Yazar "Murat, Mahmut" seçeneğine göre listele

Listeleniyor 1 - 2 / 2
  • Küçük Resim Yok
    Öğe
    Pediatric Trauma in the Emergency Department: Clinical Risk Stratification, CT Utilization and Radiation Burden in a Tertiary Care Cohort
    (Mdpi, 2026) Pepele, Mustafa Safa; Derya, Serdar; Murat, Mahmut; Akdemir, Adem; Yucel, Neslihan
    Background/Objective: Pediatric trauma frequently prompts computed tomography (CT) in emergency departments; however, the cumulative radiation burden and its distribution across initial clinical risk strata remain incompletely characterized. We aimed to describe CT utilization and cumulative effective dose in a tertiary care pediatric trauma cohort and examine how radiation exposure accrues across pragmatic presentation-based risk groups. Methods: We conducted a retrospective cohort audit of pediatric trauma presentations at our institution. Risk stratification was based on the triage category and readily available initial physiological parameters. CT utilization and radiation burden were assessed at the patient level using the cumulative effective dose (mSv) derived from scanner dose metrics and region-specific conversion coefficients. Secondary analyses examined the dose distribution according to ED disposition and consultation pathways. Sensitivity analyses were performed using green triage only as an ultra-low-risk definition. Results: Among the 935 children, 545 (58.3%) underwent at least one CT examination. Although higher-risk categories had higher CT use and higher per-patient dose, a substantial share of the cohort's cumulative radiation burden accrued in children initially classified as low-risk and/or ultimately discharged. Combined-region CT protocols contributed disproportionately to the higher dose categories. The findings were consistent in sensitivity analyses using a stricter ultra-low-risk definition. Conclusions: In this single-center audit, CT utilization and cumulative radiation burden were high, and non-trivial radiation exposure accrued among children initially classified as low-risk. These findings support targeted radiation stewardship interventions, including pathway optimization and the implementation of validated decision tools, where feasible, particularly for discharge-eligible and low-risk presentations.
  • Küçük Resim Yok
    Öğe
    Triage risk stratification in emergency department hemoptysis: associations of hemoglobin and malignancy with in-hospital mortality
    (W B Saunders Co-Elsevier Inc, 2025) Pepele, Mustafa Safa; Derya, Serdar; Murat, Mahmut
    Background: A clinically important subset of emergency department (ED) patients with hemoptysis deteriorates rapidly due to airway obstruction, hypoxemia, or hemodynamic compromise. Practical, ED-available variables are needed to prompt CT angiography (CTA) and appropriate interventional radiology (IR) notifications. Objectives: To identify independent predictors of in-hospital mortality in patients with hemoptysis and to describe early bronchial artery embolization (BAE) as a process-of-care marker. Methods: This retrospective cohort study was conducted at a tertiary teaching ED in T & uuml;rkiye (June 2020-June 2025). Adults with hemoptysis were included, while those with pseudohemoptysis/hematemesis, trauma, pregnancy, incomplete outcome data, and repeat encounters were excluded. The variables captured included demographics, comorbidities (malignancy/bronchiectasis/tuberculosis/COPD), British Thoracic Society (BTS) hemoptysis severity, first 6-h hemoglobin (g/dL), imaging, and interventions (bronchoscopy; BAE recorded descriptively as planned/performed within 24 h). The primary outcome was in-hospital mortality rate. We fitted a Firth-penalized logistic regression and assessed discrimination and calibration using bootstrap internal validation. Results: Among 391 encounters (mean age 56.7; 76.7 % male), the mortality rate was 4.1 %. Non-survivors had lower hemoglobin levels and more malignancies, and BAE clustered in sicker patients. In the multivariable analysis (with BAE excluded as a predictor), mortality was associated with malignancy (adjusted odds ratio [aOR] 4.07; 95 % confidence interval [CI] 1.20-13.74) and hemoglobin (per 1 g/dL) (aOR 0.76; 95 % CI 0.62-0.94). Model discrimination was strong (AUC 0.884) with acceptable calibration (intercept, -0.03; slope, 1.07). The sensitivity analyses were consistent. Conclusions: Two triage-available variables, malignancy and lower hemoglobin levels, identified a higher-risk subgroup of ED patients with hemoptysis in our cohort. These findings support early risk stratification at presentation and warrant prospective multicenter validation. (c) 2025 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/).