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Predictive Performance of the National Early Warning Score 2 for Stratification of Critically Ill COVID-19 Patients 新冠肺炎危重患者分层的国家预警评分2的预测性能
IF 0.2 Q4 EMERGENCY MEDICINE Pub Date : 2023-03-06 DOI: 10.4274/eajem.galenos.2023.99075
F. Baig, Amna Hamid
Aim: To validate the ability of National Early Waring Score 2 (NEWS2) for predicting the severity of Coronavirus disease-2019 (COVID-19). In addition, we also intend to examine the impact of pre-existing comorbidities to produce an advanced COVID-19 disease.Materials and Methods: A multicenter prospective cohort was performed on 108 patients having moderate-intensity COVID-19 infection during October 2020 and November 2021. NEWS2 parameters were recorded on admission to generate an output score, which then classified in accordance with the NEWS2 reference scale into low, medium, and high-risk categories. Each patient was followed till discharge or death for the clinical progression of COVID-19. The measures of validity and area under the curve (AUC) for NEWS2 threshold scores were calculated to predict the clinical deterioration of COVID-19.Results: Overall, 29.6% patients developed an advanced disease, out of which 21.8% patients died during treatment. NEWS2 score of 6 or more showed the highest sensitivity (78.1%), specificity (94.8%), and the AUC (0.838) for predicting an adverse outcome. Among comorbidities, the majority showed an increased risk of clinical deterioration.Conclusion: NEWS2 score of 6 or more at baseline showed good predictive ability to stratify patients with poor outcomes who may later require escalated care. However, we recommend more research to confirm our findings.
目的:验证国家早期预警评分2(NEWS2)预测2019冠状病毒病(新冠肺炎)严重程度的能力。此外,我们还打算研究预先存在的合并症对产生晚期新冠肺炎疾病的影响。材料和方法:在2020年10月至2021年11月期间,对108名中度新冠肺炎感染患者进行了多中心前瞻性队列研究。入院时记录NEWS2参数以生成输出分数,然后根据NEWS2参考量表将其分为低、中和高风险类别。对每位患者进行随访,直到新冠肺炎临床进展出院或死亡。计算NEWS2阈值评分的有效性和曲线下面积(AUC),以预测COVID-19的临床恶化。结果:总体而言,29.6%的患者发展为晚期疾病,其中21.8%的患者在治疗期间死亡。NEWS2评分为6分或以上时,预测不良结果的敏感性(78.1%)、特异性(94.8%)和AUC(0.838)最高。在合并症中,大多数表现出临床恶化的风险增加。结论:基线时NEWS2评分为6分或以上,显示出良好的预测能力,可以对预后不佳的患者进行分层,这些患者后来可能需要升级护理。然而,我们建议进行更多的研究来证实我们的发现。
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引用次数: 0
The Incidence of Thrombocytopenia and Its Association with Mortality in Patients with Sepsis Followed in Intensive Care Unit 重症监护病房脓毒症患者血小板减少发生率及其与死亡率的关系
IF 0.2 Q4 EMERGENCY MEDICINE Pub Date : 2023-03-06 DOI: 10.4274/eajem.galenos.2022.21549
Yeşim Şerife Bayraktar, Aslı Açıkgöz, Hatice Eyiol, H. Bayram, I. Kara, A. Duman, J. Celik
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引用次数: 0
Demographic and Cost Analysis of Intoxication Cases Admitted to University Hospital Emergency Service Within a Year 大学医院急诊一年内中毒病例的人口统计学和成本分析
IF 0.2 Q4 EMERGENCY MEDICINE Pub Date : 2023-03-06 DOI: 10.4274/eajem.galenos.2022.38358
M. Koşargelir, Hakan Hakkoymaz, Abdullah İbrahim
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引用次数: 0
One-man Below-knee Analgesia in the Emergency Department with Minimal Equipment Using the Single-operAtor Nerve block under Direct ultrasound visualization in emergencY (‘SANDY’) Technique: A Retrospective Analysis 急诊科一名男子在急诊直接超声显像下使用单一操作神经阻滞的简易设备进行膝下镇痛Y(“ANDY”)技术的回顾性分析
IF 0.2 Q4 EMERGENCY MEDICINE Pub Date : 2023-03-06 DOI: 10.4274/eajem.galenos.2022.37640
S. David, Pradeep Daniel Katumalla, P. Ganesan, P. Kundavaram
