Emergency department triaging using ChatGPT based on emergency severity index principles: a cross-sectional study.

Erroneous and delayed triage in an increasingly crowded emergency department (ED). ChatGPT is an artificial intelligence model developed by OpenAI® and is being trained for use in natural language processing tasks. Our study aims to determine the accuracy of patient triage using ChatGPT according to the emergency severity index (ESI) for triage in EDs. In our cross-sectional study, 18 years and over patients who consecutively presented to our ED within 24 h were included. Age, gender, admission method, chief complaint, state of consciousness, and comorbidities were recorded on the case form, and the vital signs were detected at the triage desk. A five-member expert committee (EC) was formed from the fourth-year resident physicians. The investigators converted real-time patient information into a standardized case format. The urgency status of the patients was evaluated simultaneously by EC and ChatGPT according to ESI criteria. The median value of the EC decision was accepted as the gold standard. There was a statistically significant moderate agreement between EC and ChatGPT assessments regarding urgency status (Cohen's Kappa = 0.659; P < 0.001). The accuracy between these two assessments was calculated as 76.6%. There was a high degree of agreement between EC and ChatGPT for the prediction of ESI-1 and 2, indicating high acuity (Cohen's Kappa = 0.828). The diagnostic specificity, NPV, and accuracy of ChatGPT were determined as 95.63, 98.17 and 94.90%, respectively, for ESI high acuity categories. Our study shows that ChatGPT can successfully differentiate patients with high urgency. The findings are promising for integrating artificial intelligence-based applications such as ChatGPT into triage processes in EDs.

The relationship between bony changes of the mandibular condyle and eichner index.

INTRODUCTION: The aim of this study was to evaluate whether degenerative bone changes in the mandibular condyle on cone beam computed tomography images are associated with the Eichner index. METHODOLOGY: 336 cone beam computed tomography images condyle images of 168 patients were analyzed for degenerative bone changes. These changes were named as condyle flattening, osteophytes, erosions, subchondral sclerosis, generalized sclerosis and subchondral cysts. The edentulous status of the patients was classified as group A-B-C and subtypes according to the Eichner index. Categorical variables were evaluated with chi-square test and p < 0.05 was considered statistically significant. RESULTS: According to the results of the study, the most common degenerative condyle change was flattening of the condyle. Among the Eichner index groups, the most common group was A and the least common group was C. Condyle changes on the right and left sides were most commonly observed in group A patients. The statistically significant majority of patients with right-sided condyle flattening and erosion were in group C. No significant difference was found between all other condyle changes and Eichner index groups. There was no significant relationship between Eichner index and gender. CONCLUSION: Degenerative bone changes (flattening and erosion of the condyle) in the condyle region were more common in group C patients with more tooth loss. There is a significant relationship between condyle changes and posterior toothlessness.

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.

Epidemiology of geriatric patients presenting to emergency departments in Europe: EGERS study.

BACKGROUND AND IMPORTANCE: Patients aged 65 and above constitute a large and growing part of emergency department (ED) visits in western countries. OBJECTIVE: The primary aim of this European prospective study was to determine the epidemiologic characteristics of elderly patients presenting to EDs across Europe. Our secondary objective was to determine the hospitalization rate, characteristics, and in-hospital mortality rates of geriatric patients presenting to EDs. DESIGN SETTING AND PARTICIPANTS: An observational prospective cohort study over seven consecutive days between 19 October and 30 November 2020, in 36 EDs from nine European countries. Patients aged 65 years and older presenting to EDs with any complaint during a period of seven consecutive days were included. OUTCOME MEASURES: Data were collected on demographics, the major presenting complaint, the presenting vital signs, comorbidities, usual medication, and outcomes after the ED, including disposition, in-hospital outcome, and the final hospital diagnosis. The patients were stratified into three groups: old (65-74 years), older (75-84 years), and oldest age (>85 years). MAIN RESULTS: A total of 5767 patients were included in the study. The median age of the patients was 77 (interquartile range: 71-84) years. The majority presented with a non-traumatic complaint (81%) and about 90% of the patients had at least one comorbid disease and were on chronic medication. An ED visit resulted in subsequent hospital admission in 51% of cases, with 9% of patients admitted to an intensive care unit. Overall in-hospital mortality was 8%, and ED mortality was 1%. Older age was associated with a higher female proportion, comorbidities, need for home care service, history of previous falls, admission rates, length of ED, and hospital stay. CONCLUSION: The characteristics of ED elderly patients and their subsequent hospital stay are reported in this prospective study.

Manual cardiopulmonary resuscitation versus mechanical cardiopulmonary resuscitation: Which one is more effective during ambulance transport?

