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    A novel model for early prediction of in-hospital mortality in seawater drowning: the SNOP score
    (Bmc, 2025) Oncu, Kivanc; Ozcan, Ozhan; Kara, Seyma Simsirgil; Parmaksiz, Ayhan; Ersen, Teoman
    Background : Drowning is a leading cause of preventable mortality worldwide; however, early in-hospital risk stratification remains limited. Although tools such as the Szpilman score assist in early severity assessment, they may not fully capture the evolving clinical status after admission. This study aimed to develop a simplified and objective model based on readily available parameters to predict in-hospital mortality following seawater drowning. Methods : This retrospective study was conducted at a referral emergency department (ED) in northern Turkey between July 1, 2011, and December 31, 2024. Of 190 patients initially included, 166 with complete clinical and laboratory data were analyzed. Data were obtained from institutional and national health information systems. Clinical, physiological, and biochemical variables were assessed. Predictors of in-hospital mortality were identified using receiver operating characteristic (ROC) analysis and multivariable logistic regression. Variables with near-perfect discrimination (e.g., GCS, pH, Szpilman score) were excluded to avoid overfitting. Results : Among the 166 patients, 34 (20.5%) died during hospitalization. CPR and endotracheal intubation rates were significantly higher among non-survivors (CPR: 97.1% vs. 0%; intubation: 97.1% vs. 2.3%; both p < 0.001). Non-survivors also presented with lower GCS (median 3 vs. 15), lower arterial pH, and higher Szpilman scores (all p < 0.001). ROC analysis identified four potential predictors with AUC values between 0.90 and 0.95-pCO(2), lactate, SpO(2), and sodium-all showing significant discriminatory capacity (p < 0.001). These variables were entered into a binary logistic regression model, from which serum sodium (OR = 2.110; 95% CI: 1.310-3.401; p = 0.002) and SpO(2) (OR = 0.902; 95% CI: 0.847-0.961; p = 0.001) emerged as independent predictors. These formed the basis of the SNOP score (Saturation and Natremia-based Outcome Predictor), a two-parameter logistic model demonstrating excellent performance: AUC = 0.996, sensitivity = 99.0%, specificity = 96.2%, and overall accuracy = 98.4%. Conclusion: The SNOP score is a simple, ED-specific tool for early prediction of in-hospital mortality in seawater drowning. It complements existing assessment systems by incorporating objective, admission-based parameters. Prospective multicenter validation is warranted to confirm its clinical applicability and support broader implementation.
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    Öğe
    Epidemiological and clinical characteristics of seawater drowning cases in Sinop, a Turkish coastal city: a 13-year retrospective study
    (Bmc, 2025) Ersen, Teoman; Oncu, Kivanc; Ozcan, Ozhan; Kara, Seyma Simsirgil; Saglam, Mustafa; Orhun, Elif; Saglam, Dilsan Ozcanoglu
    Background Drowning is a significant public health issue, particularly in coastal regions such as Sinop, Turkey, where seasonal variations contribute to a high incidence of cases. However, there is a lack of long-term, population-based studies from the Black Sea region, where distinct environmental factors may influence drowning patterns. This study provides a comprehensive 13-year analysis of seawater drowning cases, including detailed demographic, clinical, and outcome characteristics, to inform prevention strategies and improve emergency response. Methods A retrospective, observational study was conducted on all patients admitted to the regional referral Emergency Department (ED) due to seawater drowning between July 2011 and July 2024. Demographic characteristics, clinical parameters, and outcomes were retrieved from institutional and national health record systems. Descriptive statistical analyses were performed. Results A total of 198 patients were included, of whom 69.2% were male, with a mean age of 29.6 years. The majority of cases (over 82%) occurred in July and August, and 51% involved tourists. Cardiopulmonary resuscitation (CPR) was performed in 17.7% of patients. Trauma was documented in 7.1% of patients; among these, the most commonly affected regions were the extremities (50.0%) and the head (35.7%). Laboratory analysis showed elevated lactate levels and reduced pH. On admission, most patients had preserved neurological status, while 19.2% presented with severe impairment (GCS <= 8). According to the Szpilman score, 37.9% had mild and 17.7% severe symptoms. The overall mortality was 19.7%, and 22.2% of patients required admission to the intensive care unit (ICU). Notably, 35.9% of all fatal cases (n = 14) involved individuals who drowned while attempting to rescue others. Conclusions Drowning imposes a substantial burden in coastal regions, disproportionately affecting young males during the summer. Our findings highlight the need for enhanced emergency preparedness and structured clinical response, as well as public education on water safety and safe rescue practices. These findings contribute valuable insight for developing regional and international strategies to mitigate drowning outcomes.
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    Preferences for mechanical ventilation modes among intensivists in Türkiye: a nationwide point-prevalence study
    (Tubitak Scientific & Technological Research Council Turkey, 2026) Yildirim, Suleyman; Kilincozgun, Nurhayat; Alpdogan, Ozcan; Ucar, Huseyin; Taskiran, Imren; Ata, Adnan; Ozcan, Ozhan
    Background/aim: Invasive mechanical ventilation (IMV) is a fundamental intervention for patients with respiratory failure in intensive care units (ICUs). This nationwide, multicenter point-prevalence study aimed to describe current mechanical ventilation mode preferences (conventional, adaptive, and biphasic) in Turkish ICUs and to report associated clinical outcomes descriptively, without assessing causal relationships. Materials and methods: A nationwide, multicenter point-prevalence study was conducted on 17 April 2024 and included adult patients (>= 18 years) who had been receiving IMV for more than 24 h. Data on patient demographics, ventilation mode distribution, ventilatory parameters, and descriptive clinical outcomes on day 28 (weaning status, tracheostomy, and mortality) were recorded without comparative outcome analysis. Results: A total of 426 patients were included. Conventional modes were used in 84.5% of patients, adaptive modes in 10.6%, and biphasic modes in 4.9%. Synchronized intermittent mandatory ventilation (SIMV) was the most commonly used conventional mode. The primary indication for IMV was acute respiratory failure (61%), with pneumonia being the leading cause. Among the 350 orotracheally intubated patients, 25.6% were in the weaning phase on the study day. A total of 59 (16.9%) patients were extubated, 150 (42.9%) underwent tracheostomy, and 64 (18.2%) remained intubated on day 28. Overall, 185 (43.4%) patients died during their ICU stay, 152 (35.7%) remained in the ICU, and 89 (20.9%) were successfully discharged from the ICU. Conclusion: Conventional ventilation modes, particularly SIMV, were more commonly used in Turkish intensive care units (ICUs), whereas adaptive modes were less frequently applied. These patterns may reflect factors such as clinician familiarity, institutional practices, and equipment availability rather than definitive preferences. Although the impact of ventilation modes on clinical outcomes was not comparatively evaluated in this study, the choice of ventilation mode may still influence patient outcomes. Therefore, further prospective and comparative studies are warranted to better elucidate this relationship.