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Öğe Blood urea nitrogen to albumin ratio is a predictor of in-hospital mortality in older emergency department patients(W B Saunders Co-Elsevier Inc, 2021) Dundar, Zerrin Defne; Kucukceran, Kadir; Ayranci, Mustafa KursatIntroduction: In this study, we aimed to evaluate the first measured blood urea nitrogen (BUN)/albumin ratio in the emergency department (ED) as a predictor of in-hospital mortality in older ED patients. Methods: This retrospective observational study was conducted at a university hospital ED. Consecutive patients aged 65 and over who visited the ED in a three-month period were included in the study. The BUN, albumin, creatinine, and estimated glomerular filtration rate (eGFR) of patients were recorded. The primary end point of the study was in-hospital mortality. Results: A total of 1253 patients were included in the statistical analyses of the study. Non-survivors had increased BUN levels (32.9 (23.3-55.4) vs. 20.2 (15.4-28.3) mg/dL, p < 0.001), decreased albumin levels (3.27 (2.74-3.75) vs. 3.96 (3.52-4.25) g/dL, p < 0.001), and increased BUN/albumin ratios (10.19 (6.56-18.94) vs. 5.21 (3.88-7.72) mg/g, p < 0.001) compared to survivors. An increased BUN/albumin ratio was a powerful predictor of in-hospital mortality with an area under the curve of 0.793 (95% CI: 0.753-0.833). Malignancy (OR: 2.39; 95% CI: 1.59-3.74, p < 0.001), albumin level < 3.5 g/dL (OR: 2.75; 95% CI: 1.74-4.36, p < 0.001), and BUN/albumin ratio > 6.25 (OR: 2.82; 95% CI: 1.22-6.50, p < 0.015) were found to be independent predictors of in-hospital mortality in older ED patients. Conclusion: According to our findings, older patients with a BUN level > 23 mg/dL, an albumin level < 3.5 g/dL, and a BUN/albumin ratio > 6.25 mg/g in the ED have a higher risk of in-hospital mortality. Additionally, the BUN/albumin ratio is a more powerful independent predictor of in-hospital mortality than the BUN level, albumin level, creatinine level, and eGFR in older ED patients. (c) 2020 Elsevier Inc. All rights reserved.Öğe Comparison of cardiopulmonary resuscitation that applied synchronous 30 compressions-2 ventilations with that applied asynchronous 110/min compression-10/min ventilation: A mannequin study(Sage Publications Ltd, 2023) Kucukceran, Kadir; Ayranci, Mustafa Kursat; Dundar, Zerrin DefneBackground: CPR model of a resuscitation to be ventilated with a bag valve mask constitutes a discussion when evaluated with the current guidance. Objective: This study aims to compare the synchronous (30-2) ventilation-compression method with asynchronous 110/min compression-10/min ventilation in cardiac arrests where an advanced airway management is not applied and where ventilation is provided by a bag valve mask on a mannequin. Methods: This simulation trial was performed using two clinical cardiopulmonary resuscitation scenarios: an asynchronous scenario with 10 ventilations per minute asynchronously when compression is applied as 110 compression per minute and a synchronous scenario in which 30 compressions:2 ventilations were performed synchronously. A total of 100 people in 50 groups applied these two scenarios on mannequin. Ventilation and compression data of both scenarios were recorded. Results: Evaluating the compression criteria in both the scenarios performed by 50 groups in total, in terms of all criteria except compression fraction, there was no statistically difference between the two scenarios (p > 0.05). Compression fraction values in the asynchronous scenario were found to be statistically significantly higher than the synchronous scenario (96.02 +/- 2.35, 81.34 +/- 4.42, p < 0.001). Evaluating the ventilation criteria in both the scenarios performed by 50 groups in total; there was a statistically significant difference in all criteria. Mean ventilation rate of the asynchronous scenario was statistically higher than the synchronous scenario (7.22 +/- 2.42, 5.08 +/- 0.75, p < 0.001). Mean ventilation volume of the synchronous scenario was statistically higher than the asynchronous scenario (353.24 +/- 45.46, 527.40 +/- 96.60, p < 0.001). Ventilation ratio in sufficient volume of the synchronous scenario was statistically higher than the asynchronous scenario (36.84 +/- 14.47, 75.00 +/- 21.24, p < 0.001). Ventilation ratio below the minimum volume limit of the asynchronous scenario was statistically higher than the synchronous scenario (62.48 +/- 14.72, 17.86 +/- 19.50, p < 0.001). Conclusion: In our study, we concluded that the cardiopulmonary resuscitation applied by the synchronous method reached better ventilation volumes. Evaluating together with any interruption in compression, comprehensive studies are needed to reveal which patients would benefit from this result.