Emergency Department Of University Hospital Research Articles

Evaluate the incidence, topography, management, and outcomes in patients with polytrauma in the Suez Canal and Sinai areas.

The global prevalence of trauma-related mortality ranges from 2% to 32%; however, In Egypt, it reaches 8%. Trauma chiefly affects people in the productive age group; seriously ill patients with multiple injuries present with various levels of polytrauma. Application of incorrect triage systems and improperly trained trauma teams increase mortality and morbidity rates in non-dedicated institutions; however, these rates can decrease with appropriate infrastructure. This study aimed to improve the quality of care for patients with polytrauma through improved knowledge of the different severity levels of polytrauma and defined databases, using a suitable triage trauma system, well-trained trauma team, and appropriate infrastructure. This observational cross-sectional study was conducted at the emergency department (ED), over a study period of 7 months, from August 10, 2019, to March 09, 2020. This study included 458 patients with polytrauma who had met the inclusion and exclusion criteria and attended the ED of Suez Canal University Hospital. The incidence of trauma among all emergency cases in the ED was 5.3%. However, most multiple injuries are mild, accounting for 44.4%, while 27.3% of the cases had life-threatening injuries. Moreover, 41.9% of the patients were managed non-operatively, whereas 58.1% of the patients required surgical interventions. Concerning the outcome, 56% and 6.9% of patients with and without life-threatening injuries respectively, died. Facilities of the highest quality should be available for patients with polytrauma, especially those with life-threatening injuries. In addition, training emergency medical service staff for trauma triage is essential, and at least one tertiary hospital is required in every major city in the Suez Canal and Sinai areas to decrease trauma-related mortality.

Clinical Characteristics in Panic Disorder Patients in Emergency Department

IntroductionPanic disorder is a widespread mental illness associated with the use of high levels of emergency care. However, the clinical characteristics of patients with panic disorder in the emergency department are not known.ObjectivesThis study was designed to investigate datas related to panic attack and treatment in emergency room of panic disorder patients who visited emergency room for panic attack.MethodsA retrospective analysis of medical records was conducted on 92 patients with panic disorder who visited Chungju Konkuk university hospital emergency department due to panic attack and had bodily symptoms from 1st January 2010 to 31th December 2019. In addition to demographic characteristics and comorbid disorders, triggering stressors and alcohol consumption were corrected as pre-panic attack datas, bodily symptoms at the time of panic attack were corrected as datas during attack, electrocardiogram trial, consultation with psychiatrist, admission and information of used psychotropic drugs were corrected as post-attack data. Depending on size of data, Chi-square test or Fisher’s exact test was used. Collected data was analyzed using R 4.03.ResultsCardiovascular disease was accompanied by 5.4% and depressive disorder was the most common coexisting mental disorder. Among triggering stressors, economic problem/work-related stress was significantly higher in men than women (x2=4.322, p<0.005). The most common physical symptom during attack was circulatory (65.2%), followed by respiratory (57.6%), numbness-paralysis (33.7%), dizziness (19.6%), gastro-intestinal (14.1%) and autonomic symptom (12.0%). Electrocardiogram was taken at higher rate when patients complained circulatory symptom (x2=8.46, p<0.005). The psychotropic drug most commonly used in emergency room was lorazepam, used in 92.1%.ConclusionsThe most common bodily symptom during panic attack was circulatory symptom and the most common triggering stressor in men was economic problem/work-related stress. The most commonly used psychotropic for panic attack was lorazepam.Disclosure of InterestNone Declared

Validation of the Risk Instrument for Screening in the Community (RISC) among Older Adults in the Emergency Department

