Turkish Journal of Emergency Medicine最新文献

{"title":"A tale of three mimickers: Amitraz, fipronil, and 2,4-dichlorophenoxyacetic acid poisoning confounding organophosphate toxicity.","authors":"Keyur Savjibhai Bhimani, Varsha Shinde, Pratik Kanani, Joshua Daniel Birru, Mohammed Arif Abdul Salam","doi":"10.4103/tjem.tjem_314_25","DOIUrl":"10.4103/tjem.tjem_314_25","url":null,"abstract":"<p><p>Organophosphates (OP) and carbamates frequently cause acute poisoning worldwide via acetylcholinesterase inhibition, leading to characteristic cholinergic toxidrome manifestations. However, some agents such as Amitraz, Fipronil, and 2,4-dichlorophenoxyacetic acid act through different mechanisms yet clinically mimic OP poisoning, complicating diagnosis and management. This case series presents three patients exposed to these mimickers, highlighting differing clinical features, investigations, and management strategies. Recognizing these pesticide mimickers is critical to avoid inappropriate therapy and optimize outcomes.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"26 3","pages":"248-251"},"PeriodicalIF":6.6,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13460704/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound-guided fascia iliaca compartment block for pain control in peritrochanteric fractures in the emergency department: A prospective observational study.","authors":"S R Vinayak, Sibin Surendran, R S Krishnakumar, S L Akhil, Austin Joju Mangaly, Midhun Mohan, Chandni Radhakrishnan","doi":"10.4103/tjem.tjem_287_25","DOIUrl":"10.4103/tjem.tjem_287_25","url":null,"abstract":"<p><strong>Objective: </strong>Hip fractures are associated with moderate-to-severe pain, which is frequently managed inadequately in emergency departments (EDs). This study set out to evaluate the analgesic effectiveness of an ultrasound-guided fascia iliaca compartment block (FIB) administered by emergency physicians to patients with peritrochanteric hip fractures.</p><p><strong>Methods: </strong>A prospective observational study was conducted on 142 patients presenting to the ED with peritrochanteric hip fractures and a baseline Visual Analog Scale (VAS) score of 4 or higher. An ultrasound-guided FIB was performed, and pain scores were assessed at baseline, 1, 2, and 6 h. The primary outcome was ≥ 50% reduction in VAS. The secondary outcomes included need for rescue analgesia (intravenous fentanyl 1 μg/kg) and adverse events. Data were nonnormally distributed and analyzed using the Friedman test with Bonferroni-adjusted pairwise comparisons. Effect size and 95% confidence intervals (CIs) were calculated.</p><p><strong>Results: </strong>The median VAS decreased from 7 (interquartile range [IQR]: 6-8) at baseline to 3 (IQR: 2-3) at 1 h, 2 (IQR: 1-2) at 2 h, and 1 (IQR: 1-2) at 6 h (<i>P</i> < 0.001, Friedman test; effect size <i>r</i> = 0.83). A successful block (≥50% VAS reduction) was achieved in 97.2% of patients (95% CI: 92.9%-99.1%). Only 4 (2.8%) patients required rescue fentanyl. No complications, including local anesthetic systemic toxicity or delirium, were recorded.</p><p><strong>Conclusion: </strong>Ultrasound-guided FIB administered by trained emergency physicians is associated with significant and sustained analgesia in patients with peritrochanteric hip fractures, with minimal need for rescue opioids and no observed adverse events.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"26 3","pages":"217-222"},"PeriodicalIF":6.6,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13460694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Manikin-based noninferiority simulation study of Airgency™: A novel automatic bag valve mask device for emergency respiratory support.","authors":"Reza Widianto Sudjud, Jenifer Kiem Aviani","doi":"10.4103/tjem.tjem_146_25","DOIUrl":"10.4103/tjem.tjem_146_25","url":null,"abstract":"<p><strong>Objectives: </strong>This study evaluated the performance of Airgency™, an automated bag valve mask (BVM) ventilation device developed by Institut Teknologi Bandung and Padjadjaran University, Indonesia, using a manikin-based simulation model. Its performance was compared with conventional hand-squeezed bagvalvemask ventilation performed by medical professionals, with a focus on reducing operator-dependent variability and fatigue.