Nurdan Acar

In this study, we sought to determine the consistency of symptoms in patients admitted to three high-volume emergency departments with a diagnosis of COVID-19 with the standard definition published by the Turkish Ministry of Health, and to examine the relationship between symptom type and clinical outcomes. This multicentre, retrospective, observational study included adult patients aged 18 years and over who tested positive for SARS-CoV-2 by RT-PCR in the emergency departments of three hospitals between 11 March and 31 December 2020. Presentation symptoms were classified as typical or atypical in accordance with the national COVID-19 guidelines dated 7 December 2020. Demographic characteristics, vital signs, laboratory results, comorbidities and clinical outcomes were compared between the two groups. A total of 5,274 patients were enrolled; 2,763 (52.4%) were male, and the median age was 63 years. Of these, 4,262 (80.8%) had typical and 1,012 (19.2%) had atypical presentations. Dyspnea was the leading complaint (38.7%), followed by cough (29.9%) and fatigue (20.6%). Patients in the typical group were older (median 64 vs. 60 years, p<0.001), had lower oxygen saturation (90% vs. 91%, p<0.001), and demonstrated higher inflammatory markers including CRP, D-dimer, LDH, and ferritin. Intensive care unit admission was more frequent in the typical group (10.1% vs. 3.2%, p<0.001), as was in-hospital mortality (10.5% vs. 3.0%, p<0.001). Approximately one in five COVID-19 patients presented to the ED with atypical complaints. It should be noted that atypical or asymptomatic patients in terms of clinical course may be missed with symptom-based screening alone. Patients presenting with typical symptoms, particularly those with dyspnea and underlying comorbidities, had considerably worse outcomes and warrant close monitoring.

Aim: This study aimed to assess the health literacy (HL) levels of patients visiting the emergency department of a university hospital and identify related factors. Methods: This cross-sectional study aimed to assess the health literacy levels of patients visiting the emergency department of a university hospital, and to identify related factors. The re-quired sample size was at least 384 individuals, assuming an inadequate HL level of 50%, with 95% confidence interval and 5% margin of error. Data were collected through a two-part questionnaire designed by the researchers. The first part covered the patients’ socio-demographic characteristics and details regarding their emergency department visits. Meanwhile, the second part included the widely used Chew’s short questions to assess inadequate HL. The analysis was conducted using IBM SPSS version 27.0. Descriptive sta-tistics, including frequency, percentage, and mean, were used to summarize the charac-teristics of the study group. The Chi-square test was applied for data analysis. Results: The study group included 58% (n = 250) female and 42% (n = 181) male. Their ages ranged from 18 to 64 years, with a mean (SD) of 29.6 (10.8) and a median of 26.0. In terms of HL levels, 197 individuals (45.7%) had inadequate HL. The frequency of inadequate HL was higher in individuals over the age of 40 years and those with an education level of ≤8 years (p < 0.05 for each). A total of 39.2% (n = 169) of the patients had visited the emergency department multiple times for their current complaints, whereas 243 participants (56.4%) visited the emergency department for a different reason within the past six months. Conclusions: In our study, four out of ten individuals had inadequate HL, and the frequency of repeated emergency department visits was quite high. No statistically significant association was found between emergency department usage characteristics and health literacy levels in the present sample, highlighting the need for larger longitudinal studies with adjusted analyses.

Introduction: The global disruption to healthcare systems caused by the pandemic has had a particular impact on time-sensitive emergencies such as acute ischaemic stroke. This study aimed to evaluate the impact of the pandemic on the pre-hospital and hospital management of acute ischemic stroke patients receiving recanalisation therapies. Methods: This single-center retrospective study compared 227 pre-pandemic (2019–2020) and 206 pandemic-era (2020–2021) AIS patients treated with intravenous thrombolysis (IV rt-PA) or mechanical thrombectomy (MT). Data included demographics, time metrics (e.g., onset-to-door, door-to-needle), NIHSS/mRS scores, and outcomes. Results: A total of 433 patients were included in the study; 227 were treated pre-pandemic, and 206 were treated during the pandemic. No significant differences were found in the demographic characteristics of the patients in the two periods. During the pandemic, we observed a decline in MT referrals from other centres, as well as a shift in ambulance usage patterns. Among IV rtPA patients, EMS dispatch time decreased while scene and hospital delivery times increased (P<.01). Door-to-CT and door-to-needle times were prolonged in both groups during the pandemic (P<.05). The proportion of patients receiving IV rtPA within the 0–3-hour window remained stable. NIHSS scores at admission increased significantly in the MT group (P=.005). Functional outcomes and mortality worsened significantly in the IV rtPA group during the pandemic (P<.05), whereas outcomes in the MT group remained unchanged. Discussion and Conclusion: The negative impact of the pandemic on several components of acute ischaemic stroke care, particularly prehospital timelines and emergency department efficiency in cases involving IV rtPA, contributed to poorer functional outcomes. These findings emphasise the importance of maintaining stroke care pathways and preparedness strategies during public health emergencies.

