Ahmet Burak Erdem

Neurogenic Stunned Myocardium (NSM) is a clinical condition that develops following neurological events and is accompanied by cardiac abnormalities. Studies in the literature suggest that autonomic nervous system dysregulation and increased catecholamine levels cause myocardial damage. NSM can be diagnostically challenging due to findings mimicking acute coronary syndrome, such as elevated troponin, left ventricular dysfunction, and electrocardiographic changes. Therefore, cardiac catheterization may be performed to rule out coronary artery disease. This study presents two cases diagnosed with NSM, aiming to increase awareness of the clinical features and diagnostic approach of the disease.

Background: Accurate assessment of intravascular volume status in hypernatremic patients presenting to the emergency department is often challenging due to advanced age, altered mental status, and unreliable physical examination. Bedside ultrasonography may provide rapid, noninvasive support for early volume evaluation. This study aimed to assess the clinical utility of inferior vena cava (IVC) diameter and the IVC-to-aorta (IVC/Ao) ratio in relation to early sodium response in patients with hypernatremia. Methods: This prospective observational study included 60 adult patients with hypernatremia presenting to a tertiary emergency department. Ultrasonographic measurements (IVC diameter, aortic diameter, and IVC/Ao ratio) and manometric measurements (central and peripheral venous pressures) were obtained before fluid resuscitation and repeated at the third hour of treatment. Early sodium response was exploratorily assessed using the 3-hour change in serum sodium (ΔNa ₁ ). Receiver operating characteristic analysis was used to determine the optimal ΔNa ₁ cut-off associated with 30-day mortality. Results: Patients without early sodium response (n = 42) had significantly higher baseline IVC/Ao ratios than patients with early sodium response (0.74 vs. 0.50, p = 0.037). Ultrasonographic parameters, including baseline and 3-hour IVC diameter and IVC/Ao ratio, demonstrated moderate discriminative performance for predicting early sodium response (AUC range: 0.671–0.683), whereas manometric measurements did not significantly differ between groups. These indices demonstrated high sensitivity but modest specificity for early sodium response. Conclusion: In hypernatremic patients, bedside ultrasound assessment of IVC diameter and IVC/Ao ratio may provide rapid, complementary physiologic information during early volume evaluation. These measurements should be interpreted alongside clinical and laboratory findings rather than as standalone indicators of treatment success.

Early risk stratification in geriatric patients presenting to the emergency department remains challenging. Sarcopenia has emerged as a potential marker of reduced physiological reserve and adverse clinical outcomes. This study aimed to evaluate the prognostic value of quadriceps muscle thickness and the paraspinal muscle index for predicting short-term mortality in geriatric emergency department patients and to examine their association with established frailty scales. In this single-center prospective observational study, consecutive patients aged ≥ 65 years presenting to the emergency department were enrolled. Rectus femoris and vastus intermedius muscle thicknesses were measured using bedside ultrasonography. The paraspinal muscle index was calculated from thoracic computed tomography images obtained for clinical indications. Frailty was assessed using the Clinical Frailty Scale (CFS), Elderly Risk Assessment (ERA), and Identification of Seniors at Risk (ISAR). The primary outcome was 30-day mortality. Receiver operating characteristic (ROC) analysis was performed to evaluate discriminatory performance. A total of 139 patients were included, of whom 28 (20.1%) died within 30 days. All sarcopenia indices were significantly lower among non-survivors (p < 0.05). In ROC analysis, the paraspinal muscle index demonstrated the highest discriminatory ability for predicting 30-day mortality (AUC 0.689, 95% CI 0.584-0.795), followed by the vastus intermedius (AUC 0.633) and rectus femoris indices (AUC 0.628). In subgroup analysis, quadriceps indices were associated with mortality only in non-inflammatory patients, whereas the paraspinal muscle index remained predictive across both groups. Among frailty tools, only CFS was significantly associated with mortality. Muscle-based sarcopenia markers, particularly the paraspinal muscle index, are associated with short-term mortality in geriatric emergency department patients. Integration of muscle measurements with frailty assessment may enhance early risk stratification in emergency care settings.

Background: Rapid bedside assessment of intravascular volume status is critical during early sepsis management in the emergency department (ED) yet commonly used static parameters such as central venous pressure (CVP) and isolated inferior vena cava (IVC) measurements have limited reliability for predicting fluid responsiveness. Objectives: This study aimed to evaluate the diagnostic performance of the IVC–to–aorta diameter ratio (IVC/Ao) and its dynamic change (ΔIVC/Ao) using bedside ultrasonographic measurements in septic patients. Methods: In this prospective observational study, adult patients presenting to the ED with Sepsis‐3–defined sepsis were included. Manometric CVP, ultrasonographic IVC diameter, and aortic diameter were measured at baseline and 3 hours after standardized fluid resuscitation. Fluid responsiveness was defined as a ≥10% increase in mean arterial pressure. Correlation analyses and receiver operating characteristic curve analyses were performed. Results: Sixty patients were included in the analysis. Baseline CVP, IVC diameter, and aortic diameter did not differ significantly between fluid responders and non‐responders. ΔIVC/Ao was significantly higher in responders ( p = 0.026). ΔIVC/Ao showed the highest discriminative performance among the evaluated parameters (the area under the curve = 0.679) with a specificity of 83%, whereas CVP and isolated ultrasonographic parameters demonstrated limited predictive ability. Conclusion: Dynamic bedside ultrasonographic assessment integrating venous and arterial dimensional changes may provide clinically relevant information beyond static indices. Although ΔIVC/Ao should not be used as a standalone parameter, it may serve as a useful adjunct within multimodal hemodynamic reassessment in septic patients in the ED.