</p><p><strong>Methods: </strong>A manikin-based simulation was conducted using an adult airway trainer connected to a lung simulator (ASL5000) set to mimic apneic respiratory failure with normal lung mechanics. The Ambu bag, connected to 15 L/min oxygen, was secured to the manikin. Airgency™ operated in normal mode (tidal volume [VT] 400 mL, 15 bpm) for 30 min, repeated 50 times. Seventy-eight anesthesiology residents performed manual BVM ventilation under identical conditions after standardized training. Breathing rate (BR), VT, and peak inspiratory pressure (PIP) were recorded every minute, whereas fatigue was rated using the Visual Analog Scale for Fatigue (VAS-F, 1-10).</p><p><strong>Results: </strong>Airgency™ demonstrated superior ventilation stability. BR remained consistent (14.77 ± 0.08 vs. 16.54 ± 7.05 bpm; <i>P</i> < 0.0001), with much lower variability (coefficient of variation [CV] 0.47% vs. 46.1%-121.2%). VT delivery was steady (397.8 ± 3.1 vs. 406.9 ± 85.4 mL; <i>P</i> < 0.0001; CV 2.2% vs. 13.9%-25.7%), and PIP was more uniform (29.4 ± 0.9 vs. 23.1 ± 8.2 cmH₂O; <i>P</i> < 0.00001; CV 2.5% vs. 28.3%-41.1%). Operator fatigue increased progressively during manual ventilation (VAS-F 1.83-5.09; <i>P</i> < 0.0001).</p><p><strong>Conclusion: </strong>Airgency™ maintained consistent, precise ventilation with minimal variability and eliminated operator fatigue, supporting its potential as a reliable alternative to manual BVM ventilation in emergency care.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"26 3","pages":"205-216"},"PeriodicalIF":6.6,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13460705/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of an electroencephalogram-verified 20-min power nap on fatigue and daytime sleepiness among emergency doctors following night shifts: A randomized controlled trial.","authors":"Wan Noorulfaten Azreen Wan Hussin, Mohd Johar Jaafar, Hui Jan Tan, Mohd Hisham Mohd Isa, Siti Zaleha Sahibulddin, Nur Arifah Mohd Khaili, Ismail Mohd Saiboon","doi":"10.4103/tjem.tjem_293_25","DOIUrl":"10.4103/tjem.tjem_293_25","url":null,"abstract":"<p><strong>Objective: </strong>To assess whether a 20-min power nap reduces fatigue and daytime sleepiness among emergency doctors following night shifts.</p><p><strong>Methods: </strong>We conducted a randomized controlled trial involving 54 emergency doctors randomly assigned to intervention (<i>n</i> = 27) or control (<i>n</i> = 27) groups matched for gender, body mass index, and work zone. The intervention group received a 20-min power nap monitored by an electroencephalogram (EEG), whereas the control group remained awake. We measured fatigue using the Fatigue Assessment Scale (FAS) and daytime sleepiness using the Epworth Sleepiness Scale (ESS) before and after intervention.</p><p><strong>Results: </strong>Both groups demonstrated comparable baseline fatigue levels with median FAS scores of 28 (interquartile range [IQR]: 21-32) versus 26 (IQR: 21-30) for intervention and control groups, respectively (<i>P</i> = 0.56). Following the intervention, the power nap group showed a median 3-point FAS reduction (IQR: -7 to 1), whereas controls experienced a median 4-point increase (IQR: 0 to 6) (between-group difference <i>P</i> < 0.001, Cliff's delta = 0.71, 95% confidence interval [CI]: 0.48-0.85). For daytime sleepiness, the intervention group showed a median 5-point ESS reduction (IQR: -7 to - 1) versus a median 4-point increase (IQR: 0 to 6) in controls (<i>P</i> < 0.001, Cliff's delta = 0.78, 95% CI: 0.57-0.89). Both outcomes demonstrated large effect sizes. EEG monitoring revealed that 81.4% of intervention participants achieved sleep onset within 0-4 min.</p><p><strong>Conclusion: </strong>A 20-min power nap significantly reduces fatigue and daytime sleepiness among emergency doctors following night shifts, with large effect sizes indicating substantial practical benefits and rapid sleep onset indicating severe sleep deprivation. This practical intervention supports implementing evidence-based power nap protocols in emergency departments.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"26 3","pages":"189-196"},"PeriodicalIF":6.6,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13460780/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and prospective validation of pediatric sepsis screening tool in a resource-limited setting.","authors":"Ninuma Artprom, Jarin Vaewpanich, Pasita Puttiteerachot, Rattapon Uppala, Nattachai Anantasit","doi":"10.4103/tjem.tjem_252_25","DOIUrl":"10.4103/tjem.tjem_252_25","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to develop and prospectively validate a pragmatic two-stage bedside algorithm, integrating an age-adjusted modified Pediatric Early Warning Score (mPEWS) with the American Academy of Pediatrics (AAP) trigger tool for early recognition of sepsis and septic shock.