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Susur O, Yesіlaras M, Eyler Y. The Relationship Between Lactate and Lactate Clearance with In-Hospital Mortality in Unselected Emergency Department Patients. Prehosp Disaster Med 2024; 39:178-183. [PMID: 38454833 DOI: 10.1017/s1049023x24000141] [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] [Indexed: 03/09/2024]
Abstract
INTRODUCTION Lactate is a frequently used biomarker in emergency departments (EDs), especially in critically ill patients. The aim of this study is to investigate the relationship between lactate and lactate clearance with in-hospital mortality in unselected ED patients. METHODS This study was carried out retrospectively in the ED of a tertiary hospital. Patients aged 18 years and older whose blood lactate level was obtained in the ED were included in the study. Patients whose lactate value did not have sufficient analytical accuracy, whose lactate value was recorded in the system 180 minutes after admission, who were admitted to the ED as cardiac arrest, and whose ED or hospital outcome was unknown were excluded from the study. According to the first measured lactate value, the patients were divided into three groups: < 2.0mmol/L, 2.0-3.9mmol/L, and ≥ 4.0mmol/L. Lactate clearance was calculated and recorded in patients with one-to-four hours between two lactate values. RESULTS During the five-year study period, a total of 1,070,406 patients were admitted to the ED, of which 114,438 (10.7%) received blood gas analysis. The median age of 81,449 patients included in the study was 58 years (IQR: 30, min: 18-max: 117) and 54.4% were female. The study found that non-trauma patients with a lactate level between 2.0-3.9mmol/L had a 2.5-times higher mortality risk, while those with a lactate level of ≥ 4.0mmol/L had a 20.8-times higher risk, compared to those with a lactate level < 2.0mmol/L. For trauma patients, the mortality risk was three-times higher for those with lactate levels between 2.0-3.9mmol/L and nine-times higher for those with a lactate level of ≥ 4.0mmol/L, compared to those with a lactate level < 2.0mmol/L. Among patients with a first measured lactate value ≥ 4.0mmol/L and a two-hour lactate clearance < 20%, the mortality rate was 19.7%. In addition, lactate, lactate clearance, and age were independent variables for mortality in this patient group. CONCLUSION The lactate value in unselected patients in the ED is a biomarker that can be used to predict the prognosis of the patients. In addition, lactate, lactate clearance, and age are independent predictors of mortality.
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Affiliation(s)
- Ozlem Susur
- Emergency Physician, Department of Emergency, Merkezefendi State Hospital, Manisa, Turkey
| | - Murat Yesіlaras
- Emergency Physician, Department of Emergency, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Yesim Eyler
- Emergency Physician, Department of Emergency, Tepecik Training and Research Hospital, Izmir, Turkey
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Eyler Y, Sever M, Turgut A, Ocak NY, Onata A, Gürsoy O. External validation of the "deformity, edema, and pain in pronation" model for predicting wrist fractures. Am J Emerg Med 2024; 78:95-101. [PMID: 38244246 DOI: 10.1016/j.ajem.2024.01.011] [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: 08/20/2023] [Revised: 01/09/2024] [Accepted: 01/09/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND The aim of this study is to externally validate the "Deformity, Edema, and Pain in Pronation" model, which determines the necessity for radiography in patients with wrist trauma. METHODS This prospective, cross-sectional study was performed in a tertiary emergency department (ED). All patients admitted to the ED with wrist trauma aged 18 years and older were included in the study. Patients who did not have acute and blunt wrist trauma, those who could not be fully examined due to various reasons, and patients who did not wish to participate were excluded. Each patient was examined by their responsible physician, and imaging tests were requested based on the indications. All radiographic images were evaluated by an orthopedic surgeon who was blinded to the clinical information. This evaluation was accepted as the standard reference for diagnosing fractures. RESULTS 391 patients were included in the study. 170 patients (43.5%) had at least one fracture. The sensitivity and specificity of the model formed in our study in predicting wrist fractures were 98.77% (95% CI: 95.61-99.85) and 27.60% (95% CI 21.82-34.00), respectively. The area under the receiver operating characteristic curve (AUC) on external validation of the model was 0.878 (p < 0.001; 95% CI: 0.844-0.913). With the practice of this rule, there would be a 16% decrease in X-ray imaging request, while only 0.5% patients would have missed inoperable fractures. CONCLUSION The "deformity, edema, and pain in pronation" model is a reliable and practical clinical decision rule for determining the necessity of radiography in wrist trauma.
