Pancreatic necrosis represents one of the most severe complications of acute pancreatitis (AP) and is linked to heightened risks of morbidity and mortality. Early recognition of this condition through simple and widely available biomarkers is particularly important in emergency departments, where immediate access to advanced imaging modalities may be limited. This study evaluated the diagnostic utility of the frontal QRS-T angle along with several inflammatory markers calculated from routine blood tests, including the systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and aggregate index of systemic inflammation (AISI), for predicting the presence of pancreatic necrosis. This retrospective study included adult patients diagnosed with AP in the emergency department between September 2022 and September 2024. Exclusion criteria were applied, and 227 patients were analyzed. Electrocardiographic (ECG) and laboratory data obtained upon admission were compared between patients with and without radiologically confirmed necrosis. Receiver operating characteristic curve analysis and logistic regression models were used to determine the diagnostic performance and independent predictors of necrosis. Pancreatic necrosis was present in 50 patients (22.0%). The frontal QRS-T angle (F-QRS-T) was significantly higher in patients with necrosis (113.64 ± 45.41° vs 54.63 ± 36.27°, P < .001) and showed the strongest predictive performance (area under the curve (AUC) = 0.838, 95% confidence interval (CI): 0.784–0.884), with 58.0% sensitivity and 92.7% specificity at a cutoff of 105°. Inflammatory indices SII (AUC = 0.703), SIRI (AUC = 0.658), and AISI (AUC = 0.809) were also significantly elevated in the necrosis group. In multivariate analysis, the F-QRS-T remained the most significant independent predictor of necrosis (odds ratio = 1.039, 95% CI: 1.024–1.055, P < .001), along with C-reactive protein, SII, SIRI, and AISI. The F-QRS-T and inflammatory indices are promising early markers for predicting pancreatic necrosis in AP. Their utility is particularly valuable in peripheral or resource-limited settings where computed tomography imaging is not readily available or contrast use is contraindicated. Integration of these parameters into a standardized necrosis risk score may aid in timely intervention and improve patient outcomes. Further prospective research is required to confirm and strengthen these observations.

Background: Pediatric head trauma is a common reason for emergency department presentation. Although most children have minor injuries, a small proportion harbor clinically important traumatic brain injuries requiring urgent intervention. Artificial intelligence (AI) may offer structured support in computed tomography (CT) decision making, but evidence regarding the performance of general-purpose large language models in pediatric head trauma remains limited. Objective: To evaluate the association between AI-based cranial CT recommendations and clinically meaningful outcomes in pediatric patients with blunt head trauma and to assess the diagnostic performance and clinical utility of the model. Methods: This retrospective single-center observational study included pediatric patients younger than 18 years with blunt head trauma who underwent cranial CT imaging and had complete outcome data. A general-purpose large language model generated binary CT recommendations (“CT recommended” or “CT not recommended”) using structured clinical information available at the time of emergency department presentation. The primary outcome was a composite adverse clinical outcome defined as the occurrence of at least one of the following: emergency surgical intervention, intensive care unit admission, intubation, neurological sequelae or mortality. Diagnostic performance metrics, calibration analysis and decision curve analysis were performed. Results: A total of 819 pediatric patients were included, and the AI model recommended CT in 530 patients (64.7%). The primary outcome occurred in 143 patients (17.5%) and was significantly more frequent in the CT-recommended group than in the CT-not recommended group (24.5% vs. 4.5%; OR 6.90, 95% CI 3.82–12.45; p < 0.001). Abnormal CT findings, emergency surgery, intubation and neurological sequelae were also significantly more common in patients for whom CT was recommended by the AI system. For the primary outcome, the AI recommendation demonstrated a sensitivity of 90.9%, specificity of 40.8%, positive predictive value of 24.5% and negative predictive value of 95.5%. Calibration analysis showed acceptable agreement between predicted probabilities and observed event rates. Decision curve analysis demonstrated greater net benefit than both the “treat-all” and “treat-none” strategies across a range of threshold probabilities. Conclusions: In this clinically selected cohort of pediatric patients with blunt head trauma who underwent cranial CT imaging, AI-based CT recommendations were strongly associated with adverse clinical outcomes and demonstrated high sensitivity and negative predictive value for identifying children at risk of clinically important events. These findings suggest that, within a clinically selected cohort of children who underwent cranial CT imaging, AI-generated CT recommendations were associated with clinically meaningful outcomes. However, these results should not be interpreted as validation of CT decision making in the broader pediatric head trauma population and require prospective validation in unselected cohorts.

