Person: KÖKSAL, ÖZLEM
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KÖKSAL
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ÖZLEM
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Publication The combination of scoring systems and lactate for predicting short-term mortality in geriatric patients with dyspnea(Springer, 2023-06-19) Ardıç, Anıl; Köksal, Özlem; Durak, Vahide Aslıhan; Dilektaşlı, Aslı Görek; Özkaya, Güven; KÖKSAL, ÖZLEM; DURAK, VAHİDE ASLIHAN; GÖREK DİLEKTAŞLI, ASLI; ÖZKAYA, GÜVEN; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Acil Tıp Anabilim Dalı; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Göğüs Hastalıkları Anabilim Dalı; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Biyoistatistik Anabilim Dalı; 0000-0003-0836-7862; 0000-0003-0297-846X; 0000-0003-2271-5659; AAK-8332-2020; AAE-9483-2021; CNP-1063-2022; IVU-2672-2023BackgroundDyspnea is one of the most common causes for admission to the emergency department. Lactate (L), which can be used as a prognostic marker, was first studied by Broder and Weil and it was shown that a level > 4 mmol/l is associated with a poor prognosis. There are also scoring systems to assess the severity of illness of patients presenting to the emergency department such as the National Early Warning Score (NEWS), Modified Early Warning Score (MEWS), Rapid Emergency Medicine Score (REMS) and VitalPAC Early Warning Score (ViEWS).ObjectivesIn this study, we aimed to investigate the combination of risk scoring systems and lactate in predicting short-term mortality in patients over 65 years of age with the complaint of nontraumatic dyspnea.Materials and methodsThe population of the study consisted of adult patients aged 65 and over who presented to Bursa Uludag University Medical Faculty Emergency Department with dyspnea. Admission NEWS, MEWS, REMS, ViEWS scores and their combined forms with added lactate levels at first admission, and 7-, 14-, and 28-day survival were recorded.ResultsWe found that the modified composite scores with lactate value, and the NEWS, MEWS, REMS, and ViEWS scores could predict the 28-day mortality. Ranking the scores and lactate value predicting 28-day mortality according to the area under the curve (AUC) value revealed that the 28-day mortality was best predicted by the NEWS + lactate with 64.97% sensitivity and 77.53% specificity (p < 0.001). We have shown that increasing lactate levels, NEWS, MEWS, REMS, ViEWS scores and their modified composite scores with lactate above suggested thresholds are independent risk factors for increased mortality in multivariable Cox regression analysis.ConclusionsIn cases with dyspnea, lactate value, NEWS, MEWS, REMS, ViEWS, NEWS-L MEWS-L, REMS-L, and ViEWS-L scores can be used to predict early mortality. Risk scores modified with lactate value were found to be more successful in predicting 28-day mortality.Publication Is there a relationship between the diameter of the inferior vena cava and hemodynamic parameters in critically ill patients?(Medknow Publications, 2015-11-01) Aydın, Şule A.; Özdemir, Fatma; Taşkın, G.; Ocakoğlu, Gökhan; Yıldırım, H.; Köksal, Özlem; AYDIN, ŞULE; ÖZDEMİR, FATMA; Taşkın, G.; OCAKOĞLU, GÖKHAN; KÖKSAL, ÖZLEM; Uludağ Üniversitesi/Tıp Fakültesi/Acil Servis Bölümü; Uludağ Üniversitesi/Tıp Fakültesi/Biyoistatistik Anabilim Dalı; 0000-0002-1114-6051; AAH-5180-2021; AAK-8332-2020; HLG-6346-2023; AAI-2164-2021; IOY-2055-2023; GHW-4797-2022Introduction: The early detection of critically ill patients together with the rapid initiation of effective treatment in emergency departments(ED) increase the survival rates.Aim: This study investigated whether a correlation exists between haemodynamic parameters of critically ill patients and the diameter of the inferior vena cava (IVC).Materials and Methods: A cross-sectional study was performed included patients aged >= 18 years with an unstable haemodynamic and/or respiratory status who were referred to the ED for non-traumatic issues. IVC diameters were measured by ultrasound (US) and then central venous pressures (CVP) were measured. Anteroposterior (AP) and mediolateral (ML) diameters of the IVC, both in the inspirium (IAP, IML) and expirium (EAP, EML), were measured by US.Results: 102 patients were evaluated with a median age of 59. The relationship between the diameters of IVC and CVP was evaluated and significant correlation was found in IAP, EAP according to CVP values (p<0.001). ROC analyses were performed and significant relationship was found between the EAP diameter with haemoglobin (Hmg), haemotocrit (Hct), and central venous oxygen saturation (ScvO2) and also significant correlation was detected between the IAP diameter and white blood cell (WBC).Discussion: