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Acil servisimize başvuran hastaların 5 yıllık analizi
(Muğla Sıtkı Koçman Üniversitesi, 2021) Sert, Ekrem Taha; Mutlu, Hüseyin; Yeşildağ, Kerim; Kokulu, Kamil; Sarıtaş, Ayhan
Acil servise başvuran kritik hastalıkların özelliklerinin bilinmesi, en kısa sürede tanı alması ve doğru tedavilerinin başlamasında hayati öneme sahiptir Çalışmamızda acil servise başvuran hastaların demografik ve klinik özelliklerini incelemeyi amaçladık. Ocak 2015 ile Aralık 2019 tarihleri arasında hastanemiz üçüncü basamak acil servisine başvuran tüm erişkin ve çocuk hastalar retrospektif olarak değerlendirildi. Hastaların demografik özellikleri, hastalık tanıları ve yıllara göre başvuru oranları değerlendirildi. Acile servise beş yıl içerisinde başvuran hasta sayısı 2.254.302 olarak tespit edildi. Hastaların %50.9’u erkek ve %49.1’i kadındı ve yaş gruplarına göre başvuru sıklığı değerlendirildiğinden yoğun grubun %26.73 ile 10 yaş ve altı olduğu görüldü. En çok başvuru %51 ile 16:00-24:00 saatleri arasında idi. Hastaların en sık solunum sistemi problemleri(%24,71) ile acile başvurduğu tespit edildi. Acil servise başvuran hastaların %2.24’ü ilgili bölümlere, %0.77’sinin ise yoğun bakım ünitesine yatırıldığı tespit edildi. Acil servislere başvuru oranının yüksek olması beraberinde aşırı hasta yoğunluğuna neden olmaktadır. Acil servise başvuran hasta profilinin belirlenmesi, verilecek hizmet sunumu ve hasta bakım kalitenin artırılmasında faydalı olacaktır.
All-terrain vehicle related trauma: Analysis of injury patterns, safety equipment use and mortality
(Effect Publishing Agency ( EPA ), 2025) Bulut, Bensu; Genç, Murat; Akkan Öz, Medine; Ecevit Kaya, Aynur; Topuz, Muhammed Ali Topuz; Borazan, İsmail; Kokulu, Kamil; Sert, Ekrem Taha; Mutlu, Hüseyin; Yazıcı, Ramiz
To determine age-specific patterns, effects of protective equipment use, and predictors of mortality in all-terrainvehicle (ATV)-related injuries. A total of 55 ATV-related trauma patients were retrospectively analyzed during the study period. Demographic characteristics, injury mechanisms, clinical findings and outcomes were evaluated. Injury patterns were compared according to age groups. Risk factors for mortality were determined by multivariate logistic regression analysis. The mean age of the patients was 22.3±12.8 years and 67.3% were male. Half of the victims (50.9%) were aged 18 years or younger. The majority of accidents occurred with drivers (70.9%) and on the street (70.9%). The rate of protective equipment use at the time of the accident was 21.8%. The most common mechanism of injury was ejection from the vehicle (63.6%), followed by impingement injuries (21.8%) and direct collisions (14.5%). Limb injuries were more common in patients younger than 18 years of age (68.2% vs. 43.5%), while more severe thoracic trauma was observed in patients older than 40 years. Off-road accidents were associated with higher injury severity scores than street/street accidents (mean Injury Severity Score (ISS) 22.6 vs. 16.8, p25 (odds ratio (OR), 8.64), severe head injury (OR 6.92), multiple system involvement (OR 5.78) and lack of protective equipment (OR 4.23) were independent predictors of mortality. ATV accidents are an important public health problem that can lead to serious injuries and fatalities. Injury patterns differ according to age groups. Inadequate use of protective equipment and the severity of off-road accidents are noteworthy. It is important to develop safety measures specific to age groups and to expand the use of protective equipment.
