p-ISSN: 1306-696x | e-ISSN: 1307-7945
Volume : 29 Issue : 1 Year : 2025

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Turkish Journal of Trauma and Emergency Surgery - Ulus Travma Acil Cerrahi Derg: 29 (1)
Volume: 29  Issue: 1 - January 2023
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1. Frontmatters

Pages I - V

EXPERIMENTAL STUDY
2. Effect of hyperbaric oxygen therapy when combined with fresh and frozen platelet-rich plasma on chronic wound healing in rats
Nevra Seyhan, Sinan Öksüz
PMID: 36588517  PMCID: PMC10198350  doi: 10.14744/tjtes.2022.01026  Pages 1 - 8
BACKGROUND: Hyperbaric oxygen therapy (HBOT) has an added dimension to the armamentarium of treating complicated chronic wounds. The purpose of this study is to investigate the effects of HBOT on chronic wounds when combined with fresh and frozen platelet-rich plasma (PRP).
METHODS: Rats were divided into two main groups containing 18 rats in each group as HBOT received and non-received. Each group was divided into three subgroups as Group 1: Control, Group 2: Fresh, and Group 3: Frozen PRP applied. For PRP preparation, 10 rats were used. Histologic parameters including fibroblast, collagen fibers, lymphocytes, and vessels were evaluated by Clemex Vision Lite 3.5; wound sizes were evaluated by ImageJ digital analyzing program.
RESULTS: In HBOT received group, the number of fibroblasts, collagen fibers, lymphocytes, and vessels in all fresh and frozen PRP applied and control subgroups were significantly higher than hyperbaric oxygen non-received group (p<0.05). In HBOT received group, wound surface area measurement values of control, fresh, and frozen PRP applied groups at 5-10-15 days were lower than HBOT non-received group.
CONCLUSION: HBOT accelerates wound healing when combined with both fresh and frozen PRP. Frozen PRP is as effective as fresh form to be considered as an alternative in clinical setting.

3. Effect of L-carnitine on regeneration in experimental partial hepatectomy model in rats
Ahmet Topcu, Abdullah Yildiz, Omer Faruk Ozkan
PMID: 36588511  PMCID: PMC10198347  doi: 10.14744/tjtes.2022.80460  Pages 9 - 16
BACKGROUND: In cases of major liver resections or ischemic damage made by the pringle maneuver, agents that increase regeneration or manage ischemic reperfusion injury have become a fascinating topic for researchers. The aim of this study is to see how systemic L-carnitine, an antioxidant with thorough research behind it, affects liver regeneration after major hepatectomy in a rat experimental hepatectomy (two-thirds liver resection) model.
METHODS: The liver regeneration was evaluated in this study using a rat hepatectomy model developed in the General Surgery Clinic of Health Sciences University, Umraniye Education and Research Hospital’s Laboratory. In the experiment, 15 male and 15 female Wistar Albino rats weighing between 250 and 300 g were used in a way that the genders were mixed. In each group, three groups were formed, including male and female rats randomly selected and ten rats. Gcontrol: 70% hepatic resection + intraperitoneal 0.9% saline, GSham: After laparotomy, the abdomen was closed again without any procedure, Gcarnitine: 70% hepatic resection + intraperitoneal 100 mg/kg L Carnitine was applied. It was applied systemically to GSham and Gcarnitine groups and the same procedure was applied to rats for 4 days at the same time without any restrictions. On the 5th day, the abdomen was entered with relaparotomy after sacrification and liver regeneration was evaluated macroscopically and recorded in the forms developed for each subject. Later, liver tissue was resected and microscopically recorded by measuring mitotic index, binuclear hepatocyte, gall duct proliferation, dilation in central veins, and cell proliferation in the parenchyma. The results obtained were evaluated statistically.
RESULTS: According to the results, the L-carnitine group had a statistically significant increase in overall regeneration scoring after hepatectomy in the histopathological assessment as compared to the control group.
CONCLUSION: It is thought that L-carnitine, whose many positive effects have been shown experimentally and clinically, has a positive effect on liver regeneration and immunohistochemical researches is required to elucidate this pathway.

