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Doğan NÖ, Özturan İU, Pekdemir M, Yaka E, Yılmaz S. Prognostic value of early warning scores in patients presenting to the emergency department with exacerbation of COPD. Med Klin Intensivmed Notfmed 2024; 119:129-135. [PMID: 37401954 DOI: 10.1007/s00063-023-01036-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 05/24/2023] [Accepted: 06/03/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVE Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a condition that frequently presents to the emergency department (ED) and its prognosis is not very well understood. Risk tools that can be used rapidly in the ED are needed to predict the prognosis of these patients. METHODS This study comprised a retrospective cohort of AECOPD patients presenting to a single center between 2015 and 2022. The prognostic accuracy of several clinical early warning scoring systems, Modified Early Warning Score (MEWS), National Early Warning Score (NEWS), NEWS‑2, Systemic Inflammatory Response Syndrome (SIRS) and the quick Sepsis-related Organ Failure Assessment (qSOFA), were compared. The outcome variable was determined as one-month mortality. RESULTS Of the 598 patients, 63 (10.5%) had died within 1 month after presenting to the ED. Patients who died had more often congestive heart failure, altered mental status, and admission to intensive care, and they were older. Although the MEWS, NEWS, NEWS‑2, and qSOFA scores of those who died were higher than those who survived, there was no difference between the SIRS scores of these two groups. The score with the highest positive likelihood ratio for mortality estimation was qSOFA (8.5, 95% confidence interval [CI] 3.7-19.6). The negative likelihood ratios of the scores were similar, the NEWS score had a negative likelihood ratio of 0.4 (95% CI 0.2-0.8) with the highest negative predictive value of 96.0%. CONCLUSION In AECOPD patients, most of the early warning scores that are frequently used in the ED were found to have a moderate ability to exclude mortality and a low ability to predict mortality.
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Affiliation(s)
- Nurettin Özgür Doğan
- Faculty of Medicine, Dept. of Emergency Medicine, Kocaeli University, Kocaeli, Turkey.
| | - İbrahim Ulaş Özturan
- Faculty of Medicine, Dept. of Emergency Medicine, Kocaeli University, Kocaeli, Turkey
| | - Murat Pekdemir
- Faculty of Medicine, Dept. of Emergency Medicine, Kocaeli University, Kocaeli, Turkey
| | - Elif Yaka
- Faculty of Medicine, Dept. of Emergency Medicine, Kocaeli University, Kocaeli, Turkey
| | - Serkan Yılmaz
- Faculty of Medicine, Dept. of Emergency Medicine, Kocaeli University, Kocaeli, Turkey
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Işik AK, Özturan İU, Pekdemir M, Doğan NÖ, Yaka E, Yilmaz S. Adherence to Clinical Practice Guidelines for Non-ST Elevation Acute Coronary Syndrome in the Emergency Department: Exploring the Role of Social, Healthcare-system, and Clinical Determinants. Crit Pathw Cardiol 2023; 22:128-134. [PMID: 37815841 DOI: 10.1097/hpc.0000000000000336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
OBJECTIVES The aim of this study was to assess adherence to the European Society of Cardiology 2020 non-ST elevation acute coronary syndrome (NST-ACS) guidelines, identify factors affecting this compliance, and explore the link between adherence and adverse cardiac outcomes. METHODS This prospective cohort study was conducted in a tertiary-level academic hospital between January 2022 and January 2023. Patients diagnosed with NST-ACS in the emergency department (ED) were included. The primary outcome measured was the rate of adherence to the guidelines, and secondary outcomes were factors affecting this adherence in the ED and its association with 28-day adverse cardiac outcomes. RESULTS Of the 298 patients included, guideline adherence was achieved in 32.2% in the ED. The highest compliance was observed in performing a 12-lead electrocardiogram (ECG) within 10 minutes (99.7%), while the lowest was found for obtaining additional right and posterior ECG leads when ongoing ischemia was suspected (42.3%). Factors associated with better adherence included the experience level of the treating physician, the presence of cardiac-quality chest pain, initial ischemic ECG findings, higher initial troponin levels, and advanced history, electrocardiogram, age, risk factors, and troponin score and Charlson comorbidity index. Complete guideline adherence over 28 days was achieved in 19.1% of patients and was found to be significantly associated with lower rates of adverse cardiac outcomes. CONCLUSIONS Adherence to NST-ACS guidelines was generally low but was associated with improved patient outcomes. This study highlighted the importance of various factors associated with guideline adherence. Future research should explore further barriers to guideline adherence and develop targeted interventions.
