Emergency Medicine, Toxicology, Critical Care and Intensive Care Medicine
9
Scopus Publications
Scopus Publications
Overview of Etiology and Management of Epistaxis: Through the Mnemonic EPISTAXIS Sedat Özbay, Nuray Bayar Muluk, Tarik Yagci, Volkan Ercan, Engin Özakin, Mustafa Yazir, Abuzer Coskun, Orhan Özsoy, Mustafa Safa Pepele, Erhan Arikan, Gürcan Sünnetci, Erdi Özdemir, Ahmet Arslanoğlu, Moises Gallegos, Cemal Cingi Journal of Craniofacial Surgery, 2026 Objectives: This study investigated the rate of application of various treatment steps for epistaxis using the mnemonic EPISTAXIS. Methods: Two thousand three hundred patients with epistaxis (1284 males and 1016 females) meeting the inclusion criteria from various centers in different regions of Turkey were enrolled in the study. All presented to the Emergency Department with epistaxis. Each patient was evaluated on the following items: cause of the epistaxis, accompanying diseases, and interventions performed (using the EPISTAXIS Mnemonic). Results: Idiopathic epistaxis was found in 80.0% of cases. Other causes included home accidents (7.7%), finger trauma (3.9%), rhinosinusitis (2.8%), and foreign bodies (2.4%). Hypertension was the most commonly detected accompanying condition (39.0%). Other diseases included diabetes mellitus (17.9%), blood disorders related to epistaxis (6.1%), and malignancy (5.9%). Intervention performed (EPISTAXIS Mnemonic) results were as follows: E xamination: Anterior epistaxis was detected at 95.0% and posterior epistaxis at 5.0%. P ressure (apply pressure over the nose with fingers) was applied in 48.3%. I rrigation (irrigate with warm water) was performed at 0.52%. S ilver nitrate: Cauterization was applied at a concentration of 22.86%. T ampons/nasal pack (anterior or posterior tampon) were applied at 73.86%. A frin: Vasoconstrictor spray (oxymetazoline spray) was applied to a tampon at 40.34%. T ransamine—tranexamic acid—applied on a tampon was performed at 17.0%. I nterventional radiology (embolization) was not performed (0.0%). S urgical consultation: ENT consultation was requested at 11.3%. Conclusions: For the treatment of epistaxis, the mnemonic EPISTAXIS (1) is suggested for a proper understanding and recall of appropriate treatment steps.
Pediatric Trauma in the Emergency Department: Clinical Risk Stratification, CT Utilization and Radiation Burden in a Tertiary Care Cohort Mustafa Safa Pepele, Serdar Derya, Mahmut Murat, Adem Akdemir, Neslihan Yücel Journal of Clinical Medicine, 2026 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.
The Association Between Post-Earthquake Trauma Levels and Compassion Fatigue, Secondary Traumatic Stress, and Occupational Burnout Among Health Professionals Following the Kahramanmaraş Earthquakes Serdar Derya, Rümeysa Alptekin, Mustafa Safa Pepele, Neslihan Yücel, Şükrü Gürbüz, M. Ediz Sarihan International Journal of Clinical Practice, 2026 Background Major earthquakes impose sustained operational and psychological stress on clinicians. Clarifying how post‐disaster trauma relates to compassion fatigue, secondary traumatic stress, and burnout can guide service planning and support. Objectives To describe post‐earthquake trauma levels among physicians and nurses and examine their associations with compassion fatigue, secondary traumatic stress, and occupational burnout following the 2023 Kahramanmaraş earthquakes. Methods A cross‐sectional survey of frontline clinicians from multiple hospital units was conducted using validated instruments for trauma‐related symptoms, compassion fatigue, secondary traumatic stress, and occupational burnout. Descriptive statistics were used to summarize the sample. Group comparisons were used to evaluate differences by sex, profession, and exposure‐related factors (bereavement, displacement, difficulty contacting family, and basic‐needs problems). Bivariate correlations were used to characterize the associations among continuous scores. Two‐tailed tests were used with α = 0.05. Results The clinicians reported a substantial psychosocial burden. Among female and nursing healthcare personnel, participants who had lost contact with a loved one, experienced nutritional problems, lost a loved one, or relocated due to home damage had higher mean post‐earthquake trauma scores ( p < 0.05). Furthermore, it was determined that those experiencing nutritional problems had higher levels of occupational burnout and those who had lost contact with a loved one had higher levels of secondary trauma ( p < 0.05). A moderately positive and significant correlation was found between the total mean score of the “Scale for Determining the Level of Post‐Earthquake Trauma (PETLDS)” and the mean scores of the “Compassion Fatigue‐Short Scale (CF‐SS),” “CF‐SS/sub‐dimension of Secondary Trauma Stress,” and “CF‐SS/sub‐dimension of Occupational Burnout” ( p < 0.001). Conclusions After mass‐casualty events, clinicians may experience coupled elevations in trauma‐related distress, compassion fatigue, and burnout. Unit‐proximal supports—facilitated family contact, reliable access to basic needs, and low‐barrier psychosocial resources—may help maintain service capacity. Longitudinal adjusted analyses are warranted to refine risk stratification and inform targeted interventions.
