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A retrospective clinical trial on nasal bone fractures admitted to a level three emergency room
(Annals of Medical Research, 2020) Çayır, Serkan; Mutlu, Hüseyin; Sert, Ekrem Taha
Aim: The anatomical location and protruding structure of the nasal bone can easily lead to fracture as a result of trauma. The high incidence rates have emphasized that the causes, treatments, and complications of these fractures should be investigated. The purpose of this study is to investigate our treatment modalities and complications by reviewing the current information about such fractures. Material and Methods: A total of 582 patients presented with nasal bone fractures between January 2014 and December 2019 were retrospectively analyzed. Examination findings, patient records, and radiological examinations of fractures were analyzed in detail. Results: The age of the patients was between 2 and 83 years (mean age: 33.9 ± 6.11 years). The study included 451 (77.5%) males and 131 (22.5%) females. The most common etiologic factor was assault (35.7%). The most common postoperative complications included deformity (53 patients; 9.1%), nasal congestion (41 patients; 7.1%), and smell disorders (5 patients; 0.9%), with the complications increased with the severity of fracture. Conclusion: Reduction procedures are successfully performed within the first 2 weeks following nasal fractures, and if there is a suspicion of causing deformity in patients under observation, necessary surgical interventions should be performed.
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.
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.
ChatGPT's ECG interpretations: Sensitivity or specificity? Which matters more in the emergency department
(W.B. Saunders, 2025) Sert, Ekrem Taha; Akay, Muhammed
We read with great interest the article by Zaboli et al. [1], titled “Exploring ChatGPT's potential in ECG interpretation and outcome prediction in the emergency department.” This study provides valuable insights into a critical issue in emergency medicine, where both high patient volumes and the potential consequences of misdiagnoses demand precise and efficient decision-making. By exploring the potential role of ChatGPT, the study contributes significantly to the ongoing dialogue on leveraging artificial intelligence (AI) to enhance diagnostic accuracy and streamline workflows in emergency settings.
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.
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.
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.
Etiological characteristics and management of patients with epistaxis in Aksaray
(Annals of Medical Research (Ann Med Res), 2020) Çayır, Serkan; Mutlu, Hüseyin; Sert, Ekrem Taha
Aim: Epistaxis is a common condition in humans, particularly in patients with hypertension, and is one of the most common presenting symptoms in ear, nose, and throat emergency consultation. The present study aimed to examine the treatment and hospitalization characteristics of the patients who presented with epistaxis in Aksaray city and to propose an optimized and updated protocol. Material and Methods: The present study retrospectively evaluated 758 patients who presented with epistaxis to the Training and Research Hospital in Aksaray between January 2016 and February 2020. The patients were analyzed in terms of age, sex, seasonal characteristics, hospitalization rates, pathogenesis of epistaxis, sites of bleeding, and treatments. Results: The study included 349 females (46.1%) and 409 males (53.9%); mean patient age was 60.9 ± 9.3 years (range: 3–89 years). The most common comorbidity was hypertension (47.3%), and the most common site of bleeding was the anterior region including the Kiesselbach’s plexus (88.2%). Nasal packing (58.5%) and electrocauterization (29.9%) were performed in most cases. The treatment success was defined as no instance of re-visit by the patients to the hospital due to nasal bleeding within 24 h after the procedure; the treatment was successful in 698 patients (92.1%). Conclusion: Most cases of epistaxis are successfully treated using endoscopic electrocauterization on an outpatient basis. Hospitalization is indicated if surgical intervention, posterior packing, or embolization is required and if deterioration of general condition is observed. The present study proposes an updated protocol optimized for the management of epistaxis.
