Objectives: Ultrasonography (US) has been shown to be helpful in diagnosing fractures in the emergency department (ED) setting. The aim of this study was to determine the diagnostic accuracy of US for fractures in patients presenting to the ED with foot and/or ankle sprain and positive Ottawa foot and ankle rules.Methods: This was a prospective study of consecutive patients aged 18 years and over were admitted to the ED with acute foot and/or ankle sprain and positive Ottawa foot and ankle rules. After the patients by were examined by bedside US, anteroposterior and lateral ankle radiographs were obtained, as well as anteroposterior and oblique foot radiographs. The films were evaluated by an orthopedic surgeon who was blinded to the US examination results. The orthopedic surgeon's evaluation was considered the criterion standard for diagnosing a fracture.Results: A total of 246 patients were included in the study. In 76 (30.9%) of the patients, a total of 79 fractures were detected by radiography. Ten false-negative and nine false-positive results were obtained by US examination. Only one patient, whose US showed a fracture but whose radiographs were normal, had a fracture detected by computed tomography (CT). The sensitivity and specificity of US scanning in detecting fractures were 87.3% (95% confidence interval [CI] = 77.5% to 93.4%) and 96.4% (95% CI = 93.1% to 98.2%), respectively.Conclusions: Ultrasound had good sensitivity and specificity for diagnosing fifth metatarsal, lateral, and medial malleolus fractures in the patients with foot and/or ankle sprain. However, sensitivity and specificity of US for navicular fractures were low.

ObjectiveNon-urgent patients are one of the important causes of emergency department (ED) overcrowding. In this study, it is aimed to identify the characteristics of these patients and the reasons why they prefer the ED.MethodThis study was conducted during regular office hours. The characteristics of non-urgent patients, their complaints, the frequency of visits to family physicians (FPs), the frequency of using the Central Hospital Appointment System (CHAS) and reasons for preferring the ED were questioned by a questionnaire.ResultsThis study was conducted on 624 patients. Among them, 326 (52.2%) were male. The mean age was 38.4 years (SD: 14.4). It was identified that 80.3% of the patients had no chronic disease and that 97.4% had health insurance. The most common complaints at presentation were musculoskeletal system pain (25.2%) and upper respiratory tract infections symptoms (19.7%). It was identified that 28.7% of the patients did not prefer to visit their FPs and that 48.6% did not use the CHAS. The reasons of preferring ED were as follows: rapid physical examination (36.4%), not being able to book an earlier appointment at alternative health facilities (30.9%), being close to the facility (12.8%) and being at the hospital for a different reason (12.3%). Among the patients, 20.2% did not express any particular reason.ConclusionsNon-urgent patients who admitted to the ED are mostly middle-aged patients with no chronic disease. They usually visit the ED for preventable reasons. The use of alternative health facilities and CHAS should be encouraged.

Sonographic examination can be used as an effective diagnostic tool in patients with fifth metacarpal trauma.

No abstract

AMAÇTravmayı takiben acil servise başvuran hastalarda paramediklerce uygulanan travmaya odaklanmış ultrasonografi değerlendirmesinin (PFAST) serbest sıvı saptamadaki doğ-ruluğu araştırıldı. GEREÇ VE YÖNTEMDört saatlik teorik ve dört saatlik uygulamalı eğitim sonrası, dört paramedik travma hastalarını ileriye dönük inceledi. Altın standardımız ultrasonografi ve karın bilgisayarlı tomografisinin (KBT) resmi radyolog raporlarıydı. PFAST'in duyarlılık, seçicilik, pozitif ve negatif olabilirlik oranları ve tanısal odds oranı hesaplandı ve ki-kare testi ile SPSS 15.0 kullanılarak analiz edildi. BULGULARYüz yirmi yedi hasta paramedikler tarafından değerlendi-rildi. On dört hastada karında serbest sıvı vardı. Bunlardan 11 tanesi radyoloji raporlarıyla ve KBT ile uyumlu iken (gerçek pozitifler), üç tanesi negatif geldi (yanlış pozitifler). Yüz on üç olguda PFAST serbest sıvı için negatif idi. Bunlardan 111 tanesinde serbest sıvı yokken (gerçek negatifler), iki tanesinde KBT ile tespit edildi (yanlış negatifler). Sırasıyla duyarlılık, seçicilik, pozitif ve negatif olabilirlik oranları ve tanısal odds oranı 84,62, 97,37, 32,15, 0,16 ve 203,50 idi. SONUÇÇalışmamız, hastane acil servislerinde paramediklerin yük-sek doğruluk oranıyla FAST uygulayabileceklerini göster-mektedir.