Introducdion: Immature granulocyte count (IGc) and percentage (IG%) are emerging inflammatory markers, yet their early prognostic value in undifferentiated abdominal pain in the emergency department (ED) remains unclear. In this study we aimed to compare the predictive performance of IGc, IG%, and C-reactive protein (CRP) for hospitalization and surgical intervention.Materials and Methods: This prospective observational study included adult ED patients presenting with abdominal pain. Predictive accuracy was assessed using ROC analysis with AUC values compared by the DeLong test. Independent predictors of hospitalization were identified using multivariable logistic regression adjusted for IG levels, CRP and key clinical variables.Results: A total of 526 patients were analyzed. Hospitalized patients had higher CRP, IG count, and IG% levels (all p

Acute cholecystitis is a common inflammatory condition encountered in emergency departments (EDs), with severity varying widely among patients. Rapid risk stratification and appropriate management are critical in preventing complications and mortality. This study aimed to evaluate the association between the acute-phase reactant index (APhRI) and disease severity, and to investigate the potential prognostic value of APhRI in clinical decision-making. We conducted a single-center, retrospective observational study of adult patients diagnosed with acute cholecystitis in a tertiary ED between January 2024 and January 2025. APhRI was calculated as (C-reactive protein [CRP] × procalcitonin [PCT])/ albumin. Patients were stratified according to the Tokyo Guidelines 2018 (TG18). Statistical analyses included chi-square/Fisher exact tests, t -test/Mann–Whitney U test, receiver operating characteristic curve analysis, and DeLong test. A total of 547 patients were included. According to TG18, 28.7% were classified as moderate-to-severe acute cholecystitis. APhRI levels were significantly higher in these patients. The area under the curve of APhRI for predicting severity was 0.687, superior to CRP (0.673), PCT (0.567), and albumin (0.618) ( P < .05 for all). Higher APhRI values were also observed in patients requiring surgery ( P = .008) or interventional radiology ( P < .001), and positively correlated with hospital stay (ρ = 0.327, P < .001). APhRI appears to be a practical and useful biomarker not only for predicting severity in acute cholecystitis but also for supporting early triage and treatment decisions in the ED.

The Global Emergency and Critical Care is a peer-reviewed, open-access scientific journal of the Turkish Emergency Medicine Foundation, publishing high-quality research in emergency medicine and related fields. The journal is published quarterly in March, June, September, and December. Objective: Rapid assessment of disease severity in diabetic foot disease is essential in the emergency department. While the Wagner classification reflects local wound severity, th...

OBJECTIVES: In acute pancreatitis (AP), the variable clinical course and high mortality have led to the use of complex and time-consuming scoring systems. This study aimed to evaluate the diagnostic performance of the hemoglobin, albumin, lymphocyte, and platelet (HALP) score in predicting mortality and intensive care unit (ICU) admission in patients with AP, and to compare it with the Atlanta classification and the Bedside Index for Severity in AP (BISAP). METHODS: This single-center retrospective study included 455 patients diagnosed with AP. Demographic data, laboratory findings, and clinical course of the patients were recorded, and HALP, BISAP, and Atlanta classification scores were calculated. RESULTS: The Atlanta classification showed the highest predictive accuracy for both mortality and ICU admission (mortality: sensitivity 91%, specificity 96%; ICU admission: sensitivity 77%, specificity 99%). The HALP score demonstrated a moderate predictive ability for both mortality (sensitivity = 0.64; specificity = 0.79) and ICU admission (sensitivity = 0.74; specificity = 0.67). The sensitivity of the HALP score was significantly higher than that of the BISAP score for both outcomes (P < 0.001). CONCLUSION: Although the HALP score has a lower overall predictive power compared to the Atlanta and BISAP scores, its higher sensitivity and easily calculable structure compared to the BISAP score suggest that it may serve as a supportive tool for early prognostic assessment of AP patients in emergency department settings.

Background:Traumatic brain injury (TBI) is a critical public health issue, particularly among young adults, and the presence of intracranial hemorrhage (ICH) has a direct impact on clinical outcomes. In patients presenting with mild head trauma, early prediction of ICH remains challenging. In recent years, hematologic biomarkers such as platelet indices have attracted increasing interest as potential diagnostic tools in trauma evaluation. Objective:This study aimed to investigate the association between platelet indices—including mean platelet volume (MPV), platelet distribution width (PDW), and platelet-large cell ratio (P-LCR), and the presence of ICH in patients presenting to the emergency department (ED) with isolated head trauma. Methods:This retrospective observational study included adult patients aged ≥18 years who presented to the ED with isolated head trauma between March 1, 2023 and March 1, 2024. Patients were divided into two groups based on the presence or absence of ICH on brain computed tomography. Hematological and biochemical parameters were recorded, and comparisons between the groups were conducted using appropriate parametric and non-parametric tests (significance level set at p <0.05). Results:A total of 215 patients were included to the trial, of whom 45 (20.9%) had confirmed ICH. White blood cell (WBC) counts were significantly higher in the ICH group (11.6 ± 4.0 vs. 9.6 ± 3.5; p = 0.003). No significant differences were observed between groups for MPV (p = 0.484), PDW (p = 0.724), or P-LCR (p = 0.567). Similarly, no significant associations were found between platelet indices and emergency department disposition. Conclusion:While WBC count was associated with both the presence of ICH and hospital admission, MPV, PDW and P-LCR did not demonstrate predictive value for ICH in patients with isolated head trauma. Further prospective, multicenter studies with serial measurements are needed to clarify the clinical utility of these indices in neurotrauma.