All-terrain vehicle related trauma: Analysis of injury patterns, safety equipment use and mortality
(Effect Publishing Agency ( EPA ), 2025) Bulut, Bensu; Genç, Murat; Öz, Medine Akkan; Ecevit Kaya, Aynur; Topuz, Muhammed Ali; Borazan, İsmail; Kokulu, Kamil; Sert, Ekrem Taha; Mutlu, Hüseyin; Yazıcı, Ramiz
To determine age-specific patterns, effects of protective equipment use, and predictors of mortality in all-terrainvehicle (ATV)-related injuries. A total of 55 ATV-related trauma patients were retrospectively analyzed during the study period. Demographic characteristics, injury mechanisms, clinical findings and outcomes were evaluated. Injury patterns were compared according to age groups. Risk factors for mortality were determined by multivariate logistic regression analysis. The mean age of the patients was 22.3±12.8 years and 67.3% were male. Half of the victims (50.9%) were aged 18 years or younger. The majority of accidents occurred with drivers (70.9%) and on the street (70.9%). The rate of protective equipment use at the time of the accident was 21.8%. The most common mechanism of injury was ejection from the vehicle (63.6%), followed by impingement injuries (21.8%) and direct collisions (14.5%). Limb injuries were more common in patients younger than 18 years of age (68.2% vs. 43.5%), while more severe thoracic trauma was observed in patients older than 40 years. Off-road accidents were associated with higher injury severity scores than street/street accidents (mean Injury Severity Score (ISS) 22.6 vs. 16.8, p25 (odds ratio (OR), 8.64), severe head injury (OR 6.92), multiple system involvement (OR 5.78) and lack of protective equipment (OR 4.23) were independent predictors of mortality. ATV accidents are an important public health problem that can lead to serious injuries and fatalities. Injury patterns differ according to age groups. Inadequate use of protective equipment and the severity of off-road accidents are noteworthy. It is important to develop safety measures specific to age groups and to expand the use of protective equipment.
An effective treatment option for pain caused by urolithiasis: A randomised-controlled trial of local active warming with heat-patch
(Blackwell Publishing Ltd, 2021) Mutlu, Hüseyin; Ertaş, Kasım; Kokulu, Kamil; Sert, Ekrem Taha; Diri, Mehmet Akif; Gül, Murat
Background: There is growing interest in physical medicine treatment options for renal colic. In this study, we aimed to determine whether or not heat-patch treatment with no drug was effective in relieving renal colic. Methods: For this purpose, patients who were diagnosed with renal colic in the emergency department were randomised to have either heat-patch or sham treatment. The Visual Analogue Scale (VAS) scores of renal colic, body temperature (Btemp), and sub-patch skin temperature (Stemp) values were measured at 0, 15, 30, 45, and 60 minutes. In addition, the salvage treatment needs of the groups were compared. Results: The average age of the study group was 30.5 ± 8.3 years and that of the sham group was 31.0 ± 8.2 years (P =.75). According to the baseline VAS score of the patients, 15, 30, 45, and 60 minutes VAS scores significantly decreased in the heat-patch group (P <.001). The Btemp values did not differ significantly between the heat-patch and sham groups. In addition, no statistically significant difference was found between the two groups in terms of Stemp values at 0 and 15 minutes (P =.39 and P =.10, respectively). However, there was a significant difference in the heat-patch group in terms of Stemp values at 30, 45, and 60 minutes compared with the sham group (P <.001). The salvage treatment rates for the heat-patch and sham groups were 11.5% and 31.4%, respectively (P =.01). Conclusion: As non-pharmaceutical treatment, the heat-patch has been shown to be a possible candidate for pain relief in patients with urolithiasis. Further research should concentrate on multicentre and large scale randomised studies.