We detected significant correlation between the CVP and the IVC diameter in our study compatible with recent studies besides, significant correlation was found between the diameter of the IVC and CVP values as well as between the EAP diameter and Hmg, Hct, ScvO2 levels.Conclusion: Measurement of IVC diameters, especially EAP may be useful at the monitoring of critically ill patients in ED.Publication Clinical probability and risk analysis of patients with suspected pulmonary embolism(Zhejiang Univ Press, 2014-12-01) Yetgin, Gülden Özeren; Aydın, Şule Akköse; Köksal, Özlem; Özdemir, Fatma; Mert, Dilek Kostak; Torun, Gökhan; AYDIN, ŞULE; KÖKSAL, ÖZLEM; ÖZDEMİR, FATMA; Mert, Dilek Kostak; Torun, Gökhan; AAI-2164-2021; AAA-2367-2020; AAK-8332-2020BACKGROUND: Pulmonary embolism (PE) is one of the most frequent diseases that could be missed in overcrowded emergency departments as in Turkey. Early and accurate diagnosis could decrease the mortality rate and this standard algorithm should be defined. This study is to find the accurate, fast, non-invasive, cost-effective, easy-to-access diagnostic tests, clinical scoring systems and the patients who should be tested for clinical diagnosis of PE in emergency department.METHODS: One hundred and forty patients admitted to the emergency department with the final diagnosis of PE regarding to anamnesis, physical examination and risk factors, were included in this prospective, cross-sectional study. The patients with a diagnosis of pulmonary embolism, acute coronary syndrome or infection and chronic obstructive pulmonary disease (COPD) were excluded from the study. The demographics, risk factors, radiological findings, vital signs, symptoms, physicallaboratory findings, diagnostic tests and clinical scoring systems of patients (Wells and Geneva) were noted. The diagnostic criteria for pulmonary emboli were: filling defect in the pulmonary artery lumen on spiral computed tomographic angiography and perfusion defect on perfusion scintigraphy.RESULTS: Totally, 90 (64%) of the patients had PE. Age, hypotension, having deep vein thrombosis were the risk factors, and oxygen saturation, shock index, BNP, troponin and fibrinogen levels as for the biochemical parameters were significantly different between the PE (+) and PE (-) groups (P<0.05). The Wells scoring system was more successful than the other scoring systems.CONCLUSION: Biochemical parameters, clinical findings, and scoring systems, when used altogether, can contribute to the diagnosis of PE.Publication Uludag University Medical Faculty research hospital emergency service an epidemiological investigation into blood and blood product transfusion(Galenos Yayınevi, 2012-06-01) Esen, Mehmet; Aydın, Şule Akköse; Özdemir, Fatma; Köksal, Özlem; Öner, Nuran; AYDIN, ŞULE; ÖZDEMİR, FATMA; KÖKSAL, ÖZLEM; Öner, Nuran; Uludağ Üniversitesi/Tıp Fakültesi/Acil Tıp Anabilim Dalı.; 0000-0003-2180-6946; 0000-0002-4761-7863; AAK-8332-2020; JLX-9240-2023; ITH-9225-2023; DJG-5702-2022Objective: This study was designed prospectively to investigate the demographic data of patients (n=434) who received blood and blood products at the Uludag University Medical Faculty Research Hospital Emergency Service between June 2009 and December 2009. The indications for the blood products used, the amount and the type of products used and the documentation of reactions were investigated and compared with data in the literature.Materials and Methods: 83.0% patients had normal vital parameters, 3.4% had hypotension, 2.1% had tachycardia, 1.1% had fever, 9.7% had hypotension and tachycardia and 0.7% had hypotension, tachycardia and fever. In terms of hemoglobin levels, 40.6% of patients had a level below 7 g/dL, 13.1% were between 7-8 g/dL, 26.7% were between 8-10 g/dL and 19.6% were above 10 g/dL. The patients who were transfused with an erythrocyte suspension were mostly the group who had a hemoglobin level below 7 g/dL. Platelets were transfused mostly for thrombocytopenia in patients with a platelet count between 10-20 x 10(3)/mm(3).Results: Of all transfused patients, 3.9% had an acute complication related to transfusion. 1.2% of these were acute febrile non-hemolytic reactions (FNHR), 1.1% were heart failure, 0.9% were allergic reactions and 0.7% were both FNHR and allergic reactions. 76.5% of all transfused patients were discharged from the emergency department, 19.4% were hospitalized, 2.5% were sent to other hospitals and 1.6% died in the emergency department.Conclusion: In light of our findings, it can be seen that many transfusions are performed in the emergency department, transfusion protocols are not normally followed and most transfusions are performed to support the outpatient clinic.