A retrospective study of CT scan utilization in the emergency department for patients presenting with seizures.

BACKGROUND/AIM: The indications for neuroimaging in emergency department (ED) patients presenting with seizures have not been clearly defined. In this study, we aimed to investigate the findings that may influence the emergency management of patients with seizures undergoing brain computed tomography (CT) and the factors that influence these findings. MATERIAL AND METHODS: This is a retrospective, single-center study. Patients presenting to the ED with seizures-both patients with diagnosed epilepsy and patients with first-time seizures-who underwent brain CT were included. Demographic information and indications for CT scans were recorded. According to the CT findings, patients were classified as having or not having significant pathology, and comparisons were made. Intracranial mass, intraparenchymal, subdural, and subarachnoid hemorrhage, fracture, and cerebral edema were considered significant pathologies. RESULTS: This study included 404 patients. The most common reason for a CT scan was head trauma. A significant pathology was found on the CT scan in 5.4% of the patients. A regression analysis showed that hypertension, malignancy, and a prolonged postictal state were the predictive factors for significant pathology on CT. CONCLUSION: CT scanning of patients presenting to the ED with seizures has a limited impact on emergency patient management. Clinical decision-making guidelines for emergency CT scanning of patients with seizures need to be reviewed and improved to identify zero/near-zero risk patients for whom imaging can be deferred.

The effect of follow-up blood cultures on mortality and antibiotic use in gram-negative bloodstream infections.

BACKGROUND: Gram-negative bloodstream infections (GN-BSIs) are a significant clinical challenge. The utility of follow-up blood cultures (FUBCs) in GN-BSIs and their impact on mortality and antibiotic consumption are areas of debate. This study aimed to evaluate the effect of FUBCs on mortality and antibiotic consumption in patients with GN-BSIs. METHODS: This single-center, retrospective study was conducted in aged > 18 years of patients with GN-BSIs. FUBC was defined as a blood culture performed 2-7 days after the first blood culture. Patients were grouped as FUBC and no FUBC and compared. A 1:1 match analysis was performed between the groups according to the SOFA score. The matched subgroup was compared for mortality risk factors with logistic regression models. The two groups were compared for the duration of effective antibiotic therapy and total antibiotic consumption (days of therapy per 1000 patient days (DOT/1000 PD)). RESULTS: FUBC was performed in 564 (69.4%) of 812 patients. Persistent, positive and negative FUBC rates were 7.9%, 14%, and 78%, respectively. The frequency of persistent GN-BSI in patients with appropriate antibiotic therapy was 3.9%. SOFA score (OR:1.33; 95% CI, 1.23-1.44), Charlson comorbidity index score (OR:1.18; 95% CI, 1.08-1.28), hospital-acquired infections (OR:1.93; 95% CI, 1.08-3.46) and carbapenem-resistant GN-BSI (OR: 2.92; 95% CI, 1.72-4.96) were independent risk factors for mortality. No relationship was found between FUBC and mortality (p > 0.05). Duration of effective antibiotic therapy (10(4-16) vs. 15(9-20), p < 0.001) and DOT/1000 PD (1609 (1000-2178) vs. 2000 (1294-2769), p < 0.001) were longer in the FUBC group. CONCLUSION: Routine FUBC should not be recommended because of the low prevalence of persistent infections in patients under appropriate antibiotic therapy and FUBC increases antibiotic consumption.

The effect of patient weight on the success of converting sinus rhythm in patients with PSVT treated with standard dose adenosine.