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引用次数: 0
Malpractice Allegations in Adult and Pediatric Emergency Departments Resulting in Death 在成人和儿童急诊部门导致死亡的医疗事故指控
IF 0.2 Q4 EMERGENCY MEDICINE Pub Date : 2022-12-09 DOI: 10.4274/eajem.galenos.2022.83713
E. Gürbüz, İ. Üzün, Erdem Hösükler, Bilgin Hösükler
Aim: This study aimed to increase the awareness of physicians working in adult and pediatric emergency departments (ED) about malpractice allegations. Materials and Methods: A retrospective analysis was conducted of cases with malpractice allegations occurring in ED from the lawsuit files decided by the First Specialization Board of the İstanbul Forensic Medicine Institute between 01/01/2012-31/12/2014. Results: Evaluation was made of 556 cases, comprising 357 (64.2%) males and 199 (35.8%) females, with a mean age of 38.92±24.8 years (minimum: 0, maximum: 87), with the highest number of cases in the 40-59 years age group (n=157, 28.2%). Two-thirds (n=377, 67.8%) of the cases with alleged medical malpractice occurred in a public hospital. The board decided that 24.4% (n=136) of the cases were medical malpractice. Of 556 cases, 1.102 physicians were accused and 151 physicians (13.7%) were found to be at fault by the board. More than half of the physicians accused of medical malpractice (51.7%) were general practitioners. The most common cause of malpractice in 136 files was diagnostic error (n=79, 58.1%). The most common actions of malpractice were failure to diagnose on time, and misdiagnosis (n=29, 21.3%). The most frequent diagnosis was trauma (n=156, 28.1%). Conclusion: Most of the malpractice allegations against the physicians working in the ED were unfounded and dismissed by the board. order to avoid diagnostic errors, it can be recommended that novice general practitioners should not be employed alone in ED without the support of more experienced colleagues.
目的:本研究旨在提高成人和儿科急诊科医生对医疗事故指控的认识。材料和方法:对伊斯坦布尔法医研究所第一专业委员会于2012年1月1日至2014年12月31日决定的诉讼文件中ED发生的渎职指控案件进行了回顾性分析。结果:对556例病例进行了评估,其中男性357例(64.2%),女性199例(35.8%),平均年龄38.92±24.8岁(最小值:0,最大值:87),其中40-59岁年龄组的病例数最高(n=157,28.2%)。三分之二(n=377,67.8%)的医疗事故发生在公立医院。委员会认定24.4%(n=136)的案件是医疗事故。在556起案件中,1.102名医生被指控,151名医生(13.7%)被委员会认定有过错。被指控医疗事故的医生中,有一半以上(51.7%)是全科医生。在136份档案中,医疗事故最常见的原因是诊断错误(n=79,58.1%)。最常见的医疗事故行为是未能及时诊断和误诊(n=29,21.3%)。最频繁的诊断是创伤(n=156,28.1%)。结论:大多数针对急诊科医生的医疗事故指控都是没有根据的,并被委员会驳回。为了避免诊断错误,可以建议,如果没有更有经验的同事的支持,新手全科医生不应该单独受雇于ED。
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引用次数: 0
Association of Smoking Status with Outcomes in Intensive Care Unit with COVID-19 新冠肺炎重症监护室吸烟状况与预后的关系
IF 0.2 Q4 EMERGENCY MEDICINE Pub Date : 2022-12-09 DOI: 10.4274/eajem.galenos.2022.75508
Deniz Heppekcan, M. Sabak
Aim: The effect of smoking on patients hospitalized in the intensive care unit (ICU) due to Coronavirus disease-2019 (COVID-19) infection is unknown. The study determines the relationship between COVID-19 and smoking status on the development of disease and critical illness. Materials and Methods: The patient files and hospital information system records of COVID-19 patients over the age of eighteen who were hospitalized in the ICU of our hospital between March 2020 and January 2021 and confirmed by polymerase chain reaction method were retrospectively reviewed. Results: 1.003 of 226 COVID-19 patients included in the study, 