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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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2
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Doğan NÖ. Initial Vasopressor Dosing After Return of Spontaneous Circulation: Which Drug, Which Dose? J Emerg Med 2024; 66:e391-e392. [PMID: 38499403 DOI: 10.1016/j.jemermed.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/31/2023] [Accepted: 11/04/2023] [Indexed: 03/20/2024]
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3
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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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Doğan S, Öztürk O, Aydoğan Diş S, Argun Barış S, Doğan NÖ. Elderly-onset pulmonary sarcoidosis: A radiological approach to diagnosis. Sarcoidosis Vasc Diffuse Lung Dis 2023; 40:e2023028. [PMID: 37712365 PMCID: PMC10540715 DOI: 10.36141/svdld.v40i3.14829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 07/12/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND AND AIM The aim was to compare the radiological and clinical characteristics of sarcoidosis between elderly and non-elderly patients. METHODS This retrospective observational study was carried out in patients with sarcoidosis. Elderly-onset sarcoidosis was defined as sarcoidosis diagnosed in patients ≥65 years-old. Patients were stratified by age (≥65 years versus <65 years) and radiological and clinical data were compared between age groups. RESULTS Of the 163 patients, 38 (23.3%) were in the elderly group and 125 (76.7%) were in the non-elderly group. Elderly patients more frequently demonstrated arthralgia (50% vs. 12.8%, p<0.001), coronary artery disease (15.8% vs. 2.4%, p=0.005), congestive heart failure (13.2% vs. 0.8%, p=0.003), pneumonia (7.9% vs. 0.8%, p=0.04), and pleural fluid (18.4% vs. 0.0%, p<0.001). Clinical remission was significantly more likely in younger patients than in the elderly (76.8% vs. 55.3%, p=0.01). The clinical course to chronic-progressive disease was similar in both groups (p=0.635). Radiologically, lymph nodes measuring 10-25 mm in the short axis (89.5% vs. 72.6%, p=0.032), usual interstitial pneumonia pattern (10.5% vs. 0.8%, p=0.011), and main pulmonary artery diameter above 30 mm (34.2% vs. 16.0%, p=0.014) were significantly more frequent in the elderly group. Elderly patients tended to demonstrate Scadding stage I and II sarcoidosis (39.5% and 31.6%). CONCLUSIONS Presentation of elderly-onset sarcoidosis appears to differ from young-onset sarcoidosis. Radiologically, lymph node enlargement and the pattern of fibrosis may be distinctive.
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Doğan S, Güldiken GS, Alpaslan B, Barış SA, Doğan NÖ. Impact of COVID-19 pneumonia on interstitial lung disease: semi-quantitative evaluation with computed tomography. Eur Radiol 2023:10.1007/s00330-023-09441-2. [PMID: 36764951 PMCID: PMC9918400 DOI: 10.1007/s00330-023-09441-2] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 01/04/2023] [Accepted: 01/14/2023] [Indexed: 02/12/2023]
Abstract
OBJECTIVES To evaluate the CT scores and fibrotic pattern changes in interstitial lung disease (ILD) patients, with and without previous COVID-19 pneumonia. METHODS Patients with ILD (idiopathic pulmonary fibrosis (IPF) and connective tissue disease-associated ILD (CTD-ILD)) were retrospectively enrolled in the study which consisted of patients who had COVID-19 pneumonia while the control group had not. All patients had two CT scans, initial and follow-up, which were evaluated semi-quantitatively for severity, extent, and total CT scores, fibrosis patterns, and traction bronchiectasis. RESULTS A total of 102 patients (pneumonia group n = 48; control group n = 54) were enrolled in the study. For both groups, baseline characteristics were similar and CT scores were increased. While there was a 4.5 ± 4.6 point change in the total CT score of the COVID-19 group, there was a 1.2 ± 2.7 point change in the control group (p < 0.001). In the IPF subgroup, the change in total CT score was 7.0 points (95% CI: 4.1 to 9.9) in the COVID-19 group and 2.1 points (95% CI: 0.8 to 3.4) in the control group. Seven patients (14.6%) in the COVID-19 group progressed to a higher fibrosis pattern, but none in the control group. CONCLUSIONS Semi-quantitative chest CT scores in ILD patients demonstrated a significant increase after having COVID-19 pneumonia compared to ILD patients who had not had COVID-19 pneumonia. The increase in CT scores was more prominent in the IPF subgroup. There was also a worsening in the fibrosis pattern in the COVID-19 group. KEY POINTS • The impact of COVID-19 pneumonia on existing interstitial lung diseases and fibrosis is unclear. • COVID-19 pneumonia may worsen existing interstitial lung involvement with direct lung damage and indirect inflammatory effect. • COVID-19 pneumonia may affect existing lung fibrosis by triggering inflammatory pathways.
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Affiliation(s)
- Sevtap Doğan
- Department of Radiology, Faculty of Medicine, Kocaeli University, 41380, Kocaeli, Turkey.
| | - Gözde Selvi Güldiken
- grid.411105.00000 0001 0691 9040Department of Pulmonary Diseases, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Burcu Alpaslan
- grid.411105.00000 0001 0691 9040Department of Radiology, Faculty of Medicine, Kocaeli University, 41380 Kocaeli, Turkey
| | - Serap Argun Barış
- grid.411105.00000 0001 0691 9040Department of Pulmonary Diseases, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Nurettin Özgür Doğan
- grid.411105.00000 0001 0691 9040Department of Emergency Medicine, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
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Doğan NÖ. Problems in Conducting and Reporting Logistic Regression Analysis. J Emerg Med 2022; 63:709-710. [PMID: 36517118 PMCID: PMC9742809 DOI: 10.1016/j.jemermed.2022.04.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/23/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Nurettin Özgür Doğan
- Department of Emergency Medicine, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey.