PURPOSE: The study aimed to investigate whether there is a difference in the amount of adenosine per kilogram (mg/kg) between the patient groups that can and cannot be converted to sinus rhythm (SR) with adenosine therapy in patients with supraventricular tachycardia (SVT). MATERIAL AND METHOD: This single-centered, retrospectively designed study was conducted in the ED of a training and research hospital between December 1, 2019 and December 1, 2022 on patients who were admitted to the ED with SVT diagnosis and treated with a 6-12-18 mg adenosine protocol. The main analyses were carried out in three stages. The first analysis was performed considering the first 6 mg dose of adenosine administered. The second analysis was performed by considering the 12 mg adenosine administered as the second dose because it did not respond to the first dose. Finally, the third analysis was performed by considering the 18 mg adenosine administered as the third dose because it did not respond to preciously dosages. The primary outcome variable was determined to be converting SR and created two groups according to this; the success SR group and the failure SR group. RESULTS: During the study period, 73 patients who were admitted to the ED with PSVT diagnosis and treated with intravenous adenosine were included. After the first 6 mg of adenosine treatment was administered to all 73 patients, SR was achieved in only 38% of patients. The mean adenosine dose (mg/kg) was significantly lower in the failure SR group, 0.07373 ± 0.014, compared with 0.08885 ± 0.017 mg/kg in the success SR group (mean difference with 95% CI: -0.01511 [-0.023 to -0.0071]; p < 0.001). In the second and third stage analyses, considering 12 and 18 mg adenosine doses, when the administrations with successful and failed SR were compared, no difference was found in terms of the applied adenosine doses per kilogram. CONCLUSION: This study suggest that the success of terminating SVT with the first 6 mg dose of adenosine appears to be dependent on patient weight. In patients given larger doses of adenosine, determinants of PSVT termination success may be factors other than patient weight.

The Role of Brain CT in Patients with Out-of-Hospital Cardiac Arrest with Return of Spontaneous Circulation.

BACKGROUND AND AIM: The diagnosis and treatment process after resuscitation of patients with spontaneous return of circulation (ROSC) after cardiac arrest is important. There is no clear recommendation on utilization of computerized tomography (CT) of the brain in patients with ROSC. In this study, it was aimed to diagnosis the pathology detection rates in the brain tomography of out-of-hospital cardiac arrest (OHCA) patients with ROSC after resuscitation in the emergency department and the effect of these pathologies on treatment management. MATERIALS AND METHODS: 131 patients who were admitted to the Emergency Medicine Clinic with cardiac arrest between 08.05.2019 and 07.12.2020, had ROSC after resuscitation and underwent brain CT in the first 24 h were included in the study. The patients were divided into two groups; those with clinically significant pathology in brain CT who underwent treatment changes and those without clinically significant pathology. All data recorded in the study form were analyzed using IBM SPSS 20.0 (Chicago, IL, USA) statistics program. P < 0.005 value was considered statistically significant. RESULTS: 51.1% (67) of the patients were women. The age median value was 73 (IQR25-IQR75;63-83). The most common comorbidity in patients was hypertension with 42% (55). Patients with clinically significant pathology observed in brain tomography studied after ROSC were 12.2% (16) of all patients. The most common management changes were requesting a consultation from the neurology department (n = 9) and adding a new drug to the treatment (n= 5) The 30-day and 1-year mortality rates showed no significant difference between the two groups (p > 0.05). CONCLUSION: We have seen that the data obtained from the CT studied in the early period after the ROSC was achieved, did not change the management of our patients x in the early and late periods after resuscitation. We conclude that it is not necessary to have a brain CT scan in the emergency department in the early period.

The prognostic role of neopterin in COVID-19 patients.

In Coronavirus disease-2019 (COVID-19) cases, hyper inflammation is associated with the severity of the disease. High levels of circulating cytokines were reported in severe COVID-19 patients. Neopterin produced by macrophages on stimulation with interferon-gamma, which is an important cytokine in the antiviral immune response, hence it can be used to predict the severity of disease in COVID-19 cases. In this study, it was aimed to determine the prognostic value of the neopterin for the prediction of severe disease in patients with COVID-19. This single-center, prospective study was conducted in hospitalized COVID-19 patients and healthy volunteers. Severe and mild COVID-19 cases were compared in terms of clinical and laboratory findings as well as serum neopterin levels on hospital admission. To assess the prognostic utility of neopterin between the severe and mild COVID-19 groups, a receiver-operating characteristic (ROC) curve was generated, and the area under the curve (AUC) was calculated. The median serum neopterin level was four times higher in COVID-19 patients than the healthy controls (46 vs. 12 nmol/L; p < .001). The AUC value of serum neopterin was 0.914 (95% confidence interval, 0.85-0.97). The sensitivity and specificity of serum neopterin for the cut-off value of 90 nmol/L to identify severe COVID-19 cases were 100% and 76%, respectively. Serum neopterin levels on hospitalization were significantly higher in severe COVID-19 disease than mild COVID-19 patients. Neopterin levels can be used as an early prognostic biomarker for COVID-19 on admission.