Anxiety level in pre-hospital emergency medical services personnel during coronavirus disease-2019 pandemic
(Emergency Medicine Physicians Association, 2021) Mutlu, Hüseyin; Sert, Ekrem Taha; Kokulu, Kamil; Sarıtaş, Ayhan
Aim: This study aimed to determine the anxiety level in pre-hospital emergency medical services personnel (PHEMSPs) and investigate the factors that potentially affect the anxiety level during the pandemic. Materials and Methods: This cross-sectional survey was conducted with PHEMSPs during the Coronavirus Disease-2019 (COVID-19) pandemic. A 60-item survey, including socio-demographic characteristics, anxiety-related demographic factors, and State-Trait Anxiety Inventory (STAI) scale scores was used. Results: Among 586 PHEMSPs participating in the study, 50.5% were female, with median age of 30 years. The mean STAI-S value was 42.2, and the median STAI-T value was 48. The anxiety levels of female PHEMSPs (STAI-S=51 and STAI-T=44.14) were higher than male (STAI-S=44 and, STAI-T=40.26). The anxiety level of patients with chronic diseases (STAI-S=56 and, STAI-T=45.77) was significantly higher than those without chronic diseases. State anxiety scores in married individuals (STAI-S=49) were higher than those unmarried individuals. Conclusion: Clearly, people who provide this service should be psychologically healthy to efficiently provide healthcare for the benefit of the people. All types of media assume a great responsibility in reducing the unrest or anxiety that may occur in humans, especially because of their potential to reach many parts of the society.
Argyrophilic nucleolar organizer regions as a promising biomarker for the detection of brain hypoxia levels caused by different doses of carbon monoxide poisoning
(Academia Nacional de Medicina de México, 2021) Yeşildağ, Kerim; Kokulu, Kamil; Mutlu, Hüseyin; Eröz, Recep; Taha Sert, Ekrem; Sarıtaş, Ayhan
The purpose of the study is to investigate whether there is any relationship between mean argyrophilic nucleolar organizing regions (AgNOR) number and total AgNOR area/total nuclear area (TAA/TNA) ratio and the levels of brain hypoxia after exposure to different acute doses of carbon monoxide (CO) gas. Methods: Each experimental group was exposed to CO gas (concentrations of 1,000, 3,000 and 5,000 ppm). Then, the rats were anesthetized, and blood samples were taken from the right jugular vein for carboxyhemoglobin levels detection. The rats were sacrificed on seventh day. AgNOR staining was applied to brain tissues. TAA/TNA and mean AgNOR number were detected for each nucleus. Results: Significant differences were detected among the all groups for TAA/TNA ratio, mean AgNOR number and carboxyhemoglobin level. According to double comparison of groups, the differences between control and 1000ppm, control and 3000ppm, control and 5000ppm and 1000 and 5000ppm were significant for TAA/TNA ratio. When mean AgNOR number to be considered, significant differences were detected between control and 1000ppm, control and 3000ppm, control and 5000ppm and 1000 and 3000ppm. Conclusion: AgNOR proteins may be used for early detection of the duration, intensity and damage of brain injury caused by CO intoxication. Thus, effective treatment strategies for the prevention of hypoxic conditions may be developed.
Artificial intelligence application for identifying toxic plant species: A case of poisoning with Datura stramonium
(Elsevier Ltd, 2024) Kokulu, Kamil; Sert, Ekrem Taha
The management of plant poisonings in the emergency department (ED) presents various challenges. Foremost among these is the identification of the specific botanical species responsible for the toxic effect. In cases of plant poisoning, it is crucial to accurately identify the plant in order to promptly evaluate if it has cardiotoxic, neurotoxic, hepatotoxic, or anticholinergic properties. Furthermore, it is typically not possible to determine the identity of these plants through blood tests conducted in the ED. Case report: An otherwise healthy 23-year-old male patient presented to the ED with symptoms of restlessness, altered mental state, and hallucinations that occurred 2 h after consuming herbal tea. On physical examination, he was tachypneic, tachycardic, and disoriented. The pupils were bilaterally mydriatic. The patient's symptoms were consistent with both sympathomimetic and anticholinergic (antimuscarinic) toxidromes. We were unable to promptly reach a botanist to identify the plant to which the patient had been exposed. Therefore, we employed Google Gemini, an artificial intelligence software, to ascertain the plant's identity. Google Gemini identified the plant we photographed as Datura stramonium, commonly known as jimson weed, which is known to cause anticholinergic toxicity. The botanist we contacted later confirmed that the plant was D. stramonium. The patient's symptoms were alleviated with the use of intravenous diazepam and physostigmine. Conclusion: We propose that the utilization of artificial intelligence applications with visual recognition capabilities could be beneficial for physicians, patients, and foragers of edible wild plants to accurately identify plants and distinguish toxic species.
