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.

Retrograde Screw Fixation Results of Coronoid Fractures in Terrible Triad.

In this study, we aimed to evaluate the results of coronoid fracture fixation, in terrible triad of elbow injury with retrograde screws. Patients between 2008 and 2012 were reviewed. Six were men and 2 were women. Mean age was 44.5(21-62). Mean follow-up period was 25.25 months (8-50). According to Regan and Morrey classification, 6 of the fractures were Type 3 and 2 were Type 2. All cases were operated with single lateral incision. For coronoid fracture, reduction was maintained from anterior aspect and fixed with posterior percutaneous screws which were single 4.5 mm screw in 3 patients and double 3.5 mm screws in 5 patients. Mini and micro cannulated screws for 4 patients and anatomic radial head plates for 4 patients were used for radial head fractures. All lateral ligament complex repairs were performed with bone tunnel technique. The results of the treatment were evaluated with Mayo elbow performance scoring system. All the fractures were united and mean union time was 4 months (3-6). Mean active elbow flexion – extension range of motion at last visit was 108.2º (70º-130º). Mean Mayo elbow performance score of the patients was 87.5 (70-100). With retrograde screw fixation of coronoid fractures in terrible triad, we achieved a stable fixation.