Introduction Trauma is one of the major causes of death among all age groups. It is the leading cause of death and disability among children older than 1 year of age (1). In addition to designing pre-hospital and hospital trauma organizations, taking meticulous preventive measures and providing public education are greatly important for efforts aimed at reducing trauma-related mortality (2). Initial assessment and management of multi-trauma patients is a difficult task requiring a rapid and systematic approach. According to the ATLS principles, injured patients are assessed and treated based on their vital signs, level of consciousness, and injury mechanism (3). Additionally, a variety of trauma severity scoring systems has been devised to predict trauma severity and to predict and prevent trauma-related death (4). Trauma severity scoring refers to the process of prediction and quantification of the risks associated with death, hospitalization, and discharge (5). Trauma severity scores assess trauma in terms of its anatomic and/or physiological properties. abbreviated injury scale (AIS) and injury severity score (ISS) take into account injury's anatomic Aim: We aimed to evaluate and compare the performance of BIG score (Base deficit, INR, GCS), pediatric trauma score, revised trauma score, injury severity score, new injury severity score (NISS) in mortality and stay intensive care unit. Materials and Methods: One thousand five hundred ten pediatric patients aged less than 18 years who were admitted to the emergency department with multi-trauma between 1 July 2012 and 1 July 2016 were included in the retrospective research. Demographic data, vital signs in the emergency department, trauma location, injury severity indexes and follow up of patients were examined. Results: One thousand five hundred ten patients were included, 40.5% were female and 59.5% were male. Mean age was 7.81±4.8; mortality was 4.2%. The best score to evaluate mortality was "probability of survival 2014 (PS14)". The best score to force the stay in ICU was found as NISS, the most sensitive system was NISS and PS14 (94.9%) and the most specific was NISS (86.7). PS14 was the first to evaluate the survival. In our research, 94.3% of patient had blunt trauma and 5.7% had penetrating trauma. PS14 was found the best score to determine survival and mortality for blunt trauma patients. Conclusion: Although all scoring systems appeared similarly predictive among pediatric trauma patients, The PS14 score was more predictive for mortality and survival, and the NISS score for the need of intensive care admission. The NISS score was the most predictive score for intensive care admission in blunt and penetrating traumas combined. Particularly the newly developed PS14 score can be used as a powerfully predictive scoring system for outcomes among all pediatric trauma patients, irrespective of trauma mechanism.
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*This study was presented as an oral presentation on November 10-13, 2016 at the 15 th 5 th Eurasian Congress on Emergency Medicine Congress (EACEM 2016).
Bouveret’s syndrome is defined as gastrointestinal obstruction due to an impacted gallstone secondary to biliary-enteric fistula. This is often observed with nonspecific symptoms such as epigastric pain, nausea, and vomiting. The diagnosis is made by visualization of pneumobilia, gastric outlet obstruction and ectopic gallstone. In this report, we discussed an elderly patient who was admitted to the emergency department with abdominal pain and vomiting without any signs of bowel obstruction in plain x-ray and ultrasound imaging. We aimed to remind the importance of clinical suspicion and the diagnostic value of computed abdominal tomography for emergency physicians.
