Halil Dogan

Introduction: In the aftermath of the 2023 Turkey earthquakes, severely damaged hospitals necessitated efficient patient transportation. This research aims to assess the applicability of trauma assessment tools (TRISS, ISS, RTS) in determining transportation methods for earthquake-affected patients when local hospitals are incapacitated, particularly for patients transported by air ambulance and those who self-arrive from a location 1,100 km away. Methodology: This retrospective analysis involved 397 patients from a hospital 1,100 km away from the 2023 Turkey Earthquake. We assessed patients who arrived by air ambulance or self-transport following the earthquake, calculating TRISS, ISS, and RTS scores. We sought intergroup differences to establish transportation strategies. Results: TRISS and ISS exhibited good predictive value (AUC 0.723 and 0.880, respectively), while RTS was less useful. The median RTS score was 8 for both the Air transfer and Walk-in patients’ groups. The median RTS score was similar for air transfer and walk-in patients. For air transfer patients, most admissions occurred on the first day, while walk-in patients peaked on the eighth day. Conclusion: ISS and TRISS effectively identify patients requiring air transport post-earthquake. Distant hospitals should prepare to receive air transferred patients within the first five days, and self-admitted patients from the fourth day onward.

Objective: Within the scope of medical services provided during disasters, the aim is to reduce fatalities as much as possible. Therefore, it is crucial to assess, through pre-disaster training for volunteers currently involved or with high potential for involvement, their willingness to volunteer in disaster situations and their sense of preparedness for emergencies. This study investigates the disaster awareness level, perceived preparedness for disaster events, thoughts on the safety of their living environments against disasters, reasons for willingness or unwillingness to volunteer in disasters, and the level of disaster preparedness among healthcare personnel working in emergency medicine clinics of public hospitals on the European side of Istanbul, who are either currently involved or have high potential for involvement in disasters. Methods: The study included personnel working in emergency medicine clinics of public hospitals affiliated with the Istanbul European Side Public Hospitals Association. Personnel working in the emergency medicine clinics of these hospitals were asked to voluntarily answer the questionnaire provided in Appendix 1. The data obtained were recorded in an Excel file. Results: Of the 338 participants, 196 (58%) were male and 142 (42%) were female, with a mean age of 29.49 ± 8.11 years. 185 participants (54.7%) were single. Participants informed about the hospital disaster plan had greater belief that the hospital's disaster response plan administrators could report to their posts very quickly. Those who had previously lost a close relative had received disaster training at a higher rate. It was found that those who had received training before had a stronger belief in their own adequacy. Conclusion: Recent pre-disaster training programs have shown an increase in the willingness to volunteer during disasters and the sense of preparedness for emergencies. Our study predicts that the level of disaster awareness and preparedness is directly proportional to the willingness to volunteer during disasters. bunu tıbbı dılde turlceye cevır

Aim: It was aimed to investigate whether ultrasonographic evaluation of the lungs has a diagnostic value for COVID-19 pneumonia in patients who presented to the emergency department (ED) with symptoms suggestive of COVID-19. Materials and Methods: A prospective, cross-sectional, observational study was conducted in the Emergency Medicine Department of XXX Hospital over 2 months. A total number of 204 adult patients who presented with symptoms suggestive of COVID-19 were included in the study. The findings and results obtained from the Lung Ultrasonography (LUS) and Thorax Computed Tomography (CT) were collected. Results: 112 patients had Thorax CT findings consistent with COVID-19 pneumonia. 104 (92.86%) of them were “LUS positive”. The sensitivity of LUS in the diagnosis of COVID-19 was 93.33% and specificity was 80%, Positive Predictive Value was 82.96%, and Negative Predictive Value was 92%. Patchy B-lines was the most sensitive LUS finding. ROC analysis was performed for two different COVID-19 LUS scores: In the patient group, an “LUS score” above 13 had a 80% sensitivity and 52.63% specificity in terms of 14-day mortality. Also a “Total LUS Score” above 13 had a sensitivity of 79.46% and specificity of 57.89% for 14-day mortality. Conclusion: LUS can assist the emergency physician in triage and clinical decision-making in COVID-19. We have defined a novel COVID-19 “Total LUS Score”. This score had a better specificity, and similar sensitivity compared to “LUS Score” which was defined in the literature before, and both were found to be associated with poor clinical outcomes. Patchy B-lines (89.3%) and Pleural Thickening (63.4%) are the most common COVID-19 related findings in LUS. It is recommended to look for these two findings in patients with suspected COVID-19.