Although several short-risk-prediction instruments are used in the emergency department (ED), there remains insufficient evidence to guide healthcare professionals on their use. The Risk Instrument for Screening in the Community (RISC) is an established screen comprising three Likert scales examining the risk of three adverse outcomes among community-dwelling older adults at one-year: institutionalisation, hospitalisation, and death, which are scored from one (rare/minimal) to five (certain/extreme) and combined into an Overall RISC score. In the present study, the RISC was externally validated by comparing it with different frailty screens to predict risk of hospitalisation (30-day readmission), prolonged length of stay (LOS), one-year mortality, and institutionalisation among 193 consecutive patients aged ≥70 attending a large university hospital ED in Western Ireland, assessed for frailty, determined by comprehensive geriatric assessment. The median LOS was 8 ± 9 days; 20% were re-admitted <30 days; 13.5% were institutionalised; 17% had died; and 60% (116/193) were frail. Based on the area under the ROC curve scores (AUC), the Overall RISC score had the greatest diagnostic accuracy for predicting one-year mortality and institutionalisation: AUC 0.77 (95% CI: 0.68-0.87) and 0.73 (95% CI: 0.64-0.82), respectively. None of the instruments were accurate in predicting 30-day readmission (AUC all <0.70). The Overall RISC score had good accuracy for identifying frailty (AUC 0.84). These results indicate that the RISC is an accurate risk-prediction instrument and frailty measure in the ED.

Palliative care patient emergency department visits at tertiary university-based emergency department in Ireland

IntroductionPalliative care patients often present to the emergency department (ED) for various reasons e.g., acute illness, pain, altered mental status, and complications of therapy. Many visits involve less severe etiologies e.g., dyspnea, constipation, fear as patients approach the end of life, which may be more effectively and efficiently managed outside of the ED. The objective of this study is to identify and assess the frequency of presenting complaints, primary diagnosis, triage acuity, need for admission, in an Irish setting. MethodsA single-center retrospective, observational study of palliative care patients presenting to a tertiary-care university hospital emergency department in Dublin, Ireland. Study subjects were identified using the palliative care database and cross-referencing with the ED electronic patient record system database. The primary objective to identify potential areas to minimize ED visits and improve patient care and quality of life by elucidating reasons for visits. Outcome measures include presenting complaint, primary diagnosis, triage severity score, admission, discharge, death in hospital. Statistical analysis presented as descriptive statistics. ResultsFour-hundred-ninety-nine ED visits, 245 (49%) were male, and 254 (51%) were female with a mean age of 69.3 years-of-age. Most patients, 285 (57.1%) self-referred to the emergency department, with general practitioners and skilled nursing facility referrals 72 (14.4%) and 39 (7.8%), respectively. Primary diagnoses were various cancers, chronic obstructive pulmonary disease, congestive heart failure, and dementia. Major reasons for visits were dyspnea, pain, falls, trauma, fever, and altered mental status. Two-hundred-eighty-nine patients (58%) had an emergency severity index (ESI) score of 1 or 2 demonstrating a higher level of acuity. Three-hundred-fifty-eight (71.7%) were admitted, 141 (28.3%) discharged to home, 64 (12.8%) admitted patients died during their hospital admission. ConclusionsPalliative care patients utilize ED services not uncommonly. Though many of these patients presented with higher acuity triage scores, 42% had lower ESI scores and may be effectively managed outside of the ED. These data suggest developing mechanisms for these patients to be urgently evaluated in their homes or facilities obviating the need for an ED evaluation.

IMPLEMENTAÇÃO DA METODOLOGIA LEAN NA EMERGÊNCIA DE UM HOSPITAL UNIVERSITÁRIO: GESTÃO E DESENVOLVIMENTO SUSTENTÁVEL

ABSTRACT Objective: to describe the implementation of the Lean Methodology in an emergency department and its contribution to sustainable and quality management. Method: this is a methodological study carried out between October 2018 and January 2022 in the adult emergency department of a public university hospital in southern Brazil, analyzing the results before and after the implementation of the Lean Methodology. The study followed the model and standards adopted by the Standards for Quality Improvement Reporting Excellence 2.0 (SQUIRE) for the description of improvement cycle standards. Results: with the implementation of this methodology, actions were developed, such as innovations in work routines, both care and management, changes in patient reception with risk classification, construction of units for patient care and allocation, daily interdisciplinary meetings (huddle), full contingency plan, hospital discharge routines, external transfers, changes in the communication process with users and professionals, among other actions. Conclusion: the use of the Lean Methodology has resulted in a reduction in occupancy, which has helped to optimize health resources and ensure quality care and management practices. This reduction is believed to be proof of sustainable management in health services and contributes to reducing socio-economic inequalities.

