Turkish Journal of Emergency Medicine最新文献

{"title":"Circulatory shock in adults in emergency department","authors":"AshokKumar Pannu","doi":"10.4103/tjem.tjem_271_22","DOIUrl":"https://doi.org/10.4103/tjem.tjem_271_22","url":null,"abstract":"","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135686191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"E-HEART score: A novel scoring system for undifferentiated chest pain in the emergency department","authors":"SVimal Krishnan, V Yuvaraj, SachinSujir Nayak","doi":"10.4103/tjem.tjem_26_23","DOIUrl":"https://doi.org/10.4103/tjem.tjem_26_23","url":null,"abstract":"OBJECTIVE: Cardiovascular disease is the leading cause of death worldwide. As there is an increase in the global burden of ischemic heart disease, there are multiple scoring systems established in the emergency department (ED) to risk stratify and manage acute coronary syndrome (ACS) in patients with chest pain. The objective of this study was to integrate point-of-care echo into the existing history, electrocardiogram, age, risk factors, and troponin (HEART) score and evaluate a novel scoring system, the echo HEART (E-HEART) score in risk stratification of patients presenting with undifferentiated chest pain to the ED. The E-HEART Score was also compared with existing traditional scoring systems for risk-stratifying acute chest pain. METHODS: A diagnostic accuracy study involving 250 patients with chest pain at the ED of a single tertiary care teaching hospital in India was conducted. The emergency physicians assessed the E-HEART score after integrating their point-of-care echo/focused echo findings into the conventional HEART score on presentation. The primary endpoint was the occurrence of major adverse cardiovascular events (MACE) within 4 weeks of initial presentation. The accuracy of the E-HEART score was compared with other conventional risk stratification scoring systems such as the thrombolysis in myocardial infarction (TIMI), history, electrocardiogram, age, and risk factors, Troponin Only Manchester ACS (T-MACS), and HEART scores. RESULTS: A total of 250 patients with a median age of 53 years (42.25–63.00) were part of the study. Low E-HEART scores (values 0–3) were calculated in 121 patients with no occurrence of MACE in this category. Eighty-one patients with moderate E-HEART scores (4–6) were found to have 30.9% MACE. In 48 patients with high E-HEART scores (values 7–11), MACE occurred in 97.9%. The area under receiver operating characteristics (AUROC) of E-HEART score is 0.992 (95% confidence interval: 0.98–0.99), which is significantly higher than AUROC values for HEART (0.978), TIMI (0.889), T-MACS (0.959), and HEAR (0.861), respectively (P < 0.0001). At a cutoff of E-HEART score >6, it accurately predicted ACS with a sensitivity of 92% and a specificity of 99% with a diagnostic accuracy of 97%. CONCLUSION: The E-HEART score gives the clinician a quick and accurate forecast of outcomes in undifferentiated chest pain presenting to the ED. Low E-HEART scores (0–3) have an extremely low probability for short-term MACE and may aid in faster disposition from the ED. The elevated risk of MACE in patients with high E-HEART scores (7–11) may facilitate more aggressive workup measures and avoid disposition errors. E-HEART is an easily adaptable scoring system with improved accuracy compared to conventional scoring systems.","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135953613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of the first wave of the COVID-19 pandemic on hospital admissions and treatment management of ectopic pregnancy","authors":"Hande Gurbuz, Gulfem Basol, MehmetMustafa Altintas, Betul Kuru","doi":"10.4103/tjem.tjem_37_23","DOIUrl":"https://doi.org/10.4103/tjem.tjem_37_23","url":null,"abstract":"OBJECTIVES: We aimed to evaluate the clinical features and treatment strategies applied to the patients with ectopic pregnancy admitted to our tertiary care center before and during the pandemic. METHODS: Women aged 18–45 years, who were admitted to the hospital with a diagnosis of ectopic pregnancy in the pre- and postpandemic periods, were included in this case–control study. RESULTS: A total of 173 patients, 116 patients before the pandemic and 57 patients during the pandemic, were included in the study. The rate of admissions from the emergency department was higher during the pandemic than before the pandemic (P = 0.003). The rupture was detected significantly higher during the outbreak (13/116 [11.2%]) than before the pandemic (16/57 [28.1%]) (P = 0.009). While conservative treatment was applied more frequently in the prepandemic period, it was observed that