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    Can end-tidal CO2 measurement replace arterial partial CO2 in emergency department respiratory distress management?
    (Elsevier Espana Slu, 2024) Selki, Kudret; Demir, Mehmet Cihat; Senguldur, Erdinc; Erdem, Emre; Guldal, Hatice; Tasdemir, Murat; Kiciroglu, Alp Kaan Furkan
    Objective: To assess the feasibility of using end-tidal carbon dioxide (EtCO2) as a non-invasive substitute for partial pressure of arterial carbon dioxide (PaCO2) in emergency department (ED) triage and follow-up, and to explore the potential of partial pressure of venous carbon dioxide (PvCO(2)) as an alternative to PaCO2. Design: Prospective cross-sectional study. Setting: Tertiary university hospital. Patients or participants: 97 patients presenting with acute respiratory distress to the ED. Interventions: EtCO2, arterial blood gases, and venous blood gases measured at admission (0 min), 60 min, and 120 min. Main variables of interest: CO2 levels. Results: Among 97 patients (mean age: 70.93 +/- 9.6 years; 60.8% male), EtCO2 > 45 mmHg at admission showed strong positive correlations with PaCO2 and PvCO(2) (r = 0.844, r = 0.803; p < 0.001, respectively). Significant positive correlation was observed between 60-min EtCO2 and PaCO2 (r = 0.729; p < 0.001). Strong correlation between PaCO2 and PvCO(2) at 120 min when EtCO2 > 45 mmHg (r = 0.870; p < 0.001). EtCO2 was higher in hospitalized patients compared to discharged ones. Conclusions: EtCO2 appears promising as a substitute for PaCO2 in ED patients with acute respiratory distress within the initial two hours of treatment. Venous blood gas sampling offers a less invasive alternative to arterial sampling, facilitating simultaneous blood tests. (c) 2024 Elsevier Espana, S.L.U. and SEMICYUC. All rights are reserved, including those for text and data mining, AI training, and similar technologies.
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    Characteristics of patients leaving the emergency department without being seen by a doctor: The first report from Türkiye
    (Lippincott Williams & Wilkins, 2024) Senguldur, Erdinc; Demir, Mehmet Cihat; Selki, Kudret; Erdem, Emre; Guldal, Hatice
    The presence of patients who leave without being seen (LWBS) by a physician in the emergency department (ED) is an essential indicator of the accessibility and quality of healthcare delivery. A high LWBS rate implies low patient satisfaction. This study aims to analyze the prevalence and characteristics of LWBS patients in T & uuml;rkiye and their ED readmission rate within 3 days. This retrospective, single-center, observational study was conducted in the ED of a Turkish tertiary university hospital. It looked at patients who left without being evaluated by a physician admitted to the ED between June 01, 2021, and June 01, 2023. Data on age, gender, residential area, health insurance status, ED readmission within 3 days, complaints, and hospitalization were obtained through the hospital's electronic record system. The prevalence of LWBS patients was 0.43%. Only 0.6% (n = 5) of LWBS patients had no health insurance. About 12.8% (n = 99) of them were 65 years and older. About 10.2% (n = 79) of LWBS patients were readmitted to the ED within 72 hours. The most common reason for readmission was musculoskeletal system complaints. Statistically, ED readmission was significantly more common in older adults (P = .05). Older LWBS patients are more likely hospitalized upon return visits to the ED (P = .014). LWBS patients are both a result and a consequence of ED crowding. A zero LWBS rate is crucial for older adults' health as they may fall victim to an invisible accident while avoiding ED traffic. Prioritizing older adults and reorganizing waiting areas can reduce ED crowding and cost burden due to delayed treatments.
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    Diagnostic value of tearing pain alone in aortic dissection
    (Mre Press, 2024) Senguldur, Erdinc; Selki, Kudret; Demir, Mehmet C.; Guldal, Hatice
    Severe and sudden chest or back pain that feels like tearing is the most common symptom of aortic dissection. This study aimed to investigate if chest or abdominal pain alone is a marker of aortic dissection and to determine its patient characteristics. This was a retrospective, single-center observational study. It was conducted in the emergency department (ED) of a tertiary university hospital in Turkey. During three years, patients admitted to the ED and underwent contrast-enhanced thoracic and abdominal computed tomography angiography (CTA) were detected through the hospital computer system. Patients with tearing chest or abdominal pain at admission were identified. Patients with and without aortic dissection were compared based on gender, triage code, comorbidity, aortic aneurysm, and one-month mortality. 76.3% (n = 730) out of 957 CTAs were performed due to complaints of tearing chest or abdominal pain. Aortic dissection was detected in 4.5% (n = 33) of patients with tearing pain. Pre-existing aortic aneurysm was statistically significantly higher in the dissection group (p <0.001). When the chest or abdominal pain and CTA findings regarding the presence of aortic dissection were compared, the sensitivity of tearing pain was 84.62%, and the specificity was 24.07%. The positive predictive value of tearing pain was 4.52%, and the negative predictive value was 97.36%. In conclusion, the negative predictive value of tearing pain for aortic dissection was approximately 97%. This severe pain raises the possibility of aortic dissection. However, aortic dissection is only detected in a small percentage of cases in CTAs performed immediately to confirm the diagnosis.