Background: The Recognition of Stroke in The Emergency Room (ROSIER( scale has been designed to provide physicians in the emergency department with a framework which can be used to assess patients with suspected stroke and to facilitate early identification of acute stroke & appropriate referral. Aims: To assess the sensitivity and specificity of the ROSIER score in order to improve outcome of stoke patients. Methodology: The current study was designed as a prospective cross sectional study that included Patients over 18 years of age with suspected stroke presenting at emergency department in Suez Canal university hospital. Results: Patients with stroke formed about 65.2% of the patients with suspected stroke in the ER. Patients with stroke/ TIA were found to have significantly higher age compared to other patients (63.58 ±12.55 vs 39.18±11.12) (p<0.001). The most frequent comorbid diseases among patients were hypertension and diabetes mellitus. For ROSIER accuracy, a value of 1.00 or more was found to be the best cut-off point for prediction of stoke among patients attending with suspected stroke, with sensitivity = 98.3% and specificity = 87.5 % and accuracy= 94.5%. Conclusion: The ROSIER scale is simple, rapid, effective and sensitive screening tool in early detection of patients presenting with stroke and differentiating stroke from stroke mimics in the emergency room.

Background:  Septic acute kidney injury is a syndrome of acute impairment of function and organ damage linked with long-term adverse outcomes depending on the extent of acute injury superimposed on underlying organ reserve. Sepsis is the most important cause of Acute Kidney Injury (AKI). Interleukin-18 (IL-18) is a pro-inflammatory cytokine expressed in the renal cortex, peritubular capillaries, and interstitium. Aim: To assess the role of IL-18 in comparison to serum creatinine in the early detection of sepsis-induced acute kidney injury in the Emergency Department (ED) at Suez Canal University Hospital. Subjects and Methods: A comparative cross-sectional study that included two groups of participants. Study group: patient diagnosed with sepsis-induced acute kidney injury attending to the ED at Suez Canal University Hospital. Control group: healthy individuals of the same age group. Patients were clinically assessed and managed by the ABCDE protocol. All patients were subjected to Initial assessment including History, clinical examination, and laboratory investigation, including urinary IL-8. Results: Cases had statistically significant higher urinary IL-18 compared to controls (121.97 ± 75.84 vs 69.07 ± 35.59) (p<0.001). IL-18, a value of 69.5 IU/L was found to be the best cut-off point for the prediction of sepsis-induced AKI among cases, with sensitivity = 6 and 5% specificity = 57.5%. Conclusion: Urinary IL-18 can be used as an early predictor for AKI than serum creatinine in patients presenting with sepsis.

Background: Easy-to-use trauma scoring systems can be used for making good clinical decision before the patient reaches the hospital and at emergency department. These scoring systems can also be used for timely delivering medical support and preparing the patient for surgery in early stage. The objective of this study was to assess the ability of trauma scoring systems such as the Glasgow Coma Scale (GCS), Injury Severity Score (ISS), and Revised Trauma Score (RTS) to predict outcomes in young children with traumatic injuries. Methods: This was a potential cross-sectional study that was conducted in the emergency department of Suez Canal University Hospitals. We included 86 children patients younger than 6 years of age who were presented to hospital via the emergency department with any traumatic injury and compared the trauma outcomes for GCS, ISS, and RTS on patient outcomes. Results: The main type of accident encountered in our study was fall from height (33.7%) followed by road traffic accidents (29.1%). Mortality rate in our study was 4.7%. The mean trauma scores of ISS, GCS, and RTS in our studied population were 11.47, 14.21, and 7.79, respectively. All trauma scores differed with statistical significance (p<0.001, <0.001, <0.030, respectively) between the survivors and mortality groups. We found a mean ISS of 10.30 ± 5.84 in survived children and 35.25 ± 25.97 in those who died. Mean GCS was 14.62 ± 1.10in survivors and 5.75 ± 1.50 in non-survivors. RTS means were7.96 ± 0.33in survived children and 4.25 ± 0.50 in those who died, respectively. ROC curve analysis of the three scores regarding mortality prediction revealed close results; all showed a modest ability to predict mortality. The highest AUC was for RTS and GCS; 0.998 and 0.997, respectively. ISS had a slightly lower AUC of 0.0816. In the current study, RTS and GCS showed the best sensitivity and specificity to predict mortality of 100% and 98.78%, respectively. A slight lower ability was found for ISS with a sensitivity of75%.  The desired cut-offs to predict mortality were ≤7 for the GCS, ≤5 for the RTS and ≥17 for the ISS with the previously mentioned sensitivity and specificity. Regarding the need for surgery, among survived patients, those who had surgery had statistically significant higher ISS compared to those who did not have surgery (14.69 ± 9.98 Vs 7.39 ± 6.04) (p<0.001). On the other hand, there was no statistically significant difference between the two groups in regard to GCS (p=0.053) and RTS (p=0.251). Conclusion: In conclusion, we found that worse trauma scores of ISS, GCS, and RTS were associated with increased mortality and prolonged hospital stays among young children’s injuries. Among these three trauma scores, we found RTS and GCS to have the best predictive value. The cutoff values of ISS, GCS, and RTS for predicting mortality were >17, ≤7, and ≤5, respectively.

Background: In-hospital cardiac arrest (IHCA) is defined as cessation of cardiac activity, confirmed by the absence of signs of circulation, in a hospitalized patient who had a pulse at the time of admission. The purpose of the present study was to record the definitive predictors of IHCA, focusing on the relation between cause and outcome as well as the influence of location on survival. Subjects and Methods: This prospective observational study (cross sectional) was carried out in Emergency Department at Suez Canal University Hospital and included 223 patients experiencing IHCA at the Emergency Department (ED). Results: Our study showed return of spontanous circulation (ROSC) rate of 27.4%, which is lower than those reported in other studies from the region. In our study, we found that the overall mean duration for comprehensive cardiopulmonary resuscitation (CPR) was 21 min (SD ± 10).We found that Pulse, RR, BP, Witnessed and advanced life support (ALS) interventions at time of event were significant positive predictors to ROSC with patients while age, modified early warning score (MEWS), Interval between collapse to start CPR and CPR duration were negative predictors to cognitive impairment with diabetic patients. Conclusions: IHCA can be predicted using different variable related to patients vital data, laboratories, radiological investigations and patient demographic data which helps in predicting and modifying the outcome in limited situations.