patients were treated surgically more frequently during the pandemic period (P = 0.003). While laparoscopic surgery was preferred before the pandemic, laparotomy was applied to all patients during the pandemic (P < 0.001). CONCLUSIONS: In the first wave of the outbreak, there were delays in the diagnosis of ectopic pregnancies, and these patients presented with ruptures more frequently than before the pandemic. Furthermore, surgical treatment methods were used more than conservative therapies during the outbreak.","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135784099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of initial cardiac activity assessed by point-of-care ultrasonography in predicting cardiac arrest outcomes: A prospective cohort study.","authors":"Soumitra Thandar,&nbsp;Ankit Kumar Sahu,&nbsp;Tej Prakash Sinha,&nbsp;Sanjeev Bhoi","doi":"10.4103/2452-2473.366482","DOIUrl":"https://doi.org/10.4103/2452-2473.366482","url":null,"abstract":"<p><strong>Objectives: </strong>This study was conducted to investigate the association between visible cardiac activity in point-of-care ultrasound (POCUS) and outcomes of cardiac arrest such as the return of spontaneous circulation (ROSC), survival to inpatient admission (SIA), and survival to hospital discharge (STHD).</p><p><strong>Methods: </strong>This was a single-center, prospective cohort study conducted in the emergency department (ED). Adult (age >18 years) patients in cardiac arrest were included in the study. Exclusion criteria of the study were - traumatic arrest, out-of-hospital cardiac arrest resuscitated before ED admission, and patients presenting with initial shockable rhythm. Patients whose ultrasound images could not be obtained and whose resuscitation stopped following POCUS were also excluded from the study. POCUS examination was done after 2 min of initiation of cardiopulmonary resuscitation (CPR) and visible cardiac activity was defined as any visible movement of the myocardium, excluding movement of blood within cardiac chambers, or isolated valve movement. The duration of POCUS examinations was limited to 10 s. The association of initial cardiac activity in POCUS with the outcomes of cardiac arrest was investigated.</p><p><strong>Results: </strong>Out of 140 patients screened, 84 patients were included in the study. Rates of ROSC, SIA, and STHD were found in 23 (27.4%), 9 (10.7%), and 2 (2.4%) patients, respectively. Only 15 out of 84 (17.9%) patients had cardiac activity on the initial POCUS examination. Cardiac activity was seen in 52.2% of patients with ROSC, which was significantly higher (<i>P</i> < 0.001) as compared with the no-ROSC group (4.9%). Unlike the above association, there was no difference in the incidence of initial cardiac activity in patient groups who got admitted (SIA) and discharged (STHD) versus those who died. In the multivariate regression analysis, the duration of CPR and initial cardiac activity significantly predicted the rate of ROSC, with an adjusted odds ratio of 0.93 (95% confidence interval [CI]: 0.86-0.99, <i>P</i> = 0.04) and 24.8 (95% CI: 3.17-89.41, <i>P</i> = 0.002), respectively. None of the variables predicted SIA and STHD. The positive likelihood ratio of cardiac activity for predicting ROSC, SIA, and STHD were 10.6, 2.1, and 2.9, respectively.</p><p><strong>Conclusion: </strong>Integration of POCUS in cardiac arrest resuscitation was shown to be helpful in terms of prognostic significance of the presence of initial cardiac activity in terms of ROSC.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b5/76/TJEM-23-24.PMC9930388.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10773215","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":"Transient ischemic liver injury and respiratory failure in a COVID-19-positive patient after multiple bee stings.","authors":"Onder Yesiloglu,&nbsp;Ahmet Sonmez,&nbsp;Begum Seyda Avci,&nbsp;Hilmi Erdem Sumbul,&nbsp;Akkan Avci","doi":"10.4103/2452-2473.366488","DOIUrl":"https://doi.org/10.4103/2452-2473.366488","url":null,"abstract":"<p><p>We present a patient with multiple bee stings who developed lung and liver injuries and subsequently tested positive for coronavirus disease 2019 (COVID-19). A 65-year-old male patient presented to the emergency department after being stung by more than 100 honeybees. His physical examination revealed pustular lesions distributed across his chest, arms, back, legs, and head, marking the sting zones. While the patient had no history of liver disease, initial laboratory test results showed elevated liver enzyme levels. A chest computer tomography scan was ordered, revealing bilateral ground-glass opacities