Transolecranon and lateral Kirschner wire fixation for displaced supracondylar humeral fracture in children

Abstract Introduction Percutaneous pinning of supracondylar humerus fracture(SCHF) in children is an effective way to maintain the anatomic reduction of a displaced. closed reduction and percutaneous pinning (CRPP) had been considered the standard treatment for displaced SCHF in children. Patients and methods A prospective case series, was conducted at the emergency department of Helwan university hospital from February 2020 to September 2021. It includes 40 patients with Gartland type III fracture who presented to the orthopaedic casualty and were included in the study. Four patients (10%) had the transolecranon wire was directed intramedullary, 11 patients (27%) had the wire directed posterolaterally, and 16 patients (40%) had the wire directed posteromedially and 9 patients (23%) had the wire directed posteriorly. Results The mean age was 5.57 years (range from 2–12 years). The mean Baumann angle in the patients was (70.89 ± 2.40). The mean follow-up duration was 3 months (range from 3–3.2 months). with mean carrying angle was about (9.37 ± 2.52) and no one of the patients had an excessive deformity of carrying angle that required correction. Regarding ROM loss, there were 25, but always poor. A few complications occurred including pin tract infection and broken transolecranon wire and all were tolerable with no effect on the outcome. Conclusion The Transolecranon and lateral Kirschner wires fixation is an effective option that provides good stability with the little number of trials in the management of supracondylar fracture of the humerus in children, and the risk of nerve injury or fishtail deformity was avoided especially in the hands of junior trainees in their first 3 years of training.

Trends in the incidence of hospital-treated suicide attempts during the COVID-19 pandemic in Oviedo, Spain.

The potential impact of the COVID-19 pandemic on suicidal behavior has generated predictions anticipating an increase in suicidal tendencies. The aim of this research is to study its influence on the incidence of hospital-treated suicide attempts throughout the year 2020 in Oviedo, Spain. Data were collected on all patients admitted to the emergency department of Central University Hospital of Asturias in Oviedo for attempted suicide during 2020. Incidence rates were calculated for three lockdown periods. Suicide attempt trends in 2020 were compared with a non-COVID-19 year (2009) to avoid seasonal variations bias. Chi-square and Fisher's exact tests were performed. The influence of COVID-19 incidence in Oviedo was analyzed using Spearman's correlation coefficient. The cumulative incidence rate of attempted suicide per 100,000 person-years was 136.33 (pre-lockdown), 115.15 (lockdown), and 90.25 (post-lockdown) in adults (over 19years old), and 43.63 (pre-lockdown), 32.72 (lockdown), and 72.72 (post-lockdown) in adolescents (10-19years old). No association was found with COVID-19 incidence rates (Spearman's rho -0.222; p=0.113). Comparing the years 2020 and 2009, statistically significant differences were observed in adolescents (Fisher's exact test; p=0.024), but no differences were observed in adults (chi-square test=3.0401; p=0.218). Hospital-treated suicide rates attempted during the COVID-19 outbreak in Oviedo, Spain showed a similar trend compared with a non-COVID-19 year. In contrast, the number of adolescents hospital-treated for attempted suicide increased during lockdown, suggesting more vulnerability to COVID-19 restrictions after the initial lockdown period in this age group.