Objective: The objective of this study is to evaluate the diagnostic accuracy of Extended Focused Assessment with Sonography for Trauma (E‐FAST) performed by senior emergency medicine residents compared with computed tomography (CT) in patients with blunt thoracoabdominal trauma. Methods: This prospective observational diagnostic accuracy study was conducted at a Level 1 trauma center between December 2023 and June 2024. Adult patients presenting with isolated blunt thoracoabdominal trauma who underwent both E‐FAST and thoracoabdominal CT were included. E‐FAST examinations were performed at the bedside by senior emergency medicine residents certified in ultrasonography. CT served as the reference standard. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of E‐FAST were calculated. Concordance between E‐FAST and CT findings was analyzed using Fisher's exact test wherever appropriate. Results: A total of 170 patients were analyzed (124 males [72.9%] and mean age: 38.2 ± 14.7 years). E‐FAST demonstrated a sensitivity of 100%, specificity of 98.7%, PPV of 88.2%, and NPV of 100% compared to CT. Concordance between E‐FAST and CT findings was statistically significant for intra‐abdominal free fluid, pneumothorax, and hemothorax ( p < 0.001 for each). No pericardial effusion was detected by either modality. Conclusion: E‐FAST performed by adequately trained emergency medicine residents is a rapid, reliable, and highly accurate diagnostic tool in the initial evaluation of blunt thoracoabdominal trauma. Incorporating E‐FAST into standard trauma assessment protocols can enhance diagnostic efficiency and reduce unnecessary CT utilization.

Objective: Coronary artery bypass grafting (CABG) remains a widely performed surgical intervention for coronary artery disease. Despite advances in perioperative care and preoperative risk stratification, postoperative complications and mortality continue to pose significant clinical challenges. This study aimed to investigate the prognostic value of platelet related parameters specifically, mean platelet volume (MPV) and platelet count (PLT) in predicting postoperative outcomes and 30-day mortality in patients undergoing CABG. Material and Methods: This retrospective, single-center study included 406 adult patients who presented to the emergency department with acute coronary syndrome and subsequently underwent isolated CABG between 2019 and 2023. Demographic characteristics, preoperative EuroSCORE II and logEuroSCORE values, laboratory parameters and echocardiographic findings were recorded. Postoperative outcomes included 30-day mortality, major adverse cardiac events (MACE) and composite poor outcomes. Hematologic and biochemical parameters were analyzed at admission and on postoperative day 30 or the day of death. Associations between these variables and clinical outcomes were assessed using ROC and regression analyses. Results: Among the 406 patients (mean age: 63.5±8.6 years; 76.1% male), the 30-day mortality rate was 4.7%, with MACE and poor outcomes occurring in 9.4% and 10.1% of cases, respectively. Postoperative MPV and PLT were significantly associated with all outcome groups (p

The aim of the study is to evaluate the association between the initial respiratory support modality (high-flow nasal oxygen [HFNO] vs. noninvasive ventilation [NIV]) and 30-day mortality among patients presenting to the emergency department with acute hypercapnic respiratory failure (AHRF). This prospective observational cohort study was conducted in the emergency department of a tertiary care teaching hospital between September 25, 2019, and September 25, 2020. Adult patients with AHRF requiring noninvasive respiratory support were consecutively enrolled. Patients were analyzed according to the respiratory support modality ultimately continued after the early clinical reassessment. The primary outcome was 30-day mortality. A total of 141 patients were included; 71 (50.4%) received HFNO and 70 (49.6%) received NIV. Thirty-day mortality did not differ significantly between the HFNO and NIV groups (29.6 vs. 31.4%; p = 0.956). Similarly, treatment failure requiring invasive mechanical ventilation (52.1 vs. 55.7%; p = 0.795) and ICU admission (69.0 vs. 65.7%; p = 0.812) did not differ significantly between groups. After adjustment for age, sex, baseline pH, baseline PaCO2, and COPD status, the initial respiratory support modality was not independently associated with 30-day mortality (adjusted OR, 1.14; 95% CI, 0.52–2.51) or treatment failure (adjusted OR, 1.36; 95% CI, 0.64–2.86). The adjusted mortality model demonstrated limited discrimination while the treatment failure model showed modest discrimination. In this prospective observational cohort, initial HFNO was not associated with statistically significant differences in 30-day mortality, treatment failure, or ICU admission compared with NIV after adjustment for measured confounders. However, these findings should be interpreted cautiously because of the observational study design, residual confounding, and post-treatment selection bias. Randomized controlled trials are needed to determine the comparative effectiveness of HFNO and NIV in AHRF.