Effects of spinal immobilization at 20° on end-tidal carbon dioxide.

OBJECTIVE: The aim was to determine the effect on end-tidal carbon dioxide (ETCO2) of spinal immobilization (SI) at a conventional 0° angle and to investigate the usefulness of immobilization at a 20° angle for preventing possible hypoventilation. METHODS: The study included 80 healthy volunteers, randomly divided into two groups. Spinal backboards and cervical collars were applied in Group 1 using a 0° angle and in Group 2 using a 20° angle, with the head up. SI was continued for 1 h, and ETCO2 values were measured at the 0th, 30th and 60th minute. RESULTS: There were no significant differences between the groups in 0th and 30th minute ETCO2. However, after 60th minute, results showed a statistically significant increase in ETCO2 in Group 1 (35.5 mmHg [IQR 25-75:35-38]) compared to Group 2 (34 mmHg [IQR 25-75:33-36]) (p < 0.001). During SI, there was a statistically significant increase in ETCO2 in Group 1 (35 mmHg [IQR 25-75:34-36], 35.5 mmHg [IQR 25-75:34-37] and 36 mmHg [IQR 25-75:35-38] respectively at the 0th, 30th and 60th minute after SI) (p < 0.001) and no change in Group 2. Also, we found statistically significant differences between ΔETCO2 levels in Groups 1 and 2 at all 3 time intervals. CONCLUSION: Conventional SI with an angle of 0° led to an increase in ETCO2 while subjects immobilization at a 20° angle maintained their initial ETCO2 values. Immobilization at 20° may prevent decompensation in patients who have thoracic trauma or lung diseases or those who are elderly, pregnant, or obese.

Effects of 20-degree spinal immobilization on respiratory functions in otherwise healthy volunteers with android-type obesity.

AIM: The aim of the study was to assess whether spinal immobilization with long back board (LBB) and semi-rigid cervical collar (CC) at 20° instead of 0° conserves pulmonary functions in obese volunteers, including forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio. METHODS: The study included adult volunteer subjects with android-type obesity who were otherwise healthy. First, pulmonary functions were tested in a seated position to obtain baseline levels, than volunteers were immobilized with LBB and CC at 0-degree and measurements repeated at 0th and 30th minute of immobilization. Next day, same procedures were repeated with the trauma board at 20-degree. Changes over time in FEV1, FVC values and FEV1/FVC ratios during spinal immobilization at 0° and 20° were compared to baseline levels. RESULTS: Study included 30 volunteers. Results showed a significant decline in all values for both situations following spinal immobilization (p < .001). We also compared the decrease over time in those values (ΔFEV1, ΔFVC, and ΔFEV1/FVC ratio) during spinal immobilization at 0° and 20°. The decrease in pulmonary functions was similar in both groups (p > .05). CONCLUSION: The present findings confirm that spinal immobilization reduces pulmonary functions in obese volunteers, and that 20-degree immobilization has no conservative effect on these values when compared to the traditional 0-degree immobilization. It may be that 20° is insufficient to decrease the negative effect of abdominal obesity on pulmonary functions.

Predictive value of capnography for severity of acute gastroenteritis in the emergency department.

