Correlation of prognosis and cost-effectiveness of computed tomography for out-of-hospital cardiac arrest patients with return of spontaneous circulation in the Emergency Department

Objective: To assess the prevalence of computed tomography application in out-of-hospital cardiac arrest cases during emergency department processes, its contribution to changes in patient management, and effects on hospital discharge, and its cost-effectiveness. Method: The retrospective study was conducted at the Izmir Bakircay University Cigli Training and Research Hospital, Izmir, Turkey, and comprised data of adult out-of-hospital cardiac arrest patients who were brought to the emergency department and survived for at least 24 hours between June 21, 2016, and December 31, 2018. Demographic variables and computed tomography results were collected and analysed. Abnormalities found in computed tomography results that could have changed patient management, discharge results, and the cost of the computed tomography were recorded. Results: Of the 109 patients, 65(59.6%) were men with a mean age of 62.1± 14.2 years (range: 28-95 years), and the mean age of the 44(40.3%) female patients was 69.2 ± 15.8 years (range: 18-96 years). Overall, 74(67.9%) patients underwent computed tomography in the emergency department after resuscitation. Acute abnormalities were found in 4(3.6%) scans, and 3(2.7%) abnormal scans resulted in management changes. Conclusion: Computed tomography of out-of-hospital cardiac arrest patients in the emergency department should not be a matter of routine, and the scan, if necessary, should be done post-admission. Key Words: Out-of-hospital cardiac arrest, Return of spontaneous circulation, Computed tomography, Emergency medicine. Continue..

Could Mean Platelet Volume Be a Reliable Indicator for Acute Mesenteric Ischemia Diagnosis? A Case-Control Study

WOS: 000386287000001Objective. Acute mesenteric ischemia (AMI) is a disease, usually seen in elderly people and accompanied by comorbid diseases. Mean platelet volume (MPV), the significant indicator of platelet activation and function, is associated with AMI. In this study, we considered that we can use MPV as a reliable indicator in the diagnosis of AMI. Methods. This study was conducted among AMI patients with two control groups. Age, gender, MPV, platelet count, concomitant diseases, abdominal computed tomography, and patient outcomes were recorded for evaluation. Control group I contained 41 healthy patients whose ages-genders were matched. Control group II contained 41 patients with no AMI, whose ages-genders-concomitant diseases were matched. Results. Of the total 41 AMI patients, 22 were female and 19 were male. The average age of them was 72.12 +/- 13.2 (44-91) years. MPV was significantly increased in the AMI (p = 0.001) and control group II (p < 0.001) in comparison with healthy control groups. In the comparison of the AMI patients with their matched controls for concomitant diseases, no statistical difference was found in the MPV values. Conclusion. MPV may be used as an indicator of AMI only if the patient has no concomitant diseases. The existence of a concomitant disease brings into question the reliability of high MPV values as a suitable indicator

Analysis of factors affecting satisfaction in the emergency department: A survey of 1019 patients

The objective of this study was to identify factors that affect overall satisfaction of patients admitted to the emergency department (ED). All consecutive adult patients in the ED during a 14-day period who could communicate well were enrolled into this cross-sectional analytic study. Patients' demographic data, information on care, and level of satisfaction were recorded. Patients were asked to rate specific issues concerning their satisfaction (good and excellent) on a 5-point Likert scale. Response to the survey was obtained from 1019 (91.6%.) of 1113 patients for analysis during the study. Satisfaction with physician experience, physician attitude, triage, explanation of health status and treatment, and discharge instructions were found to have significant impact on satisfaction (P < .001 for each). Satisfaction with physician experience level was the most important factor affecting overall satisfaction. Patient perception of the total time spent in the ED as "short" and "very short" was not demonstrated to be significantly related to overall satisfaction (P = .162). Temporal perceptions as "long" and "very long" were shown to be significantly related to overall satisfaction (P < .001). Behavioral characteristics of the healthcare providers and the hospital itself were the factors that had the greatest impact on overall satisfaction of the ED population evaluated