The effect of multiple triage points on the outcomes (time and accuracy) of hospital triage during mass casualty incidents.

INTRODUCTION: During mass casualty incidents (MCIs), the accuracy and timing of the triage of patients by the emergency department (ED) triage officers are essential. The primary triage is performed at the event's location by paramedics and intends a quick evaluation of the victims. Secondary triage may be used when the transfer of the victim is delayed. In this study, we aimed to investigate the effectiveness of two-point triage in a simulated environment of an MCI in the hospital setting. MATERIALS AND METHODS: In this case-control study, we used an online test module to assess single triage points (Group 1, n = 41) and two triage points (Group 2, n = 40). 60 vignettes for Group 1 and 55 vignettes (5 deceased cases removed) for Group 2 were used. The assessment utilized clinical MCI scenarios in a scheduled online meeting by using the Simple Triage and Rapid Treatment (START) system. Triage time and accuracy of the triage, along with the experience, and previous training of the participants, were assessed. RESULTS: A total of 81 triage officers participated in this study. The participants were divided into two independent groups homogenously according to their profession and experience. Groups were comparable primarily without any statistically significant difference in terms of the profession (p = 0.101), sex (p = 0.923), and MCI experience (p = 0.785). The difference between the two groups was not significant with regard to having received practical or theoretical triage training (p = 0.099). The mean time of a single vignette triage was 19.2 (SD 6.5) seconds and mean percentage of correct triage score was 65.0 (SD 12.6). The participants had a statistically significantly better performance in the single-point triage group regarding the median triage time (p < 0.001) and median percentages of under triage (p = 0.001), but a worse median percentage of over triage (p < 0.001). However, there was no significant difference between the two groups in terms of the percentage of accurate triage. Emergency residents performed better in accuracy and triage time than their non-physician colleagues (p = 0.019). CONCLUSIONS: Two-point triage does not demonstrate better outcomes in terms of accuracy and timing. Triage officers should be trained frequently with the preferred training methodology to prevent improper triage accuracy and timing. Well-defined medical disaster planning should include frequent training of the triage officers with case scenarios.

Evaluation of factors affecting the length of stay of geriatric patients in the emergency department.

OBJECTIVE: The emergency department length of stay (EDLOS) is one of the essential parameters of emergency healthcare management efficacy, and prominent factors that contribute to EDLOS are critical in enhancing emergency department (ED) patient care effectiveness, particularly for older patients, which is rarely investigated. METHODS: This single-center, prospective cohort study was performed in the ED of a tertiary care hospital. The patients were classified into two groups according to EDLOS (≥4 h vs. <4 h). The chief complaints, consultant branches, the patients' comorbidities, polypharmacy status, time of presentation, laboratory, imaging investigations, EDLOS, Clinical Frailty Score (CFS) score, mini mental examination test, National Early Warning Score 2 (NEWS2), consultations, and outcome of the patients were compared with Spearman and Kendall tau-b correlations. RESULTS: During the 30-day study period, a total of 222 geriatric patients were included in the study. The mean age of study patients was 79.13±9.43 years, and 47.05% of patients were male. The Median EDLOS was 250 (range, 60-1440) min. The patients who arrived on the night shift (p=0.047), who had chronic heart failure (p=0.025), chronic obstructive pulmonary disease (p=0.03), severe dementia according to the MMSE (p=0.008), higher CFS frailty scores (p=0.03), and higher clinical acuity according to the NEWS2 score, were found to be positively correlated to an EDLOS of >4 h. (p=0.001) Any specialty consultation and specialty consultation number, along with hospitalization, were also positively correlated to an EDLOS of >4 h. (p=0.001). CONCLUSION: High-acuity patients with frailty and dementia are at increased risk for increased EDLOS via consultations. Emergency and consultation physicians should communicate better about which patients are vulnerable to EDLOS case by case, and the patient outcome must be decided as soon as possible.

Factors in Vaccine Refusal by Patients Applying for COVID-19 PCR Test.