Retrospective analysis of urine culture results of patients admitted to the emergency department with urinary tract infection symptoms

Aim: In this study, we aimed to examine the prognostic factors for infection and the approach and demographic data of patients admitted to the emergency department of a university training and research hospital with signs and symptoms of urinary tract infection. Materials and Methods: In this retrospective observational study, using the hospital data management system, we analyzed the demographic data, presenting complaints, type of urinary tract infection, comorbid diseases, culture positivity, other laboratory results, imaging reports, and mortality rates of 115 patients admitted to the emergency department of a tertiary care university hospital with symptoms of urinary tract infection. Results: Pyelonephritis and cystitis rates were 47.8% and 52.1%, respectively. Of all patients admitted with pyelonephritis and cystitis, 28.6% were hospitalized. We observed that 18% of the hospitalized cases were admitted to the intensive care unit. The urine culture positivity rate of all cases was 24.3%. The most common microorganisms grown in urine culture were Escherichia coli (E. coli) (50%), Klebsiella pneumoniae (K. pneumoniae) (17.8%), and Enterococcus faecalis (E. faecalis) (10.7%). In blood culture results, the blood culture positivity rate was 6% and the isolated microorganisms were E. coli (42.8%), and coagulase-negative staphylococci (28.5%). Extended-spectrum beta-lactamase was detected in 50% of E. coli and 40% of K. pneumoniae. The total mortality rate was calculated as 1.7% in the whole study group. Conclusion: Urinary tract infections are common in the community and may be fatal when complicated or involving the upper urinary tract. These cases should be evaluated carefully and rapidly in the emergency department.

Occupational Hand Injuries and Third-line University Hospital Emergency Department Admissions in Istanbul

Occupational Hand Injuries and Third-line University Hospital Emergency Department Admissions in Istanbul

The outcome of “non-urgent'' patients diverted by triage at an emergency department

No universal definitions have been proposed for non-urgent emergency department (ED) patients. Robust evidence on safety issues and the subsequent utilisation of health care services among diverted patients is insufficient. The aim of this study was to establish the revisit rate within 7 days, as well as the 30-day mortality and outcome of patients diverted by triage. An observational single-centre retrospective study was conducted at the Tampere University Hospital ED for the full calendar year of 2019. The primary outcomes were a revisit within 7 days and 30-day mortality. A total of 92,406 ED visits were registered. Of these patients, 7.8% (7216 visits) were diverted by triage. Among the diverted patients, the hospital revisit rate within 7 days was 10.1%, and a diagnostic or therapeutic intervention was performed on 81.4% of the readmitted patients. The all-cause 30-day mortality, hospitalisation and intensive care unit admission rates of diverted patients were 0.07%, 1.7% and 0.1%, respectively. Diverting non-urgent patients reduces ED visits. The current study showed a revisit rate of 10.1% and a 30-day mortality rate of 0.07% for diverted patients. There were more unanticipated adverse outcomes than reported previously, and the strategy may thus be suitable only for some groups of patients without increasing risks. Therefore, further investigation is needed to determine the factors associated with readmissions and adverse outcomes to enhance the performance of triage in the future.

Pulmoner Emboli ile D-dimer Düzeyinin Korelasyonu ve Yaşa Göre Eşik Değerlerinin Belirlenmesi

Aim: This study was conducted to determine the D-dimer threshold levels according to age in patients diagnosed with pulmonary embolism (PE) by pulmonary computed tomography (CT) angiography. Material and Methods: Patients who had pulmonary CT angiography performed and whose D-dimer test was obtained with the suspicion of pulmonary embolism (PE) in the emergency department of a tertiary university hospital between January 01, 2015, and December 30, 2019, were included in the study. The demographic characteristics of the patients, imaging reports, and 1-month mortality were evaluated retrospectively by examining the hospital information management system and patient files. Patients with missing records and patients who had diagnostic examinations other than the preliminary diagnosis of PE were excluded from the study. Results: Among the 6240 patients included in the study, 58.1% were female. The mean age of the patients was 43±17 years. Of the 1,507 patients who had a pulmonary CT angiogram, 9.8% were diagnosed with PE. When we looked at the 1-month mortality of 6240 patients, whose D-dimer assay was analyzed with the preliminary diagnosis of PE, we found that 0.3% of patients died. The monthly mortality rate was 0.7% in patients with high D-dimer levels while the mortality rate in patients with normal D-dimer levels was 0.1%. A positive and statistically significant correlation was found between the location of the pulmonary embolism in pulmonary CT angiography and the D-dimer level (spearman’s rho= 0.251, p&amp;lt;0.001). The cut-off D-dimer value in predicting the presence of PE in all age groups was calculated as 1.34 mg/L. The cut-off values of D-dimer to predict the presence of PE according to age ranges was calculated as 1.18 mg/L (&amp;lt;50 years), 1.19 mg/L (50-60 years), 1.58 mg/L (60-70 years) 1.79 mg/L (70-80 years), 2.83 mg/L (&amp;gt;80 years) respectively. Conclusion: As age increases, the D-dimer cut-off value for the diagnosis of PE also increases. There is a positive and significant relationship between D-dimer level and pulmonary embolism severity.