</p><p><strong>Methods: </strong>This prospective study enrolled children admitted to a hospital from August 2020 to January 2022; all admissions aged 1 month-18 years were monitored. Stage-1 alerted when age-adjusted mPEWS is more than 3, plus abnormal temperature or leukocytosis/leukopenia with band form. Stage-2 applied the trigger tool by physicians; dual positivity in both stages defined a positive screening test. Diagnostic test performance was compared and calculated with Sepsis-2 (sepsis), Sepsis-3 (septic shock), Phoenix septic shock definitions, and 30-day mortality.</p><p><strong>Results: </strong>Among 3202 admissions (1765 patients; median age: 81 months; 54% male), 172 episodes (5.4%) met both stages of the new screening. Compared to the Sepsis-2 criteria, the tool achieved 60.4% sensitivity, 99.1% specificity, 84.3% positive predictive value (PPV), 96.9% negative predictive value (NPV), and area under the curve (AUC) of 0.80. For the Phoenix septic shock definition, sensitivity increased to 100% with 96.2% specificity, 30.2% PPV, 100% NPV, and AUC 0.98. Predicting 30-day mortality yielded 65.0% sensitivity, 95.1% specificity, 13.1% PPV, 99.6% NPV, and AUC 0.80. Screen-positive patients experienced markedly higher in-hospital (24.2% vs. 0.9%) and 30-day (13.1% vs. 0.4%) mortality than those screening negative (<i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>The combined mPEWS/APP trigger tool delivers rapid, simple with entirely clinical stratification, and excellent sensitivity for septic shock with high NPV for sepsis and early mortality. Its simplicity and minimal resource requirements make it a practical solution for improving timely sepsis recognition in resource-constrained pediatric settings.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"26 3","pages":"197-204"},"PeriodicalIF":6.6,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13460792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of invasive mechanical ventilation requirement and mortality in hypercapnic respiratory failure: A retrospective analysis.","authors":"Şeyma Özarslan, Ersin Aksay, Sinan Saray, Alanur Tarhan","doi":"10.4103/tjem.tjem_193_25","DOIUrl":"10.4103/tjem.tjem_193_25","url":null,"abstract":"<p><strong>Introduction: </strong>While hypercapnic respiratory failure (HRF) has been widely studied in emergency department (ED) populations, the prognostic significance of metabolic compensation and lactate levels remains unclear. This study aimed to evaluate the association of creatinine, bicarbonate (HCO₃), chloride, and lactate levels with the need for invasive mechanical ventilation (IMV) and inhospital mortality in patients with HRF.</p><p><strong>Methods: </strong>This single-center, cross-sectional study included adult patients who presented to the ED with respiratory distress and arterial partial pressure of carbon dioxide >50 mmHg between 2020 and 2023. The relationships between initial laboratory parameters and clinical outcomes were analyzed.</p><p><strong>Results: </strong>A total of 420 patients were included (median age: 77 years [interquartile range: 68-85]; 51.4% female). The mortality rate among bedridden patients was 55.9% and 34.3% among patients diagnosed with pneumonia. Creatinine ≥1.6 mg/dL was associated with inhospital mortality (odds ratio [OR]: 3.7; 95% confidence interval [CI]: 2.044-6.696) and IMV requirement (OR: 2.323; 95% CI: 1.216-4.439). Lactate >1.5 mmol/L was also associated with higher mortality (OR: 10.441; 95% CI: 5.739-18.996). Delta HCO₃ (ΔHCO₃) <-7.5 mEq/L predicted mortality (OR: 2.965; 95% CI: 1.756-5.008) and IMV need (OR: 10.181; 95% CI: 5.709-18.156). Low ΔHCO₃, hemoglobin, pH levels, elevated lactate, creatinine levels, and immobility are the independent risk factors for mortality. The AUC values of lactate levels for predicting mortality were higher than those of pH (0.662 vs. 0.655).