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Objective: Each imaging technique has a special application and usage, and should be used in the right situation. Physicians choose the type of imaging technique by considering the type of tissue and the benefits and disadvantages of the imaging method as well as its financial burden on the patient. The aim of this study was to estimate the cost of imaging tests performed in the emergency department (ED) of an educational hospital and determine their financial burden on both the patients and the healthcare system of the country. Methods: This retrospective descriptive cross-sectional single-center study was conducted in Shohadaye Tajrish, an educational hospital, during one year. The study population consisted of all patients who had undergone some type of imaging (CT scan, ultrasound, radiography, magnetic resonance imaging [MRI]) in the ED. The information was collected using a predesigned checklist. The costs of a variety of imaging methods for patients referred to the ED were calculated using different types of accounting units and PACS system. Results: The number of patients who visited the ED of the studied hospital during a one year period was 63507. The total cost of performing different types of imaging methods in the studied center throughout the one-year target period was 44018695695 Rials (≃$US 423745) (59.27% of which was spent on CT scan, 16.09% on ultrasound, 13.75% on plain radiography and 10.87% on MRI). Conclusion: According to the collected data, the total cost of radiology was 44018695695 Rials. The highest cost was related to CT scan modality, and the lowest belonged to MRI.

Introduction: Predicting the outcome is one of the most frequent and important issues when approaching patients with intracranial hemorrhage (ICH). Objective: This study aimed to evaluate the correlation of SUSPEKT score variables plus electrocardiogram (ECG) abnormalities with one-month mortality of patients with ICH presenting to emergency department (ED). Methods: In this cohort study, adult patients presenting to the EDs of three educational hospitals, during one year, were followed and their one-month mortality rate as well as independent predictors of outcome among the variables of SUSPEKT score plus electrocardiography findings were evaluated. Results: One hundred seventy-seven patients with the mean age of 63.07±14.89 years were studied (59.9%). The most common locations of intra-parenchymal hemorrhage were basal ganglia (53.7%) and cortex (36.2%). Ninety-two (52.0%) of cases had at least one ECG abnormality. The most frequent ECG abnormalities were ST segment depression (20.3%), T wave inversion (16.4%), and left ventricular hypertrophy (14.7%). Thirty (16.9%) cases died during the 30-day follow-up. Survived and non-survived cases were significantly different regarding the location of intra-parenchymal hemorrhage (p < 0.0001), presence of intraventricular hemorrhage (IVH) (p = 0.007), ST segment elevation (p < 0.0001), bradycardia (p < 0.0001), tachycardia (p < 0.0001), arterial fibrillation (p < 0.0001), blood sugar (p = 0.044), and serum level of potassium (p = 0.022). Conclusions: The location of hemorrhage (basal ganglia), higher blood sugar, and presence of ECG abnormalities (ST segment elevation, tachycardia, bradycardia, atrial fibrillation) were among the independent predictors of one-month mortality of ICH patients in this study.

Introduction As radiologic assessment is a key part in evaluating patients visited in emergency department, this survey was conducted to measure emergency medicine residents' competency in choosing appropriate diagnostic imaging in different clinical scenarios. Methods All emergency medicine residents enrolled in an academic emergency medicine discipline in the three medical universities of Tehran, Iran were recruited. A questionnaire was designed consisting of 10 clinically common scenarios selected from the American College of Radiology appropriateness criteria. Each resident completed the survey separately with answers only given after all residents participated. Results 196 residents completed the survey (95% of all residents). The results were stratified by post-graduate year and university. The average number of correct answers was 6.2. First, second and third year residents scored the average of 6.1, 5.8 and 6.5, respectively (P=0.04). The average score of residents from different universities did not differ significantly. Conclusion According to the low average score, it is recommended that attentive educational perfections are needed to help residents order more appropriate diagnostic images, which may also be helpful for other healthcare providers. However, it seems that our emergency medicine academic curriculum is relatively efficient to enhance residents' skills in choosing proper imaging.

