The utility of NIRS in follow-up of patients with acute ischaemic stroke treated with IV thrombolysis and mechanical thrombectomy in the emergency department

Revascularization treatments (IV thrombolysis, mechanical thrombectomy) related to ischemic stroke have developed in recent years. With devices such as NIRS, non-invasive monitoring of treatment efficacy is provided. In this study, we aimed to use near-infrared spectroscopy (NIRS) as an objective monitoring method to see the effect of intravenous (IV) thrombolysis or mechanical thrombectomy treatments applied for cerebral oxygenation in patients with acute ischemic stroke. This study was carried out as a prospective study involving patients admitted to the emergency department in the years 2021-2022. NIRS measured regional oxygen saturation (rSO2) of both hemispheres of the brain before IV thrombolysis treatment, during the treatment at 0. min, 15. min, 30. min, 45. min, 60. min, after the treatment, and before and after the mechanical thrombectomy procedure. The significance level of the change in rSO2 values measured by NIRS was examined. 80 patients were included in the study. IV thrombolysis was applied to 58 patients, mechanical thrombectomy was applied to 5 of them, and both treatments were applied to 17 of them. In patients receiving IV thrombolysis, a significant difference was found in the affected hemisphere between the NIRS values measured at 0.min-15.min, 0.min-30.min, 0.min-45.min, 0.min-60.min, 0.min-post-treatment, 15.min-60.min (p < 0.001). In the patients included in the study, there was a strong and significant negative correlation between the deltaNIHSS value and the deltaNIRS values in the affected hemisphere (r=- 0.307, p = 0.013). There was a significant increase in the NIRS measurement values during and after the IV thrombolysis treatment in the affected hemisphere in the group with clinical improvement (p < 0.001). It is thought that IV thrombolysis or mechanical thrombectomy treatment applied to patients admitted to the emergency department with acute ischemic stroke can be followed objectively by NIRS.

Brain computed tomography in centenarians presenting to the emergency department: is age an indication to CT scan?

OBJECTIVE

This study aimed to explore the relationship between admission complaints and brain computed tomography (CT) examinations. Also, we evaluated the relationship between age and CT scan results in centenarians admitted to the emergency department for non-traumatic reasons.

PATIENTS AND METHODS

This study was a retrospective analysis of patients aged 100 years and older who presented to the tertiary hospital emergency department for non-traumatic reasons between 2012 and 2021. Demographic characteristics, admission complaints, and indications used for brain CT were evaluated. The Fazekas grade and Evans index were compared with a younger population aged 85-90 years.

RESULTS

Brain CT was ordered in 41.1% (n: 15/34) of the patients due to their atypical symptoms. While no acute pathology was found in the CT scans, 23.5% of the patients had an incidental intracranial mass and/or chronic ischemic areas. When the leukoencephalopathy findings of the centenarian patients were compared to the patients aged 85-90, it was determined that the Fazekas grade increased with age (p = 0.002). Concerning the ventricle diameter, there was a significant difference between the two groups (p = 0.017), with larger values detected in the 85-90 years group.

CONCLUSIONS

Although no acute pathology was found in the brain CT scans of the centenarian patients who presented to the emergency department for any reason other than trauma, CT plays a fundamental role in determining emergency diagnosis and management strategies in patients presenting with atypical symptoms. While the degree of leukoencephalopathy increased with age, the ventricle diameter was significantly larger in the younger age group than in the centenarian patients.

The role of repeated extended FAST in patients with stable blunt thoracoabdominal trauma

BACKGROUND

Thoracic and abdominal computed tomography scans are widely used modalities for trauma patients in emergency department (ED). However, alternative diagnostic and follow-up tools are also needed, due to limitations such as high cost and exces-sive radiation exposure. This study aimed to investigate the utility of repeated extended focused abdominal sonography for trauma (rE-FAST) performed by the emergency physician in patients with stable blunt thoracoabdominal trauma.

METHODS

This was a prospective, single-center diagnostic accuracy study. Patients with blunt thoracoabdominal trauma admitted to the ED were included in the study. The E-FAST was performed on the patients included in the study at the 0th h, the 3rd h, and the 6th h during their follow-up. Then, the diagnostic accuracy metrics of E-FAST and rE-FAST were calculated.

RESULTS

The sensitivity and specificity of E-FAST in determining thoracoabdominal pathologies were found to be 75% and 98.7%, respectively. The sensitivity and specificity for specific pathologies were 66.7% and 100% for pneumothorax, 66.7% and 98.8% for hemothorax, and 66.7% and 100% for hemoperitoneum, respectively. The sensitivity and specificity of rE-FAST in determining thoracal and/or abdominal hemorrhage in stable patients were found to be 100% and 98.7%, respectively.

CONCLUSION

E-FAST successfully rules in thoracoabdominal pathologies in patients with blunt trauma, with its high specificity. However, only a rE-FAST might be sensitive enough to exclude traumatic pathologies in these stable patients.