ORIGINAL ARTICLE
4. Evaluation of versatility and outcomes of the first dorsal metacarpal artery flap in thumb defects
Arda Küçükgüven, Hakan Uzun, Ali Emre Aksu
PMID: 36588507  PMCID: PMC10198346  doi: 10.14744/tjtes.2022.58336  Pages 16 - 21
BACKGROUND: It is clinically vital to determine the best technique to reconstruct thumb defects with satisfactory esthetic and functional outcomes. We aimed to quantitatively present the safety, versatility, limitations, advantages, and functional results of the first dorsal metacarpal artery flap (FDMAF) and evaluate its outcomes in thumb defect reconstruction by comparing it with the other current surgical options.
METHODS: A total of 21 patients underwent thumb defect reconstruction. They were evaluated with the following parameters: Etiology, age, timing of reconstruction, flap vitality, Semmes-Weinstein monofilament (SWM) test, static two-point discrimination (2PD) test, pain, cortical reorientation, cold intolerance questionnaire, and Michigan hand outcomes questionnaire. Their functional outcomes were evaluated by comparing their scores with the other current surgical options published in the literature.
RESULTS: The mean follow-up period was 22.3 months. The mean pain score of the flap was 0.4±0.6 and no patient had pain in the donor area (range, 0–10). The sensory outcome was “good” (8.6 mm) based on the static 2PD test. The mean SWM test score was 4.02 g. Patient satisfaction was 4.6 according to the Michigan hand outcomes questionnaire (range, 0–5). The cold intolerance questionnaire scores showed that the patients had mild cold intolerance (mean, 10.5; range 0–100). Complete cortical reorientation was seen in 81% of the patients.
CONCLUSION: Restoration of the innervation of thumb defects is possible with the FDMAF with high satisfaction rates based on our results. The absence of the microsurgical vessel or nerve repair facilitates the surgery, shortens its duration, and reduces morbidity, reserving the microsurgical options for more complicated cases. Therefore, it can be concluded that the FDMAF is an effective flap with great modifications for complicated thumb defects but surgeons should consider their clinical outcomes and prolonged surgery when choosing which technique to be used.

EXPERIMENTAL STUDY
5. Are the cytokines and chemokines important for the early diagnosis of mesenteric ischemia?
Ali Emre Nayci, Selim Dogan
PMID: 36588519  PMCID: PMC10198361  doi: 10.14744/tjtes.2022.25042  Pages 17 - 21
BACKGROUND: Acute mesenteric ischemia (AMI) has very high mortality and morbidity rates, and the most important factor in the prognosis of AMI is the duration of ischemia. This study aims to evaluate the changes of these markers according to the ischemia duration and possible use of cytokines and chemokines in the early diagnosis of AMI.
METHODS: Twenty-one male Sprague–Dawley rats were divided into three equal groups. The Superior Mesenteric Artery and Superior Mesenteric Vein were tied tightly and exposed to ischemia for 2 h for Group 1 and 6 h for Group 2. There was no intervention for Group 3, and it was selected as a control group. Intracardiac blood samples were collected after 2 h in Group 1 and 6 h in Groups 2 and 3. The IL-1α, 1β, 6, 10, 12p70, 17A, 18, 33, CXCL1/KC, CCL2/MCP-1, GM-CSF, IFN-γ, and TNF-α were measured using flow cytometry.
RESULTS: Significant differences were observed between the groups in IFN-γ, CXCL1, MCP1, TNF-α, and IL-6 parameters. In the correlation analyses performed according to the mesenteric ischemia time, a very strong correlation was observed in CXCL1, as well as a strong level for MCP-1, TNF-α, and IL-6. Furthermore, a moderate level of correlation was found in IFN-γ, IL-10, and IL-18.
CONCLUSION: The increased levels of CXCL1, MCP-1, TNF-α, and IL-6, which had a high correlation with the duration of ischemia in patients with intestinal ischemia, may help clinicians with diagnoses and treatment decision-making.

