Background/Objectives: Accurate and timely triage is essential for optimizing clinical outcomes and resource allocation in emergency departments (EDs). The Peripheral Perfusion Index (PPI), a non-invasive and objective parameter derived from pulse oximetry, may offer added value in early risk stratification. This study aimed to analyze the correlation between the PPI measured at triage and at Emergency Severity Index (ESI) levels, as well as to determine if the PPI may function as a predictive tool to facilitate early risk identification before patient disposition. Methods: In this prospective cross-sectional study, adult ambulatory patients presenting to a tertiary care ED were enrolled. At triage, PPI and standard vital signs were recorded, and patients were classified using the five-level ESI system. The diagnostic performance of PPI and ESI in predicting ED discharge was assessed using receiver operating characteristic (ROC) curve analysis, with comparative evaluation performed via DeLong’s test. Results: Lower PPI values were consistently associated with higher ESI acuity levels and more intensive care requirements. Patients who were discharged had significantly higher median PPI values (4.0) compared to those admitted to wards (2.1) or intensive care units (1.9). PPI also distinguished survivors from non-survivors (median PPI: 3.60 vs. 1.15). ROC analysis showed that the PPI demonstrated a good discriminative capacity for forecasting ED discharge, equal to the efficacy of ESI (AUC: 0.926 vs. 0.903; p < 0.001). Conclusions: The PPI could improve post-triage risk classification and enhance current triage techniques like ESI, especially in cases of unclear or borderline presentations, but further validation in prospective trials is required.

Acute cholecystitis is a common inflammatory condition encountered in emergency departments (EDs), with severity varying widely among patients. Rapid risk stratification and appropriate management are critical in preventing complications and mortality. This study aimed to evaluate the association between the acute-phase reactant index (APhRI) and disease severity, and to investigate the potential prognostic value of APhRI in clinical decision-making. We conducted a single-center, retrospective observational study of adult patients diagnosed with acute cholecystitis in a tertiary ED between January 2024 and January 2025. APhRI was calculated as (C-reactive protein [CRP] × procalcitonin [PCT])/ albumin. Patients were stratified according to the Tokyo Guidelines 2018 (TG18). Statistical analyses included chi-square/Fisher exact tests, t -test/Mann–Whitney U test, receiver operating characteristic curve analysis, and DeLong test. A total of 547 patients were included. According to TG18, 28.7% were classified as moderate-to-severe acute cholecystitis. APhRI levels were significantly higher in these patients. The area under the curve of APhRI for predicting severity was 0.687, superior to CRP (0.673), PCT (0.567), and albumin (0.618) ( P < .05 for all). Higher APhRI values were also observed in patients requiring surgery ( P = .008) or interventional radiology ( P < .001), and positively correlated with hospital stay (ρ = 0.327, P < .001). APhRI appears to be a practical and useful biomarker not only for predicting severity in acute cholecystitis but also for supporting early triage and treatment decisions in the ED.

Introduction:Darifenacin is a medication that has anticholinergic and antimuscarinic effects and is used in the treatment of overactive bladder.Adverse and overdose effects of the medication such as dry mouth and eyes,headache,nausea, constipation, urinary retention, and dyspepsia have been reported .An overdose effect on AKI has not been reported in the literature, and no dose adjustment is recommended in patients with renal impairment Case:A 24-year-old male patient applied to the emergency department with a declaration of taking 25 drugs containing darifenacin active ingredient for suicidal purposes.The patient had complaints of nausea and difficulty urinating.The patient's physical examination was normal.In laboratory, creatinine was 2.09mg/dL, and hemoglobi (+++) and protein(++) were found in urine test.Renal USG revealed a grade 1-2 increase in echogenicity of both kidneys.The patient was followed up with intravenous fluid replacement therapy, and the patient whose creatinine levels regressed was discharged with the recommendation of nephrology outpatient control. Conclusion:Any molecule taken in overdose can cause AKI via ATN should not be ignored by emergency physicians.The fact that such a side effect or undesirable situation has not been reported with Darifenacin so far doesn’t mean that the molecule is safe for this situation.An overdose of Darifenacin may cause AKI in patients.

Aim: The aim of this study is to investigate the changes in hemoglobin levels in hemodynamically stable patients admitted to the emergency department with a prediagnosis of upper GI bleeding. Material and Methods: This study consisted of patients aged over 18 years who applied to the emergency department of Ankara Training and Research Hospital and underwent endoscopy with a prediagnosis of upper GI bleeding between January 1st, 2017, and March 1st, 2020. The patients’ demographic data, laboratory parameters, Glasgow-Blatchford and Rockall scores, endoscopy results, and 28-day mortality data were recorded. Results: The study sample consisted of 120 patients with a mean age of 62.0 ± 20.9 years. No significant difference was detected in the amount or percentage of change in patients' hemoglobin levels between the two measurements performed at admission and within 3-6 hours. ((0.6(-5,6%), 0.4(-5,3%), p>0.05)) The most common endoscopic finding was a peptic ulcer, which was detected in 64 (53.3%) patients. The multivariate regression analysis revealed that age ((Odds Ratio (OR) = 1.13, confidence interval (CI) 95%: 1.03–1.31, p = 0.0031)) and hypertension (OR = 11.45, CI 95%: 1.80–138.88, p = 0.021) were independent risk factors for 28-day mortality. Conclusion: No significant difference was detected in the amount or percentage of change in hemoglobin levels of hemodynamically stable patients with a prediagnosis of upper GI bleeding between the two measurements performed at admission and within 3-6 hours. Older age and hypertension were determined as the risk factors that predicted 28-day mortality in this patient group.