Öğe Comparison of Emergency Department Patient Visits One Year Before and After the Star of the COVID-19 Pandemic(Erciyes Univ Sch Medicine, 2022) Kucukceran, Kadir; Ayranci, Mustafa Kursat; Girisgin, Abdullah Sadik; Kocak, Sedat; Dundar, Zerrin DefneObjective: Planning for emergency department (ED) services based on epidemiological data is essential. This study retrospectively examined ED patient presentations at a tertiary hospital 1 year before and 1 year after the start of the coronavirus 2019 (COVID-2019) pandemic to assist with planning efforts. Materials and Methods: The study period was March 1, 2019 to February 28, 2021. The patient cases were separated into 2 groups using a reference date of March 2020. The period between March 1, 2019 and February 29, 2020 was defined as the pre-COVID period, or ordinary circumstances, and the period between March 1, 2020 and February 28, 2021 was defined as the period following the COVID-19 outbreak, which reflected extraordinary conditions. The primary outcome was the difference in the number of patients and the mortality rate between groups. Results: A total of 74,063 (62%) people presented at the ED in the pre-COVID period, and there were 45,397 (38%) ED visits in the post-COVID period. The median daily number of patients seen in the pre-COVID period was significantly higher than that of the post-COVID period (200.5 [181-219.25] vs. 123 [103.5-139], respectively [p<0.001]). The in-hospital mortality rate and the hospitalization rate in the post-COVID period were significantly higher than in the pre-COVID period (in-hospital mortality rate: 1105 [2.4%], 852 [1.2%], [p<0.001]; hospitalization rate: 9404 [20.7%], 9019 [12.2%], [p<0.001]). Conclusion: Although the number of patients presenting at the ED decreased in the period after the outbreak of COVID-19, the number of those who died increased. While the number of hospitalized patients was similar between the 2 groups, the hospitalization rate was greater in the post-COVID period. This information and additional detailed study may prove useful to ED planning efforts.Öğe Comparison of Emergency Department Patient Visits One Year Before and After the Star of the COVID-19 Pandemic(Erciyes Univ Sch Medicine, 2022) Kucukceran, Kadir; Ayranci, Mustafa Kursat; Girisgin, Abdullah Sadik; Kocak, Sedat; Dundar, Zerrin DefneObjective: Planning for emergency department (ED) services based on epidemiological data is essential. This study retrospectively examined ED patient presentations at a tertiary hospital 1 year before and 1 year after the start of the coronavirus 2019 (COVID-2019) pandemic to assist with planning efforts. Materials and Methods: The study period was March 1, 2019 to February 28, 2021. The patient cases were separated into 2 groups using a reference date of March 2020. The period between March 1, 2019 and February 29, 2020 was defined as the pre-COVID period, or ordinary circumstances, and the period between March 1, 2020 and February 28, 2021 was defined as the period following the COVID-19 outbreak, which reflected extraordinary conditions. The primary outcome was the difference in the number of patients and the mortality rate between groups. Results: A total of 74,063 (62%) people presented at the ED in the pre-COVID period, and there were 45,397 (38%) ED visits in the post-COVID period. The median daily number of patients seen in the pre-COVID period was significantly higher than that of the post-COVID period (200.5 [181-219.25] vs. 123 [103.5-139], respectively [p<0.001]). The in-hospital mortality rate and the hospitalization rate in the post-COVID period were significantly higher than in the pre-COVID period (in-hospital mortality rate: 1105 [2.4%], 852 [1.2%], [p<0.001]; hospitalization rate: 9404 [20.7%], 9019 [12.2%], [p<0.001]). Conclusion: Although the number of patients presenting at the ED decreased in the period after the outbreak of COVID-19, the number of those who died increased. While the number of hospitalized patients was similar between the 2 groups, the hospitalization rate was greater in the post-COVID period. This information and additional detailed study may prove useful to ED planning efforts.