Ertugrul Altinbilek

Comparison of the Canadian CT head rule and the new orleans criteria in patients with minor head injury

AimThe aim of the study was to compare the New Orleans Criteria and the New Orleans Criteria according to their diagnostic performance in patients with mild head injury.MethodsThe study was designed and conducted prospectively after obtaining ethics committee approval. Data was collected prospectively for patients presenting to the ED with Minor Head Injury. After clinical assessment, a standard CT scan of the head was performed in patients having at least one of the risk factors stated in one of the two clinical decision rules.Patients with positive traumatic head injury according to BT results defined as Group 1 and those who had no intracranial injury defined as Group 2. Statistical analysis was performed with SPSS 11.00 for Windows. ROC analyze was performed to determine the effectiveness of detecting intracranial injury with both decision rules. p < 0.05 was considered statistically significant.Results175 patients enrolled the study. Male to female ratio was 1.5. The mean age of the patients was 45 ± 21,3 in group 1 and 49 ± 20,6 in group 2. The most common mechanism of trauma was falling. The sensitivity and specificity of CCHR were respectively 76.4% and 41.7%, whereas sensitivity and specificity of NOC were 88.2% and 6.9%.ConclusionThe CCHR has higher specificity, PPV and NPV for important clinical outcomes than does the NOC.

Analysis and injury paterns of walnut tree falls in central anatolia of turkey.

IntroductionFalls are the second most common cause of injury-associated mortality worldwide. This study aimed to analysis the injuries caused by falls from walnut tree and assess their mortality and morbidity risk.MethodsThis is a retrospective hospital-based study of patients presenting to emergency department (ED) of Ahi Evran Univercity between September and October 2012. For each casualty, we computed the ISS (defined as the sum of the squares of the highest Abbreviated Injury Scale (AIS) score in each of the three most severely injured body regions). Severe injury was defined as ISS ≥ 16. The duration of hospital stay and final outcome were recorded. Statistical comparisons were carried out with Chi-Square test for categorical data and non-parametric spearman correlation tests were used to test the association between variables. A p value less than 0.05 was considered to be statistically significant.ResultsFifty-four patients admitted to our emergency department with fall from walnut tree. Fifty (92.6%) patients were male. The mean age was 48 ± 14 years. Spinal region (44.4%) and particularly lumbar area (25.9%) sustained the most of the injuries among all body parts. Wedge compression fractures ranked first among all spinal injuries. Extremities injuries were the second most common injury. None of the patients died. Morbidity rate was 9.25%.ConclussionFalls from walnut trees are a significant health problem. Preventive measures including education of farmers and agricultural workers and using mechanized methods for harvesting walnut will lead to a dramatic decrease in mortality and morbidity caused by falls from walnut trees.

Role of H-FABP values in determining the etiologic factors of the cardiac injuries

Introduction Cardiac injury resulting from blunt thoracic trauma is a frequent clinical occurrence which is difficult to diagnose. Our purpose in this study was to research whether H-FABP, which is a new marker for the diagnosis of cardiac injury, can be used in this patient group. Methods 50 patients with blunt thoracic injury who were admitted to our emergency service within a period of 8 months and 50 cases as controls were included in our study. Results Of the 50 patients with blunt thoracic injury in our study, 88% were male while 12% were female. The average age of the patients was 43 ± 15.15. While 27 (54%) of the 50 patients with blunt thoracic injury had cardiac injury, 23 (46%) did not have cardiac injury. The results of the statistical analyses showed a significant association between thorax trauma and cTnI, CPK, CPKMB and H-FABP (p<0.05). While there was a significant association between cardiac injury resulting from thoracic trauma and cTnI, ECG and TTE (p<0.05), there was no significant association between CPK, CPKMB and H-FABP (p>0.05). Conclusion In thoracic traumas, cardiac injury diagnosis can be made as a result of the assessment with Troponin-I, ECG and ECHO. For cardiac injury diagnosis, wide scale prospective studies are needed for H-FABP use.

DIAGNOSTIC APPROACH AND EVALUATION OF SYNCOPE ETIOLOGY IN PATIENTS PRESENTING TO EMERGENCY DEPARTMENT WITH SYNCOPE

Syncope is a rapidly developing and automatically recovering loss of consciousness and tonus, frequently see n in emergency services. We aimed that to evaluete syncope patients presenting to the emergency department and to create recommendations for rapid diagnozis and treatm ent at clinical approaches according to the results. The study evaluates a total of 310 p atients administered to Şisli Hamidiye Etfal Hospitals Emergency Medical Clinic between 01/02/2014 and 31/07/2014 due to syncope. The information was recorded in study forms . Average, standard deviation, median, lowest, highest, ratio and frequency values were used in the descriptive statistics of the data. Distribution of variables was checked with Kolmogorov - Smirnov Test. Mann - Whitney U Test was used for the analysis of quantitative data. Chi - Squared Test was used for the analysis of qualitative data. SP SS 22.0 program was used in the Analyses. The syncope etiology was neurocardiogenic in 80 (25.8 %) patients, orthostatic in 46 (14.8 %), cardiogenic in 31 (10 %), neurogenic in 25 (8.1 %), metabolic in 24 (7.7 %) and hypovolemic in 15 (4.9 %). The remainin g 89 (28.7 %) patients had syncope of unknown origin. A risk stratification based on SFSR showed that 228 (73.5 %) patients were in the non - risk group while 82 (26.5 %) were in the at - risk group. We believe that the low administration rate of patients, who were administered to our emergency service with high risks according to syncope risk scores, can increase by using risk - scoring systems, and that unnecessary administrations of low - risk patients can be prevented.

SPONTANEOUS CERVİCAL EPİDURAL HEMATOMA DUE TO ORAL ANTİCOAGULANT USE

Spontaneous spinal epidural hematoma (SCEH) is a considerbaly rare clinical condition. It may lead to persistent neurological deficits or even death unless recognized and treated early in its course. It usually occurs after trauma but m ay also develop spontaneously. Majority of cases can be diagnosed with a detailed neurological examination and magnetic resonance imaging (MRI). Urgent surgical tehrapy is the preferred mode of trea tment in advanced cases while a conservative approach is s elected for cases with mild neurological deficit. MRI is regarded as the imaging modality of choice fort he diagnosis of SCEH . We report a case of nontrumatic SCEH after oral anticoagulant (OAC) use that presented with sudden - onset paraplegia. We also revi ewed the relevant literature.