The Effect of Out-of-Hours Admission on Mortality in Patients Who Underwent Thrombectomy Due to Ischemic Stroke.

Background: It is important to investigate the factors that may delay the diagnosis and treatment process of ischemic stroke. The aim of this study was to investigate whether in-hospital mortality increased in patients who presented to the emergency department out-of-hours and underwent thrombectomy. Methods: A total of 59 patients who applied to the emergency department between January 1, 2018 and November 1, 2021 and underwent thrombectomy due to ischemic stroke were included in the study. Patient age, gender, thrombectomy success (successful recanalization), in-hospital mortality status, intracranial hemorrhage status after thrombectomy, and out-of-hours admission status were recorded and compared according to out-of-hours admission status. Results: Twenty-seven (45.8%) patients were male, and the median age was 74 (61-81) years. Forty-two (71.2%) patients applied to the emergency department out-of-hours. In-hospital mortality occurred in 27 (45.8%) patients. There was no statistically significant difference in out-of-hours admission status between the non-survivor group and the survivor group (non-survivor: 24 [75%]; survivor: 18 [66.7%], p = 0.481). Nor was a statistically significant difference found in the intracranial hemorrhage complication rate of the patients admitted out-of-hours compared to the patients admitted during working hours (out-of-hours: 17 [40.5%]; during working hours: 6 [35.3%], p = 0.712). Conclusion: No statistically significant difference was found in the rate of in-hospital mortality and intracranial bleeding complications in patients who underwent thrombectomy out of working hours compared to during working hours.

An Evaluation of the National Early Warning Score 2 and the Laboratory Data Decision Tree Early Warning Score in Predicting Mortality in Geriatric Patients.

BACKGROUND: Due to the high rate of geriatric patient visits, scoring systems are needed to predict increasing mortality rates. OBJECTIVE: In this study, we aimed to investigate the in-hospital mortality prediction power of the National Early Warning Score 2 (NEWS2) and the Laboratory Data Decision Tree Early Warning Score (LDT-EWS), which consists of frequently performed laboratory parameters. METHODS: We retrospectively analyzed 651 geriatric patients who visited the emergency department (ED), were not discharged on the same day from ED, and were hospitalized. The patients were categorized according to their in-hospital mortality status. The NEWS2 and LDT-EWS values of these patients were calculated and compared on the basis of deceased and living patients. RESULTS: Median (interquartile range [IQR]) NEWS2 and LDT-EWS values of the 127 patients who died were found to be statistically significantly higher than those of the patients who survived (NEWS2: 5 [3-8] vs. 3 [1-5]; p < 0.001; LDT-EWS: 8 [7-10] vs. 6 [5-8]; p < 0.001). In the receiver operating characteristic curve analysis, the NEWS2, LDT-EWS, and NEWS2+LDT-EWS-formed by the sum of the two scoring systems-resulted in 0.717, 0.705, and 0.775 area under curve values, respectively. CONCLUSIONS: The NEWS2 and LDT-EWS were found to be valuable for predicting in-hospital mortality in geriatric patients. The power of the NEWS2 to predict in-hospital mortality increased when used with the LDT-EWS.

The Role of Procalcitonin/Albumin Ratio and CRP/Albumin Ratio in Predicting In-hospital Mortality in COVID-19 Patients.

Background: Hospitalized coronavirus disease 2019 (COVID-19) patients have higher mortality rates. Parameters to predict mortality are needed. Therefore, we investigated the power of procalcitonin/albumin ratio (PAR) and C-reactive protein/albumin ratio (CAR) to predict in-hospital mortality in hospitalized COVID-19 patients. Methods: In this study, 855 patients were included. Patients' PAR and CAR values were recorded from the hospital information management system. The patients were evaluated in two groups according to their in-hospital mortality status. Results: In-hospital mortality was observed in 163 patients (19.1%). The median PAR and CAR values of patients in the non-survivor group were statistically significantly higher than those of patients in the survivor group, PAR (median: 0.07, interquartile range [IQR]: 0.03-0.33 vs. median: 0.02, IQR: 0.01-0.04, respectively; p < 0.001); CAR (median: 27.60, IQR: 12.49-44.91 vs. median: 7.47, IQR: 2.66-18.93, respectively; p < 0.001). The area under the curve (AUC) and odds ratio (OR) values obtained by PAR to predict in-hospital mortality were higher than the values obtained by procalcitonin, CAR, albumin, and CRP (AUCs of PAR, procalcitonin, CAR, albumin, and CRP: 0.804, 0.792, 0.762, 0.755, and 0.748, respectively; OR: PAR > 0.04, procalcitonin > 0.14, CAR > 20.59, albumin < 4.02, and CRP > 63; 8.215, 7.134, 5.842, 6.073, and 5.07, respectively). Patients with concurrent PAR > 0.04 and CAR > 20.59 had an OR of 15.681 compared to patients with concurrent PAR < 0.04 and CAR < 20.59. Conclusions: In this study, PAR was found to be more valuable for predicting in-hospital COVID-19 mortality than all other parameters. In addition, concurrent high levels of PAR and CAR were found to be more valuable than a high level of PAR or CAR alone.

