Artificial intelligence (AI) has shown promise in generating multiple-choice questions (MCQs) for medical education, yet the psychometric quality of such items remains underexplored. This study aimed to compare the psychometric properties of MCQs created by ChatGPT-4o and those written by emergency medicine clinicians. Eighteen emergency medicine residents completed a 100-item examination comprising 50 AI-generated and 50 clinician-authored questions across core emergency medicine topics. Each item was analyzed for difficulty (P_index), discrimination (D_index), and point-biserial correlation (PBCC). Items were also categorized based on standardized index classifications. ChatGPT-4o-generated questions exhibited a higher mean difficulty index (P_index: 0.76 ± 0.23) compared to those created by clinicians (0.65 ± 0.24; p = 0.02), indicating that the AI-generated items were generally easier. Participants achieved significantly higher scores on AI-generated items (76.8 ± 8.18) than on clinician-authored questions (67.3 ± 9.65; p = 0.003). The mean discrimination index did not differ significantly between AI-generated (0.172 ± 0.23) and clinician-generated items (0.196 ± 0.26; p = 0.634). Likewise, the mean point-biserial correlation coefficient (PBCC) was nearly identical between the two groups (AI: 0.23 ± 0.28; clinicians: 0.23 ± 0.25; p = 0.99), suggesting similar internal consistency. Categorical analysis revealed that 56% of AI-generated items were classified as “easy,” compared to 36% of clinician-designed items. Furthermore, based on PBCC values, 36% of AI-generated items and 24% of clinician items were identified as “problematic” (p = 0.015), indicating a higher rate of psychometric concerns among AI-generated questions. The findings suggest that AI-generated questions, while generally easier and associated with higher participant scores, may pose psychometric limitations, as evidenced by a greater proportion of items classified as problematic. Although the overall internal consistency and discrimination indices were comparable to clinician-authored items, careful quality control and validation are essential when integrating AI-generated content into assessment frameworks.

Background: Gastrointestinal (GI) bleeding is a common and potentially life-threatening condition frequently encountered in emergency departments (EDs). The optimal strategy for red blood cell suspension (RBCS) transfusion, including timing and location, remains unclear. This study aimed to evaluate the impact of transfusion location (ED vs. inpatient units) on mortality and hospital stay in patients with GI bleeding. Methods: A cross-sectional descriptive study was conducted in the ED of a tertiary care hospital. Patients admitted with GI bleeding between 1 June 2021, and 1 June 2023, who received RBCS transfusion were included. Data on demographics, laboratory parameters, transfusion details, and clinical outcomes were collected from the hospital information system. Logistic regression was used to identify mortality predictors. Results: A total of 244 patients were included. Patients transfused in the ED had a significantly shorter hospital stay compared to those transfused in inpatient units. However, mortality did not differ between the groups. Logistic regression identified age, albumin, hemoglobin, creatinine, and hospital stay as independent mortality predictors, while transfusion location was not significant. Conclusions: Early RBCS transfusion in the ED may reduce hospital stay but does not significantly impact mortality. Identifying mortality-associated factors is crucial for optimizing patient management. Further prospective studies are needed to clarify the role of transfusion location in GI bleeding outcomes.

Background: Gastrointestinal (GI) bleeding is a common and potentially life-threatening condition frequently encountered in emergency departments (EDs). The optimal strategy for red blood cell suspension (RBCS) transfusion, including timing and location, remains unclear. This study aimed to evaluate the impact of transfusion location (ED vs. inpatient units) on mortality and hospital stay in GI bleeding patients. Methods: A cross-sectional descriptive study was conducted in the ED of a tertiary care hospital. Patients admitted with GI bleeding between June 1, 2021, and June 1, 2023, who received RBCS transfusion were included. Data on demographics, laboratory parameters, transfusion details, and clinical outcomes were collected from the hospital information system. Logistic regression was used to identify mortality predictors. Results: A total of 244 patients were included. Patients transfused in the ED had a significantly shorter hospital stay compared to those transfused in inpatient units. However, mortality did not differ between groups. Logistic regression identified age, albumin, hemoglobin, creatinine, and hospital stay as independent mortality predictors, while transfusion location was not significant. Conclusions: Early RBCS transfusion in the ED may reduce hospital stay but does not significantly impact mortality. Identifying mortality-associated factors is crucial for optimizing patient management. Further prospective studies are needed to clarify the role of transfusion location in GI bleeding outcomes.

