Introduction: Earthquakes are sudden-onset natural disasters that are associated with substantial material damage, resulting in the collapse of built environment with a high rate of mortality, injury, and disability. Crush syndrome, which can be seen after devastating earthquakes, can lead to acute kidney injury (AKI) and patients may require amputation, fasciotomy, and dialysis. Supportive treatment has an important role in the prognosis of these patients.Study Objective: The aim of this study was to investigate the demographic and clinical characteristics of traumatic earthquake survivors admitted to the emergency department (ED) of a hospital, which was close to the earthquake zone but not affected by the earthquake, after the February 6, 2023 Kahramanmaraş (Turkey) earthquakes.Materials and Methods: This study was conducted by retrospectively analyzing the data of 1,110 traumatized earthquake survivors admitted to the ED of a tertiary care university hospital from February 6^th through February 20^th, 2023. Age; gender; time of presentation; presence of comorbid diseases; ED triage category; duration of stay under debris; presence of additional trauma; laboratory tests; presence of AKI; presence of crush injury and injury sites; supportive treatment (fluid replacement and intravenous [IV] sodium bicarbonate); need for amputation, dialysis, and fasciotomy; duration of hospitalization; and outcome of ED were evaluated.Results: Of the 1,110 traumatic victims in this study, 55.5% were female patients. The mean age of the patients was 45.94 (SD = 16.7) years; the youngest was 18 years old and the oldest was 95 years old. Crush injury was detected in 18.8% and AKI in 3.0% of the patients. Dialysis, amputation, and fasciotomy were required in 1.6%, 2.8%, and 1.4% of the patients, respectively. In total, 29.2% of patients were hospitalized, including 2.9% admitted to the intensive care unit (ICU) and 26.3% to the relevant ward. In total, 0.3% of the patients included in the study died at ED.Conclusion: Post-earthquake patients may present with crush injury, AKI may develop, and fasciotomy, amputation, and dialysis may be needed, so hospitals and EDs should be prepared for natural disasters such as earthquakes.

Background: Acute appendicitis is a common cause of acute abdominal pain, typically treated surgically, although medical management is also an option. Laboratory investigations play a valuable role in diagnosis and predicting prognosis. We aimed to investigate and compare the effectiveness of indices such as the Systemic Immune-Inflammation Index (SII), Systemic Inflammatory Response Index (SIRI), and Pan-Immune-Inflammatory Value (PIV), all derived from complete blood count, in diagnosing acute appendicitis and distinguishing between complicated and uncomplicated cases. Methods: We retrospectively analyzed data from 334 patients diagnosed with acute appendicitis and 350 healthy individuals. The SII, SIRI, and PIV parameters were compared between the acute appendicitis group and the healthy group. The SII, SIRI, and PIV parameters were also compared between the complicated and uncomplicated groups. Results: All three parameters demonstrated good performance in predicting the diagnosis of appendicitis. An SII value above 1,008.43 (p < 0.0001, AUC = 0.707), a SIRI value above 2.60 (p < 0.0001, AUC = 0.743), and a PIV value above 904.85 (p < 0.0001, AUC = 0.726) were found to support the diagnosis of appendicitis. For predicting complicated appendicitis, thresholds were identified as SII values above 2501.13 (p = 0.0012, AUC = 0.634), SIRI values above 7.98 (p = 0.0005, AUC = 0.645), and PIV values above 1,869.66 (p = 0.0012, AUC = 0.635). Conclusions: All three indices showed good predictive performance for diagnosing appendicitis and acceptable performance for predicting complicated cases. Among the indices, SIRI was slightly superior to the other two in both scenarios.

Objectives: This study was designed to investigate the possible relationship between the anatomical location of the PFF (head-neck fractures) and the demographic features, comorbidities, and risk factors of elderly patients. Methods: 233 patients aged 65 years and over, who were admitted to the emergency department with a diagnosis of proximal femur fracture were included in this study. Results: Most patients (59.6%) had a trochanteric fracture. The incidence of trochanteric fractures had a statistically significant positive correlation with age. Falls at ground level were found to be highly associated with trochanteric fractures (92,8%). At least one complication was observed in 57 (41,0%) cases and 31 (22,3%) died in one year, of the patients with trochanteric fractures. Comorbidity was not related to fracture location statistically. Fall ground level (p = 0.013), complication rate (73.7%; p <0.001), and Charlesen comorbidity index (p = 0.019) were statistically significantly associated with death. The logistic regression analysis of variables determined that only the quantity of comorbidities may be related to femoral neck fractures (p = 0.047). Conclusion: Female patients with trochanteric fractures were found to be older than male patients. Fall ground level, mortality, and complications were more frequently seen in patients with trochanteric fractures. Level of Evidence II, Retrospective study.