Objective: This study was designed to determine the reasons for vaccine rejection in patients who applied for the coronavirus disease-2019 (COVID-19) polymerase chain reaction (PCR) test but did not receive the vaccine. Methods: The study was conducted prospectively in the emergency department of a tertiary hospital between 31.01.2022 and 31.05.2022. 1000 patients who applied for the COVID-19 PCR test and refused to be vaccinated were included. The COVID-19 status of the participants, reasons for their application, number of PCR tests, methods of obtaining information about the vaccine, and reasons for the rejection of the vaccine were questioned. Results: 54.6% of the participants were male and 45.4% were female. 60.7% of the patients applied for testing due to symptoms, 25.4% due to contact with people with symptoms, and 23.9% due to travel. 43.3% of the cases had COVID-19 infection; 53.6% of them had tested an average of 2-5 times in the last year. Most of the information about the vaccine was taken from social media, television, medical publications, and people around, respectively. Of the participants, 62.0% believed that COVID-19 vaccines had side effects, 47.3% believed that it had no protection, and 30.9% believed that there was not enough study on the subject. As the age grew, the rate of learning information from social media increased. Conclusions: The most common reasons for COVID-19 vaccine rejection were vaccine side effects, doubtful vaccine protection, and concerns about the lack of sufficient studies on the vaccine. The higher the education level, the higher the vaccine rejection rate.

Evaluation of the risk factors for falls in the geriatric population presenting to the emergency department.

BACKGROUND: We evaluated risk factors and frailty assessments to identify fall-prone geriatric patients in the emergency department (ED). METHODS: This prospective study included 264 consecutive patients aged ≥65 years who presented to the ED. The participants were divided into those who had fallen or not. The patient groups were compared in terms of age, sex, presenting complaints (falls vs. others), comorbidities, medications, frailty assessment tools, and orthostatic hypotension (OH). RESULTS: In total, 264 patients were included: 129 (48.8%) patients who had fallen and 135 (51.2%) who hadn't fallen. The mean ages of patients who had fallen and those who had not fallen were 80.48±8.38 and 79.42±7.94 years, respectively. In addition, 62.01% (n=80) and 51.85% (n=70) of patients were females. There were no statistically significant differences between the groups in terms of age or sex (P=0.290 and P=0.096, respectively). In total, 89.92% (n=116) of patients who had fallen had at least one chronic medical condition. There was a significant difference in the proportion of patients with OH between the groups. Frailty scores such as the Edmonton Frail Scale, Frail Non-Disabled Questionnaire, PRISMA-7 questionnaire, Identification of Seniors at Risk test, and Rockwood Clinical Frailty Scale scores were also significantly different between the groups. A higher PRISMA-7 score at admission was found to be an independent predictor of fall risk. CONCLUSION: Falls occur more frequently in the older population and in females. In addition, the frailty assessment scores, except for the FRESH Frailty Scale, were associated with falls in geriatric patients. After elimination of non-significant variables in multivariate analysis, a high PRISMA-7 questionnaire score at admission was identified as an independent predictor of fall risk.

Motives behind low-acuity geriatric emergency medicine attenders: a picture from free healthcare system.

BACKGROUND: Current evidence about the low-acuity ED visits of old patients has been generated in various healthcare systems; however, this is not a well-researched area in middle-income countries by patients' perspectives. METHODS: A study of 231 patients attending the ED of a tertiary public hospital was conducted using a structured questionnaire from June to August 2021. Eligible patients were community-dwelling, aged > 65 years, who presented with lower clinical urgency. The questionnaire tool was developed using questions from available studies on health service utilization. Additional commentary was obtained from the patients regarding on the reasons for attending the ED and was administered on weekdays between 8:00 am and 5:30 pm. RESULTS: The study included 221 patients over 65 years of age, with a mean age of 72.21 ± 4.2. A total of 58.4% of the patients thought that they should be examined urgently, 15.4% had symptoms that had lasted more than one month, and 59% requested emergency imaging. Patients preferred the ED via treatment, imaging, transportation opportunities of emergency department, past negative experiences, and access problems with family medicines or appointment problems with specialist outpatient clinics with expectations of continuity of care. CONCLUSION: Old individuals have unique healthcare needs, and the motives behind this group of patients with low-acuity problems to apply to the ED is complex. As one of the key objectives of healthcare policies is to make sure that patients are assessed at proper time and place, studies that consider patient perspectives might lead to accurate conclusions for this aim.

Effectiveness of Two Different Methods on the Perceived Pain and Satisfaction During Intramuscular Antibiotic Injection: ShotBlocker and Local Vibration.