Carbon monoxide poisoning from Charcoal-Heated Hookah vs Electrically Heated Hookah
(W.B. Saunders, 2024) Kokulu, Kamil; Sert, Ekrem Taha
We have read with great interest the article titled “Waterpipe vs non-Waterpipe carbon monoxide poisoning: Comparison of patient characteristics, clinical presentation, and outcomes” by Abdul-Nabi et al. [1]. There is a limited number of studies in the literature that specifically address this topic [2,3], and we express our gratitude to the authors for their insightful contribution. We would like to highlight several key points related to carbon monoxide (CO) poisoning associated with hookah use.
Characteristic profile of the patients consulted from emergency department to otolaryngology clinic
(Kula Burun Boğaz ve Baş Boyun Cerrahisi Derneği, 2020) Mutlu, Hüseyin Nizam; Sert, Ekrem Taha; Çayır, Serkan; Kokulu, Kamil
Objective: Currently, consultation requests are frequently made from emergency departments to other clinics. The aim of this study is to perform a detailed analysis of the consultation requests from the emergency department to the otolaryngology clinic and to evaluate the case results and the need for consultation. Material and Methods: The files of 743 cases consulted from the emergency room to the otolaryngology clinic between January 2016 and December 2019 were reviewed retrospectively. Reasons for requesting consultation, symptoms and diagnoses of the cases, and procedures performed as a result of the consultation were analyzed in detail. Results: The ages of the patients ranged between 1 and 93 years (mean: 49.7 ± 9.38 years), and there were 354 (47.6%) female and 389 (52.4%) male patients. The most common reason for consultation request was epistaxis (24.5%). As a result of the consultation, 1.6% of all cases underwent emergency surgical operation and 4.9% underwent various surgical procedures under local anesthesia, and 4.2% were hospitalized for medical treatment. Outpatient clinic follow-up was recommended for 381 cases (51.3%), while elective operation was recommended for 125 cases (16.8%). As a result of 119 consultations (16.1%), no otolaryngologic pathology was found and these consultations were considered unnecessary. Conclusion: By having a sufficient number of specialist physicians in emergency departments, evaluating the problems associated with consultations with regular meetings between clinics, and organizing training programs in institutions that train specialist doctors, unnecessary requests for consultations can be reduced.
Characteristics of school injuries presenting to the emergency department
(PMC, 2022) Özdemir, Serdar; Akça, Hatice Şeyma; Algın, Abdullah; Kokulu, Kamil; Özkan, Abuzer
School injuries account for approximately one-fifth of pediatric injuries. We aimed to investigate the frequency and severity of school injuries among school-aged children and determine clinical diagnoses and surgery requirement data. Methods In this prospective study, children who were admitted to the emergency department due to school accidents over a 5-month period were included. Demographics, activity during trauma, mechanism of trauma, nature, severity, emergency department outcomes, and surgery requirement were evaluated. Results The study included a total of 504 school-aged children, of whom 327 (64.9%) were male and 177 (35.1%) were female. Of the children, 426 (84.5%) had no evidence of injury or minor injury, while 78 (15.5%) had moderate or severe injury. There was a statistically significant difference between these two groups in terms of gender ( p = 0.031). Of the 78 children with moderate or severe injuries, 45 had extremity fractures, 18 had lacerations, 5 had maxillofacial injuries, 4 had cerebral contusion, 1 had lung contusion, and 1 had cervical soft-tissue damage. Two patients with fractures and two with eyelid lacerations were treated surgically, and four patients with brain contusion were hospitalized for a close follow-up. Conclusion This study revealed that the most common moderate or severe injuries in school accidents referred to emergency department were distal radius fractures and lacerations.