6. Anatomical variations of intercostobrachial nerve: A potential candidate for neurotization after traumatic median nerve injury?
Mahmut Kursat Ozsahin, Gökhan Kaynak, Muhammed Yusuf Afacan, Ahmet Ertaş, Bedri Karaismailoglu, Mehmet Alp, Önder Aydıngöz, Hüseyin Botanlıoğlu
PMID: 36588508  PMCID: PMC10198354  doi: 10.14744/tjtes.2022.68622  Pages 22 - 29
BACKGROUND: This study focused on the anatomical characteristics and variations of intercostobrachial (ICBN) nerve and median nerve to investigate the possible use of ICBN in restoration of sensory damage of hand after traumatic median nerve injury and to evaluate the feasibility of ICBN neurotization to median nerve.
METHODS: Variations of ICBN were noted in 16 axillary region dissections of eight cadavers. Measurements for ICBN’s suitability in terms of neurotization to brachial plexus were done with millimetric devices. The distance of ICBN to the distal end of the lateral (LCMN) and medial (MCMN) contributions of the median nerve and the diameters of ICBN, LCMN, and MCMN were measured.
RESULTS: Fifteen axillary dissections exhibited ICBN, whereas it was absent on the left side of one of the cadavers. The mean diameter of ICBN at its origin was 2.0±0.7 mm and the mean diameter of ICBN at its coaptation point was 3.1±0.9 mm. The mean diameter of the LCMN was 3.9±2.0 mm, the mean diameter of MCMN was 3.5±0.9 mm. The length of ICBN was found to be adequate at both 45 and 90° of shoulder abduction to be extended to both LCMN and MCMN. The diameters of LCMN and MCMN were not significantly correlated with the diameter of ICBN both at origin and at coaptation point (LCMN: p=0.55–0.63 and MCMN: p=0.89–0.85). There is no significant difference between the diameter of LCMN and the diameter of ICBN at its coaptation point (p=0.168) and also between the diameter of MCMN and the diameter of ICBN at its coaptation point (p=0.232).
CONCLUSION: All ICBNs dissected showed adequate length to reach the lateral and medial contribution of the median nerve directly. The ICBN could be a feasible candidate since its diameter was close to LCMN and MCMN according to the descriptive and inferential statistics.

7. Histological examination of the effects of epidermal growth factor on regeneration of acute peripheral nerve injuries on rabbit model
Gökhan Ayık, Gazi Huri, Ramin Hashemihesar, Sinan Yürüker, Mahmut Nedim Doral
PMID: 36588515  PMCID: PMC10198360  doi: 10.14744/tjtes.2022.99201  Pages 30 - 39
BACKGROUND: Peripheral nerve injuries are one of the most common and costly injuries especially in the young population. In this study, it is aimed to determine the histological role of epidermal growth factor (EGF) in nerve regeneration with an acute damage made on sciatic nerve in the rabbit model.
METHODS: We used 18 New Zealand rabbits (nine in control group and nine in experimental group). Each group was divided into two groups consisting of five rabbits planned for diameter measurement and four rabbits planned for spatial measurement. The sciatic nerve exploration in the right flank of each animal, full-thickness nerve damage, and then epineural repair was made by a single researcher. 10 µg/kg EGF was given to the repair area of the experimental group and five more EGF injections were given to the experimental group every other day postoperatively. In the control group, we used saline solution. Rabbits were observed for 8 weeks. During follow-up, two rabbits died. At the end of 8 weeks, the nerve tissue of each animal was evaluated histologically and morphologically.
RESULTS: In the experimental group consisting of five rabbits, the mean thickness of connective tissue (epineurium+ mesoneurium) was 156,867 µm; while, in the control group, the thickness was 25,170 µm. In the other groups, the numerical increase in epineurium and mesoneurium areas was detected in the EGF (+) group as a result of the comparative spatial measurements. Epineurium and mesoneurium enlargement was observed in the EGF-given group. Adipocyte and capillary increase was observed in connective tissue.
CONCLUSION: EGF increases epineurium and mesoneurium diameters in peripheral connective tissue in acute peripheral nerve injury regeneration. However, further studies are needed to understand this effect clinically and physiologically.