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Affiliation(s)
- Abdullah Kürşat Işik
- From the Department of Emergency Medicine, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
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Özturan İU, Sarbay İ. Scholarly impact of the dissertation requirement for postgraduate medical education and factors affecting transformation into publication: A bibliometric analysis of 2434 dissertations in the field of emergency medicine. Turk J Emerg Med 2023; 23:219-224. [PMID: 38024192 PMCID: PMC10664198 DOI: 10.4103/tjem.tjem_45_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 03/20/2023] [Indexed: 12/01/2023] Open
Abstract
OBJECTIVES In Turkey, conducting research for a dissertation is necessary to obtain a specialist degree, but publication of this research is not mandatory. Previous studies have shown a low rate of publication for dissertation-derived research. The aim of this study was to determine publication rates, factors affecting the transformation of the dissertations into high-quality publications, and bibliometric analysis of published articles in the field of emergency medicine (EM). METHODS This was a retrospective bibliometric study of EM dissertations submitted between 1998 and 2021 to the National Thesis Center. Research characteristics, publication status, journal characteristics, indexing, citation analysis, and institution characteristics were recorded. Journals indexed in the web of science (WOS) were defined as high-quality journals. A logistic regression was performed to identify factors affecting publication in high-quality journals. RESULTS A total of 2434 dissertations were included. Of these, 864 (35.5%) were published and 474 (54%) were published in WOS-indexed journals. The most common area of research was trauma (n = 150, 17%), and the most common journal was the American Journal of EM (n = 74, 8%). Prospective data collection (odds ratio [OR] = 2.5, 95% confidence interval [CI] = 1.8-2.5), experimental design (OR = 2, 95%, CI = 1.3-3), university-type residency program (OR = 1.4, 95% CI = 1.02-2.1), and duration between year of graduation and publication (OR = 0.9, 95% CI = 0.84-0.95) were associated with publishing in WOS-indexed journals. CONCLUSION EM is a relatively successful specialty for publishing dissertation-derived studies. Prospective and experimental research design, graduation from a university-type residency program, and shorter duration between the graduation and publication may increase the chance of publishing in high-quality journals.
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Affiliation(s)
- İbrahim Ulaş Özturan
- Department of Emergency Medicine, Faculty of Medicine, Kocaeli University, İzmit, Kocaeli, Turkey
- Department of Medical Education, Institute of Health Sciences, Acibadem University, Istanbul, Turkey
| | - İbrahim Sarbay
- Department of Emergency Medicine, Keşan State Hospital, Edirne, Turkey
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Sarbay İ, Berikol GB, Özturan İU. Performance of emergency triage prediction of an open access natural language processing based chatbot application (ChatGPT): A preliminary, scenario-based cross-sectional study. Turk J Emerg Med 2023; 23:156-161. [PMID: 37529789 PMCID: PMC10389099 DOI: 10.4103/tjem.tjem_79_23] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 04/13/2023] [Accepted: 05/24/2023] [Indexed: 08/03/2023] Open
Abstract
OBJECTIVES Artificial intelligence companies have been increasing their initiatives recently to improve the results of chatbots, which are software programs that can converse with a human in natural language. The role of chatbots in health care is deemed worthy of research. OpenAI's ChatGPT is a supervised and empowered machine learning-based chatbot. The aim of this study was to determine the performance of ChatGPT in emergency medicine (EM) triage prediction. METHODS This was a preliminary, cross-sectional study conducted with case scenarios generated by the researchers based on the emergency severity index (ESI) handbook v4 cases. Two independent EM specialists who were experts in the ESI triage scale determined the triage categories for each case. A third independent EM specialist was consulted as arbiter, if necessary. Consensus results for each case scenario were assumed as the reference triage category. Subsequently, each case scenario was queried with ChatGPT and the answer was recorded as the index triage category. Inconsistent classifications between the ChatGPT and reference category were defined as over-triage (false positive) or under-triage (false negative). RESULTS Fifty case scenarios were assessed in the study. Reliability analysis showed a fair agreement between EM specialists and ChatGPT (Cohen's Kappa: 0.341). Eleven cases (22%) were over triaged and 9 (18%) cases were under triaged by ChatGPT. In 9 cases (18%), ChatGPT reported two consecutive triage categories, one of which matched the expert consensus. It had an overall sensitivity of 57.1% (95% confidence interval [CI]: 34-78.2), specificity of 34.5% (95% CI: 17.9-54.3), positive predictive value (PPV) of 38.7% (95% CI: 21.8-57.8), negative predictive value (NPV) of 52.6 (95% CI: 28.9-75.6), and an F1 score of 0.461. In high acuity cases (ESI-1 and ESI-2), ChatGPT showed a sensitivity of 76.2% (95% CI: 52.8-91.8), specificity of 93.1% (95% CI: 77.2-99.2), PPV of 88.9% (95% CI: 65.3-98.6), NPV of 84.4 (95% CI: 67.2-94.7), and an F1 score of 0.821. The receiver operating characteristic curve showed an area under the curve of 0.846 (95% CI: 0.724-0.969, P < 0.001) for high acuity cases. CONCLUSION The performance of ChatGPT was best when predicting high acuity cases (ESI-1 and ESI-2). It may be useful when determining the cases requiring critical care. When trained with more medical knowledge, ChatGPT may be more accurate for other triage category predictions.
