ABSTRACT: The objective of this study was to investigate the diagnostic value of serum tau protein in determining the severity of traumatic
brain injury in patients with mild traumatic brain injury (mTBI) and high-risk patients. Adult patients who presented to our
emergency department (ED) with mTBI over 1 year were prospectively enrolled. Patients underwent cranial computed tomography
(CT) and were subdivided into high and low-risk groups, according to the probability of resultant intracranial injury. Serum
tau levels of 60 patients and 20 healthy volunteers, who served as a control group, were measured. The mean age of the 60
patients (45 males, 15 females) was 32.5 years (range, 15–66 y). Mean Glasgow Coma Scale (GCS) score was 14±0.6. CT scans
demonstrated intracranial injury in 11 patients (18.3%) and depressed fracture in 4 patients (6.7%). Serum tau levels of patients
(188±210 pg/mL), compared with those of controls (86±48 pg/mL), were relatively higher; however, differences were not statistically
significant (P=.445). Also, serum tau levels of high-risk patients (307±246 pg/mL) were significantly higher than those of
low-risk patients (77±61 pg/mL) (P=.001). A total of 48 patients (80%) were accessible for follow-up after 6 months. Postconcussive syndrome was observed in
8 patients, 5 of whom had serum tau protein levels that were higher than those of the other 3 patients. However, no statistically
significant difference was observed (P > .05). Investigators of the present study noted that serum tau levels in patients with mTBI were increased. Therefore, it
is believed that this biomarker may prove helpful in identifying high-risk patients with mTBI. However, additional studies
are needed to establish the diagnostic value of serum tau in detecting traumatic brain injury in patients with mTBI.
Advances in Therapy 04/2012; 23(1):12-22. · 2.11 Impact Factor
ABSTRACT: To create a better scoring system for outcome prediction for patients with Fournier's gangrene in order to design more appropriate and feasible management strategies.
Using logistic regression, the medical records of 80 patients who underwent surgery for Fournier's gangrene in the last 10 years were reviewed using a prospectively maintained database, and a novel scoring system was adopted combining this data with the Fournier's gangrene severity index (FGSI). The new system consists of a physiological score, an age score, and an extent of gangrene score.
The mortality rate of the 80 patients was 21%. Using the new scoring system (UFGSI), at a threshold value of 9, there was a 94% probability of death with a score greater than 9 and an 81% probability of survival with a score of 9 or less (P < 0.001). The receiver operating characteristics (ROC) analysis concluded that the new scoring system was more powerful than the FGSI (P = 0.002).
The power of the novel scoring system introduced in this study proves that in patients with Fournier's gangrene, the extent of the gangrene as well as the patient's age and physiological status have a significant effect on the outcome.
Techniques in Coloproctology 09/2010; 14(3):217-23. · 1.29 Impact Factor
ABSTRACT: The aim of this study was to determine the general characteristics of childhood falls, factors affecting on mortality, and to compare the Injury Severity Score (ISS) and the New Injury Severity Score (NISS) as predictors of mortality and length of hospital stay in childhood falls.
We retrospectively analysed over a period of 8 years children aged younger than14 years who had sustained falls and who were admitted to our emergency department. Data on the patients' age, sex, type of fall, height fallen, arrival type, type of injuries, scoring systems, and outcome were investigated retrospectively. The ISS and NISS were calculated for each patient. Comparisons between ISS and NISS for prediction of mortality were made by receiver operating characteristic (ROC) curve and Hosmer-Lemeshow (HL) goodness of fit statistics.
In total, there were 2061 paediatric trauma patients. Falls comprised 36 (n = 749) of these admissions. There were 479 male and 270 female patients. The mean (SD) age was 5.01 (3.48) years, and height fallen was 3.8 (3) metres. Over half (56.6%) of patients were referred by other centres. The most common type of fall was from balconies (38.5%), and head trauma was the most common injury (50%). The overall mortality rate was 3.6%. The cut off value for both the ISS and NISS in predicting mortality was 22 (sensitivity 90.5%, specificity 95.4% for ISS; sensitivity 100%, specificity 88.7% for NISS) (p>0.05). Significant factors affecting mortality in logistic regression analysis were Glasgow Coma Scale (GCS) <9, ISS >22, and NISS >22. There were no significant differences in ROC between three scoring systems. The HL statistic showed poorer calibration (p = 0.02 v p = 0.37, respectively) of the NISS compared with the ISS.
