Turkish Journal of Emergency Medicine最新文献

{"title":"Ratio of oxygen saturation index for predicting high-flow nasal cannula outcomes in emergency department for COVID-19 patients with severe hypoxemia: A retrospective study.","authors":"Cynthia Karam, Ahmad Oseili, Fadia M Shebbo, Mohamad Fakih, Mohamad F El-Khatib","doi":"10.4103/tjem.tjem_159_23","DOIUrl":"https://doi.org/10.4103/tjem.tjem_159_23","url":null,"abstract":"<p><strong>Objectives: </strong>High-flow nasal cannula (HFNC) oxygen therapy has been used as an initial ventilatory support for coronavirus disease 2019 (COVID-19) patients with mixed levels of acute hypoxemic respiratory failure (AHRF). However, the effectiveness of HFNC when used as initial ventilatory support in COVID-19 patients with severe AHRF exclusively is not well documented. Ratio of oxygen saturation (ROX) index (ROX = [SpO₂/fraction of inspired oxygen]/respiratory rate) was shown to predict the outcome of HFNC in intensive care unit patients. Our study aimed to evaluate the utility of the ROX index for predicting HFNC therapy success/failure in COVID-19 patients with severe AHRF when HFNC is used as the first line of ventilatory support.</p><p><strong>Methods: </strong>Retrospective study in 67 COVID-19 patients with severe AHRF receiving HFNC in the emergency department at a tertiary care academic medical center. ROX index was determined at 0, 2, 6, 12, and 24 h of HFNC onset. The need to escalate to noninvasive or invasive ventilatory support was documented. The receiver operating characteristic curves were performed and areas under the curves (AUCs) were calculated to evaluate the accuracy of ROX index for differentiating between patients who will succeed or fail HFNC therapy.</p><p><strong>Results: </strong>HFNC therapy was successful in 19 patients (28.1%) and failed in 48 patients (71.6%). ROX index after 6 h of HFNC initiation had the best predictive capacity for the outcome of HFNC therapy (AUC = 0.78). ROX index >4.4 at 6 h of HFNC onset was significantly associated with HFNC success/failure.</p><p><strong>Conclusion: </strong>ROX index at 6 h after initiating HFNC therapy in COVID-19 patients with severe AHRF has a good predictive capacity for HFNC success/failure.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"24 1","pages":"41-47"},"PeriodicalIF":0.9,"publicationDate":"2024-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10852130/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139724485","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":"Re-emergence of a forgotten diabetes complication: Euglycemic diabetic ketoacidosis.","authors":"Murat Dagdeviren, Tolga Akkan, Derun Taner Ertugrul","doi":"10.4103/tjem.tjem_110_23","DOIUrl":"https://doi.org/10.4103/tjem.tjem_110_23","url":null,"abstract":"<p><p>Diabetic ketoacidosis (DKA) is the most common emergency complication of diabetes. Euglycemic DKA (EDKA), on the other hand, has been known for many years but is a rare and under-recognized condition and constitutes a very small proportion of DKA cases. However, in recent years, an increase in the incidence of EDKA has been observed with the widespread use of sodium-glucose co-transporter 2 inhibitors, which have proven benefits in the treatment of diabetes mellitus and its cardiorenal complications, heart failure, and chronic kidney disease. Unlike classical DKA, these patients without significant hyperglycemia can easily be missed in emergency departments. EDKA should be kept in mind in patients with diabetes presenting with DKA but with a blood glucose level <250 mg/dL. The diagnostic and therapeutic approach after clinical suspicion in these patients is similar to classical DKA and is briefly summarized in this review. The most important point in treatment is that these patients are normoglycemic but have a significant insulin deficiency (relative or absolute). Therefore, insulin is the mainstay of the treatment and should be given together with dextrose solutions to avoid hypoglycemia.