ChatGPT and pediatric advanced life support: A performance evaluation
(Elsevier Ireland Ltd, 2024) Kokulu, Kamil; Demirtaş, Mehmet Semih; Sert, Ekrem T.; Mutlu, Hüseyin
The development of artificial intelligence (AI) tools, such as large language models (LLMs), holds significant promise for enhancing patient care and medical education. ChatGPT (Chat Generative Pre-trained Transformer), an LLM developed by OpenAI utilizing the GPT-4 architecture, currently demonstrates the highest level of medical domain knowledge among its peers.1 While ChatGPT’s performance has been assessed in various medical examinations,2,3 its capabilities in pediatric resuscitation and advanced life support remain unexplored. This study aimed to evaluate the clinical reasoning ability of ChatGPT by testing its performance on the American Heart Association (AHA) Pediatric Advanced Life Support (PALS) exam.
Clinical predictors of delayed neurological sequelae in charcoal-burning carbon monoxide poisoning
(W.B. Saunders, 2021) Sert, Ekrem Taha; Kokulu, Kamil; Mutlu, Hüseyin
Background: The main objective of the treatment of acute carbon monoxide (CO) poisoning is to prevent delayed neurological sequelae (DNS). However, today there is still no objective screening tool to identify patients at high risk of developing DNS. The aim of this study was to identify clinical factors that could predict DNS after acute charcoal-burning CO poisoning. Methods: This prospective observational study was conducted from September 1, 2019 to August 31, 2020 in a single academic medical center. Patients older than 18 years of age suffering from charcoal-burning CO poisoning were included in the study. After acute recovery, patients were followed up for six weeks to investigate for DNS development. The clinical predictors of DNS were determined using a multivariate logistic regression model. Results: Of the 217 patients—113 males (52.1%), median age 37.0 (27.5–51.5) years—included, 49 (22.6%) developed DNS. The multivariate logistic regression analysis revealed the independent predictors of DNS as a lower initial Glasgow Coma Scale (GCS) score (adjusted odds ratio (AOR): 0.73, 95% confidence interval (CI): 0.62–0.87), a longer duration of CO exposure (AOR: 2.18, 95% CI: 1.65–2.88), and the presence of acute brain lesions with high signal intensity on diffusion-weighted imaging (AOR: 5.22, 95% CI: 1.50–18.08). The created multivariate regression model predicted DNS development with high accuracy (area under the curve: 0.93, 95% CI: 0.89–0.97). Conclusion: A low initial GCS score, longer exposure to CO and abnormal findings on diffusion-weighted magnetic resonance imaging can assist in the early identification of patients at high risk of DNS development.