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Çaylak ST, Yaka E, Yilmaz S, Doğan NÖ, Ozturan IU, Pekdemir M. Comparison of PECARN clinical decision rule and clinician suspicion in predicting intra-abdominal injury in children with blunt torso trauma in the emergency department. ULUS TRAVMA ACIL CER 2022; 28:529-536. [PMID: 35485505 PMCID: PMC10521006 DOI: 10.14744/tjtes.2020.40156] [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: 08/27/2021] [Accepted: 02/17/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND The Pediatric Emergency Care Applied Research Network (PECARN) developed a clinical decision rule to identify children at low risk for intra-abdominal injury requiring acute intervention (IAI-I) for reducing unnecessary radiation exposure of ab-dominal computed tomography (CT) after blunt torso trauma. This study aimed to compare the PECARN decision rule with clinician suspicion in identifying children at low risk of intra-abdominal injuries that an abdominal CT scan can be safely avoided. METHODS This study is a retrospective review of children with blunt torso trauma in an academic emergency department (ED) between 2011 and 2019. Patients were considered positive for the PECARN rule if they exhibited any of the variables. Clinician suspi-cion was defined as actual CT ordering of the treating physician. The primary outcome was IAI-I detected by imaging or surgery within 1 month after the trauma, and the secondary outcome was any intra-abdominal injury (IAI) presence. RESULTS Among the 768 children included, 48 (6.25%) had intra-abdominal injuries and 21 (2.73%) of whom underwent acute in-tervention. Four hundred and fifty-three (59%) children underwent abdominal CT scanning. If the PECARN rule had been applied, 232 patients would have undergone abdominal CT. The rule revealed 90.48% (95% CI=68.17-98.33%) sensitivity for IAI-I and 81.25% (95% CI=66.9-90.56%) for IAI. Clinician suspicion revealed sensitivities of 100% (95% CI=80.76-00%) and 93.75% (95% CI=81.79-98.37%) for IAI-I and IAI, respectively. Sensitivities of the rule and clinician suspicion were statistically similar for both IAI-I (p=0.5) and IAI (p=0.146). CONCLUSION In this study, the PECARN abdominal rule and clinician suspicion performed similarly in identifying intra-abdominal injuries in children with blunt torso trauma. However, our study supports the use of PECARN abdominal rule in addition to clinical judgment to limit unnecessary abdominal CT use in pediatric patients with blunt torso trauma in the ED.
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Affiliation(s)
- Sevinç Taş Çaylak
- Department of Emergency Medicine, Gebze Fatih State Hospital, Kocaeli-Turkey
| | - Elif Yaka
- Department of Emergency Medicine, Kocaeli University Faculty of Medicine, Kocaeli-Turkey
| | - Serkan Yilmaz
- Department of Emergency Medicine, Kocaeli University Faculty of Medicine, Kocaeli-Turkey
| | - Nurettin Özgür Doğan
- Department of Emergency Medicine, Kocaeli University Faculty of Medicine, Kocaeli-Turkey
| | - Ibrahim Ulas Ozturan
- Department of Emergency Medicine, Kocaeli University Faculty of Medicine, Kocaeli-Turkey
| | - Murat Pekdemir
- Department of Emergency Medicine, Kocaeli University Faculty of Medicine, Kocaeli-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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Doğan NÖ, Varol Y, Köktürk N, Aksay E, Alpaydın AÖ, Çorbacıoğlu ŞK, Aksel G, Baha A, Akoğlu H, Karahan S, Şen E, Ergan B, Bayram B, Yılmaz S, Gürgün A, Polatlı M. 2021 Guideline for the Management of COPD Exacerbations: Emergency Medicine Association of Turkey (EMAT) / Turkish Thoracic Society (TTS) Clinical Practice Guideline Task Force. Turk J Emerg Med 2021; 21:137-176. [PMID: 34849428 PMCID: PMC8593424 DOI: 10.4103/2452-2473.329630] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 09/30/2021] [Revised: 10/08/2021] [Accepted: 10/09/2021] [Indexed: 01/18/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is an important public health problem that manifests with exacerbations and causes serious mortality and morbidity in both developed and developing countries. COPD exacerbations usually present to emergency departments, where these patients are diagnosed and treated. Therefore, the Emergency Medicine Association of Turkey and the Turkish Thoracic Society jointly wanted to implement a guideline that evaluates the management of COPD exacerbations according to the current literature and provides evidence-based recommendations. In the management of COPD exacerbations, we aim to support the decision-making process of clinicians dealing with these patients in the emergency setting.
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Affiliation(s)
- Nurettin Özgür Doğan
- Department of Emergency Medicine, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Yelda Varol
- Department of Pulmonology, Dr. Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital, University of Health Sciences, İzmir, Turkey
| | - Nurdan Köktürk
- Department of Pulmonology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ersin Aksay
- Department of Emergency Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Aylin Özgen Alpaydın
- Department of Pulmonology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Şeref Kerem Çorbacıoğlu
- Department of Emergency Medicine, Keçiören Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Gökhan Aksel
- Department of Emergency Medicine, Ümraniye Training and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - Ayşe Baha
- Department of Pulmonology, Near East University, Nicosia, TRNC
| | - Haldun Akoğlu
- Department of Emergency Medicine, Faculty of Medicine, Marmara University, İstanbul, Turkey
| | - Sevilay Karahan
- Department of Biostatistics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Elif Şen
- Department of Pulmonology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Begüm Ergan
- Department of Pulmonology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Başak Bayram
- Department of Emergency Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Serkan Yılmaz
- Department of Emergency Medicine, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Alev Gürgün
- Department of Pulmonology, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Mehmet Polatlı
- Department of Pulmonology, Faculty of Medicine, Aydın Adnan Menderes University, Aydın, Turkey
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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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Koçkan E, Doğan NÖ, Pekdemir M, Yılmaz S, Yaka E. Predictors of prolonged hospitalization in patients with mild and moderate pancreatitis presenting to the emergency department. Med Klin Intensivmed Notfmed 2021; 117:459-465. [PMID: 34455458 DOI: 10.1007/s00063-021-00855-8] [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: 11/10/2020] [Revised: 07/04/2021] [Accepted: 07/22/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients with acute pancreatitis often present to the emergency department (ED) and usually require hospital admission. The aim of this study was to determine predictors of prolonged hospital stays in patients with mild forms of acute pancreatitis. METHODS This retrospective cohort study was conducted in patients diagnosed in the ED with mild and moderate acute pancreatitis according to the revised Atlanta classification. Patients with available data between 2007 and 2017 were included and were divided based on their admission duration. Eight days or more was considered a long hospitalization. A multivariate logistic regression model was constructed to determine the independent predictors of prolonged hospital stays. RESULTS Of the 485 evaluated patients, 335 were included in the analysis. Baseline characteristics, determined by vital signs and laboratory parameters, were similar between the short and long hospitalization groups. However, the long hospitalization group received more intravenous crystalloid in the ED, and this group used more diuretics and more angiotensin-converting enzyme inhibitor and angiotensin-receptor blocker (ACEI/ARB) drugs than the other group. Diuretic use was present in 8 patients (4.8%) in the short hospital length of stay group and in 26 patients (15.3%) in the long hospital length of stay group. Age, gender, ACEI/ARB use, diuretic use, total amount of intravenous crystalloid administered in the ED, aPTT, BUN, creatinine, and presence of biliary pathology were included in the multivariate analysis. Regarding the final analysis, diuretic use was an independent predictor of prolonged hospitalization (odds ratio 2.89, 95% confidence interval 1.05-8.00, p = 0.041). CONCLUSION Diuretic use is an independent predictor of long hospitalization in patients with mild and moderate pancreatitis. Drugs affecting total volume balance may prolong hospital stays in these patients.