Aim: To assess the accuracy and decision-support potential of ChatGPT in pediatric emergency practice by comparing its performance with human responses to structured multiple-choice questions.Material and Methods: This cross-sectional study used 100 randomly selected questions from Pediatric Emergency Medicine: Just the Facts, Second Edition. The GPT-4o model was tested without prior prompts, and its answers were compared with the reference solutions and human accuracy rates reported in the source. Accuracy rates were calculated and compared using z-tests. Correlation between ChatGPT and human performance was analyzed with Spearman’s test.Results: ChatGPT answered 85 of 100 questions correctly, achieving an accuracy of 85% (95% CI: 78.0–92.0), which was significantly higher than the mean human accuracy of 54% (95% CI: 50.8–57.4) (p < 0.001). Topic-based analysis showed that ChatGPT’s accuracy ranged from 75% to 100%, while human accuracy ranged from 30% to 65%, with higher variance. Among the 15 questions answered incorrectly by ChatGPT, 60% were case-based; the average correct human response rate for these was 35 ± 17%. A moderate positive correlation was observed between human and ChatGPT performance (ρ = 0.40, p < 0.001).Conclusion: ChatGPT demonstrated high accuracy on structured pediatric emergency questions, suggesting potential as a supportive tool in decision-making and education. While its strengths lie in knowledge-based tasks, limitations remain in complex case-based reasoning. These findings indicate that LLMs could complement, but not replace, human expertise. Prospective studies are warranted to evaluate real-world integration in pediatric emergency care.

Background: Head trauma is one of the most common causes of morbidity and mortality in emergency departments. It is essential to understand the factors leading to intracranial hemorrhage (IH) in order to improve outcomes and reduce healthcare costs. The aim of this study was to evaluate the factors associated with IH in patients presenting to the emergency department with head trauma. Methods: This prospective observational study was conducted between 27 February 2019 and 27 February 2020 at the emergency department of Eskisehir Osmangazi University. Patients aged ≥18 years with head trauma were included. Data were collected from medical records, with follow-up information obtained via telephone or hospital revisits. Analyses were performed using the chi-squared test in IBM SPSS Statistics (version 21), with p < 0.05 being considered significant. Results: Of the 556 patients, 59.7% were male, and 40.3% were female, with an average age of 45.9 years (SD 21.5). Intracranial hemorrhage (IH) was more prevalent in patients aged over 60 years, with comorbidities, taking medication (especially anticoagulants and non-vitamin K antagonist oral anticoagulants [NOACs]), with altered consciousness, pathological neurological findings or experiencing non-minor trauma. Prolonged activated partial thromboplastin time and new or increased hemorrhage on follow-up CT scans were associated with IH. Conclusions: Advanced age, comorbidities, and anticoagulant use were key factors associated with intracranial hemorrhage (IH) in patients with head trauma. Further studies should assess predictors of mortality and outcomes.

Contrast-induced nephropathy (CIN) is a serious complication following the administration of iodinated contrast media, contributing significantly to hospital-acquired acute kidney injury. Contrast-induced nephropathy is defined as either a ≥25% increase from baseline creatinine levels or an absolute increase >0.5 mg/dL, within 48–72 hours after contrast media administration. This study evaluated CIN incidence and associated risk factors in emergency department (ED) patients undergoing contrast-enhanced CT. A prospective observational study was conducted at a tertiary-care ED (June 2013–September 2014). Adults (≥18 years) undergoing CT were enrolled, excluding those with baseline creatinine >1.2 mg/dL, acute kidney injury, or hemodynamic instability. Of the contrast-enhanced CT group (n=171), 14 patients (8.1%) developed CIN, whereas in the non-contrast CT group (n=171), 12 patients (7.0%) developed nephropathy. Hospitalization (p=0.030), advanced age (p=0.026), anemia (p=0.045), leukocytosis (p=0.005), and reduced GFR (p=0.028) were identified as risk factors for contrast-induced nephropathy. In the non-contrast group, anemia (p=0.003), hospitalization (n=9; p=0.039), and leukocytosis (p=0.007) were identified as risk factors for nephropathy. No cases of nephropathy was observed in patients discharged from the ED in either group. Contrast media did not significantly increase nephropathy risk in ED patients with normal renal function. However, older age, anemia, and hospitalization identified high-risk subgroups. Prophylactic measures showed no clear benefit, possibly due to ED time constraints. Vigilance is recommended for elderly and hospitalized patients, with renal monitoring following contrast administration.

