Objective: The research aims to identify preoperative factors that prolong surgical time in laparoscopic cholecystectomy (LC) before the procedure and to inform patient and surgeon selection decisions. Materials and Methods: Retrospective cross-sectional review of surgical records was conducted involving 400 LC cases. The patients who had LC are divided into two groups. An operative time of up to 90 minutes was classified as Group I, while a duration exceeding 90 minutes was categorized as Group II. The parameters compared for operative time of surgery are; gender, age, medical co-morbidity, single or multiple stones, previous surgery, gallbladder wall thickness, history of endoscopic retrograde cholangio pancreatography (ERCP) and endoscopic sphincterotomy (ES), laparoscopy performed by a resident or specialist, white blood cell count, and presence of adhesions in the sac site. Results: When patients who had ERCP and/or ES prior to LC in Group I and Group II were compared, preoperative ERCP/ES was associated with prolonged operative time [odds ratio (OR): 2.48; 95% confidence interval (CI): 1.3-4.58; p=0.03]. Additionally, trainee-led procedures increased operative time (OR: 1.85; 95% CI: 1.18-2.88; p=0.02). As a result of statistical analyses, the surgeon’s experience (assistant or specialist) and preoperative ERCP or ES were identified as two key determinants contributing to the extended duration of LC. Conclusion: Preoperative estimation of prolonged operative time before LC facilitates improved surgical, anesthetic, and staffing planning. Preoperative ERCP/ES, (p=0.03) and surgeon inexperience (p=0.05) independently prolonged the operative time (OR: 2.48 and 1.85, respectively). Prioritizing experienced surgeons for such cases optimizes OR scheduling.
Standard spinal immobilization traditionally involving a spinal board and cervical collar, has long been the prehospital standard of care for trauma patients. However, recent studies highlight potential adverse effects, including pain and respiratory impairment. A narrative mini-review was conducted using Medline, Web of Science, Scopus, and Google Scholar. Nine articles published in the last five years were selected, comprising observational studies, literature reviews, and expert consensus documents. The S.T.A.B.I.L.E. protocol emerged as a structured, evidence-based decision-making model for prehospital spinal management. Integrated within the Airway, Breathing, Circulation, Disability, Exposure framework, it supports emergency medical services personnel in assessing whether to apply and, if so, how to apply spinal motion restriction, considering clinical and logistical variables. Compared to traditional protocols such as NEXUS and the Canadian C-Spine Rule, S.T.A.B.I.L.E. emphasizes a broader clinical context-such as respiratory status, hemodynamic stability, and environmental conditions-providing a more pragmatic and patient-centered approach. The protocol may enhance patient safety, reduce unnecessary immobilization, and support clinical decision-making. While the S.T.A.B.I.L.E. protocol represents a promising alternative to traditional immobilization practices, further clinical validation is needed to confirm its efficacy and facilitate its adoption in prehospital trauma care.
Mass casualty incidents require a rapid and coordinated response from medical personnel, where triage is a critical skill. Tabletop exercise training has emerged as an innovative method to enhance triage skills by providing a safe, risk-free environment for scenario-based practice. This systematic review aims to evaluate the effectiveness of tabletop exercise training in improving triage skills among medical personnel. A comprehensive literature search was conducted in March 2024 across the following databases: ScienceDirect, PubMed, Wiley Online Library, and Cochrane. The search strategy included combinations of the following terms: • “Tabletop exercise” AND “triage” • “Tabletop simulation” AND “emergency preparedness” • “Triage training” OR “disaster drill” • “Medical personnel” AND and “simulation-based learning” Boolean operators and or were used to refine the search results. Inclusion criteria covered studies published between 2014 and 2024 involving medical personnel trained in triage. The primary outcomes measured included improvements in triage accuracy, response time, decision-making, and teamwork. Out of 178 articles identified, 10 studies met the inclusion criteria. Findings indicate that tabletop exercises (TTX) significantly improve triage accuracy, reduce response times, and foster better teamwork and communication among healthcare providers. TTX are an effective training method for enhancing triage skills in medical personnel and should be integrated into regular training programs to improve preparedness for real-world emergencies.
Objective: The aim of this study is to evaluate the prognostic value of the C-reactive protein (CRP)/albumin ratio (CAR) compared to the simplified pulmonary embolism severity index (sPESI)in predicting 30-day and 180-day mortality in patients with pulmonary embolism (PE). Materials and Methods: This retrospective cross-sectional study included patients over 18 years of age, diagnosed with PE and admitted to the intensive care or pulmonary diseases departments. The study investigated the relationship between CRP/CAR, sPESI, and clinical outcomes such as 30-day and 180-day mortality, and hospital admissions. Results: Among 111 patients, 17 died within 180 days and 7 within 30 days. While no significant association was found between 30-day mortality and the CRP/CAR or the sPESI the CRP/CAR was significantly higher in those with 180-day mortality (p<0.001). The area under the curve for the CRP/CAR in predicting 180-day mortality was 0.782 (p<0.001), compared to 0.593 for the the sPESI (p=0.224).The DeLong test confirmed the superior predictive performance of the CRP/CAR. Conclusion: This study shows that the CRP/CAR has greater prognostic value than the sPESI in predicting 180-day mortality in PE patients, though no significant association was found for 30-day mortality.