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Affiliation(s)
- Esra Koçkan
- Dept. of Emergency Medicine, Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, İstanbul, Turkey
| | - Nurettin Özgür Doğan
- Faculty of Medicine, Dept. of Emergency Medicine, Kocaeli University, Kocaeli, Turkey.
| | - Murat Pekdemir
- Faculty of Medicine, Dept. of Emergency Medicine, Kocaeli University, Kocaeli, Turkey
| | - Serkan Yılmaz
- Faculty of Medicine, Dept. of Emergency Medicine, Kocaeli University, Kocaeli, Turkey
| | - Elif Yaka
- Faculty of Medicine, Dept. of Emergency Medicine, Kocaeli University, Kocaeli, Turkey
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Doğan NÖ. Can on-admission anemia predict severe COVID-19 cases? A discussion about statistical and clinical significance. Am J Emerg Med 2021; 47:315. [PMID: 33992488 PMCID: PMC8106199 DOI: 10.1016/j.ajem.2021.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 05/06/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- Nurettin Özgür Doğan
- Kocaeli University, Faculty of Medicine, Dept. of Emergency Medicine, Kocaeli, Turkey.
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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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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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Kandemir Y, Doğan NÖ, Yaka E, Pekdemir M, Yılmaz S. Clinical characteristics of neutrophilic, eosinophilic and mixed-type exacerbation phenotypes of COPD. Am J Emerg Med 2020; 45:237-241. [PMID: 33041140 DOI: 10.1016/j.ajem.2020.08.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 05/28/2020] [Revised: 08/03/2020] [Accepted: 08/12/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) comprises a significant number of emergency department (ED) presentations, and hematological phenotypes may have prognostic significance. The aim of this study was to investigate the effect of hematological phenotypes on serious outcomes in COPD exacerbations. METHODS A prospective cohort study was carried out in patients with COPD exacerbation presenting to the ED. The patients were classified into three groups, including neutrophilic, eosinophilic, and mixed-type (including neutrophilic and eosinophilic features) COPD exacerbation. Outcome measures were defined as mortality, hospitalization, and need for intensive care unit (ICU) care within three months, and these outcomes were compared among groups. RESULTS A total of 173 COPD patients were assessed for eligibility, and 147 of them were included in the final analysis. The study population consisted of 90 patients with neutrophilic exacerbation (61.2%), 26 patients with eosinophilic exacerbation (17.7%), and 31 patients with mixed-type exacerbation (21.1%). The neutrophilic exacerbation group was older, was more often tachycardic and desaturated, and had more sputum production compared with the eosinophilic exacerbation group. Mortality was seen in 35 patients in the neutrophilic exacerbation group (38.9%), whereas 5 patients in the eosinophilic group (19.2%) and 6 patients in the mixed-type group (19.4%) died (p = .044). No difference was observed among groups in terms of hospital and ICU admission. CONCLUSION COPD exacerbations with neutrophilic phenotypes presented to the ED with more serious clinical findings compared with eosinophilic exacerbations. This may also have a possible effect on mortality.
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Affiliation(s)
- Yasemin Kandemir
- Başakşehir City Hospital, Dept. of Emergency Medicine, İstanbul, Turkey
| | - Nurettin Özgür Doğan
- Kocaeli University, Faculty of Medicine, Dept. of Emergency Medicine, Kocaeli, Turkey.
| | - Elif Yaka
- Kocaeli University, Faculty of Medicine, Dept. of Emergency Medicine, Kocaeli, Turkey
| | - Murat Pekdemir
- Kocaeli University, Faculty of Medicine, Dept. of Emergency Medicine, Kocaeli, Turkey
| | - Serkan Yılmaz
- Kocaeli University, Faculty of Medicine, Dept. of Emergency Medicine, Kocaeli, Turkey
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Aslaner MA, Doğan NÖ. Inaccurate outcome evaluation and conflict in odds ratio in multivariable analysis. Am J Emerg Med 2020; 38:2224. [PMID: 32811711 DOI: 10.1016/j.ajem.2020.07.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 07/31/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
- Mehmet Ali Aslaner
- Department of Emergency, Gazi University School of Medicine, Ankara, Turkey.
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Doğan NÖ, Pekdemir M, Yılmaz S, Yaka E, Karadaş A, Durmuş U, Avcu N, Koçkan E. Intravenous metoclopramide in the treatment of acute migraines: A randomized, placebo-controlled trial. Acta Neurol Scand 2019; 139:334-339. [PMID: 30629285 DOI: 10.1111/ane.13063] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 11/12/2018] [Revised: 01/03/2019] [Accepted: 01/04/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVES The present study aimed to evaluate the efficacy and safety of intravenous metoclopramide for acute migraine treatment. MATERIALS AND METHODS A double-blind, randomized, parallel-group, placebo-controlled trial was carried out in an academic emergency department. After the patients were assessed for eligibility via the International Headache Society criteria for migraines, they were randomized into 10 mg intravenous metoclopramide and normal saline groups. The headache intensity was evaluated using an 11-point numeric rating scale (NRS) score. The primary outcome measure was determined as the median between-group change in the score at the 30th minute. The secondary outcome measures were rescue medication needs, adverse events, and emergency department (ED) revisits after discharge. RESULTS A total of 148 patients were randomized into two equal groups with similar baseline characteristics, including the baseline NRS scores (8 points). The median reduction in the NRS scores at the 30th minute was 4 [interquartile range (IQR): 2-6)] in the metoclopramide group and 3 (IQR: 1-4) in the normal saline group [median difference: -1.0, 95% confidence interval (CI): -2.1 to 0.1]. No serious adverse events were observed, and the rescue medication needs were similar in both groups. CONCLUSION No difference was found between intravenous metoclopramide and placebo regarding efficacy and safety in patients with acute migraines.
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Affiliation(s)
- Nurettin Özgür Doğan
- Department of Emergency Medicine, Faculty of Medicine; Kocaeli University; Kocaeli Turkey
| | - Murat Pekdemir
- Department of Emergency Medicine, Faculty of Medicine; Kocaeli University; Kocaeli Turkey
| | - Serkan Yılmaz
- Department of Emergency Medicine, Faculty of Medicine; Kocaeli University; Kocaeli Turkey
| | - Elif Yaka
- Department of Emergency Medicine, Faculty of Medicine; Kocaeli University; Kocaeli Turkey
| | - Adnan Karadaş
- Department of Emergency Medicine; Balıkesir Atatürk State Hospital; Balıkesir Turkey
| | - Uğur Durmuş
- Department of Emergency Medicine; Cizre State Hospital; Şırnak Turkey
| | - Nazire Avcu
- Department of Emergency Medicine, Faculty of Medicine; Maltepe University; İstanbul Turkey
| | - Esra Koçkan
- Department of Emergency Medicine, Faculty of Medicine; Kocaeli University; Kocaeli 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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Abstract
Background: Although altered mental status is a term commonly used for older patients, the limits of the definition are unclear. Objectives: We aimed to determine the predictive factors of altered mental status and to standardize this broad-spectrum definition. Methods: The level and content of consciousness were assessed both in the basal status and in the emergency department presentation status of patients who were aged 65 years and above. The Richmond Agitation–Sedation Scale (RASS) for level and five features for content of consciousness were used to determine the actual change in consciousness. Results: Among 1250 patients, the rate of true altered mental status was 7.7% ( n = 96), transient altered mental status was 3.5% ( n = 44), and non-altered mental status was 88.8% ( n = 1110). The 1- and 3-month mortality rates were higher for patients with true altered mental status (32.3% and 40.6%, respectively) than for other patients (3.3% and 8.4%, respectively; p < .001). The following criteria predicted true altered mental status with a high specificity: a change in RASS score ⩾2 points, newly disorganized thoughts, a perception disorder, inattention and disorientation, and an inability to communicate. Conclusion: True altered mental status criteria can be used to determine alterations in consciousness that lead to high mortality, and they can also be used as a common language for current and further investigations.
