The frequency of emergency department visits associated with adverse drug reactions in Dokuz Eylul University hospital

AMAÇ: Türkiye'de advers ilaç reaksiyonu nedeni ile acil servis başvuru sıklığı bilinmemektedir. Çalışmamızda Dokuz Eylül Üniversitesi acil servisine AİR nedeni ile başvuruların sıklığını araştırdık. YÖNTEM: Prospektif tanımlayıcı özellikteki çalışmamızda Temmuz 2010 ve Nisan 2011 tarihleri arasında, 4 farklı mevsimde ve birer haftalık dönemlerde acil servise başvuran 17 yaşından büyük olan hastalar çalışma kapsamına alındı. Anamnezlerinde son 15 gün içerisinde herhangi bir ilaç tedavisi almayan hastalar çalışma dışı bırakıldı. Hastaların demografik özellikleri, acil servise asıl başvuru nedenleri, tıbbi geçmişleri ve sonuçta aldıkları tanı ve sınıflandırmaları, kullanılan ilaca maruziyet yolu ve süresi kaydedildi. İlaç-ilaç ve ilaç-gıda ve ilaç-bitkisel ürün etkileşimleri de değerlendirildi. İlaç-ilaç, ilaç-gıda, ilaç-bitkisel ürün etkileşimleri de değerlendirildi. Veriler proje ekibi tarafından değerlendirildi. AİR nedensellik sııflandırılması WHO-UMC nedensellik kategorisine göre yapıldı ve kesin, olası, olanaklı olarak sınıflandırıldı. BULGULAR: Çalışmanın yapıldığı dönem boyunca acil servise başvuran hasta sayısı 6928'di. Herhangi bir ilaç kullanımı olmayan hastalar (%73,5, n=5090) çalışma dışı bırakıldı. Acil servise başvuran ve herhangi bir ilaç kullanımı olan hastaların %26,5'i (n=1838) AİR bağlantılı olabileceği yönünde incelendi. Ortalama yaş 51,1±19,2 (18-95) , erkek/kadın oranı 0,74 idi. Kesin, olası ve olanaklı advers ilaç reaksiyonu %5,9 (n=108) olarak saptandı. AİR ile ilişkili en sık belirtiler kaşıntı (%19,4, n=21), karın ağrısı (%14,8, n=16) ve diyare (%10,2, n=11) olarak saptandı. ATC sınıflamasına gore AİR'a en sık neden olan ilaçlar antibakeriyal (%31,6, n=37), sindirim sistemi ilaçları (%14,5, n=17), antikoagulan ilaçlar (%12, n=14) idi. Çalışmamızda ilaç reaksiyonuna bağlı ölüm gözlenmedi. SONUÇ: Çalışmamızda acil servise başvuruların %5,9'u AİR olarak saptanmıştır. Travma dışı nedenlerle acil servis başvurularında AİR sıklıkla gözlenmekte ve AİR akılda tutulmalıdır. OBJECTIVES: The frequency of adverse drug reactions (AİRs) lead to the emergency department (ED) visits was unknown in Turkey. Therefore, we aimed to investigate the frequency of AİRs related ED visits in Dokuz Eylul University Hospital. METHODS: In this prospective descriptive study, all patients older than 17 years old that were admitted to our ED during one-week periods of four different seasons between July 2010 and April 2011 were enrolled the study. We excluded the patients who have not taken any medication in the medical history during last 15 days. Demographics of the patients, main reason of the ED visit, medical history and last diagnosis, classification, duration and exposure route of the medication were recorded. Drug-drug and drug-food and drug-herbal product interactions were also evaluated. Data were evaluated by the project team. Causality assessment of AİRs was done according to WHO-UMC causality categories, and AİRs were categorized as certain, probable or possible. RESULTS: The number of all patients admitted to ED was 6928 during the study periods. Patients who have not any medication use were excluded from the study (n=5090, 73.5%). Of the patients who are on medications, 26.5% (n=1838) were evaluated for AİR-related ED admissions. Mean age was 51.1 ±19.2 (range 18-95). Male/female ratio was 0.75. Certain, probable and possible advers drug reactions accounted for 5.9% (n=108). The most frequently seen AİRs-related symptoms upon arrival were pruritus (19.4%, n=21), abdominal pain (14.8%, n=16) and diarrhea (10.2%, n=11). According to the main anatomic therapeutic classification (ATC), drugs that caused AİRs were antibacterials (31.6%, n=37), digestive system drugs (14.5%, n=17), anticoagulant drugs (12%, n=14). We did not observe any AİR-related death in our study. DISCUSSIONS: In our ED, nearly 5.9% of the admissions were medication-related AİRs. Our results showed that non-traumatic ED visits caused by AİRs are common. AİRs should always be considered ED patients who are on medicatio

An investigation of the emergency medicine journals published in Turkey

Introduction: There are many academic journals in Turkey and the world. Medical journals have a significant place among those publications. The aim of this study is to examine qualitatively and categorize the scientific studies of the two journals in Turkey. It also aims to contribute the related literature in the area. Material-Method: Academic journals of medical emergencies published in Turkey between January 1, 2003 and December 20, 2014 were investigated in detail. All the works in journals were categorized briefly as research articles, case presentations, review articles, and other works. Moreover, research articles were investigated as observational and experimental, and discussed according to the including topics. Results: 943 scientific works in 86 issues were fully investigated. The total number was found to be 472 for research articles (50.1%), 242 for case presentations (25.7%), 108 for review articles (11.5%), and finally it was 12.8% for other works. Research articles included 450 observational (95.3%) and 22 experimental studies (4.7%). The key topics covered in research articles were the management and training of medical emergencies, trauma 96 (20.3%), toxicology 50 (10.6%), and gastrointestinal tract 36 (7.6%). Conclusion: Despite its relatively short history, medical emergencies have improved progressively in Turkey. The number of domestic research articles has demonstrated an increase over the years. However, extra efforts are needed in order to improve the quality of articles. The most common contents encountered in research articles were the management and training of medical emergencies, trauma and toxicology. Keywords: Emergency medicine, Epidemiologic studies, Journal articl