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"24 1","pages":"1-7"},"PeriodicalIF":0.9,"publicationDate":"2024-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10852133/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139724486","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":"A case presented with fever enlightened by cardiac auscultation: Sarcoma originated in pulmonary artery.","authors":"Yavuz Fatih Yavuz, Nazmi Toprak, Cemil Kavalci, Fevzi Yilmaz","doi":"10.4103/tjem.tjem_358_22","DOIUrl":"https://doi.org/10.4103/tjem.tjem_358_22","url":null,"abstract":"<p><p>In the emergency department, there are many symptoms patients present. One of the major symptoms is fever which could be the only symptom, as our patient had. Not only do infections, drugs, trauma, etc., cause fever, but also undetermined cancer types do. In this case, we are presenting a 28-year-old male coming with a 3-week duration of fever and being admitted with the diagnosis of pulmonary artery intimal sarcoma as generally misconceived with pulmonary thromboembolism, to raise awareness of this fatal cancer.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"24 1","pages":"55-57"},"PeriodicalIF":0.9,"publicationDate":"2024-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10852132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139724470","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":"Does apneic oxygenation with nasopharyngeal cannula during intubation improve the oxygenation in patients with acute hypoxemic respiratory failure compared to the standard bag valve mask preoxygenation? An open-labeled randomized control trial.","authors":"Irfan Zubair Shahul Hameed, Darpanarayan Hazra, Priya Ganesan, Abhilash Kundavaram Paul Prabhakar","doi":"10.4103/tjem.tjem_176_23","DOIUrl":"https://doi.org/10.4103/tjem.tjem_176_23","url":null,"abstract":"<p><strong>Objectives: </strong>In the context of acute hypoxemic respiratory failure (AHRF), ensuring effective preoxygenation and apneic oxygenation emerges as the pivotal approach ensuring for averting hypoxemic adverse events during endotracheal intubation. To investigate this, we conducted an open-label randomized controlled trial, aiming to assess the comparative effectiveness of nasopharyngeal high-flow oxygenation in conjunction with Bag-Valve-Mask (BVM) versus standard BVM preoxygenation in patients experiencing AHRF within the emergency department (ED).</p><p><strong>Methods: </strong>This prospective single-center, open-labeled, randomized controlled trial enrolled patients aged 18 years and above requiring rapid sequence intubation due to AHRF in the ED. Participants were randomly assigned in a 1:1 ratio to either the intervention arm (involving nasopharyngeal high-flow oxygenation and BVM preoxygenation) or the control arm (involving BVM preoxygenation alone).</p><p><strong>Results: </strong>A total of 76 participants were enrolled in the study, evenly distributed with 38 individuals in each arm. Median (interquartile range [IQR]) SpO₂ at 0 min postintubation was 95.5 (80%-99%) versus 89 (76%-98%); z-score: 1.081, <i>P</i> = 0.279 in the intervention and control arm, respectively. The most common postintubation complications included hypoxia (intervention arm: 56.7% vs. control arm: 66.7%) and circulatory/hypoxic arrest (intervention arm: 39.5% vs. control arm: 44.7%). There were no adverse complications in 36.7% (<i>n</i> = 11) of patients in the intervention arm. Despite the best possible medical management, almost half (52.6%) of patients in the intervention arm and 47.4% of patients in the control arm succumbed to their illnesses in the ED.</p><p><strong>Conclusion: </strong>The primary outcome revealed no statistically significant difference between the two arms. However, patients in the intervention arm exhibited fewer intubation-related adverse effects.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"24 1","pages":"33-40"},"PeriodicalIF":0.9,"publicationDate":"2024-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10852139/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139724471","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":"Unraveling the clinical significance and prognostic value of the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, systemic immune-inflammation index, systemic inflammation response index, and delta neutrophil index: An extensive literature review.","authors":"Mehmet Muzaffer Islam, Merve Osoydan Satici, Serkan Emre Eroglu","doi":"10.4103/tjem.tjem_198_23","DOIUrl":"https://doi.org/10.4103/tjem.tjem_198_23","url":null,"abstract":"<p><p>In the field of critical care