Background: Antimicrobial resistance among uropathogens causing community-acquired urinary tract infections (UTIs) is a worldwide concern. It has been suggested that diabetes could be a possible cause of antibiotic resistance. This study was undertaken to identify the responsible microbial culprits for UTI in patients with different range of glycosylated hemoglobin (HbA1C) and evaluate their corresponding resistance pattern. Methods: In a cross-sectional study between 2013 to 2018, data related to the urine culture and sensitivity of patients who had bacteriuria were gathered. For patients with positive urine culture, HbA1C was requested and correlations between HbA1C level with microorganism and its susceptibility were evaluated. Results: In total, 121 patients were recruited. All study participants were female. The mean age of the patients was 50.2 ± 22.5 (range 19-96). All study participants were of the same race. Fifteen (12.4%) out of 121 patients were diabetics. There were no difference between bacteriology of UTIs in diabetic and nondiabetic patients with the preponderance being caused by E. coli and other gram-negative organisms but, there were positive association between HbA1C and resistance to Nalidixic acid and Gentamicin. Conclusion: Our study supports the findings that diabetes in itself could be a possible cause of antibiotic resistance to some antimicrobial agents. J Pharm Care 2019; 7(3): 70-74.

Objective: Cardiopulmonary resuscitation (CPR) has been known in its present form since 1960. Different studies have reported variable outcomes among different countries. Therefore, the purpose of this study was to assess the rate of CPR success and the survival rate in managing cardiac arrest among patients in an educational medical center. Methods: This cross-sectional study was performed at Imam Hosein hospital, Tehran, Iran. All patients, admitted to the emergency department with cardiac arrest between March 2007 and January 2008 were included. We used a formerly designed registration form and hospital documentation to retrieve the data of included patients. The main outcomes were the rate of CPR success and the survival rate of these patients. Results: Totally 855 patients were included, from which 510 (59.64%) were males. The mean age of included patients was 63 ± 17.6. The CPR process was successful among 364 (42.58%) patients. A total number of 101 (11.82%) patients were discharged from the hospital. Different factors as the cause of cardiac arrest and past medical problems affected the probability of CPR success and the survival of patients with cardiac arrest. Conclusion: Survival rate at hospital discharge was less than one-third of patients and nearly half of the patients received successful CPR. More intensive care unit (ICU) facilities and educational interventions for the emergency staff and the community can enhance the survival of cardiac arrest patients in our health system.

Objective Vertigo, the hallucination of movement of oneself or one's surroundings, can have substantial adverse effects on the quality of life of affected patients. It is essential to decrease the frequency, severity, and duration of vertigo attacks using effective medications with minimal debilitating adverse effects. We performed a meta-analysis of available clinical trials to evaluate the efficacy of histamine antagonists in the treatment of vertigo compared to the rate of resolution in untreated control groups. Materials and methods A systematic search of articles in any language from January 1970 to March 2015 was performed through the following databases: the Cochrane Central Register of Controlled Trials, Medical Literature Analysis and Retrieval System Online, the Excerpta Medica Database, Cumulative Index to Nursing and Allied Health Literature, Latin American and Caribbean Health Sciences Literature, Allied and Complementary Medicine Database, Web of Science, ClinicalTrials.gov, and Google. Randomized controlled trials comparing each kind of antihistamine to untreated control participants in the treatment of vertigo (blinded/unblinded) were screened for inclusion. Three reviewers separately performed data extraction from the included trials using a standard data abstraction form. Three other researchers read the final list of all articles retained. Discrepancies were settled by mutual consensus between the authors. Random effects models were applied to estimate the pooled odds ratio (OR) and 95% confidence interval (CI) using the Review Manager software. The evaluation of publication bias was performed by Egger's test and Begg's funnel plot. Results We identified 13 eligible citations. The pooled OR was 5.370, 95% CI (3.263-8.839), and I2=56.0%, with no obvious evidence of publication bias. Conclusion Our results provide clarification of the effectiveness of several categories of histamine antagonists compared with placebos in controlling peripheral vertigo.