Comparison of the effect of two different intravenous methylprednisolone doses on the occurrence time of biphasic reaction
(İnönü Üniversitesi, 2021) Sert, Ekrem Taha; Kokulu, Kamil; Mutlu, Hüseyin; Parlak, İsmail
The aim of this study is to determine the effect of two different doses of methylprednisolone administered in our emergency department (ED) on the elapsed time in biphasic or recurrent anaphylaxis cases. Materials and Methods: The patients with anaphylaxis admitted to the ED were retrospectively analyzed. A total of 82 patients who received methylprednisolone in combination with epinephrine in the ED due to anaphylaxis and who developed biphasic reaction within 48 h after discharge were included in the study. The patients were classified into two groups according to the dose of methylprednisolone administered: 80 mg (Group 1, low-dose) and 120 mg (Group 2, high-dose). The effect of different doses of methylprednisolone on the development time of biphasic reaction was evaluated. Results: Two different doses of IV methylprednisolone administered in the ED did not affect the development time of biphasic reaction (p = 0.24). The biphasic reaction development times were 335 (IQR, 212–950) min in the low-dose group and 520 (IQR, 265– 1150) min in the high-dose group. The earliest development time of biphasic reaction was 125 min (low-dose group) and the latest development time was 2270 min (high-dose group). The relationship between dose and biphasic reaction development times was evaluated using Kaplan–Meier curve. No significant difference was observed between the two groups (p = 0.28). Upon comparing the symptoms in patients’ second admission to the ED due to biphasic reaction, no statistically significant difference was observed in patient symptoms with respect to the dose administered (p > 0.05). Conclusions: Corticosteroids are often used in ED, although there is no definitive evidence that they prevent biphasic reactions. The administration of two different doses of methylprednisolone has no effect on biphasic reaction development time.
Comparison of the incidence of recovery agitation with two different doses of ketamine in procedural sedation: A randomized clinical trial
(John Wiley and Sons Inc, 2025) Türkücü, Çağrı; Parlak, İsmet; Kokulu, Kamil; Sert, Ekrem T.; Mutlu, Hüseyin
The objective was to compare the incidence of recovery agitation and efficacy of two different intravenous (IV) doses of ketamine (0.5 mg/kg vs. 1 mg/kg) in adult patients who presented to the emergency department (ED) requiring procedural sedation with ketamine. Methods: This randomized, prospective clinical trial included patients aged 18–75 years who required procedural sedation with ketamine in the ED. Patients were randomized to receive IV ketamine at either 0.5 mg/kg (low dose) or 1 mg/kg (high dose). The primary outcome was the incidence of recovery agitation, assessed by the Richmond Agitation–Sedation Scale (RASS) at 5, 15, and 30 min following the procedure, in both dosage groups. Secondary outcomes included overall efficacy, sedation duration, and changes in vital signs. Results: A total of 108 patients were enrolled in the study, 54 in each group. The median (IQR) RASS scores at 5, 15, and 30 min were −4 (−5 to −4), −1 (−1.3 to 0), and 0 (−1 to 0.5), respectively, in the low-dose group and −4 (−5 to −4), −1 (−3 to 0), and 0 (0 to 0), respectively, in the high-dose group. The incidence of recovery agitation was similar between the low- and high-dose groups (difference 1.9%, 95% confidence interval [CI] −14.8% to 18.4%). No significant difference was observed in sedation duration between the two groups (difference 0%, 95% CI −3.0% to 4.0%). While no additional ketamine was required in the high-dose group, four patients (7.4%) in the low-dose group required an additional half-dose (difference 7.4%, 95% CI −2.3% to 18.7%). Changes in vital signs were similar between the two groups. Conclusions: There was no significant difference in recovery agitation, sedation duration, and changes in vital signs between 0.5 and 1 mg/kg IV ketamine for procedural sedation in the ED.
Demographic and Injury Characteristics of Patients Injured in a Hailstorm
(Cambridge University Press, 2025) Kokulu, Kamil; Sert, Ekrem Taha; Özdemir, Serdar; Mutlu, Hüseyin; Altunok, İbrahim
The aim of this study was to describe the demographic characteristics, injury characteristics, and outcomes of individuals sustaining injuries during a hailstorm in Istanbul, Turkey. Methods: In this study, the medical records of 76 patients who presented to the emergency department (ED) of a tertiary hospital after incurring injuries due to hailstorms were retrospectively reviewed. Analyses were performed to identify hailstorm-associated injury profiles, injury mechanisms, patient demographics, and ED resource use. Results: Of the 76 patients, 42 (55.3%) were male and 34 (44.7%) were female, with the ages of the patients ranging from five to 79 years. Of the patients, 93.4% presented to the ED within the first eight hours after a hailstorm. The most common injury mechanisms were the direct impact of hailstones on the body surface (36.8%) and slips and falls during escape (35.6%). The most frequently injured anatomical areas were skin (60.5%), head (44.7%), and extremities (16.7%). Significant injuries occurred in only 11.8% of the patients, of whom three were treated surgically and one died. The most common injuries were soft tissue and minor head injuries. Conclusions: Severe hailstorms often strike suddenly and can be difficult to predict. In response, EDs must handle a large number of injured patients in the aftermath of a hailstorm. It is important to remember that hailstorms, like other natural disasters, can cause serious injuries.