Extended Focused Assessment with Sonography for Trauma (E-FAST) is considered a critical assessment tool for patients with trauma. This study aimed to investigate the diagnostic accuracy of the E-FAST examination performed by newly trained emergency medicine residents and its effect on clinical outcomes. Patients with multiple trauma presenting to the adult emergency department of a university hospital were prospectively evaluated. Senior emergency medicine residents with no prior ultrasonography experience were included in the study after completing a 2-day official and nationally certified theoretical and practical course, which also covered E-FAST training, and performing at least 50 E-FAST examinations. Computed tomography (CT) results were accepted as the gold standard, and the sensitivity, specificity, positive and negative predictive values (PPV, NPV), and accuracy of E-FAST were calculated. Clinical outcomes were defined as the need for emergency surgery and, in patients with false-negative (FN) E-FAST evaluations, chest tube placement, hospitalization, and need for surgery. A total of 158 patients were included. For hemoperitoneum, sensitivity was 81.25%, specificity 100%, PPV 100%, NPV 95.45%, accuracy 96.2%, and area under the receiver operating characteristic curve (AUC) 0.91; for hemothorax, sensitivity was 35.71%, specificity 100%, PPV 100%, NPV 94.12%, accuracy 94.3%, and AUC 0.68; and for pneumothorax, sensitivity was 59.38%, specificity 100%, PPV 100%, NPV 90.65%, accuracy 91.77%, and AUC 0.80. None of the six hemoperitoneum patients assessed as FN required a treatment plan for this reason. Chest tubes were placed in 5 of the 9 hemothorax patients assessed as FN due to subsequent hemodynamic instability, and in 4 of the 13 pneumothorax patients due to the need for mechanical ventilation. E-FAST assessment was positive in 7 of the 8 patients requiring emergency surgery. In patients with a positive E-FAST assessment who require emergency surgery, CT scanning should not delay surgical procedures or lead to time loss. Our study demonstrates that when performed by clinical personnel with training and experience, E-FAST provides accurate results with high specificity and correctly identifies patients requiring surgical intervention. Furthermore, in patients with FN results, serial E-FAST assessments can enhance diagnostic accuracy and contribute to improved patient management. Not applicable.

COVID-19 can cause a wide range of effects on patients, from asymptomatic cases to mortality. Many factors can affect the prognosis of the disease. Our study aims to evaluate the predictive power of the Systemic Inflammatory Index (SII) and Systemic Inflammatory Response Index (SIRI) in determining prognosis and mortality in patients. Patients who tested positive for COVID-19 by polymerase chain reaction and presented to the emergency department of Merin Hospital between September 1, 2020, and August 31, 2021, were included in the study. The data of the patients were retrospectively analyzed. A total of 446 patients were included in our study. The rate of patients with severe disease was 55.6%, and the mortality rate was 30.5%. It was found that mortality increased with age (p<0.001). SII and SIRI levels were found to be higher in patients who died or had severe disease (p<0.001). It was determined that the severity level increased in COVID-19 patients when the SIRI value was above 1.648 (p<0.0001, AUC=0.689), and the mortality rate increased when the SIRI value was above 2.057 (p<0.0001, AUC=0.640). It was determined that the severity level increased in COVID-19 patients when the SII value was above 867.834 (p<0.0001, AUC=0.744), and the mortality rate increased when it was above 1370.353 (p<0.0001, AUC=0.682). In patients diagnosed with COVID-19, it was found that SII and SIRI parameters could predict the severity and mortality of the disease. Further comprehensive studies are needed to determine the future roles of these indices.

Introduction: Many risk factors have been reported to be responsible for morbidity and mortality in motorcycle and electric bike (e-bike) accidents. This study aims to determine the associations between the demographic features of motorcycle or e-bike riders and clinical outcomes. Methods: This is a retrospective case-control study conducted in an academic emergency department (ED). All adult patients admitted to the ED due to motorcycle or e-bike accidents were included. Results: A total of 358 patients were included in the study. Of the patients, 100 (28.1%) required hospitalization where 58 (16.3%) required surgery. Injuries were related with the upper extremities (15.4%), head and neck (14.8%), and lower extremities (11.2%) in the patients. Nighttime accidents, alcohol use, and lack of protective equipment were related to multiple injuries, need for hospitalization, surgery, blood transfusion, and mortality (p0.05). Conclusion: Nighttime accidents, alcohol or drug use, and lack of protective equipment could lead to multiple injuries, need for hospitalization, surgery, blood transfusion, and mortality. Moreover, the risk of poor outcomes is similar between the motorcycle and e-bike riders. Keywords: Non Vehicle Traffic Accident, Motorcycle Accident, E- Bike Accident, Emergency Department