Suha Turkmen

Retrospective observational studies are a cornerstone of emergency medicine research, offering practical ways to address important clinical questions using real-world data. Yet, despite their widespread use, these studies are often misunderstood. Associations may be interpreted too confidently as causal effects, while important issues such as bias, confounding, and limitations of statistical adjustment may be overlooked or oversimplified. This practical guide provides a clinically grounded framework for understanding how retrospective studies should be designed, interpreted, and critically appraised. It reviews core methodological principles, including protocol development, sampling strategies, data abstraction, common sources of bias, confounding by indication, and responsible interpretation of observational findings. Frequent misconceptions, such as equating statistical significance with clinical importance or assuming adjustment can fully resolve confounding, are discussed through pragmatic examples relevant to emergency care. Rather than focusing on complex statistical techniques, this review emphasizes conceptual clarity, transparency, and thoughtful interpretation. It highlights practical principles that can improve validity and reproducibility while helping readers recognize both the strengths and inherent limitations of retrospective research. Emerging analytical approaches and evolving discussions around reproducibility and reporting standards are also considered. By linking foundational epidemiologic principles with the realities of emergency medicine practice, this article aims to support clinicians, trainees, reviewers, and early career investigators in designing stronger studies, interpreting findings more critically, and using observational evidence more thoughtfully in clinical decision-making and future research.

Vascular malignancy may rarely present as soft tissue swelling related to a spontaneous pseudoaneurysm. Our case report highlights the importance of prompt clinical examination, imaging, and surgical exploration for diagnosing vascular sarcoma presenting as a spontaneous pseudoaneurysm in a healthy patient.

The Interfacility transportation of critically ill patients is a common practice in modern medical care. Transportation of patients may be necessary for clinical or hospital capacity issues. Patient transfers are typically conducted by specialized teams via ground emergency medical services (GEMS) using emergency medical vehicles (i.e. ambulances) or helicopter emergency medical services (HEMS) using rotary-wing air ambulances. The primary objective of this study is to compare the efficacy of HEMS and GEMS in terms of the duration of time-critical interfacility transfers. This is a retrospective observational study of emergency interfacility transfer of critically ill adult patients in Qatar between 2018 and 2022. Data on patient demographics, facilities' locations, and multiple mission-related time parameters were collected from the Ambulance Service database and the hospitals' centralized electronic medical records and analyzed. Patients with non-emergency conditions, incomplete transfer data, or HEMS activation delays exceeding 30 minutes were excluded. Data of 518 emergency interfacility transfers (355 GEMS and 163 HEMS) was collected and analyzed. Patients' median age was 45 years old. For transfers shorter than 50 km, HEMS was used in 50.2% (109/217) of cases, while for transfers over 50 km, GEMS was used in 82.1% (247/301) of cases (p < 0.001). The GEMS transfers had a significantly shorter call-to-departure time by 21.9 minutes, whereas HEMS had a significantly shorter departure-to-arrival time by 23.6 minutes. However, the difference in total mission time was not significant (p > 0.05). In transfers less than 50 kilometers, HEMS had a longer call-to-departure time by 18.4 minutes and a shorter departure-to-arrival time by 12.3 minutes (both p < 0.001). Similar trends were observed in both short (50 km) transfers. Ground ambulance may offer a comparably as efficient option for emergency patient transfers over short and medium distances, as no significant difference was found in the total transfer times and clinical patient outcomes were not assessed. The results obtained in Qatar's context may not be universally generalizable. Helicopter ambulance may be advantageous when the patient needs to be transferred very quickly over a longer distance.

Objective: Mechanical bowel obstruction (MBO) is a common surgical pathology among patients presenting to the emergency department with abdominal pain worldwide and is associated with high morbidity rates. Delays in diagnosis and surgical intervention decisions can lead to severe complications such as bowel ischemia, adversely affecting patient survival rates. Therefore, reliable biomarkers are needed for the early diagnosis of MBO and in the surgical decision-making process. This study aimed to evaluate the diagnostic value of i-FABP, SCUBE-1, and IMA in predicting strangulation and bowel ischemia. Method: This prospective study was conducted at a tertiary hospital between January 2020 and January 2022. The study included 44 patients diagnosed with mechanical bowel obstruction who presented to the emergency department with abdominal pain, along with a control group of 40 healthy individuals. Patients were classified into two groups based on the need for surgical intervention: those who underwent surgery (Group B) and those who did not (Group A). Venous blood samples were collected, and the levels of i-FABP, SCUBE-1, and IMA were measured using the ELISA method. Data were analyzed using SPSS software. Results: The mean i-FABP levels were 56.4±11.5 ng/mL in Group A, 62.3±10.1 ng/mL in Group B, and 41.9±12.2 ng/mL in the control group, with a statistically significant difference observed between the groups (p