Impact of chronic medical conditions on mortality in geriatric trauma, 10-year analysis of a single centre in Turkey
(Taylor & Francis, 2022) Çağlar, Ahmet; Sert, Ekrem Taha; Mutlu, Hüseyin
Background The healthy and active lifestyle adopted by the elderly as a result of improvements in the standards of living may lead to an increase in the risk of injury. Comorbidities increase the risk of posttraumatic complications and mortality. The aim of this study was to investigate the impact of chronic medical conditions (CMCs) on the risk of mortality in geriatric trauma patients. Methods All geriatric trauma patients admitted to emergency department over a 10-year period were retrospectively analysed. Patients were stratified by baseline characteristics, injury severity score (ISS), presence of CMCs, and in-hospital mortality. Multivariate logistic regression was used to determine variables significantly associated with in-hospital mortality. Results 9455 patients included in the study. The median age was 74 (10) years and 57% of them were female. The presence of >= 1 CMC and >= 2 CMCs increased the risk of mortality 5.64 and 2.38 times respectively in mild traumas and 2.67 and 2.59 times respectively in moderate traumas. Age, ISS and penetrating traumas had a significant impact on the risk of mortality in all ISS groups. In severe traumas, only renal disease had an impact on the risk of mortality (OR = 2.58, 95%CI = 1.03-6.43, p = 0.042). All other CMCs, >= 1 CMC, and >= 2 CMCs had no impact on the risk of mortality. Conclusion The presence of CMCs in elderly patients with mild and moderate injuries increases the risk of mortality. Such patients should be diagnosed and treated more quickly and aggressively during the prehospital process and in the hospital.
Lipocalin-type prostaglandin D synthase levels are associated with the severity of pulmonary embolism
(Springer, 2020) Mutlu, Hüseyin; Kokulu, Kamil; Sert, Ekrem Taha; Çağlar, Ahmet
Pulmonary thromboembolism (PTE) is an acute emergency with high mortality and morbidity rates. This study aimed to investigate the importance of Lipocalin-type prostaglandin D synthase (L-PGDS) in predicting mortality and prognosis in PTE. The study prospectively included 90 patients who were admitted to the emergency department and in whom PTE was confirmed by computed tomographic pulmonary angiography as well as 40 healthy volunteers with no disease. L-PGDS levels in the venous blood were measured and compared. Pulmonary embolism severity index (PESI) prognosis scores of all patients and 1-month mortality rate were calculated. There was a statistically significant difference between the L-PGDS levels of the patient and control groups (P?=?0.024), and 1-month mortality of patients diagnosed with PTE was 20% (n?=?18). Furthermore, the patients were divided into two groups: patients deceased within 1 month following the diagnosis and survivors. L-PGDS levels of the deceased patients were significantly higher than those of the survivors (P?
Performance of the PATHOS score in predicting in-hospital mortality in patients aged 65 years and older admitted to the intensive care unit from the emergency department
(2025) Sert, Ekrem Taha; Kokulu, Kamil
Purpose: The aim of this study was to investigate the performance of the platelets, age, troponin, heart rate, oxygenation, and systolic blood pressure (PATHOS) score in predicting in-hospital mortality among patients aged 65 years and older admitted to the intensive care unit (ICU) from the emergency department (ED). Materials and Methods: This single-center, retrospective observational study included patients aged 65 years and older who presented to the ED and were admitted to the ICU between 2018 and 2024. The PATHOS score was calculated using routine vital signs and blood parameters obtained at ED admission. The patients were divided into two groups: survivors and non-survivors. The predictive power of the PATHOS score for in-hospital mortality was evaluated by comparing these groups. Results: The study included a total of 1,131 patients. The number of survivors was 889 (78.6%), while that of non-survivors was 242 (21.4%). Multivariate logistic regression analysis revealed that the PATHOS score (odds ratio [OR]: 3.80, 95% confidence interval [CI]: 3.07–4.70, p<0.001) independently predicted in-hospital mortality. According to the receiver operating characteristic analysis, the area under the curve of the PATHOS score was 0.827 (0.804–0.849). A PATHOS score greater than 2 predicted in-hospital mortality with a specificity of 75.9% and a sensitivity of 77.6%. Conclusion: The PATHOS score may serve as a valuable tool for predicting in-hospital mortality in geriatric patients admitted to the ICU from the ED. By effectively identifying critically ill elderly patients, this score may facilitate timely ICU transfers and contribute to the more efficient use of limited resources.

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