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Affiliation(s)
- İbrahim Sarbay
- Department of Emergency Medicine, Keşan State Hospital, Edirne, Turkey
| | - Göksu Bozdereli Berikol
- Department of Emergency Medicine, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - İbrahim Ulaş Özturan
- Department of Emergency Medicine, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey
- Department of Medical Education, Acibadem University, Institute of Health Sciences, Istanbul, Turkey
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Karademir D, Yılmaz S, Özturan İU, Doğan NÖ, Yaka E, Pekdemir M. Performance of bedside lung ultrasound in emergency (BLUE) protocol in the diagnosis of pneumonia. Notf Rett Med 2021. [DOI: 10.1007/s10049-021-00967-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Yeşil O, Pekdemir M, Özturan İU, Doğan NÖ, Yaka E, Yılmaz S, Karadaş A, Pınar SG. Performance of qSOFA, SIRS, and the qSOFA + SIRS combinations for predicting 30-day adverse outcomes in patients with suspected infection. Med Klin Intensivmed Notfmed 2021; 117:623-629. [PMID: 34586431 DOI: 10.1007/s00063-021-00870-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 08/04/2021] [Accepted: 08/20/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The use of the quick sequential organ failure assessment score (qSOFA) score and systemic inflammatory response syndrome (SIRS) criteria to identify patients at high risk for adverse outcomes in the emergency department (ED) remains controversial due to their low predictive performance and lack of supporting evidence. This study aimed to determine the predictive performance of qSOFA, SIRS, and the qSOFA + SIRS combinations for adverse outcomes. METHODS All adult patients admitted to the ED with suspected infection were prospectively included. qSOFA scores ≥ 2, SIRS score ≥ 2 were defined as risk-positive for adverse outcome. Furthermore, combination‑1, which was defined as either qSOFA or SIRS positivity, and combination‑2, which was defined as both qSOFA and SIRS positivity, were also considered as risk-positive for adverse outcome. The predictive performance of qSOFA, SIRS, combination‑1, and combination‑2 for a composite adverse outcome within 30 days, including mortality, intensive care unit (ICU) admission, and non-ICU hospitalization, were determined. RESULTS A total of 350 patients were included in the analysis. The composite outcome occurred in 211 (60.3%) patients within 30 days: mortality in 84 (24%), ICU admission in 78 (22.3%), and non-ICU hospitalization in 154 (44%). The sensitivity and specificity, respectively, were determined in predicting composite outcome as 0.34 and 0.93 for qSOFA, 0.81 and 0.31 for SIRS, 0.84 and 0.28 for combination‑1, and 0.31 and 0.96 for combination‑2. CONCLUSION The study results suggest that qSOFA and combination‑2 could be a useful tool for confirming patients at high risk for adverse outcomes. Although SIRS and combination‑1 could be helpful for excluding high-risk patients, the requirement of white blood cell counts limits their utilization for screening.
