Predictors of mortality in ST-elevation MI patients: A prospective study.

We aimed to define factors predicting mortality in patients having ST elevation myocardial infarction (STEMI) who had Primary Percutaneous Coronary Intervention (PCI) in our setting.This is a prospective study on patients presenting to the emergency department with STEMI who underwent PCI during a 12-month period. Physiological parameters were calculated using the vital signs and age of patients. Time-based factors in the institutional protocol were collected. Univariate analysis was performed to define significant factors that affected mortality. Significant factors were then entered into a logistic regression model. Factors significantly affecting mortality were defined. Receiving operating characteristic curve was applied to define the best predictors of mortality.A total of 167 consecutive patients were studied; 128 (76.6%) were males. The mean (SD) age of the patients was 61.9 (12.8) years. The logistic regression model showed that significant factors were age (P = .002), Modified Shock Index, MSI (P = .028), systolic blood pressure (P = .028), and time between consultation and activation of catheter laboratory (P = .047). The cut-off points with best prediction of mortality were age of 71.5 years, systolic blood pressure of less than 95 mmHg, MSI of 0.85, and a time more than 3.5 minutes between consultation and activation of catheter laboratory.Our study shows that significant predictors of 30-days mortality of STEMI were age, systolic blood pressure on presentation, MSI, and the time between consultation and catheter laboratory activation. Improving prehospital resuscitation and activation of the catheter laboratory by emergency physicians may reduce mortality in our setting.

Low perfusion index affects the difference in glucose level between capillary and venous blood.

AIM: In emergency cases, finger stick testing is primarily used to check the blood glucose value of patients since it takes longer to obtain the venous value. In critical patients, under conditions that cause an increase in metabolic state and level of stress, there occurs considerable difference in glucose levels between capillary and venous measurements. This study aimed to investigate the comparability of capillary and venous glucose values, according to the perfusion index level obtained with the Masimo Radical-7(®) device, in critical patients aged 18 years and over. METHOD: We conducted this prospective and observational study in the emergency department of the Eskisehir Osmangazi University hospital between November 3, 2008 and February 2, 2009. RESULTS: The blood glucose of 300 critical patients was checked by finger stick in the emergency unit. The participants with normal vital signs had perfusion index between 0 and 5; the results obtained by the two methods were more consistent for perfusion index values of 6 and over. The results were most consistent in aged participants with normal vital sign findings and low perfusion index and in young patients with high perfusion index. In the cases where at least one of the vital signs was abnormal, the glucose values obtained by the two methods were more consistent when the perfusion index was 6 or over. In this group, independently from the perfusion index value, the consistency was higher in younger patients compared with aged patients. CONCLUSION: In the emergency department, perfusion index value measured by Masimo Radical-7 and capillary blood glucose levels can serve in blood sugar management in critically ill patients.

Characteristics of Patients Presenting to the Academic Emergency Department in Central Anatolia.

OBJECTIVES: Determining the properties of patients admitted to the emergency department (ED) is important to plan for future and quality assurance. In this study, we aimed to evaluate the properties of patients admitted to our ED to improve the quality of care within our hospital. METHODS: In the study period, the patients: (i) who have their full information in hospital information and management system (HIMS) and (ii) older than 17 years of age were included into the study. Demographic information, admission and discharge rates, mean staying time in the ED, triage categories, International Classification of Diseases - 10 (ICD-10) diagnoses were evaluated. RESULTS: During the study period, 32,117 cases were seen by the ED. However, 22,955 patients (71.4%) had complete information in the HIMS. The mean age was 44.92±19.50 and female gender was found 52.2%. The patients who were located in 18-29 age group was the major group of all cases (30.8%). Emergent and urgent cases were 26.1% and 14.8%, respectively. Non-urgent cases were also found (59.1%). The mean age of patients located in the emergent group (55.19±18.59) were significantly higher than urgent and non-urgent group (p≤0.01). The highest patient volume was seen on Sunday, between 20:00 and 22:00 o'clock. The mean staying time in the ED was 183.6 minutes and the admission rate was 17.6%. The three most noted ICD-10 codes were respiratory (16.6%), gastrointestinal (11.3%), musculoskeletal (11.2%) codes. CONCLUSIONS: The data that was correctly uploaded into the system did not reach our expectation. Data can be more appropriately uploaded by medical secretaries. Registering patient information in a digital atmosphere while performing analyses will undoubtedly have an effect on future focused studies.