</p><p><strong>Conclusions: </strong>In patients with HRF, ΔHCO₃, hemoglobin, pH, lactate and creatinine levels, and immobility are strong predictors of poor outcomes. Lactate is a robust and independent predictor of poor outcomes, with prognostic accuracy comparable to that of pH, and may be valuable for clinical risk stratification.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"26 3","pages":"234-241"},"PeriodicalIF":6.6,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13460703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency department airway management-2026: EMAT clinical policy guideline.","authors":"Şeref Kerem Çorbacıoğlu, Gökhan Aksel, Başak Bayram, Ersin Aksay, Faruk Danış, Fatma Sarı Doğan, Emir Ünal, Mehmet Muzaffer İslam, Emre Kudu, Alp Şener, Murtaza Kaya, Göksu Bozdereli Berikol, Fatma Nur Karaarslan, Merve Osoydan Satıcı, Volkan Arslan, Haldun Akoğlu, Buğra İlhan, Mustafa Emin Çanakçı, Demet Devrimsel, Resul Çinpolat, İbrahim Sarbay, Enis Ademoğlu, Ali Cankut Tatlıparmak, Yaylanur Hande Temizer","doi":"10.4103/tjem.tjem_12_26","DOIUrl":"10.4103/tjem.tjem_12_26","url":null,"abstract":"<p><p>This clinical policy was developed by Emergency Medicine Association of Türkiye (EMAT) to evaluate current evidence on airway management in the emergency department (ED) and to provide clinicians with practical, evidence-based recommendations. Although rapid sequence intubation in the ED is a life-saving intervention in critically ill patients, the choice of techniques and medications during its implementation has a decisive impact on patient safety and clinical outcomes. This policy was developed by the research committee (RC) using the \"<i>Grading of Recommendations, Assessment, Development, and Evaluations (GRADE)</i>\" methodology, based on systematic literature reviews and expert opinion. Within the framework of five key clinical questions, the following topics were examined: preoxygenation strategies (noninvasive mechanical ventilation, high-flow nasal oxygen, face mask, and conventional techniques); the effectiveness and safety of apneic oxygenation; the use of a gum elastic bougie during intubation; the role of push-dose vasopressors in patients at high risk of hypotension; and the safety of ketamine use in patients at risk of increased intracranial pressure. This policy aims to reduce complications related to airway management and improve patient outcomes by providing emergency physicians with an evidence-based framework for preintubation preparation, medication selection, and equipment use.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"26 3","pages":"159-182"},"PeriodicalIF":6.6,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13460706/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of extended reality-based cardiopulmonary resuscitation training for healthcare students: A systematic review.","authors":"John Raymund P Suazo, Grasiela Piuvezam, Isac Davidson Santiago Fernandes Pimenta, Lucía López Ferrándiz, Manuel Pardo Ríos, Rafael Castro-Delgado","doi":"10.4103/tjem.tjem_373_25","DOIUrl":"10.4103/tjem.tjem_373_25","url":null,"abstract":"<p><strong>Background: </strong>Cardiopulmonary resuscitation (CPR) is a lifesaving intervention where timely, effective actions improve survival. However, traditional Basic and Advanced Life Support (BLS and ALS) training often lacks realism, limiting preparedness among healthcare students. Extended Reality (XR) technologies, including Virtual, Augmented, and Mixed Reality, offer promising tools to enhance CPR training. The aim is to assess the effects of XR on CPR training outcomes among healthcare students.</p><p><strong>Methodology: </strong>Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols guidelines, PubMed/MEDLINE, EMBASE, CINAHL, Cochrane, Web of Science, and Scopus were searched for randomized controlled trials and quasi-experimental studies. Two reviewers independently extracted data, with disagreements resolved by a third. Risk of bias was evaluated using Cochrane ROB 2 and ROBINS-I. Due to heterogeneity, findings were synthesized narratively.</p><p><strong>Results: </strong>Eight studies from six countries were included. Evidence showed mixed outcomes: XR improved confidence and reduced anxiety in Basic Life Support and ALS training, but results on technical performance, including CPR knowledge and quality, were inconsistent. Variability in study design and concerns about bias limited generalizability.