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Affiliation(s)
| | - Necmi Baykan
- Clinic of Emergency, Nevşehir State Hospital, Nevşehir, Turkey
| | - Nurettin Özgür Doğan
- Department of Emergency Medicine, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Murat Ziyan
- Clinic of Emergency, Nevşehir State Hospital, Nevşehir, Turkey
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21
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Durmuş U, Doğan NÖ, Pekdemir M, Yılmaz S, Yaka E, Karadaş A, Güney Pınar S. The value of lactate clearance in admission decisions of patients with acute exacerbation of COPD. Am J Emerg Med 2017; 36:972-976. [PMID: 29113693 DOI: 10.1016/j.ajem.2017.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 09/25/2017] [Revised: 10/31/2017] [Accepted: 11/02/2017] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Lactate and lactate clearance are being used as biomarkers in several critical conditions. The aim of this study was to examine the value of sixth hour lactate clearance in patients who were hospitalized with chronic obstructive pulmonary disease (COPD) exacerbations. METHODS This single-center, cross-sectional study was conducted in a tertiary emergency department (ED) on patients who presented with acute exacerbation of COPD. Discharge or admission decisions were specified according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria and the clinician's decision. In the study, lactate clearance was defined as the percent decrease in lactate from the time of presentation to the ED to the sixth hour. RESULTS A total of 495 patients were evaluated and 397 patients were excluded. Among included patients, 53 (54.1%) were admitted to the hospital and 45 (45.9%) were discharged. The median lactate clearance was found to be -11.8% (95% CI: -50.0 to 34.5) in the admitted group and 14.7% (95% CI: -11.3 to 42.3) in the discharged group. Between the two groups, the median difference of lactate clearance was found to be 26.5% (95% CI: 0.6 to 52.4). Multivariate logistic regression analysis revealed that the delta lactate value can determine the hospitalization need of patients (OR: 0.91, 95% CI: 0.85 to 0.97). CONCLUSION Lactate clearance can be evaluated as a useful marker in patients with COPD exacerbations. This study suggests that lactate monitoring in the ED has clinical benefits in addition to GOLD guidelines when deciding whether to discharge or hospitalize a patient.
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Affiliation(s)
- Uğur Durmuş
- Department of Emergency Medicine, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey
| | - Nurettin Özgür Doğan
- Department of Emergency Medicine, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey.
| | - Murat Pekdemir
- Department of Emergency Medicine, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey
| | - Serkan Yılmaz
- Department of Emergency Medicine, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey
| | - Elif Yaka
- Department of Emergency Medicine, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey
| | - Adnan Karadaş
- Department of Emergency Medicine, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey
| | - Seda Güney Pınar
- Department of Emergency Medicine, Kocaeli University, Faculty of Medicine, 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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Acar H, Yılmaz S, Yaka E, Doğan NÖ, Özbek AE, Pekdemir M. Evaluation of the Diagnostic Role of Bedside Lung Ultrasonography in Patients with Suspected Pulmonary Embolism in the Emergency Department. Balkan Med J 2017; 34:356-361. [PMID: 28443595 PMCID: PMC5615969 DOI: 10.4274/balkanmedj.2016.1181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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] [Indexed: 01/10/2023] Open
Abstract
Background: Despite the existence of detailed consensus guidelines, challenges remain regarding efficient, appropriate, and safe imaging methods for the diagnosis of suspected pulmonary embolism. Aims: To investigate the role of the wedge sign, B-lines, and pleural effusion seen on bedside lung ultrasound in the diagnosis of pulmonary embolism. Study Design: Diagnostic accuracy study. Methods: During the first evaluation of patients with suspected pulmonary embolism, bedside lung ultrasound was performed, and the B-lines, wedge sign, and pleural effusion were investigated. Computed tomography angiography was used as a confirmatory test and was compared with the lung ultrasound findings. Results: Pulmonary embolism was detected in 38 (38%) patients. In the comparison of bedside lung ultrasound results, statistically significant differences were found between the groups in terms of the B-lines and wedge sign (p=0.005 and p<0.001, respectively). There were no significant differences in terms of effusion (p=0.234). Comparison of these findings with computed tomography angiography of the chest showed weak negative correlations between the groups in terms of B-lines (r=-0297) and a moderately positive correlation in terms of the wedge sign (r=0.523). The sensitivity, specificity, and positive and negative predictive values of lung ultrasound findings alone were low. In the logistic regression analysis, the wedge sign (p<0.01, OR=69.45, 95% CI=6.94-695.17) and B-line (p=0.033, OR=1.96, 95% CI=0.41-8.40) were found to be effective in the diagnosis of pulmonary embolism. Conclusion: Although the role of lung ultrasound has been increasing in the management of critically ill patients, its value is limited and cannot replace the gold standard tests in the diagnosis of pulmonary embolism.
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Affiliation(s)
- Hüseyin Acar
- Clinic of Emergency, Tunceli State Hospital, Tunceli, Turkey
| | - Serkan Yılmaz
- Department of Emergency, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Elif Yaka
- Department of Emergency, Kocaeli University School of Medicine, Kocaeli, Turkey
| | | | - Asım Enes Özbek
- Clinic of Emergency, Derince Training and Research Hospital, Kocaeli, Turkey
| | - Murat Pekdemir
- Department of Emergency, Kocaeli University School of Medicine, Kocaeli, Turkey
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Avcu N, Doğan NÖ, Pekdemir M, Yaka E, Yılmaz S, Alyeşil C, Akalın LE. Intranasal Lidocaine in Acute Treatment of Migraine: A Randomized Controlled Trial. Ann Emerg Med 2016; 69:743-751. [PMID: 27889366 DOI: 10.1016/j.annemergmed.2016.09.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 09/15/2016] [Accepted: 09/21/2016] [Indexed: 01/03/2023]
Abstract
STUDY OBJECTIVE The study aims to evaluate the efficacy and safety of intranasal lidocaine administration for migraine treatment. METHODS This single-center, double-blind, randomized, controlled trial was conducted in a tertiary care emergency department. Included patients met the migraine criteria of the International Headache Society. Patients were randomized to intranasal lidocaine or saline solution; all participants received 10 mg of intravenous metoclopramide. Patient pain intensity was assessed with an 11-point numeric rating scale score. The primary outcome measure was the change in pain scores at 15 minutes; secondary outcomes were changes in pain intensity after pain onset and need for rescue medication. RESULTS Patients (n=162) were randomized into 2 groups with similar baseline migraine characteristics and numeric rating scale scores. The median reduction in numeric rating scale score at 15 minutes was 3 (interquartile range [IQR] 2 to 5) for the lidocaine group and 2 (IQR 1 to 4) for the saline solution group (median difference=1.0; 95% confidence interval 0.1 to 2.1). The reduction in pain score at 30 minutes was 4 (IQR 3 to 7) for the lidocaine group and 5 (IQR 2 to 7) for the saline solution group (median difference=1.0; 95% confidence interval 0.1 to 2.1). Need for rescue medication did not differ between the groups, and local irritation was the most common adverse event in the lidocaine group. CONCLUSION Although intranasal lidocaine was found no more efficacious than normal saline solution in our study, future studies should focus on patients who present earlier after headache onset.