We aim to evaluate the demographic and clinical characteristics of patients with acute carbon monoxide (CO) poisoning, who had a Glasgow Coma Score (GCS) below 15, and who had cerebral lesions detected in magnetic resonance imaging (MRI). Methods: The age, gender, causes of CO intoxication, clinical signs, neurological findings, GCS, blood carboxyhemoglobin level (COHb), serum pH, lactate, creatine kinase (CK), creatinine kinase-myocardial band MB (CK-MB), troponin-I level, brain MRI (T1weighted, T2-weighted, FLAIR and diffusion-weighted imaging), treatment, and mortality status of 327 patients were evaluated retrospectively. Results: The median age of patients was 31.5 years (IQR=19.5 years), 72.2% of the patients were women. Neurological findings were detected in 34 (10.4%) of the patients. The frequency of dyspnea was significantly higher in patients with neurological findings (p<0.05). The COHb and lactate levels of patients with neurological findings were found to be significantly high, the pH level was significantly lower (p<0.05). There was no significant relationship between the presence of neurological findings and CK, CK-MB, and troponin-I levels (p>0.05). Patients with neurological findings were found to have a significantly longer follow-up period, more frequently received hyperbaric oxygen therapy (p<0.05). The rate of hospitalization was 10.7%, the mortality rate was 0.9%. Hospitalization and mortality rates were significantly high in patients with neurological findings (p <0.05). Pathological findings were detected in 13 (40.6%) of 32 of patients (except for 2 patients who did not respond to the resuscitation) who had an MRI. Conclusions: It was determined that acute CO poisoning may lead to acute brain damage, 40.6% would be detected in brain MRIs taken in patients during the acute phase.
BACKGROUND: Intimate partner violence (IPV) is an important human rights problem faced by one in three women worldwide. The aim of this study is to evaluate the demographic, trauma, and radiological characteristics of patients admitted to a tertiary emergency department due to IPV. METHODS: Sociodemographic characteristics (age, gender, education level, and marital status), trauma characteristics (severity, type, and location), radiological imaging findings (radiography, computed tomography, and magnetic resonance imaging) of patients diagnosed with IPV were evaluated. RESULTS:In the study, 1225 patients were evaluated, and 98.7% of them were women (mean age 35 [IQR: 17] years). Of the patients, 63.1% were high school and university graduates. The rate of married women was 74.6%. No relationship was found between gender, age, educational status, and marital status (p>0.05). Most of the traumas were minor (85.4%) and blunt (81.9%) trauma, and the most common types of trauma were kicking (49.9%) and punching (47.3%). It was found that the most frequently affected areas of the patients were the head and neck (76.7%), and the frequency of pelvic trauma was high in male patients (p<0.05). The most common bone fracture was nasal (40.5%) followed by ulna fractures (14.5%). The left-sided diaphyseal fractures were the most common in patients exposed to IPV. In our study, the frequency of mortality was 12.9%, and it was found to be significantly higher in males (p<0.05). CONCLUSION:Female patients are more frequently exposed to IPV. Specific injury characteristics can be detected in patients diagnosed with IPV and old fractures detected in these patients should alert the clinician about IPV.
Aim: To investigate the epidemiological characteristics of patients with pelvic fractures. Material and Methods:We evaluated age, gender, comorbid disease, admission season, mechanisms of the injury, type of the fractures (Young Burgess classification), associated injuries, and mortality of patients with pelvic fractures in the emergency department (ED).Results: Of the 919 patients included in the study, 307 (33.4%) were female and 612 (66.6%) were male. The mean age was 36,5±14,82 (18-80) years. The mean age of males was 35.1 ± 13.63 years, and it was 39.2 ± 16.63 years for females. Of the males, 46.4% were in the 28-37 years range. Comorbid diseases were found in 254 (27.6%) patients. Of the patients, 302 (32.9%) were admitted in winter and 285 (31%) in summer. It was mostly occurred due to automobile accidents 268 (29.2%), followed by falls from height 211 (23%). Automobile accidents were most common in the winter season, while falls from height was more common in the summer. While automobile accidents, falls from height, motorcycle accidents were more common in males compared to females, falls from own height, pedestrians hit by a car, and other injuries were observed more frequently in females than males (p <0.001). While the mean age of females fell from their own height was 62.79 years, it was 68.46 years for males. 423 (46%) lateral compression 1 was detected most frequently. It was accompanied by abdominal trauma in 321 (34.9%) patients and head trauma in 299 (32.5%) patients. Eighty (8.7%) patients died in ED. Conclusion:The most common mechanisms of pelvic fracture injury are automobile accidents and falls. Associated injuries are frequently observed.
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