Öğe Comparison of Endotracheal Intubations Performed With Direct Laryngoscopy and Video Laryngoscopy Scenarios With and Without Compression: A Manikin-Simulated Study(Taiwan Soc Emergency Medicine, 2021) Ayranci, Mustafa Kursat; Kucukceran, Kadir; Dundar, Zerrin DefneBackground: In the International Liaison Committee on Resuscitation 2019 update, it is recommended that endotracheal intubation (ETI) implementation trainings be held more frequently. There is limited data in the current literature on the comparison of cardiopulmonary resuscitation performance using direct laryngoscopy (DL) and video laryngoscopy (VL) by new ETI operators. The aim of this study was to compare the intubation period of intubations operated with DL and VL for the scenarios with and without compression and to assess the performance criteria of compression and ventilation in a manikin-simulated scenario with compression, for the experienced and new ETI operators. Methods: This manikin trial was carried out through a total of four scenarios, two of which were elective intubation and the other two were intubations with compression. A total of 90 people in 45 groups (each group consists of 2 persons) performed four scenarios in the manikin. Ventilation and compression performance data of the scenarios were recorded. Results: A signifi cant difference was found between the scenarios in terms of intubation period and VL in both scenarios with and without compression (in scenarios with compression, DL: 23.21 +/- 11.33, VL: 17.06 +/- 4.71, p < 0.001; in scenarios without compression, DL: 19.40 +/- 8.03, VL: 15.04 +/- 3.31, p < 0.001). In intubation interventions with and without compression, the success rate of DL in the second intervention was more statistically signifi cant compared to VL (p = 0.008 andp = 0.011). In the intubation scenarios with compression, the intubation success rates of the new operators were lower than the experienced participants, and it was statistically signifi cant (p = 0.009). Conclusions: During intubation interventions with and without compression, in terms of the success rate after the first attempt and ensuring adequate airway management, VL was found to be more effective. In all intubation attempts, especially in compression intubations, new operators should be encouraged especially for using VL (at least until they have suffi cient experience).Öğe The Effect of a Pandemic on Computed Tomography Pulmonary Angiography Results and Utilize in the Emergency Department(Marmara Univ, Inst Health Sciences, 2022) Kucukceran, Kadir; Ayranci, Mustafa KursatObjective: The incidence of pulmonary embolism (PE) increases with COVID-19. With the pandemic, changes occur in the utilization of computed tomography pulmonary angiography (CTPA), which we use in the diagnosis of PE. In our study, we investigated the impact of the pandemic on the utilized and result of CTPA. Methods: Patients over the age of 18 who applied to the emergency department between 01.03.2019 and 28.02.2021 and underwent CTPA was included in this retrospective study. Patients were separated to two groups based on the date of the first case. CTPA result and Polymerase chain reaction (PCR) positivity status were recorded. Data were compared between groups. Results: While 757(1.022%) out of 74,063 patients underwent CTPA in the pre-pandemic period, 649(1.430%) out of 45,397 patients underwent CTPA in the during-pandemic period. The PE rate in patients who underwent CTPA in the during-pandemic period was statistically significantly higher compared to the pre-pandemic period (pre-pandemic: 89(11.9%), during-pandemic: 122(19%), p<0.001). In the during-pandemic period, there was no statistically significant difference in the rate of PCR positivity in any time in patients with PE detected as a result of CTPA compared to patients without PE (PE: 14(11.5%), non-PE: 54(10.4%), p=0.725). Conclusion: Higher rate of CTPA shoot was obtained in the during-pandemic period compared to the pre-pandemic period. Additionally, the rate of PE detection among patients who underwent CTPA was statistically significantly higher in the during-pandemic period compared to the pre-pandemic period.