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    The dynamics of prehospital/hospital care and modes of transport during civil conflict and terrorist incidents
    (W B Saunders Co Ltd, 2017) Celik, S.; Dursun, R.; Aycan, A.; Gonullu, H.; Adanas, C.; Eryilmaz, M.; Gonullu, E.
    Objective: Prehospital and hospital care during incidents of mass violence and civil conflict involve a number of aspects that distinguish it from care during times of peace. We aimed to analyze the dynamics and outcomes of prehospital and hospital care during ongoing conflicts. Study design: Multicentric prospective observational study. Method: Patients enrolled in the study, which was conducted in Turkey, were all injured in armed conflict and taken to level 1 trauma centers. On admittance, patients were requested to complete a semistructured questionnaire containing questions on patient demographics, transport type, weapons used, injury severity score (ISS), and other incident-related factors. We analyzed patient outcomes (mortality, morbidity, complications, and length of hospital stay) and transfers of patients between hospitals. The present study evaluated the cases of 390 victims enrolled over a 9-month period and followed up for 6 months. Results: The majority of patients were transported by ambulances (n = 334, 85.6%); other transport modes were helicopters (n = 32, 8.2%) and private vehicles (n = 24, 6.2%). Nearly half of patients (48.7%) did not benefit by changing hospitals. During transport to hospitals, 4.1% of the vehicles in the study were involved in accidents. Using multiple regression analysis, only ISS (odds ratio [OR]: 1.098, 95% confidence interval [CI]: 1.044-1.156) and the Glasgow Coma Scale (OR: 0.744, 95% CI: 0.639-0.866) were found to affect mortality. In Receiver-operator characteristic analysis, a cutoff value of 22.5 for ISS had a sensitivity of 100% and a specificity of 89.6% for mortality. Conclusions: Despite lower ISS values, patient outcomes were worse in terror incidents/civil conflicts. Transport modes did not significantly affect outcomes, whereas hospital transport was found to be inefficiently used. (C) 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
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    Treatment and outcomes of patients with metastatic spinal cord compression: a double-center study
    (Verduci Publisher, 2023) Aycan, A.; Eren, B.; Tas, A.; Celik, S.; Guzey, F. Karagoz; Kuyumcu, F.; Akyol, M. E.
    OBJECTIVE: Spinal metastases may only affect the bone tissue and result in spi-nal instability or may additionally result in epi-dural compression, leading to neurological defi-cits. Surgery has emerged as a popular method in treating metastatic epidural spinal cord com-pression (MESCC) due to the advances in surgical techniques and instrumentation. In this study, we evaluated patients with MESCC regarding neuro-logical status, pain status, and survival rates, and presented our experience managing MESCC.PATIENTS AND METHODS: Clinical and ra-diographic records of 53 patients diagnosed with MESCC between January 2011 and March 2017 were retrospectively evaluated. The study included patients with a pathological diagnosis of primary cancer, those who complained of spi-nal metastasis, and those who had indications of MESCC on Magnetic Resonance Imaging (MRI). Bone structure and spinal stability were evaluat-ed using assessed Computed Tomography (CT), and metastatic spread was considered using as-sessed Positron Emission Tomography (PET) in suitable cases. For each patient, the presence of a tumor compressing the spinal cord, age, gen-der, preoperative, and postoperative American Spinal Injury Association scores (ASIA), Toku-hashi prognostic score (TPS), affected spinal segment, pathological diagnosis, preoperative, and postoperative Visual Analog Scale (VAS), the status of spinal stability, follow-up period, and complications were evaluated.RESULTS: Forty-five patients (82.2% of them were women) underwent surgery with a mean age of 58.29 & PLUSMN; 15.14 years. The most frequent type of primary tumor was multiple myeloma (33.9%), followed by lung (24.6%), gastric (7.5%), and prostate (5.7%). The most common site of metastasis was the thoracic region (43.4%), fol-lowed by lumbar (24.5%), multiple (24.5%), and cervical (5.7%). The analysis indicated that a sig-nificant difference was found between the sur-vival rates of the TPS categories.CONCLUSIONS: Common symptoms of MES-CC include spinal pain and neurological defi-cit below the level of the injury. Prompt surgi-cal treatment followed by oncological treatment leads to significant neurological recovery, more prolonged survival, pain relief, and improved quality of life in patients with a short survival time. Oncological treatments, including radio-therapy (RT), should be recommended after sur-gical treatment.