Objective: The objective of this study was to ascertain the effectiveness of the immature granulocyte (IG) count and percentage in diagnosing and discriminating between non-complicated acute appendicitis (NCAA) and complicated acute appendicitis (CAA). Materials and Methods: This study was conducted using data from 244 adult patients who underwent appendectomy. A retrospective assessment of demographic details, preoperative white blood cell (WBC) count, number and percentage of neutrophils, neutrophil-to-lymphocyte ratio (NLR), lymphocyte (LYM) count (IGC), IG count and IG percentage (IG%), operation findings, and pathology results was conducted. Patients diagnosed with acute appendicitis (AA) were categorised as NCAA and CAA according to pathology reports and surgical outcomes. Results: The WBC, NLR, IGC and IG% did not differ significantly (p>0.05) between the CAA and NCAA groups. Conclusion: The findings of this study indicate that AA is statistically more prevalent in the early 30s.The number and percentage of neutrophil counts, NLR, IG in the diagnoses of AA, in conjunction with the elevated number of WBC, prove negligible in differentiating between CAA and NCAA. In the emergency room, examining the hemogram parameters merely reveals that the prediction of complications is rendered meaningless. The study revealed no statistically significant relationship between the groups. Consequently, hemogram parameters (LYM, WBC, NLR, IGC, and IG%) were deemed unreliable for distinguishing between CAA and NCAA.
Objective: Early risk stratification in acute pancreatitis (AP) is essential for guiding clinical decisions in the emergency department (ED). This study aimed to compare the clinical utility of three accessible indicators—Harmless acute pancreatitis score (HAPS), Ranson score, and neutrophil-to-lymphocyte ratio (NLR)—in predicting in-hospital mortality. Materials and Methods: This retrospective cohort study included 347 adult patients (≥18 years) diagnosed with non-traumatic AP between January 2020 and January 2024 at a tertiary care ED. The diagnosis was established using the American College of Gastroenterology criteria. HAPS, Ranson score (based on admission data), and NLR were calculated at initial presentation. Patients with chronic pancreatitis, traumatic etiology, malignancy-related AP, or incomplete data were excluded. Predictive performance for in-hospital mortality was evaluated using receiver operating characteristic analysis and compared using the DeLong test. Results: In-hospital mortality occurred in 35 patients (10.1%). HAPS showed a sensitivity of 82.9%, specificity of 64.7%, and a negative predictive value (NPV) of 97.1%. Ranson score had a sensitivity of 68.6%, specificity of 72.8%, and NPV of 95.4%. NLR ≥4.9 yielded a sensitivity of 82.9%, specificity of 59.9%, and NPV of 96.9%. Area under the curve (AUC) values were 0.757 [95% confidence interval (CI): 0.708-0.801] for HAPS, 0.755 (95% CI: 0.706-0.799) for Ranson, and 0.642 (95% CI: 0.589-0.692) for NLR. No significant difference was observed between HAPS and Ranson (p=0.956), while comparisons involving NLR approached statistical significance. Conclusion: HAPS and Ranson scores demonstrated comparable and superior performance in predicting in-hospital mortality in patients with AP. Due to its simplicity and excellent NPV, HAPS may be particularly useful as a bedside exclusion tool in the emergency setting.
Objective: This study aimed to compare the predictive accuracy of five commonly used clinical scoring systems - albumin, international normalised ratio,altered mental status, systolic blood pressure, age (AIMS65), Charlson Comorbidity Index ≥2, in-hospital onset, albumin <2.5 g/dL, altered mental status, Eastern Cooperative Oncology Group performance status ≥2, and steroid use (CHAMPS), age, blood tests, and comorbidities (ABC), Glasgow-Blatchford score (GBS), and Complete Rockall score (CRS)- in estimating in-hospital mortality among patients presenting with non-variceal upper gastrointestinal bleeding (UGIB). Materials and Methods: This retrospective, single-center observational study included 917 adult patients diagnosed with non-variceal UGIB between January 2020 and January 2025. Clinical data were extracted from electronic medical records. Each patient’s risk scores (AIMS65, CHAMPS, ABC, GBS, and CRS) were calculated based on admission data. The predictive performance of each scoring system for in-hospital mortality was assessed using receiver operating characteristic curve analysis, and area under the curve (AUC) values were compared using the DeLong test. Results: The overall in-hospital mortality rate was 5.2%. AIMS65 demonstrated the highest predictive performance (AUC: 0.815, 95% confidence interval: 0.788-0.840), significantly outperforming GBS (AUC: 0.631, p<0.001) and showing comparable accuracy to CHAMPS (AUC: 0.801, p=0.493). The CHAMPS score also showed good discriminatory power, particularly in high-risk patients. The ABC score (AUC: 0.708) and CRS (AUC: 0.702) demonstrated moderate predictive ability, while GBS had the lowest accuracy. Conclusion: Among the five evaluated scoring systems, AIMS65 exhibited the best performance in predicting in-hospital mortality in non-variceal UGIB patients, followed closely by CHAMPS.