OBJECTIVES: Although studies in the field of emergency medical services (EMS) generally compare survival and hospital discharge rates, there are not many studies measuring the quality of cardiopulmonary resuscitation (CPR). In this study, we aimed to compare the mechanical chest compression device and paramedics in terms of CPR quality. METHODS: This is an experimental trial. This study was performed by the EMS of Ankara city (capital of Turkey). Twenty (ten males and ten females) paramedics participated in the study. We used LUCAS™ 2 as a mechanical chest compression device in the study. Paramedics applied chest compression in twenty rounds, whereas mechanical chest compression device applied chest compression in another set of twenty rounds. The depth, rate, and hands-off time of chest compression were measured by means of the model's recording system. RESULTS: The median chest compression rate was 120.1 compressions per minute (interquartile range [IQR]: 25%-75% = 117.9-133.5) for the paramedics, whereas it was 102.3 compressions per minute for the mechanical chest compression device (IQR: 25%-75% = 102.1-102.7) (P < 0.001). The median chest compression depth was 38.9 mm (IQR: 25%-75% = 32.9-45.5) for the paramedics, whereas it was 52.7 mm for the mechanical chest compression device (IQR: 25%-75% = 51.8-55.0) (P < 0.001). The median hands-off time during CPR was 6.9% (IQR: 25-75 = 5.0%-10.1%) for the paramedics and 9% for the mechanical chest compression device (IQR: 25%-75% = 8.2%-12.5%) (P = 0.09). CONCLUSION: During patient transport, according to the chest compression performed by the health-care professionals, it was found that those performed by the mechanical chest compression device were more suitable than that performed by the guides in terms of both speed and duration.

Seasonal variations of patients presenting dyspnea to emergency departments in Europe: Results from the EURODEM Study

Background/aim: To describe seasonal variations in epidemiology, management, and short-term outcomes of patients in Europe presenting to an emergency department (ED) with a main complaint of dyspnea. Materials and methods: Anobservational prospective cohort study was performed in 66 European EDs which included consecutive patients presenting to EDs with dyspnea as the main complaint during 3 72-h study periods. Data were collected on demographics, comorbidities, chronic treatment, prehospital treatment, mode of arrival of patient to ED, clinical signs at admission, treatment in the ED, ED diagnosis, discharge from ED, and in-hospital outcome. Results: The study included 2524 patients with a median age of 69 (53­80) years old. Of the patients presented, 991 (39.3%) were in autumn, 849 (33.6%) were in spring, and 48 (27.1%) were in winter. The winter population was significantly older (P < 0.001) and had a lower rate of ambulance arrival to ED (P < 0.001). In the winter period, there was a higher rate for lower respiratory tract infection (35.1%), and patients were more hypertensive, more hypoxic, and more hyper/hypothermic compared to other seasons. The ED mortality was about 1% and, in hospital, mortality for admitted patients was 7.4%. Conclusion: The analytic method and the outcome of this study may help to guide the allocation of ED resources more efficiently and to recommend seasonal ED management protocols based on the seasonal trend of dyspneic patients.

Quality Comparison of the Manual Chest Compression and the Mechanical Chest Compression During Difficult Transport Conditions.

BACKGROUND: Although there are several studies comparing the quality of manual and mechanical chest compressions, we decided to conduct this study because results of previous studies were not sufficient for us to arrive at a definite conclusion. OBJECTIVE: In this study, our goal was to evaluate the quality of cardiopulmonary resuscitation (CPR) performed manually and by mechanical chest compression device (MCCD) when removing out-of-hospital cardiac arrest patients from their homes via stairs. METHODS: A total of 20 paramedics participated in the study. The patient simulator manikin was moved down the stairs while each of 20 paramedics performed chest compressions, then it was moved down the stairs again 20 times while the MCCD performed chest compressions. Compression depth, compression rate, and hands-on times were recorded and the data were compared. RESULTS: The median chest compression rate was 142.0 compressions/min (interquartile [25th to 75th percentile] range [IQR] 134.9-148.7 compressions/min) for the paramedics and 102.3 compressions/min for the MCCD (IQR 102.2-102.5 compressions/min) (p < 0.01). The median chest compression depth was 25.2 mm (IQR 23.2-30.9 mm) for the paramedics and 52.0 mm for the MCCD (IQR 51.4-52.6 mm) (p < 0.001). The rate of hands-on time for chest compressions performed by the paramedic participants was 92.0% (IQR 86.5-100%). Hands-on rate of the MCCD was 100% (p = 0.09). CONCLUSIONS: In our study, while carrying the patient simulator manikin to the lower floor, it was found that the MCCD achieved high-quality CPR targets recommended by resuscitation guidelines in terms of compression rate, depth, and hands-on-time.