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Affiliation(s)
- Nazire Avcu
- Department of Emergency Medicine, Bitlis State Hospital, Bitlis, Turkey
| | - Nurettin Özgür Doğan
- 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
| | - Serkan Yılmaz
- Department of Emergency Medicine, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Cansu Alyeşil
- Department of Emergency Medicine, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Latif Erdem Akalın
- Department of Emergency Medicine, Bandırma State Hospital, Bandırma, Turkey
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Affiliation(s)
- NÖ Doğan
- Department of Emergency Medicine, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
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Çevik Y, Doğan NÖ, Daş M, Ahmedali A, Kul S, Bayram H. The association between weather conditions and stroke admissions in Turkey. Int J Biometeorol 2015; 59:899-905. [PMID: 25145443 DOI: 10.1007/s00484-014-0890-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 08/08/2014] [Accepted: 08/12/2014] [Indexed: 06/03/2023]
Abstract
Although several factors such as cigarette smoking, blood pressure, diabetes, obesity, hypercholesterolemia, physical inactivity and dietary factors have been well documented to increase the risk for stroke, there are conflicting data about the role of meteorological variables in the etiology of stroke. We conducted a retrospective study to investigate the association between weather patterns, including daily temperature, humidity, wind speed, and air pressure, and stroke admissions to the Emergency Department of Atatürk Training and Research Hospital in Ankara, Turkey, between January 2009 and April 2010. Generalized additive models with logistic link function were used to investigate the relationship between predictors and days with and without stroke admission at lags 0-4. A total of 373 stroke patients were admitted to the emergency department (ED) between January 2009 and April 2010. Of patients, 297 had ischemic stroke (IS), 34 hemorrhagic stroke (HS), and 42 subarachnoidal hemorrhage (SAH). Although we did not find any association between overall admissions due to stroke and meteorological parameters, univariable analysis indicated that there were significantly more SAH cases on days with lower daily mean temperatures of 8.79 ± 8.75 °C as compared to relatively mild days with higher temperatures (mean temperature = 11.89 ± 7.94 °C, p = 0.021). The multivariable analysis demonstrated that admissions due to SAH increased on days with lower daily mean temperatures for the same day (lag 0; odds ratio (OR) [95% confidence interval (95% CI)] = 0.93 [0.89-0.98], p = 0.004) and lag 1 (OR [95% CI] =0.76 [0.67-0.86], p = 0.001). Furthermore, the wind speed at both lag 1 (OR [95% CI] = 1.63 [1.27-2.09], p = 0.001) and lag 3 (OR [95% CI] = 1.43 [1.12-1.81], p = 0.004) increased admissions due to HS, respectively. In conclusion, our study demonstrated that there was an association between ED admissions due to SAH and HS and weather conditions suggesting that meteorological variables may, at least in part, play as risk factors for intracranial hemorrhages.
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Affiliation(s)
- Yunsur Çevik
- Department of Emergency Medicine, Keçiören Training and Research Hospital, Ankara, Turkey
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Çorbacıoğlu SK, Er E, Aslan S, Seviner M, Aksel G, Doğan NÖ, Güler S, Bitir A. The significance of routine thoracic computed tomography in patients with blunt chest trauma. Injury 2015; 46:849-53. [PMID: 25683210 DOI: 10.1016/j.injury.2014.12.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 12/05/2014] [Accepted: 12/19/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study is to investigate whether the use of thoracic computed tomography (TCT) as part of nonselective computed tomography (CT) guidelines is superior to selective CT during the diagnosis of blunt chest trauma. SUBJECTS AND METHODS This study was planned as a prospective cohort study, and it was conducted at the emergency department between 2013 and 2014. A total of 260 adult patients who did not meet the exclusion criteria were enrolled in the study. All patients were evaluated by an emergency physician, and their primary surveys were completed based on the Advanced Trauma Life Support (ATLS) principles. Based on the initial findings and ATLS recommendations, patients in whom thoracic CT was indicated were determined (selective CT group). Routine CTs were then performed on all patients. RESULTS Thoracic injuries were found in 97 (37.3%) patients following routine TCT. In 53 (20%) patients, thoracic injuries were found by selective CT. Routine TCT was able to detect chest injury in 44 (16%) patients for whom selective TCT would not otherwise be ordered based on the EP evaluation (nonselective TCT group). Five (2%) patients in this nonselective TCT group required tube thoracostomy, while there was no additional treatment provided for thoracic injuries in the remaining 39 (15%). CONCLUSION In conclusion, we found that the nonselective TCT method was superior to the selective TCT method in detecting thoracic injuries in patients with blunt trauma. Furthermore, we were able to demonstrate that the nonselective TCT method can change the course of patient management albeit at low rates.
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Affiliation(s)
- Seref Kerem Çorbacıoğlu
- Emergency Medicine Specialist, Kecioren Training and Research Hospital, Department of Emergency Medicine, Ankara, Turkey.
