Predictive value of modified early warning scoring system for identifying critical patients with malignancy in emergency department

Background: Identification of critically ill patient is particularly important in the emergency department (ED). The prolonged duration from hospital admission to delivering intensive care service is related to increased mortality. The aim of this study is to evaluate the effectiveness of Modified Early Warning Score (MEWS) for identifying critical patients with malignancy in ED settings. Methods: We evaluated patients with malignancy who were admitted to our ED of a tertiary university hospital in Turkey over a three-month period. We evaluated MEWS on admission as MEWS 1. After the initial treatment depending on the patients' health status in ED, at 2 hours after admission, we evaluated MEWS again and recorded as MEWS 2. All patients were followed up for 30 days after the initial admission. Results: Mean age (SD) was 59.2 (13.5) and male/female ratio was 295/206. MEWS1 was higher than MEWS2, (MEWS1: 3.05 3.31, MEWS2: 2.35 +/- 3.17, P < 0.001). A total of 362 patients (72.3%) survived and 139 (27.7%) died within 30 days of initial admission. MEWS1/MEWS2 values for alive and dead patients were 1.66/0.87, and 6.67/6.21, respectively, and the difference was significant (P < 0.001). ROC analysis was performed for MEWS 1; the area under curve (AUC) for hospitalization was 0.768 (95% CI 0.729 to 0.804) and for mortality was 0.900 (95% CI 0.870 to 0.924). ROC analysis revealed a cut-off value of 2 for predicting both hospitalization and mortality in these patients. The sensitivity of the presented cut-off was 77.32% (72.1%-82.0%) for hospitalization and 76.24% (95% CI 71.5-80.5) for mortality; the specificity was 69.52 (95% CI 62.8-75.7) for hospitalization and 90.65 (95% CI 84.65-94.9) for mortality. Conclusion: We found in our study that MEWS evaluation for patients with malignancy on admission to ED is predictive of mortality in the subsequent 30 days, and it is a valuable tool for identifying the critical group. Also, AVPU scores alone can predict mortality in patients admitted to ED

Acil serviste yapılan bilgisayarlı tomografi görüntüleme istemleri ne kadar etkin?

Amaç: Son yıllarda giderek gelişen radyolojik görüntüleme yöntemleri tanısal süreçte önemli bir araç haline gelmiştir. Kolay ulaşılabilir olmaları nedeniyle görüntüleme yöntemleri acil servislerde hasta değerlendirmede anamnez ve fizik muayenenin önüne geçmiş fakat uygun endikasyon konulmamış, gereksiz tetkik istemleri sayısında artışı beraberinde getirmiştir. Özellikle bilgisayarlı tomografinin fazla miktarda, endikasyon dışı istenmesi günümüzde sağlık harcamalarını giderek arttırmış, bu da bedel-etkinlik konusunu gündeme getirmiştir. Çalışmamızda amaç acil serviste bilgisayarlı tomografi istemi yapılan hastaların istem gerekçelerini ve saptanan mevcut patolojileri değerlendirerek, tetkiklerin uygunluğunu saptamaktır.Gereç ve Yöntem: Çalışmaya Yüksek İhtisas Eğitim ve Araştırma Hastanesi Acil servisine altı aylık sürede başvuran ve tanısal test olarak Bilgisayarlı tomografi görüntüleme istenen 1700 hasta dahil edildi. Bu hastaların kayıtları hastane otomasyonu ve hasta dosyaları kullanılarak retrospektif olarak incelendi. Çalışmaya dahil edilen hastaların yaş grupları, cinsiyeti, travma öyküsü, ön tanıları kaydedildi. Görüntüleme ile saptanan patolojiler kaydedilerek istem gerekçesindeki ön tanılar ile karşılaştırıldı.Bulgular: Çalışmaya dahil edilen hastaların tanı gruplarına göre sınıflandırılmasında; travma nedeniyle görüntülemeye başvurulan hastaların oranı  %42.9 olarak saptanırken travma nedeniyle maksillofasial BT çekilen olguların %81’ inde omurga BT çekilen olguların %91’ inde patoloji saptandı. Çocukluk yaş döneminde travma nedeniyle yapılan kranial görüntülemelerin %98.5’ inde ise patoloji saptanmadı. Cinsiyete göre abdominopelvik BT sonuçları incelendiğinde erkeklerin %68.6’ sının kadınların ise %63.9’unun acil patoloji saptanmadığı görüldü. Sonuç: Görüntüleme sonuçları incelendiğinde normal görüntüleme sayısı oldukça yüksekti. Hastalarda tomografi istem gerekçeleri iyi irdelenmeli ve klinik karar verme kılavuzları eşliğinde doğru endikasyonlar ile görüntüleme yapılmalıdır. Bu sayede mevcut yüksek çekim oranları, maliyet ve hastaların radyasyon maruziyeti azaltılabilir