suggesting COVID-19. His condition worsened over the course of the following day, and when he was admitted to the intensive care unit (ICU), his SpO₂ decreased to 83% despite oxygen support with a mask. The second polymerase chain reaction test taken in the ICU was positive for COVID-19 infection. After stung with multiple bees, the patient developed acute liver injury and suffered from concomitant COVID-19-related respiratory insufficency, and he was treated accordingly. Starting on the 5^th day, the patient's liver markers began to improve, and on the 13^th day, he was discharged with normal vital signs and liver enzyme values. There seem to be varying outcomes across different studies with regard to the relationship between bee stings and COVID-19. Further research is needed to explore the possibility of this complementary treatment with bee venom in the prevention of severe acute respiratory syndrome coronavirus-2 infection.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/1d/0c/TJEM-23-57.PMC9930383.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10763935","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":"Scholarly impact of the dissertation requirement for postgraduate medical education and factors affecting transformation into publication: A bibliometric analysis of 2434 dissertations in the field of emergency medicine","authors":"İbrahim Ulaş Özturan, İbrahim Sarbay","doi":"10.4103/tjem.tjem_45_23","DOIUrl":"https://doi.org/10.4103/tjem.tjem_45_23","url":null,"abstract":"OBJECTIVES: In Turkey, conducting research for a dissertation is necessary to obtain a specialist degree, but publication of this research is not mandatory. Previous studies have shown a low rate of publication for dissertation-derived research. The aim of this study was to determine publication rates, factors affecting the transformation of the dissertations into high-quality publications, and bibliometric analysis of published articles in the field of emergency medicine (EM). METHODS: This was a retrospective bibliometric study of EM dissertations submitted between 1998 and 2021 to the National Thesis Center. Research characteristics, publication status, journal characteristics, indexing, citation analysis, and institution characteristics were recorded. Journals indexed in the web of science (WOS) were defined as high-quality journals. A logistic regression was performed to identify factors affecting publication in high-quality journals. RESULTS: A total of 2434 dissertations were included. Of these, 864 (35.5%) were published and 474 (54%) were published in WOS-indexed journals. The most common area of research was trauma (n = 150, 17%), and the most common journal was the American Journal of EM (n = 74, 8%). Prospective data collection (odds ratio [OR] = 2.5, 95% confidence interval [CI] = 1.8–2.5), experimental design (OR = 2, 95%, CI = 1.3–3), university-type residency program (OR = 1.4, 95% CI = 1.02–2.1), and duration between year of graduation and publication (OR = 0.9, 95% CI = 0.84–0.95) were associated with publishing in WOS-indexed journals. CONCLUSION: EM is a relatively successful specialty for publishing dissertation-derived studies. Prospective and experimental research design, graduation from a university-type residency program, and shorter duration between the graduation and publication may increase the chance of publishing in high-quality journals.","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135953353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of novel anteroposterior short-axis in-plane technique with conventional short-axis out-of-plane technique for ultrasound-guided internal jugular vein cannulation: A randomized-controlled trial.","authors":"Karma Ongmu Bhutia,&nbsp;Ankur Sharma,&nbsp;Shilpa Goyal,&nbsp;Nikhil Kothari,&nbsp;Kamlesh Kumari,&nbsp;Akhil Dhanesh Goel,&nbsp;Priyanka Sethi,&nbsp;Pradeep Bhatia","doi":"10.4103/2452-2473.366485","DOIUrl":"https://doi.org/10.4103/2452-2473.366485","url":null,"abstract":"<p><strong>Objectives: </strong>Various ultrasound (US)-guided probe positioning and needle procedures have been described in the literature for cannulation of the internal jugular vein (IJV). In the present study, we compared the conventional short-axis out-of-plane (SAX-OOP) method with a novel anteroposterior short-axis in-plane (APSAX-IP) technique for IJV cannulation under US guidance. The APSAX-IP method of IJV cannulation has not been compared to other IJV cannulation techniques.