Background and Purpose: Patient absconding from a hospital or leaving without permission is a major challenge with economic and social consequences for patients, healthcare staff, and society. Identification of the characteristics of absconding patients is essential to the prediction and prevention of such behaviors. Methods: This cross sectional study was performed in a large general teaching hospital in Tehran, Iran. Data of 460 absconding patients and 460 nonabsconding patients, admitted during March 2010 - March 2016, were extracted from the hospital information system. Backward stepwise logistic regression analysis was used to describe the importance and effect of each predictor. Results: The findings showed that 0.4% of the patients had left the hospital without permission or notice to the staff. Addiction (OR, 27.15), lack of insurance coverage (OR, 12.39), male gender (OR, 2.14), age ≤ 40 years (OR, 1.89), and emergency admission (OR, 1.77) were predictors of absconding. Hospital financial loss amounted to 3,818,788,624 IRR ($126,283) due to this problem, with an average cost of 7,178,174 IRR ($237) per patient. Conclusions: Identification of high-risk individuals, including young men, uninsured patients, and drug addicts with emergency admission warrants preventive measures. Moreover, assessment of patients by physicians or nurses upon admission, staff training and raising awareness, and use of technologies such as radiofrequency identification can be other strategies for preventing or reducing this problem.

The present study was a double-blind clinical trial to compare the efficiency of hysocine and diazepam in vertigo treatment. Eligible patients (n=69) were randomly divided into 2 groups of 5 mg hyoscine and 10 mg diazepam. Severity of vertigo was measured in supine and sitting position, and while turning the head. Vertigo severity was assessed before, and 1 and 2 hours after administration of the drug. Treatment success rate of diazepam in relieving vertigo in different positions varied between 88.9 and 100%, while this rate was 31.2–73.5% in hyoscine treatment group (p

Background The Alvarado score is utilized to determine the likelihood of appendicitis based on clinical signs, symptoms, and laboratory results. The goal of this study was to determine whether Alvarado scores can be used to aid in the accurate diagnosis of appendicitis. Methods Alvarado score evaluations were performed on 300 patients that were referred to or presented to the emergency room with acute abdominal pain. Results Out of the 300 patients, 85.66% had Alvarado scores of 7 or less and 14.33% had Alvarado scores greater than 7. For patients that had confirmed appendicitis, 25.7% had Alvarado scores of 7 or less, whereas 93% had Alvarado scores greater than 7. The Alvarado scoring system had poor sensitivity at 37%, and the specificity of this scoring system was high at 95%. Conclusion Our findings suggest that patients presenting with abdominal pain and Alvarado scores greater than 7 are more likely to have appendicitis. As such, the Alvarado scoring system may be utilized to better predict whether a patient has appendicitis. An Alvarado score that is positive for appendicitis would consist of a score greater than 7, which suggests that the patient has a 93% chance of having appendicitis. A negative Alvarado score is 7 or lower, suggesting a 26% probability of having appendicitis. In all, the Alvarado scoring system is a good rule-in test, but it does not adequately rule-out appendicitis.

Study objective: Aero medical crews offer an advanced level of practice and rapid transport to definitive care; however, their efficacy remains unproven. Previous studies have used relatively small sample sizes or have been unable to adequately control the effect of other potentially influential variables. Here we explore the impact of aeromedical response in patients with moderate to severe traumatic brain injury. Methods: This was a cross-sectional study using our county trauma registry. All patients with trauma injury, who referred to our emergency department by helicopter or car, were included. The impact of aeromedical response was determined using logistic regression, adjusting for age, sex, mechanism, preadmissionGlasgowComa Scale score and Injury Severity Score. Finally, the aeromedical patients undergoing field intubation were compared with ground patients undergoing emergency department (ED) intubation. Results: A total of 243 patients meeting all inclusion and exclusion criteria and with complete data sets were identified. Overall mortality was 25% in the air- and ground-transported cohorts, but outcomes were not significantly better for the aeromedical patients when adjusted for age, sex, mechanism of injury, hypotension, Glasgow Coma Scale score, head Abbreviated Injury Score, and Injury Severity Score (adjusted odds ratio [OR] 1.90; 95% confidence interval [CI] 1.60 to 2.25; P: 0001). Good outcomes (discharge to home, jail, psychiatric facility, rehabilitation, or leaving against medical advice) were also higher in aeromedical patients (adjusted OR 1.36; 95% CI 1.18 to 1.58; P: 0001). Conclusion: Here we analyze a large database of patients with moderate to severe traumatic brain injury. Aeromedical response appears to yield no significantly improved outcomes after adjustment for multiple influential factors in patients with moderate to severe traumatic brain injury.