An Investigation of Waiting Times of Patients Admitted to the General Surgery Clinic from an Emergency Department

AbstractBackground/Aims:The study aimed to determine the waiting times of the patients admitted to the general surgery clinic from an emergency department and to investigate the effectiveness of services.Methods:1564 patients over the age of 18 admitted to the General Surgery Clinic from the emergency department of Health University BursaTraining and Research Hospital between 01.01.2018 and 31.12.2018 were included. Age, gender, admission and waiting times, the diagnoses, and surgical history or hospitalization were retrospectively analyzed. The difference between the admission time to the emergency department and the admission time to the general surgery clinic was accepted as waiting time.Results:56% of the patients (n: 876) were male and the mean age was 49.9. The mean waiting time in the emergency department was 440.85 minutes and the mean hospital stay was 4.67 days. The minimum waiting time was in abdominal trauma (249.49 min) whereas the longest waiting time was in mesenteric ischemia (732.27 min) in the emergency department.Conclusions: We believe that having a separate and senior team in emergency services of work-intensive departments such as general surgery will contribute to shortening waiting times and providing faster and more effective health care

Does blood transfusions in the emergency department (ED) adversely affect the operations in the ED?

Bu çalışmanın amacı acil serviste yapılan kan ve kan ürünleri transfüzyonlarının acil servis işleyişini etkileyip etkilemediğini araştırmaktır. 01.08.2019 ile 31.12.2019 tarihleri arasında Sağlık Bilimleri Üniversitesi Bursa Yüksek İhtisas Eğitim ve Araştırma Hastanesi Acil Servisi’nde kan ve kan ürünü transfüzyonu yapılan hastalar çalışmaya dahil edildi. Çalışmaya alınan hastaların yaş, cinsiyet, yapılan transfüzyon türü ve sayısı, kan grubu, kan bekleme süresi, transfüzyon işlem süresi ve acil servisteki toplam kalış süresi değişkenleri kaydedildi. Toplam 227 hasta çalışmaya dahil edildi. Hastaların %54,6’sı erkek olup ortalama yaş 63,86±17,81, ortalama hemoglobin (Hg) düzeyi 7,12±2,42 g/dL, ortalama kan bekleme süresi 6,44±3,02 saat, ortalama transfüzyon işlem süresi 3,54±3,45 saat, ortalama toplam acil serviste kalış süresi 10,13 ±4,00 saat olarak saptandı. Hastaların %74,0’ ünde anemi tanısı mevcut idi. Oneway Anova testi ile yapılan analizde acil serviste toplam kalış süresi ile hasta tanıları arasında anlamlı fark olduğu görüldü (F=4,235; p=0.001). Post hoc tukey testi ile farkın koagülasyon bozuklukları ile anemi (p=0.001) ve koagülasyon bozuklukları ile gastrointestinal sistem kanamalarından (p=0.013) kaynaklandığı saptandı. Acil endikasyonu olmayan kan ve kan ürünleri transfüzyonlarının acil servislerde yapılması acil servis yoğunluğuna ve hastaların bekleme sürelerinin uzamasına neden olmaktadır. Dolayısıyla bu işlemlerin acil servislerde yapılması acil servis işleyişini olumsuz yönde etkilemektedir.The goal of this study is to investigate whether blood and blood products transfusions in the emergency department (ED) affect the operations in the ED. Patients who were subjected to blood and blood product transfusions in the ED at the Health Sciences University Bursa Yüksek İhtisas Training and Research Hospital between 01.08.2019 and 31.12.2019 were included in the study. The patients were classified with regard to age, gender, transfusion type and numbers, blood type, waiting duration for blood, duration of transfusion operation, and total hospitalization period in the ED. In total, 227 patients were included. 54.6% of the patients were male and the average age was 63,86±17,81. The average hemoglobin (Hg) level was 7,12±2,42 g/dL, the average blood waiting duration 6,44±3,02 hours, average transfusion operation duration was 3,54±3,45 hours, and the average total service in the ED was 10,13±4,00 hours. 74,0% of the patients had been diagnosed with anemia. Through the one-way Anova test, it was observed that there was a meaningful difference between the total service time and the diagnosis (F=4,235; p=0.001). With the post-hoc Tukey test, it was determined that the difference arose from coagulation abnormalities and anemia (p=0.001) and coagulation abnormalities and gastrointestinal hemorrhages (p=0.013). Blood and blood product transfusions with no associated emergency indicators contribute to additional load and longer waiting times in the ED. Therefore, conducting these operations in the ED adversely affects the operational capacities of the ED

