Objective The aim of the present study is to evaluate the frequency, etiology, risk factors and clinical outcomes in acute traumatic SCI patients who develop fever and to evaluate the relationship between fever and mortality. Design Retrospective data were collected between January 2007 and August 2016 from patients diagnosed with persistent fever from SCI cases observed in the ICU. Participants Among 5370 intensive care patients, 435 SCI patients were evaluated for the presence of fever. A total of 52 patients meeting the criteria were evaluated. Outcome measures Fever characteristics were evaluated by dividing the patients into two groups: infectious (group-1) and non-infectious (group-2) fever. Demographic and clinical data, ICU and hospital stay, and mortality were evaluated. Results In the patients with noninfectious fever, mortality was significantly higher compared to the group with infectious fever (P < 0.001). Of 52 acute SCI cases, 25 (48.1%) had neurogenic fever that did not respond to treatment in intensive care follow-up, and 22 (88%) of these patients died. Maximal fever was 39.10 ± 0.64 °C in Group-1 and 40.22 ± 1.10 ° C in Group-2 (P = 0.001). There was a significant difference in the duration of ICU stay and hospital stay between the two groups (P = 0.005, P = 0.001, respectively), while there was no difference in the duration of mechanical ventilation between the groups (P = 0.544). Conclusion This study demonstrates that patients diagnosed with neurogenic fever following SCI had higher average body temperature and higher rates of mortality compared to patients diagnosed with infectious fever.

BACKGROUND:Multiple traumas are a leading cause of mortality among young adults worldwide. Thoracic trauma causes approximately 25% of all trauma-associated deaths. This study aims to determine the independent prognostic factors of mortality in cases with thoracic trauma (isolated or with accompanying organ injuries) who were admitted to the intensive care unit (ICU). METHODS:We retrospectively reviewed data from patients with thoracic trauma who were admitted to our ICU between 2007 and 2016. After excluding pediatric patients (aged <18 years), the study sample included 564 cases. From the records, we collected the patients' demographical data, comorbid diseases, primary trauma as an indication for ICU admission, other traumas accompanying thoracic trauma, type of thoracic injury, and therapeutic interventions. The study sample was divided into two subsets: survival and non-survival groups. These two groups were compared with regards to first ICU day laboratory results and intensive care scores, mechanical ventilation times, and ICU stay lengths. RESULTS:Of the 8063 patients admitted to the ICU between 2007 and 2016, 616 (7.6%) had thoracic trauma. The median age (min-max) of the 564 patients eligible for this study was 43 (18-87) years. Mortality occurred in 159 (28.1%) cases, while 405 (71.8%) were discharged from the ICU. Multivariate regression analyses were also performed, in which every increment in age was associated with a 1.025-fold increase in the odds of mortality due to thoracic trauma. Additionally, the presence of central nervous system (CNS) trauma was associated with a 2.147-fold increase, and the presence of pulmonary contusion was associated with a 1.752-fold increase. CONCLUSION:Results of this study indicate that advanced age, the presence of pulmonary contusion, and accompanying CNS trauma are independent predictors of mortality in patients with thoracic trauma in the ICU. Our non-invasive approach is further supported by the trauma and injury severity score (TRISS) scoring system, which is one of the latest scoring systems used in trauma cases.

Background/Aim: The SARS-CoV-2 pandemic is spreading rapidly all over the world and has high mortality rates. Governments implement quarantine or restrictions to prevent the virus from getting out of control. Computed Tomography (CT) has an important place in the diagnosis of COVID-19 and patient management. This study aimed to evaluate the changes in chest CT findings and the disease prognosis of COVID-19 pneumonia during the restriction and post-restriction periods. Methods: A total of 1150 patients whose COVID-19 disease was confirmed by a reverse transcriptasepolymerase chain reaction and who underwent chest CT examination between April 1-September 30, 2020 were included in this retrospective cohort study. The participants were categorized into two groups according to CT examination dates, as during (April 1-May 31), and after the restriction periods (June 1-September 30). Each patient's CT severity score (CTSS) was calculated, and the need for admission to the intensive care unit (ICU) and mortality related to COVID-19 were noted for statistical analysis. Results: Of the 1150 cases, 213 were in the restriction period group (RPG), while 937 were in the postrestriction period group (PRPG). The median value of CTSS was 5 in the RPG, and 6 in the PRPG (P=0.095). In the RPG and PRPG, the number of patients who needed ICU admission were 20 (9.4%), and 50 (5.3%), respectively, while 12 (7%) and 39 (4.2%) patients, respectively, died from COVID-19. Both parameters were comparable between the two groups (P=0.073, P=0.060 respectively). Conclusion:The restrictions did not change the severity of the COVID-19 disease, ICU hospitalization rate, and death rate.

Brain death is defined as the irreversible loss of brain function following various pathophysiological changes. In many countries, the brain death diagnosis is carried out in conjunction with organ transplant programs. In Turkey, at third level health institutions in particular, healthcare units established entities that follow similar procedures. The increased number of patients waiting for organs and donor discovery studies have enhanced the public's interest in this topic. Since the emergency department is usually the first line in admitting patients, its staff must have the firsthand knowledge of managing brain death and organ donation process. In this article, we present three clinical cases that we followed and diagnosed with brain death in our emergency department. Due to the lack of studies addressing brain death procedures in the emergency service, we believe that this report will greatly contribute to our awareness and handling of brain death treatment.

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