Background and aims An increase in the intracranial pressure (ICP) might aggravate patient outcomes by inducing neurologic injuries. In patients with increased ICP the optic nerve sheath diameter (ONSD) increases due to its close association with the flow of cerebrospinal fluid. The present study was an attempt to evaluate the efficacy of sonographic ONSD in estimating ICP of patients who are candidates for lumbar puncture (LP). Materials and methods In this descriptive prospective study, the ONSD was measured before LP using an ultrasonography in 50 nontraumatized patients who were candidates for LP due to varies diagnoses. Immediately after the sonography, the ICP of each patient was measured by LP. Correlation tests were used to evaluate the relationship between ICP and the sonographic diameter of the optic nerve sheath. Receiver operating characteristic curve was used to find the optimal cut-off point in order to diagnose ICP values higher than 20 cm H 2 O. Results The means of the ONSD were 5.17 ± 1.01 and 5.19 ± 1.06 mm on the left and right sides, respectively ( P = .552). The mean ONSD for the patients with increased ICP and normal individuals were 6.66 ± 0.58 and 4.60 ± 0.41 mm, respectively ( P P r = 0.88). The ONSD of greater than 5.5 mm predicted an ICP of ≥20 cm H 2 O with sensitivity and specificity of 100% (95% CI, 100-100) ( P Conclusion The sonographic diameter of the optic nerve sheath might be considered a strong and accurate predicting factor for increased intracranial pressure.

Background: This double-blind randomized clinical trial aimed at comparing the effect of intranasal desmopressin with that of intravenous ketorolac in pain management of patients with renal colic referring to the emergency department. Methods: The patients were randomly divided to two groups. One group received intravenous ketorolac 30 mg and intranasal normal saline, while, the other one received intranasal desmopressin 40 μg and 1 mL of intravenous distilled water. The patients’ pain was evaluated using the visual analog scale at the time of admission, 10, 30, and 60 minutes after drug administration. Results: Overall, 40 patients with mean age of 32.53 ± 6.91 participated in this study. Gender ratio (P = 0.288), mean age (P = 0.165), and mean pain score on arrival (P = 0.694) had no significant difference. The mean pain scores, 10, 30, and 60 minutes after drug administration in the ketorolac group was significantly lower than the desmopressin group, and decreased more rapidly (P < 0.001). Conclusions: It is likely for desmopressin to be less efficacious than ketorolac, and desmopressin leads to a significant alleviation of pain in patients with renal colic.

The widespread epidemic of emerging abuse in Emergency Departments (ED) toward residents generates negative effects on the residents’ health and welfare. The purpose of this study was to determine and highlight the high prevalence of abuse and harassment toward Emergency residents. In 2011, a multi-institutional, cross-sectional study was conducted at seven Emergency Residencies of central hospitals in Iran. Residents were asked about their age, marital status, postgraduate year (PGY) levels, and work experiences before residency. Prevalence of abuse in four categories was evaluated: verbal abuse; verbal and physical threat; physical assault and sexual harassment; and by whom. The data were analyzed by SPSS version 17.0 (SPSS, Inc., Chicago, IL, USA). Two hundred fifteen of the 296 residents (73%) completed the survey. The prevalence of any type of abuse experienced was 89%; 43% of residents experienced verbal and physical threats, 10% physical assault, and 31% sexual harassment. Verbal abuse and verbal and physical threats without the use of weapons were higher in men in comparison with women ( p< .04). Women were more likely than men to encounter sexual harassment (31% vs. 7%, p< .01). Among the sexual harassment categories, sexual jokes (51%) were the most prevalent between residents. Junior residents (PGY-1) were more likely to experience abuse than senior residents (PGY-2 and PGY-3; p< .01). Patients and their companions were the main agents of abusive behaviors. Abuse and harassment during residency in ED are highly prevalent. Educational programs and effective preventive measures against this mistreatment are urgently required.