</p><p><strong>Conclusion: </strong>XR shows potential as a valuable complement to traditional CPR training, particularly in blended learning approaches aligned with modern pedagogy. However, inconsistent findings highlight the need for standardized assessments, evaluation of long-term outcomes, and integration of haptic torso simulators to improve technical skills and clarify XR's role in resuscitation education.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"26 3","pages":"223-233"},"PeriodicalIF":6.6,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13460771/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postpartum retroperitoneal hematoma secondary to ovarian artery rupture: A case presentation.","authors":"Ahmet Faruk Yildiz, Sulbiye Sari, Mustafa Sabak","doi":"10.4103/tjem.tjem_409_25","DOIUrl":"10.4103/tjem.tjem_409_25","url":null,"abstract":"<p><p>Postpartum retroperitoneal hematoma (RPH) is a rare but potentially life-threatening complication of vaginal delivery, often presenting with subtle and nonspecific symptoms that delay diagnosis. We describe a case of a 29-year-old multiparous woman who developed severe abdominal pain and cardiovascular compromise 2 days after an uncomplicated vaginal delivery. Initial hemoglobin was 6.6 g/dL with no evidence of external bleeding. Contrast-enhanced computed tomography angiography (CTA) revealed a large 140 mm × 80 mm left-sided RPH associated with the ovarian artery. Emergency laparotomy confirmed ovarian artery rupture, which was surgically ligated, leading to full recovery. This case underscores the importance of maintaining a high index of suspicion for RPH in postpartum patients with unexplained shock, the critical role of prompt CTA imaging, and the necessity of timely surgical intervention in unstable patients. Risk factors, diagnostic pitfalls, and management strategies are discussed, emphasizing the multidisciplinary approach required in emergency settings.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"26 3","pages":"242-247"},"PeriodicalIF":6.6,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13460691/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retrospective studies in emergency medicine: A practical guide to study design, bias, confounding, and interpretation.","authors":"Suha Turkmen, Sinan Pasli","doi":"10.4103/tjem.tjem_214_26","DOIUrl":"10.4103/tjem.tjem_214_26","url":null,"abstract":"<p><p>Retrospective observational studies are a cornerstone of emergency medicine research, offering practical ways to address important clinical questions using real-world data. Yet, despite their widespread use, these studies are often misunderstood. Associations may be interpreted too confidently as causal effects, while important issues such as bias, confounding, and limitations of statistical adjustment may be overlooked or oversimplified. This practical guide provides a clinically grounded framework for understanding how retrospective studies should be designed, interpreted, and critically appraised. It reviews core methodological principles, including protocol development, sampling strategies, data abstraction, common sources of bias, confounding by indication, and responsible interpretation of observational findings. Frequent misconceptions, such as equating statistical significance with clinical importance or assuming adjustment can fully resolve confounding, are discussed through pragmatic examples relevant to emergency care. Rather than focusing on complex statistical techniques, this review emphasizes conceptual clarity, transparency, and thoughtful interpretation. It highlights practical principles that can improve validity and reproducibility while helping readers recognize both the strengths and inherent limitations of retrospective research. Emerging analytical approaches and evolving discussions around reproducibility and reporting standards are also considered. By linking foundational epidemiologic principles with the realities of emergency medicine practice, this article aims to support clinicians, trainees, reviewers, and early career investigators in designing stronger studies, interpreting findings more critically, and using observational evidence more thoughtfully in clinical decision-making and future research.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"26 3","pages":"183-188"},"PeriodicalIF":6.6,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13460785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}