Comparative etiological analysis of critical patients presenting to the emergency department with altered consciousness across age groups: A prospective observational study

Abstract Introduction The aim of our study is to assess the relationship between altered consciousness in patients presenting to the emergency department (ED) without a history of trauma and the physiological changes associated with aging. Additionally, we aim to compare diagnostic differences between patients under the age of 65 and those aged 65 and above. Methods This prospective study was conducted at the ED of Uludağ University Medical Faculty Hospital over a 1‐year period from December 2012 to November 2013. Patients aged 18 and above presenting with non‐traumatic altered consciousness were included, and they were categorized into two groups based on age: <65 years and ≥65 years. Comparison between age groups included gender, seasonal presentation, vital signs, consciousness level, Glasgow Coma Scale (GCS) score, requested consultations, diagnoses, and outcomes. Results Out of 646 patients, 312 (48%) were female, and 334 (52%) were male, with a mean age of 64.9 ± 16.4 years. The highest number of admissions for altered consciousness occurred during the summer season (n = 200, 31%). In the 65 and above age group, a statistically significant elevation was found in the mean systolic blood pressure (p < 0.05). In neurological diagnoses, cerebrovascular events were observed most frequently, while in non‐neurological diagnoses, endocrine/metabolic diseases were more common. It was observed that GCS scores were lower in neurological diagnoses (p = 0.020). Discharges were more frequent in the under 65 age group, with a statistically significant difference (p < 0.05). It was found that the mortality rate was higher in non‐neurological diagnoses, and this was statistically significant (p < 0.001). Conclusion When determining the cause of altered consciousness in patients with such symptoms, a comprehensive understanding of physiological changes in elderly individuals is crucial. While high blood pressure may indicate neurological diagnoses, tachycardia, tachypnea, and fever may suggest non‐neurological causes

Comparison of Fatal Injuries Resulting from Tractor and High Speed Motorcycle Accidents in Turkey: A Multicenter Study

Aim. Injuries are among the main causes of mortality and morbidity all over the world, and effective initial triage of these patients can determine the thin line between death and life. Tractor accidents and related injuries are significant problems particularly in rural areas. However, major trauma classification systems do not include tractor accidents as a criterion for trauma team activation or transportation of the patients to a trauma center. This study evaluated the general characteristics and outcomes of tractor accidents in comparison to motorcycle accidents, which are considered as a comparison criterion for major trauma. Materials and Methods. This is a multicenter study conducted in 6 emergency departments in 4 cities over a six month period. All cases over 18 years of age who were admitted to emergency service due to tractor or motorcycle accidents and meet the criteria were included in the study. The general characteristics and outcomes of both trauma types were compared to determine whether tractor accident should be considered as major traumas. Results. Eighty-eight patients had a tractor accident, and 339 patients had a motorcycle accident. The tractor accident victims were significantly younger (p<0.001), and the proportion of females was higher in this group (p=0.001). Glasgow coma score (p=0.062), revised trauma score (p=0.201), duration from incident to admission (p=0.481), and route of admission (p=0.810) were similar between both accident types. The rates of thoracic traumas (42% versus 23%, p<0.001) and spinal injuries (17% versus 5.9%, p=0.002) were significantly higher in tractor accidents. The hospitalization rates of the patients were significantly higher in tractor accidents (p=0.008). Conclusion. The findings of this study support the hypothesis that tractor accidents should be included in the criteria of ATLS major trauma classification system and trauma team activation procedures