To evaluate the prognostic accuracy of the Get With The Guidelines-Heart Failure (GWTG-HF) score, Shock Index (SI), Modified Shock Index (MSI), and Age Shock Index (Age-SI) alone and with lactate in patients with acute symptomatic heart failure (HF). A retrospective cohort study was conducted in the emergency department of a tertiary hospital between January 1, 2019, and December 31, 2019. Patients aged >18 years and diagnosed with acute symptomatic HF were consecutively included in the study. Patients referred from another center and missing medical records were excluded. Arrival type, vital parameters, demographic characteristics, comorbid diseases, consciousness status, laboratory results, and outcomes of the patients were recorded. The primary endpoint of the study was in-hospital mortality. A total of 368 patients were included in the final analysis. The in-hospital mortality rate of the patients was 7.6%. The GWTG-HF score outperformed other scores in predicting in-hospital, 24-hour, and 30-day mortality (area under the curve (AUC) =0.807, 0.844, and 0.765, P < .001, respectively). The overall performance of the GWTG-HF score with lactate (GWTG-HF+L) was better in predicting in-hospital, 24-hour, and 30-day mortality than the original GWTG-HF score (AUC = 0.872, 0.936, and 0.801, P < .001, respectively). Adding lactate values to the SI, MSI, and Age-SI improved their overall performance for all 3 outcomes. Both the GWTG-HF and GWTG-HF+L scores have acceptable discriminatory power in patients with acute symptomatic HF. The GWTG-HF score, SI, MSI, and Age-SI can be used together with lactate to predict mortality in patients with acute HF.

Background The diagnosis of pneumothorax is usually made through clinical examination and radiography. Pulsed wave (PW) Doppler mode has not previously been used in the diagnosis of pneumothorax on chest USG. Aims The aim of this study is to present, for the first time, a new finding demonstrating pleural movements using PW Doppler mode and to examine the value of the new sonographic finding in the diagnosis of pneumothorax. Methods We investigated the presence of PW artifact in patients with and without pneumothorax using the high-frequency probe in PW Doppler. The Dogan’s sign, defined as the absence of PW artifact, was then compared with lung sliding and the barcode sign in pulsed wave Doppler for the diagnosis of pneumothorax. Results Of the 141 patients, 39 were in the pneumothorax group. The sensitivity and specificity of the Dogan’s sign in the diagnosis of pneumothorax were 95.12% and 99.3%, respectively, in this study. The sensitivity and specificity of lung sliding were 95.12% and 98.08%, respectively; the sensitivity and specificity of the barcode sign were 92.86% and 98.08%, respectively, in the diagnosis of pneumothorax by ultrasonography in this study. Conclusion PW Doppler is a useful tool in the diagnosis of pneumothorax. It has a high sensitivity and specificity for the detection of pneumothorax. It is also superior to both lung sliding and the barcode sign in detecting pneumothorax. The Dogan’s sign can be used safely in the diagnosis of pneumothorax, together with lung sliding and the barcode sign.

Thorax computed tomography in patients with thoracic trauma is undeniably a highly beneficial method. However, it also has disadvantages such as difficulties in transferring critical patients to computed tomography, delays in diagnosis, the risk of radiation exposure, and higher costs. On the other hand, ultrasonography can be rapidly performed at the bedside and is a non-invasive technique that poses no risk of radiation exposure. These advantages make it a valuable method in the early diagnosis of thoracic trauma. Therefore, this study aimed to provide insights into the sensitivity and accuracy of bedside ultrasonography in diagnosing pneumothorax in patients presenting with thorax trauma in an emergency department. The study sample comprised 132 patients over 18 years of age who were transferred with thorax trauma to the Emergency Clinic of Bakırköy Dr. Sadi Konuk Training and Research Hospital between January 30, 2015, and June 30, 2015. Ultrasonographic examinations were performed before thoracic computed tomography in all patients for whom a thorax computed tomography was indicated based on the clinical examination by the emergency room physician. The thoracic computed tomography reports, interpreted by a radiologist who was blinded to the ultrasonographic and clinical findings of the patients, were accepted as the gold standard. All 132 patients included in the study underwent Thorax ultrasonography. The average age of the patients was 76.5%, with the youngest patient being 18 years old and the oldest one being 90 years old. Of the patients, 45.38% (n = 101) were men. The results of Thorax ultrasonography showed that 19 patients had pneumothorax. These findings were then compared with the Thorax computed tomography results accepted as the gold standard. The results revealed that Thorax ultrasonography had a sensitivity of 56.2% and a specificity of 99% in detecting pneumothorax. According to the grading on CT, our observation revealed that the sensitivity of ultrasonography to detect pneumothorax increased proportionally with the severity of pneumothorax detected on thoracic computed tomography. The sensitivity of ultrasonography in patients with a grade 2 pneumothorax and those with a grade 3 pneumothorax, according to Thorax computed tomography, was found to be 70% and 100%, respectively. Thorax ultrasonography is a useful technique with high specificity in diagnosing pneumothorax, but its sensitivity decreases significantly when the size is below 1 cm.