ORIGINAL ARTICLE
8. The effect of COVID-19 pandemic period on acute appendicitis and its complications
Ahmet Başkent, Murat Alkan, Mehmet Furkan Başkent
PMID: 36588509  PMCID: PMC10198358  doi: 10.14744/tjtes.2022.74711  Pages 40 - 45
BACKGROUND: Acute appendicitis is the most common abdominal surgical emergency. This new type of coronavirus, also called SARS-CoV-2, causes severe acute respiratory syndrome, and this has turned into a pandemic. We aimed to determine the risk factors associated with appendectomy and complicated appendicitis during the COVID-19 pandemic period and to evaluate the effects on the surgical treatment of acute appendicitis and its outcomes. In the current comparative study, we analyzed its effects on appendectomy management and complicated appendicitis in patients with appendicitis during the COVID-19 pandemic and past year covering the same period.
METHODS: The patients in this study consisted of adult patients with acute appendicitis who applied to the Emergency Surgery Department of Kartal Dr. Lütfi Kırdar City Hospital General Surgery Clinic between March 1, and August 31, 2020 (COVID-19 pe-riod) (Group B) and the same period of 2019 (Group A). A comparative and retrospective study was planned. A total of 658 patients who presented with acute appendicitis were included in the study. Group A and Group B consist of 347 and 311 people, respectively.
RESULTS: No significant difference was found in the demographic and clinical characteristics of the study population. There was no significant difference between Group A and B in terms of the duration of the application of patient complaints, the duration of the procedure, the time the patient was admitted to the hospital, the time of the patient being taken to the surgery, the findings during the operation, and the post-operative complications. There were similar features in general appendectomy pathologies, but in our study, a significant decrease in catarrhal appendicitis was observed in Group B, namely, during the COVID-19 pandemic period (p=0.04).
CONCLUSION: During the COVID-19 pandemic, there was no significant increase in complicated appendicitis, but a significant reduction in negative appendectomies. This result shows that during the pandemic period, patients do not come to the emergency surgery unit unnecessarily and receive timely and appropriate surgical care.

9. The effect of COVID-19 pandemic on the characteristics of patients presenting to the pediatric ocular emergency department in Türkiye: Demographic and diagnoses
Deniz Kilic
PMID: 36588510  PMCID: PMC10198352  doi: 10.14744/tjtes.2022.78928  Pages 46 - 51
BACKGROUND: This study aims to evaluate how the coronavirus disease 2019 (COVID-19) pandemic has impacted the demographics and diagnoses of patients presenting at a pediatric ophthalmology emergency department (POED) in Türkiye.
METHODS: The electronic medical records of patients <18 years old who presented at the POED from March 15 to May 31, 2020 (first stay-at-home period), and from November 15 to December 31, 2020 (second stay-at-home period), were retrospectively scanned. The demographic data and clinical diagnoses from those periods and the same periods in 2019 were compared.
RESULTS: No significant differences emerged regarding age (p=0.067) or sex (p=0.268) among the 839 pediatric patients who visited the POED in 2019 (n=510) versus 2020 (n=329). Compared with 2019, 50.63% of fewer patients visited the POED in the first stay-at-home period (i.e., 322 vs. 159) and 9.66% fewer visited in the second period (i.e., 188 vs. 170). The diagnoses in 2019 and 2020 were similar, with foreign body being the most common diagnosis, followed by ocular trauma.
CONCLUSION: Amid the COVID-19 pandemic, fewer pediatric patients visited the POED during the first and second stay-at-home periods than during the same periods in 2019, although the difference was less during the second period. Demographic data and diagnoses from year to year, however, were similar. These findings could aid clinicians in developing new strategies and guidelines for POED management in extraordinary situations such as pandemics.

10. The role of neutrophil–albumin ratio in the diagnosis of acute appendicitis and its efficacy in predicting perforation
Bora Çekmen, Busra Bildik, Şeref Emre Atiş, Hüseyin Güven
PMID: 36588506  PMCID: PMC10198349  doi: 10.14744/tjtes.2022.56570  Pages 52 - 58
BACKGROUND: Acute appendicitis (AA) is one of the most common causes of abdominal pain in patients presenting to the emergency department with abdominal pain, and despite developments in radiological imaging for its diagnosis, researchers are still in pursuit of a simpler, cheaper, and safer biomarker. Our study investigated the usability of the neutrophil–albumin ratio, a biomarker that predicts prognosis in cases with severe inflammation, in diagnosing AA and anticipating perforation.
METHODS: Our study is a retrospective and cross-sectional study. The study was conducted with patients who presented to the emergency department between January 2018 and December 2020 and were hospitalized with a preliminary diagnosis of AA. The cases were first divided into two groups as “Not appendicitis” and “AA,” and then the patients with “AA” were divided into two subgroups as “Perforated” and “Non-perforated.” The demographic data of the patients, their symptoms, physical examination findings, and the decision-making process for surgery were noted. The neutrophil count and albumin levels detected in the blood samples obtained at the time of admission to the emergency department were noted. Afterward, the neutrophil-albumin ratio (NAR) was calculated and the cutoff level was determined to predict the diagnosis of AA and the development of perforation.
RESULTS: The rate of complaints of pain in the periumbilical region was significantly higher in the patient group without AA compared to the patients in the AA group (70.6% and 40.3%, p=0.034). Although the leukocyte count, neutrophil count and percentage, and NAR were significantly higher in the AA group, the lymphocyte count was found to be significantly lower (p=0.005). However, no significant correlation was found between the NAR and the development of perforation (p=0.697).
CONCLUSION: The NAR is useful for the diagnosis of AA. Nevertheless, it is not a sufficient biomarker for detecting perforation.