The role of the neutrophil-lymphocyte ratio in the diagnosis of cerebral venous sinus thrombosis.

OBJECTIVES: We aimed to assist in the diagnosis of cerebral venous sinus thrombosis (CVST) with the neutrophil-lymphocyte ratio (NLR). BACKGROUND: Diagnosis of CVST is difficult. METHODS: Patients, who visited the emergency department between March 1, 2013 and March 1, 2021 and underwent magnetic resonance (MR) venography were included. The patients' MR venography results, ages, gender, NLR, were collected. The patients were categorized according to their CVST diagnosis status, and NLR were compared. RESULTS: Of the 530 patients included in the study, 366 (69.1 %) were female, and the median age was 40 (31-58) years. CVST was detected in 57 (10.8 %) patients, no pathological diagnosis was detected in 251 (47.4 %) patients. The median NLR of the patients with CVST was statistically significantly higher than in the patients without CVST and in the patients without any diagnosis ((3.94 [2.5-6.47] vs 3.03 [1.93-5.43], p = 0.023) (3.94 [2.5-6.47] vs 2.92 [1.86-4.95], p = 0.009). In the ROC analysis performed with reference to the patients without any diagnosis, NLR obtained 0.612 AUC. CONCLUSION: Significantly higher NLR levels were found in CVST patients compared to the patients, who were not diagnosed with CVST and the patients without any diagnosis (Tab. 5, Fig. 2, Ref. 22).

The Role of NEWS2 + Lactate + D-Dimer in Predicting Intensive Care Unit Admission and In-Hospital Mortality of COVID-19 Patients.

Background: We investigated the parameters of National Early Warning Score 2 (NEWS2) + lactate + D-dimer in predicting the intensive care unit (ICU) admission and in-hospital mortality in patients hospitalized with COVID-19. Methods: Patients, who applied to the emergency department of a tertiary university hospital and were taken to the COVID-19 zone with suspected COVID-19 between March 2020 and June 2020, were retrospectively examined. In this study, 244 patients, who were hospitalized and had positive polymerase chain reaction test results, were included. NEWS2, lactate, and D-dimer levels of the patients were recorded. Patients were grouped by the states of in-hospital mortality and ICU admission. Results: Of 244 patients who were included in the study, 122 (50%) were male, while their mean age was 53.76 ± 17.36 years. 28 (11.5%) patients were admitted to the ICU, while in-hospital mortality was seen in 14 (5.7%) patients. The levels of D-dimer, NEWS2, NEWS2 + lactate, NEWS2 + D-dimer, NEWS2 + lactate + D-dimer were statistically significantly higher in patients with in-hospital mortality and admitted to ICU ( p < 0.05). The area under the curve (AUC) values of D-dimer, lactate, NEWS2, NEWS2 + lactate, NEWS2 + D-dimer, NEWS2 + lactate + D-dimer in predicting ICU admission were as 0.745 (0.658-0.832), 0.589 (0.469-0.710), 0.760 (0.675-0.845), 0.774 (0.690-0.859), 0.776 (0.692-0.860), and 0.778 (0.694-0.862), respectively; while the AUC values of these parameters in predicting in-hospital mortality were found to be as 0.768 (0.671-0.865), 0.695 (0.563-0.827), 0.735 (0.634-0.836), 0.757 (0.647-0.867), 0.752 (0.656-0.848), and 0.764 (0.655-0.873), respectively. Conclusions: Compared to using the NEWS2 value alone, a combination of NEWS2, lactate, and D-dimer was found to be more valuable in predicting in-hospital mortality and ICU admission.

