Browsing by Author "Aksel, Gokhan"

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Analyses of Demographical and Injury Characteristics of Adult and Pediatric Patients Injured in Syrian Civil War
(2017) Er, Erhan; Corbacioglu, Seref Kerem; Guler, Sertac; Aslan, Sahin; Seviner, Meltem; Aksel, Gokhan; Bekgoz, Burak; https://orcid.org/0000-0002-1670-7188; 27771222; AAJ-5930-2021
Purpose: Aimed to analyze demographical data and injury characteristics of patients who were injured in the Syrian Civil War (SCW) and to define differences in injury characteristics between adult and pediatric patients. Methodology: Patients who were injured in the SCW and transferred to our emergency department were retrospectively analyzed in this study during the 15-month period between July 2013 and October 2014. Results: During the study period, 1591 patients who were the victims of the SCW and admitted to our emergency department due to war injury enrolled in the study. Of these patients, 285 were children (18%). The median of the injury severity score was 16 (interquartile range [IQR]: 9-25) in all patients. The most frequent mechanism of injury was blunt trauma (899 cases, 55%), and the most frequently-injured region of the body was the head (676 cases, 42.5%). Head injury rates among the children's group were higher than those of the adult group (P <.001). In contrast, injury rates for the abdomen and extremities in the children's group were lower than those in the adult group (P <.001, P <.001). Conclusion: The majority of patients were adults, and the most frequent mechanism of injury was blunt trauma. Similarly, the children were substantially affected by war. Although the injury severity score values and mortality rates of the child and adult groups were similar, it was determined that the number of head injuries was higher, but the number of abdomen and extremity injuries was lower in the children's group than in the adult group. (C) 2016 Elsevier Inc. All rights reserved.
The Association Between Blood Alcohol Levels and the Severity of Head Trauma in Patients with Minor Head Trauma
(2015) Aksel, Gokhan; Ozel, Betul Akbuga; Guler, Sertac; Kavalci, Cemil; Dogan, Nurettin Ozgur; Corbacioglu, Seref Kerem
Introduction: Alcohol intake is associated with a wide variety of traumatic hazards. Although most authors accept that head injuries are frequently sustained in the state of alcohol intoxication, contributing to major post-traumatic disability and mortality, the specific effects of alcohol exposure on injury severity and subsequent outcomes remain controversial. Materials and methods: This was a prospective cross-sectional study, which compared alcohol ingested and alcohol free patients presenting to the emergency department following minor head trauma according to their severity of head injury. Adult patients presenting to emergency department with minor head trauma, as defined by a GCS score of 15 and blunt trauma to the head are enrolled to the study consecutively. Patients with a blood alcohol level of >= 10mg/dL were defined as alcohol group and <10mg/dL were defined as non-alcohol group (control group). Cranial computed tomography results of two groups were compared. Results: A total number of 424 patients included in the study and 208 of them composed alcohol group and 216 non-alcohol group. There were 19 patients having (45%) positive findings in their cranial computed tomographies. 3 (0.7%) of them had clinically important intracranial injuries while 16 (3.8%) had clinically unimportant intracranial injuries. There was no statistically significant difference in two groups according to patients having intracranial injuries (p=0.273). 22 of the patients needed neurosurgical or non-neurosurgical interventions. Patients in alcohol group needed more operative interventions compared to non-alcohol group (p<0.001). Conclusion: Alcohol did not influence the severity of head trauma while it influenced the severity of whole body trauma. Although not reaching statistical significance, both patients with positive computed tomography results and patients who needed neurosurgical intervention were higher in alcohol-intoxicated patients. We believe that patients with alcohol intoxication need more elaborative evaluation than alcohol free patients in order to detect life-threatening complications in patients with mild head injury.