58% were male, and the mean age was 65.38 (+/- 14.99). The patients' smoking status was categorized as non-smokers, ex-smokers, and current daily smokers (74.8%;23%;2.2%;respectively). The most common comorbid disease of the patients was hypertension (58%). One hundred seventy-nine patients were given respiratory support with invasive mechanical ventilation (IMV), and 37.2% were discharged. The mean duration of IMV application, hospitalization, and hospitalization in the ICU was 7.11 (+/- 5.51);14.42 (+/- 10.25), respectively;it was 7.58 (+/- 6.29) days. The average APACHE-II score was 23.87 +/-;8.86. Mortality was statistically significantly higher in those who received mechanical ventilator support from patients with no smoker stage and without the comorbid disease (p=0.009). Conclusion: Although the percentage of current smokers in patients hospitalized in the ICU due to COVID-19 is relatively low, we believe that polygenetic and multiple factors can explain it. It should not be recommended that tobacco products be administered for either preventive or therapeutic purposes in the case of COVID-19 infection.
目的:尚不清楚吸烟对2019冠状病毒病(COVID-19)重症监护病房(ICU)住院患者的影响。研究确定了COVID-19与吸烟状况对疾病发展和危重疾病的关系。材料与方法:回顾性分析2020年3月至2021年1月我院ICU收治的经聚合酶链反应法确诊的18岁以上新冠肺炎患者的患者档案和医院信息系统记录。结果:纳入研究的226例COVID-19患者中有1.003例,其中58%为男性,平均年龄65.38岁(±14.99岁)。患者的吸烟状况分为不吸烟者、戒烟者和日常吸烟者(分别为74.8%、23%和2.2%)。最常见的合并症是高血压(58%)。179例患者给予有创机械通气(IMV)呼吸支持,出院37.2%。IMV应用、住院和ICU住院的平均时间分别为7.11(+/- 5.51)、14.42(+/- 10.25)天,7.58(+/- 6.29)天。APACHE-II平均评分为23.87 +/-;8.86。接受机械呼吸机支持的无吸烟期和无合并症患者的死亡率有统计学意义上的显著增高(p=0.009)。结论:虽然新冠肺炎住院ICU患者中吸烟者的比例相对较低,但我们认为这可能是多遗传、多因素所致。在COVID-19感染病例中,不应建议将烟草制品用于预防或治疗目的。
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引用次数: 0
Content and Adequacy of Emergency Medicine Point of Care Ultrasound Training: Evaluation of Turkey 急诊医学护理点超声培训的内容和充分性——对土耳其的评估
IF 0.2 Q4 EMERGENCY MEDICINE Pub Date : 2022-12-09 DOI: 10.4274/eajem.galenos.2022.71224
Fatma Selman, Ertuğ Günsoy, Aslıhan Yürüktümen Ünal, Y. Şenol
Aim: With its widespread use for emergency patient care, point-of-care ultrasound (PoCUS) is included in postgraduate education in Turkey, but its practice may vary depending on the training program. Our study aimed to determine the content of practices regarding PoCUS training in Turkey, and to present a future perspective by revealing the relationship between years of education and competence perceptions. Materials and Methods: This is a descriptive study conducted on emergency medicine students who were still residents approximately 2018-2019. The first part includes demographic data, theoretical and practical training content. The second part is created according to the Likert scale for self-assessment that questions the competence. The survey was conveyed to. Results: In our study, including 249 residents, the participants reported their practical training hours for emergency ultrasound (US) use as 12.5 h, and theoretical training hours as 12.1 h. For all sonographic evaluations, it was found that 10.1% of the practices were performed under the supervision of an academic member. Conclusion: It was found that Emergency Medicine clinics in Turkey had adequate equipment for the use and training of US, residents had a certain level of competence to using US, but there was no regular training with curriculum and assessment criteria in clinics.