Öğe The Impact of Body Mass Index Values on the Quality of Cardiopulmonary Resuscitation: A Manikin Study(Marmara Univ, Inst Health Sciences, 2021) Kucukceran, Kadir; Ayranci, Mustafa Kursat; Ozer, Muhammet RasitObjective: The purpose of this study is to assess the impact of body mass index (BMI) on the quality of cardiopulmonary resuscitation (CPR) by using a manikin. Methods: 50 people composed of research assistants, intern doctors, emergency medical technicians and nurses who had previous cardiopulmonary resuscitation experience performed CPR on Laerdal Skillmeter Resusci-Anne (R) with SimPad manikin during the study. BMI data of participants were recorded and then the participanst were categorised as BMI <21 and BMI >21. Compression data obtained from the summary section of SimPAD QCPR were compared with the participants BMI values. Results: 18 (36%) out of 50 participants were male, while 32 (64%) were female. 16 (32%) out of 50 participants were in the slim group, while 34 (68%) were in the normal group. Mean age of participants was calculated as 26.8 +/- 4.2, and mean BMI as 22.56 +/- 3.32. Mean compression depth in the slim group was significantly lower in comparison to the normal group (slim51.94 +/- 4.64, normal 55.79 +/- 4.35, p=0.006). Compression ratiowith sufficient depth in the slim group was statistically lower than the normal group (slim 66.19 +/- 25.79, normal 87.29 +/- 19.36, p=0.002). A statistically significant positive correlation was found in the lineer regression analysis conducted between mean compression depth and BMI (r2:0.179, p=0.002). Moreover, a significant positive correlation was observed in the pearson correlation analysis of mean compression depth and BMI (r: 0.423, p=0.002). Conclusion: As a result, it was found out that low BMI values are associated with low mean compression depth.Öğe NLR and CRP to albumin ratio as a predictor of in-hospital mortality in the geriatric ED patients(W B Saunders Co-Elsevier Inc, 2021) Ayranci, Mustafa Kursat; Kucukceran, Kadir; Dundar, Zerrin DefneIntroduction: We aimed to investigate the role of neutrophil to lymphocyte ratio (NLR) and the C-Reactive Protein/Albumin Ratio (CAR), which are obtained from the first laboratory values of the elderly patients at admission to the emergency department (ED), in predicting in-hospital mortality. Methods: This retrospective observational study includes the patients aged 65 and above who applied to the emergency department for two months. The patients' neutrophil, lymphocyte, C-reactive protein (CRP), albumin, NLR and CAR values were recorded. Statistical analysis of NLR and CAR values was performed according to in hospital mortality and ED outcome. Results: 784 patients were included in the statistical analysis of the study. Increased NLR (8.82 (4.16-16.63), 4.76 (2.62-8.56), p<0.001) and increased CAR (21.39 (6.02-55.07), 4.82 (1.17-17.03), p < 0.001) values were found to be statistically significant in the group with mortality compared to the group without mortality. Increased NLR (AUC: 0.642) and increased CAR (AUC: 0.723) were a predictor of in-hospital mortality. It was found that in hospital mortality risk in patients with concurrent high NLR and CAR values (CAR'12.3, NLR'7.1) was 9.87 times more than the patients with concurrent low NLR and CAR values (CAR<12.3, NLR < 7.1). NLR and CAR values of the patients hospitalized in intensive care and service (NLR 7.21 (4.07-13.36), 5.77 (3.45-11.22); CAR 12.65 (2.79-36.8), 9.56 (1.74-33.97)) were found to be statistically significantly higher than those who were discharged (NLR 3.64 (2.26-7.02); CAR 2.88 (0.9-10.59)). Conclusion: According to our results, the concurrent high levels of NLR and CAR values were found to be more effective in predicting in-hospital mortality compared to a separate evaluation. (c) 2021 Elsevier Inc. All rights reserved.Öğe Predictive value of D-dimer/albumin ratio and fibrinogen/albumin ratio for in-hospital mortality in patients with COVID-19(Wiley-Hindawi, 2021) Kucukceran, Kadir; Ayranci, Mustafa Kursat; Girisgin, Abdullah Sadik; Kocak, SedatIntroduction Due to the high mortality of coronavirus disease 2019 (COVID-19), there are difficulties in the managing emergency department. We investigated whether the D-dimer/albumin ratio (DAR) and fibrinogen/albumin ratio (FAR) predict mortality in the COVID-19 patients. Methods A total of 717 COVID-19 patients who were brought to the emergency department from March to October 2020 were included in the study. Levels of D-dimer, fibrinogen and albumin, as well as DAR, FAR, age, gender and