuracy was assessed, and factors predicting interpretation failure were analyzed using univariate and multivariate regression models. RESULTS: The median accuracy rate of residents was 64.9 %, with higher accuracy in normal CT findings. Using the Angoff method, 14 % of residents scored below the passing threshold. Factors associated with interpretation failure included shorter interpretation times (OR, 0.97; 95 % CI, 0.95-0.99), lower self-confidence in detecting serious pathologies (OR, 2.50; 95 % CI, 1.42-4.42), reliance on in-hospital radiology department reports (OR, 3.45; 95 % CI, 1.47-8.05), and receiving final radiology reports for CT scans (OR, 3.30; 95 % CI, 1.67-6.52), and lack of in-department training programs (OR, 2.51; 95 % CI, 1.34-4.70). CONCLUSION: The TraCT-EM study highlighted a 65 % accuracy rate for senior EM residents in trauma CT interpretation, with specific predictors of failure identified. These findings suggest a need for tailored radiology education strategies to enhance training and competency in trauma CT interpretation for EM residents. Further optimization of educational programs could address these gaps, ultimately improving patient outcomes in trauma care.

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.

Kahramanmaras-Pazarcik Earthquake 2023: Characteristics of Patients Presented to the Emergency Department of a Tertiary Hospital Far from the Region and Infection Characteristics in Hospitalized Patients.

OBJECTIVE: The aim of this study is to determine the demographic, clinical characteristics, and outcomes of the patients who applied to the emergency department (ED) of Akdeniz University Faculty of Medicine Hospital (Antalya, Türkiye) after the Kahramanmaras-Pazarcik earthquake dated February 6, 2023, as earthquake victims were included in the study. The results of the study could be a guide in terms of emergency health services and the healthy management of disasters. METHODS: The study included patients over the age of 18 who presented as earthquake victims to the ED of Akdeniz University Medical Faculty Hospital from February 6, 2023 through March 8, 2023. The demographic data of the patients, including age, gender, earthquake zone, time and manner of arrival to the ED, time under debris, length-of-stay (LOS) in the service and intensive care unit (ICU), infection rates, culture results, and mortality, were retrospectively analyzed using the hospital automation system. RESULTS: A total of 1,833 earthquake victims presented to the ED. Of these patients, 1,294 were adults and 539 were children. Services and the ICU admitted a total of 137 adult patients. In the first week, 414 (31.99%) of the patients presented to the ED, while 82 (59.85%) of the hospitalized patients were admitted.Hatay ranked first with 573 (44.28%) patients in the distribution of patients presented to the ED according to earthquake regions. In the distribution of hospitalized patients by earthquake regions, the patients requiring the most hospitalization were from the province of Hatay, with 68 (49.63%) patients.During hospital observations, the medical staff took 132 culture samples based on the positive clinic of the patient. The microorganisms detected in the culture studies were different from the flora of the hospital. The mortality at seven days was two (1.45%), and at the end of 30 days, the mortality was six (4.37%). CONCLUSIONS: The ED evaluated all affected cases, with most patients being brought by their relatives using their own means, and had low mortality rates despite presenting with fewer injuries. New environmental conditions that developed after the earthquake caused unexpected results, especially in terms of community-acquired agents.

Prospective, multicenter, Turkish out-of-hospital cardiac arrest study: TROHCA.

OBJECTIVES: There is no sufficient data to provide a clear picture of out-of-hospital cardiac arrest (OHCA) across Türkiye. This study is the first to present the prognostic outcomes of OHCA cases and the factors associated with these outcomes. MATERIALS AND METHODS: The study was conducted in a prospective, observational, multicenter design under the leadership of the Emergency Medicine Association of Turkey Resuscitation Study Group. OHCA cases aged 18 years and over who were admitted to 28 centers from Türkiye were included in the study. Survived event, return of spontaneous circulation (ROSC), survival to hospital discharge, and neurological outcome at discharge were investigated as primary outcomes. RESULTS: One thousand and three patients were included in the final analysis. 61.1% of the patients were male, and the average age was 67.0 ± 15.2. Cardiopulmonary resuscitation (CPR) was performed on 86.5% of the patients in the prehospital period by emergency medical service, and bystander CPR was performed on only 2.9% by nonhealth-care providers. As a result, the survived event rate was found to be 6.9%. The survival rate upon hospital discharge was 4.4%, with 2.7% of patients achieving a good neurological outcome upon discharge. In addition, the overall ROSC and sustained ROSC rates were 45.2% and 33.4%, respectively. In the multiple logistic regression analysis, male gender, initial shockable rhythm, a shorter prehospital duration of CPR, and the lack of CPR requirement in the emergency department were determined to be independent predictors for the survival to hospital discharge. CONCLUSION: Compared to global data, survival to hospital discharge and good neurological outcome rates appear to be lower in our study. We conclude that this result is related to low bystander CPR rates. Although not the focus of this study, inadequate postresuscitative care and intensive care support should also be discussed in this regard. It is obvious that this issue should be carefully addressed through political moves in the health and social fields.

Non-invasive ventilation in the ED: Whom, When, How?

As emergency physicians, we encounter patients suffering from either hypoxemic and/or hypercarbic respiratory problems on a daily basis. A stepwise approach to solving this problem seems logical from an emergency medicine perspective. Current literature supports the notion that NIV decreases endotracheal intubation rates and, mortality in select patient populations. The key to the success of NIV is patient cooperation and support for the care givers. In this narrative review, non-invasive ventilation (NIV) is discussed in terms of modes of delivery, interface and patient selection, as well as practical considerations.