Traumatic Head Injuries in Infants

We read the article titled " Factors Affecting Mortality in Pediatric Severe Traumatic Cerebral Injury " prepared Özcan et al. published in the fourth issue of your journal in 2022, with great interest. Thanks to the authors and editorial board for this informative and interesting article. However, we would like to point out a few points about infant trauma that may contribute to the discussion of the article

Systemic immune inflammation index may be a new powerful marker for the accurate early prediction of complications in patients with acute appendicitis

To investigate the relationship between the systemic immune-inflammatory index (SII) and acute appendicitis (AA). Materials and Methods: We retrospectively evaluated patients aged over 18 years who were diagnosed with AA and underwent surgery at our clinic from January 1, 2019, through July 31, 2022. The patients were divided into three groups: complicated acute appendicitis (CAA), uncomplicated acute appendicitis (UAA), and control. The clinical and laboratory characteristics of the patients evaluated at the emergency department were recorded. The neutrophil/lymphocyte ratio (NLR), the platelet/lymphocyte ratio (PLR), and SII (neutrophil count x platelet count/lymphocyte count) were calculated.Results: The study included a total of 1,456 patients, of whom 628 had UAA, 104 had CAA, and 714 were controls. The NLR, PLR, and SII values were statistically significantly higher in the CAA group than in the control group and the UAA group. The multivariate logistic regression analysis revealed that SII was an independent predictor of CAA development (odds ratio [OR]: 4.65; 95% confidence interval [CI]: 2.31-10.17). The predictive power of SII in the prediction of CAA (area under the curve [AUC]: 0.809) was much higher than that of NLR (AUC: 0.729), neutrophil count (AUC: 0.696), and C -reactive protein (AUC: 0.732) alone. It was determined that an SII value greater than 1,989.2 had a sensitivity of 78.4% and a specificity of 88.5% in predicting CAA development.Conclusion: SII is a simple, inexpensive, and promising marker that could predict both the diagnosis and severity of appendicitis

Patients non-covıd-19 diagnosis in pandemic clinics: three case reports

With the pandemic process, the frequency of clinicians' referrals for thoracic imaging has increased. In this article, three cases diagnosed other than COVID-19 in pandemic clinics are presented. A 33-years-old male admitted to the pandemic clinic with sore throat and dyspnea for two days. A large pneumothorax was observed on thorax imaging. The tube thoracostomy was performed. The patient was discharged after 14 days of follow-up. A 31-years-old female patient was admitted to pandemic clinic with the complaints of exertional dyspnea, cough, sore throat and abdominal pain for two weeks. Massive effusion was observed on thorax imaging. As a result of further examinations, the patient was diagnosed with metastatic colon carcinoma. An 18-years-old male patient was admitted to the pandemic clinic with chest pain lasting for a day. Mediastinal emphysema was observed on thorax imaging. The increased number of thoracic imaging during the pandemic process will lead to an increase in the incidence of asymptomatic and subclinical thoracic pathologies. This increase of incidence should be reveled with further epidemiological studies.Pandemi süreciyle birlikte klinisyenlerin toraks görüntülesine başvuru sıklığı artmıştır. Bu yazımızda pandemi kliniklerinde COVİD-19 dışı tanı konulan üç olgu sunulmuştur. Otuzüç yaşında erkek hasta pandemi kliniğine iki gündür devam eden göğüs ağrısı nefes darlığı şikayeti ile başvurdu. Toraks görüntülemesinde geniş pnömotoraks izlendi. Hastaya tüp torakostomi uygulandı. Hasta 14 gün izlem sonrası taburcu edildi. Otuzbir yaşında kadın hasta pandemi kliniğine iki haftadır devam eden efor dispnesi, öksürük, göğüs ağrısı ve karın ağrısı şikayeti ile başvurdu. Toraks görüntülemesinde massif efüzyon izlendi. Ileri tetkikler sonucu hastaya metastatic kolon carsinomu tanısı konuldu. Onsekiz yaşında erkek hasta pandemi kliniğine bir gündür devam eden göğüs ağrısı nedeniyle kabul edildi. Toraks görüntülemesinde mediastinal amfizem izlendi. Pandemik süreç sırasında artan torasik görüntüleme sayısı, asemptomatik ve subklinik torasik patolojilerin görülme sıklığında artışa neden olacaktır. İnsidanslardaki bu artış geniş epidemiyolojik çalışmalar ile ortaya konulmalıdır