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Affiliation(s)
- Olcay Yeşil
- Faculty of Medicine, Dept. of Emergency Medicine, Kocaeli University, Kabaoğlu, Baki Komsuoğlu bulvarı No:515, Umuttepe, 41001, İzmit, Kocaeli, Turkey
| | - Murat Pekdemir
- Faculty of Medicine, Dept. of Emergency Medicine, Kocaeli University, Kabaoğlu, Baki Komsuoğlu bulvarı No:515, Umuttepe, 41001, İzmit, Kocaeli, Turkey
| | - İbrahim Ulaş Özturan
- Faculty of Medicine, Dept. of Emergency Medicine, Kocaeli University, Kabaoğlu, Baki Komsuoğlu bulvarı No:515, Umuttepe, 41001, İzmit, Kocaeli, Turkey.
| | - Nurettin Özgür Doğan
- Faculty of Medicine, Dept. of Emergency Medicine, Kocaeli University, Kabaoğlu, Baki Komsuoğlu bulvarı No:515, Umuttepe, 41001, İzmit, Kocaeli, Turkey
| | - Elif Yaka
- Faculty of Medicine, Dept. of Emergency Medicine, Kocaeli University, Kabaoğlu, Baki Komsuoğlu bulvarı No:515, Umuttepe, 41001, İzmit, Kocaeli, Turkey
| | - Serkan Yılmaz
- Faculty of Medicine, Dept. of Emergency Medicine, Kocaeli University, Kabaoğlu, Baki Komsuoğlu bulvarı No:515, Umuttepe, 41001, İzmit, Kocaeli, Turkey
| | - Adnan Karadaş
- Faculty of Medicine, Dept. of Emergency Medicine, Kocaeli University, Kabaoğlu, Baki Komsuoğlu bulvarı No:515, Umuttepe, 41001, İzmit, Kocaeli, Turkey
| | - Seda Güney Pınar
- Faculty of Medicine, Dept. of Emergency Medicine, Kocaeli University, Kabaoğlu, Baki Komsuoğlu bulvarı No:515, Umuttepe, 41001, İzmit, Kocaeli, Turkey
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7
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Alyeşil C, Yilmaz S, Özturan İU, Pekdemir M, Yaka E, Doğan NÖ. Reliability of chest pain risk scores in cancer patients with suspected acute coronary syndrome. Clin Exp Emerg Med 2021; 7:275-280. [PMID: 33440105 PMCID: PMC7808833 DOI: 10.15441/ceem.19.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 11/26/2019] [Indexed: 11/29/2022] Open
Abstract
Objective The history, electrocardiogram, age, risk factors, troponin (HEART), the thrombolysis in myocardial infarction (TIMI), and Global Registry of Acute Coronary Events (GRACE) scores are useful risk stratification tools in the emergency department (ED). However, the accuracy of these scores in the cancer population is not well known. This study aimed to compare the performance of cardiac risk stratification scores in cancer patients with suspected acute coronary syndrome (ACS) in the ED. Methods This prospective cohort study recruited patients with cancer who visited the ED because of suspected ACS. The development of any major adverse cardiac events (MACE) within 6 weeks was recorded, with the study outcome being a MACE within 6 weeks of ED admission. Results A total of 178 patients participated in this study, of whom 5.6% developed a MACE. Statistically significant differences were found between the mean HEART and TIMI scores in predicting MACE. The HEART score had the highest area under the curve (0.64; 95% confidence interval, 0.48–0.81), highest sensitivity (80%), and highest negative predictive value (97.5) in patients with cancer. Conclusion We found a similar rate of MACE in cancer patients with low-risk chest pain compared to that in the general population. However, the HEART, TIMI, and GRACE scores had a lower performance in cancer patients with MACE compared to that in the general population.
