Mustafa Çalık

Aim: Micromobility includes low-speed, lightweight vehicles such as electric scooters and bicycles used for short-distance urban travel. The growing popularity of e-scooters has been accompanied by increasing accident-related emergency admissions and safety concerns. This study aimed to compare injury severity, anatomical injury patterns, and hospital-related costs between patients presenting to a tertiary emergency department (ED) following e-scooter versus bicycle accidents.Material and Methods: This retrospective observational study included 373 trauma-related ED admissions between January 2023 and January 2025, comprising 87 e-scooter (23.3%) and 286 bicycle (76.7%) accidents. Demographic characteristics, accident timing, injury types, Injury Severity Scores (ISS), and cost data were assessed. Group comparisons were performed using the Chi-square test, the independent samples t-test, or the Mann–Whitney U test, as appropriate.Results: Minor trauma accounted for 81.5% of cases and major trauma for 18.5%. Major trauma was slightly more common following e-scooter accidents (20.7%) than bicycle accidents (17.8%), though the difference was not statistically significant. Upper extremity fractures were the most frequent major injury in both groups. Rib and lower extremity fractures occurred more often in e-scooter users, whereas clavicular fractures occurred more frequently among bicycle users. The mean hospital cost per patient was $44.19. Hospitalization and ICU admission rates were comparable between groups.Conclusion: In this urban Turkish ED cohort, most micromobility-related injuries were minor, with low ISS values and modest per-patient costs. Bicycle users more frequently sustained facial, clavicle, and visceral injuries. Despite similar overall injury severity, vehicle-specific injury patterns warrant further multicenter investigation.

Background: Acute pulmonary embolism (PE) carries substantial mortality risk, yet readily available electrocardiographic markers of ventricular repolarisation heterogeneity remain underutilised in prognostication. This study evaluated the prognostic value of QT dispersion (QTd) and corrected QT dispersion (QTcd) for predicting 30-day mortality in patients with acute PE. Methods: This single-centre, retrospective observational study enrolled 143 consecutive adult patients with CT-angiography-confirmed acute PE presenting to the emergency department between January 2023 and November 2024. PE severity was stratified per 2019 ESC guidelines. Standard 12-lead ECGs obtained at admission, prior to any PE-directed treatment, were analysed by a single blinded observer. The primary outcome was 30-day all-cause mortality. Independent predictors were identified by multivariable logistic regression, and optimal cut-off values were determined by ROC curve analysis. Results: The 30-day mortality rate was 32.2% (n=46/143). The mean age was 71.0 ± 14.3 years; 13.3% of patients were haemodynamically unstable and 20.3% had active malignancy. Non-survivors exhibited significantly greater QTd (60.2 vs 49.3 ms) and QTcd (80.6 vs 63.1 ms) than survivors (both p< 0.001). On multivariable analysis, QTcd remained an independent predictor of mortality (OR 1.09 per ms, 95% CI 1.05– 1.13; p=0.001), alongside malignancy (OR 5.05), altered mental status (OR 6.10), mean arterial pressure (OR 0.97 per mmHg), and CT-derived left ventricular diameter (OR 0.92 per mm). ROC analysis identified cut-off values of QTd ≥ 56 ms (AUC 0.812, sensitivity 72%, specificity 83%) and QTcd ≥ 67 ms (AUC 0.829, sensitivity 87%, specificity 67%, negative predictive value 92%). Conclusion: QTcd is an independent predictor of 30-day mortality in acute PE and provides clinically useful discrimination across all ESC risk strata. The cut-off values identified may complement established risk scores in emergency prognostication; prospective multicentre validation is required before broader clinical adoption.