medicine, substantial research efforts have focused on identifying high-risk patient groups. This research has led to the development of diverse diagnostic tools, ranging from basic biomarkers to complex indexes and predictive algorithms that integrate multiple methods. Given the ever-evolving landscape of medicine, driven by rapid advancements, changing treatment strategies, and emerging diseases, the development and validation of diagnostic tools remains an ongoing and dynamic process. Specific changes in complete blood count components, such as neutrophils, lymphocytes, monocytes, and platelets, are key immune system responses influenced by various factors and crucial in systemic inflammation, injury, and stress. It has been reported that indices such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and delta neutrophil index calculated using various ratios of these elements, are important predictors of various outcomes in conditions where the inflammatory process is at the forefront. In this narrative review, we concluded that NLR, PLR, SII, and SIRI show promise in predicting outcomes for different health conditions related to inflammation. While these tests are accessible, reliable, and cost-effective, their standalone predictive performance for a specific condition is limited.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"24 1","pages":"8-19"},"PeriodicalIF":0.9,"publicationDate":"2024-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10852137/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139724487","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":"Face-to-face awake intubation in an upright position in severe maxillofacial trauma.","authors":"Laurensia Vidya Ayuningtyas, Airi Mutiar, Prananda Surya Airlangga","doi":"10.4103/tjem.tjem_84_23","DOIUrl":"https://doi.org/10.4103/tjem.tjem_84_23","url":null,"abstract":"<p><p>Maxillofacial injury may cause difficulty during airway assessment and management in the emergency setting. Alternative intubation positions and techniques should be considered to ensure patient safety. A 37-year-old male patient arrived at the emergency department with a degloving maxillofacial injury after a high-impact motor vehicle accident. Active bleeding from his wounds prevented him from lying supine and raised concerns of aspiration, requiring immediate securing of the airway. Since the patient was alert and cooperative, awake face-to-face intubation in the upright position was performed. Intubation was successful on the first attempt without any complications using a video laryngoscope with topical anesthesia sprayed intraorally. Awake intubation in the face-to-face upright position can be successful in a cooperative patient with severe maxillofacial trauma.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"24 1","pages":"58-61"},"PeriodicalIF":0.9,"publicationDate":"2024-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10852136/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139725688","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":"Posttraumatic stress disorder in health-care workers after two major earthquakes centered in Kahramanmaras, Turkey.","authors":"Dilay Satilmis, Egemen Yildiz, Erdem Cevik","doi":"10.4103/tjem.tjem_192_23","DOIUrl":"https://doi.org/10.4103/tjem.tjem_192_23","url":null,"abstract":"<p><strong>Objectives: </strong>Earthquakes are one of the most studied uncontrollable natural conditions that cause negative psychological consequences. Although health-care workers (HCWs) are trained to manage trauma in the out-of-hospital area, uncontrollable tragic events in the earthquake field and exposure to life-threatening situations may cause psychological disorders. This study aimed to investigate the risk of the development of probable posttraumatic stress disorder (PTSD) and the factors affecting it in HCWs working in the region during major earthquakes centered in Kahramanmaras.</p><p><strong>Methods: </strong>The questionnaire, which consists of the Turkish version of the 20-item PTSD Checklist for DSM-5 (PCL-5) self-report measure assessing DSM-5 symptoms of PTSD, was applied to HCWs. The Turkish version of the PCL-5 proved validity and reliability, with a cutoff point of ≥47 to diagnose probable PTSD.