How successful is "pleural sound sign" in the identification of pneumothorax?

OBJECTIVE: In the present study, in thorax ultrasonography (USG) Doppler images obtained from cases with occult pneumothorax, we investigated the status of pulsatile pleural sounds over the pleural line and called these as the pleural sound sign (PSS). The purpose of the present study was to identify the efficacy of the proposed PSS in diagnosing pneumothorax and to compare it with the other USG findings including the sliding lung sign (SLS) and seashore sign (SSS). METHODS: The present study included 66 consecutive patients who were referred to the emergency unit with a blunt trauma from October 2009 to January 2010 at a tertiary university hospital. RESULTS: Of the 66 patients, 34 were in the patient group, and 32 were in the control group. Males accounted for 66.7% (n=44) of the study population. In predicting pneumothorax, the areas under receiver operating characteristic (ROC) curves of PSSmax and PSSdifference were 0.989 and 0.990, respectively. While the sensitivity of the SLS was 88% and the sensitivity of the SSS was 56%, the specificities of the SLS and SSS were 100%. Based on our findings, accuracy ranking was as follows: PSSmax = PSSdifference > SLS > SSS. CONCLUSION: New applications of thorax USG are rapidly growing. Our findings have to be confirmed in a large patient series. PSS is not a novel method, but it enhanced the importance of USG in the diagnosis of pneumothorax. We can stipulate that it can replace thorax computed tomography imaging particularly for the diagnosis of occult pneumothoraxes.

Tissue adhesives to secure peripheral intravenous catheters: A randomized controlled trial in patients over 65 years.

INTRODUCTION: Peripheral venous catheterization is one of the most used medical procedures in hospitals worldwide. Recent researches state that using intravascular devices is a risk factor for both local and systemic complications. In this study, we aimed to test that addition of tissue adhesive to the insertion site of peripheral intravenous catheters (PIVC) in the emergency department (ED) would reduce the device failure rate at 6 h and 24 h following insertion. MATERIAL AND METHODS: We designed a single-site, two-arm, randomized, controlled trial. We inserted 115 PIVCs into 115 adult patients. RESULTS: PIVC device failure for the 6th hour follow up was 15.4% in the tissue adhesive group (95% CI: 4.1-26.7) vs. 25.6% with standard care group (95% CI: 11.9-39.3). There was no statistically significant difference between two groups (p = 0.33).The number of patients for 24 h follow-up was not enough and the obtained data could not be included in the study. DISCUSSION: In this study, the routine use of tissue adhesives in addition to standard care to reduce PIVC failure for patients 65 years or older in ED was not supported due to not clear benefits and cost effectivity. CONCLUSION: Even though the routine use of tissue adhesives is not recommended according to the study results, it may be reasonable to use tissue adhesives for long term hospitalization expected patients to protect from related complications due to current literature.

The role of soluble urokinase plasminogen activator receptor (SuPAR) as an indicator of the severity of acute pancreatitis

Background/aim: Soluble urokinase plasminogen activator receptor (suPAR) has been reported to have a positive correlation with the activation degree of the immune system. This study's aim is to investigate the efficiency of SuPAR serum levels in acute pancreatitis (AP) patients in determining the severity of disease. Materials and methods: This prospective research involves patients who arrived at the emergency service, were over 18 years old, had nontraumatic abdominal pain and diagnosis of AP, and agreed to join the study. Demographic characteristics, contact information, laboratory and imaging test parameters, Ranson's criteria, the Balthazar Severity Index, the Rapid Acute Physiologic Score (RAPS), and the modified Glasgow (Imrie) score of all patients were recorded. Two study groups were created as score of <3 (mild, Group I) and ≥3 (severe, Group II) for pancreatitis according to Ranson's criteria. Results: During the study period, 59 sequential patients with AP were included in the study. It was seen that 79.7% of the study group (n = 47) were in Group I. Etiologically 67.8% (n = 40) cases were biliary and 32.3% (n = 19) were nonbiliary diseases. According to the results, suPAR level was effective in distinguishing the severity of AP (AUC = 0.902, P < 0.001 (95% CI: 0.821­0.984)). With regard to determining severe disease, suPAR had an optimum cutoff value of 6.815 ng/mL, sensitivity of 91.66%, specificity of 82.97%, and negative predictive value of 97.5%. Conclusion: Our study was performed the determine the efficiency of suPAR level in predicting severe disease in AP patients. We found it significant in indicating the severity of disease according to the study results.