Mehmet Akif Karamercan

Mean Platelet Volume and Red Cell Distribution Width as a Diagnostic Marker in Acute Appendicitis

Background: Acute appendicitis (AA) is one of the most common causes of emergent surgeries. Many methods are used for its diagnosis. Objectives: This study was conducted to investigate the diagnostic value of MPV and RDW in acute appendicitis. Patients and Methods: This study was a retrospective multi-center cross sectional planned study. The study included 260 patients operated for AA and 158 patients as the control group. Groups were compared in terms of MPV, RDW, white blood cell count (WBC), neutrophil predominance (NP) and platelet count (PC). Results: MPV was significantly lower in AA group, compared to the control group (P < 0.001). The best cut-off level for MVP in AA was ≤ 7.3 fL and the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and overall accuracy ratio were 45%, 89.2%, 87.3%, 49.6% and 61.7%, respectively. There was no significant difference between the two groups in terms of RDW and platelet values. Conclusions: MPV is a routinely measured parameter in complete blood count (CBC) and requires no additional cost. It significantly decreased in AA, having a greater sensitivity and NPV when combined with WBC and NP.

Modified Early Warning Score and VitalPac Early Warning Score in geriatric patients admitted to emergency department.

Objective The aim of this study was to evaluate the value of the Modified Early Warning Score (MEWS) and the VitalPac Early Warning Score (VIEWS) in predicting hospitalization and in-hospital mortality in geriatric emergency department (ED) patients. Patients and methods This prospective, single-centered observational study was carried out over 1 month at the ED of a university hospital in patients 65 years of age and older presenting to the ED. The vital parameters of the patients measured on admission to ED were recorded. The MEWS and VIEWS were calculated using the recorded physiological parameters of the patients. Hospitalization and in-hospital mortality were used as the primary outcomes. Results A total of 671 patients included in the study. The median age of the patients was 75 (11) years, and 375 (55.9%) were men. The MEWS is effective for discriminating patient groups that have been discharged from ED, admitted to a ward and admitted to ICU [1 (2) vs. 1 (1) vs. 3 (3), respectively, P<0.001]. The VIEWS is also effective for discriminating patient groups that have been discharged from ED, admitted to a ward, and admitted to ICU [2 (3) vs. 5 (5) vs. 8 (8), respectively, P<0.001]. The AUCs of the MEWS and VIEWS were 0.727 [95% confidence interval (CI) 0.689–0.765] and 0.756 (95% CI 0.720–0.792) in predicting hospitalization, respectively. The AUCs of the MEWS and VIEWS were 0.891 (95% CI 0.844–0.937) and 0.900 (95% CI 0.860–0.941) in predicting in-hospital mortality, respectively. Conclusion The MEWS and VIEWS are powerful scoring systems that are easy-to-use for predicting the hospitalization and in-hospital mortality of geriatric ED patients.

Microscopic hematuria as a marker of blunt abdominal trauma in rats: description of an experimental model.

BACKGROUND Microscopic hematuria is an extremely important sign in blunt abdominal trauma (BAT) patients. Controversies still exist in the literature on whether microscopic hematuria is a sign of intra-abdominal extrarenal organ injury and is an indication for radiographic assessment of BAT patients. In this study, a new BAT rat model was developed, and we tried to determine the relationships between microscopic hematuria and extrarenal intra-abdominal organ injury. METHODS After verifying our model, lethal and maximal sublethal intensity of impact energy determined in the rats. Animals allocated into six sublethal impact energy groups. BAT was induced by dropping a standard mass from variable heights. After 2 hours of examining period, macroscopic laparotomy findings, histopathological liver, spleen and renal injury grades, and microscopic hematuria levels were recorded in these six groups. RESULTS According to our results, while the trauma intensity increase severity of the histopathological injury increases for all organs. Although there was a significant correlation between microscopic hematuria and trauma intensity, we could not show same relationship between microscopic hematuria and histopathological organ injury. On the other hand, microscopic hematuria was correlated with the macroscopic laparotomy findings. CONCLUSIONS Microscopic hematuria could serve as a predictor of the severity of trauma and intra-abdominal organ injury. This study would support the use of abdominal imaging and attentive assessment for intra-abdominal organ injury in stable BAT patients with hematuria. The laparotomy threshold may be lowered for unstable BAT patients with hematuria.

Secondary Assessment of Life-Threatening Conditions of Older Patients

People aged 65 years and older have higher rate of emergency department (ED) use than other age groups. Critically ill older ED people have specific characteristics. Older patients with life-threatening conditions often present with atypical signs and symptoms unspecific of the altered organ or tissue, and often usual severity criteria are missing. Some symptoms such as delirium, faintness, general malaise, digestive problems, fatigue, balance impairments, or falls can be incorrectly regarded as mild, whereas they are the only sign of a life-threatening condition. Even small initial insults in patients with multisystem deterioration and loss of physiological reserve (frailty) can induce a disabling cascade of adverse effects, called the “domino” effect, which can threaten the life of older patients. Determining whether the older patient is frail, i.e., his (her) medical, psychological, and functional ability to cope with the acute condition, is therefore crucial in older ED patients for optimizing therapeutic options and anticipating treatment adverse effects. Ethical consideration and whether the patient has an advanced directive, health-care power of attorney, or living will on admission are also crucial parts of the assessment of older ED patients. The present chapter displays a model of geriatric secondary assessment adapted to critically ill older ED patients that takes into account the above specificities and particular needs of these patients.

Primary Assessment and Stabilization of Life-Threatening Conditions in Older Patients

Although the main approach to life-threatening conditions in older patients does not differ from younger adults, the evaluation of the severity and the decision to start resuscitation are much more challenging. The clinical presentation of instability and life-threatening situations is often atypical in older patients. When the instability and severity are confirmed, the classical chain of basic and advanced life support recommended by the European and international guidelines must be respected for improving outcomes in older patients. The decision of stopping or not starting resuscitation in older patients should not be taken too quickly just because it is thought that it can appear futile or of a result of advanced age. The decision depends also on patients’ and relatives’ wishes and respects individual patient’s needs for end-of-life care. As in younger people, resuscitation in older patients is appropriate when its likely benefits in term of quantity and quality of life outweigh over its adverse consequences. This is especially important for older patients in continuing care settings, which might potentially divert staff time and resources away from core elements of care.