</p><p><strong>Results: </strong>In this study, of the 79 HCWs, 62.7% were male. The overall probable PTSD rate was 37.9% (<i>n</i> = 30). Female participants had a significantly higher probable PTSD rate than males (<i>P</i> < 0.001). The nurses met probable PTSD criteria statistically significantly more than the doctors (<i>P</i> = 0.026). The multiple regression analysis for predictors of probable PTSD revealed that female gender, previously working in a level 1 hospital, and being a nurse were among the independent risk factors.</p><p><strong>Conclusion: </strong>This study showed that the probable PTSD rate was high among HCWs and that female HCWs were at higher risk for PTSD. HCWs, especially females working in the disaster area, should be closely monitored, and more mental health services should be provided to ensure that HCWs receive the necessary support in the postdisaster period.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"24 1","pages":"27-32"},"PeriodicalIF":0.9,"publicationDate":"2024-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10852134/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139725689","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 7-day symptomatic hemorrhagic transformation in patients with acute ischemic stroke and proposal of a novel screening tool: A retrospective cohort study.","authors":"Mehmet Muzaffer Islam,&nbsp;Cemrenur Uygun,&nbsp;Melike Delipoyraz,&nbsp;Merve Osoydan Satici,&nbsp;Servan Kurt,&nbsp;Enis Ademoglu,&nbsp;Serkan Emre Eroglu","doi":"10.4103/tjem.tjem_33_23","DOIUrl":"https://doi.org/10.4103/tjem.tjem_33_23","url":null,"abstract":"<p><strong>Objectives: </strong>Hemorrhagic transformation (HT) is significantly related to poor neurological outcomes and mortality. Although variables and models that predict HT have been reported in the literature, the need for a model with high diagnostic performance continues. We aimed to propose a model that can accurately predict symptomatic HT within 7 days of acute ischemic stroke (AIS).</p><p><strong>Methods: </strong>Patients with AIS admitted to the emergency department of a tertiary training and research hospital between November 07, 2021, and August 26, 2022, were included in this single-center retrospective study. For the model, binary logistics with the forced-entry method was used and the model was validated with 3-fold cross-validation. After the final model was created, the optimal cutoff point was determined with Youden's index. Another cut-off point was determined at which the sensitivity was the highest.</p><p><strong>Results: </strong>The mean age of the 423 patients included in the study was 70 (60-81) and 53.7% (<i>n</i> = 227) of the patients were male. Symptomatic HT was present in 31 (7.3%) patients. Mechanical thrombectomy, atrial fibrillation, and diabetes mellitus were the independent predictors (<i>P</i> < 0.001, <i>P</i> = 0.003, <i>P</i> = 0.006, respectively). The mean area under the curve of the receiver operating characteristics of the model was 0.916 (95% confidence interval [CI] = 0.876-0.957). The sensitivity for the optimal cut-off point was 90.3% (95% CI = 74.3%-97.9%) and specificity was 80.6% (95% CI = 76.4%-84.4%). For the second cutoff point where the sensitivity was 100%, the specificity was 60.5% (95% CI = 55.4%-65.3%).</p><p><strong>Conclusion: </strong>The diagnostic performance of our model was satisfactory and it seems to be promising for symptomatic HT. External validation studies are required to implement our results into clinical use.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"23 3","pages":"176-183"},"PeriodicalIF":0.9,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/74/f5/TJEM-23-176.PMC10389091.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9980699","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":"Role of Janus Kinase inhibitors in the management of pulmonary involvement due to Long COVID-19 disease: A case control study.","authors":"Pawan Kumar Singh,&nbsp;Vinod Kumar Sharma,&nbsp;Lokesh Kumar Lalwani,&nbsp;Dhruva Chaudhry,&nbsp;Manjunath B Govindagoudar,&nbsp;Chaudhari Pramod Sriram,&nbsp;Aman Ahuja","doi":"10.4103/tjem.tjem_363_22","DOIUrl":"https://doi.org/10.4103/tjem.tjem_363_22","url":null,"abstract":"<p><strong>Objectives: </strong>Ongoing symptomatic coronavirus disease 2019 (OSC) is defined as persistent symptoms beyond 4 weeks of acute illness. OSC leads to prolonged hospitalization and oxygen dependence. We aimed to find the outcome of Janus kinase inhibitors (JAKi) as a steroid-sparing agent to treat OSC.