Comparison of Endotracheal Intubations Performed With Direct Laryngoscopy and Video Laryngoscopy Scenarios With and Without Compression: A Manikin-Simulated Study.

BACKGROUND: Optimal management for trauma-induced coagulopathy (TIC) is a clinical conundrum. In conjunction with the transfusion of fresh-frozen plasma (FFP), additional administration of prothrombin complex concentrate (PCC) was proposed to bring about further coagulative benefit. However, investigations evaluating the efficacy as well as corresponding side effects were scarce and inconsistent. The aim of this study was to systematically review current literature and to perform a meta-analysis comparing FFP+PCC with FFP alone. METHODS: Web search followed by manual interrogation was performed to identify relevant literatures fulfilling the following criteria, subjects as TIC patients taking no baseline anticoagulants, without underlying coagulative disorders, and reported clinical consequences. Those comparing FFP alone with PCC alone were excluded. Comprehensive Meta-analysis software was utilized, and statistical results were delineated with odd ratio (OR), mean difference (MD), and 95% confidence interval (CI). I2 was calculated to determine heterogeneity. The primary endpoint was set as all-cause mortality, while the secondary endpoint consisted of international normalized ratio (INR) correction, transfusion of blood product, and thrombosis rate. RESULTS: One hundred and sixty-four articles were included for preliminary evaluation, 3 of which were qualified for meta-analysis. A total of 840 subjects were pooled for assessment. Minimal heterogeneity was present in the comparisons (I2 < 25%). In the PCC + FFP cohort, reduced mortality rate was observed (OR: 0.631; 95% CI: 0.450-0.884, p = 0.007) after pooling. Meanwhile, INR correction time was shorter under PCC + FFP (MD: -608.300 mins, p < 0.001), whilst the rate showed no difference (p = 0.230). The PCC + FFP group is less likely to mandate transfusion of packed red blood cells (p < 0.001) and plasma (p < 0.001), but not platelet (p = 0.615). The incidence of deep vein thrombosis was comparable in the two groups (p = 0.460). CONCLUSIONS: Compared with FFP only, PCC + FFP demonstrated better survival rate, favorable clinical recovery and no elevation of thromboembolism events after TIC.

Predictive value of D-dimer/albumin ratio and fibrinogen/albumin ratio for in-hospital mortality in patients with COVID-19.

INTRODUCTION: Due to the high mortality of coronavirus disease 2019 (COVID-19), there are difficulties in the managing emergency department. We investigated whether the D-dimer/albumin ratio (DAR) and fibrinogen/albumin ratio (FAR) predict mortality in the COVID-19 patients. METHODS: A total of 717 COVID-19 patients who were brought to the emergency department from March to October 2020 were included in the study. Levels of D-dimer, fibrinogen and albumin, as well as DAR, FAR, age, gender and in-hospital mortality status of the patients, were recorded. The patients were grouped by in-hospital mortality. Statistical comparison was conducted between the groups. RESULTS: Of the patients included in the study, 371 (51.7%) were male, and their median age was 64 years (50-74). There was in-hospital mortality in 126 (17.6%) patients. The area under the curve (AUC) and odds ratio values obtained by DAR to predict in-hospital mortality were higher than the values obtained by the all other parameters (AUC of DAR, albumin, D-dimer, FAR and fibrinogen: 0.773, 0.766, 0.757, 0.703 and 0.637, respectively; odds ratio of DAR > 56.36, albumin < 4.015, D-dimer > 292.5, FAR > 112.33 and fibrinogen > 423:7.898, 6.216, 6.058, 4.437 and 2.794, respectively). In addition; patients with concurrent DAR > 56.36 and FAR > 112.33 had an odds ratio of 21.879 with respect to patients with concurrent DAR < 56.36 and FAR < 112.33. CONCLUSION: DAR may be used as a new marker to predict mortality in COVID-19 patients. In addition, the concurrent high DARs and FARs were found to be more valuable in predicting in-hospital mortality than either separately.

The role of the BUN/albumin ratio in predicting mortality in COVID-19 patients in the emergency department.