The Effect of COVID-19 Lockdown on Cerebrovascular Accidents, Acute Coronary Syndrome, and Diabetic Ketoacidosis Visits the Emergency Department: A Retrospective Study.

Objective This study aims to assess the effect of the COVID-19 lockdown on acute coronary syndrome (ACS), cerebrovascular accident (CVA), and diabetic ketoacidosis (DKA) visits the emergency department (ED). Methods We compared two groups of patients attending King Abdulaziz University Hospital (KAUH) ED diagnosed with one of the following ACS, CVA, or DKA; patients presenting from 21 December 2019 to 23 March 2020 and patients presenting from 23 March 2020 to 21 June 2020, representing COVID-19 pre-lockdown and during-lockdown period, respectively. The variables we analyzed were age, nationality (Saudi/non-Saudi), and gender. Results Our total sample size was 285 patient visits, ACS (n=130), CVA (n=98), and DKA (n=57). Results showed a statistically significant relationship between the number of patients with ACS and the period of visitation to ED (45.24% reduction, p-value <0.001), while CVA (18.5% reduction, p-value 0.312) and DKA (16% reduction, p-value 0.508) showed no statistically significant relationship. Conclusion A lockdown may be necessary to control a pandemic. However, it may carry potential collateral damage, such as a decrease and delay in the presentation of life-threatening conditions, which may lead to worsening outcomes. A clinical presentation of these conditions should warrant comprehensive evaluation by healthcare workers regardless of an ongoing pandemic while implementing infection control guidelines.

Frailty Screening in the Emergency Department: Comparing the Variable Indicative of Placement Risk, Clinical Frailty Scale and PRISMA-7

Prompt recognition of frailty in the emergency department (ED) is important to identify patients at higher risk of adverse outcomes. Despite this, few studies examine the diagnostic accuracy of screening instruments for frailty, instead focusing on predictive validity. We compared three commonly used, short frailty screens to an independent comprehensive geriatric assessment (CGA) in an urban University Hospital ED. Consecutive attendees aged ≥70 years were screened by trained raters, blind to the CGA, with the Variable Indicative of Placement risk (VIP), 3 and 4-item versions, Clinical Frailty Scale (CFS) and PRISMA-7. Accuracy was measured from the area under the ROC curve (AUROC). In total, 197 patients were included, median age 79 (±10); 46% were female. Half (49%) were confirmed as frail after CGA. All instruments differentiated frail from non-frail states, although the CFS (AUROC: 0.91) and PRISMA-7 (AUROC: 0.90) had higher accuracy compared to the VIP-4 (AUROC: 0.84) and VIP-3 (AUROC: 0.84). The CFS was significantly more accurate than the VIP-3 (p = 0.026) or VIP-4 (p = 0.047). There was no significant difference between the CFS and PRISMA-7 (p = 0.90). The CFS and PRISMA-7 were more accurate and should be considered in preference to the VIP (3 or 4-item versions) to identify frailty in EDs.