11. A medicolegal evaluation of geriatric cases with traumatic injuries
Gözde Bağcı, Güven Seçkin Kırcı
PMID: 36588512  PMCID: PMC10198362  doi: 10.14744/tjtes.2022.89039  Pages 59 - 67
BACKGROUND: The morbidity and mortality of traumatic injuries are higher in individuals aged >65 years, which are a population group showing an increase worldwide, compared to other age groups. The aim of this study was to compare the medicolegal aspects, such as abuse of the elderly with the morbidity and mortality rates of injuries resulting from trauma by examining the age, gender, trauma history, type of traumatic injury, clinical progress following injury, elderly abuse, and the care environment of the person in cases aged 65 years and older.
METHODS: In this cross-sectional and descriptive study, a retrospective examination was made of the electronic and physical patient files of patients aged 65 years and older who presented at the Emergency Department of Blacksea Tecnical Univercity Medical Faculty Farabi Hospital between 2019 and 2020.
RESULTS: Of the 647 patients who presented because of trauma, 384 (59.4%) were male and 263 (40.6%) were female. The leading cause of trauma was a same-level fall in 244 (37.7%) cases, followed by piercing or cutting injuries in 123 (19.0%), and a fall from height in 80 (12.4%) cases. Same-level falls and burns injuries were determined at a statistically significantly higher rate in females (p<0.001).
CONCLUSION: Abuse of the elderly and the mechanisms of all traumas, primarily falls as the most common cause of geriatric trauma, are a subject that should be addressed in terms of forensic medicine. Preventative measures against trauma should be implemented and reviewed for the elderly, and health-care personnel should take responsibility for the legal reporting of forensic traumatic injuries.

12. Analysis of trauma scoring system for patients with abdominal trauma
Youngjin Jang, Heungman Jun
PMID: 36588514  PMCID: PMC10198355  doi: 10.14744/tjtes.2022.94475  Pages 68 - 72
BACKGROUND: This study investigated the correlations between several trauma scoring systems, including the injury severity score (ISS), clinical abdominal scoring system (CASS), new injury severity score (NISS), and clinical outcomes, including laparotomy, in-hospital mortality (IHM), and long hospital stay (LS) in patients with abdominal trauma.
METHODS: Data of 749 patients with abdominal trauma between January 2009 and December 2019 were reviewed retrospectively. Data from medical records included age, sex, initial vital signs, type and mechanism of trauma, hospital stay, laparotomy, and IHM. Injured organs and grades were collected using computed tomography. Correlations between the scoring system and clinical outcomes were analyzed using the area under Curves (AUC) of the receiver operating characteristic (ROC) curve.
RESULTS: The mean age of the patients was 40.14±19.47 years. Blunt trauma was the most common type of trauma in 704 patients (94.0%), and traffic accident was the most common mechanism in 475 (63.4%). Injured organs included liver (45.1%) and spleen (25.1%). A total of 179 patients (23.9%) underwent laparotomy and IHM was reported in 35 (4.6%). The AUC of ROC for ISS, NISS, and CASS was significantly associated with laparotomy (0.682; p=0.001, 0.713; p=0.001; 0.845; p=0.001). The AUCs showed significant for IHM (0.606; p=0.034, 0.626; p=0.012, 0.701; p=0.001). The AUCs for LS were 0.554 (p=0.041), 0.549 (p=0.062), and 0.581 (p=0.002).
CONCLUSION: The CASS is excellent for predicting laparotomy, IHM, and LS in patients with abdominal trauma. The NISS is more appropriate than the ISS for predicting laparotomy and IHM.