Characteristics of school injuries presenting to the emergency department

School injuries account for approximately one-fifth of pediatric injuries. We aimed to investigate the frequency and severity of school injuries among school-aged children and determine clinical diagnoses and surgery requirement data. Methods In this prospective study, children who were admitted to the emergency department due to school accidents over a 5-month period were included. Demographics, activity during trauma, mechanism of trauma, nature, severity, emergency department outcomes, and surgery requirement were evaluated. Results The study included a total of 504 school-aged children, of whom 327 (64.9%) were male and 177 (35.1%) were female. Of the children, 426 (84.5%) had no evidence of injury or minor injury, while 78 (15.5%) had moderate or severe injury. There was a statistically significant difference between these two groups in terms of gender ( p = 0.031). Of the 78 children with moderate or severe injuries, 45 had extremity fractures, 18 had lacerations, 5 had maxillofacial injuries, 4 had cerebral contusion, 1 had lung contusion, and 1 had cervical soft-tissue damage. Two patients with fractures and two with eyelid lacerations were treated surgically, and four patients with brain contusion were hospitalized for a close follow-up. Conclusion This study revealed that the most common moderate or severe injuries in school accidents referred to emergency department were distal radius fractures and lacerations

Re-Prealbumin: A New Biomarker for Predicting Prognosis in Patients with Severe COVID-19

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Relationship between microscopic haematuria and hydronephrosis in urolithiasis

The aim of this study was to investigate the relationship between the degree of hydronephrosis and the presence of microscopic haematuria in patients who presented to the emergency department (ED) with ureteral stones. Methods: The records of patients who presented to our ED due to urolithiasis between January 2017 and December 2020 were retrospectively analysed. Patients aged 18 years or older who underwent non-contrast computed tomography (CT abdomen/pelvis) and urinalysis (UA) and were diagnosed with ureteral stones were included in the study. Radiology reports were reviewed for stone size, localisation and degree of hydronephrosis. Patients with and without microscopic haematuria and the degree of hydronephrosis were compared. Results: A total of 476 patients were included, which consisted of 391 with microscopic haematuria and 85 without microscopic haematuria. The median stone size was 4.1 mm in the presence of microscopic haematuria and 5.5 mm in the absence of microscopic haematuria. Logistic regression analysis was performed to determine the factors associated with the development of hydronephrosis. Stone size [odds ratio (OR):2.15, 95% confidence interval (CI):1.12-4.16, P <.001), presence of pyuria (OR: 2.58, 95% CI: 1.78-3.48, P <.001) and absence of microscopic haematuria (OR: 1.31, 95% CI 1.04-2.89, P =.017) were identified as risk factors for moderate and severe hydronephrosis. Conclusion: We consider that imaging studies may be necessary for the diagnosis, and treatment of emergency cases in which microscopic haematuria is not detected in urinalysis since their stone size may be larger and degree of hydronephrosis may be more severe

The role of the lactate/albumin ratio in predicting survival outcomes in patients resuscitated after out-of-hospital cardiac arrest: A preliminary report

Objective: To investigate the effect of lactate/albumin (L/A) ratio on survival to discharge in patients who have had out-of-hospital cardiac arrest (OHCA). Methods: We analyzed adult patients (aged ≥18 years) who were admitted to our hospital's emergency department (ED) due to OHCA between January 2018 and June 2020 and who achieved return of spontaneous circulation after successful resuscitation. Blood lactate and albumin concentrations were obtained within the first 10 min after admission to the ED. Patients were grouped according to clinical outcomes. The primary outcome was survival until hospital discharge. The groups were then statistically compared. Results: In this study, 235 OHCA patients were analyzed, 42 (17.9%) of whom had survived until discharge. The L/A ratio was higher in the non-survivor group than in the survivor group (2.0 (interquartile range: 1.4–2.8) vs 1.4 (0.9–1.9); P < 0.001). A low L/A ratio was significantly associated with survival at discharge (odds ratio: 2.55; 95% confidence interval (CI): 3.24–11.08; P < 0.001). In the prediction of survival to discharge, the area under the curve (AUC) for the L/A ratio (AUC: 0.823) was higher than that for lactate (AUC: 0.762) or albumin (AUC: 0.722) alone. Moreover, the predictive value of L/A ratio for survival to discharge might significantly improve when the cutoff value is higher than 1.62. Conclusion: The L/A ratio is more valuable than the lactate or albumin levels alone in predicting survival to discharge. Our findings indicate that a combination of these parameters might increase the predictability of survival to discharge in OHCA patients

Role of thoracic and abdominal tomography in identifying a potential source of infection in patients with acute fever of unknown focus