</p><p><strong>Methods: </strong>In this single-center case-controlled study comparing JAKi and corticosteroids in OSC cases, data of 41 cases out of 86 were included - 21 in the JAKi group and 20 in the corticosteroid group from 4 weeks of acute illness to the next 4 weeks. Clinical parameters and inflammatory markers were recorded. The primary outcome was to compare the proportion of patients who were able to maintain oxygen saturation ≥95% with any oxygen supplementation in the two groups.</p><p><strong>Results: </strong>The baseline clinical and demographic characteristics were similar in the two groups. The age was 53.65 ± 9.8 years and 51.48 ± 14.0 years in the corticosteroid group and JAKi group, respectively. At the baseline, 85% of patients in the corticosteroid group and 85.8% in the JAKi group were on oxygen support. The most common symptom in both groups was breathlessness followed by cough. Twenty percent of patients in the JAKi group received baricitinib and the remaining were given tofacitinib. At the time of follow-up, the majority of cases had a significant reduction in C-reactive protein (CRP) and D-dimer; however, the change in CRP and D-dimer was similar in both groups. The number of patients off oxygen support at 4 weeks was higher in the JAKi group (85% in the corticosteroid group vs. 95.2% in the JAKi group, <i>P</i> = 0.269), and the median time to liberation from oxygen support was significantly lower in JAKi group (19 days in corticosteroid group vs. 9 days in JAKi group, <i>P</i> < 0.001). The frequency of any adverse event was also higher in the corticosteroid group (70% vs. 23.8%, <i>P</i> = 0.003).</p><p><strong>Conclusion: </strong>JAKi can be used as immunomodulatory drugs in hypoxic OSC cases having evidence of ongoing inflammation.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"23 3","pages":"149-155"},"PeriodicalIF":0.9,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a4/67/TJEM-23-149.PMC10389097.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9929307","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":"The effects of playing digital games on children's pain, fear, and anxiety levels during suturing: A randomized controlled study.","authors":"Muhammet Kavlakci,&nbsp;Filiz Ogce,&nbsp;Tulay Yavan","doi":"10.4103/tjem.tjem_8_23","DOIUrl":"https://doi.org/10.4103/tjem.tjem_8_23","url":null,"abstract":"<p><strong>Objective: </strong>The aim was to determine the effects of digital game play on children's pain, fear, and anxiety levels during suturing.</p><p><strong>Methods: </strong>Data were obtained from 84 children between the ages of 8 and 17 years at the pediatric emergency department between January 16 and March 19, 2020, using the Socio-Demographic and Clinical Characteristics Form, the Wong-Baker Faces Pain Rating Scale (WBFPS), the Visual Analogue Scale (VAS), the Fear of Medical Procedures Scale (FMPS), and the State-Trait Anxiety Inventory for Children (STAI-CH). A four-block randomization system was used. The study group (<i>n</i> = 42) played digital games during the suturing procedure, unlike the control group (<i>n</i> = 42). Ethical permissions were obtained from the ethical committee, hospital, and families.</p><p><strong>Results: </strong>Before the suturing procedure, there was no statistically significant difference between the groups' mean scores. The intervention group was found to have statistically significantly lower WBFPS and VAS pain scores than the control group during the suturing procedure, and after the procedure, statistically significantly lower WBFPS, VAS, FMPS, and STAI-CH mean scores than the control group.</p><p><strong>Conclusions: </strong>The digital game-playing approach applied before and during the suture procedure was found to be effective in reducing children's pain, fear, and anxiety levels.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"23 3","pages":"162-168"},"PeriodicalIF":0.9,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/bb/5c/TJEM-23-162.PMC10389094.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9980702","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}