Ali Halici

Introduction: The growing aging population has led to an increasing number of geriatric patients presenting to emergency departments (EDs), many of whom have complex clinical profiles characterized by frailty, comorbidity, and polypharmacy. Early identification of patients requiring intensive care is challenging in this population, as clinical presentations are often atypical and physiological responses may be blunted. Although various clinical scoring systems are available, their comparative performance in predicting intensive care unit (ICU) admission and ICU length of stay (LOS) in the general geriatric ED population remains unclear.Methods: This retrospective, single-center observational cohort study included patients aged ≥65 years presenting to the emergency department of a tertiary-care hospital. Clinical data, including vital signs and scores such as qSOFA, NEWS2, Clinical Frailty Scale (CFS) and Charlson Comorbidity Index (CCI) were collected. The primary outcome was ICU admission and the secondary outcome was ICU length of stay. Receiver operating characteristic (ROC) analysis and multivariable regression models were used to evaluate predictive performance and identify independent predictors.Results: A total of 294 patients were included, of whom 34 (11.6%) required ICU admission. Lower diastolic blood pressure, lower oxygen saturation and higher respiratory rate were significantly associated with ICU admission. Among the evaluated scores, qSOFA demonstrated the highest discriminatory performance (AUC = 0.702), followed by CCI (AUC = 0.653), NEWS2 (AUC = 0.633) and CFS (AUC = 0.625). In multivariable analysis, qSOFA (OR 3.33, 95% CI 1.78–6.24), CFS (OR 2.42, 95% CI 1.51–3.88), CCI (OR 1.24, 95% CI 1.03–1.49) and age (OR 1.07, 95% CI 1.01–1.13) were independent predictors of ICU admission, whereas NEWS2 was not. For ICU LOS, only CCI was independently associated with prolonged stay (β = 0.152, p = 0.030).Conclusion: In geriatric patients presenting to the emergency department, qSOFA appears to be a useful tool for predicting ICU admission, while frailty and comorbidity burden also play important roles. However, the overall discriminative performance of these scores is modest, suggesting that they should be used in conjunction with clinical judgment. ICU length of stay is primarily influenced by comorbidity burden rather than acute physiological parameters. An integrated approach combining acute and baseline patient characteristics may improve early risk stratification in this population.Keywords: Aged, Emergency Service, Hospital, Intensive Care Units, Frailty, Comorbidity, Risk Assessment

Background: Pediatric head trauma is a common reason for emergency department presentation. Although most children have minor injuries, a small proportion harbor clinically important traumatic brain injuries requiring urgent intervention. Artificial intelligence (AI) may offer structured support in computed tomography (CT) decision making, but evidence regarding the performance of general-purpose large language models in pediatric head trauma remains limited. Objective: To evaluate the association between AI-based cranial CT recommendations and clinically meaningful outcomes in pediatric patients with blunt head trauma and to assess the diagnostic performance and clinical utility of the model. Methods: This retrospective single-center observational study included pediatric patients younger than 18 years with blunt head trauma who underwent cranial CT imaging and had complete outcome data. A general-purpose large language model generated binary CT recommendations (“CT recommended” or “CT not recommended”) using structured clinical information available at the time of emergency department presentation. The primary outcome was a composite adverse clinical outcome defined as the occurrence of at least one of the following: emergency surgical intervention, intensive care unit admission, intubation, neurological sequelae or mortality. Diagnostic performance metrics, calibration analysis and decision curve analysis were performed. Results: A total of 819 pediatric patients were included, and the AI model recommended CT in 530 patients (64.7%). The primary outcome occurred in 143 patients (17.5%) and was significantly more frequent in the CT-recommended group than in the CT-not recommended group (24.5% vs. 4.5%; OR 6.90, 95% CI 3.82–12.45; p < 0.001). Abnormal CT findings, emergency surgery, intubation and neurological sequelae were also significantly more common in patients for whom CT was recommended by the AI system. For the primary outcome, the AI recommendation demonstrated a sensitivity of 90.9%, specificity of 40.8%, positive predictive value of 24.5% and negative predictive value of 95.5%. Calibration analysis showed acceptable agreement between predicted probabilities and observed event rates. Decision curve analysis demonstrated greater net benefit than both the “treat-all” and “treat-none” strategies across a range of threshold probabilities. Conclusions: In this clinically selected cohort of pediatric patients with blunt head trauma who underwent cranial CT imaging, AI-based CT recommendations were strongly associated with adverse clinical outcomes and demonstrated high sensitivity and negative predictive value for identifying children at risk of clinically important events. These findings suggest that, within a clinically selected cohort of children who underwent cranial CT imaging, AI-generated CT recommendations were associated with clinically meaningful outcomes. However, these results should not be interpreted as validation of CT decision making in the broader pediatric head trauma population and require prospective validation in unselected cohorts.