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Affiliation(s)
- Yesim Eyler
- Department of Emergency, University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Turkey.
| | - Mustafa Sever
- Department of Emergency, University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Ali Turgut
- Department of Orthopedics and Traumatology, University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Necmiye Yalcin Ocak
- Department of Emergency, University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Ahmet Onata
- Emergency Department, University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Olcay Gürsoy
- Department of Emergency, University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Turkey
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Yalcin Ocak N, Yesilaras M, Kilicaslan B, Eyler Y, Mutlu İ, Kutlu M. Comparing TIMI, HEART, and GRACE Risk Scores to Predict Angiographic Severity of Coronary Artery Disease and 30-Day Major Adverse Cardiac Events in Emergency Department Patients with NSTEACS. Prehosp Disaster Med 2023; 38:740-748. [PMID: 37830209 DOI: 10.1017/s1049023x23006490] [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] [Indexed: 10/14/2023]
Abstract
BACKGROUND Acute coronary syndromes (ACS) are hard to diagnose because their clinical presentation is broad. Current guidelines suggest early clinical risk stratification to the optimal site of care. The aim of this study was to investigate the ability of Thrombolysis in Myocardial Infarction (TIMI); History, Electrocardiogram, Age, Risk Factors, Troponin (HEART); and Global Registry of Acute Coronary Events (GRACE) risk scores to predict the development of major adverse cardiac events (MACE) and the angiographic severity of coronary artery disease (CAD) in patients diagnosed with non-ST-segment elevation acute coronary syndrome (NSTEACS) in the emergency department (ED). In addition, independent variables associated with the development of MACE were also examined. METHODS This study is a prospective, observational, single-center study. All patients over 18 years of age who were planned to be hospitalized for pre-diagnosed NSTEACS (NSTEMI + UAP) were included in the study consecutively. Patients' demographic information and all variables necessary for calculating risk scores (TIMI, HEART, and GRACE) were recorded. Two experienced cardiologists evaluated all coronary angiograms and calculated the Gensini score. RESULTS The median age was 60 (IQR: 18) years, and 220 (61.6%) were male of the 357 patients included in the study. In this study, 91 MACE (52 percutaneous coronary interventions [PCI], 28 coronary artery bypass graft [CABG], three cerebrovascular disease [CVD], and eight deaths) occurred. The 30-day MACE rate was 25.5%. The low-risk group constituted 40.0%, 1.4%, and 68.0% of the population, respectively, in TIMI, HEART, and GRACE scores. Multiple logistic regression models for predicting MACE, age (P = .005), mean arterial pressure (MAP; P = .015), and High-Sensitive Troponin I (P = .004) were statistically significant. CONCLUSION The ability of the GRACE, HEART, and TIMI risk scores to predict severe CAD in patients with NSTEACS is similar. In patients with NSTEACS, the HEART and GRACE risk scores can better predict the development of MACE than the TIMI risk score. When low-risk groups are evaluated according to the three risk scores, the HEART score is more reliable to exclude the diagnosis of NSTEACS.
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Affiliation(s)
- Necmiye Yalcin Ocak
- Emergency Physician, Department of Emergency, University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Murat Yesilaras
- Emergency Physician, Assoc. Prof., Department of Emergency, University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Baris Kilicaslan
- Cardiologist, Prof., Department of Cardiology, University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Yesim Eyler
- Emergency Physician, Department of Emergency, University of Health Sciences, Tepecik Training and Research Hospital, Izmir, Turkey
| | - İnan Mutlu
- Cardiologist, Assist. Prof., Department of Cardiology, Izmir Tınaztepe University, Izmir, Turkey
| | - Murat Kutlu
- Emergency Physician, Ergani State Hospital, Emergency Services, Diyarbakır, Turkey
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Eyler Y, Kilic TY, Duman Atilla O, Arslan Y, Capar AE, Idil H, Suner A. The Relation of End-Tidal CO 2 Values With Infarct Volume and Early Prognosis in Patients With Acute Ischemic Stroke. Neurologist 2022; 27:309-312. [PMID: 35051967 DOI: 10.1097/nrl.0000000000000418] [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: 11/25/2022]
Abstract