</p><p><strong>Methods: </strong>A total of 104 patients above 18-year-old were randomly allocated to one of two groups - APSAX-IP or SAX-OOP and evaluated for US-guided IJV cannulation in either the operating room or critical care unit. The primary outcome of this research was the access time for IJV cannulation using both approaches. The secondary outcomes were the number of attempts of needle insertion, success rate, and complications of IJV cannulation.</p><p><strong>Results: </strong>The access time for IJV cannulation was 13.0 (12.0-15.0) sec in the APSAX-IP group and 13.0 (12.0-14.0) sec in the SAX-OOP group; <i>P</i> = 0.947. The number of successful 1^st attempts was 90.91%, and the 2^nd attempts were 9.09% in the APSAX-IP group and 85.19% and 14.81% in the SAX-OOP group, respectively. Both techniques did not have any complications.</p><p><strong>Conclusions: </strong>We conclude that the US-guided APSAX-IP IJV cannulation method has comparable access time to the SAX-OOP technique.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ad/ac/TJEM-23-17.PMC9930384.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10763938","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":"Predictive value of cardiovascular risk scoring systems for the detection of myocardial injury following carbon monoxide intoxication.","authors":"Mustafa Özkoç,&nbsp;Emrah Aksakal,&nbsp;Ömer Faruk Derman,&nbsp;Ibrahim Saraç,&nbsp;Yavuzer Koza","doi":"10.4103/2452-2473.366483","DOIUrl":"https://doi.org/10.4103/2452-2473.366483","url":null,"abstract":"<p><strong>Objectives: </strong>This single-center, retrospective study investigates the predictive value of cardiovascular (CV) risk-calculation systems in patients admitted to the emergency department with carbon monoxide (CO) intoxication for the identification of potential myocardial injury.</p><p><strong>Methods: </strong>The total CV risk of 558 patients presenting to the emergency department with CO intoxication were calculated on admission using different CV risk scoring systems, including SCORE Turkey, European Heart SCORE, and FRAMINGHAM to predict potential myocardial injury secondary to poisoning, and the risk levels were categorized based on the calculated scores. The presence of myocardial injury was identified based on the level of elevation of a cardiac biomarker (Serum cardiac troponin-I >99^th percentile upper reference limit).</p><p><strong>Results: </strong>Myocardial injury due to CO intoxication was detected in 132 (23.7%) of the patients. A comparison of the risk scoring systems' ability to detect the presence of myocardial injury revealed that all had significant, similar, but low predictive values (the \"area under the curve\" values of SCORE Turkey, European Heart SCORE and FRAMINGHAM were 0.653, 0.632, and 0.629, respectively; <i>P</i> < 0.001). Among the three risk scoring systems, SCORE Turkey was the most successful test in diagnosing myocardial injury with 87% specificity, while FRAMINGHAM scoring was the most successful test in excluding the presence of myocardial injury with 72.1% sensitivity.</p><p><strong>Conclusion: </strong>Among the tested CV risk-calculation systems SCORE Turkey, was found to be the most effective in the prediction of myocardial injury secondary to CO poisoning, but all produced similar and significant results.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4b/bc/TJEM-23-30.PMC9930385.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10763939","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":"Diagnostic accuracy of drooling, reluctance, oropharynx, others, and leukocytosis score as a predictor of mortality and complications following acute corrosive ingestion","authors":"Jamshed Nayer, Fawaz Poonthottathil, Soorya Suresh, Praveen Aggarwal","doi":"10.4103/tjem.tjem_128_23","DOIUrl":"https://doi.org/10.4103/tjem.tjem_128_23","url":null,"abstract":"OBJECTIVES: Esophagogastroduodenoscopy is considered the gold standard in assessing the severity of injury to the gastrointestinal tract following corrosive ingestion. Zargar’s endoscopic grading of injury helps in prognostication as well as guiding management. Since the major burden of cases lies in resource-limited settings, the availability of endoscopic evaluation is a limiting factor. Hence, it is prudent to develop bedside tools that can be used as screening tools to identify patients at high risk of mortality and complications so that timely referrals and judicious utilization of resources can be made. Literature in this regard is limited and published studies have shown that clinical features fail to predict the severity of injury. We aimed our study to find the role of Drooling, Reluctance, Oropharynx, Others, and Leukocytosis (DROOL) score as a predictor of mortality and complications following acute corrosive ingestion. METHODS: This