This study aimed to assess nutritional risk in older adults admitted to the intensive care unit (ICU) from the emergency department (ED) and to examine its relationship with 30-day mortality by comparing nutritional assessment tools with physiological severity scores. The study was conducted simultaneously across 20 EDs. Patients aged 65 years and older who presented to the ED and were subsequently admitted to the ICU were included. Nutritional risk scores including the Nutritional Risk Screening-2002 (NRS-2002), Geriatric Nutritional Risk Index (GNRI), Malnutrition Universal Screening Tool (MUST), and modified Nutrition Risk in the Critically Ill (mNUTRIC) and clinical severity scores, including the Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation II (APACHE II) were calculated using parameters obtained at ED presentation. Univariate and multivariate logistic regression analyses were performed to identify predictors of 30-day mortality. A total of 150 patients were included, with a 30-day mortality rate of 21.3%. In multivariate logistic regression analysis, SOFA score independently predicted 30-day mortality (OR: 1.30 per point increase, 95% CI: 1.03-1.63; p = 0.028). ROC analysis showed excellent discriminative ability for SOFA (AUC = 0.87), APACHE II (AUC = 0.85), and mNUTRIC (AUC = 0.83), while GNRI demonstrated good predictive performance (AUC = 0.79). NRS-2002 (AUC = 0.67) and MUST (AUC = 0.66) showed poor discriminative ability. DeLong comparisons showed no significant differences among SOFA, APACHE II, mNUTRIC, and GNRI (all p > 0.05), while these scores performed significantly better than NRS-2002 and MUST (p < 0.01). Among the nutritional assessment tools evaluated, the mNUTRIC score demonstrated good discriminative ability for predicting 30-day mortality in geriatric ICU patients admitted from the ED. However, among all evaluated parameters, the SOFA score was the only independent predictor of 30-day mortality.

Objective: Emergency departments are resource-intensive environments in which diagnostic testing accounts for a significant share of overall healthcare spending. Inadequate physician awareness of the costs associated with these tests has been associated with unnecessary utilization and increased strain on healthcare systems. This study assessed Emergency Medicine (EM) residents in Türkiye regarding their knowledge and awareness of costs for commonly ordered laboratory and imaging tests.Materials and Methods: This prospective cross-sectional survey was conducted among EM residents across Türkiye. A 35-item questionnaire evaluated demographics, cost awareness, and estimation accuracy for 14 diagnostic tests. Estimates within ±25% of actual costs per the national Public Health Service Pricing Schedule were considered accurate, in accordance with thresholds used in prior studies assessing physicians’ awareness of medical costsResults: A total of 270 residents participated (mean age 29.6 ± 3.4 years; 65.2% male). Only 12.6% believed they had sufficient knowledge, and 2.6% had prior cost-related training. The mean accuracy across participants was 17.7% (95% CI: 16.6%-18.9%), with no test accurately estimated by more than one-third of participants. The highest accuracies were observed for serum β-hCG (30.7%), abdominal ultrasound (26.3%), and blood gas analysis (23.3%). Laboratory tests like troponin (50.0%) and blood gas (47.0%) were mostly underestimated, whereas β-hCG (40.0%) and diffusion MRI (34.4%) were overestimated. Over half (56%) reported ordering unnecessary tests. Subgroup analyses showed no significant differences in accuracy by gender, hospital type, or experience.Conclusion: EM residents in Türkiye show limited knowledge and low accuracy in estimating diagnostic test costs. The very low rate of prior education and high demand for training indicate a critical gap in medical curricula that should be addressed to reduce unnecessary testing and healthcare costs.

Drug-related poisoning remains a significant public health problem and is a common cause of emergency department (ED) admissions worldwide. The primary obj

1. Acute ischemic stroke (AIS) is a leading cause of disability and the second most common cause of death worldwide, but most importantly, it is preventable [1]. In recent years, immunometabolic pr...

Objectives: Large language models, such as GPT‐4o, have demonstrated potential in clinical decision‐making; however, their reliability in high‐stakes environments, including emergency department triage, remains uncertain. This study assessed the triage performance of GPT‐4o and GPT‐o1‐mini using raw Turkish trauma notes, focusing on accuracy, expert agreement, and severity of misclassification as determined by the Emergency Severity Index (ESI). Methods: The GPT‐4o and GPT‐o1‐mini models were prompted with unstructured Turkish triage notes to retrospectively predict ESI levels. Model outputs were compared to expert‐labeled ESI scores. Performance was evaluated using F1 scores, accuracy, weighted error analysis, and interrater agreement (Cohen's kappa). Spearman correlation was used to assess associations between model predictions and ESI scores. Results: A total of 5031 patients were analyzed based on age, sex, and raw triage notes. GPT‐4o achieved its best F1 scores in ESI‐3 (0.42) and ESI‐5 (0.57), whereas GPT‐o1‐mini performed better in ESI‐3 and ESI‐4. Both models achieved high overall accuracy in the binary classification of high‐acuity trauma cases (GPT‐4o: 91%, GPT‐o1‐mini: 93%). However, sensitivity was limited (GPT‐4o: 0.45; GPT‐o1‐mini: 0.29). GPT‐4o performed better in identifying critical cases (ESI 1–2), whereas GPT‐o1‐mini excelled in low‐acuity predictions (ESI 4–5). Agreement with expert ratings was fair ( κ ≈ 0.22–0.25). The area under the curve was 0.69 (95%CI: 0.645–0; p ≤ 0.001) for GPT‐4o and 0.62 (95%CI: 0.577–0.669; p ≤ 0.001) for GPT‐o1‐mini, suggesting limited clinical reliability. Weighted error analysis showed that GPT‐o1‐mini resulted in less severe misclassifications. Conclusion: Neither GPT‐4o nor GPT‐o1‐mini achieved expert‐level performance in trauma triage, particularly for high‐acuity cases. Although GPT‐4o showed slightly better accuracy and GPT‐o1‐mini produced fewer severe errors, both models require substantial refinement before they can be considered for clinical use.