Objectives: The objective of this study was to evaluate the relationship between clinical features and the presence of infection on thoracic and abdominal tomography (CT) scans in emergency department (ED) patients with acute febrile illness without apparent source. Methods: Patients aged 18 years and over who presented to ED with acute fever of unknown origin between January 1, 2020 and December 31, 2020 and underwent CT imaging (thoracic and abdomen) as a diagnostic test were included in the study retrospectively. Acute fever of unknown origin was defined as the absence of a history or physical examination finding that could explain the possible cause of fever, normal values of parameters that would suggest an infection in the urine analysis, and absence of infiltration on chest X-ray. The patients were divided into two groups according to the presence and absence of a source of infection on CT. The clinical and demographic data of the patients were evaluated. The effect of clinical factors on the presence of infection in CT scans was determined using the logistic regression analysis. Results: Among the 173 patients included in the study, the CT scans were positive for the source of infection in 31.2% (n = 54) and negative in 68.8% (n = 119). In the multiple logistic regression analysis, age ≥ 65 years [odds ratio (OR): 2.72, 95% confidence interval (CI):1.15–4.35, p < 0.001), presence of comorbidity (OR:2.37, 95%CI:1.08–4.14, p = 0.033), and procalcitonin positivity (PCT) (OR: 2.54, 95%CI: 1.29–4.95, p = 0.006) were identified as risk factors for the presence of infection in CT. Conclusion: Patient's age, presence of comorbidity and PCT level should be considered when deciding on the use of CT in determining the source of infection in acute febrile patients without clinical clues

Serum netrin-1 levels at presentation and delayed neurological sequelae in unintentional carbon monoxide poisoning

*Mutlu, Hüseyin ( Aksaray, Yazar ) *Sert, Ekrem Taha ( Aksaray, Yazar )Objectives: The early identification of patients with a high risk of developing delayed neurological sequelae (DNS) can improve the quality of care in carbon monoxide (CO) poisoning cases. The aim of this study is to investigate whether the serum netrin-1 levels measured at presentation to the emergency department (ED) predicted the development of DNS after acute CO intoxication. Methods: This prospective observational study was conducted between 1 August 2018 and 31 July 2019 in a single tertiary hospital. The patients with acute CO intoxication and serum netrin-1 levels measured at the time of ED presentation were included in the study. All patients were followed up for six weeks regarding the development of DNS. The patients were divided into two groups, including those who developed DNS (DNS group) and those who did not (non-DNS group). Results: A total of 183 patients were included in the study, and 54 (29.5%) developed DNS. The median serum netrin-1 level at ED presentation was significantly lower in the DNS group (391.5 pg/mL [263.0–550.5]) than in the non-DNS group (626.0 pg/mL [505.9–755.6]) (p <.001). Multivariate analysis revealed that a low serum netrin-1 level (adjusted odds ratio [AOR]: 8.02, 95% CI: 2.45–26.20), low Glasgow coma scale (GCS) score at ED presentation (AOR: 0.81, 95% CI: 0.68–0.97), long CO exposure time (AOR: 1.96, 95% CI: 1.49–2.56), and the presence of acute brain lesions (AOR: 8.24, 95% CI: 2.37–28.58) on diffusion-weighted imaging were independent predictors of DNS. Serum netrin-1 levels less than 432 pg/mL predicted the development of DNS with a sensitivity of 68.5% (95% CI: 54.4%-80.5%) and a specificity of 86.0% (95% CI: 78.8%-91.5%). Conclusions: Low serum netrin-1 levels were significantly associated with the development of DNS. Therefore, serum netrin-1 at ED presentation can help identify patients at risk of developing DNS following discharge

The use of PECARN and CATCH rules in children with minor head trauma presenting to emergency department 24 hours after injury

Major studies (PECARN [Pediatric Emergency Care Applied Research Network], CATCH [Canadian Assessment of Childhood Head Injury]) that regulate the use of computed tomography (CT) algorithms in children with minor head trauma (MHT) have been conducted among children presenting in 24 hours after injury. In this study, we aimed to compare use and results of PECARN and CATCH rules in children presenting in and after 24 hours following injury. Methods: Records of children who were admitted to emergency department and underwent CT imaging because of MHT during a 5-year period were retrospectively reviewed. Efficacy of PECARN and CATCH rules was investigated for predicting traumatic CT findings in patients presenting in and after 24 hours. Logistic regression was performed to evaluate whether presenting after 24 hours affected the ability of guidelines in predicting traumatic CT findings. Results: This study included 2490 patients who met the criteria. Of these patients, 6.7% (168/2490) presented after 24 hours following injury. Traumatic CT findings were found in 6.7% (168/2490) of patients. This rate was 6.9% (161/2322) in those presenting in 24 hours and 4.2% (7/168) in those presenting after 24 hours, and there was no significant difference in the incidence of traumatic CT findings between the 2 groups (P = 0.17). Among children presenting in 24 hours, the sensitivity of PECARN was 96.3% (95% confidence interval [CI], 91.7%–98.5%), whereas the sensitivity of CATCH was 91.9% (95% CI, 86.3%–95.4%) in detecting traumatic intracranial injury. The sensitivity of both PECARN and CATCH was 85.7% (95% CI, 42.0%–99.2%) among children presenting after 24 hours. Presence of CT scan indication according to PECARN statistically predicted intracranial damage, and this was not affected by the admission time. Conclusions: Patients with MHT presenting after 24 hours following injury constitute a clinically important population. Regardless of the admission time, current guidelines predict traumatic CT abnormalities