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Affiliation(s)
- Cansu Alyeşil
- Department of Emergency Medicine, Mersin City Training and Research Hospital, Mersin, Turkey
| | - Serkan Yilmaz
- Department of Emergency Medicine, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | | | - Murat Pekdemir
- Department of Emergency Medicine, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Elif Yaka
- Department of Emergency Medicine, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Nurettin Özgür Doğan
- Department of Emergency Medicine, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
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Özturan İU, Köse B, Özkan B, Köse A. Myopericarditis caused by severe acute respiratory syndrome coronavirus 2. Clin Exp Emerg Med 2020; 7:326-329. [PMID: 33440111 PMCID: PMC7808828 DOI: 10.15441/ceem.20.109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 11/06/2020] [Indexed: 01/07/2023] Open
Abstract
A 25-year-old man presented to the emergency department with acute-onset chest pain and shortness of breath. A physical examination revealed coarse crackles in the both lower lungs. Consolidation and ground-glass opacities suggesting viral infection were detected in the right lower lobe on chest computed tomography. Laboratory findings revealed elevated troponin, leukocytosis, and lymphopenia. Electrocardiography revealed ST segment elevation with PR depression in leads I, aVL, V5, and V6, and ST depression and PR elevation in aVR. Echocardiography revealed diffuse cardiac hypokinesia and a decreased left ventricular ejection fraction. Suspecting coronavirus disease 2019 (COVID-19)–related myopericarditis, the patient was hospitalized. After one week of empirical antibiotics, antivirals, and supportive therapy, his condition improved. Antibody testing for COVID-19 was positive on hospitalization day 8. The presentation of myopericarditis can be vague and mislead physicians during the COVID-19 pandemic. Myopericarditis should be included as a differential diagnosis for patients with suspected COVID-19.
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Affiliation(s)
| | - Beril Köse
- Department of Emergency Medicine, Mersin Toros State Hospital, Mersin, Turkey
| | - Buğra Özkan
- Department of Cardiology, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Ataman Köse
- Department of Emergency Medicine, Faculty of Medicine, Mersin University, Mersin, Turkey
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9
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Güney Pınar S, Pekdemir M, Özturan İU, Doğan NÖ, Yaka E, Yılmaz S, Karadaş A, Ferek Emir D. Assessment of end-tidal carbon dioxide and vena cava collapsibility in volume responsiveness in spontaneously breathing patients. Med Klin Intensivmed Notfmed 2020; 117:34-40. [PMID: 33103218 DOI: 10.1007/s00063-020-00749-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/06/2020] [Accepted: 09/16/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The benefit of end-tidal carbon dioxide (ETCO2) and inferior vena cava collapsibility index (IVCCI) in predicting fluid responsiveness in mechanically ventilated patients has been demonstrated. However, the data on spontaneously breathing patients is controversial. This study aims to investigate the accuracy of variations in the ETCO2 (∆ETCO2) and IVCCI (∆IVCCI) gradient in predicting volume responsiveness in spontaneously breathing patients with hypovolemia. METHODS This was a prospective observational study conducted in an academic emergency department (ED). Spontaneously breathing patients who required fluid resuscitation due to hypovolemia were included in the study. Cardiac output (CO), IVCCI and ETCO2 were measured before and after the passive leg raise (PRL). A change in the CO of ≥15% after the PLR were considered volume responsive. The difference in the ∆ETCO2 and ∆IVCCI were compared between the volume responsive and nonresponsive groups. RESULTS A total of 31 patients were included in the study, of whom 15 patients were volume responsive. The difference in the ∆ETCO2 was 4 mm Hg in the volume responsive and 2 mm Hg in the nonresponsive group (p = 0.02). There was no significant difference in ∆IVCCI between the groups. A moderate correlation was detected between the difference in ∆ETCO2 and CO (0.585; p = 0.001). CONCLUSION ∆ETCO2 can be an alternative method in predicting volume responsiveness in spontaneously breathing patients with hypovolemia.
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Affiliation(s)
- S Güney Pınar
- Faculty of Medicine, Department of Emergency Medicine, Kocaeli University, 41700, Kocaeli, Turkey
| | - M Pekdemir
- Faculty of Medicine, Department of Emergency Medicine, Kocaeli University, 41700, Kocaeli, Turkey
| | - İ U Özturan
- Faculty of Medicine, Department of Emergency Medicine, Kocaeli University, 41700, Kocaeli, Turkey.
