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    Modified Early Warning Score and VitalPac Early Warning Score in geriatric patients admitted to emergency department
    (Lippincott Williams & Wilkins, 2016) Dundar, Zerrin Defne; Ergin, Mehmet; Karamercan, Mehmet A.; Ayranci, Kursat; Colak, Tamer; Tuncar, Alpay; Cander, Basar
    ObjectiveThe 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 methodsThis 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.ResultsA 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.ConclusionThe MEWS and VIEWS are powerful scoring systems that are easy-to-use for predicting the hospitalization and in-hospital mortality of geriatric ED patients.
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    Rapid Emergency Medicine Score and HOTEL Score in Geriatric Patients Admitted to the Emergency Department
    (Elsevier Taiwan, 2015) Dundar, Zerrin Defne; Karamercan, Mehmet Akif; Ergin, Mehmet; Colak, Tamer; Tuncar, Alpay; Ayranci, Kursat; Kocak, Sedat
    Background: Emergency risk scoring systems have been defined in order to identify the health status of the patients on admission to the emergency department. In this study, we aimed to investigate the prognostic values of Rapid Emergency Medicine Score (REMS), REMS without age and the HOTEL scores in geriatric patients. Methods: This prospective, single-centered, observational study was carried out between the January 15, 2014 February 28, 2014. Patients admitted to the emergency department during the study period and aged 65 years or older were included in the study. Results: In total, 939 patients were included in the study. In predicting the intensive care unit admission, the area under the curve values of the REMS, REMS without age, and HOTEL scores were 0.772, 0.760, and 0.827 (p < 0.001, for all), respectively. The median (interquartile range) REMS and REMS without age scores of the nonsurvivors were statistically significantly higher than those of the survivors [10 (6) vs. 6 (3), 5 (6) vs. 1(2), respectively; p < 0.001 for both]. Similarly, the HOTEL scores of the nonsurvivors were also statistically significantly higher than those of the survivors [2 (1) vs. 1(1), p < 0.001]. In predicting the in-hospital mortality, the area under the curve values of the REMS, REMS without age and HOTEL scores were 0.833, 0.819, and 0.858 (p < 0.001 for all), respectively. Conclusion: The REMS, REMS without age, and the HOTEL scores cannot be efficiently employed to discriminate geriatric patients requiring hospitalization. Nonetheless, all three scores are proper predictive systems regarding intensive care unit admission and in-hospital mortality in geriatric emergency department patients. Copyright (C) 2015, Taiwan Society of Geriatric Emergency & Critical Care Medicine. Published by Elsevier Taiwan LLC. All rights reserved.
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    The role of soluble urokinase plasminogen activator receptor (SuPAR) as an indicator of the severity of acute pancreatitis
    (2018) Küçükceran, Kadir; Ergin, Mehmet; Kılınç, İbrahim; Karaibrahimoğlu, Adnan; Çolak, Tamer; Tuncar, Alpay; Dündar, Zerrin Defne; Koçak, Sedat; Girişgin, Abdullah Sadık; Gül, Mehmet; Cander, Başar
    Background/aim: Soluble urokinase plasminogen activator receptor (suPAR) has been reported to have a positive correlation with theactivation degree of the immune system. This study’s aim is to investigate the efficiency of SuPAR serum levels in acute pancreatitis (AP)patients in determining the severity of disease.Materials and methods: This prospective research involves patients who arrived at the emergency service, were over 18 years old, hadnontraumatic abdominal pain and diagnosis of AP, and agreed to join the study. Demographic characteristics, contact information,laboratory and imaging test parameters, Ranson’s criteria, the Balthazar Severity Index, the Rapid Acute Physiologic Score (RAPS), andthe modified Glasgow (Imrie) score of all patients were recorded. Two study groups were created as score of 3 (mild, Group I) and 3(severe, Group II) for pancreatitis according to Ranson’s criteria.Results: During the study period, 59 sequential patients with AP were included in the study. It was seen that 79.7% of the study group(n 47) were in Group I. Etiologically 67.8% (n 40) cases were biliary and 32.3% (n 19) were nonbiliary diseases. According to theresults, suPAR level was effective in distinguishing the severity of AP (AUC 0.902, P 0.001 (95% CI: 0.821–0.984)). With regardto determining severe disease, suPAR had an optimum cutoff value of 6.815 ng/mL, sensitivity of 91.66%, specificity of 82.97%, andnegative predictive value of 97.5%.Conclusion: Our study was performed the determine the efficiency of suPAR level in predicting severe disease in AP patients. We foundit significant in indicating the severity of disease according to the study results.