The aim of this study was to evaluate the performance of the Charlson Comorbidity Index ≥2, in-hospital onset, albumin <2.5 g/dL, altered mental status, Eastern Cooperative Oncology Group performance status ≥2, steroid use score in predicting mortality in patients with nonvariceal upper gastrointestinal bleeding and compare it with the Glasgow-Blatchford score; the albumin, international normalized ratio; alteration in mental status, systolic blood pressure, and age 65 score; the age, blood tests, and comorbidities score; and Complete Rockall score. The data of patients with acute upper gastrointestinal bleeding who visited the emergency department during the study period were obtained from the hospital automation system by using the classification of disease codes and analyzed in this retrospective study. Adult patients with endoscopically confirmed nonvariceal upper gastrointestinal bleeding were included in the study. Patients with bleeding from the tumor, bleeding after endoscopic resection, or missing data were excluded. The prediction accuracy of the Charlson Comorbidity Index ≥ 2, in-hospital onset, albumin < 2.5 g/dL, altered mental status, Eastern Cooperative Oncology Group performance status ≥ 2, steroid use score was calculated using the area under the receiver operating characteristic curve and compared with that of Glasgow-Blatchford score, the albumin, international normalized ratio; alteration in mental status, systolic blood pressure, and age 65 score, the age, blood tests, and comorbidities score, and Complete Rockall score. A total of 805 patients were included in the study, and the in-hospital mortality rate was 6.6%. The performance of the Charlson Comorbidity Index ≥ 2, in-hospital onset, albumin < 2.5 g/dL, altered mental status, Eastern Cooperative Oncology Group performance status ≥ 2, steroid use score (area under the receiver operating characteristic curve 0.812, 95%CI 0.783-0.839) was better than Glasgow-Blatchford score (area under the receiver operating characteristic curve 0.683, 95%CI 0.650-0.713, p=0.008), and similar to the the age, blood tests, and comorbidities score (area under the receiver operating characteristic curve 0.829, 95%CI 0.801-0.854, p=0.563), the albumin, international normalized ratio; alteration in mental status, systolic blood pressure, and age 65 score (area under the receiver operating characteristic curve 0.794, 95%CI 0.764-0.821, p=0.672), and Complete Rockall score (area under the receiver operating characteristic curve 0.761, 95%CI 0.730-0.790, p=0.106). The performance of the Charlson Comorbidity Index ≥ 2, in-hospital onset, albumin < 2.5 g/dL, altered mental status, Eastern Cooperative Oncology Group performance status ≥ 2, steroid use score in predicting in-hospital mortality for our study population is better than Glasgow-Blatchford score and similar to the the age, blood tests, and comorbidities score, the albumin, international normalized ratio; alteration in mental status, systolic blood pressure, and age 65 score, and Complete Rockall score.

Aim: Methanol poisoning (MP) is an significant medical problem worldwide, and despite advances in diagnosis and treatment, the mortality rate in these cases remains high. This study aimed to evaluate the clinical and laboratory factors to determine in-hospital mortality in patients with MP.Methods: This single-center, retrospective, observational study was conducted with 65 adult MP cases visiting the emergency department (ED) of a tertiary training and research hospital, between January 01, 2017 and February 01, 2022. Data was statistically compared between survivors and non-survivors.Results: The in-hospital mortality rate was 41.5%. The rate of cases with respiratory distress, low Glasgow coma scale (GCS) (≤8), and delayed arrival to the hospital (>24 hours) was higher in the group of non-survivors compared to the group of survivors. Non-survivors had a higher anion gap (30.5 mEq/L vs. 25.5mEq/L), base excess (-25.0 mmol/L vs. -18.6 mmol/L), lactate (10.2 mmol/L vs. 2.2 mmol/L) levels, and lower pH (6.76 vs. 7.14) and bicarbonate (6.3 mmol/L vs. 10.3 mmol/L) levels than survivors (p<0.001). In ROC analysis, pH (AUC= 0.916) and base excess (AUC=0.915) were blood gas parameters with the highest AUC values in predicting mortality in MP cases. Folate use in the treatment had a statistically significant effect on mortality (P=0.015).Conclusion: In MP cases, delay in a hospital visit, severe metabolic acidosis, high lactate levels, low GCS on arrival to the ED and no folate therapy, were associated with increased in-hospital mortality rates. Our data will contribute to the clinical management of MP patients and the development of treatment protocols.

Background: Early recognition and treatment of patients with acute pancreatitis (AP) is important to improve prognosis and increase survival. Many scoring systems have been developed to assess the prognosis and disease severity in AP. The aim of this study was to compare the effectiveness of the Charlson Comorbidity Index (CCI), Bedside Index for Severity in AP (BISAP), and Acute Physiology and Chronic Health Evaluation (APACHE II) scores in predicting 30-day mortality and the development of severe AP (SAP) in patients with mild AP (MAP). Materials and Methods: This single-center, retrospective, and observational study was conducted with adult patients classified as MAP within 48 hours of arrival at the emergency department. Areas under the receiver operating characteristic curve (AUC) were calculated for each score to evaluate the effectiveness of the scores in predicting the development of SAP and 30-day mortality. Results: A total of 1419 patients with MAP were included in the study between January 01, 2018 and April 01, 2022. In MAP patients, SAP development rate was 14.4%, and the 30-day mortality rate was 1.8%. The accuracy of CCI (AUC=0.797±0.015) in predicting the development of SAP was significantly higher than BISAP (AUC =0.736±0.019, p