in-hospital mortality status of the patients, were recorded. The patients were grouped by in-hospital mortality. Statistical comparison was conducted between the groups. Results Of the patients included in the study, 371 (51.7%) were male, and their median age was 64 years (50-74). There was in-hospital mortality in 126 (17.6%) patients. The area under the curve (AUC) and odds ratio values obtained by DAR to predict in-hospital mortality were higher than the values obtained by the all other parameters (AUC of DAR, albumin, D-dimer, FAR and fibrinogen: 0.773, 0.766, 0.757, 0.703 and 0.637, respectively; odds ratio of DAR > 56.36, albumin < 4.015, D-dimer > 292.5, FAR > 112.33 and fibrinogen > 423:7.898, 6.216, 6.058, 4.437 and 2.794, respectively). In addition; patients with concurrent DAR > 56.36 and FAR > 112.33 had an odds ratio of 21.879 with respect to patients with concurrent DAR < 56.36 and FAR < 112.33. Conclusion DAR may be used as a new marker to predict mortality in COVID-19 patients. In addition, the concurrent high DARs and FARs were found to be more valuable in predicting in-hospital mortality than either separately.Öğe The Role of NEWS2(Taiwan Soc Emergency Medicine, 2022) Kucukceran, Kadir; Ayranci, Mustafa Kursat; Dundar, Zerrin Defne; Keklik, Muhammed Idris; Vatansev, HulyaBackground: We investigated the parameters of National Early Warning Score 2 (NEWS2) + lactate + D-dimer in predicting the intensive care unit (ICU) admission and in-hospital mortality in patients hospitalized with COVID-19. Methods: Patients, who applied to the emergency department of a tertiary university hospital and were taken to the COVID-19 zone with suspected COVID-19 between March 2020 and June 2020, were retrospectively examined. In this study, 244 patients, who were hospitalized and had positive polymerase chain reaction test results, were included. NEWS2, lactate, and D-dimer levels of the patients were recorded. Patients were grouped by the states of in-hospital mortality and ICU admission. Results: Of 244 patients who were included in the study, 122 (50%) were male, while their mean age was 53.76 +/- 17.36 years. 28 (11.5%) patients were admitted to the ICU, while in-hospital mortality was seen in 14 (5.7%) patients. The levels of D-dimer, NEWS2, NEWS2 + lactate, NEWS2 + D-dimer, NEWS2 + lactate + D-dimer were statistically signifi cantly higher in patients with in-hospital mortality and admitted to ICU (p < 0.05). The area under the curve (AUC) values of D-dimer, lactate, NEWS2, NEWS2 + lactate, NEWS2 + D-dimer, NEWS2 + lactate + D-dimer in predicting ICU admission were as 0.745 (0.658-0.832), 0.589 (0.469-0.710), 0.760 (0.675-0.845), 0.774 (0.690-0.859), 0.776 (0.692-0.860), and 0.778 (0.694-0.862), respectively; while the AUC values of these parameters in predicting in-hospital mortality were found to be as 0.768 (0.671-0.865), 0.695 (0.563-0.827), 0.735 (0.634-0.836), 0.757 (0.647-0.867), 0.752 (0.656-0.848), and 0.764 (0.655-0.873), respectively. Conclusions: Compared to using the NEWS2 value alone, a combination of NEWS2, lactate, and D-dimer was found to be more valuable in predicting in-hospital mortality and ICU admission.Öğe The role of serum lactate levels in predicting abdominal surgery in geriatric patients who had computed tomography(Marmara Univ, Fac Medicine, 2021) Kucukceran, Kadir; Ayranci, Mustafa KursatObjective: We investigated the importance of serum lactate levels in making decision regarding abdominal surgery in elderly patients who underwent computed tomography . Patients and Methods: Patients over 65 years of age who presented to the emergency department of a tertiary teaching hospital in 2019 were scanned within the hospital data processing system according to the criteria of tomography of the abdomen. Patients' age, gender, lactate levels, the medical reason for their visit, pathological condition of abdominal computed tomography (aCT), a recommendation of emergent surgery, mortality status, and length of stay in the hospital were collected. The patients were divided into four groups according to surgery recommendation and pathologic status in aCT. Results: Of the 356 patients who were included in the study, 194 (54.5%) were male. The mean age of the participants was 77.1 +/- 7.82 years, and their mean lactate level was 2.59 +/- 2.41 mmol/liter. Lactate values were statistically significant according to ROC analysis that predict the state of surgery recommendation (AUC:0.796, p<0.001). There was a statistically significant difference in lactate values between the groups (1.78 +/- 1.46, 3.19 +/- 2.71, 4.44 +/- 3.22, I-II p<0.001, I-III p<0.001, II-III p=0.002). Conclusion: In geriatric patients, the aCT results and lactate levels were found to be reliable in deciding to eliminate abdominal surgery.