Mild Traumatic Brain Injury: What We Can Learn from a Qualitative Study of Patient Perceptions Following Emergency Department Discharge

Aims: This study investigated the experiences of patients with mild traumatic brain injury (mTBI) to identify barriers and suggest clinically relevant areas for improvement in the current system of care.&#x0D; Methods: 16 patients with a clinical diagnosis of mTBI were recruited from the Cork University Hospital Emergency Department (ED) for participation in this study. Semi-structured phone interviews were conducted at approximately 2.5-3 months post-discharge. Reflexive thematic analysis with an inductive and realist approach was used to code and inductively analyse the data. The most frequently occurring themes and their relationship to subthemes are reported.&#x0D; Results: A total of 16 mTBI adult patients were interviewed (mean age: 50.5 (18-85)). Major themes identified in the experience of mTBI patients were: lack of clarity in diagnosis and treatment, poor access to information, and ongoing symptoms. Notably, 87.5% of participants reported being uncertain about their diagnosis of mTBI and 93.8% of participants did not seek further information regarding their head injury. Nearly half (43.8%) of the participants reported prolonged recovery with two participants (12.5%) reporting ongoing symptoms. Headache, photophobia, and difficulty with thinking and memory were the predominant symptoms reported.&#x0D; Conclusion: Several overarching themes were identified in the qualitative self-reported experiences of mTBI patients following ED discharge. Participants reported persistent symptoms, lack of clarity, and a lack of access to information regarding their mTBI diagnosis and treatment. Suggested recommendations for future practice include adding psychoeducational resources and increasing awareness and training among staff to provide timely patient education.

Long-term outcome of convulsive status epilepticus: a 10-year follow-up

This study aimed to determine the mortality, causes of death and factors affecting the outcome of convulsive status epilepticus (CSE) at 10 years. This retrospective study consisted of 62 consecutive adult patients diagnosed with CSE at the Helsinki University Hospital (HUS) emergency department during 2002-2003. Patients were followed for up to 10 years or up to the time of death. Data on patient demographics, CSE characteristics, treatment, complications, and outcome from the time of CSE were collected. The Official Statistics of Finland provided the information on mortality and causes of death. Survival analysis was conducted using Cox proportional hazards regression analysis. In-hospital mortality was 8.1%, and mortality was 25.8% at one year, 51.6% at five years and 64.5% at 10 years. Estimated standardized mortality ratio (SMR) was 5.3 and the deceased patients lost 20.9 potential years of life, on average. The leading causes of death were disorders of the brain or the circulatory system, epilepsy-related conditions or intracranial tumours. The univariable survival analysis demonstrated that age ≥65 (HR=2.8, p=0.001), Charlson Comorbidity Index (CCI)>0 (CCI=1-3: HR=3.0, p=0.009; CCI>3: HR=8.4, p<0.001), Status Epilepticus Severity Score (STESS)>4 (HR=5.3, p<0.001) and Epidemiology-Based Mortality Score (EMSE-EAC)>15 (HR=2.2, p=0.036) were risk factors and a Glasgow outcome scale (GOS) of 5 at discharge (HR=0.14, p=0.025) was a protective factor for survival. The multivariable analysis established STESS>4 (HR=5.0, p=0.002) and CCI>0 (CCI=1-3: HR=2.9, p=0.015;CCI>3: HR=6.3, p=0.006) as independent risk factors and GOS>3 (time-dependent) (GOS=4: HR=0.33, p=0.048;GOS=5: HR=0.13, p=0.019) as a protective factor for survival. The rate of long-term mortality and number of potential years of life lost were high. Factors demonstrative of the overall situation of the patients, such as comorbidities, functional state after CSE and age, were significant predictors for long-term outcome.