13. Knowledge level on the management of pediatric burn patients among physicians working in the emergency department
Mehmet Arpacık, Aytekin Kaymakcı
PMID: 36588503  PMCID: PMC10198363  doi: 10.14744/tjtes.2022.85781  Pages 73 - 80
BACKGROUND: Prognosis of burned child is heavily influenced by how they are treated in the first 24 h. This study aimed to assess the degree of knowledge of emergency department physicians about the pediatric burn patients.
METHODS: The study included 229 physicians (80 emergency medicine specialists, 84 pediatricians, and 65 general practitioners). The questions were organized into six categories, each based on the Turkish Ministry of Health’s Burn Treatment Algorithm, American Burn Association criteria, and current literature: 1 – Etiology and Degree of Burn, 2 – Emergency Medical Intervention, 3 – Calculation of Burn Area and Fluid-electrolyte Treatment, 4 – Indications for Hospitalization in Burn Treatment Units, 5 – Judicial and Medical Liability, and 6 – Training Sufficiency and Demand for Burn Injury Training. Questionnaire form was sent to the participants through the WhatsApp application. The outcomes were rated as 75-100% good, 50%–75% moderate, and <50% poor.
RESULTS: The overall knowledge level of physicians about pediatric burns was moderate, with a score of 57.65±10.13 (emergency medicine specialists: 60.11, pediatricians: 57.56, and general practitioners: 54.75). Emergency medical intervention scores (35.02±22.43) and burn treatment units and hospitalization indications scores (38.6±18.96) were both low. Despite having a statistically significant higher medical intervention score than the pediatricians and general practitioners, the knowledge level of the emergency medicine specialists was poor.
CONCLUSION: As result, physicians practicing in the emergency department have a poor knowledge level about pediatric burns. Hence, pediatric burn education should be provided to all emergency department physicians.

14. The role of biomarkers in the early diagnosis of acute kidney injury associated with acute pancreatitis: Evidence from 582 cases
Esat Taylan Uğurlu, Mehmet Tercan
PMID: 36588520  PMCID: PMC10198356  doi: 10.14744/tjtes.2022.60879  Pages 81 - 93
BACKGROUND: One of the systemic complications of acute pancreatitis (AP) is acute kidney injury (AKI). AKI development in patients with AP increases mortality, morbidity, and the cost of treatment. Therefore, early diagnosis and prevention of AKI is important. The purpose of our study was to present biomarkers and case management of AKI developing in patients with AP.
METHODS: The participants of this retrospective study consisted of 582 patients who were followed up with the diagnosis of AP. Atlanta classification was used for the diagnosis and the identification of severity of AP. The laboratory values of patients at the time of first application to the emergency room were recorded. Blood tests were checked 48 h/l. Their blood tests were monitored daily until the day of discharge.
RESULTS: Of the 582 patients who were admitted with the AP diagnosis, 344 were female. AKI was detected in 147 patients (25.2%) of the patients admitted with AP diagnosis. The mean age of patients developing AKI was higher than those who did not develop AKI. The albumin and calcium levels in patients developing AKI were significantly lower than the group without AKI. The C-reactive protein (CRP)/albumin and neutrophil/lymphocyte ratios were statistically significantly higher in the group with AKI than the group without AKI. The increase values in AST and ALT levels between the group with AKI and the group without AKI were not statistically significant. The mean leukocyte, CRP, procalcitonin levels, and immature granulocyte percentage (IG%) ratio were higher in patients with AKI in comparison to the patient group without AKI. The decrease in the lymphocyte, hematocrit, and platelet levels was higher in the patient group with AKI compared to the patient group without AKI. Urea and creatinine levels of the group with AKI at the time of admission were higher than the group without AKI. The clinical picture in 13 of the patients we followed up with AP diagnosis was mortal.
CONCLUSION: The values of hematocrit, platelet, leukocyte, lymphocyte, albumin, CRP, CRP/albumin ratio, neutrophil/lymphocyte ration, IG%, procalcitonin, urea, and creatinine that were examined at the time of hospital admission can be useful biomarkers in predicting the development of AKI in patients with AP. In addition, accompanying diseases and age are among the factors affecting AKI development.

