Perfusion index: Could this be a new triage tool for upper gastrointestinal system bleeding in the emergency department? A prospective cohort study

ABSTRACT BACKGROUND: Many scoring systems for predicting mortality, rebleeding and transfusion needs among patients with upper gastrointestinal bleeding (UGIB) have been developed. However, no scoring system can predict all these outcomes. OBJECTIVE: To show whether the perfusion index (PI), compared with the Rockall score (RS), helps predict transfusion needs and prognoses among patients presenting with UGIB in emergency departments. In this way, critical patients with transfusion needs can be identified at an early stage. DESIGN AND SETTING: Prospective cohort study in an emergency department in Turkey, conducted between June 2018 and June 2019. METHODS: Patients' demographic parameters, PI, RS, transfusion needs and prognosis were recorded. RESULTS: A total of 219 patients were included. Blood transfusion was performed in 174 patients (79.4%). The PI cutoff value for prediction of the need for blood transfusion was 1.17, and the RS cutoff value was 5. The area under the curve (AUC) value for PI (AUC: 0.772; 95% confidence interval, CI: 0.705-0.838; P < 0.001) was higher than for RS (AUC: 0.648; 95% CI: 0.554-0.741; P = 0.002). 185 patients (84.5%) were discharged, and 34 patients (15.5%) died. The PI cutoff value for predicting mortality was 1.1, and the RS cutoff value was 7. The AUC value for PI (AUC: 0.743; 95% CI: 0.649-0.837; P < 0.001) was higher than for RS (AUC: 0.725; 95% CI: 0.639-0.811; P < 0.001). CONCLUSION: PI values for patients admitted to emergency departments with UGIB on admission can help predict their need for transfusion and mortality risk.

Analysis of Violence in a Crowded Emergency Room.

Aims: There is abundant evidence to suggest that health care staff are increasingly being exposed to violent incidents at their workplace. The purpose of our study was to identify the role of crowding in producing violence that occurs in emergency department as well as to outline the factors that affect the types of violence. Study Design: In this prospective study we collected incidents of violence against emergency staff by patients or their relatives. A survey with 20 questions about the event was completed by emergency staff just after the event. Also information about crowding at that time was recorded as well as the area of the event. Statistical analysis was done with SPSS 16.0. Place and Duration of Study: Department of Emergency Medicine, Marmara University Pendik Training and Research Hospital, Between April 1 and June 1, 2012. Methodology: A total of 116 acts of violence were reported during the 61 days of this study. 79 of 116 cases (68.1%) were verbal, 16 (13.8%) physical, and 21 (18.1%) were both verbal and physical. The information about each event was entered into a database and pooled for analysis. Results: The most common victims of violence were physicians (38.8%) and security personnel (31.0%). The presence of security personnel in the environment increases the risk of physical violence (P=.017). The average total number of patients waiting for examination or results of examinations was 24.9 ± 1.4 (95% CI, 22.3 – 27.5). It was observed that the violence increased when the number of people was close to this number and reduced when the crowding increased above this average. Conclusions: The existence of security personnel alone is not sufficient to prevent violence; new steps should be taken to prevent the entrance of the patients’ relatives to inside of the treatment areas of emergency departments.