Leukoglycemic Index and Its Prognostic Implications in Diabetic and Nondiabetic Patients with Acute Pulmonary Embolism - Article abstract #947156

Background: Emergency departments in Turkey employ both emergency medicine specialists (EMSs) and general practitioners due to an insufficient number of EMSs. Patients are triaged into green, yellow, and red codes based on urgency. Typically, EMSs manage more critical patients (yellow and red codes), while general practitioners handle less urgent cases (green codes).Objective: This study investigates differences in patient management approaches between EMSs and general practitioners in the yellow zone of an emergency department in the Sakarya Province.Method: This retrospective, cross‐sectional study was conducted at the Sakarya Training and Research Hospital from 31 December 2020 to 31 December 2021. The study included patients aged 18 and older who were assigned to the yellow zone and discharged by the attending physician. Data on patient monitoring times, consultation requests, hospitalization rates, resource utilization, readmission rates, and hospital revenue contributions were collected and analyzed. Statistical analyses were performed using IBM SPSS version 21, comparing the performance of EMSs and general practitioners.Result: The study included 59 physicians (14 EMSs and 45 general practitioners) and a large number of patients. EMSs had significantly more experience, shorter consultation request times, and higher ICU admission rates. They also ordered fewer MRIs and USGs per patient and made more consultation requests. There was no significant difference between EMSs and general practitioners in terms of the number of examinations, patient observation times, ward hospitalization rates, CT orders, readmission rates, and hospital revenue contributions.Conclusion: EMSs demonstrated more efficient use of emergency department resources, effective consultation processes, and higher ICU admission rates, indicating better patient management. Despite the limited scope of this single‐center study, the findings highlight the importance of EMSs in improving emergency care quality. Further research is needed to validate these results across multiple centers.

Objective: In our study, the effect of earthquake victims who applied to the emergency department (ED) of our hospital, despite being far from the earthquake area, on the workload and the need for additional precautions will be examined. As a result, it is aimed to create a guiding resource for future disasters. Materials and Methods: This study was conducted with patients who applied to Sakarya Training and Research Hospital (STRH) Emergency Department within 15 days after the Kahramanmaraş earthquake and were diagnosed as X34-Earthquake Victims according to ICD-10. Results: The mean age of the 405 patients were 20.98 years, and 52.6% were female. The ratio of the admitted patients to the total number of patients was 1.62%. Regarding resource use, the laboratory was requested for 32.3%, imaging examination for 55.1%, consultation for 19%, and 353 patients were discharged from the emergency department. Conclusions: Although earthquake victims may apply to the emergency departments regardless of the distance after the earthquake, this number is insufficient to require additional measures regarding the workload it creates. However, since this study is the first analysis based on distance, it should be supported by similar studies.

Objective: Increased Achilles tendon thickness is associated with hypercholesterolemia and cardiovascular disease, and ultrasonography is the preferred method for its assessment. This study aimed to evaluate the agreement between Achilles tendon ultrasonographic measurements obtained in different supine positions and those acquired using the standard prone technique.Materials and Methods: This prospective methodological study included 180 healthy adults (70 women, 110 men), representing 360 Achilles tendons. Individuals with systemic disease, regular medication use, or Achilles tendon pathology were excluded. Tendon thickness, width, and cross-sectional area were measured ultrasonographically using four positioning techniques: the conventional prone position (Method 1) and three supine alternatives: leg extended beyond the examination table (Method 2), ankle over the contralateral knee (Method 3), and hip and knee flexed at 90° (Method 4). Measurements were obtained 2 cm proximal to the calcaneal insertion.Results: No significant differences were found between Method 1 and Method 2 for tendon thickness, width, or cross-sectional area (For all parameters; p>0.05). Strong correlations were observed for thickness and cross-sectional area (r>0.8), while width showed a moderate correlation (r=0.6-0.8).Conclusion: Method 2 demonstrated good agreement with the standard prone technique and may serve as a practical alternative for Achilles tendon ultrasonography, particularly when prone positioning is not feasible. This approach may facilitate cardiovascular risk assessment using Achilles tendon thickness in a wider range of clinical settings.

Background: This study aimed to compare the emergency department (ED) and intensive care unit (ICU) admission processes of the local population and individuals with migrant, refugee, or asylum status as well as to evaluate differences between the groups. Methods: This retrospective observational study was conducted by analyzing the data of 10,163 patients who presented to the Emergency Medicine Clinic of Sakarya Training and Research Hospital between 1 January 2022 and 1 January 2024, and were determined to require ICU care. Among these, 10,060 were from the local population and 103 were refugees. Key variables, such as patients’ demographic characteristics, comorbidities, ED processes, hospital admission, and referral statuses, were collected and analyzed. The data were analyzed using Statistical Package for the Social Sciences (SPSS) version 26.0. Results: The mean age of refugee patients was 39.1 ± 26.5 years, and they were younger than the local population. No significant difference was observed between the two groups in terms of examination waiting times and time to the first consultation (p = 0.721 and p = 0.060, respectively). Refugees were more frequently admitted to the ICU at the study hospital than the local population (85.4% vs. 61.0%, p < 0.001). Refugee status remained independently associated with ICU admission at the study hospital after adjustment for age, sex, and major comorbidities (adjusted OR: 2.57, 95% CI: 1.47–4.50; p = 0.001). Conclusions: In this study, no significant differences were observed between refugees and the local population in examination waiting time, time to first consultation, or ED length of stay. Refugees were younger and had a higher rate of ICU admission at the study hospital. These findings may contribute to a better understanding of healthcare utilization patterns among refugees requiring intensive care in Türkiye.

Background and Objectives: Various hematological and biochemical parameters, including derived indices such as the platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR), have been investigated for prognostic assessment in cardiac arrest. The lactate-to-albumin ratio (LAR) may also predict mortality in critically ill patients. The primary objective of this study was to determine the prognostic value of hematological and biochemical parameters in predicting in-hospital mortality among patients who achieved ROSC following cardiac arrest. Materials and Methods: This retrospective cohort study was conducted in patients who experienced cardiac arrest. Laboratory parameters obtained at emergency department admission, including PLR, NLR, LAR, albumin and lactate, were recorded together with clinical outcomes, including return of spontaneous circulation (ROSC) and in-hospital mortality. The study examined the effectiveness of hematological and biochemical parameters in clinical ROSC prediction in patients experiencing both in-hospital and out-of-hospital cardiac arrest. The relationship between these parameters and in-hospital mortality in patients who achieved ROSC was also investigated. Results: During the study period, 505 patients were included, of whom 225 achieved ROSC and 168 died during hospitalization. LAR values were significantly higher in patients with in-hospital mortality (p < 0.001). For predicting in-hospital mortality after ROSC, LAR showed an AUC of 0.737 (95% CI: 0.661–0.812) and significantly outperformed lactate, PLR, and NLR (all p < 0.001). Adding LAR to the clinical model increased the AUC from 0.731 to 0.789 (ΔAUC = 0.058, p = 0.022). In multivariable analysis, higher LAR was independently associated with increased in-hospital mortality (aOR 1.61, 95% CI 1.21–2.16; p = 0.001). Conclusions: In patients who achieved ROSC after cardiac arrest, high initially recorded LAR levels were independently associated with in-hospital mortality. Although lower LAR values were associated with achievement of ROSC, the discriminative performance of LAR for predicting ROSC was insufficient to support its use as a standalone clinical predictor. However, the lack of standardized sampling times relative to cardiac arrest and ROSC limits the interpretation of LAR as a post-ROSC prognostic marker.