Determination of the Cricothyroid Membrane Height by Age and Sex and Optimal Tracheal Tube Size
(John Wiley and Sons Inc, 2024) Kokulu, Kamil; Alkan, Ender; Sert, Ekrem T.; Mutlu, Hüseyin; Türkücü, Çağrı; Akar, Emin H.
The primary aim of this study was to determine the average cricothyroid membrane (CTM) height in healthy volunteers, and the secondary aim was to determine the hypothetical success rate for emergency cricothyrotomy with a tracheal tube with an 8.0 mm outer diameter. Methods: This study included healthy volunteers aged 18 years and older. The participants' clinical characteristics were recorded, and their CTM height was measured using ultrasound, with their necks placed sequentially in the neutral and extension positions. The relationship between the CTM height and sex, age, height, weight, body mass index, and sternomental distance was evaluated using linear regression analysis. An equation that could estimate the height of the CTM was obtained with the parameters found significant in this analysis. Results: Of the 340 participants, 208 (61.2%) were male. The mean (SD) height of the CTM in the extension position was 9.60 (1.54) mm, and it was significantly shorter in the women than in the men (8.72 [1.19] mm vs. 10.16 [1.48] mm, p < 0.001). Among the participants of short stature, the CTM was significantly shorter, regardless of sex. The hypothetical success rate for emergency cricothyrotomy was 93.3% for the males and 73.5% for the females. The equation for estimating the height of the CTM in the extension position was determined as ?4.36 + 5.27 × height (m) + 0.32 × sternomental distance (cm). Conclusions: Since the CTM height may differ according to age, sex, and height, cricothyrotomy sets should be available in various outer diameters.
Diagnostic value of lateral ankle radiography in achilles tendon rupture
(SAGE Publications Ltd, 2023) Kokulu, Kamil; Altunok, İbrahim; Sert, Ekrem Taha; Özdemir, Serdar; Mutlu, Hüseyin; Akça, Hatice Şeyma
Achilles tendon rupture (ATR) is a common sports injury, but approximately 20% of acute ATR cases are misdiagnosed as ankle sprains at first presentation. This study aimed to investigate the diagnostic value of lateral ankle radiography in the diagnosis of acute ATR. Methods: This was a retrospective case-control study in which the lateral ankle radiographs of patients who presented to the emergency department between January 1, 2015 and December 31, 2019 were examined. The study included a total of 154 patients with acute ATR, who underwent lateral ankle radiography at the presentation and were surgically or magnetic resonance imaging (MRI) confirmed to have ATR in our hospital. The lateral ankle radiographs of the patients were examined by 2 clinicians blinded to clinical data for the following 3 findings: Kager’s fat pad sign, tibio-first metatarsal angle, and tibiocalcaneal angle. The same procedure was repeated for 308 controls who underwent lateral ankle radiography and were diagnosed with ankle sprain.