INTRODUCTION: Due to the high mortality and spread rates of coronavirus disease 2019 (COVID-19), there are currently serious challenges in emergency department management. As such, we investigated whether the blood urea nitrogen (BUN)/albumin ratio (BAR) predicts mortality in the COVID-19 patients in the emergency department. METHODS: A total of 602 COVID-19 patients who were brought to the emergency department within the period from March to September 2020 were included in the study. The BUN level, albumin level, BAR, age, gender, and in-hospital mortality status of the patients were recorded. The patients were grouped by in-hospital mortality. Statistical comparison was conducted between the groups. RESULTS: Of the patients who were included in the study, 312(51.8%) were male, and their median age was 63 years (49-73). There was in-hospital mortality in 96(15.9%) patients. The median BUN and BAR values of the patients in the non-survivor group were significantly higher than those in the survivor group (BUN: 24.76 [17.38-38.31] and 14.43 [10.84-20.42], respectively [p < 0.001]; BAR: 6.7 [4.7-10.1] and 3.4 [2.5-5.2], respectively [p < 0.001]). The mean albumin value in the non-survivor group was significantly lower than that in the survivor group (3.60 ± 0.58 and 4.13 ± 0.51, respectively; p < 0.001). The area-under-the-curve (AUC) and odds ratio values obtained by BAR to predict in-hospital COVID-19 mortality were higher than the values obtained by BUN and albumin (AUC of BAR, BUN, and albumin: 0.809, 0.771, and 0.765, respectively; odds ratio of BAR>3.9, BUN>16.05, and albumin<4.01: 10.448, 7.048, and 6.482, respectively). CONCLUSION: The BUN, albumin, and BAR levels were found to be reliable predictors of in-hospital mortality in COVID-19 patients, but BAR was found to be a more reliable predictor than the BUN and albumin levels.

NLR and CRP to albumin ratio as a predictor of in-hospital mortality in the geriatric ED patients.

INTRODUCTION: We aimed to investigate the role of neutrophil to lymphocyte ratio (NLR) and the C-Reactive Protein/Albumin Ratio (CAR), which are obtained from the first laboratory values of the elderly patients at admission to the emergency department (ED), in predicting in-hospital mortality. METHODS: This retrospective observational study includes the patients aged 65 and above who applied to the emergency department for two months. The patients' neutrophil, lymphocyte, C-reactive protein (CRP), albumin, NLR and CAR values were recorded. Statistical analysis of NLR and CAR values was performed according to in-hospital mortality and ED outcome. RESULTS: 784 patients were included in the statistical analysis of the study. Increased NLR (8.82 (4.16-16.63), 4.76 (2.62-8.56), p˂0.001) and increased CAR (21.39 (6.02-55.07), 4.82 (1.17-17.03), p < 0.001) values were found to be statistically significant in the group with mortality compared to the group without mortality. Increased NLR (AUC: 0.642) and increased CAR (AUC: 0.723) were a predictor of in-hospital mortality. It was found that in-hospital mortality risk in patients with concurrent high NLR and CAR values (CAR˃12.3, NLR˃7.1) was 9.87 times more than the patients with concurrent low NLR and CAR values (CAR<12.3, NLR < 7.1). NLR and CAR values of the patients hospitalized in intensive care and service (NLR 7.21 (4.07-13.36), 5.77 (3.45-11.22); CAR 12.65 (2.79-36.8), 9.56 (1.74-33.97)) were found to be statistically significantly higher than those who were discharged (NLR 3.64 (2.26-7.02); CAR 2.88 (0.9-10.59)). CONCLUSION: According to our results, the concurrent high levels of NLR and CAR values were found to be more effective in predicting in-hospital mortality compared to a separate evaluation.

Bag-Valve-Mask versus Laryngeal Mask Airway Ventilation in Cardiopulmonary Resuscitation with Continuous Compressions: A Simulation Study.