| | - Erhan Er
- Emergency Medicine Specialist, Antakya State Hospital, Department of Emergency Medicine, Hatay, Turkey
| | - Sahin Aslan
- Emergency Medicine Specialist, Antakya State Hospital, Department of Emergency Medicine, Hatay, Turkey
| | - Meltem Seviner
- Emergency Medicine Specialist, Antakya State Hospital, Department of Emergency Medicine, Hatay, Turkey
| | - Gökhan Aksel
- Emergency Medicine Specialist, Umraniye Training and Research Hospital, Department of Emergency Medicine, Istanbul, Turkey
| | - Nurettin Özgür Doğan
- Emergency Medicine Specialist, Kocaeli University, Faculty of Medicine, Department of Emergency Medicine, Kocaeli, Turkey
| | - Sertaç Güler
- Emergency Medicine Specialist, Ankara Training and Research Hospital, Department of Emergency Medicine, Ankara, Turkey
| | - Aysen Bitir
- Thoracic Surgeon, Antakya State Hospital, Department of Chest Surgery, Hatay, Turkey
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Yaka E, Yılmaz S, Özgür Doğan N, Pekdemir M. Comparison of the Glasgow-Blatchford and AIMS65 scoring systems for risk stratification in upper gastrointestinal bleeding in the emergency department. Acad Emerg Med 2015; 22:22-30. [PMID: 25556538 DOI: 10.1111/acem.12554] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 08/07/2014] [Accepted: 08/19/2014] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The aim of this study was to compare the performance of the Glasgow-Blatchford and the AIMS65 scoring systems as early risk assessment tools for accurately identifying patients with upper gastrointestinal (GI) bleeding who are at a low risk of requiring clinical interventions, including emergency endoscopy. The secondary objective was to compare their performance regarding relevant clinical outcomes. METHODS Data were collected prospectively over a 2-year period in the emergency department of a university hospital. Adult patients with upper GI bleeding from either variceal or nonvariceal sources were included. Composite clinical outcomes consisted of a need for surgical or endoscopic intervention, rebleeding, intensive care unit admission, or in-hospital mortality. Patients who required blood transfusions or suffered composite clinical outcomes were considered high-risk patients. Glasgow-Blatchford score (GBS) and AIMS65 score were calculated for each patient. The sensitivity and specificity of the scoring systems were calculated. The areas under the receiver-operating characteristic curve (AUC) of the scores were compared. RESULTS There were 254 patients in the study, of whom 163 (64.2%) were men. The median age was 61 years (interquartile range = 45 to 72 years). Among the patients, 211 (83.1%) underwent endoscopy, of whom 49 (19.3%) required endoscopic intervention to achieve hemostasis. Five (2%) patients required surgical intervention. Rebleeding was observed in 33 (13%) patients. A total of 143 (56.3%) patients received blood transfusions. A total of 152 (59.8%) were defined as high risk. Eighty-one (31.9%) experienced at least one component of the composite clinical outcomes, 18 (7.1%) of whom suffered in-hospital mortality. A GBS of 0 was observed in 16 patients (6.3%) in the study group. Two of these were high-risk patients. A total of 101 (39.8%) patients had AIMS65 scores of 0. Thirty-four of these were high-risk patients. A GBS of 0 had higher sensitivity than an AIMS65 score of 0 (98.68% vs. 77.6%). The negative predictive values of the GBS and AIMS65 of 0 were 87.5 and 66.3%, respectively. The GBS and AIMS65 were similar with regard to the composite outcome prediction, with AUCs of 0.795 (95% confidence interval [CI] = 0.74 to 0.843) and 0.746 (95% CI = 0.688 to 0.798), respectively (p = 0.137). The scores were also similar with respect to predicting in-hospital mortality (AUCs of 0.85 vs. 0.81; p = 0.342). The GBS was superior to the AIMS65 in identifying high-risk patients, with AUCs of 0.896 (95% CI = 0.85 to 0.93) and 0.771 (95% CI = 0.714 to 0.821; p < 0.001), respectively. The GBS was also more accurate than the AIM65 in predicting the need for blood transfusions (AUCs of 0.904 vs. 0.796; p < 0.001) and interventions (AUCs of 0.727 vs. 0.647; p = 0.05). CONCLUSIONS These results suggest that the GBS has superior sensitivity relative to the AIMS65 in identifying patients who were not likely to require interventions, including emergency endoscopy. Additional work to determine the use in real-time decision making may be warranted and helpful in providing guidance to clinicians.
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Affiliation(s)
- Elif Yaka
- The Department of Emergency Medicine; School of Medicine; Kocaeli University; Kocaeli Turkey
| | - Serkan Yılmaz
- The Department of Emergency Medicine; School of Medicine; Kocaeli University; Kocaeli Turkey
| | - Nurettin Özgür Doğan
- The Department of Emergency Medicine; School of Medicine; Kocaeli University; Kocaeli Turkey
| | - Murat Pekdemir
- The Department of Emergency Medicine; School of Medicine; Kocaeli University; Kocaeli Turkey
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Doğan NÖ. A Case of Laptop Computer-Induced Erythema Ab Igne. Haseki 2014. [DOI: 10.4274/haseki.1637] [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: 12/01/2022] Open
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Doğan NÖ. The author response—end-tidal CO2 prediction of Chronic Obstructive Pulmonary Disease exacerbations. Am J Emerg Med 2014; 32:1536-7. [DOI: 10.1016/j.ajem.2014.09.019] [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] [Received: 09/20/2014] [Accepted: 09/21/2014] [Indexed: 11/29/2022] Open
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Aksel G, Güler S, Doğan NÖ, Çorbacioğlu ŞK. A randomized trial comparing intravenous paracetamol, topical lidocaine, and ice application for treatment of pain associated with scorpion stings. Hum Exp Toxicol 2014; 34:662-7. [PMID: 25304965 DOI: 10.1177/0960327114551394] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Appropriate treatment for scorpion-associated pain was not previously studied in detail in the literature. The aim of this study was to compare the efficacy of three treatment modalities in patients with painful scorpion stings using visual analog scale (VAS) scores. MATERIALS AND METHODS A randomized study was carried out during a 1-year period in patients with scorpion stings who did not have any systemic signs or symptoms. Patients were treated with intravenous paracetamol, topical lidocaine, or ice application. Pain intensity was evaluated using VAS score at the time of presentation to emergency department and at 30th, 60th, 120th, and 240th minutes. Changes in VAS scores from baseline were recorded. RESULTS A total of 130 patients were included in the statistical analysis. Significant reduction in pain intensity was observed with topical lidocaine group when compared with the ice application group (p < 0.001) and paracetamol group (p < 0.001) in all selected time intervals. The median reduction in scores at 30 min after therapeutic intervention was 25.0 mm for topical lidocaine, 14.5 mm for ice application, and 10.0 mm for intravenous paracetamol. No adverse events were reported. DISCUSSION Our results revealed that topical lidocaine is superior to both intravenous paracetamol and local ice application and its effect lasts several hours after envenomation. CONCLUSION Topical lidocaine is an effective and safe treatment in scorpion sting associated with pain in patients with nonsystemic signs and symptoms.
