ObjectivesThe aim of this study was to compare the performance of the Glasgow‐Blatchford and the AIMS65 scoring systems as early risk assessment tools for accurately identifying patients with upper gastrointestinal (GI) bleeding who are at a low risk of requiring clinical interventions, including emergency endoscopy. The secondary objective was to compare their performance regarding relevant clinical outcomes.MethodsData were collected prospectively over a 2‐year period in the emergency department of a university hospital. Adult patients with upper GI bleeding from either variceal or nonvariceal sources were included. Composite clinical outcomes consisted of a need for surgical or endoscopic intervention, rebleeding, intensive care unit admission, or in‐hospital mortality. Patients who required blood transfusions or suffered composite clinical outcomes were considered high‐risk patients. Glasgow‐Blatchford score (GBS) and AIMS65 score were calculated for each patient. The sensitivity and specificity of the scoring systems were calculated. The areas under the receiver‐operating characteristic curve (AUC) of the scores were compared.ResultsThere were 254 patients in the study, of whom 163 (64.2%) were men. The median age was 61 years (interquartile range = 45 to 72 years). Among the patients, 211 (83.1%) underwent endoscopy, of whom 49 (19.3%) required endoscopic intervention to achieve hemostasis. Five (2%) patients required surgical intervention. Rebleeding was observed in 33 (13%) patients. A total of 143 (56.3%) patients received blood transfusions. A total of 152 (59.8%) were defined as high risk. Eighty‐one (31.9%) experienced at least one component of the composite clinical outcomes, 18 (7.1%) of whom suffered in‐hospital mortality. A GBS of 0 was observed in 16 patients (6.3%) in the study group. Two of these were high‐risk patients. A total of 101 (39.8%) patients had AIMS65 scores of 0. Thirty‐four of these were high‐risk patients. A GBS of 0 had higher sensitivity than an AIMS65 score of 0 (98.68% vs. 77.6%). The negative predictive values of the GBS and AIMS65 of 0 were 87.5 and 66.3%, respectively. The GBS and AIMS65 were similar with regard to the composite outcome prediction, with AUCs of 0.795 (95% confidence interval [CI] = 0.74 to 0.843) and 0.746 (95% CI = 0.688 to 0.798), respectively (p = 0.137). The scores were also similar with respect to predicting in‐hospital mortality (AUCs of 0.85 vs. 0.81; p = 0.342). The GBS was superior to the AIMS65 in identifying high‐risk patients, with AUCs of 0.896 (95% CI = 0.85 to 0.93) and 0.771 (95% CI = 0.714 to 0.821; p < 0.001), respectively. The GBS was also more accurate than the AIM65 in predicting the need for blood transfusions (AUCs of 0.904 vs. 0.796; p < 0.001) and interventions (AUCs of 0.727 vs. 0.647; p = 0.05).ConclusionsThese results suggest that the GBS has superior sensitivity relative to the AIMS65 in identifying patients who were not likely to require interventions, including emergency endoscopy. Additional work to determine the use in real‐time decision making may be warranted and helpful in providing guidance to clinicians.
BACKGROUND: Measuring and monitoring end-tidal carbon dioxide (P ETCO 2 ) is an important aspect of caring for critically ill patients. The 2 methods used for P ETCO 2 measurement are the mainstream and sidestream methods. OBJECTIVE: To assess the agreement between P ETCO 2 measurements performed by mainstream and sidestream methods with the P aCO 2 values. METHODS: This was a prospective observational study. A total of 114 subjects were enrolled in the study. P ETCO 2 measurements using mainstream and sidestream methods were performed simultaneously with the arterial blood sampling in subjects who were observed in the emergency department and required arterial blood gas analysis. Agreement between the P ETCO 2 measurements and the P aCO 2 values obtained from arterial blood gas analysis were evaluated using the Bland-Altman method. RESULTS: Sixty subjects (52.6%) were female, and the mean age was 60.9 years (95% CI 58.3-63.6). The mean P aCO 2 was 35.16 mm Hg (95% CI 33.81-36.51), the mainstream P ETCO 2 was 22.11 (95% CI 21.05-23.18), and the sidestream P ETCO 2 was 25.48 (95% CI 24.22-26.75). Bland-Altman analysis showed an average difference between mainstream P ETCO 2 and P aCO 2 values of 13 mm Hg (95% limits of agreement ؊0.6 to 25.5) and moderate correlation (r ؍ 0.55, P < .001). The average difference between the sidestream P ETCO 2 and P aCO 2 values was 9.7 mm Hg (95% limits of agreement ؊5.4 to 24.7) and poor correlation (r ؍ 0.41, P < .001). CONCLUSIONS: P ETCO 2 values obtained by mainstream and sidestream methods were found to be significantly lower than the P aCO 2 values. There was essentially no agreement between the measurements obtained by 2 different methods and the P aCO 2 values.
This study demonstrates substantial reliability of Turkey's Ministry of Health's mandatory three-level triage instrument. Significant association was also observed between the triage levels and the validity parameters measured in the study.
Objectives:The present study aimed to evaluate the efficacy and safety of intravenous metoclopramide for acute migraine treatment. Materials and methods:A double-blind, randomized, parallel-group, placebo-controlled trial was carried out in an academic emergency department. After the patients were assessed for eligibility via the International Headache Society criteria for migraines, they were randomized into 10 mg intravenous metoclopramide and normal saline groups. The headache intensity was evaluated using an 11-point numeric rating scale (NRS) score. The primary outcome measure was determined as the median between-group change in the score at the 30th minute. The secondary outcome measures were rescue medication needs, adverse events, and emergency department (ED) revisits after discharge. Results: A total of 148 patients were randomized into two equal groups with similar baseline characteristics, including the baseline NRS scores (8 points). The median reduction in the NRS scores at the 30th minute was 4 [interquartile range (IQR): 2-6)] in the metoclopramide group and 3 (IQR: 1-4) in the normal saline group [median difference: −1.0, 95% confidence interval (CI): −2.1 to 0.1]. No serious adverse events were observed, and the rescue medication needs were similar in both groups. Conclusion: No difference was found between intravenous metoclopramide and placebo regarding efficacy and safety in patients with acute migraines. K E Y W O R D S emergency department (MeSH Database), headache, metoclopramide, migraine How to cite this article: Doğan NÖ, Pekdemir M, Yılmaz S, et al. Intravenous metoclopramide in the treatment of acute migraines: A randomized, placebo-controlled trial.
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