Göğüs ağrısı (GA), acil servislere en sık başvuru nedenlerinden biri olup bu hastalar yüksek mortalite ve morbidite ile seyredebilir. Acil servisimize 87320 başvurunun 2878’i (%3,3) travma dışı göğüs ağrısı nedeniyledir ve 2,811 hasta (%97,7) çalışmaya dahil edilmiştir. EKG bulguları normal olan hasta oranı %63, ST segment elevasyonlu miyokard infarktüsü tanısı alan hasta oranı %6,3’tür. Akut koroner sendrom (AKS) görülme riski erkeklerde yaklaşık olarak 1,5 kat fazla saptanmıştır. Taburculuktan sonra 1 ay içinde ciddi kardiyak olay görülme oranı %2,8’dir. Bu sürede TIMI skorlamasında yüksek riskli olanlarda %18,4’ünde ve GRACE skorlamasında yüksek riskli olanlarda ise %7,7’sinde ciddi kardiyak olay ve/veya ölüm görüldü. GA ile başvuru yapan hastaların en sık aldığı tanı AKS olup; bu kapsamda en sık unstable angina pektoris (UAP) saptandı. Kadınlarda AKS tanısının atipik göğüs ağrısıyla daha sık ilişkilendirildiği bulunmuştur. Sonuç olarak çalışmamızdaki hastalar başta kardiyak nedenler olmak üzere pulmoner emboli, pnömotoraks, aort diseksiyonu hatta digoksin intoksikasyonuna uzanan geniş yelpazede yüksek mortalite ve morbiditeye neden olabilecek tanılar almışlardır. Atipik ağrı nedeniyle başvuran hastaların %28,5’u, başvuru sırasında ağrısı devam etmeyen hastaların %33,4’ü AKS tanısı almıştır. Bu nedenle göğüs ağrısı ayırıcı tanısının hızlı ve doğru yapılması hayati öneme sahiptir.

Syncope is a clinical picture that can affect all age groups and has an important place in admissions to the emergency department. There is an important diagnostic challenge in cases where there are different clinical presentations and patients cannot express the situation clearly. Although the emergency department facilities for the diagnosis of syncope are limited, the diagnosis of many patients can be differentiated from life-threatening conditions with a detailed history and physical examination. High-risk patients should be identified and directed for definitive treatment by emergency medicine physicians. This review contains information about the management of the syncope patient in the emergency department.

Objective: To evaluate the outcomes of cardiopulmonary resuscitation (CPR) of oncological cases versus non-oncological admitted to the emergency department as out-of-hospital cardiac arrest (OHCA) or in-hospital cardiac arrest (IHCA). Study Design: Descriptive study. Place and Duration of Study: Emergency Department (ED) of Eskisehir Osmangazi University Hospital, between January 2014 to January 2020. Methodology: Victims over the age of 18 years who had OHCA and IHCA were inducted. The outcomes of 109 patients with an oncological diagnosis and 109 controls without cancer underwent CPR and were compared. Results: The median age of the participants was 65 (58-76) years. Patients with an oncological diagnosis were more likely to have an IHCA [OR: 2.98 (95% CI: 1.68-5.30), p <0.001]. The IHCA and OHCA rates of patients without an oncological diagnosis were similar. Solid-organ malignancies were observed in 102 patients (93.6%). The initial rhythm of 88 patients (80.7%) in the oncological arrest group was asystole versus 77 patients (70.6%) in the control group. Pulseless electrical activity was observed in 17 patients (15.6%) in the study group and in 24 patients (22.0%) in the control group. Although the non-oncological group was found to have a longer stay. No statistically significant difference was found between the study and control groups regarding duration of stay in the intensive care unit. Only one patient (2.0%) with cancer was discharged in stable state as against 10 (21.3%) of non-oncological arrests [OR: 12.97 (95% CI: 1.59-105.93), p = 0.008]. Conclusion: The presence of cancer is not a favourable prognostic factor for the success of CPR.