Impact of COVID-19 Lockdown on Traumatic Bone Fracture Patterns and Hospital Outcomes in 1646 Elderly Patients: A Retrospective Study in Turkey.

BACKGROUND During the Coronavirus Disease-2019 (COVID-19) pandemic-related lockdowns, modifications in trauma-related behavior and other factors in the elderly population may have occurred. The present retrospective study aimed to compare outcomes from emergency admissions to a major trauma center in Turkey of 1646 elderly patients with traumatic bone fractures that occurred before, during, and after the COVID-19 pandemic lockdown period. MATERIAL AND METHODS A cohort of 1646 elderly trauma patients admitted between September 15, 2019 and September 15, 2020 were retrospectively scanned from the hospital registry system and were grouped as admitted during the COVID-19 pandemic before (Group 1), during (Group 2), or after (Group 3) the lockdown restrictions. Demographic and clinical data were examined by making comparisons between the 3 groups. RESULTS In all groups, female sex was more prevalent. Fractures were more common in the ulna and femur than in other bones (P=0.026, P=0.035). Among the groups, in Group 2, injuries due to the mechanism of falling from one's own height on the ground were more prominent (79.2%). Hospital costs were lower in Group 1 (P<0.001). The majority of hospitalized patients (n=874; 53.1%) were in Group 2 (P=0.009). CONCLUSIONS During pandemic lockdowns, the mechanism of falling from one's own height was more common in the elderly population. The ulna and femur were the predominant bones fractured. Therefore, during lockdown periods, precautions should be taken to prevent the elderly from falling from their own height.

Evaluation of descriptive performances of platelet indices, neutrophil/lymphocyte ratio, and platelet/lymphocyte ratio in aortic dissections.

OBJECTIVE: Mechanical damage resulting from aortic dissection creates a thrombus in the false lumen, in which platelets are involved. Platelet index is useful for the function and activation of platelets. The aim of this study was to show the clinical relevance of the platelet index of aortic dissection. METHODS: A total of 88 patients diagnosed with aortic dissection were included in this retrospective study. Demographic data and hemogram and biochemistry results of the patients were determined. Patients were divided into two groups: deceased and surviving patients. The data obtained were compared with 30-day mortality. The primary outcome was the relationship of platelet index with mortality. RESULTS: A total of 88 patients, 22 of whom were female (25.0%), diagnosed with aortic dissection, were included in the study. It was determined that 27 (30.7%) of the patients were mortal. The mean age of the entire patient group was 58±13 years. According to the DeBakey classification of aortic dissection of the patients, the percentages of the 1-2-3 type were determined as 61.4, 8.0, and 30.7%, respectively. Platelet index was not found to be directly related to mortality. Increase in age, decrease in bicarbonate value, and presence of diabetes mellitus were associated with mortality. CONCLUSION: Although there were no significant changes in platelet index in aortic dissection, neutrophil/lymphocyte ratio and platelet/lymphocyte ratio were found to be high in line with the literature. In particular, the presence of advanced age diabetes mellitus and decrease in bicarbonate are associated with mortality.

Manual versus mechanical chest compression in in-hospital cardiac arrest: A retrospective cohort in emergency department patients.

OBJECTIVE: Mechanical chest compression (CC) devices are frequently used in in-hospital and out-of-hospital settings. In this study, mechanical and manual CC in in-hospital cardiac arrest was compared in terms of survival. METHODS: Adult patients who were admitted to the emergency department (ED) for 2 years period and had cardiac arrest in the ED were included in this retrospective, observational study. Return of spontaneous circulation (ROSC), 7-day and 30-day survival and hospital discharge data were compared between the two groups of patients who underwent manual CC and those who had mechanical CC with the Lund University Cardiac Assist System-2 device. RESULTS: Although the rate of ROSC in the mechanical CC group was lower than in the manual CC group, this difference was not statistically significant (41.7% vs. 50.4%; P = 0.133). The 7-day survival rate was found to be statistically significantly higher in the mechanical CC group (19.4% vs. 8.9%; P = 0.012). The 30-day survival rate was also found to be high in the mechanical CC group, but this difference was not statistically significant (10.6% vs. 7.3%; P = 0.339). CONCLUSION: In the light of these results, we can say that the use of piston-based mechanical CC devices in ED may be beneficial. More reliable results can be obtained with a prospective study to be performed in the ED.

Evaluation of residents' thoughts about giving the news of death.

OBJECTIVE: To assess behaviours and attitudes of residents toward giving news of death in emergency department and other departments. METHODS: The study was conducted between 1st and 7th December, 2012, in an urban hospital in Ankara, Turkey. It used a questionnarie that was filled by 100 residents from different disciplines of medicine. Categorical variables were analysed with Chi-square and Fisher's exact tests and continuous variables were analysed with Mann Whitney test. The level of statistical significance was set at 0.05. RESULTS: The most difficult cases to notify were those of unexpected and sudden deaths (n = 51; 51%) followed by deaths of children (n = 36; 36%). While 60% (n = 60) of the study group reported a need for training in this area, but there was no association between having difficulty in notifying a death and expressing the need for training (p = 0.187). Residents who had difficulty in notifying death informed the patient's close ones more often during resuscitation (p = 0.049) and requested for security staff more often during the final briefing compared with the group that did not express having difficulty (p < 0.001). CONCLUSION: Notifying death is still a challenging issue in medicine. Instead of educational efforts, security measures may be more beneficial and comforting for residents who have difficulty in conveying the news.

The accuracy of mainstream end-tidal carbon dioxide levels to predict the severity of chronic obstructive pulmonary disease exacerbations presented to the ED.

INTRODUCTION: The end-tidal carbon dioxide (ETCO2) measurement was considered as an essential tool for the assessment of several conditions in emergency medicine. However, the diagnostic role of capnography in dyspneic patients still remains unclear. We aimed to analyze the alteration of the ETCO2 levels in chronic obstructive pulmonary disease (COPD) exacerbations and its role in the decision-making process. METHODS: All the individuals who were presented to the emergency department (ED) after COPD exacerbations were prospectively enrolled in the study. The patients were excluded if they refused to give informed consent, intubated after initial assessment, and had uncertain COPD diagnosis. The ETCO2 measurement using a mainstream capnometer was undertaken in the pretreatment and post-treatment period of COPD exacerbations. RESULTS: A total of 102 patients were enrolled in the study. Pre-ETCO2 and post-ETCO2 levels were positively correlated with arterial partial carbon dioxide pressure levels (r=0.756, P<.001 and r=0.629, P<.001, respectively). The median pre-ETCO2 level was 32.0 (30.5-40.5) in discharged patients and 39.0 (31.0-53.5) in admitted patients. After the initial therapy in the ED was completed, the median post-ETCO2 level was found to be 32.0 (28.0-37.5) in discharged patients and 36.0 (32.0-52.0) in admitted patients. Although a statistically significant difference was observed in the pretreatment period (P=.043), no difference was observed in post-treatment period between ETCO2 levels (P=.107). CONCLUSION: End-tidal carbon dioxide levels were higher in admitted patients when compared with discharged patients on arrival to the ED. ETCO2 measurement has very little contributions while evaluating patients with COPD exacerbation in the ED.