15. Correct triage at the scene increases success in the ED: Sabiha Gökçen Airport plane accident
Kenan Ahmet Turkdogan, Yusuf Uğurlu, Selim Altinarik, Osman Türk, Fatih Türkmen, Levent Özder, Ahmet Çelik, Elif Arslan, Erdal Yılmaz
PMID: 36588505  PMCID: PMC10198353  doi: 10.14744/tjtes.2022.48092  Pages 94 - 99
BACKGROUND: Triage is the most important part of the management of events, such as accidents, earthquakes, fires, and floods, in which mass injuries occur. The aim of this study is to evaluate the effects of triage on patient outcomes, injuries, the role of trauma mechanisms, and spinal immobilization during transportation following the plane crash at the İstanbul Sabiha Gökçen airport that involved 183 patients on February 5, 2020.
METHODS: Command control center data and ambulance and medical charts were examined retrospectively. The results were evaluated in terms of spinal immobilization, injury type, triage codes, and ISS values during emergency interventions and transportation.
RESULTS: We received the first notice at 18: 21 about the plane that had landed and crashed at 18: 19 on February 5, 2020, and the first team reached the security gate at 18: 26. The first team arrived at the debris field and performed triage. On the airside of the airport, the first victims were taken at 18: 32, transferred at 18: 36, and reached the hospital at 18: 41. The first case was taken from the debris field at 18: 35 and transferred to the hospital. Of the 183 patients on the plane, three became exitus at the scene, 43.7% of the victims were female, and the mean age was 35.0±15.7. The mean systolic blood pressure of the victims was 122.0±17.4. The mean distance to hospitals, transportation time, intervention time, heart rate, and ISS levels were measured as 55.0 (23.0–79.0) km; 780.5 (390.0–1540.0) s; 817.0 (552.0–1200.0) s; 86.0 (78.0–100.0); and 4.5 (1.0–9.0), respectively. A positive significant correlation was found between ISS and the days of hospitalization (r=0.577; p<0.001).
CONCLUSION: The fact that no patient was lost during the follow-up and treatment is an indication that triage, appropriate patient referral to the appropriate hospital, and primary and secondary care are well performed, as well as the crash of the plane while landing. Coordinated acts of the airport and 112 emergency health services and guidance for appropriate triage reduced both pre-hospital and hospital mortality.

16. Use of the AIMS65 and pre-endoscopy Rockall scores in the prediction of mortality in patients with the upper gastrointestinal bleeding
Mazlum Kılıç, Rohat Ak, Ummahan Dalkılınç Hökenek, Halil Alışkan
PMID: 36588521  PMCID: PMC10198348  doi: 10.14744/tjtes.2022.38890  Pages 100 - 104
BACKGROUND: Upper gastrointestinal (GI) bleeding is one of the most common reasons for emergency department (ED) visits. This study aimed to evaluate the predictive power of the AIMS65 and pre-endoscopy Rockall scores in predicting in-hospital mortality in patients that presented to ED and were diagnosed with the upper GI bleeding.
METHODS: Data of patients aged 18 years and older, who visited ED of Kartal Dr. Lütfi Kırdar City Hospital during the study period and were diagnosed with upper GI bleeding, were obtained from the electronic-based hospital information system and analyzed retrospectively. Each scoring system was compared using the receiver operating characteristic (ROC) curve analysis.
RESULTS: The study was completed with 592 patients. The mean age of the patients was 63.5±19.0 years, and 68.6% were male. The total in-hospital mortality rate was 5.2%. In the ROC analysis of the AIMS65 and pre-endoscopy Rockall scores in the prediction of in-hospital mortality, the area under the curve values was calculated as 0.822 (95% confidence interval [CI]: 0.788–0.852) and 0.777 (95% CI: 0.741–0.810), respectively. When these two scoring systems were compared, neither had statistically significant superiority over the other in predicting in-hospital mortality.
CONCLUSION: The AIMS65 and pre-endoscopy Rockall scores can be used to predict in-hospital mortality in patients with GI bleeding. However, since the AIMS65 score consists of only five variables that can easily be calculated in ED, we recommend its use in clinical practice.

17. Medicolegal evaluation in terms of physical abuse of children aged 0–3 years presenting at the emergency department with brain hemorrhage
Güven Seçkin Kırcı, Hacı Seyit Bölükbaşı, Deniz Utku Öztürk, Hilal Çakır, Erdal Özer
PMID: 36588518  PMCID: PMC10198357  doi: 10.14744/tjtes.2022.06730  Pages 105 - 108
BACKGROUND: Physical abuse of children covers all types of non-accidental and preventable physical violence and injury perpetrated by the caregiver.
METHODS: The study included children in the 0–3 years age group who presented at the Emergency Department (ED) with the finding of intracranial hemorrhage during the 5-year period of 2017–2021. These children were evaluated retrospectively, and findings that should be considered were revealed.
RESULTS: In the 32 cases included in the study, the most common cranial finding was subdural hematoma, and the most common extracranial finding was ecchymoses. Presentation at the ED was seen to be 2 days after the trauma in 9.37% of the cases.
CONCLUSION: Any physician who encounters findings related to physical abuse of a child must make a forensic and social services report. Physicians who do not make the necessary reports or act to the contrary have both a legal and moral responsibility in the subsequent process.