Anemia is a global health problem, and the most common cause is iron deficiency anemia (IDA). Although blood transfusion is considered for patients with hemoglobin (Hb) values below 7 g/dl, the optimal transfusion threshold for slowly developing anemia in ambulatory patients has not been clearly defined. IDA can progress slowly, allowing the hemodynamic system to compensate and prevent symptoms, even at very low hemoglobin levels, particularly in young, healthy individuals. Transfusion decisions should be individualized to the severity of symptoms rather than simply hemoglobin levels. The aim of this study is to retrospectively evaluate outpatients with iron deficiency anemia who refused blood transfusion and were treated with intravenous iron supplementation. This study is a retrospective study based on medical records. The patients with Hb level below 7 were found from medical records. The patients who did not undergo blood transfusion and were treated with IV iron were identified. The response to parenteral iron replacement therapy in severe IDA was evaluated in terms of improvement in hemoglobin, hematocrit, and ferritin levels and whether any complications developed. The study included 84 patients, with 89.3% being women and 10.7% men, and an average age of 35.1 years. The most common symptoms reported were fatigue, dizziness, and pallor. Hemoglobin levels significantly increased from 6.4 to 11.1 g/dl (p < 0.001) after IV iron treatment, as did ferritin levels, while total iron-binding capacity decreased. No complications, mortality, or morbidity were reported. Anemia such as IDA may develop without serious symptoms, even if Hb levels are below 7. It is important to manage these individuals with personalized care rather than relying solely on Hb levels for blood transfusion decisions. IV iron therapy can effectively raise Hb levels and reduce associated risks by reducing unnecessary blood transfusions. These findings highlight the need for individualized IV iron therapy as a first-line treatment in young healthy patients to improve outcomes and optimize healthcare resources.

The aim of our cross-sectional study was to evaluate the reliability of videos uploaded on YouTube demonstrating the Heimlich maneuver. We searched for the terms “Heimlich maneuver”, “abdominal thrust”, “abdominal thrust maneuver”, “foreign body airway obstruction”, or “subdiaphragmatic abdominal thrusts” to find videos uploaded on YouTube from 2020 to 2023. We analyzed the source of the upload, the time duration, the viewership, and the use of mannequins or performance on humans or neither. Of the 1,008 videos uploaded, 106 videos met the inclusion criteria. The median score for the included videos was 2.5. There was no statistical difference in the scores between the professional videos compared to non-professional videos. However, videos uploaded by professionals had a higher viewership and median score than those uploaded by non-medical sources (median scores 3 and 2, respectively). The results of our study indicate that the videos uploaded by medical professionals were viewed more frequently than unidentified sources, although they were not comparatively more reliable.

Introduction: Motor vehicle accidents (MVAs) are a leading cause of mortality and morbidity worldwide. There is limited literature on the injuries resulting from desert off-road driving accidents. This study aims to delineate the attributes of desert MVA and associated injuries as observed in Qatar. Methods: This is a Qatar-based retrospective descriptive multicenter study from electronic medical records (EMRs) between 2016 and 2022. Patients were evaluated based on demographic characteristics, type of injury and vehicle involved, injury locations, injury severity, treatments applied, length of hospital stay, number and outcome of surgeries, disability on discharge, and mortality. Results: Findings reveal a rising trend in accidents from October to March, peaking between 4:00 p.m. and 8:00 p.m. The patients were predominantly male under 40 years of age, not adhering to personal protective measures, and accidents often involved all-terrain vehicles (ATVs) and sport utility vehicles (SUVs). Blunt trauma emerged as the primary injury type, with orthopedic injuries being the most frequent. Most patients did not undergo surgery and had an average hospital stay of 2.9 days. A 1.5% mortality rate and 6.7% disability rate were observed. Conclusion: This study fills a critical gap in understanding desert traffic accidents in a Gulf Cooperation Council country. This study underscores the need for targeted interventions and public awareness campaigns tailored to the unique challenges of desert driving.