Background Patients who receive care in an emergency department (ED), are usually unattended while waiting in queues. Objectives This study was done to determine, whether the application of queuing theory analysis might shorten the waiting times of patients admitted to emergency wards. Patients and Methods This was an operational study to use queuing theory analysis in the ED. In the first phase, a field study was conducted to delineate the performance of the ED and enter the data obtained into simulator software. In the second phase, "ARENA" software was used for modeling, analysis, creating a simulation and improving the movement of patients in the ED. Validity of the model was confirmed through comparison of the results with the real data using the same instrument. The third phase of the study concerned modeling in order to assess the effect of various operational strategies, on the queue waiting time of patients who were receiving care in the ED. Results In the first phase, it was shown that 47.7% of the 3000 patient records were cases referred for trauma treatment, and the remaining 52.3% were referred for non-trauma services. A total of 56% of the cases were male and 44% female. Maximum input was 4.5 patients per hour and the minimum input was 0.5 per hour. The average length of stay for patients in the trauma section was three hours, while for the non-trauma section it was four hours. In the second phase, modeling was tested with common scenarios. In the third phase, the scenario with the addition of one or more senior emergency resident(s) on each shift resulted in a decreased length of stay from 4 to 3.75 hours. Moreover, the addition of one bed to the Intensive Care Unit (ICU) and/or Critical Care Unit (CCU) in the study hospital, reduced the occupancy rate of the nursing service from 76% to 67%. By adding another clerk to take electrocardiograms (ECG) in the ED, the average time from a request to performing the procedure is reduced from 26 to 18 minutes. Furthermore, the addition of 50% more staff to the laboratory and specialist consultations led to a 90 minute reduction in the length of stay. It was also shown that earlier consultations had no effect on the length of stay. Conclusions Application of queuing theory analysis can improve movement and reduce the waiting times of patients in bottlenecks within the ED throughput.

According to previous animal studies, aluminium phosphides (AlPs) may induce oxidative stress leading to generation of free radicals and alteration in antioxidant defense system. This study was conducted to evaluate the existence and degree of oxidative stress in patients with acute AlP ingestion. A total of 44 acute AlP ingested patients as well as 44 age- and sex-matched controls were included. All patients had acute poisoning symptoms with AlP at the time of presentation and had blood samples analyzed for lipid peroxidation, total antioxidant capacity and total thiol. Our findings showed that there is a significant increase in lipid peroxidation in AlP ingested group along with a reduction in total antioxidant capacity and total thiols groups. These clinical data confirm previous experimental models that showed AlP exposure might significantly augment lipoperoxidative damage with simultaneous alterations in the antioxidant defense system. Hence, our findings might justify use of antioxidants in treatment of acute AlP poisoning which needs to be clarified by additional clinical trials.

Objective: To compare the effectiveness of nitrous oxide/oxygen (N2O/O2) and fentanyl in relieving pain among patients with an isolated long bone fracture or main joint dislocation of the limbs. Methods: Patients with isolated long bone fracture or main joint dislocation with moderate to severe pain were randomized into two groups. For the first group, nitrous oxide/oxygen (50:50) was self-administered until pain relief was achieved up to a maximum of 15 min. Fentanyl (2 µg/kg) as a single dose was administered for the second group. Pain intensity was measured with a visual analogue scale before and at minutes three, six and nine after the start of the drug administration. We also recorded observed adverse effects in these two groups. Results: One hundred patients were enrolled in the study. No statistically significant difference in pain score was detected between the two groups with one exception. The mean visual analogue scale scores at 9 min were 2.2 and 3.1 for nitrous oxide/oxygen and fentanyl, respectively (difference −0.9 [95% CI −1.7–−0.1]) (P= 0.006). There was no statistically significant difference between two groups regarding adverse effects. Conclusions: Neither nitrous oxide/oxygen or fentanyl appeared to be superior to the other in relieving moderate to severe pain among emergency patients presenting with isolated limb fracture or dislocation. In an ED, increased use of nitrous oxide might reduce the overall need for opiate analgesia, and in our setting, the need for constant monitoring.

Various kinds of drugs have been evaluated as aparacetamol antidote; the most important of themis N-acetylcysteine (NAC), which serves as anavailable precursor for glutathione synthesis, thusreplenishing glutathione stores and preventingthe reaction of N-acetyl-p-benzoquinoneimine(NAPQI) with hepatocytes.