INTRODUCTION: The 2017 International Liaison Committee on Resuscitation (ILCOR) guideline recommends that Emergency Medical Service (EMS) providers can perform cardiopulmonary resuscitation (CPR) with synchronous or asynchronous ventilation until an advanced airway has been placed. In the current literature, limited data on CPR performed with continuous compressions and asynchronous ventilation with bag-valve-mask (BVM) are available. STUDY OBJECTIVE: In this study, researchers aimed to compare the effectiveness of asynchronous BVM and laryngeal mask airway (LMA) ventilation during CPR with continuous chest compressions. METHODS: Emergency medicine residents and interns were included in the study. The participants were randomly assigned to resuscitation teams with two rescuers. The cross-over simulation study was conducted on two CPR scenarios: asynchronous ventilation via BVM during a continuous chest compression and asynchronous ventilation via LMA during a continuous chest compression in cardiac arrest patient with asystole. The primary endpoints were the ventilation-related measurements. RESULTS: A total of 92 volunteers were included in the study and 46 CPRs were performed in each group. The mean rate of ventilations of the LMA group was significantly higher than that of the BVM group (13.7 [11.7-15.7] versus 8.9 [7.5-10.3] breaths/minute; P <.001). The mean volume of ventilations of the LMA group was significantly higher than that of the BVM group (358.4 [342.3-374.4] ml versus 321.5 [303.9-339.0] ml; P = .002). The mean minute ventilation volume of the LMA group was significantly higher than that of the BVM group (4.88 [4.15-5.61] versus 2.99 [2.41-3.57] L/minute; P <.001). Ventilations exceeding the maximum volume limit occurred in two (4.3%) CPRs in the BVM group and in 11 (23.9%) CPRs in the LMA group (P = .008). CONCLUSION: The results of this study show that asynchronous BVM ventilation with continuous chest compressions is a reliable and effective strategy during CPR under simulation conditions. The clinical impact of these findings in actual cardiac arrest patients should be evaluated with further studies at real-life scenes.

Blood urea nitrogen to albumin ratio is a predictor of in-hospital mortality in older emergency department patients.

INTRODUCTION: In this study, we aimed to evaluate the first measured blood urea nitrogen (BUN)/albumin ratio in the emergency department (ED) as a predictor of in-hospital mortality in older ED patients. METHODS: This retrospective observational study was conducted at a university hospital ED. Consecutive patients aged 65 and over who visited the ED in a three-month period were included in the study. The BUN, albumin, creatinine, and estimated glomerular filtration rate (eGFR) of patients were recorded. The primary end point of the study was in-hospital mortality. RESULTS: A total of 1253 patients were included in the statistical analyses of the study. Non-survivors had increased BUN levels (32.9 (23.3-55.4) vs. 20.2 (15.4-28.3) mg/dL, p < 0.001), decreased albumin levels (3.27 (2.74-3.75) vs. 3.96 (3.52-4.25) g/dL, p < 0.001), and increased BUN/albumin ratios (10.19 (6.56-18.94) vs. 5.21 (3.88-7.72) mg/g, p < 0.001) compared to survivors. An increased BUN/albumin ratio was a powerful predictor of in-hospital mortality with an area under the curve of 0.793 (95% CI: 0.753-0.833). Malignancy (OR: 2.39; 95% CI: 1.59-3.74, p < 0.001), albumin level < 3.5 g/dL (OR: 2.75; 95% CI: 1.74-4.36, p < 0.001), and BUN/albumin ratio > 6.25 (OR: 2.82; 95% CI: 1.22-6.50, p < 0.015) were found to be independent predictors of in-hospital mortality in older ED patients. CONCLUSION: According to our findings, older patients with a BUN level > 23 mg/dL, an albumin level < 3.5 g/dL, and a BUN/albumin ratio > 6.25 mg/g in the ED have a higher risk of in-hospital mortality. Additionally, the BUN/albumin ratio is a more powerful independent predictor of in-hospital mortality than the BUN level, albumin level, creatinine level, and eGFR in older ED patients.

Presenting symptoms of older emergency department patients: a single-center experience of 10,692 patients in Turkey.

Objective: In this study, we aimed: (1) to evaluate the presenting symptoms of older emergency department (ED) patients within a 12-month period, (2) to compare the differences in presenting symptoms between three age groups, and (3) to evaluate the seasonal variations in the presenting symptoms. Methods: This retrospective single-centered observational study was conducted at the ED of a university hospital in older ED patients with yellow and red triage code. Consecutive patients aged 65 and older admitted to ED in the study period were included in the study. Results: In our study, 14.0% of all ED admissions were patients aged 65 and older. The mean age of 10,692 patients was 75.3 ± 7.3 years, and 49.2% of them were male. The most common presenting symptoms to ED were dyspnea (18.5%), abdominal pain (12.4%), and chest pain (8.3%). Whereas 6,352 (59.4%) patients had been discharged from the ED (to home), 4,305 (40.3%) were hospitalized. Falls became the third rank presenting symptom in patients aged 85 and older. The hospital admission rate increased from 35% to 53% by age, and the in-hospital mortality rate of patients aged 85 and older was higher than that of the other age groups (p < 0.001). Conclusion: ED physicians should be aware of the common medical problems and life-threatening conditions of older patients. Morbidity and mortality rates increase by age and those patients may need different management strategies and an increased number of resources.