18. The importance of the scoring system in Fournier’s gangrene
Seracettin Eğin, Sedat Kamalı, Semih Hot, Berk Gökçek, Metin Yeşiltaş, Mehmet Güray Duman, Ali Alemdar
PMID: 36588504  PMCID: PMC10198346  doi: 10.14744/tjtes.2022.42738  Pages 109 - 115
BACKGROUND: The objective of the study was to investigate risk factors affecting mortality rates in patients with Fournier’s gangrene (FG) and develop methods to increase the survival rate.
METHODS: We collected data of 73 patients treated for FG between February 2012 and June 2021 at Istanbul Professor Doctor Cemil Taşçıoğlu City Hospital General Surgery Clinic. The data of living patients (Group 1, n=56) and deceased patients (Group 2, n=17) were analyzed separately. Demographic data of patients were sex, age, infection rate, Uludag FG severity index (UFGSI) scores and FG severity index (FGSI) scores, urea serum levels, the source of infection, the presence of diabetes, obesity, the presence of diversion stoma, duration of vacuum-assisted closure treatment in days, hospitalization time in days, intensive care period in days, and isolated bacterial species.
RESULTS: The mortality rate was 23%. A significant difference in age and dissemination score of the infection was found between the two groups. According to UFGSI and FGSI scores, the scores of the two groups of patients were significantly higher. The UFGSI had 100% sensitivity and 68% sensitivity. FGSI had 82% sensitivity and 58% specificity. The cutoff values for UFGSI and FGSI were 8 and 6, respectively.
CONCLUSION: Age and dissemination scores of diseases were important factors that cause mortality in patients with FG. However, an accurate scoring system is important in predicting patients to be treated in the intensive care unit (ICU). Patients with a UFGSI score above 8 face a higher risk of death and should be treated in the ICU.

CASE SERIES
19. The role of liver resection in the management of severe blunt liver trauma
Hakan Küçükaslan, Serkan Tayar, Şükrü Oğuz, Serdar Topaloglu, Sukran Geze Saatci, Ahmet Can Şenel, Adnan Calik
PMID: 36588513  PMCID: PMC10198359  doi: 10.14744/tjtes.2021.89678  Pages 122 - 129
BACKGROUND: The management of hepatic trauma has a historical progress from mandatory operation with selective non-operative treatment, to non-operative treatment with selective operation. Liver resection (LR) seems to have a minimal role in the management of liver injury. However, surgical treatment becomes the only life-saving treatment in cases with severe liver trauma.
METHODS: It is a retrospective presentation of five cases with severe blunt liver injury whose were admitted at our center during the 8-year period.
RESULTS: The median age of patients was 30.8 (23–43). The most frequent mechanism of injury was pedestrian struck (60%). Two of five cases were transferred to our hospital from rural state hospitals after initial attempt to achieving hemostasis. The majority of liver injury was grade V (80%). The right lobe of the liver was injured in different extensions. Major vascular injury was associated to liver injury in four of five cases. The right hepatectomy (n=1), resectional debridement of segments 5, 6, and 7 (n=1), posterior sectorectomy (n=2), and segment 7 resection (n=1) were performed for hemostasis. Vascular injuries in the junction of inferior vena cava and right hepatic vein (n=1), the anterior surface of the right hepatic vein (n=1), the junction of segment 7 hepatic vein and right hepatic vein (n=1), the main portal vein (n=1), and the right renal vein (n=1) were repaired. Median operation time was 162 min (120–180 min). Operative mortality was 20%. Reoperation was needed in three of four survived cases. In-hospital complications were observed in two of four survived cases. Median stay in intensive care unit and hospital was 12.4 days (1–48 days) and 28.2 days (1–65 days), respectively.
CONCLUSION: When a severe liver injury is unresponsive to packing, the surgeon must always keep in mind that extensive maneuvers for vascular control and LR are required for bleeding control.

LETTER
20. Intestinal hernia: An unusual intra-abdominal hernia with bloody ascites as the main clinical manifestation
Shi-ping Wang, Guo-Ming Zhang
PMID: 36588516  PMCID: PMC10198351  doi: 10.14744/tjtes.2022.25995  Pages 130 - 131
Abstract |Full Text PDF