Effectiveness of clinical risk factors in the detection of central pathology in patients with isolated vertigo
(Elsevier Inc., 2021) Sert, Ekrem Taha; Çayır, Serkan; Mutlu, Hüseyin; Kokulu, Kamil
Background: There is no clinical guidance for the indications of neuroimaging in patients with isolated vertigo. The differential diagnosis of isolated vertigo can be challenging for emergency physicians. Objective: The aim of this study was to identify the risk factors that increase the likelihood of detecting a central pathology in patients who present with isolated vertigo and in whom peripheral vertigo is considered. Methods: Patients imaged using neuroimaging, including diffusion-weighted magnetic resonance imaging (DW-MRI) with head computed tomography (CT), for isolated vertigo over a 3-year period were identified retrospectively. The patients were divided into two groups—a positive neuroimaging group and a negative neuroimaging group—according to the abnormal lesions in the head CT and DW-MRI results. We reviewed the medical records to identify presenting symptoms and signs, vascular risk factors, history of vertigo, medical comorbidities, and diagnostic imaging results (i.e., head CT and DW-MRI). Results: Two hundred and seventy-nine patients were included: 231 in the negative neuroimaging group (82.8%) and 48 in the positive neuroimaging group (17.2%). Univariate and multivariate logistic regression analyses were performed. It was found in the regression analysis that being 65 years or older (odds ratio [OR] 2.53; 95% confidence interval [CI] 1.29–4.96; p = 0.006), having two or more vascular risk factors (OR 2.45; 95% CI 1.10–5.46; p = 0.028), and not responding to the treatment (OR 2.57; 95% CI 1.08–6.14; p = 0.033) increased the likelihood of detecting a pathology in neuroimaging. Conclusions: We suggest that patients unresponsive to ED treatment, 65 years or older, and with two or more vascular risk factors, should alert physicians for central causes and increase the yield of neuroimaging.
Effects of Clinical Frailty Scale Score on Adverse Outcomes and Length of Emergency Department Stay Before Intensive Care Unit Admission
(Elsevier, 2024) Sert, Ekrem Taha; Kokulu, Kamil; Mutlu, Hüseyin; Yortanlı, Betül Çiğdem
Background: Older adults living with frailty who require treatment in hospitals are increasingly seen in emergency departments (EDs). Objective: This study investigated the effects of frailty severity according to the Clinical Frailty Scale (CFS) on adverse outcomes and length of stay in the ED before intensive care unit (ICU) admission. Methods: We conducted this prospective observational study with patients 65 years or older and admitted to the ICU from March 1, 2021 to December 31, 2022. We divided the patients into four groups according to their CFS scores. We determined the effects of frailty severity on length of ED stay and clinical outcomes using logistic regression analysis. Results: Of the 920 patients included in the study, 25.4% were nonfrail, 26.2% had mild frailty, 25.9% had moderate frailty, and 22.5% had severe frailty. In the regression analysis, compared with those who were nonfrail, the length of ED stay was significantly longer for those with moderate frailty (odds ratio [OR] 2.13; 95% confidence interval [CI] 1.63-2.90) or severe frailty (OR 3.32; 95% CI 1.92-3.87), but the result was not significant for those with mild frailty (OR 1.65; 95% CI 1.21-2.45). ICU mortality was significantly higher among patients with mild, moderate, or severe frailty than among those who were nonfrail. Conclusions: We found CFS score to be a predictor of length of ED stay and adverse outcomes. Accordingly, CFS evaluation can provide an idea of the length of ED stay and the likelihood of adverse outcomes.
Evaluating Artificial Intelligence Competency in Education: Performance evaluation of ChatGPT in the neonatal resuscitation program exam
(Elsevier Ireland Ltd, 2025) Demirtaş, Mehmet Semih; Kokulu, Kamil; Tunç, Gaffari
Artificial intelligence (AI) applications are increasingly used in the healthcare field and, in addition to their potential benefits, they also bring with them important questions such as accuracy, ethics, security and implementation difficulties.1,2 In addition to the widespread use of social media such as YouTube® and TikTok® among clinicians and healthcare professionals, especially for education and patient care, the use of AI applications has also been increasing in the last 5 years.2,3 In our study, we evaluated the success of ChatGPT, one of the large language models (LLMs), in the neonatal resuscitation program (NRP) with a total of 50 multiple choice questions.4,5 . This can be seen as a step towards understanding the potential role of AI in clinical education and assessment processes.

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