Dokuz Eylul Triage System: A five category triage algorithm in Turkey, reliability and validity study

Introduction: Triage systems are useful tools to detecting severity of illness in the emergency department’s waiting areas. Because of the lack of similarity in terms of disease and the patient profile each triage system may not be effective in another country. Dokuz Eylul Triage System was developed as a five-level triage system and this paper evaluates validity and reliability of Dokuz Eylul Triage System to use in a tertiary Turkish emergency department. Methods: This study was performed in a tertiary emergency department. Patients with any symptoms who were admitted to the emergency department in one-month period and selected by systematic sampling method were included into the study. Hospital admission, length of stay in the emergency department, 48h mortality, resource uses were assessed for validity and blinded paired triage assignments were compared with weighted kappa analysis for reliability. Results: Five-hundred-sixty-seven patients were enrolled; 30 were excluded. The resulting of 537 patients was 55% female and had a median age of 46 years. Seven of them were triage level-1 (1.3%), 142 of them were level-2 (26.4%), 167 of them were level-3 (31.1%), 166 of them were level-4 (30.9%) and 55 of them were level-5 (10.3%). Weighted kappa for triage assignment was found as 0.825. Resource use, hospitalization rates, mean length of stay and 48h mortality were found as strongly associated with triage level. Over-triage rate was 15.5%, under-triage rate was 3.7% and the sensitivity and specificity of the triage system were calculated 99.3% and 96%. Conclusions: Dokuz Eylul Triage System is a reliable and validated five-category triage algorithm for Turkey to be implanted into clinical practice of a tertiary emergency department. We report that Dokuz Eylul Triage System could be able to detect and sieve the patients safely who need resuscitation and emergent care</p

Comparison of near-infrared spectroscopy and head CT interpretations of the ED patients with minor head injury

This study compares near-infrared spectroscopy device and brain computed tomography results in detection of intracranial hemorrhages of patients in an emergency department with minor head trauma and whose computed tomography scans were obtained. In our prospective and cross-sectional study, sociodemographic and clinical features, and brain computed tomography and near-infrared spectroscopy device data of patients diagnosed with minor head trauma were compared. Among 546 trauma patients diagnosed with minor head trauma, 151 of them met the criteria for inclusion in the study. When compared with brain computed tomography, near infrared spectroscopy device data are 85.7% sensitive, are 66.6% specific, and have a negative predictive value of 98.9% and a positive predictive value of 11.1%. There was a statistically significant difference in rates of diagnosis of pathology between near-infrared spectroscopy device data and official radiologist decision of brain computed tomography results In our study, although we could not reach evidence showing that Infrascanner could be used as an alternative to cerebral computed tomography in intracranial hemorrhages, it is a valuable screening tool in some cases such as bedside monitoring, mass casualty events, remote areas, ambulance services, and others. (C) 2016 Elsevier Inc. All rights reserved

Emergency department visits caused by adverse drug reactions: results of a Turkish university hospital

Background/aim: We aimed to evaluate adverse drug reaction (ADR)-related emergency department (ED) visits in the ED of the Dokuz Eylül University Hospital prospectively. Materials and methods: Patients who were admitted to the ED during 1-week periods of four different seasons between July 2010 and April 2011 were enrolled. Demographics of patients, previous ADR history, clinical progress, and outcomes were recorded. Causality assessment was done according to World Health Organization Uppsala Monitoring Centre categories. ADRs were categorized as certain, probable, or possible. Results: Patients who were on medications (26.5%, n = 1838) were evaluated for ADR-related ED admissions. ADRs accounted for 5.9% of cases (n = 108). The most frequently affected systems were the gastrointestinal (35.2%, n = 38), dermatological (23.1%, n = 25), and hematological (10.2%, n = 11) systems (7.4%, n = 8). The most common causes of ADRs were antiinfectives (31.6%, n = 33). Amoxicillin, Coumadin, and paracetamol were the most common medications that caused ADRs. Conclusion: Nearly 6% of the admissions were ADR-related. ADRs should always be considered when patients who are on medication are admitted to the ED. Multicenter epidemiologic studies are required to know the real rates of ADR cases in EDs in TurkeyBackground/aim: We aimed to evaluate adverse drug reaction (ADR)-related emergency department (ED) visits in the ED of the Dokuz Eylül University Hospital prospectively. Materials and methods: Patients who were admitted to the ED during 1-week periods of four different seasons between July 2010 and April 2011 were enrolled. Demographics of patients, previous ADR history, clinical progress, and outcomes were recorded. Causality assessment was done according to World Health Organization Uppsala Monitoring Centre categories. ADRs were categorized as certain, probable, or possible. Results: Patients who were on medications (26.5%, n = 1838) were evaluated for ADR-related ED admissions. ADRs accounted for 5.9% of cases (n = 108). The most frequently affected systems were the gastrointestinal (35.2%, n = 38), dermatological (23.1%, n = 25), and hematological (10.2%, n = 11) systems (7.4%, n = 8). The most common causes of ADRs were antiinfectives (31.6%, n = 33). Amoxicillin, Coumadin, and paracetamol were the most common medications that caused ADRs. Conclusion: Nearly 6% of the admissions were ADR-related. ADRs should always be considered when patients who are on medication are admitted to the ED. Multicenter epidemiologic studies are required to know the real rates of ADR cases in EDs in Turke