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    Accuracy of emergency physicians’ interpretation of computed tomography for urgent?emergent diagnoses in nontraumatic cases
    (2022) Karakoyun, Ömer Faruk; Kozaci, Nalan; Avci, Mustafa; Uzunay, Hüseyin
    OBJECTIVE: The aim of this study is to evaluate the accuracy levels of the emergency physicians (EPs) \rmanaging the patient in the interpretation of the urgent?emergent pathological findings in thoracic \rand abdominal computed tomography (CT) scans.\rMETHODS: The EPs interpreted the CT scans of patients who visited the emergency department \rbecause of nontraumatic causes. Then, a radiology instructor made final assessments of these CT \rscans. Based on the interpretation of the radiology instructor, the false?positive rate, false?negative \rrate, sensitivity, specificity, positive predictive value, negative predictive value, and kappa \rcoefficient (?) of the EPs’ interpretations of the CT scans were calculated.\rRESULTS: A total of 268 thoracics and 185 abdominal CT scans were assessed in our study. The \roverall sensitivity and specificity of the EPs’ interpretation of the thoracic CT scans were 90% and 89%, \rrespectively, whereas the abdominal CT interpretation was 88% and 86%, respectively. There was \rexcellent concordance between the EPs and the radiology instructor with regard to the diagnoses of \rpneumothorax, pulmonary embolism, pleural effusion, parenchymal pathology, and masses (?: 0.90, \r?: 0.87, ?: 0.71, ?: 0.79, and ?: 0.91, respectively) and to the diagnoses of intraabdominal free fluid, \rintraabdominal free gas, aortic pathology, splenic pathology, gallbladder pathology, mesenteric artery \rembolism, appendicitis, gynecological pathology, and renal pathology (?: 1, ?: 0.92, ?: 0.96, ?: 0.88, \r?: 0.80, ?: 0.79, ?: 0.89, ?: 0.88, and ?: 0.82, respectively).\rCONCLUSION: The EPs are successful in the interpretation of the urgent?emergent pathological \rfindings in thoracic and abdominal CT scans.
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    Öğe
    Comparison of diagnostic accuracy of point-of-care ultrasonography and X-ray of bony injuries of the knee
    (Springer Heidelberg, 2022) Kozaci, Nalan; Avci, Mustafa; Yuksel, Serkan; Donertas, Eda; Karaca, Adeviye; Gonullu, Gizem; Etli, Ibrahim
    Purpose We aimed to compare the accuracy of point-of-care ultrasonography (POCUS) and X-ray (XR) in the diagnosis of knee bone fractures and fracture characteristics in cases of injuries to the knee. Methods The study was conducted in the emergency department (ED) of a tertiary hospital between March 2017 and March 2019. It included patients who presented to the ED with isolated knee injuries, were suspected to have a bony lesion based on clinical examinations, and were ultimately referred for XR. Five emergency physicians (EPs) who had at least three years of ED experience participated in the study. Before the study, these EPs received training on knee examination and radiographic investigation of the knee joint. They were also trained on how to assess the knee joint using POCUS. The knee bones, patella, femur, tibia, and fibula were evaluated. A POCUS examination of the knee bones was carried out according to the eight-step Kozaci Protocol. Results This study included 92 patients with knee trauma. The mean age of the patients was 34 +/- 16 years (6-55 years). Using POCUS and XR, fractures were detected in 40 (43%) and 32 patients (35%), respectively. Relative to XR, for detecting fractures, POCUS showed sensitivity, specificity, positive predictive value, and negative predictive value of 97%, 85%, 78%, 98%, respectively, and the kappa value was 0.774. POCUS examination revealed hematoma and edema in the soft tissue in 34 (37%) patients and hemarthrosis in 33 patients (36%). Conclusion XR is the first and most widely used imaging modality to identify fractures of the knee bone trauma. However, POCUS examination can successfully diagnose bony lesions of the knee in patients with stable vital signs and without life-threatening injuries. It can also easily diagnose hematoma and hemarthrosis. Therefore, POCUS can be used as a diagnostic tool in emergency situations where XR is not available.
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    Öğe
    Diagnosis of Pulmonary Hydatid Cyst with Point of Care Ultrasound in an Emergency Department: A Case Report
    (2020) Kozaci, Nalan; Avci, Mustafa
    Ultrasonography is widely used for diagnostic and invasive purposes in emergency departments. We present here a case with acquired immune deficiency syndrome who was diagnosed with a hydatid cyst and pneumonia in the lung parenchyma during a pointof-care-ultrasonography examination.