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Affiliation(s)
- G Aksel
- Department of Emergency Medicine, Ümraniye Training and Research Hospital, Istanbul, Turkey
| | - S Güler
- Department of Emergency Medicine, Ankara Training and Research Hospital, Ankara, Turkey
| | - N Ö Doğan
- Department of Emergency Medicine, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey
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Doğan NÖ, Akıncı E, Gümüş H, Akıllı NB, Aksel G. Predictors of Inhospital Mortality in Geriatric Patients Presenting to the Emergency Department With Ischemic Stroke. Clin Appl Thromb Hemost 2014; 22:280-4. [PMID: 25228671 DOI: 10.1177/1076029614550820] [Citation(s) in RCA: 5] [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] [Indexed: 11/17/2022] Open
Abstract
AIM To determine the most important predictors of inhospital mortality that could be assessed in geriatric patients presenting with ischemic stroke at admission to the emergency department(ED). METHODS A retrospective cohort study was carried out in geriatric patients with ischemic stroke who were diagnosed in the ED. The primary outcome measure was determined as all-cause inhospital mortality after 30 days of ischemic cerebrovascular event. RESULTS During the study period, 247 (35.7%) patients died in the hospital and 445 (64.3%) patients survived the 30-day period. The median age of the patients was 78 (72-83). Higher National Institutes of Health Stroke Scale (NIHSS) scores (odds ratio [OR]: 2.085; 95% confidence interval [CI]: 1.835-2.370), increased creatinine levels (OR: 2.002; 95% CI: 1.235-3.243), increased platelet levels (OR:1.006; 95% CI: 1.002-1.010), and hyperglycemia (OR: 2.610; 95% CI: 1.023-6.660) were found as independent predictors of inhospital mortality. CONCLUSION In evaluating geriatric patients with ischemic stroke, laboratory values including platelet count, creatinine levels, hyperglycemia, and NIHSS scores should be considered to predict inhospital mortality in the ED.
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Affiliation(s)
| | - Emine Akıncı
- Department of Emergency Medicine, Keçiören Training and Research Hospital, Ankara, Turkey
| | - Haluk Gümüş
- Department of Neurology, Konya Training and Research Hospital, Konya, Turkey
| | - Nazire Belgin Akıllı
- Department of Emergency Medicine, Konya Training and Research Hospital, Konya, Turkey
| | - Gökhan Aksel
- Department of Emergency Medicine, Ümraniye Training and Research Hospital, İstanbul, Turkey
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Doğan NÖ, Avcu N, Yaka E, Yılmaz S, Pekdemir M. Comparison of the therapeutic efficacy of intravenous dimenhydrinate and intravenous piracetam in patients with vertigo: a randomised clinical trial. Emerg Med J 2014; 32:520-4. [PMID: 25052217 DOI: 10.1136/emermed-2014-204006] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 07/03/2014] [Indexed: 11/03/2022]
Abstract
BACKGROUND The present study aimed to compare the therapeutic efficacy of dimenhydrinate and piracetam in patients with vertigo. METHODS A blinded, parallel group, superiority, randomised clinical trial was carried out on patients who presented to the emergency department (ED) with vertigo. Healthy adult patients presenting to the ED with undifferentiated vertigo were included in the study. The efficacy of intravenous dimenhydrinate (100 mg) and intravenous piracetam (2000 mg) for reducing the intensity of vertigo was compared in two randomised treatment groups using a 10-point numeric rating scale (NRS). The determination of NRS scores was performed at presentation and at the 30th minute of presentation, after the study drug was implemented, both in immobile and ambulatory positions. The primary outcome variable was reduction in vertigo intensity documented on the NRS at the 30th minute after medication administration, analysed by intention to treat. RESULTS A total of 94 patients were included in the randomisation (n=47 in both groups). The baseline NRS scores were 7.55±2.00 in the dimenhydrinate group and 8.19±1.79 in the piracetam group. The changes from baseline for dimenhydrinate and piracetam were 2.92±3.11 and 3.75±3.40 (difference -0.83 (95% CI -2.23 to 0.57)) in the immobile position and were 2.04±3.07 and 2.72±2.91 (difference -0.68 (95% CI -2.03 to 0.67)) in the ambulatory position. Rescue medication need was similar in both treatment groups (p=0.330), and only one adverse reaction was reported. CONCLUSIONS We found no evidence of a difference between dimenhydrinate and piracetam in relieving the symptoms of vertigo. TRIAL REGISTRATION NUMBER Clinical Trials Registration ID: NCT01890538.
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Affiliation(s)
- Nurettin Özgür Doğan
- Department of Emergency Medicine, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Nazire Avcu
- Department of Emergency Medicine, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Elif Yaka
- Department of Emergency Medicine, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Serkan Yılmaz
- Department of Emergency Medicine, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Murat Pekdemir
- Department of Emergency Medicine, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
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Doğan NÖ, Savrun A, Levent S, Günaydın GP, Çelik GK, Akküçük H, Çevik Y. Can initial lactate levels predict the severity of unintentional carbon monoxide poisoning? Hum Exp Toxicol 2014; 34:324-9. [DOI: 10.1177/0960327114538986] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: Accidental carbon monoxide (CO) intoxication is a major cause of unintentional poisoning. This study aimed to determine the value of initial lactate levels in patients with CO poisoning and to evaluate its utilization in the emergency department (ED). Methods: A retrospective cross-sectional study was carried out among patients with CO intoxication, who were admitted to the ED between April 1, 2011 and April 1, 2012. The study data were extracted from a hospital database system using International Classification of Diseases-10 diagnosis codes. The patients were analyzed according to lactate levels, carboxyhemoglobin (COHb) levels, electrocardiographic manifestations, and clinical features at admission to the ED. Results: A total of 74 patients with CO poisoning were enrolled in this study. The average COHb value of the patients was 21.5 ± 13.9%. A total of 50 patients (67.6%) received normobaric oxygen treatment and 24 patients (32.4%) received hyperbaric oxygen (HBO) treatment. The patients who received HBO treatment had increased lactate levels compared with patients receiving normobaric oxygen treatment (2.3 mmol/L vs. 1.0 mmol/L, p < 0.001). The lactate levels were positively correlated with COHb values ( r = 0.738, p < 0.001). We determined that a lactate level of 1.85 mmol/L has a sensitivity of 70.8% and a specificity of 78.0% to predict the HBO treatment needed in CO poisoning. Conclusion: In evaluating patients with CO poisoning, an initial lactate level could be taken into consideration as an adjunctive parameter of severity, together with the clinical criteria and levels of COHb.