Background: Malnutrition is a major global geriatric health problem, reported in approximately one-fifth of older adults worldwide and occurring even more frequently in acute care and hospital settings. Among older adults presenting to the emergency department (ED), nutritional vulnerability is often underrecognized because early ED decision-making is primarily dominated by acute physiological instability and the need for rapid disposition. Clarifying whether commonly used malnutrition screening tools provide clinically useful information beyond frailty, comorbidity burden and acute illness severity may help determine their role in early geriatric ED risk stratification, in-hospital care planning, and resource utilization. Objectives: To evaluate the prevalence, agreement, and clinical utility of three validated malnutrition screening tools the Malnutrition Universal Screening Tool (MUST), Nutritional Risk Screening 2002 (NRS-2002), and the clinician-administered Subjective Global Assessment (SGA) in older ED patients, and to examine their associations with hospital admission and length of stay (LOS). Methods: This prospective single-center study included 325 patients aged ≥65 years presenting to the ED. Nutritional status was assessed using the MUST, the NRS-2002, and the SGA. Agreement between tools was evaluated using Cohen’s kappa, positive percent agreement, and negative percent agreement. Associations with hospital admission were analyzed using multivariable logistic regression adjusted for age, sex, Clinical Frailty Scale, National Early Warning Score 2, and Charlson Comorbidity Index. Multivariable linear regression was used to identify predictors of LOS. Results: Overall, 32.6% of patients required hospital admission. Among admitted patients, the median hospital length of stay was 5 days (IQR 2–9). The prevalence of high nutritional risk varied substantially across tools, from 16.6% with the MUST to 41.5% with the NRS-2002 and 23.4% with the SGA. Agreement between tools was moderate overall (κ = 0.41–0.60), with moderate concordance in identifying low-risk and high-risk patients. After adjustment for clinically relevant covariates, none of the screening tools was independently associated with hospital admission. However, high-risk classification by the NRS-2002 was independently associated with prolonged LOS (β = 0.47, 95% CI 0.10–0.85; p = 0.01), whereas the MUST and the SGA were not. Conclusions: In older ED patients, malnutrition screening tools did not add independent value for predicting immediate hospital admission beyond frailty, comorbidity burden, and acute illness severity. However, the NRS-2002 was associated with longer hospital stay, suggesting potential value for early identification of patients who may require more complex in-hospital care and resource planning.

Objective: Coronary artery bypass grafting (CABG) remains a widely performed surgical intervention for coronary artery disease. Despite advances in perioperative care and preoperative risk stratification, postoperative complications and mortality continue to pose significant clinical challenges. This study aimed to investigate the prognostic value of platelet related parameters specifically, mean platelet volume (MPV) and platelet count (PLT) in predicting postoperative outcomes and 30-day mortality in patients undergoing CABG. Material and Methods: This retrospective, single-center study included 406 adult patients who presented to the emergency department with acute coronary syndrome and subsequently underwent isolated CABG between 2019 and 2023. Demographic characteristics, preoperative EuroSCORE II and logEuroSCORE values, laboratory parameters and echocardiographic findings were recorded. Postoperative outcomes included 30-day mortality, major adverse cardiac events (MACE) and composite poor outcomes. Hematologic and biochemical parameters were analyzed at admission and on postoperative day 30 or the day of death. Associations between these variables and clinical outcomes were assessed using ROC and regression analyses. Results: Among the 406 patients (mean age: 63.5±8.6 years; 76.1% male), the 30-day mortality rate was 4.7%, with MACE and poor outcomes occurring in 9.4% and 10.1% of cases, respectively. Postoperative MPV and PLT were significantly associated with all outcome groups (p