Effect of a Novel Brief Motivational Intervention for Alcohol-Intoxicated Young Adults in the Emergency Department

Heavy drinking among young adults is a major public health concern. Brief motivational interventions in the emergency department have shown promising but inconsistent results. To test whether young adults receiving a newly developed brief motivational intervention reduce their number of heavy drinking days and alcohol-related problems over 1 year compared with participants receiving brief advice. This randomized clinical trial was conducted at an emergency department of a tertiary care university hospital in Lausanne, Switzerland. Recruitment ran from December 2016 to August 2019. Follow-up was conducted after 1, 3, 6, and 12 months. All adults aged 18 to 35 years presenting for any cause and presenting with alcohol intoxication were eligible (N = 2108); 1764 were excluded or refused participation. Follow-up rate was 79% at 12 months and 89% of participants provided follow-up data at least once and were included in the primary analyses. Statistical analysis was performed from September 2020 to January 2021. The novel intervention was based on motivational interviewing and comprised in-person discussion in the emergency department and up to 3 booster telephone calls. The control group received brief advice. Primary outcomes were the number of heavy drinking days (at least 60 g of ethanol) over the previous month and the total score on the Short Inventory of Problems (0-45, higher scores indicating more problems) over the previous 3 months. Hypotheses tested were formulated before data collection. There were 344 young adults included (median [IQR] age: 23 [20-28] years; 84 women [24.4%]). Among the 306 participants providing at least 1 follow-up point, a statistically significant time × group interaction was observed (β = -0.03; 95% CI, -0.05 to 0.00; P = .02), and simple slopes indicated an increase of heavy drinking days over time in the control (β = 0.04; 95% CI, 0.02 to 0.05; P < .001) but not in the intervention group (β = 0.01; 95% CI, -0.01 to 0.03; P = .24). There was no effect on the Short Inventory of Problems score (β = -0.01; 95% CI, -0.03 to 0.02; P = .71). This randomized clinical trial found that a brief motivational intervention implemented in the emergency department provided beneficial effects on heavy drinking, which accounts for a substantial portion of mortality and disease burden among young adults. ISRCTN registry: 13832949.

Assessment of Effectiveness of the Recognition of Stroke in the Emergency Room Scale in Emergency Department of Suez Canal University Hospital, Egypt

Background: The Recognition of Stroke in The Emergency Room (ROSIER( scale has been designed to provide physicians in the emergency department with a framework which can be used to assess patients with suspected stroke and to facilitate early identification of acute stroke &amp; appropriate referral.&#x0D; Aims: To assess the sensitivity and specificity of the ROSIER score in order to improve outcome of stoke patients.&#x0D; Methodology: The current study was designed as a prospective cross sectional study that included Patients over 18 years of age with suspected stroke presenting at emergency department in Suez Canal university hospital.&#x0D; Results: Patients with stroke formed about 65.2% of the patients with suspected stroke in the ER. Patients with stroke/ TIA were found to have significantly higher age compared to other patients (63.58 ±12.55 vs 39.18±11.12) (p&lt;0.001). The most frequent comorbid diseases among patients were hypertension and diabetes mellitus. For ROSIER accuracy, a value of 1.00 or more was found to be the best cut-off point for prediction of stoke among patients attending with suspected stroke, with sensitivity = 98.3% and specificity = 87.5 % and accuracy= 94.5%.&#x0D; Conclusion: The ROSIER scale is simple, rapid, effective and sensitive screening tool in early detection of patients presenting with stroke and differentiating stroke from stroke mimics in the emergency room.