BACKGROUND The aim of this study is to reveal the relationship between end-tidal CO 2 (EtCO 2 ) values with infarct volume and early prognosis in patients diagnosed with acute ischemic stroke in the emergency department. MATERIALS AND METHODS This prospective cross-sectional study was conducted in a tertiary hospital. The demographics, characteristics, EtCO 2 , volume of the stroke area on diffusion-weighted magnetic resonance imaging and the modified Rankin Scale (mRS) of the patients were recorded. The values calculated at admission and at discharge were labeled as "mRS-1" and "mRS-2," respectively, and the mRS-2 measurement was used as a prognostic indicator. The "good" and the "poor" functional outcomes were defined as mRS ≤2 and mRS >2, respectively. Correlations between levels of EtCO 2 and infarct volume, mRS were calculated. RESULTS In total, 44 patients were included in the study. The median age of the patients was 69 years (interquartile range; 16; min-max: 35 to 88 y) and 68.2% of them were male. In the univariate logistic regression models of the mRS-2 [0 to 2 (0) and 3 to 6 (1)], all variables were not statistically significant to predict mRS-2 group. There were statistically significant differences in EtCO 2 values between mRS-1 ( P =0.03) and mRS-2 ( P =0.04). A negative moderate correlation was found between EtCO 2 and mRS-2 ( r =-0.410; P =0.006). The correlation between EtCO 2 and infarct volume was not statistically significant ( r =-0.256; P =0.093). CONCLUSIONS This study highlights the importance of capnography follow-up of patients with acute ischemic stroke. In patients with acute ischemic stroke, the EtCO 2 value measured at the time of admission is lower in the group with high mRS at both admission and discharge.
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Affiliation(s)
| | | | | | - Yildiz Arslan
- Neurology
- Department of Neurology, Izmir Medicana International Hospital
| | - Ahmet Ergin Capar
- Radiology, Tepecik Training and Research Hospital, University of Health Sciences
| | | | - Asli Suner
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Ege University, Izmir, Turkey
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Eyler Y, Sever M, Turgut A, Yalcin N, Zafer N, Suner A, Aksay E, Yesilaras M. Corrigendum to "The evaluation of the sensitivity and specificity of wrist examination findings for predicting fractures" [American Journal of Emergency Medicine 36 (2018) 425-429]. Am J Emerg Med 2022; 54:330. [PMID: 35033406 DOI: 10.1016/j.ajem.2021.12.034] [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] [Indexed: 11/17/2022] Open
Affiliation(s)
- Yesim Eyler
- Emergency Physician, Department of Emergency, Tepecik Training and Research Hospital, Izmir, Turkey.
| | - Mustafa Sever
- Emergency Physician, Department of Emergency, Tepecik Training and Research Hospital, Izmir, Turkey.
| | - Ali Turgut
- Orthopedic Surgeon, Department of Orthopedics and Traumatology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Necmiye Yalcin
- Emergency Physician, Department of Emergency, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Nur Zafer
- Emergency Resident, Emergency Department, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Aslı Suner
- Biostatistician, Department of Biostatistics and Medical Informatics, Ege University, School of Medicine, Izmir, Turkey
| | - Ersin Aksay
- Emergency Physician, Department of Emergency, DokuzEylul University, School of Medicine, Izmir, Turkey
| | - Murat Yesilaras
- Emergency Physician, Department of Emergency, Tepecik Training and Research Hospital, Izmir, Turkey
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Yalcin Ocak N, Yesilaras M, Eyler Y, Hakoglu O. Occupational accidents of emergency medicine residents in Turkey. Int J Occup Saf Ergon 2021; 28:2210-2215. [PMID: 34615447 DOI: 10.1080/10803548.2021.1986298] [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] [Indexed: 10/20/2022]
Abstract
Objectives. Healthcare workers face many biologic, chemical, physical and psychosocial hazards and risks in their work environment. Our research aimed to examine the types and frequency of occupational accidents, their notification status and predisposing factors to which emergency medicine residents (EMRs) were exposed in the last 12 months in Turkey. Methods. This research is a national, multicenter, online descriptive survey study. Participants' descriptive features, characteristics of occupational accidents they were exposed to in the last 12 months and their use status of personal protective equipment (PPE) were examined. Results. We found that 215 EMRs were exposed to 1919 occupational accidents in the last 12 months, and only 287 of these accidents were reported. All participants had at least one occupational accident in the previous 12 months. PPE was not used in 37.9 and 44% of biologic and chemical transmission accidents, respectively. The PPE use frequency of the EMRs in necessary situations for examination gloves, surgical masks, respirators, goggles, gowns and face shields was 60, 19, 19, 8, 15 and 4%, respectively. Conclusion. The actual number of occupational accidents was determined to be considerably higher than those reported. PPE use habits of EMRs were less than they should be.