Background: Motor vehicle collisions (MVC) comprise a majority cause of referral to the emergency department (ED). A large proportion of MVC appear to be preventable, if more effective measures against driving after substance abuse can be implemented. Objective: This study was aimed to investigate the prevalence of substance abuse among drivers of MVC, following road traffic accidents (RTA). Materials and Methods: This case-control research was conducted from July to October 2007. One hundred MVC drivers admitted in the ED were included as the case group and 110 hospitalized patients, due to nontraumatic causes were used as controls. History of substances abused was obtained and urine samples were tested for opium in both groups. Finally the history and laboratory results of the groups were compared using SPSS 18. Results: Of the 100 patients in the case group, 39 (39%) were positive for substance abuse (100% males). On the other hand, 49 (44.5%) patients in the control group had positive history or laboratory findings of substance abuse (73.9% male). Opioids were the most common agent abused in both groups. There was no significant difference between two groups regarding the prevalence of substance abuse (P = 0.92). Conclusions: The prevalence of substance abuse is high among victims of road traffic injury but in equal proportion to the control group. Health education and counseling is needed to reduce substance abuse in the general population although it was not significantly related to the cause of RTA.

Background: Uncontrolled hemorrhage is a well-recognized cause of mortality in trauma victims and the control of active hemorrhage is among the initial steps in resuscitation. Objectives: The purpose of this study was to assess the role of a hemostatic agent “celox” in the management of civilian stab-wound trauma. Patients and Methods: In this clinical trial study, 160 patients with penetrating limb trauma were randomly allocated to either the control or intervention group (n = 80, each group). Controls were treated with the simple pressure dressing, while the celox-coated gauze was used in the intervention group. The time for achievement of hemostasis and the amount of bleeding were recorded. Data were analyzed using SPSS Version 21 and Stata 13. A P value of less than 0.05 was considered statistically significant. Results: The mean age of participants was 30.5 and the majority of patients were male (90.6%). The forearm and distal leg were the most sites of injury. Hemostasis was achieved within 5 minutes in 32.5% of the control group and 51.3% of the intervention group. Using the celox-coated gauze significantly reduced the time to hemostasis (P = 0.01). Moreover, the blood loss was significantly lower in the celox group compared to the controls (P < 0.05). Conclusions: Using the celox-coated gauze is able to achieve hemostasis in penetrating limb trauma faster than the conventional pressure bandage. Further research is required to clarify the subset of patients who will benefit the most from this effect in the emergency department.

Introduction. Evaluation of Guidelines in Syncope Study (EGSYS) is designed to differentiate between cardiac and noncardiac causes of syncope. The present study aimed to evaluate the accuracy of this predictive model.Methods. In this prospective cross-sectional study, screening performance characteristics of EGSYS-U (univariate) and EGSYS-M (multivariate) in prediction of cardiac syncope were calculated for syncope patients who were referred to the emergency department (ED).Results. 198 patients with mean age of 59.26 ± 19.5 years were evaluated (62.3% male). 115 (58.4%) patients were diagnosed with cardiac syncope. Area under the ROC curve was 0.818 (95% CI: 0.75–0.87) for EGSYS-U and 0.805 (CI 95%: 0.74–0.86) for EGSYS-M (p=0.53). Best cut-off point for both models was≥3. Sensitivity and specificity were 86.08% (95% CI: 78.09–91.59) and 68.29% (95% CI: 56.97–77.86) for EGSYS-U and 91.30% (95% CI: 84.20–95.52) and 57.32% (95% CI: 45.92–68.02) for EGSYS-M, respectively.Conclusion. The results of this study demonstrated the acceptable accuracy of EGSYS score in predicting cardiogenic causes of syncope at the≥3 cut-off point. It seems that using this model in daily practice can help physicians select at risk patients and properly triage them.