OBJECTIVE: This study first aims to assess the utility of ETCO2 levels in evaluating the severity of dehydration in adult patients that present to the ED with acute gastroenteritis. AGE. Second, it intends to evaluate the correlation between ETCO2 and several metabolic parameters: creatinine, pH, bicarbonate (HCO3), and bases excessive (BE). METHOD: This prospective study was conducted with AGE patients in the ED of a training and research hospital between June 2018 and April 2019 after approval of the local ethical-committee. The two groups were defined according to the severity of AGE: mild and non-mild groups. For both groups, ETCO2 levels were measured and recorded on admission of the patients. RESULTS: 87 patients were included in the analyses. The median of ETCO2 values was found as lower in non-mild group than mild group; 30 (25-35) & 39 (33-34), respectively (p < 0.001). In ROC analysis for distinguishing between the both groups, the AUC value was found to be 0.988 and the best cut-off level was found as 33.5 with 95% sensitivity and 93% specificity. In addition, strong negative correlation between ETCO2 and creatinine (p < 0.001, r: -0.771) were found. CONCLUSION: ETCO2 levels decreased in the non-mild group of AGE patients; it could be useful to distinguish the mild group from the non-mild group. ETCO2 could be a reliable marker in predicting AKI in the management of AGE patients.

The effects of spinal immobilization at 20° on intracranial pressure.

OBJECTIVE: In this study, it was aimed to evaluate whether spinal immobilization at 20°, instead of the traditional 0°, affects intracranial pressure (ICP) via the ultrasonographic (USG) measurement of optic nerve sheath diameter (ONSD). METHODS: 140 healthy, adult, non-smoking volunteers who had no acute or chronic diseases were included this study. Volunteers were randomly divided into two groups; performed spinal immobilization at 0° (Group 1) and at 20° (Group 2). After spinal immobilization (at 0 or 20°), measurements of ONSD were performed at 0, 30, and 60 min in an immobilized position. RESULTS: When evaluating the change in ONSD over time (at 30 and 60 min) as compared to basal measurements at 0 min, it was found that the ONSD values of both sides (the right and left eyes) were significantly increased in Group 1 and Group 2. For Groups 1 and 2, these differences existed both between 0 and 30 min and between 30 and 60 min. In addition, in this study, the amounts of increase in the ONSD measurements from 0 to 30 min and from 30 to 60 min (ΔONSD0-30 min and ΔONSD30-60 min) in both groups were compared. The results showed that there was no significant difference between Group 1 and Group 2 in terms of ΔONSD measurements. CONCLUSIONS: Spinal immobilization at 0° as a part of routine trauma management increased ONSD and thus ICP. Secondly, we found that similar to immobilization at 0°, spinal immobilization at 20° increased ONSD.

Association of trans-myocardial repolarisation parameters with size of the diffusion limitation area in acute ischaemic stroke.

OBJECTIVES: This study aimed to evaluate the relationship between transmyocardial repolarisation parameters and the size of the diffusion limitation area measured using diffusion weighted magnetic resonance imaging (DWMRI) in patients diagnosed with ischaemic stroke without known cardiac diseases. MATERIAL AND METHODS: The study was a prospective, observational clinical study. Patients without cardiac disease with acute ischaemic stroke were included in the study. Electrocardiography (ECG) was received from the patients. P, QT, QTc and Tp-e dispersions were calculated. All the patients had computerised brain tomography (CT) and then DWMRI carried out so as to calculate infarct areas. RESULTS: Seventy ischaemic stroke patients and 30 control patients were included in the study. All parameters except for QTc dispersion (p = 0.88) were higher in the stroke group than in the control group (p < 0.05 for all values). The infarct area calculated with DWMRI was divided into four groups according to quartiles, and QT, QTc, P, and Tp-e dispersions of patients were evaluated. Patients were found to have a prolonged dispersion as the infarct area expanded, and this difference was statistically significant (p < 0.05 for all values). CONCLUSIONS: When we compared the patients with ischaemic stroke who had no known cardiac disease to those in the control group we found an increase in transmyocardial repolarisation parameters. As diffusion limitation areas grew larger, QT, QTc, P, and Tp-e dispersions increased. Physicians should be aware of dysrhythmias and sudden cardiac death in acute stroke and should observe these patients, especially those with larger stroke lesions.

Analyses of demographical and injury characteristics of adult and pediatric patients injured in Syrian civil war.