INTRODUCTION: Despite the declining clinical importance of Coronavirus Disease 2019 (COVID-19), the virus is still causes mortality in the critically ill patients. This study aims to determine the impact COVID-19 on mortality, evaluate the performance of Acute Physiology and Chronic Health Evaluation-2 Scores (APACHE II), Sequential Organ Failure Assessment Scores (SOFA) and Pneumonia Severity Index (PSI) for mortality prediction in the COVID-19 suspected patients. MATERIALS AND METHODS: This study is a retrospective cross-sectional analysis of patients who were admitted to the pandemic intensive care unit with possible COVID-19. 28-day mortality difference between positive and negative groups was defined as the primary outcome. RESULTS: Of the 397 patients, 111 (28 %) patients had positive polymerase chain reaction (PCR). 75 (67.6 %) patients deceased in the PCR positive group while 163 (57.0 %) patients deceased in the negative group (p > 0,05). The median values of APACHE II, SOFA and PSI scores were significantly higher in the deceased group, for all patients. Cutoff points were determined for APACHE II score at 19 (AUC 0,96, PLR 14, 16, NLR 0,12), SOFA score at 9 (AUC 0,96, PLR 20,23, NLR 0,11) and PSI score at 81 points (AUC 0,91, PLR 7,01, NLR 0,23). The AUCs of PSI was significantly lower from AUC of APACHE II and SOFA score (DeLong Test, p < 0,001). CONCLUSION: There was no statistically significant difference on mortality between positive and negative group.

Aim: Hypoxemia, hypercapnia, and automaticity—which are dependent on exacerbation—increase the risk of arrhythmia by causing abnormal atrial and ventricular repolarization in chronic obstructive pulmonary disease (COPD). This study aimed to foresee the possibility of arrhythmia by evaluating the electrocardiograms (ECG) of patients having COPD attacks. Material and Method: In total, 120 patients (66 in the COPD group and 54 in the control group) were included. The differences between the two groups were statistically examined by determining (in milliseconds) QT and QTc interval maximum (max), minimum (min), and dispersion (disp); T-wave peak to end (Tp-e) max, min, and disp; Tp-e max/QT max, Tp-e max/QTc max proportions; and P wave max, min, and disp duration in the ECG parameters of the patients. Results: Forty-eight (64%) of the males included in the study were in the COPD group and 27 (36%) in the control group, whereas 18 (40%) of the females were in the COPD group and 27 (60%) in the control group. There was no significant difference between the ages of the patients and the levels of sodium and potassium (p = 0.189, 0.353, and 0.071). There was a significant difference between QT max and min in the groups, whereas there was no difference in terms of QT disp (p < 0.001, p < 0.001, and p = 0.490). There was a significant difference between the Tp-e max, min, and disp values in the COPD and control groups (p = 0.041, p < 0.001, and p = 0.001, respectively). There was no significant difference between the groups in terms of the P max duration (p = 0.442), but significant differences between the two groups in P min and disp durations were determined (p = 0.003 and p < 0.001, respectively). In receiver operating characteristic analysis made for P disp and Tp-e disp values in which a firm difference was made, 30 ms was determined as the cutoff for both parameters. Conclusion: To our knowledge, this is the first study that the rise of the dispersions of P wave and Tp-e intervals (without rise of QTc disp.) is detected on the evaluation of atrial and ventricular arrhythmia risks on COPD acute attacks.

Background and Aim: Mechanical ventilation is essential in conditions such as acute respiratory failure. However, prolonged use may lead to complications; therefore, there is a need for timely liberation. Special indicators are important for this purpose, including the Rapid Shallow Breathing Index (RSBI), the dead space to tidal volume ratio (VD/VT), and the Integrative Weaning Index (IWI), which offers a composite evaluation of ventilatory mechanics. This study aimed to compare these indices in Type 1 and Type 2 respiratory failure to examine their feasibility in assessing the likelihood of successful extubation. Methods The present cross-sectional study involved 35 participants (23 with Type 1 respiratory failure and 12 with Type 2 respiratory failure) successfully weaned from mechanical ventilation in the Emergency Department of a tertiary care hospital between 2022 and 2024. RSBI, VD/VT, IWI, and arterial blood gas values were evaluated. Data were analyzed descriptively and statistically, with statistical significance determined at p < 0.05. Results: Type 2 respiratory failure patients had a higher VD/VT ratio (0.37±0.04 vs. 0.29±0.13, p = 0.046) and a lower PaO₂/FiO₂ ratio (169±49.6 vs. 244±95.6, p = 0.017) than Type 1 patients. RSBI values did not differ significantly between the groups (p = 1.00). IWI values showed a trend toward lower scores in Type 2 patients, reflecting reduced weaning readiness, although the difference was not statistically significant. These results demonstrate that patients with hypercapnia have more significant impairments in gas exchange. Conclusion: RSBI was found to be less discriminative in identifying weaning failure, whereas VD/VT proved to be a more reliable predictor in hypercapnic respiratory failure. Additionally, IWI may serve as a useful complementary tool to improve weaning accuracy by integrating multiple physiological parameters into a single predictive measure.