A novel biomarker in acute cholecystitis: YKL-40

BackgroundThe lack of a specific biomarker that can be used in the diagnosis of acute cholecystitis, a common cause of admission to the emergency department, delays physician efforts to diagnose and treat these patients. Therefore, the aim of this study was to measure plasma YKL-40 levels and investigate their diagnostic value in patients with acute cholecystitis (AC). MethodsThis study was carried out between February 2020 and September 2020 in the adult emergency department of a tertiary university hospital. Permission was obtained from the Ethics Committee of Scientific Research on 03/02/2020 with Decision No. 03/16. The study included 80 patients who were diagnosed with acute cholecystitis and 80 healthy volunteers without known chronic diseases. ResultsThe median YKL-40 protein level was 798.66 pq/mL in the patient group and 392.45 pq/mL in the control group. A statistically significant difference in YKL-40 protein levels was found between the two groups. YKL-40 protein levels were significantly higher in patients diagnosed with acute cholecystitis than in healthy individuals (p < 0.001). A positive correlation was found between YKL-40 protein levels and ALT, AST, LDH, and GGT levels (r = 0.272, p = 0.015; r = 0.397, p < 0.001; r = 0.386, p < 0.001; and r = 0.264, p = 0.018; respectively). ConclusionWhen evaluated together with physical examination, radiological imaging and other laboratory parameters, we think that plasma YKL-40 levels can be used effectively in the diagnosis of acute cholecystitis.

Global longitudinal strain to predict myocardial fibrosis in patients in carbon monoxide poisoning

Abstract Background Carbon monoxide (CO) inhibits oxygen delivery and subsequently causes ischemic changes that can lead to myocardial damage. Late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMR) reflects myocardial fibrosis and detects subclinical myocardial damage in patients with acute CO poisoning. However, CMR is expensive and hard to perform in patients with neurologic deficit. Therefore, this study aims to investigate which echocardiographic parameters could predict the presence of myocardial fibrosis represented by LGE in CO intoxication patients. Methods This prospective observational study included 128 consecutive patients (Mean age: 52.2±16.2) with acute CO poisoning and elevated troponin I (defined as &amp;gt;0.045 ng/mL) at the emergency department of a tertiary university hospital. All participants underwent hyperbaric oxygen therapy (HBOT). CMR and conventional echocardiography with 2D speckle-tracking were performed within 7 days. Subjects were categorized into late gadolinium enhancement (LGE) and no LGE group according to the CMR findings. Results Mean left ventricular (LV) ejection fraction (EF) and global longitudinal strain (GLS) were 57.0±10.0% and −16.3±3.7% respectively. LGE was observed in 89 (69.5%) patients and the most common pattern was mid-wall involvement. Clinical characteristics such as age, sex, shock, time elapsed from rescue to HBOT, and the level of troponin I were not different between groups with LGE and without LGE. Among echocardiographic parameters, LV EF was not significantly different between groups (LGE: 56.0±10.5% vs 59.3±8.1%, p=0.089). LV GLS was more impaired in patients with LGE compared to those without LGE (−15.7±3.8% vs −17.9±3.0%, p=0.003). In multivariate logistic analysis, LV GLS was independently associated with the presence of LGE [Odds ratio (OR) 1.279, 95% confidence interval (CI) (1.047–1.563), p=0.016], but not LV EF. Conclusion In patients with acute CO poisoning and elevated troponin I, LV GLS predicted the presence of LGE in CMR. These finding suggest that subclinical myocardial dysfunction represented by LV GLS may reflect the burden of CO induced myocardial fibrosis. Funding Acknowledgement Type of funding sources: None.

Current status of acute ischemic stroke management in Iran: Findings from a single-center study.

This study investigated the current status of acute ischemic stroke (AIS) management in an Iranian emergency department (ED). A descriptive study using a retrospective chart review was conducted on medical records of 270 patients with AIS who presented to the ED of a tertiary university hospital in the northeast of Iran from March 22 to September 22, 2019. The steps of this review process included instrument identification, medical records retrieval, data extraction, and data verification. Of patients with AIS, 88.9% (n = 240) did not receive stroke code activation. For the 11.1% of patients (n = 30) who received activation, 7% of codes (n = 19) were canceled by the acute stroke team and IV recombinant tissue plasminogen activator (r-tPA) was only administered for 4.1% of patients (n = 11). ED arrival outside 4.5 h from symptom onset was the main barrier to IV r-tPA administration for 83.8% of potentially eligible patients with AIS (n = 217). The median door-to-needle time was 70 min (interquartile range: 47-90 min). There was a better clinical performance in terms of critical time goals in potentially eligible patients with AIS if managed with stroke team activation compared to no stroke team activation.