PURPOSE: Aimed to analyze demographical data and injury characteristics of patients who were injured in the Syrian Civil War (SCW) and to define differences in injury characteristics between adult and pediatric patients. METHODOLOGY: Patients who were injured in the SCW and transferred to our emergency department were retrospectively analyzed in this study during the 15-month period between July 2013 and October 2014. RESULTS: During the study period, 1591 patients who were the victims of the SCW and admitted to our emergency department due to war injury enrolled in the study. Of these patients, 285 were children (18%). The median of the injury severity score was 16 (interquartile range [IQR]: 9-25) in all patients. The most frequent mechanism of injury was blunt trauma (899 cases, 55%), and the most frequently-injured region of the body was the head (676 cases, 42.5%). Head injury rates among the children's group were higher than those of the adult group (P < .001). In contrast, injury rates for the abdomen and extremities in the children's group were lower than those in the adult group (P < .001, P < .001). CONCLUSION: The majority of patients were adults, and the most frequent mechanism of injury was blunt trauma. Similarly, the children were substantially affected by war. Although the injury severity score values and mortality rates of the child and adult groups were similar, it was determined that the number of head injuries was higher, but the number of abdomen and extremity injuries was lower in the children's group than in the adult group.

Comparing the success rates of standard and modified Valsalva maneuvers to terminate PSVT: A randomized controlled trial.

PURPOSE: The study aimed to detect whether modified Valsalva maneuver (VM) is more effective than the standard VM in terminating paroxysmal supraventricular tachycardia (PSVT). METHODOLOGY: This randomized controlled trial was conducted in the emergency department of a training and research hospital between Dec. 1, 2015 and Dec. 31, 2016. Participants were divided into two groups, randomly assigned standard VM or modified VM, as the first treatment with two-dimensional permutation blocks; in the order of arrival of the patients. In both groups; the determined procedure for standard or modified VM was repeated up to three times in patients whose PSVT did not convert to sinus rhythm. In both groups; if the maneuver was unsuccessful after three attempts, anti-arrhythmic medication was administered. The primary outcome was defined to compare the success rate of achieving sinus rhythm after standard VM or modified VM. RESULTS: Fifty-six patients were randomized to modified or standard VM with 28 patients in each treatment arm. Three of 28 patients (10.7%) in VM group and 12 of 28 patients (42.9%) in modified VM group were returned to sinus rhythm after intervention (p=0.007). The number of patients who needed rescue treatment was lower in the modified VM group - 16 (57.1%) of 28 versus 25 (89.3%) of 28 in the standard VM group (p=0.007). CONCLUSION: This study suggests that modified VM therapy was more effective than standard VM for terminating PSVT. The modified VM therapy also indirectly reduced the need for anti-arrhythmic medication and indirectly caused fewer side effects.

Value of Leucine-rich alpha-2-glycoprotein-1 (LRG-1) on diagnosis of acute appendicitis in female patients with right lower-quadrant abdominal pain.

OBJECTIVE: To assess the diagnostic usefulness of leucine-rich alpha-2-glycoprotein-1 in female patients with acute abdominal pain on right lower-quadrant and acute appendicitis. METHODS: The prospective, cross-sectional study was conducted at the emergency department of Kecioren Training and Research Hospital, Ankara, Turkey, during a two-month period in 2014, and comprised patients with acute abdominal pain in right lower-quadrant, and control subjects. Female patients aged 18-60 years who were admitted to the hospital's emergency department were included. The control group consisted of healthy females without acute or chronic diseases. Venous blood was obtained from all the subjects to measure leucine-rich alpha-2-glycoprotein-1. RESULTS: Of the 160 participants, 80(50%) were patients and 80(50%) were control subjects. The mean value of leucine-rich alpha-2-glycoprotein-1 level in the patient and control groups were 6.78±2.21mg/ml and 6.59±2.37mg/ml, respectively (p>0.05). Among the cases, 32(40%) patients were diagnosed with acute appendicitis, whereas 48(60%) with non-acute appendicitis. The mean leucine-rich alpha-2-glycoprotein-1level was 6.96±2.76mg/ml in patients diagnosed with acute appendicitis, and 6.66±1.78mg/ml in those diagnosed with non-acute appendicitis (p>0.05). CONCLUSIONS: Plasma leucine-rich alpha-2-glycoprotein-1 levels were not useful in diagnosing acute appendicitis in female patients with acute abdominal pain in right lower-quadrant.