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Affiliation(s)
- NÖ Doğan
- Department of Emergency Medicine, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - A Savrun
- Department of Emergency Medicine, Faculty of Medicine, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey
| | - S Levent
- Department of Emergency Medicine, Ankara Atatürk Training and Research Hospital, Ankara, Turkey
| | - GP Günaydın
- Department of Emergency Medicine, Ankara Atatürk Training and Research Hospital, Ankara, Turkey
| | - GK Çelik
- Department of Emergency Medicine, Ankara Atatürk Training and Research Hospital, Ankara, Turkey
| | - H Akküçük
- Department of Emergency Medicine, Alanya State Hospital, Antalya, Turkey
| | - Y Çevik
- Department of Emergency Medicine, Ankara Keçiören Training and Research Hospital, Ankara, Turkey
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Akinci E, Doğan NÖ, Gümüş H, Akilli NB. Can we use serum gamma-glutamyl transferase levels to predict early mortality in stroke? Pak J Med Sci 2014; 30:606-10. [PMID: 24948989 PMCID: PMC4048516 DOI: 10.12669/pjms.303.4456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 03/05/2014] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Serum gamma-glutamyl transferase (GGT) is a marker for alcohol consumption and hepatobiliary diseases. There are reports on the prognostic role of GGT in coronary artery diseases and stroke. The aim of our study was to identify the potential differences in GGT levels in different types of stroke, and to evaluate the correlation between GGT and 30-day mortality. METHOD Patients diagnosed with stroke in emergency department between 01.01.2010 and 30.12.2012 was included in the study. Imaging techniques were used to distinguish between hemorrhagic and ischemic stroke. Ischemic strokes were further classified as either atherosclerotic/lacunar or embolic. Parameters including age, gender, vital signs (systolic and diastolic blood pressure), comorbid diseases (HT, DM, CAD, smoking and alcohol consumption), used medications, previous history of stroke, NIHSS score at the time of admission to emergency department, laboratory parameters (glucose, white blood cell count, hemoglobin, platelet, total cholesterol, creatinine) and duration of hospitalization were recorded. Death records were obtained from patients' medical records. RESULTS One thousand eighty six patients were included in the study. GGT levels were not significantly different between ischemic and hemorrhagic strokes (p=0.435). On the other hand, GGT levels in embolic strokes were significantly higher compared to atherosclerotic/lacunar strokes (p=0.001). GGT levels [median 24.50 (16.00-43.00)] in Intensive Care Unit patients were significantly higher compared to GGT level [22.00 (15.00-34.25)] in admitted to service beds patients (p=0.015). Median GGT level of deceased patients was 24.00 (16.00-41.25) and median GGT level of alive patients was 22.00 (15.00-35.00). GGT level of deceased patients was significantly higher compared to GGT levels of alive patients (p=0.048). CONCLUSION There was no difference in GGT levels between ischemic and hemorrhagic strokes; however, GGT levels in embolic strokes were significantly higher compared to atherosclerotic/lacunar strokes. High GGT levels are correlated with early mortality in stroke. We believe that GGT may be used as a predictor of mortality in future studies.
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Affiliation(s)
- Emine Akinci
- Emine Akinci, Keçiören Training and Research Hospital, Emergency Department, Ankara, Turkey
| | - Nurettin Özgür Doğan
- Nurettin Özgür Doğan, Kocaeli University Medicine Faculty, Emergency Department, Kocaeli, Turkey
| | - Haluk Gümüş
- Haluk Gümüş, KonyaTraining and Research Hospital, Neurology Department, Konya, Turkey
| | - Nazire Belgin Akilli
- Nazire belgin Akilli, KonyaTraining and Research Hospital, Emergency Department, Konya, Turkey
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Kama A, Yılmaz S, Yaka E, Dervişoğlu E, Özgür Doğan N, Erimşah E, Pekdemir M. Comparison of short-term infusion regimens of N-acetylcysteine plus intravenous fluids, sodium bicarbonate plus intravenous fluids, and intravenous fluids alone for prevention of contrast-induced nephropathy in the emergency department. Acad Emerg Med 2014; 21:615-22. [PMID: 25039544 DOI: 10.1111/acem.12400] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 02/05/2014] [Accepted: 02/12/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is no evidence regarding the several short-term prophylaxis protocols for contrast-induced nephropathy (CIN) that may be most feasibly convenient in emergency settings. OBJECTIVES The purpose of this study was to compare the efficacies of short-term CIN prophylaxis protocols of normal saline, N-acetylcysteine (NAC) plus saline, and sodium bicarbonate plus saline in emergency department (ED) patients at moderate or high risk of CIN after receiving intravenous (IV) contrast agent. METHODS This single-center, randomized, nonblinded clinical trial was conducted in the ED with adult patients requiring contrast-enhanced computed tomography (CT). Patients with moderate to high risk of CIN according to the Mehran risk score, who consented to participate, were eligible. Patients with continuous renal replacement therapy or who reported contrast allergy were excluded. Enrolled patients were randomly assigned to receive 150 mg/kg NAC in 1000 mL of 0.9% sodium chloride (NaCl), 150 mEq of sodium bicarbonate in 1000 mL of 0.9% NaCl, or 1000 mL of IV saline infusion, all given at 350 mL/hr for 3 hours. All of the patients were administered less than 100 mL of nonionic, low-osmolality contrast agent. The primary outcome of CIN was defined as a 25% increase or a greater than 0.5 mg/dL increase in the serum creatinine level 48 to 72 hours later compared with the baseline measurement. RESULTS A total of 107 patients were randomized to NAC (n = 36), sodium bicarbonate (n = 36), and saline prophylaxis (n = 35). The mean age of the patients was 71 years (95% confidence interval [CI] = 65 to 77 years), and 58 (54.2%) were male. The groups were similar regarding baseline characteristics and nephropathy risks. Of the 16 (14.9%) patients who eventually developed CIN, seven (19.4%) were in the NAC plus saline group, four (11.1%) were in the sodium bicarbonate plus saline group, and five (14.2%) were in the saline group. There were no significant differences between the groups in terms of the prevention of CIN (p = 0.60). CONCLUSIONS None of the short-term protocols with normal saline, NAC, or sodium bicarbonate was superior in ED patients requiring contrast-enhanced CT who had a moderate or high risk of CIN.
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Affiliation(s)
- Ahmet Kama
- The Department of Emergency Medicine; Faculty of Medicine; Kocaeli University; Kocaeli Turkey
| | - Serkan Yılmaz
- The Department of Emergency Medicine; Faculty of Medicine; Kocaeli University; Kocaeli Turkey
| | - Elif Yaka
- The Department of Emergency Medicine; Faculty of Medicine; Kocaeli University; Kocaeli Turkey
| | - Erkan Dervişoğlu
- The Department of Nephrology; Faculty of Medicine; Kocaeli University; Kocaeli Turkey
| | - Nurettin Özgür Doğan
- The Department of Emergency Medicine; Faculty of Medicine; Kocaeli University; Kocaeli Turkey
| | - Emre Erimşah
- The Department of Emergency Medicine; Faculty of Medicine; Kocaeli University; Kocaeli Turkey
| | - Murat Pekdemir
- The Department of Emergency Medicine; Faculty of Medicine; Kocaeli University; Kocaeli Turkey
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Doğan NÖ, Şener A, Günaydın GP, İçme F, Çelik GK, Kavaklı HŞ, Temrel TA. The accuracy of mainstream end-tidal carbon dioxide levels to predict the severity of chronic obstructive pulmonary disease exacerbations presented to the ED. Am J Emerg Med 2014; 32:408-11. [DOI: 10.1016/j.ajem.2014.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 12/30/2013] [Accepted: 01/05/2014] [Indexed: 10/25/2022] Open
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Doğan NÖ, Temizkan E, Bildik F, Demircan A, Keleş A. Ischemic stroke in trauma patients: investigating the source of embolus. Am J Emerg Med 2010; 28:114.e3-4. [DOI: 10.1016/j.ajem.2009.03.009] [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] [Received: 03/08/2009] [Accepted: 03/09/2009] [Indexed: 11/30/2022] Open
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