Objective: Cognitive impairment and delirium occur frequently in older emergency department (ED) patients and could be caused by low volume status and acute disease severity. Unfortunately, frail older patients can be difficult to include in clinical trials due to problems with informed consent and the burden of participation. To assess the feasibility and acceptability of obtaining informed consent, cognitive impairment, frailty, volume status and disease severity of older ED patients. Secondly, to assess disease severity and volume status in the patients with or without cognitive impairment and delirium. Materials and Methods: A prospective study including ED patients ≥70 years who were hospitalized with a suspected infection or hip fracture was conducted. We assessed the Modified Early Warning score (MEWS; acute disease severity) and inferior vena cava (IVC) collapsibility with ultrasound; low volume status. Primary outcomes were the feasibility of obtaining informed consent and the experienced burden. Secondary outcomes were cognitive impairment in the ED [4 ‘A’s test (4AT) score] and delirium (Delirium Observation Screening score) on the ward. Results: Health-care professionals found the study feasible, and all 28 included patients experienced no burden. Eighteen of 28 (64%) patients had >50% vena cava inferior-collapsibility, despite fluids being hardly administered. Patients with a 4AT ≥1 had higher MEWS. Nine of 28 (32%) patients developed delirium during hospitalization, of whom 56% had 4AT ≥1 and all had IVC <2.1 cm. Conclusion: The study was feasible and acceptable for health care professionals and older ED patients. Acute disease severity in these patients was associated with impaired cognition, which was highly prevalent in those who developed delirium during hospitalization. Low volume status was also observed in these patients.
Objective: This study aims to evaluate the correlation between pulmonary artery diameter (PAD) measured by computed tomography (CT) and pulmonary artery systolic pressure (PASP) measured by right heart catheterization (RHC) in patients undergoing lung transplantation. Materials and Methods: This retrospective study included 88 patients who underwent lung transplantation at a tertiary hospital in İstanbul between 2013 and 2021. Patients with available data on PASP measured by RHC and PAD measured by CT were included in the analysis. Data obtained from both the preoperative and postoperative periods were analyzed using the Pearson correlation test. Results: The mean age of the 88 patients included in the study was 44.5±13.5 years, and 78.4% were male. The mean PASP measured by RHC was 43.44±14.17 mmHg, while the value measured by echocardiography was 38.08±12.71 mmHg. The mean main PAD value measured by preoperative CT was 3.17±0.52 cm. A higher correlation was observed between PAD and PASP in the preoperative period (r=0.773; p<0.001), while a lower correlation was found in the postoperative period (r=0.575; p<0.001). Conclusion: This study demonstrated a strong correlation between PAD measured by CT and pulmonary arterial pressure measured by RHC, particularly in the preoperative period, in patients undergoing lung transplantation. This finding represents a significant advancement in clinical practice, as it may help reduce complication risks and improve patient comfort.
Objective: Pregnant mortality is one of the important health indicators in the country. In the event of cardiovascular arrest, the necessary interventions should be performed in accordance with the guidelines to increase the chances of survival of both the mother and the fetus. The American Heart Association’s (AHA) constantly updated cardiopulmonary resuscitation (CPR) guidelines guide us in this regard. YouTube is a frequently used video sharing website for obtaining information in the field of health as well as in many other fields. The aim of this study was to evaluate the adequacy of YouTube videos in terms of information content in the approach to pregnant patients experiencing cardiac arrest. Materials and Methods: On February 13, 2024, the terms “cardiopulmonary arrest in a pregnant patient” and “basic life support” were entered into the YouTube search bar. The AHA CPR guideline recommendations for pregnant arrest were used as references. Journal of the American Medical Association (JAMA), Video Power Index, Global Quality Score (GQS), Quality Criteria for Consumer Health Information (DISCERN), and like rate were used as review criteria. Results: A total of 87 videos published in English on YouTube about pregnant arrest were analyzed. Among the videos included in the analysis, 17 videos (45.9%) had a JAMA Score of 3 and GQS Score of 3 12 videos (32.4%) had. AHA CPR guidelines were analyzed. Conclusion: Intervention for pregnant cardiac arrest patients and education on this subject have an important place. As a result of this study, it was concluded that there is not enough information available on YouTube regarding pregnant CPR training. We recommend that videos on pregnant CPR training posted on YouTube be reviewed and supervised by specialized healthcare professionals in accordance with current guidelines.