The aim of present study was to determine the reliability of the dipstick values (protein, glucose, and pH) for differentiation of exudate from transudate ascites in comparison with the serum-ascites albumin gradient as criterion standard. A total of 100 patients with ascites (58 males and 42 females; mean age, 55.6 ± 16.1 years) were studied for the different causes of ascites. Peripheral blood samples were obtained, and at the same time, the patients underwent paracentesis. There were 62 cases (62.0%) of transudate ascites and 38 (38.0%) of exudates ascites, based on serum-ascites albumin gradient. Using logistic regression, we found a dipstick equation (K = 0.012Protein - 0.012Glucose - 3.329pH + 23.498) to differentiate transudate (K0) from exudate (K0) ascites. The sensitivity, specificity, positive predictive value, and negative predictive value of dipstick equation to diagnose ascites as transudate and exudate were 93.8%, 94.4%, 96.8%, and 89.5%, respectively, and 94.4%, 93.9%, 89.5%, and 96.9%, respectively. The area under the receiver operating characteristic curve was 0.915 (95% confidence interval, 0.848-0.982; P.001). We concluded that the dipstick can be an inexpensive, rapid, and simple option for categorizing ascites into transudate and exudate and can be used routinely for this purpose in clinical practice.

Introduction Tetanus vaccine and immunoglobulin administration are challenging decisions mostly because of the fact that the current protocol for immunization against tetanus is based on 2 variables: the vaccination status of the patient and the nature of wound and its exposure. To solve this problem, Tetanus Quick Stick (TQS; Nephrotek Laboratory, Rungis, France), an immunochromatographic dipstick test, was developed to determine the tetanus immunity of the patients. The aim of this present study was to investigate the sensitivity, specificity, and the positive and negative predictive values and cost-effectiveness of TQS in the emergency department (ED) setting. Methods Blood samples were collected from 200 patients presenting to our ED. Information including demographic information, tetanus immunization status, wound description, and the preventive measures taken by the emergency physician were gathered by a preeducated nurse. Tetanus Quick Stick test and enzyme-linked immunosorbent assay were performed as the standard diagnostic test by an emergency physician and a laboratory technician, respectively; and results of the 2 techniques were compared. Result Overall, tetanus vaccine was administered to 141(70.5%) patients and immunoglobulin to 105 (52.5%) patients. The analysis revealed 88.1% sensitivity and 97.6% specificity for the TQS test. The positive and negative predictive values of TQS test were 99.3% and 66.1%, respectively. Our analysis is also showed a significant decrease in cost when TQS was applied for patients with dirty, tetanus prone wounds or injuries and unknown or incomplete vaccination history (€ 9.48 versus € 12.1). Conclusion This study revealed TQS test to be appropriate and cost-effective for ED use especially in evaluating patients who do not remember or cannot give their tetanus immunization history.

ObjectivesMany of critically ill patients are being cared for prolonged periods in ED just because of limited number of ICU beds and utilize of ED as the entry point to the health care system. The aim of this study is evaluation efficiency of APACHE III scoring system in predicting mortality rate of the mentioned patients.Materials and MethodsThis cross-sectional, observational, analytic study was performed in one year period. A hundred patients remaining in ED and necessitating ICU hospitalizing were enrolled by the convenience type of non-probability sampling. Then, the APACHE III scores, predicted and observed mortality rates were calculated using of information obtained from patients' files, interview with the patients' family and performing required physical exams and lab tests.ResultsIn the assessment of 100 patients, men group were 56% (56) and women group 44% (44). The age of patients and the ED lengths of stay were 66.07 ± 19.92 years and 5.11 ± 3.79 days respectively. The average (± SD) of APACHE III score of the enrolled patients was 58.89 ± 18.24 and the predicted mortality rate calculated 32.73%; while, the total of observed mortality rate was 55%. The average (± SD) of APACHE III score of survivors and non-survivors were 48.63 ± 16.35 and 67.63 ± 14.84 respectively. So, there was a significant deference (p < 0.001). Also, there was a significant deference in the ED lengths of stay between survivors and non-survivors (3.20 ± 1.34 and 6.57 ± 4.40 respectively, p < 0.001).ConclusionIn our study, APACHE III score and ED lengths of stay were higher versus other studies in Iran and other countries; which show more critical patients presenting to our hospital and limited ICU beds versus patients. This study results nevertheless there was significant difference between predicted and observed mortality rates, the APACHE III scoring system is applicable to evaluating care, treatment and prognosis of ED patients, as is used in ICU.