目的:由于其在急诊患者护理中的广泛应用,护理点超声(PoCUS)被纳入土耳其的研究生教育,但其实践可能因培训计划而异。我们的研究旨在确定土耳其PoCUS培训实践的内容,并通过揭示教育年限与能力认知之间的关系,提出未来的观点。材料和方法:这是一项对2018-2019年左右仍为住院医师的急诊医学生进行的描述性研究。第一部分包括人口统计数据、理论和实践培训内容。第二部分是根据Likert量表创建的,用于对能力提出质疑的自我评估。调查被传达给。结果:在我们的研究中,包括249名居民,参与者报告他们使用紧急超声(US)的实际训练时间为12.5小时,理论训练时间为12.1小时。对于所有超声评估,发现10.1%的实践是在一名学术成员的监督下进行的。结论:土耳其急诊医学诊所有足够的US使用和培训设备,居民有一定的US使用能力,但诊所没有定期培训课程和评估标准。
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引用次数: 0
Diagnostic Value of S100B and Neuron-specific Enolase in Distinguishing Acute Central and Peripheral Vertigo S100B和神经元特异性烯醇化酶对急性中枢性和外周性眩晕的诊断价值
IF 0.2 Q4 EMERGENCY MEDICINE Pub Date : 2022-12-09 DOI: 10.4274/eajem.galenos.2022.82687
B. Masoumi, Razieh Bagheri, Farhad Heydari, Abaris Massoumi, B. Ansari, Mohammad Nasr-Esfahani
Aim: Vertigo is a common presenting complaint to the emergency department (ED). Distinguishing between acute central and peripheral vertigo can be challenging. During recent years, several biomarkers have been introduced for use in distinguishing central and peripheral vertigo. The current study determined whether S100 calcium-binding protein B (S100B) and neuron-specific enolase (NSE) serum concentrations could effectively predict the central causes of vertigo. Materials and Methods: This was a prospective study performed on 117 patients with acute vertigo who were admitted to the ED. All patients underwent magnetic resonance imaging (MRI) and the results of the MRI were considered the gold standard. S100B and NSE from blood samples taken <8 h after the onset of symptoms were measured in all patients. Results: Finally, 117 patients were enrolled in the study, of which 43 patients had central vertigo and 74 patients had peripheral vertigo. The serum levels of S100B and NSE in the central group were significantly higher (60.62 vs 28.01 pg/mL, and 11.86 vs 7 ng/mL, p<0.001, respectively). The receiver-operating characteristic analysis demonstrated an AUC of 0.91 [95% confidence interval (CI): 0.84-0.96] and 0.93 (95% CI: 0.87-0.97) for S100B and NSE for predicting central vertigo and reported a sensitivity of 97.7% and 93% and a specificity of 87.8% and 89.2% for detecting the central cause of vertigo with S100B and NSE. Conclusion: The serum S100B and NSE concentrations in central vertigo were significantly higher, and could be useful markers in screening central from peripheral vertigo in the ED.