In this study aimed to examine the effectiveness of ShotBlocker and local vibration on the perceived pain and satisfaction during intramuscular antibiotic injection. The sample of the randomized controlled experimental study consisted of 100 patients (32 in vibration group, 35 in ShotBlocker group, 33 in control group) who applied to the adult emergency clinic for antibiotic (amoxicillin/cefuroxime sodium) injection between April and May 2021. The study data were collected using the Structured Information Form, VAS for Pain and VAS for Satisfaction. CONSORT statement was followed for reporting. After the intramuscular antibiotic injection, a significant difference was found between the groups in terms of the mean scores of VAS for Pain and VAS for Injection Satisfaction (p < .001). It was determined that local vibration application was more effective in reducing the pain and in increasing satisfaction that occurs during intramuscular antibiotic injection according to ShotBlocker and control groups.

The characteristics of the patients in mass public shootings among coup attempt in Turkey: A single-center hospital response.

BACKGROUND: Turkey is an experienced country for both military and civilian mass casualties that arise from explosions and shootings by various terrorist groups. In this study, we aimed to investigate the characteristics of patient flow admitted to our hospital caused by primarily gunshot wounds during the coup attempts on the 15th of July. METHODS: This descriptive, retrospective study included a total of 50 patients who were injured during a coup attempt on the date of July 15, 2016, and admitted to our emergency department (ED). Demographic characteristics, anatomical injury sites, postoperative clinical outcomes, and hospitalization settings were recorded. The Glasgow Coma Scale (GCS), Trauma and Injury Severity Score (TRISS), Abbreviated Injury Scale (AIS), Revised Trauma Score (RTS) and Injury Severity Score (ISS) were used to measure the severity of injuries. RESULTS: A total of 63 medical personnel voluntarily reached the ED within two hours. Extremity injuries were the most common injuries. The mean RTS, GCS, and TRISS scores did not differ significantly between the patients discharged from the ED and the patients who were hospitalized (p>0.05). However, there was a statistically significant difference in the ISS scores (p<0.001, independent t-test). There was no statistically significant difference in the GCS and RTS scores between the discharged and hospitalized patients, although the ISS scores were higher in hospitalized patients (p>0.05 and p<0.001, respectively). A total of 33 patients (66%) were admitted to the hospital for follow-up and/or surgical intervention. Five (10%) of the patients were hospitalized for more than 14 days. CONCLUSION: The management of each disaster is unique. Armed conflicts result in gunshot wounds, and preparations must be focused on surge capacity and a prolonged hospital stay of the patients. In our study, the length of stay in the hospital decreased after the arrival of volunteer staff to the ED, but we should note that the ISS increased. Hospital disaster plans should be reorganized not only for ED but also for the whole hospital.

Importance of red blood cell distribution width (RDW) in patients with upper gastrointestinal haemorrhage.

OBJECTIVE: To explore the effect of red blood cell distribution width levels on the diagnosis and management of upper gastrointestinal haemorrhage. METHODS: The retrospective study was conducted at Ankara Numune Education and Research Hospital, Turkey, and comprised record of patients diagnosed with upper gastrointestinal haemorrhage from January 1, 2013, to December 31, 2013. Factors analysed were age, gender, red blood cell distribution width level, admission haemoglobin and haematocrit levels, endoscopy findings classified according to the Forrest system, comorbid diseases, use of medications, unhealthy habits like alcohol usage and smoking, and mortality rate. RESULTS: Of the 147 patients, 93(64%) were men. The overall median age of the sample was 60 years. Besides, 117(79.6%) patients had comorbid diseases, of which hypertension 56(38.4%) was the most common. A total of 24(16.8%) patients were using antiplatelet or anticoagulant drugs, while 30(20.5%) were on non-steroidal anti-inflammatory drugs. Peptic ulcer in 128(87.1%) patients was the most common cause of haemorrhage. The median red blood cell distribution width level of the study population was 15.25% which was significantly higher compared to the reference values (p<0.05).. In contrast, haemoglobin 9.55% (3.7) and haematocrit 28.75% (10.8)were significantly lower (p<0.05). Mortality rates were significantly higher in patients with higher red blood cell distribution width values (p<0.05). CONCLUSIONS: Red blood cell distribution width levels were higher during the acute phase of upper gastrointestinal haemorrhage.