| | - N Ö Doğan
- Faculty of Medicine, Department of Emergency Medicine, Kocaeli University, 41700, Kocaeli, Turkey
| | - E Yaka
- Faculty of Medicine, Department of Emergency Medicine, Kocaeli University, 41700, Kocaeli, Turkey
| | - S Yılmaz
- Faculty of Medicine, Department of Emergency Medicine, Kocaeli University, 41700, Kocaeli, Turkey
| | - A Karadaş
- Faculty of Medicine, Department of Emergency Medicine, Kocaeli University, 41700, Kocaeli, Turkey
| | - D Ferek Emir
- Faculty of Medicine, Department of Emergency Medicine, Kocaeli University, 41700, Kocaeli, Turkey
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Duyan M, Ünal AY, Özturan İU, Günsoy E. Contribution of caval index and ejection fraction estimated by e-point septal separation measured by emergency physicians in the clinical diagnosis of acute heart failure. Turk J Emerg Med 2020; 20:105-110. [PMID: 32832729 PMCID: PMC7416849 DOI: 10.4103/2452-2473.290065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 03/19/2020] [Accepted: 05/20/2020] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Although the reliability of e-point septal separation (EPSS) and caval index (CI) is proven in the diagnosis of acute heart failure (AHF), how much they contribute to the initial clinical impression is unclear. This study aimed to determine the diagnostic contribution of EPSS and CI to the initial clinical impression of AHF. METHODS This is a prospective observational study conducted in an academic emergency department (ED). The patients admitted to the ED with acute undifferentiated dyspnea were included. Primary diagnosis was made after an initial clinical evaluation, and a secondary diagnosis was made after EPSS and CI measurements. Independent cardiologists made the final diagnosis. The primary outcome was the diagnostic contribution of EPSS and CI to the primary diagnosis. RESULTS A total of 182 patients were included in the study. The primary diagnosis was found with a sensitivity of 0.55 and specificity of 0.84 and the secondary diagnosis was determined with a sensitivity of 0.78 and specificity of 0.83 in predicting the final diagnosis. The agreement coefficient between the primary and final diagnosis was 0.44 and between the secondary diagnosis and the final diagnosis was 0.61. When the primary diagnosis was coherent with secondary diagnosis, sensitivity and specificity were found to be 0.74 and 0.90, respectively. CONCLUSION Although a detailed history and physical examination are the essential factors in shaping clinical perception, CI and EPSS combined significantly contribute to the initial clinical impression.
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Affiliation(s)
- Murat Duyan
- Department of Emergency Medicine, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Turkey
| | | | | | - Ertuğ Günsoy
- Department of Emergency Medicine, Sivas Numune Hospital, Sivas, Turkey
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Işıkkent A, Yılmaz S, Özturan İU, Doğan NÖ, Yaka E, Gültekin H, Kum T, Pekdemir M. Utility of neutrophil gelatinase-associated lipocalin in the management of acute kidney injury: A prospective, observational study. HONG KONG J EMERG ME 2018. [DOI: 10.1177/1024907918806641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Utilization of renal biomarkers such as neutrophil gelatinase-associated lipocalin in the management of acute kidney injury may be useful as a diagnostic tool in the emergency department. Objective: The aim of this study is to determine the relationship between serum neutrophil gelatinase-associated lipocalin level and the severity of the acute kidney injury based on the Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease (RIFLE) classification, and to investigate the role of the serum neutrophil gelatinase-associated lipocalin level in differentiating the etiology and predicting the 30-day mortality rate and need for dialysis. Methods: This prospective, observational study was conducted from March 2015 to 2016. Adult patients with acute kidney injury in the emergency department were enrolled in the study. Demographic and clinical features such as hypovolemic state, nephrotoxic substance exposure, renal functions, and serum neutrophil gelatinase-associated lipocalin level were evaluated. After the etiology of the acute kidney injury was ascertained, the severity of the acute kidney injury was determined according to RIFLE criteria. Primary outcome was defined as the correlation between serum neutrophil gelatinase-associated lipocalin level and the severity of the acute kidney injury according to RIFLE classification. Secondary outcomes were defined as the relationship between the serum neutrophil gelatinase-associated lipocalin level and the etiology of the acute kidney injury; need for dialysis and 30-day mortality were defined as poor outcomes. Results: A total of 87 patients were included in the study. Mean serum neutrophil gelatinase-associated lipocalin levels were 380.14 ± 276.65 ng/mL in RIFLE-R, 425.80 ± 278.99 ng/mL in RIFLE-I, and 403.60 ± 293.15 ng/mL in RIFLE-F groups. There was no statistically significant relationship between the severity of acute kidney injuries and serum neutrophil gelatinase-associated lipocalin level. Initial serum neutrophil gelatinase-associated lipocalin levels in the emergency department did not indicate a statistically significant ability to predict the etiology of acute kidney injury, 30-day mortality rates, or need for dialysis. Conclusion: Initial serum neutrophil gelatinase-associated lipocalin level in the emergency department is not a determinant tool for predicting the severity, etiology, 30-day mortality rates, or need for dialysis in cases of acute kidney injuries.