Triage risk stratification in emergency department hemoptysis: associations of hemoglobin and malignancy with in-hospital mortality Mustafa Safa Pepele, Serdar Derya, Mahmut Murat American Journal of Emergency Medicine, 2025 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 Türkiye (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.
A Cross-Sectional Study on the Relationship between the HEART Score and the Severity of CAD using the SYNTAX Score in Patients with NSTEMI Admitted to the Emergency Department: A Study from Turkey MS Pepele, I Aktas, O Demiroz, S Derya, E Yildirim, MN Bilen, B Demir Nigerian Journal of Clinical Practice, 2025 Background: The HEART score is a risk stratification tool for acute chest pain, evaluating history, ECG, age, risk factors, and troponin. The SYNTAX (synergy between percutaneous coronary intervention with TAXUS and cardiac surgery) score assesses the extent and complexity of coronary artery disease (CAD) and is widely used in patients undergoing coronary interventions. Aim: To determine the relationship between the HEART and SYNTAX scores in patients with non-ST elevation myocardial infarction (NSTEMI). Method: A total of 222 NSTEMI patients who underwent coronary angiography were included. The HEART score was calculated at admission, and all patients underwent angiography within 12 hours. SYNTAX was used to evaluate CAD severity. Patients were divided into two groups based on SYNTAX scores. Comparisons were made according to demographic data, laboratory findings, and risk factors. Variables associated with high SYNTAX scores were identified. A P value of < 0.05 was considered statistically significant. Results: The mean age was 63.67 ± 11.89 years, and 74.77% of the patients were male. Patients with high SYNTAX scores had significantly higher HEART scores and more frequent diabetes and hypertension. High HEART score (OR: 3.09; 95% confidence intervals [CI]: 2.06–4.63; P < 0.001) and diabetes mellitus (OR: 4.57; 95% CI: 1.44–14.47; P = 0.010) were independently associated with high SYNTAX scores. A HEART score >7.5 predicted high SYNTAX scores with 82.1% sensitivity and 84.3% specificity (area under curve [AUC]: 0.892; P < 0.001). A strong positive correlation was found between HEART and SYNTAX scores (P < 0.001, R² =0.672). Conclusion: The HEART score was significantly associated with the severity and complexity of CAD in patients with NSTEMI.
Evaluation of patients directed from emergency department to dermatology clinic Zekiye KANAT, Mustafa Safa PEPELE Turkiye Klinikleri Dermatoloji, 2021 Amaç: Dermatolojik şikâyetler nedeni ile acil servise başvuran hastalar, genellikle polikliniklere yönlendirilmektedir. Bu uygulama, doğru tanı ve tedavi oranını artırarak, aynı zamanda acil servisin gereksiz meşguliyetini de önlemektedir. Bu yazıda, acil servise başvuran ancak dermatolojik acil olmayıp, polikliniğimize yönlendirilen hastaları irdelemek istedik. Gereç ve Yöntemler: Ağustos 2018 ile Şubat 2020 tarihleri arasında acil servisten polikliniğimize yönlendirilen hastalar; bilgisayar kayıtlarından, poliklinik doktor kayıtlarından retrospektif olarak değerlendirildi. Yaş, cinsiyet, şikâyet süresi ve tanı açısından tanılarına göre ürtiker, ilaç erüpsiyonu, viral döküntülü hastalıklar, dermatitler, böcek ısırığı, enfektif durumlar ve pruritus olarak ayrıldı. Bulgular: Acil servisten polikliniğimize yönlendirilen %61,1'i kadın ve %38,9'u erkek, toplam 72 hasta değerlendirildi. Ortalama yaş 39,94±14,10 (18-68) yıl idi. Yirmi altı (%36,1) hasta ürtiker, 12 (%16,7) hasta dermatit, 12 (%16,7) hasta pruritus, 7 (%9,7) hasta enfektif durumlar, 6 (%8,3) hasta ilaç erüpsiyonu, 5 (%6,9) hasta viral döküntülü hastalıklar ve 4 (%5,6) hasta böcek ısırığı tanısı aldı. Tanılara göre yaş ortalamalarına bakıldığında en genç grubu 32,75±15,34 yıl ortalaması ile böcek ısırığı tanısı alan hastalar oluşturmaktayken; en yaşlı grubu ise 52,00±14,68 yıl ile viral döküntülü hastalık tanısı alan grup oluşturuyordu. Tüm hastaların ortalama şikâyet süresi 2,47±1,85 (1-10) gün idi. Sonuç: Mesai saatleri içerisinde gerçek dermatolojik acil olmayan hastaların, dermatoloji polikliniklerine yönlendirilmesi faydalı olabilir.