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Affiliation(s)
- Necmiye Yalcin Ocak
- University of Health Sciences, Tepecik Training and Research Hospital, Turkey
| | - Murat Yesilaras
- University of Health Sciences, Tepecik Training and Research Hospital, Turkey
| | - Yesim Eyler
- University of Health Sciences, Tepecik Training and Research Hospital, Turkey
| | - Onur Hakoglu
- Odemis State Hospital, Emergency Services, Turkey
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Eyler Y, Sever M, Turgut A, Yalcin N, Zafer N, Suner A, Aksay E, Yesilaras M. The evaluation of the sensitivity and specificity of wrist examination findings for predicting fractures. Am J Emerg Med 2017; 36:425-429. [PMID: 28912085 DOI: 10.1016/j.ajem.2017.08.050] [Citation(s) in RCA: 8] [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] [Received: 05/08/2017] [Accepted: 08/23/2017] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the sensitivity and specificity of physical examination findings and functional tests in adult acute wrist trauma patients who presented to the emergency department (ED) and to create a reliable and practical clinical decision rule for determining the necessity of radiography in wrist trauma. METHODS This prospective observational study was conducted in a tertiary ED. Each patient was checked for 18 physical examination findings and functional tests. Patients with suspected fracture were enrolled consecutively. Antero-posterior and lateral wrist views were performed for each patient. All radiographical studies were interpreted by an orthopedic surgeon. The prevalence, sensitivity and specificity, negative and positive predictive values of each finding were calculated. A modeling for predicting fractures was created using computer. RESULTS 207 patients were evaluated and 69 patients (33.3%) had fractures. The most common encounterd fracture site was distal radius (29.5%). The most sensitive examination finding was pain in dorsiflexion (95.7%) and the most specific finding was ecchymosis (97.8%). Wrist edema, deformity and pain aggravated by pronation were found to be strong predictors of fracture. The area under the receiver operating characteristic curve at internal validation for a prediction model based on these three predictors was 0.88 (95% CI: 0.83-0,93). The overall sensitivity and specificity of this model were 94% (95% CI: 85-98%) and 51% (95% CI 43-60%) respectively. According to the model created in this study, 34% of acute blunt wrist trauma patients do not require any X-ray imaging. CONCLUSIONS This triple modeling may be used as an effective decision rule for predicting all wrist fractures in the ED and in the disaster setting.
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Affiliation(s)
- Yesim Eyler
- Department of Emergency, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Mustafa Sever
- Department of Emergency, Tepecik Training and Research Hospital, Izmir, Turkey.
| | - Ali Turgut
- Department of Orthopedics and Traumatology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Necmiye Yalcin
- Department of Emergency, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Nur Zafer
- Emergency Department, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Aslı Suner
- Department of Biostatistics and Medical Informatics, EgeUniversity, School of Medicine, Izmir, Turkey
| | - Ersin Aksay
- Department of Emergency, DokuzEylul University, School of Medicine, Izmir, Turkey
| | - Murat Yesilaras
- Department of Emergency, Tepecik Training and Research Hospital, Izmir, Turkey
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Sever M, Eyler Y, Suner A. A study to develop clinical decision rules for the use of radiography in wrist trauma: Karadeniz wrist rules. Am J Emerg Med 2017; 36:161-162. [PMID: 28754319 DOI: 10.1016/j.ajem.2017.07.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 06/13/2017] [Accepted: 07/14/2017] [Indexed: 10/19/2022] Open
Affiliation(s)
- Mustafa Sever
- Department of Emergency Medicine, Tepecik Training and Research Hospital, Izmir, Turkey.
| | - Yesim Eyler
- Department of Emergency Medicine, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Aslı Suner
- Department of Biostatistics and Medical Informatics, Ege University, School of Medicine, Izmir, Turkey
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Dagar S, Kilic TY, Aksay E, Dogan T, Eyler Y, Tanrisev M, Ustuner F. Can High BNP Levels Predict The Necessity of Emergency Hemodialysis in Patients With Acute Renal Failure. Turk J Emerg Med 2013. [DOI: 10.5505/1304.7361.2013.45722] [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: 11/04/2022] Open
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Duman Atilla O, Caliskan Tur F, Aksay E, Dogan T, Eyler Y, Akin S. Clinical Factors in Geriatric Blunt Trauma. Turk J Emerg Med 2012. [DOI: 10.5505/1304.7361.2012.04127] [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: 11/04/2022] Open
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