Emergency Department During Long Public Holidays

SUMMARY: Objectives: The purpose of this study is to determine the impact of the expected increase in the volume of patient visits in the emergency department during holiday periods on physicians' tendencies regarding test and consultation requests as well as on the length of time patients stay in the emergency department. Methods: The study groups included all of the patients who visited the emergency department during the nine-day public holiday (Eid al-Adha, a religious festival of sacrifice) celebrations and a nine-day non-holiday “normal” period. The patients' demographic information, reasons for their visits, comorbid diseases, whether or not they had undergone laboratory and screening tests, consultations, length of stay, and the way their visits ended were compared statistically. Results: Of the 6353 patients enrolled in the study, 3523 (55.5%) were seen in the emergency department during the holiday period, while 2830 (45.5%) were seen during the non-holiday period (p≤0.001). During the holiday period, there was a 1.9% decrease in laboratory test requests (p=0.108), a 7.7% increase in radiology examination requests (p≤0.001), and a 1.2% increase in consultation requests (p=0.063). The patients' length of stay during the holiday period was 55.9±75.3 minutes and was 56.3±71.9 minutes during the non-holiday period (p=0.819). The length of time for the patients who underwent tests or consultations was 88.6±92.8 minutes during the holiday period and 92.6±87.5 minutes during the non-holiday period (p=0.224). Conclusions: As expected, the number of patient visits to the emergency department increased during the holiday period, but this increase did not lead to a similar increase in test and consultation requests by the physicians, except for radiology examination requests. In addition, the length of time that patients stayed in the emergency department was not affected by the increase in the volume of patient visits during the holiday period. ÖZET: Amaç: Çalışmamızda uzun tatillerde acil servis başvurularında artış beklentisinin, hekimlerin inceleme ya da konsültasyon isteme yönelimine ve acil serviste hastaların kalış süresine etkisi olup olmadığını ortaya çıkarmayı amaçladık. Gereç ve Yöntem: Çalışmamızda tatil dönemi olarak dokuz günlük Kurban Bayramı tatili kabul edilirken, karşılaştırma grubu ise dokuz günlük tatil dışı bir dönemde acil servise başvuran tüm hastalardan oluşturuldu. Her iki dönemde acil servise başvuran hastalar demografik bilgileri, başvuru nedenleri, komorbid hastalıkları, laboratuvar ve görüntüleme incelemesi yapılıp yapılmadığı, konsültasyon istemleri, acil serviste kalış süreleri ve sonuçlanma şekilleri bakımından karşılaştırıldı. Bulgular: Tatil döneminde 3523 (%55.5), tatil dışı dönemde 2830 (%45.5) olmak üzere toplam 6353 acil servis başvurusu kaydedildi (p≤0.001). Tatil dışı döneme göre tatil döneminde laboratuvar inceleme istemlerinde %1.9 oranında azalma (p=0.108), radyolojik inceleme kullanımında %7.7 oranında artış (p≤0.001), konsültasyon istemlerinde %1.2 oranında artış (p=0.063) saptadık. Acil serviste ortalama kalış süreleri tatil döneminde 55.9±75.3 dakika, tatil dışı dönemde 56.3±71.9 dakika olarak bulundu (p=0.819). İnceleme veya konsültasyon yapılan hastaların ortalama kalış süresini tatil döneminde (88.6±92.8 dakika) tatil dışı döneme (92.6±87.5 dakika) göre daha kısa saptadık (p=0.224). Sonuç: Uzun süreli tatillerde acil servislerde beklendiği gibi hasta yoğunluğu artmaktadır. Bu yoğunluk, hekimlerin laboratuvar incelemesi ve konsültasyon istemlerinde artışa yol açmazken, radyolojik inceleme istemlerinde artış gözlenmiştir. Ayrıca acil serviste ortalama kalış süresi başvuru sayısındaki artıştan etkilenmemektedir. Key words: Consultation, emergency, holiday, length of stay, test, Anahtar sözcükler: Konsültasyon, acil, tatil, kalış süresi, incelem

Delirium in older emergency department patients is associated with increased in-hospital mortality

Introduction: In this study, it was aimed determine in-hospital mortality, in-hospital length of stay, and independent predictors that predisposes to the development of delirium for identifying geriatric emergency department patients with delirium as well as those admitted to the hospital

Rabies Suspected Animal Contact Cases in a City with Animal Husbandry and the Appropriateness of Prophylactic Procedures