The diagnostic role of adiponectin in pulmonary embolism Evrim Gul, Yeliz Gul, Ersin Yıldırım, Mustafa Safa Pepele, Mustafa Yıldız, Mehmet Nuri Bozdemir, Mehmet Ruhi Onur, Bengü Mutlu, Feti Yıldız, Ömer Doğan Alataş, Necip İlhan Biomed Research International, 2016 Background and Aims. Pulmonary thromboembolism (PTE) is a frequent disease with difficult diagnosis and high mortality. Misdiagnosis occurs in 2/3 patients and mortality rates reach up to 30%. The aim of our study was to investigate the role of adiponectin used in emergency service in diagnosis of PTE.Materials and Methods. 95 patients with suspected PTE included in the study. Plasma adiponectin and D-dimer levels were measured and chest X-ray and multidetector row computed tomography scan obtained. Diagnosis was supported by vascular filling defect on tomography. Control group consisted of patients with suspected PTE and normal chest computed tomography findings.Results. Mean D-dimer level was4241.66±1082.98 ng/mL in patients and2211.21±1765.53 ng/mL in the control group (p≤0.05). Mean adiponectin level was5.46±4.39 μg/mL in patients and7.68±4.67 μg/mL in the control group (p≤0.05). Wells and Geneva scores were higher in patients compared to the control group.Conclusions. As a result, we conclude that lower adiponectin levels have an important role in the diagnosis of PTE.
Moxifloxacin hydrochloride related visual hallucinations: A case presentation Mustafa Safa Pepele, Cem Ertan, Neslihan Yucel Turkiye Acil Tip Dergisi, 2013 Giriş Acil servise nörolojik semptomlarla başvuran bir hastada organik beyin hastalıkları ve psikiyatrik nedenler öncelikli ayırıcı tanılar olsa da, diğer metabolik nedenler ve ilaç yan etkileri gibi olası etkenler de göz önünde bulundurulmalıdır. Moksifloksasin florokinolon grubundan geniş etki spektrumuna sahip yeni nesil bir antibiyotiktir. Başlıca endikasyonları komplike idrar yolu enfeksiyonları ve alt solunum yolu enfeksiyonları olarak sayılabilir. Halsizlik, baş dönmesi, çarpıntı, döküntüler gibi görece olarak sık görülebilen yan etkilerinin SUMMARY Although the foremost encountered differential diagnosis in patients with neurological complaints in the emergency departments (ED) are organic nervous system diseases and psychiatric disorders, other metabolic disturbances and drug related adverse effects shall be considered as well. We present a 65 year old female patient who attended to our ED with visual hallucinations such as orange colored wallpaper, boiling water on the ground and wave patterns for the last 3 hours. Past medical history was clear for all but chronic obstructive pulmonary disease. Neuropsychiatric examination revealed a fully oriented, neurologically intact patient. After further questioning, we learned that the patient was on moxifloxacin 400 mg PO for two days and the symptoms started following the first dose of moxifloxacin. Laboratory and radiological work up including brain CT showed no pathognomonic findings. The patient, whose complaints totally resolved at the 6th hour of her follow-up in the ED was discharged with the diagnosis of “Moxifloxacin related visual hallucinations” with relevant modifications on her antibacterial treatment. Telephone follow-up 24 hours later revealed that our patient was symptom free.
Paediatric trauma patients and attention deficit hyperactivity disorder: Correlation and significance Cem Ertan, Özlem Özel Özcan, Mustafa Safa Pepele Emergency Medicine Journal, 2012 Introduction Trauma is one of the leading reasons for emergency department (ED) visits in children. Hyperactivity, inattentiveness and impulsiveness may contribute to injury proneness. The aim of this study was to evaluate the prevalence and role of attention deficit hyperactivity disorder (ADHD) in children with trauma. Methods Trauma patients aged 3–17 attending the ED were included in the study group. Parents were informed after medical care had been given to their children, and demographic data and information about the trauma were collected. Later, parents were asked to complete the Conners' Parent Rating Scales-Revised questionnaire for ADHD symptoms. The control group consisted of children of similar age and sociocultural characteristics who attended the hospital for reasons other than trauma. Cases in which the child apparently had no active role in the trauma or where the parents did not complete the Conners' Parent Rating Scales-Revised questionnaire were excluded from the study. Results Fifty-five children were included in the study group (mean age 7.49 (range 3–14; SD 3.3); 33 (60%) were male). The control group was statistically similar to the study group. The most common trauma mechanism was falls (n=31, 56.4%). All the subscale scores were significantly higher in the study group, and previous trauma-related ED visits were associated with significantly higher subscale scores. Conclusion The data suggest that children who make repeated trauma-related ED visits have a predisposition to ADHD, and they may benefit from screening for this disorder while in the ED.