OBJECTIVE: This study aimed to evaluate the readability of prospectuses (Patient Information Leaflets) for antiplatelet and anticoagulant medications, which are widely prescribed for cardiovascular conditions.MATERIAL AND METHODS: A total of 13 drug prospectuses (6 anticoagulants, 7 antiplatelets) were retrieved from the Turkish Drug Guide. Readability scores were calculated using the Ateşman, Bezirci-Yılmaz, and Çetinkaya-Uzun formulas. Textual metrics such as word count, sentence length, and syllable count were analyzed.RESULTS: According to the Ateşman formula, the average readability score was 71.45, indicating an “easy” level. However, the Bezirci-Yılmaz and Çetinkaya-Uzun scores revealed that these texts require at least a high school education level to comprehend. The high proportion of multi-syllabic words and complex sentence structures in the prospectuses limits accessibility for patients with low health literacy.CONCLUSIONS: Most antiplatelet and anticoagulant medication prospectuses exceed the recommended readability level for patient materials. This may negatively impact patient understanding, medication adherence, and safety. The results underscore the need for regulatory oversight and collaboration with health literacy experts to improve the design and clarity of drug information materials.

Amaç:Bu çalışmada, acil servise başvuran 65 yaş ve üzeri bireylerde kırılganlık düzeyine göre ağrı şiddeti ve süresinin günlük yaşam aktiviteleri ve fonksiyonel bağımsızlık üzerindeki etkisinin değerlendirilmesi amaçlandı.Gereç ve Yöntem:Bu tanımlayıcı-kesitsel anket çalışması, Kütahya Şehir Hastanesi Acil Servisi’ne başvuran 65 yaş ve üzeri 222 katılımcı ile gerçekleştirildi. Katılımcıların kırılganlık düzeyi FRAIL ölçeği ile non-frail, pre-frail ve frail olarak sınıflandırıldı. Ağrı şiddeti; istirahat, aktivite ve gece dönemleri için Görsel Analog Ölçeği (VAS) ile değerlendirildi. Temel günlük yaşam aktiviteleri Katz Günlük Yaşam Aktiviteleri Ölçeği (KATZ-ADL) ile, enstrümantal günlük yaşam aktiviteleri ise Lawton–Brody Enstrümantal Günlük Yaşam Aktiviteleri Ölçeği (IADL) ile ölçüldü. Gruplar arası karşılaştırmalarda uygun parametrik ve nonparametrik istatistiksel testler kullanıldı.Bulgular:Pre-frail ve frail gruplarda günlük ağrı görülme oranı, non-frail gruba kıyasla anlamlı derecede daha yüksekti (p

Objective: The objective of this study is to evaluate the diagnostic accuracy of Extended Focused Assessment with Sonography for Trauma (E‐FAST) performed by senior emergency medicine residents compared with computed tomography (CT) in patients with blunt thoracoabdominal trauma. Methods: This prospective observational diagnostic accuracy study was conducted at a Level 1 trauma center between December 2023 and June 2024. Adult patients presenting with isolated blunt thoracoabdominal trauma who underwent both E‐FAST and thoracoabdominal CT were included. E‐FAST examinations were performed at the bedside by senior emergency medicine residents certified in ultrasonography. CT served as the reference standard. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of E‐FAST were calculated. Concordance between E‐FAST and CT findings was analyzed using Fisher's exact test wherever appropriate. Results: A total of 170 patients were analyzed (124 males [72.9%] and mean age: 38.2 ± 14.7 years). E‐FAST demonstrated a sensitivity of 100%, specificity of 98.7%, PPV of 88.2%, and NPV of 100% compared to CT. Concordance between E‐FAST and CT findings was statistically significant for intra‐abdominal free fluid, pneumothorax, and hemothorax ( p < 0.001 for each). No pericardial effusion was detected by either modality. Conclusion: E‐FAST performed by adequately trained emergency medicine residents is a rapid, reliable, and highly accurate diagnostic tool in the initial evaluation of blunt thoracoabdominal trauma. Incorporating E‐FAST into standard trauma assessment protocols can enhance diagnostic efficiency and reduce unnecessary CT utilization.

This letter provides a critical appraisal of the article titled “Assessing the Prognostic Value of the Hemoglobin-to-Red Cell Distribution Width Ratio in Emergency Department Patients with Acute Coronary Syndrome” by Kudu and Danış. The study explores the prognostic utility of the hemoglobin-to-RDW ratio (HRR) in acute coronary syndrome (ACS) patients admitted to the emergency department. While the investigation highlights a clinically accessible biomarker, key methodological limitations are identified. These include the retrospective, single-center design; absence of multivariate statistical adjustment for confounders; and lack of subgroup analyses based on ACS types. Additionally, the clinical applicability of HRR is questioned due to its low specificity and limited integration into established risk models. This letter underscores the need for more comprehensive, prospective studies to clarify HRR’s independent prognostic value and its role in acute cardiovascular care.