目的:眩晕是向急诊科(ED)提出的常见投诉。区分急性中枢性眩晕和周围性眩晕可能具有挑战性。近年来,一些生物标志物被引入用于区分中枢性眩晕和周围性眩晕。目前的研究确定了S100钙结合蛋白B(S100B)和神经元特异性烯醇化酶(NSE)血清浓度是否能有效预测眩晕的中心原因。材料和方法:这是一项前瞻性研究,对117名急诊科急性眩晕患者进行了研究。所有患者都接受了磁共振成像(MRI),MRI结果被认为是金标准。在所有患者中测量症状出现后<8h采集的血样中的S100B和NSE。结果:共有117例患者参与研究,其中43例为中心性眩晕,74例为周围性眩晕。中心组的血清S100B和NSE水平显著升高(分别为60.62和28.01 pg/mL,11.86和7 ng/mL,p<0.001)。受试者操作特征分析显示,S100B和NSE预测中枢性眩晕的AUC分别为0.91[95%置信区间(CI):0.84-0.96]和0.93(95%CI:0.87-0.97),并报告了S100B和NSE检测眩晕中枢原因的敏感性为97.7%和93%,特异性为87.8%和89.2%。结论:中枢性眩晕患者血清S100B和NSE浓度明显增高,可作为ED患者中枢性眩晕和周围性眩晕的筛查指标。
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引用次数: 0
Successful Management of Severe Verapamil Overdose with VAECMO vecmo成功治疗重度维拉帕米过量
IF 0.2 Q4 EMERGENCY MEDICINE Pub Date : 2022-12-09 DOI: 10.4274/eajem.galenos.2021.05900
Vildan Özer, A. Küçük, A. Eroğlu, K. Y. Güven, Hüseyin Çetin Ketenci, A. Şahin, Z. Kazzi
U.S.A
美国
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引用次数: 0
The Effectiveness of Immature Granulocyte Count for Predicting COVID-19 Severity and Poor Outcomes 未成熟粒细胞计数预测新冠肺炎严重程度和不良预后的有效性
IF 0.2 Q4 EMERGENCY MEDICINE Pub Date : 2022-12-09 DOI: 10.4274/eajem.galenos.2021.79836
Y. Çevik, F. Karaarslan, Ş. K. Çorbacıoğlu, Gülsüm Feyza Türkeş, E. Emektar
Aim: The aim of this study was to examine the relationship between immature granulocyte (IG) counts and the severity of the disease and to evaluate the effectiveness of IG in predicting the poor outcomes in polymerase chain reaction-confirmed Coronavirus disease-2019 (COVID-19) cases. Materials and Methods: The study was conducted prospectively and observationally at the emergency department. Patients were divided into three groups according to the clinical severity indicators such as mild, moderate and severe. The IG level was measured from the whole blood samples taken at the admission to the emergency department. Intensive care unit admission, ventilation support, and death within the first 28 days after the admission were evaluated as composite outcomes. Results: The study group consisted of 203 adults, of whom 91 (44.8%) were women. According to the severity of the illness, 40 patients (19.7%) were classified as mild, 67 patients (33.0%) as moderate, and 96 patients (47.3%) as severe. When comparing IG levels between the groups, there was a statistically significant difference between the mild and severe groups (p=0.047) and between the moderate and severe disease groups (p=0.036). There was no statistically significant relationship between IG counts and the composite outcome (p > 0.05) Conclusion: The IG level, which could be measured faster than other laboratory tests without any additional cost, could be used for the determination of the clinical severity of patients with COVID-19. However, we conclude that this parameter is not effective in determining poor outcomes during the admission.
目的:本研究的目的是检查未成熟粒细胞(IG)计数与疾病严重程度之间的关系,并评估IG在预测聚合酶链式反应确诊的2019冠状病毒病(新冠肺炎)病例不良结局方面的有效性。材料和方法:本研究在急诊科进行前瞻性和观察性研究。根据临床严重程度指标,如轻度、中度和重度,将患者分为三组。IG水平是从急诊科入院时采集的全血样本中测量的。重症监护室入院、通气支持和入院后前28天内的死亡被评估为综合结果。结果:研究组包括203名成年人,其中91人(44.8%)为女性。根据疾病的严重程度,40名患者(19.7%)被归类为轻度,67名患者(33.0%)被归类于中度,96名患者(47.3%)被归类至重度。当比较两组之间的IG水平时,轻度和重度疾病组之间(p=0.047)和中度和重度疾病群之间(p=0.036)存在统计学显著差异。IG计数与综合结果之间没有统计学显著关系(p>0.05)。结论:IG水平,在没有任何额外成本的情况下可以比其他实验室测试更快地测量的检测可用于确定新冠肺炎患者的临床严重程度。然而,我们得出的结论是,这个参数不能有效地确定入院期间的不良结果。
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引用次数: 0
期刊
Eurasian Journal of Emergency Medicine
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