In our series, the head was the most frequent site of injury, and the most common type of fall was from balconies. Scores on the GCS, NISS, and ISS are significantly associated with mortality. The performance of the NISS and ISS in predicting mortality in childhood falls was similar.
Emergency Medicine Journal 08/2006; 23(7):540-5. · 1.44 Impact Factor
ABSTRACT: This study aimed to provide an overview of morbidity and mortality among patients admitted to the Hospital of the Medicine Faculty of Uludag University, Bursa, Turkey, after the 1999 Marmara earthquake.
Retrospective analysis of the medical records of 645 earthquake victims. Patients' demographic data, diagnosis, dispositions, and prognosis were reviewed.
A total of 330 patients with earthquake related injuries and illness admitted to our hospital were included and divided into three main groups: crush syndrome (n = 110), vital organ injuries (n = 57), and non-traumatic but earthquake related illness (n = 55). Seventy seven per cent of patients were hospitalised during the first three days after the earthquake. The rate of mortality associated with the crush syndrome, vital organ injury, and non-traumatic medical problems was 21% (23/110), 17.5% (10/57), and 9% (5/55), respectively. The overall mortality rate was 8% (50/645).
In the first 24-48 hours after a major earthquake, hospital emergency departments are flooded with large numbers of patients. Among this patient load, those patients with crush syndrome or vital organ injuries are particularly at risk. Proper triage and prompt treatment of these seriously injured earthquake victims may decrease morbidity and mortality. It is hoped that this review of the challenges met after the Marmara earthquake and the lessons learned will be of use to emergency department physicians as well as hospital emergency planners in preparing for future natural disasters.
Emergency Medicine Journal 08/2005; 22(7):494-8. · 1.44 Impact Factor
ABSTRACT: Trauma care is expensive and more so for the hospitals not subsidized by the government, as is the case in developing countries. In this study, the burden of trauma care on a typical Level I trauma center in Turkey was investigated.
Medical, demographic, and financial records of trauma patients who were hospitalized in the calendar year of 1996 were analyzed.
A total of 347 patients had complete data available for analysis. The mean Injury Severity Score was 13.3+/-0.5. Total hospital charges and charges per patient were $547,391 and $1,577, respectively. There was a positive correlation between the Injury Severity Score and the hospital charges. Although 54.2% of the patients were self-payer and the rest (45.8%) had some form of a health insurance, 5.5% ($30,496) of total hospital charges of these 347 trauma patients could not be collected by the hospital.
Trauma care is expensive and reimbursement is not always possible, but the hospital's nonreimbursed money was within tolerable limits, and the overall financial balance of the hospital from the trauma care was on the positive side, even in the absence of government subsidy.
The Journal of trauma 10/1999; 47(3):572-5. · 2.48 Impact Factor
ABSTRACT: The vacuum pack technique is used increasingly for temporary abdominal closure. This paper communicates the related experience of the authors.
The charts of 74 patients who underwent temporary abdominal closure with the vacuum pack technique between January 2000 and December 2005 were reviewed retrospectively. The demographic characteristics, mortality rates and long-term complications were analysed.
The vacuum pack was inserted 139 times to 74 patients who required temporary abdominal closure. The mortality rate was 60% (45/74). Survivors and non-survivors did not differ significantly with respect to etiology (traumatic vs. non-traumatic), age, number of re-laparotomies, hospital stay, type of closure (primary or with a graft). The frequency of primary fascial closure was 45%. The frequency of incisional hernia was 50% in the patients who underwent primary closure and 10% in those who underwent graft placement (p < 0.05).
Temporary abdominal closure with the vacuum pack is a simple and inexpensive technique. Primary fascial closure is possible in approximately half of the cases ; however, the frequency of incisional hernia is high.
Acta chirurgica Belgica 108(4):414-9. · 0.43 Impact Factor