Öğe The role of the BUN/albumin ratio in predicting mortality in COVID-19 patients in the emergency department(W B Saunders Co-Elsevier Inc, 2021) Kucukceran, Kadir; Ayranci, Mustafa Kursat; Girisgin, Abdullah Sadik; Kocak, Sedat; Dundar, Zerrin DefneIntroduction: Due to the high mortality and spread rates of coronavirus disease 2019 (COVID-19), there are currently serious challenges in emergency department management. As such, we investigated whether the blood urea nitrogen (BUN)/albumin ratio (BAR) predicts mortality in the COVID-19 patients in the emergency department. Methods: A total of 602 COVID-19 patients who were brought to the emergency department within the period from March to September 2020 were included in the study. The BUN level, albumin level, BAR, age, gender, and in-hospital mortality status of the patients were recorded. The patients were grouped by in-hospital mortality. Statistical comparison was conducted between the groups. Results: Of the patients who were included in the study, 312(51.8%) were male, and their median age was 63 years (49-73). There was in-hospital mortality in 96(15.9%) patients. The median BUN and BAR values of the patients in the non-survivor group were significantly higher than those in the survivor group (BUN: 24.76 [17.38-38.31] and 14.43 [10.84-20.42], respectively [p < 0.001]; BAR: 6.7 [4.7-10.1] and 3.4 [2.5-5.2], respectively [p < 0.001]). The mean albumin value in the non-survivor group was significantly lower than that in the survivor group (3.60 +/- 0.58 and 4.13 +/- 0.51, respectively; p < 0.001). The area-under-the-curve (AUC) and odds ratio values obtained by BAR to predict in-hospital COVID-19 mortality were higher than the values obtained by BUN and albumin (AUC of BAR, BUN, and albumin: 0.809, 0.771, and 0.765, respectively; odds ratio of BAR>3.9, BUN>16.05, and albumin<4.01: 10.448, 7.048, and 6.482, respectively). Conclusion: The BUN, albumin, and BAR levels were found to be reliable predictors of in-hospital mortality in COVID-19 patients, but BAR was found to be a more reliable predictor than the BUN and albumin levels. (c) 2021 Elsevier Inc. All rights reserved.Öğe Roles of CRP and Neutrophil-to-Lymphocyte Ratio in the Prediction of Readmission of COVID-19 Patients Discharged From the ED(Taiwan Soc Emergency Medicine, 2022) Avci, Ali; Ozer, Muhammet Rasit; Kucukceran, Kadir; Yurdakul, Mehmet SerkanBackground: Patient admissions beyond the capacity of emergency departments (EDs) have been reported since the coronavirus disease (COVID-19) pandemic. Thus, laboratory parameters to predict the readmission of patients discharged from the ED are needed. For this purpose, we investigated whether C-reactive protein (CRP) level and neutrophil-to-lymphocyte ratio (NLR) could predict the readmission of patients with COVID-19. Methods: Patients aged >18 years who visited the ED in October 2020 and had positive polymerase chain reaction test results were evaluated. Among these patients, those who were not hospitalized and were discharged from the ED on the same day were included in the study. The patients' readmission status within 14 days after discharge, age, sex, complaint on admission, comorbidity, systolic blood pressure, diastolic blood pressure, fever, pulse, oxygen saturation level, CRP level, blood urea nitrogen level, creatinine level, neutrophil count, lymphocyte count, and NLR were recorded. Data were compared between the groups. Results: Of the 779 patients who were included in the study, 359 (46.1%) were male. The median age was 41 years (range, 31-53 years). Among these patients, those who were not hospitalized and were discharged from the ED on logistic regression analysis, age, CRP level, NLR, loss of smell and taste, and hypertension had odds ratios of 2.494, 2.207, 1.803, 0.341, and 1.879, respectively. Conclusions: The strongest independent predictor of readmission within 14 days after same-day ED discharge was age > 50 years. In addition, CRP level and NLR were the laboratory parameters identifi ed as independent predictors of ED readmission.