Comparison of the Canadian CT head rule and the new orleans criteria in patients with minor head injury
(2014) Kavalci, Cemil; Aksel, Gokhan; Salt, Omer; Yilmaz, M. Serkan; Demir, Ali; Kavalci, Gulsum; Ozel, Betul Akbuga; Altinbilek, Ertugrul; Durdu, Tamer; Yel, Cihat; Durukan, Polat; Isik, Bahattin
Aim: The aim of the study was to compare the New Orleans Criteria and the New Orleans Criteria according to their diagnostic performance in patients with mild head injury. Methods: The study was designed and conducted prospectively after obtaining ethics committee approval. Data was collected prospectively for patients presenting to the ED with Minor Head Injury. After clinical assessment, a standard CT scan of the head was performed in patients having at least one of the risk factors stated in one of the two clinical decision rules. Patients with positive traumatic head injury according to BT results defined as Group 1 and those who had no intracranial injury defined as Group 2. Statistical analysis was performed with SPSS 11.00 for Windows. ROC analyze was performed to determine the effectiveness of detecting intracranial injury with both decision rules. p < 0.05 was considered statistically significant. Results: 175 patients enrolled the study. Male to female ratio was 1.5. The mean age of the patients was 45 +/- 21,3 in group 1 and 49 +/- 20,6 in group 2. The most common mechanism of trauma was falling. The sensitivity and specificity of CCHR were respectively 76.4% and 41.7%, whereas sensitivity and specificity of NOC were 88.2% and 6.9%. Conclusion: The CCHR has higher specificity, PPV and NPV for important clinical outcomes than does the NOC.
Effects of Fast-Track in A University Emergency Department Through The National Emergency Department Overcrowding Study
(2014) Aksel, Gokhan; Bildik, Fikret; Demircan, Ahmet; Keles, Ayfer; Kilicaslan, Isa; Guler, Sertac; Corbacioglu, Seref Kerem; Turkay, Asli; Bekgoz, Burak; Dogan, Nurettin Ozgur; https://orcid.org/0000-0002-5580-3201; 25255588; GPX-5137-2022
Objective: To determine the impact of a fast track area on emergency department crowding and its efficacy for non-urgent patients. Methods: The prospective cross-sectional study was conducted in an adult emergency department of a university-affiliated hospital in Turkey from September 17 to 30, 2010. Non-urgent patients were defined as those with Canadian Triage Acuity Scale category 4/5. The fast track area was open in the emergency department for one whole week, followed by another week in which fast track area was closed. Demographic information of patients, their complaints on admission, waiting times, length of stay and revisits were recorded. Overcrowding evaluation was performed via the National Emergency Department Overcrowding Study scale. In both weeks, the results of the patients were compared and the effects of fast track on the results were analysed. Continuous variables were compared via student's t test or Mann Whitney U test. Demographic features of the groups were evaluated by chi-square test. Results: A total of 249 patients were seen during the fast track week, and 239 during the non-fast track week at the emergency department. Satisfaction level was higher in the fast track group than the non-fast track group (p<0.001). The waiting times shortened from 20 minutes to 10 minutes and length of stay shortened from 80 minutes to 42 minutes during the fast track week. Morbidity and mortality rates remained unchanged. Conclusion: Owing to fast track, overcrowding in the emergency department was lessened. It also improved effectiveness and quality measures.
Metoclopramide-induced acute dystonic reaction misinterpreted as conversion disorder and seizure
(2017) Ozel, Betul Akbuga; Aksel, Gokhan; Kilicli, Elif; Muratoglu, Murat; Kavalci, Cemil; Gulalp, Betul; Kayipmaz, Afsin Emre; 0000-0002-9586-7509; AAK-2079-2021; AAC-2597-2020
Metoclopramide, an antiemetic, is the most common cause of drug-induced dystonic reactions. 20-year-old female patient, complaining of involuntary bilateral upward medial deviation of the eyes, generalized muscle contractions and uncontrollable cry was brought into the emergency department(ED) by an ambulance. The diagnosis of the ambulance crew was conversion or seizure. The patient has all of dystonic reaction symptoms, including facial, neck, back, and extremity spasms, opisthotonus, oculogyric crisis, torticollis, trismus. The history revealed 40 mg of metoclopramide intake. Biperiden (5 mg) was infused in 100 ml saline. Symptoms were completely resolved. She was discharged from the ED. Drug-induced dystonic reactions can be confused with conversion, seizures, encephalitis, tetanus and hypocalcemic tetany. It is important for emergency physicians to know the drugs that may have dystonic reaction as potential side effects, recognize the clinical presentation of drug-induced dystonic reactions, and properly manage them in the ED.