Background: YouTube has become one of the most widely used platforms for medical education and patient information. However, the accuracy and reliability of such unregulated content remain highly variable and sometimes misleading. This study aimed to evaluate the quality, reliability, and educational value of YouTube videos related to poisonings, insect bites, and envenomations using validated scoring systems. Methods: A cross-sectional analysis of YouTube videos was conducted using the search terms “approach to insect bites and stings,” “approach to poisonings,” “approach to scorpion envenomation,” “approach to snake envenomation,” and “approach to mushroom poisoning.” Searches were performed in incognito mode on August 1, 2025. Only English-language videos shorter than one hour were included. Video quality and reliability were evaluated using the Global Quality Score (GQS), modified DISCERN (mDISCERN), and Journal of the American Medical Association (JAMA) benchmarks, while viewer engagement was measured using the Video Power Index (VPI). Results: A total of 279 videos were analyzed. The mean ± SD scores were as follows: GQS, 3.53 ± 1.09; mDISCERN, 3.53 ± 1.08; and JAMA, 2.63 ± 0.96. Based on the GQS, 59.5% of the videos were high quality, 20.8% moderate quality, and 19.7% low quality; thus, approximately 40% of the evaluated videos (low- and moderate-quality categories combined) did not meet optimal quality standards. Videos on snake envenomation and general poisoning had significantly higher quality and reliability scores (p < 0.001). Educational, physician-sourced, and physician-presented videos achieved higher GQS, JAMA, and mDISCERN values (p < 0.001 for all). However, no significant differences were found in the VPI, indicating that popularity metrics did not correlate with content quality. Conclusions: YouTube provides wide access to poisoning-related educational materials, but content quality varies considerably, and a substantial proportion of videos fall below acceptable quality thresholds. Videos produced or presented by physicians are more reliable, whereas popularity is not a valid indicator of scientific accuracy. Active involvement of healthcare professionals and academic institutions, together with platform-level quality verification and visibility strategies, is essential to improve the credibility and impact of online health information.

Background/Objectives: Mechanical ventilation is essential in the management of acute respiratory failure (RF); however, prolonged use increases the risk of complications. Accurate predictors are therefore needed to guide timely weaning. The Rapid Shallow Breathing Index (RSBI), the dead space to tidal volume ratio (VD/VT), and the Integrative Weaning Index (IWI) are among the key indices used to assess weaning readiness. This study aimed to examine whether these indices differ between patients with Type 1 (hypoxemic) and Type 2 (hypercapnic) respiratory failure who were successfully extubated in the emergency department, in order to explore their physiologic variability across respiratory failure phenotypes. Methods: This cross-sectional study included 35 adult patients (23 with Type 1 RF, 12 with Type 2 RF) who were successfully weaned from mechanical ventilation in the Emergency Department of a tertiary care hospital between 2022 and 2024. RSBI, VD/VT, IWI, and arterial blood gas parameters were recorded. Descriptive and comparative statistical analyses were performed, with significance set at p < 0.05. Results: There were no significant differences in age, gender, or comorbidities between the groups. Type 2 RF patients had higher FiO₂ requirements (37.5% vs. 30.0%; p = 0.03) and PaCO₂ levels (49.1 ± 9.65 mmHg vs. 40.3 ± 4.49 mmHg; p < 0.001). The PaO₂/FiO₂ ratio was lower in the Type 2 group (169 ± 49.6) compared to the Type 1 group (244 ± 95.6; p = 0.017). VD/VT ratios were significantly higher in Type 2 RF patients (0.37 ± 0.04 vs. 0.29 ± 0.13; p = 0.046). RSBI values were identical between groups (40.0 in both; p = 1.00), and IWI values showed no significant difference (70.8 ± 30.7 vs. 79.3 ± 32.5; p = 0.45). Conclusions: Although RSBI and IWI values were similar across respiratory failure types, patients with Type 2 RF demonstrated higher VD/VT ratios and lower PaO₂/FiO₂, indicating reduced gas exchange and alveolar ventilation efficiency. These findings suggest that VD/VT may be a more useful parameter for assessing weaning readiness in hypercapnic patients.