was a diagnostic accuracy study conducted in the emergency department (ED) of a tertiary care hospital in North India. We screened all cases of acute corrosive ingestion presented to our ED. We collected the data on demographic profile, clinical features, investigations, endoscopy findings, treatment, and DROOL score. We followed patients for up to 12 weeks for outcomes including mortality and complications. RESULTS: We studied 79 patients of acute corrosive ingestion. The median age was 26 years with a female predominance. Nausea, vomiting, and pain abdomen were the common symptoms. The median DROOL score was 4. The majority of our patients had normal to Zargar grade 1 injury to the stomach and esophagus. Out of 79 patients, 27 patients developed some complications. The overall mortality up to 12 weeks was 10%. The receiver operating characteristics (ROC) analysis was performed, and the area under the ROC (AUROC) curve of Zargar classification in predicting overall complications was 0.909 (96% confidence interval [CI]: 0.842–0.975) and it was 0.775 (95% CI: 0.553–1.000) in predicting mortality. The AUROC of DROOL score in predicting overall complications was 0.932 (95% CI: 0.877–0.987) and the AUROC of DROOL score in predicting mortality was 0.864 (95% CI: 0.758–0.970). The ROC analysis showed that a DROOL score ≤4 has a sensitivity of 96.2% and a specificity of 77.8% in predicting overall complications. Similarly, DROOL score ≤5 has a sensitivity of 81.7% and a specificity of 62.5% in predicting the development of mortality. Delong test showed that there was no statistically significant difference in Zargar versus DROOL score in terms of prediction of mortality and overall complications (P > 0.05). CONCLUSION: DROOL score is comparable to Zargar score in identifying patients at high risk of mortality and complications. Hence, DROOL score can be used for risk stratification of patients presenting with corrosive ingestion.","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135953333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changing spectrum of acute poisoning in North India: A hospital-based descriptive study.","authors":"Ashok Kumar Pannu,&nbsp;Ashish Bhalla,&nbsp;Vitla Vamshi,&nbsp;Manish Kumar Upadhyay,&nbsp;Navneet Sharma,&nbsp;Susheel Kumar","doi":"10.4103/2452-2473.357627","DOIUrl":"https://doi.org/10.4103/2452-2473.357627","url":null,"abstract":"<p><strong>Objectives: </strong>Evaluating local trends and continued monitoring of patterns of acute poisoning are essential for prompt recognition of the toxidromes, the establishment of immediate treatment facilities (e.g., antidote availability), and effective preventive strategies (e.g., governmental regulation on hazardous substances marketing). We aimed to describe the prevalence of the various types of poisoning and associated case fatality in our academic hospital in North India.</p><p><strong>Methods: </strong>A prospective observational descriptive study was conducted, enrolling patients aged ≥13 years with acute poisoning for 17 months from December 2016 to December 2017 and from September 2019 to December 2019, for a total of 17 months.</p><p><strong>Results: </strong>Four hundred and two patients were enrolled (median age 28 years; 63.2% males). Majority of the acute poisoning cases resulted from ingestion (<i>n</i> = 391, 97.3%) and the primary intention was most commonly self-harm (<i>n</i> = 314, 78.1%). The major types of poisoning were pesticide (<i>n</i> = 264, 65.7%), drug overdose (<i>n</i> = 77, 19.2%), and corrosive ingestion (<i>n</i> = 31, 7.7%). Pesticides included insecticides (<i>n</i> = 146, 36.3%; cholinesterase inhibitors, <i>n</i> = 91), fungicides (<i>n</i> = 76, 18.9%; all aluminum phosphide), herbicides (<i>n</i> = 22, 5.5%; paraquat, <i>n</i> = 19), and rodenticides (<i>n</i> = 20, 5.0%; coumarin-derived substances, <i>n</i> = 12). Benzodiazepines (<i>n</i> = 33) and opioids (<i>n</i> = 25) were frequent causes of drug overdose. 95.3% (<i>n</i> = 379) received preliminary treatment at the previous health-care center, including gastric lavage (<i>n</i> = 239) and antidotes (<i>n</i> = 73). In-hospital case fatality rate was 17.3% (<i>n</i> = 58).</p><p><strong>Conclusion: </strong>Herbicide ingestion and opioid overdose are emerging threats with a gradual decline in organophosphate and aluminum phosphide poisoning. Despite improving management of acute poisoning, the overall case fatality rate remains substantial.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/27/61/TJEM-22-192.PMC9639736.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10216899","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}