SUMMARY: Objectives: This study aims to evaluate the features of rabies suspected animal contact cases in the emergency department and the appropriateness of administering post-exposure prophylaxis procedures according to World Health Organization (WHO) instructions. Methods: Rabies suspected animal contact cases that applied to the emergency department between August 2012 and December 2013 were included in the study. Patients’ data were obtained retrospectively from patient files, records of hospital automation system, and the “Rabies Suspected Animal Contact Cases Examination Form”. The post-exposure prophylaxis recommended by the WHO were compared to the prophylactic applications administered by the emergency department. Results: A total of 515 cases were included in the study. According to WHO classification, cases involving category 3 injuries (n=378, 73.4%) were more common than the others (p>0.0001). Compared to post-exposure prophylaxis recommendations by the WHO, 44.7% of all cases (n=230) were administered inappropriate prophylaxis. Thirty-seven percent of cases received less rabies Ig than recommended, despite category 3 contact. Six percent of cases with category 2 contact were given unnecessary rabies Ig and all cases with category 1 contact (1.5% of all cases) were given unnecessary rabies vaccine. Conclusions: We observed that in 44.7% of cases, post-exposure prophylaxis was applied inappropriately according to WHO instructions. Not only were there unnecessary vaccine and Ig applications, there were also missing prophylaxis procedures. Updating the current “Rabies Prevention and Control Directive” plus educating and controlling healthcare personnel on a regular schedule may help prevent inadequacies in prophylactic application. Key words: Post-exposure prophylaxis, rabies, World Health Organization contact categor

Assessment of prehospital medical care for the patients transported to emergency department by ambulance

Objectives: In our study we aimed to investigate the quality and quantity of medical management inside ambulances for 14 and over 14 years old patients transported to a level three emergency department (ED). Material and methods: Our study was conducted prospectively at a level three ED. 14 and over 14 years old patients who were transported to the ED by ambulance were included in the study consecutively. “Lack of vital rate” was described as missing of one or more of five vital rates during ambulance transportation. Both of two attending emergency physicians evaluated the medical procedures and management of patients at the ambulance simultaneously and this was recorded on the study forms. Results: Four hundred and fifty six patients were included in the study. Missing vital signs were identified for 90.1% (n = 322) of the patients that were transported by physicians and 92.4% (n = 73) of the patients that were transported by paramedics. For five patients with cardiac arrest two (33.3%) had cardiopulmonary resuscitation (CPR), one (20%) was intubated, one (20%) received adrenaline. Out of 120 patients, needed spinal immobilization, 69 (57.5%) had spinal board. Cervical collar usage was 65.1% (n = 69) We have revealed that 316 (69.3%) patients did not receive at least one of the necessary medical intervention or treatment. Conclusion: During ambulance transportation, life-saving procedures like cardiopulmonary resuscitation, vital sign measurement, crucial treatment administration, endotracheal intubation, defibrillation, fracture immobilization were not performed adequately. Increasing the training on the deficient interventions and performing administrative inspections may improve quality of patient care. Keywords: Emergency department, Ambulance, Prehospital emergency car

Value of plasma neutrophil gelatinase-associated lipocalin (NGAL) in distinguishing between acute kidney injury (AKI) and chronic kidney disease (CKD)

Objective: In this study, we aimed to determine whether plasma NGAL levels could be used as a biomarker for distinguishing between AKI and CKD in emergency medicine. Materials and methods: This prospective study was conducted at the ED of a training and research hospital over a six-month period in 2015. Three groups were defined: an AKI group – defined as a new onset of at least a 1.5-fold or ≥0.3 mg increment increase of SCr values from the normal baseline, a stable CKD group – only included presence of stages 2 through 4 of CKD according to the National Kidney Foundation's KDIGO 2012, and a control group. After the initial evaluation of patients, venous blood samples were taken for routine biochemical, counter blood cell, and plasma NGAL measurement at admission. Results: A total of 25 patients with AKI, 22 patients with stable CKD, and 22 control subjects were enrolled. Level of plasma NGAL in AKI group was higher than those of the stable CKD group (median: 794 ng/ml IQR: 317–1300 & 390 ng/ml IQR: 219–664, p < 0.001). AUC was measured as 0.68 (p = 0.02, 95% CIs: 0.54–0.84) to assess the utility of plasma NGAL levels at varying cut-off values for distinguishing between AKI and CKD. For plasma NGAL, the best cut-off level was found to be 457 ng/ml (sensitivity: 72.0%, specificity: 64%). Conclusion: This study has clearly demonstrated that plasma NGAL levels were higher in AKI patients than in CKD patients. However, in clinical practice, the use of plasma NGAL levels to distinguish between AKI and CKD is limited. Keywords: Acute kidney injury, Chronic kidney disease, Neutrophil gelatinase-associated lipocalin (NGAL), Emergency departmen