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Affiliation(s)
- Ali Işıkkent
- Karabuk University, Training and Reseach Hospital, Department of Emergency Medicine, Karabuk, Turkey
| | - Serkan Yılmaz
- Department of Emergency Medicine, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - İbrahim Ulaş Özturan
- Brown University, Alpert School of Medicine, Brown Advanced Emergency Medicine Academies, Providence, RI USA
| | - Nurettin Özgür Doğan
- Department of Emergency Medicine, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Elif Yaka
- Department of Emergency Medicine, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Haldun Gültekin
- Sakarya University, Training and Research Hospital, Department of Emergency Medicine, Sakarya, Turkey
| | - Tuğba Kum
- Artvin Public Hospital, Department of Biochemistry, Artvin, Turkey
| | - Murat Pekdemir
- Department of Emergency Medicine, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
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Özturan İU, Doğan NÖ, Alyeşil C, Pekdemir M, Yılmaz S, Sezer HF. Factors predicting the need for tube thoracostomy in patients with iatrogenic pneumothorax associated with computed tomography-guided transthoracic needle biopsy. Turk J Emerg Med 2018; 18:105-110. [PMID: 30191189 PMCID: PMC6107931 DOI: 10.1016/j.tjem.2018.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 05/10/2018] [Accepted: 05/17/2018] [Indexed: 01/05/2023] Open
Abstract
Objectives Traumatic iatrogenic pneumothorax occurs most often after a transthoracic needle biopsy. Since this procedure has become a common outpatient intervention, emergency department admissions of post-biopsy pneumothorax patients have increased. The aim of this study was to determine the factors that predict the need for tube thoracostomy in patients with post-biopsy pneumothorax in the emergency department. Methods A retrospective cross-sectional study was conducted on 191 patients with post-biopsy pneumothorax who were admitted to the emergency department between 2010 and 2017. Patient characteristics, clinical findings at the emergency department presentation, and procedural and radiological features were reviewed. A multivariate logistic regression model was constructed using the variables from univariate comparisons to determine the need for tube thoracostomy in patients with iatrogenic pneumothorax, and the effect sizes were demonstrated with odds ratios. Results Tube thoracostomies were performed on 69 out of 191 patients (36.1%). A total of 122 patients (63.9%) were treated with supplemental oxygen therapy without any other intervention, and 126 patients (66.0%) were hospitalized. In the multivariate model, the variables predicting the need for a tube thoracostomy were decreased breath sounds, dyspnea, decreased systolic blood pressure, decreased oxygen saturation and increased pleura–lesion distance. A distance of 19.7 mm predicted the need with a sensitivity of 69.6% and a specificity of 62.3%. Conclusion Decreased breath sounds, dyspnea, decreased systolic blood pressure, decreased oxygen saturation, and increased pleura-lesion distance may predict the need for a tube thoracostomy in patients with post-biopsy pneumothorax.
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Affiliation(s)
- İbrahim Ulaş Özturan
- Kocaeli University, Faculty of Medicine, Department of Emergency Medicine, Kocaeli, Turkey
| | - Nurettin Özgür Doğan
- Kocaeli University, Faculty of Medicine, Department of Emergency Medicine, Kocaeli, Turkey
| | - Cansu Alyeşil
- Kocaeli University, Faculty of Medicine, Department of Emergency Medicine, Kocaeli, Turkey
| | - Murat Pekdemir
- Kocaeli University, Faculty of Medicine, Department of Emergency Medicine, Kocaeli, Turkey
| | - Serkan Yılmaz
- Kocaeli University, Faculty of Medicine, Department of Emergency Medicine, Kocaeli, Turkey
| | - Hüseyin Fatih Sezer
- Kocaeli University, Faculty of Medicine, Department of Thoracic Surgery, Kocaeli, Turkey
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Özturan İU, Doğan NÖ, Karakayalı O, Özbek AE, Yılmaz S, Pekdemir M, Suner S. Comparison of loop and primary incision & drainage techniques in adult patients with cutaneous abscess: A preliminary, randomized clinical trial. Am J Emerg Med 2017; 35:830-834. [DOI: 10.1016/j.ajem.2017.01.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 01/18/2017] [Accepted: 01/20/2017] [Indexed: 11/29/2022] Open
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