Background It is necessary to identify critical patients requiring hospitalization early due to the rapid increase in the number of COVID-19 cases. Aim This study aims to evaluate the effectiveness of scoring systems such as emergency department triage early warning score (TREWS) and modified early warning score (MEWS) in predicting mortality in COVID-19 patients. Methods In this retrospective cohort study, PCR positive patients evaluated for COVID-19 and decided to be hospitalized were evaluated. During the first evaluation, MEWS and TREWS scores of the patients were calculated. Intensive care needs as well as 24-h and 28-day mortality rates were evaluated. Results A total of 339 patients were included in the study. While 30 (8.8%) patients were hospitalized in the intensive care unit, 4 (1.2%) died in the emergency. The number of patients who died within 28 days was found to be 57 (16.8%). In 24-h mortality, the median MEWS value was found to be 7 (IQR 25–75) while the TREWS value was 11.5 (IQR 25–75). In the ROC analysis made for the diagnostic value of 28-day mortality of MEWS and TREWS scores, the area under the curve (AUC) for the MEWS score was found to be 0.833 (95% CI 0.777–0.888, p < 0.001) while it was identified as 0.823 (95% CI 0.764–0.882, p < 0.001) for the TREWS. Conclusion MEWS and TREWS calculated at emergency services are effective in predicting 28-day mortality in patients requiring hospitalization due to COVID-19.

Background: Identification of critically ill patient is particularly important in the emergency department (ED). The prolonged duration from hospital admission to delivering intensive care service is related to increased mortality. The aim of this study is to evaluate the effectiveness of Modified Early Warning Score (MEWS) for identifying critical patients with malignancy in ED settings. Methods: We evaluated patients with malignancy who were admitted to our ED of a tertiary university hospital in Turkey over a three-month period. We evaluated MEWS on admission as MEWS 1. After the initial treatment depending on the patients’ health status in ED, at 2 hours after admission, we evaluated MEWS again and recorded as MEWS 2. All patients were followed up for 30 days after the initial admission. Results: Mean age (SD) was 59.2 (13.5) and male/female ratio was 295/206. MEWS1 was higher than MEWS2, (MEWS1: 3.05 ± 3.31, MEWS2: 2.35 ± 3.17, P < 0.001). A total of 362 patients (72.3%) survived and 139 (27.7%) died within 30 days of initial admission. MEWS1/MEWS2 values for alive and dead patients were 1.66/0.87, and 6.67/6.21, respectively, and the difference was significant (P < 0.001). ROC analysis was performed for MEWS 1; the area under curve (AUC) for hospitalization was 0.768 (95% CI 0.729 to 0.804) and for mortality was 0.900 (95% CI 0.870 to 0.924). ROC analysis revealed a cut-off value of 2 for predicting both hospitalization and mortality in these patients. The sensitivity of the presented cut-off was 77.32% (72.1%–82.0%) for hospitalization and 76.24% (95% CI 71.5–80.5) for mortality; the specificity was 69.52 (95% CI 62.8–75.7) for hospitalization and 90.65 (95% CI 84.65–94.9) for mortality. Conclusion: We found in our study that MEWS evaluation for patients with malignancy on admission to ED is predictive of mortality in the subsequent 30 days, and it is a valuable tool for identifying the critical group. Also, AVPU scores alone can predict mortality in patients admitted to ED.

Objective:We aimed to compare the efficacies of ice, lidocaine-prilocaine mixture cream and the classical method in reduction of the pain observed during intravenous cannulation, which is the most frequently performed procedure in emergency departments and to define the most effective method. Material and Methods: One hundred-twenty patients who applied to the emergency department of Uludag University Faculty of Medicine were included in this presented study. Cannulations were performed after one minute application of ice package in the ice group. Patients who applied to emergency only for blood transfusion were chosen for the lidocaine-prilocaine group and their cannulations were performed at the 60 th minute of cream mixture application. Finally, no applications before cannulation were used for the control group. All cannulations were performed from antecubital region and 18 G cannula were used. Visual analog scale (VAS) and patient satisfaction were scored. Results: VAS scores for ice, lidocaine-prilocaine and control groups are 2.8±1.7, 4.1±1.8, 4.4±1.9, respectively. VAS score in the ice group was significantly lower than both lidocaine-prilocaine and control groups. In addition, there was no statistically significant difference between lidocaine-prilocaine and control groups. Conclusion: Ice application method before intravenous cannulation, in addition to its advantages such as being inexpensive, easy to obtain and apply, is more effective than lidocaine-prilocaine cream. (JAEM 2013; 12: 27-9)

Aim:To evaluate the effect of the pandemic process on the white code notifications in our hospital by examining the data of the white code call system, which is carried out in order to prevent violence against healthcare workers.Material and Methods: A total of 212 White code notifications evaluated due to date, time, gender of the health worker who was exposed, duty, hospital unit where the incident occurred, the reason for the violence, type of violence, legal aid status received after the White Code notification, gender of the attacker, legal status, realization before and after the pandemic. The recorded data were grouped as pre-pandemic and post-pandemic periods, and the change caused by the pandemic on notifications was examined.Results: Considering the distribution of notices before and after the declaration of the pandemic, it was seen that 70.3% (n: 149) occurred before the Covid-19 pandemic, and 29.7% (n: 63) occurred after the Covid-19 pandemic. In the Chi-Square analysis conducted to evaluate the distribution and differences of the data obtained before and after the Covid-19 pandemic, there was a statistically significant difference for the employee's duty, crime scene, working time zones, reasons for violence, legal process and legal aid status (p<0, 05); No statistically significant difference was found in the gender of the employee, the type of violence, the gender of the aggressor, and the events that took place inside and outside the emergency room (p>0.05). Conclusion:Violence against healthcare professionals is still a social problem today. The effect of the pandemic on the White Code notifications was positive and the decrease in the number of notifications has drawn attention.