Evaluating ECG and carboxyhemoglobin changes due to smoking narghile.

PURPOSE: This study aimed to investigate whether increased carboxyhemoglobin (COHB) levels and ECG changes, which associated with fatal ventricular dysrhythmias, including increased QT, P-wave and T peak (Tp)-Tend (Te) dispersion, can be detected after smoking narghile, which is a traditional method of smoking tobacco that is smoked from hookah device. MATERIALS AND METHODS: After local ethics committee approval, this prospective study was conducted using healthy volunteer subjects at a "narghile café," which is used by people smoking narghile in an open area. Before beginning to smoke narghile, all subjects' 12-lead electrocardiographs (ECG), measurements of COHB levels, and vital signs were recorded. After smoking narghile for 30 min, the recording of the 12-lead ECGs and the measurements of COHB level and all vital signs were repeated. RESULTS: The mean age of subjects was 26.8 ± 6.2 years (min-max: 18-40), and 28 subjects (84.8%) were male. Before smoking narghile, the median value of subjects' COHB levels was 1.3% (min-max: 0-6), whereas after smoking, the median value of COHB was 23.7% (min-max: 6-44), a statistically significant increase (p < 0.001). Analysis of the subjects' ECG changes after smoking narghile showed that dispersions of QT, QTc, P-wave and Tp-Te were increased, and all changes were statistically significant (p < 0.001 for all parameters). CONCLUSION: Although, especially among young people, it is commonly thought that smoking narghile has less harmful or toxic effects than other tobacco products. The results of this study and past studies clearly demonstrated that smoking narghile can cause several ECG changes - including increased QT, P-wave and Tp-Te dispersion - which can be associated with ventricular dysrhythmias.

Effects of spinal immobilization at 20° on respiratory functions.

PURPOSE: The purpose of the study is to investigate whether spinal immobilization with a long backboard (LBB) and semirigid cervical collar (CC) at 20° instead of 0° conserve pulmonary functions, including forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio. METHODOLOGY: The study included 56 adult healthy volunteers. Volunteers were randomly divided into 2 groups, and those in the first group (group 1) had LBBs and CCs applied at 0° (n=30), whereas volunteers in the second group (group 2) had LBBs and CCs applied at 20° (n=26). All volunteers were given pulmonary function tests, which included FEV1 and FVC levels and FEV1/FVC ratios, while in the sitting position. Measurements were repeated at 0, 5, and 30 minutes. RESULTS: Results showed significant decreases in FEV1 and FVC values and FEV1/FVC ratios in group 1 and significant decreases in FEV1 values and FEV1/FVC ratios in group 2 (P<.001). However, FVC values were not decreased in group 2 when compared to basal levels taken while in a sitting position (P=.45). In addition, the study evaluated the amounts of decrease in the FEV1 and FVC levels and the FEV1/FVC ratios (ΔFEV1, ΔFVC, and ΔFEV1/FVC ratio). Results showed that ΔFEV1 values compared to basal levels and levels at 0, 5, and 30 minutes were all lower in group 2 than in group 1. However, ΔFEV1/FVC ratios were similar in both groups. CONCLUSION: The results of this and previous studies have shown that traditional spinal immobilization decreases respiratory function, whereas using spinal immobilization at 20° can reduce this decrease in function.

The effects of Ramadan fasting on the number of renal colic visits to the emergency department.