Objectives: The optimal rate and duration of isotonic hydration therapy for preventing contrast‐associated acute kidney injury (CA‐AKI) remain poorly established. As prolonged hydration therapy is impractical due to the urgency of diagnostic imaging and the limited time available for monitoring in the emergency departments (EDs), this study evaluated whether bolus hydration regimens are noninferior to prolonged hydration protocols. Methods: This single‐center, prospective, open‐label, randomized controlled, noninferiority trial was conducted at the ED of a training and research hospital between August 10, 2024, and April 26, 2025. 257 patients undergoing contrast‐enhanced computed tomography (CT) with baseline creatinine levels above the reference range (1.2 mg/dL in men and 1.1 mg/dL in women) were included. Patients were stratified by age and sex and randomized to bolus or continuous hydration. The bolus group received 500 mL of isotonic fluid within 30 min before the procedure, followed by 500 mL/hour for 2 h postprocedure. The continuous group received 150 mL/hour for 2 h before and 8 h after the procedure. The primary outcome was the development of CA‐AKI, defined as an increase in serum creatinine of ≥ 25% or ≥ 0.5 mg/dL at 48–72 h following contrast administration. Secondary outcomes included 30‐day all‐cause mortality and the need for dialysis. Results: The two groups were well‐matched in terms of demographic, clinical, or biochemical parameters. The mean baseline creatinine was 1.4 ± 0.21 mg/dL, and the eGFR was 45.6 ± 9.8 mL/min/1.73 m ² . CA‐AKI occurred in 1.7% of the continuous group and 4.9% of the bolus group (absolute risk difference 3.2%; 95% CI −1.3% to 7.7%). As the upper confidence interval limit was below the predefined noninferiority margin of 8%, bolus hydration was noninferior to continuous hydration for CA‐AKI prevention. No patients required dialysis. Thirty‐day all‐cause mortality was comparable (7.6% vs. 7.9%; p = 0.928). Significant improvements were observed in urea, creatinine, and eGFR values in both groups at 48–72 h ( p < 0.001). Conclusion: In this single‐center noninferiority trial, a bolus hydration regimen was noninferior to a prolonged continuous regimen for preventing CA‐AKI in ED patients with moderately impaired baseline renal function. Bolus hydration may offer a practical alternative in time‐constrained ED settings; however, multicenter confirmation is warranted before routine adoption. Trial Registration: ClinicalTrials.gov.identifier: NCT07286526.

Spontaneous ureteral rupture is an uncommon urological emergency characterized by the extraluminal leakage of urine in the absence of trauma or prior instrumentation. It may be mistaken for other surgical conditions. We report the case of a 24-year-old male with a history of nephrolithiasis who presented with acute left flank and abdominal pain. Contrast-enhanced computed tomography revealed proximal ureteral contrast extravasation and a sizable perirenal fluid collection, consistent with ureteral rupture. The patient underwent urgent surgical intervention, and a 6 Fr double-J stent was placed. Postoperative recovery was uneventful, and the patient was discharged in stable condition on postoperative day one. This case highlights the need to include spontaneous ureteral rupture in the differential diagnosis of acute abdominal or flank pain. Early imaging and timely urologic intervention are pivotal in achieving optimal clinical outcomes.