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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.
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    Emergency Department Neurosurgical Consultations in a Tertiary Care Hospital
    (Duzce Univ, Fac Medicine, 2023) Senguldur, Erdinc; Selki, Kudret; Tuncer, Cengiz; Demir, Mehmet Cihat
    Objective: To reveal the characteristics of patients in need of neurosurgery by examining neurosurgery consultations within the emergency department (ED) admissions of a tertiary academic hospital.Methods: This is a retrospective, single-centre observational study. Patients admitted to the ED between 01.01.2022 -31.12.2022 and consulted to the neurosurgery department were identified through the hospital computer system and included in the study. The demographic information of the patients, mode of admission to the ED, the reasons for admission, the time of admission, the number of brain computed tomography (CT) scans, whether they underwent surgery or not, and the mortality results were recorded.Results: A total of 441 neurosurgery consultations were examined. Fall 35.6% (n=157) and traffic accident 16.6% (n=73) were the most common reasons for consultation. It was observed that 92.5% (n=408) of the patients had a brain CT scan, and 19.5% (n=86) had two or more brain CTs. It was determined that 12.7% (n=56) of the patients consulted to neurosurgery were operated on, and 4.1% (n=18) of the patients' hospital admissions resulted in death. Only 53.7% (n=237) of the patients who underwent neurosurgery consultation were discharged from the ED. It was determined that significantly more Neurosurgery consultations were requested during working hours (p = 0.013).Conclusions: Most consultation calls from the ED to neurosurgery are for trauma patients. Brain CT examination is frequently used in neurosurgical patient evaluation. As a result of the consultations, almost half of the patients are hospitalized. Emergency physicians can select patients who need neurosurgery well.
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    Impact of inter-visit duration on mortality in older adults who use emergency department frequently
    (Mre Press, 2024) Demir, Mehmet C.; Selki, Kudret; Senguldur, Erdinc
    The incidence of older adults presenting to the emergency department (ED) is increasing, and assessing their potential mortality risk for those returning frequently to the ED remains important. This study aims to evaluate the effects of frequent ED visits and the interval between these visits on the mortality of older adults.We retrospectively assessed the data of patients aged 65 years and above who frequently visited an academic ED in Turkey in 2021 and divided them into two groups: ED-frequent users (FUs) (4-7 visits) and ED-highly frequent users (HFUs) (>7 > 7 visits), following which we compared their characteristics, inter-visit duration, and 6-month mortality. The results indicated that out of the 2947 ED visits, 516 older adults were identified who visited the ED at least four times, averaging 5.7 visits per patient. HFUs constituted approximately 12% (n = 61)of the cohort. Further analysis revealed a significant increase in mortality associated with shorter inter-visit duration between ED visits (p p < 0.001). Specifically, visiting the ED at intervals shorter than 74 days was associated with a fourfold increase in mortality risk (odds ratio (OR): 3.84; 95% confidence interval (CI): 2.64-5.57; p < 0.001), which escalated to sixfold in patients with a history of recent hospitalization (OR: 5.87; 95% CI: 3.81-9.07; p < 0.001).The data indicated that most older adults with frequent ED visits had multiple comorbidities, and those who did not survive were significantly older. This study highlights the important need to acknowledge the increased mortality risk among older adults with frequent ED visits, with recent hospitalization and short inter- visit duration being contributing factors.
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    Is Lactate Clearance Useful in Predicting Cardiopulmonary Resuscitation Outcome and 48-Hour Mortality?
    (Coll Physicians & Surgeons Pakistan, 2025) Senguldur, Erdinc; Demir, Mehmet Cihat; Selki, Kudret
    Objective: To investigate the predictive value of lactate clearance (AL) in witnessed cardiac arrest patients in the emergency department (ED) at two time points: Cardiopulmonary resuscitation (CPR) outcome and 48-hour mortality. Study Design: Observational study. Place and Duration of the Study: Department of Emergency Medicine, Duzce University, Duzce, Turkiye, from July 1 to December 31, 2023. Methodology: Patients aged 18 years and older presenting with cardiac arrest in the ED, whose relatives signed the informed consent form, were included. Out-of-hospital cardiac arrest, trauma-related cardiac arrest, major bleeding, and known malignancy were excluded from the study. All patients who met the criteria were included. All data were recorded prospectively. Receiver operating characteristic (ROC) analysis and risk analysis were performed for lactate clearance (AL) and 20-minut Results: The predictive power of AL at 10 minutes (AL0-10), 20 minutes (AL0-20), and between 10 and 20 minutes (AL10-20) was found to be significantly high for both the likelihood of no-ROSC (return of spontaneous circulation) and 48-hour mortality across all patients. The AUC values for AL at first 10 minutes, 20 minutes, and within 10-20 minutes were 0.991, 0.997, and 0.944, respectively for the no-ROSC group, and 0.942, 0.947, and 0.882, respectively for 48-hour mortality in the ROSC group. ROSC was not achieved in any patient with AL0-20 value of <=-0.15. AL below the calculated thresholds increased the risk of not achieving ROSC and 48-hour mortality by tenfold. Conclusion: AL during CPR is a useful tool to predict the outcome of CPR and 48-hour mortality. The AL0-20 value was evaluated as a valuable parameter that can be used after the 20th minute of CPR when deciding whether to continue or terminate CPR.
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    Prevalence and clinical significance of hypouricemia in the emergency department
    (Lippincott Williams & Wilkins, 2024) Senguldur, Erdinc; Demir, Mehmet Cihat; Selki, Kudret
    Hypouricemia prevalence has been reported in different clinical settings, but its prevalence and characteristics in the emergency department (ED) are limitedly studied. This study aimed to assess hypouricemia prevalence and clinical significance in the ED of a Turkish tertiary-care hospital. It was a retrospective, single-center observational study. Patients aged 18 years and older who presented to the ED between June 1, 2022 and June 1, 2023 were included. Data including age, gender, comorbid disease, final diagnosis, serum electrolytes, albumin, and serum uric acid (SUA) levels were obtained. SUA <2 mg/dL was considered as hypouricemia. The study included 35,923 patients, 362 of whom had SUA <2 mg/dL. The prevalence of hypouricemia was 1.008% and was higher in women (1.4% vs 0.4%, P < .001). Hypouricemic patients were younger than non-hypouricemic ones (34.5 [26-57] vs 50 [31-68], P < .001). Hypouricemic patients had a higher 6-month mortality rate than non-hypouricemic patients (5.2% vs 2.8%, P = .006). Among hypouricemic patients, men had a higher mortality rate than women (12.9% vs 3.4%, P = .004). A total of 33.7% of hypouricemic patients were pregnant, and the most common final diagnosis in the ED was abortus imminens, with 17.7%. The prevalence of hypouricemia in ED patients differs between genders. Hypouricemia increases 6-month mortality, more so in men. Obstetric pathologies are the most common final diagnosis of ED in hypouricemic patients. SUA can be monitored as a useful biomarker to ensure a healthy pregnancy and has a warning role in predicting mortality risk. Further studies are needed on hypouricemia.