To compare the accuracy of diagnosing appendicitis between emergency medicine residents using the Alvarado score and general surgery residents using ultrasonography and their clinical provision. A total of 358 patients (192 men and 166 women) were admitted to the emergency service with suspected appendicitis. Each patient was evaluated by an emergency medicine resident and then by a general surgeon independently. Age, sex, operational data, diagnosis, and the Alvarado scores were measured. The sensitivity and specificity of the Alvarado score were 95.4% (95% confidence interval 91-99%) and 45.7% (95% confidence interval 37.4-54%), respectively. There was a significant difference between the sexes in the predictive values of a positive test (P=0.045) and a negative test (P=0.02). There was no statistical difference between the emergency medicine residents and general surgery residents in terms of positive and negative predicitive values (P>0.05 each). There was no statistical difference between the emergency medicine residents using the Alvarado score and the general surgery residents in terms of suspecting the diagnosis of appendicitis.

Objective: Falls are a leading cause of traumatic brain injury in older adults, with ground-level falls being the most common mechanism. Despite the increasing use of head computed tomography (CT) in older adults with ground-level falls, there is an ongoing debate regarding the necessity of routine neuroimaging in all cases. The falls decision rule was developed to safely exclude clinically important intracranial bleeding without head CT in older adults. This study aims to validate the falls decision rule externally and assess its accuracy in identifying low-risk patients while reducing unnecessary imaging. Methods: This prospective cohort study at a Level-1 trauma center enrolled consecutive patients aged ≥ 65 years presenting within 48 h of a ground-level fall. Patient management, including the decision to perform head CT, was determined independently by the treating emergency physician. Patients were followed up for 42 days to identify clinically important intracranial bleeding cases. The rule’s diagnostic performance was evaluated using sensitivity, specificity, and predictive values using 95% confidence intervals (CI). Results: A total of 800 patients were included, with a median age of 78 years (IQR 72–85), and 59.9% were female. Clinically important intracranial bleeding was identified in 6.1% (n = 49) of patients. Head CT was performed in 67.6% of cases, identifying 43 initial hemorrhages, with six additional cases detected during follow-ups. The falls decision rule demonstrated 97.9% sensitivity (95% CI 89.1–99.9), 31.9% specificity (95% CI 28.6–35.4), and 99.5% negative predictive value (95% CI 97.1–99.9), potentially reducing CTs by one-third. Conclusion: This validation confirms the falls decision rule’s high sensitivity and negative predictive value for identifying low-risk older adults after ground-level falls, potentially reducing unnecessary CT scans by approximately one-third. This approach could alleviate ED overcrowding and resource strain while ensuring diagnostic safety.

Background. The “grayanotoxin (mad honey)” poisoning is not known commonly, there are some case series and case reports in the medical literature about it, especially in Turkey. The aim of this study was to describe the presentation of 21 natural honey intoxication cases and to review the literature. Material and Method. This study is retrospective analysis of twenty one patients who were admitted to the emergency department due to honey poisoning. Results. Median age of 21 patients was 55. The mean length of delay after consumption is 3.4 hrs. Dizziness, weakness, excessive perspiration, nausea-vomiting, and low blood pressure were the most observed symptoms. Mean pulse rate was 56/min. Mean systolic blood pressure was 102 mmHg. The mean length of hospital stay is 14.7 hrs. Patient rhytms on arrival were as follows: 10 patients were in normal sinus rhytm, 7 sinus bradycardia, 3 nodal rhytm, 1 atrial fibrillation. Atropine was given to 18 patients. None of our patients died and all were discharged home without any complication. Discussion. In the emergency setting, poisoning is a clinical state which is very hard to identify. We have to keep in mind that drugs and toxins may cause lethal dysrhythmias.

Objective/Aim: We aimed to evaluate the diagnostic utility of the widely used left ventricular hypertrophy (LVH) electrocardiography (ECG) criteria (Cornell Voltage Criteria [CVC], Sokolow-Lyon Index [SLI], Romhilt-Estes [REC], and Peguero-Lo Presti [PLP] Criteria) compared with the left ventricular mass measured by echocardiography. Methods: In this prospective diagnostic accuracy study, we screened all consecutive adults (18 to 65 years) who presented to our academic emergency department (ED) with increased blood pressure (≥130/85 mmHg) between January 2016 and January 2017, and we enrolled a convenience sample of 165 patients in our study. The attending emergency physician managed all patients as per their primary complaint. The consulting cardiologist performed a transthoracic echocardiogram (TTE) of the patient and calculated the left ventricular mass (LVM) according to the American Society of Echocardiography (ASE) formula. After completing the patient recruitment phase, researchers evaluated all ECGs and calculated scores for SLI, CVC, REC, and PLP. We used contingency tables to calculate the diagnostic utility metrics of all ECG criteria. Results: The prevalence of LVH by TTE was 31.5%. CVC, SLI, REC, and PLP criteria correctly identified (true positive rate) abnormal LVM in only 3.9%, 1.9%, 9.6%, and 19.2% of the patients, respectively. CVC, SLI, REC score and PLP criteria performed poorly with extremely low sensitivities (3.9%, 1.9%, 10%, 19.2%) and poor accuracies (67.3%, 64.9%, 57.7%, 69.7%). Conclusion: ECG voltage criteria's clinical utility in estimating LVM and LVH is low, and it should not be used for this purpose.