OBJECTIVE: The effects of fluid and diet restriction strictly during the long hours in Ramadan on the number of colic visits and biochemical factors of stone formation are controversial in the literature. The aim of this study was to assess the effects of Ramadan fasting on the number of renal colic visits and laboratory results of patients with renal colic. METHODS: This was a prospective observational study, which was conducted with patients who were admitted to our emergency department with renal colic. The study period was divided into two parts: Before Ramadan and Ramadan. All laboratory results of patients and daily air temperature values were recorded. p<0.05 was considered statistically significant for all tests. RESULTS: Total 176 patients (n:89 in before Ramadan, n:87 in Ramadan) with renal colic were enrolled into the study. During Ramadan, 49 (73.1%) of 67 patients were admitted in the first half of the month and 20 patients (26.9%) were admitted in the second half of the month. Only urine density and white blood cell values in Ramadan and non-Ramadan period were significantly different (p=0.004 and p=0.001). Hemoglobin, general crystal, and triple phosphate crystal values in the first and the second half of Ramadan were significantly different (p=0.04, p=0.03, and p=0.03). CONCLUSION: This study has shown that fasting in Ramadan does not change the number of renal colic visits. In addition, although fasting causes some changes in urinary metabolites, there is not enough evidence that these changes increase urinary calculus formation.

Effects of fast-track in a university emergency department through the National Emergency Department Overcrowding Study.

OBJECTIVE: To determine the impact of a fast track area on emergency department crowding and its efficacy for non-urgent patients. METHODS: The prospective cross-sectional study was conducted in an adult emergency department of a university-affiliated hospital in Turkey from September 17 to 30, 2010. Non-urgent patients were defined as those with Canadian Triage Acuity Scale category 4/5. The fast track area was open in the emergency department for one whole week, followed by another week in which fast track area was closed. Demographic information of patients, their complaints on admission, waiting times, length of stay and revisits were recorded. Overcrowding evaluation was performed via the National Emergency Department Overcrowding Study scale. In both weeks, the results of the patients were compared and the effects of fast track on the results were analysed. Continuous variables were compared via student's t test or Mann Whitney U test. Demographic features of the groups were evaluated by chi-square test. RESULTS: A total of 249 patients were seen during the fast track week, and 239 during the non-fast track week at the emergency department. Satisfaction level was higher in the fast track group than the non-fast track group (p < 0.001). The waiting times shortened from 20 minutes to 10 minutes and length of stay shortened from 80 minutes to 42 minutes during the fast track week. Morbidity and mortality rates remained unchanged. CONCLUSION: Owing to fast track, overcrowding in the emergency department was lessened. It also improved effectiveness and quality measures.

Determining the diagnostic value of endogenous carbon monoxide in chronic obstructive pulmonary disease exacerbations.

OBJECTIVE: To determine whether endogenous carbon monoxide levels in exacerbations of Chronic Obstructive Pulmonary Disease patients were higher compared to healthy individuals and to investigate alteration of carbon monoxide levels across the three different severity stages of Global Initiative for Chronic Obstructive Lung Disease criteria related to Chronic Obstructive Pulmonary Disease exacerbations. METHODS: The prospective study was conducted from January to March 2011 at two medical institutions in Ankara, Turkey, and comprised patients of acute Chronic Obstructive Pulmonary Disease exacerbations. The severity of the exacerbations was based on the Global Initiative for Chronic Obstructive Lung Disease criteria. Patients with active tobacco smoking, suspicious carbon monoxide poisoning and uncertain diagnosis were excluded. healthy control subjects who did not have any comorbid diseases and smoking habitus were also enrolled to compare the differences between carboxyhaemoglobin levels A two-tailed Mann-Whitney U test with Bonferroni correction was done following a Kruskal-Wallis test for statistical purposes. RESULTS: There were 90 patients and 81 controls in the study. Carboxyhaemoglobin levels were higher in the patients than the controls (p < 0.001). As for the three severity stages, Group 1 had a median carboxyhaemoglobin of 1.6 (0.95- 2.00). The corresponding levels in Group 2 (1.8 [1.38-2.20]) and Group 3 (1.9 [1.5-3.0]) were higher than the controls (p < 0.001 and p < 0.005 respectively). No statistically significant difference between Group 1 and the controls (1.30 [1.10-1.55]) was observed (p < 0.434). CONCLUSION: Carboxyhaemoglobin levels were significantly higher in exacerbations compared with the normal population. Also, in more serious exacerbations, carboxyhaemoglobin levels were significantly increased compared with healthy individuals and mild exacerbations.