Background: Wars are escalating globally with devastating impacts on all aspects of life. The conflict between Ukraine and Russia began on February 24, 2022. Approximately 80,000 students of 155 nationalities were studying in Ukraine when the war started, disrupting their education and forcing many to leave the country. We aimed to determine the physical, emotional, and moral effects of the Ukrainian war on foreign medical students, as well as the secondary impacts of the war on the students due to the ongoing conflict. Methods: The participants were non-Ukrainian medical students aged 18 years and over, studying at a medical school in Ukraine before the war started. A survey including the depression anxiety stress scales-21 (DASS-21) scale variables, a validated and reliable measure of depression, anxiety, and stress dimensions, and other questions on participants’ demographics, education, and current socio-economic status was sent to all eligible students via their registered university emails and distributed using an online link. Results: A total of 99 students were included in the study. 52 (52.5%) of the students were female and 49 (49.5%) were between the ages of 23 and 24 years old. Participants reported high levels of depression (86.9%) and anxiety (82.8%), with significant percentages experiencing extreme levels: 40.4% for depression and 55.6% for anxiety. Additionally, 74.7% reported feeling stressed, with 18.2% indicating extreme stress. Reasons for leaving Ukraine included safety concerns (67.7%), seeking a more secure educational environment (63.6%), the impact of the ongoing war and conflict on their future (56.6%), and the loss of educational opportunities (28.3%). Conclusion: It is not easy to predict how the war in Ukraine will affect the education of international students in the near future. This uncertainty situation may explain students’ depression, anxiety, and stress. As a result, it is necessary to design effective strategies to maintain the training of health professionals during wartime. Research should be conducted on how to rebuild health education systems after the wartime crises stabilize, both for students who are citizens of the country exposed to war and for foreign students who went to that country to receive education, and solutions for this should be put forward.

Key Clinical Message: Arteriovenous malformations (AVM) are extremely rare on the face and especially on the lip. Lip can be more easily exposed to traumas due to their anatomical location. Especially superficial AV malformations are very susceptible to trauma and can bleed very seriously after being exposed to such effects. AVMs management generally based on their hemodynamic characteristics and growth modalities. The surgical treatment requires elaborate planning and multidisciplinary approach. When evaluating a mass with a clinical manifestation of lip swelling, ruling out a vascular anomaly before any intervention is also crucial. Arteriovenous malformations (AVM) are abnormal fistulas between an artery and a vein, without an intervening capillary bed. AVM may occur everywhere in the body, with the brain being of particular concern, as AVM can be complicated by bleeding. Herein, we present the case of a patient with a very atypical AVM location consisting of a lip mass. Given the possibility of hemorrhage and airway obstruction, early detection and timely intervention are mandatory.

Oligoanalgesia, the undertreatment of trauma-related pain using standard analgesics in prehospital and emergency departments, has been extensively documented as one of the major challenges affecting the effective treatment of trauma-related pain. When administered in low doses, methoxyflurane has been highlighted by numerous medical works of literature to provide an effective, nonopioid, nonnarcotic treatment alternative to standard analgesics for prehospital and emergency department use. Low-dose methoxyflurane has been associated with fast-pain relief in adult patients manifesting moderate-to-severe pain symptoms. This systematic review and meta-analysis aimed to assess the clinical implication of low-dose methoxyflurane use in prehospital and emergency departments in adult patients with moderate-to-severe trauma-related pain. Moreover, the review aimed at assessing the risk stratification associated with using low-dose methoxyflurane in prehospital and emergency departments. The systematic review and meta-analysis performed a comprehensive search for pertinent literature assessing the implications and risks of using low-dose methoxyflurane in adult patients exhibiting moderate-to-severe trauma-related pain in prehospital settings. A comparison between the use of low-dose methoxyflurane and standard-of-care analgesics, placebo, in prehospital settings was reported in four clinically conducted randomized controlled trials (RCTs). These RCTs included the STOP! trial, InMEDIATE, MEDIATA, and the PenASAP trials. A meta-analysis comparing the time taken to achieve first pain relief on initial treatment of patients with moderate-to-severe trauma-related pain favored the use of low-dose methoxyflurane to the standard-of-care analgesics (mean difference = −6.63, 95% confidence interval = −7.37, −5.09) on time taken to establish effective pain relief. Low-dose methoxyflurane has been associated with superior and faster pain relief in prehospital and emergency departments in adult patients exhibiting moderate-to-severe trauma-related pain compared to other standard analgesics.