Acil servise nefes darlığı şikayeti ile başvuran hastalarda risk skorlama sistemlerinin prognostik değeri
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2017
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info:eu-repo/semantics/openAccess
Özet
Nefes darlığı acil servis hastaları arasında en sık başvuru nedenlerinden biridir. Acil servis gibi çalışma sahası kalabalık olan yerlerde risk skorlama sistemlerinin kullanımı hangi hastalara yoğun gözlem, tedavi ve hemşire bakımı sağlanmalı, hangi hastalar yoğun bakım şartlarında monitörize edilmeli ve desteklenmeli ve de bu ayrımın kaliteli, etkin bir şekilde nasıl yapılacağının belirlenmesi için önerilmektedir. Biz bu çalışmamızda MEWS, NEWS ve CREWS skorlama sistemlerini kullanılarak sadece anamnez ve fizik muayene bulguları ile hastaneye yatış ve mortalite tahmini yapılabilir mi bunu araştırmayı amaçladık. Yöntem: Acil servise herhangi bir sebeple nefes darlığı ile başvuran hastalarda acil servis başvurusunda MEWS, NEWS ve CREWS skorları hesaplandı. Bu skorlar hesaplanırken hastanın ateş, nabız, sistolik tansiyon, solunum sayısı, oksijen satürasyonu, destek oksijen ihtiyacı ve hastanın glaskow koma skoru (GKS) kullanıldı. Hastanın hastaneden taburculuk servis yatışı, YBÜ yatışı bilgisi ve son tanı kayıt edildi. Sürekli değişkenler ortanca (alt çeyrek – üst çeyrek) ve kategorik değişkenler frekans (yüzde) olarak ifade edildi. Bulgular: Çalışmaya 746 hasta kaydı kabul edildi. Hastaların ortalama yaşı 60,7±18,0 yıl idi ve 403'ü (%54) erkekti. Hastaların hastaneye yatışını tahmin etmede her 3 skorlama sistemi de kullanışlı idi. Hastaneye yatışı tahmininde MEWS, NEWS ve CREWS skorlarının EAA değerleri sırasıyla; 0.710 (95% CI 0.673-0.748, p<0.001), 0.783 (95% CI 0.749-0.818, p<0.001) ve 0.781 (95% CI 0.746-0.816, p<0.001) olarak bulundu. Bu değerler kendi aralarında değerlendirildiğinde NEWS ve CREWS skorlarının eğri altında kalan alanları MEWS'inkine göre istatistiksel anlamlı olarak daha yüksek bulundu (MEWS – NEWS için p=0,007 ve MEWS – CREWS için p=0,005). NEWS ve CREWS eğri altında kalan alanları arasında istatistiksel anlamlı fark yoktu (p=0,469). Sensitivite ve spesifisite değerlerini optimum düzeyde sağlayan kesim değerleri MEWS için 3, NEWS ve CREWS için 5 olarak tespit edildi. Hastaların yatışlarında hastane içi mortaliteyi tahmin etmede her 3 skorlama sistemi de kullanışlı idi. Mortaliteyi tahmin etmede MEWS, NEWS ve CREWS skorlarının EAA değerleri sırasıyla; 0.776 (95% CI 0.696-0.857, p<0.001), 0.839 (95% CI 0.780-0.899, p<0.001) ve 0.851 (95% CI 0.793-0.908, p<0.001) idi. MEWS, NEWS ve CREWS skorlarının eğri altında kalan alanları arasında istatistiksel anlamlı fark tespit edilmedi (MEWS – NEWS için p=0,334; MEWS – CREWS için p=0,244; NEWS – CREWS için p=0,184). Sensitivite ve spesifisite değerlerini optimum düzeyde sağlayan kesim değerleri MEWS için 4, NEWS ve CREWS için 8 olarak tespit edildi. Sonuç: Hastaneye yatış ve mortaliteyi değerlendirmede MEWS, NEWS ve CREWS her 3 skorda anlamlı bulunmuştur. NEWS ve CREWS, MEWS e göre istatiksel olarak daha anlamlı olup, bu iki skor arasında anlamlı fark bulunamamıştır.
One of the most frequent reasons for admission among emergency room patients is shortness of breath. Scoring systems have been proposed over the past years to determine which patients should be provided with intensive observation, treatment and nursing care, which patients should be monitored and supported in intensive care settings, and how this separation should be done in a quality, effective manner. In this study, we aimed to investigate whether mortality and morbidity can be predicted with MEWS, NEWS and CREWS scoring systems only with anamnesis and physical examination findings. Method: MEWS, NEWS, and CREWS scores were calculated for emergency department visits in emergency department patients with breathlessness for any reason. When these scores were calculated, the patient's fever, pulse, systolic blood pressure, respiratory rate, oxygen saturation, support oxygen requirement, and patient's Glaskow coma score (GCS) were used. Admittion or discharge to hospital, information on ICU admission and the final diagnosis were recorded. Continuous variables were expressed as median (lower quartile - upper quartile) and categorical variables as frequency (percent). Results: 746 patients were enrolled in the study. The mean age of the patients was 60.7 ± 18.0 years and 403 (54%) were male. All 3 scoring systems were useful, even if the patients predicted hospitalization. The EAA values of the MEWS, NEWS and CREWS scores in the prediction of hospital admission were; 0.795 (95% CI 0.673-0.748, p <0.001), 0.783 (95% CI 0.749-0.818, p <0.001) and 0.781 (95% CI 0.746-0.816, p <0.001). When these values were evaluated between themselves, the areas under the curve of NEWS and CREWS scores were statistically higher than those of MEWS (p = 0.007 for MEWS - NEWS and p = 0.005 for MEWS - CREWS). There was no statistically significant difference between the areas under NEWS and CREWS curves (p = 0.469). The cut-off values providing optimum sensitivity and specificity values were 3 for NEWS and 5 for NEWS and CREWS. All three scoring systems were useful, even when predicting in-hospital mortality in patients' hospitalizations. Predicting mortality MEWS, NEWS CREWS score and AUC values, respectively; 0.776 (95% CI 0.696-0.857, p <0.001), 0.839 (95% CI 0.780-0.899, p <0.001) and 0.851 (95% CI 0.793-0.908, p <0.001). There was no statistically significant difference between the areas under the curve of MEWS, NEWS and CREWS scores (p = 0,334 for MEWS - NEWS, p = 0,244 for MEWS - CREWS, and p = 0,184 for NEWS - CREWS). The cut-off values providing optimal sensitivity and specificity values were 4 for NEWS and 8 for NEWS and CREWS. Outcome: All three scores NEWS ve CREWS, MEWS were significant to predict hospital admission and mortality. NEWS and CREWS were statistically more significant than MEWS, and no significant difference was found between these two scores.
One of the most frequent reasons for admission among emergency room patients is shortness of breath. Scoring systems have been proposed over the past years to determine which patients should be provided with intensive observation, treatment and nursing care, which patients should be monitored and supported in intensive care settings, and how this separation should be done in a quality, effective manner. In this study, we aimed to investigate whether mortality and morbidity can be predicted with MEWS, NEWS and CREWS scoring systems only with anamnesis and physical examination findings. Method: MEWS, NEWS, and CREWS scores were calculated for emergency department visits in emergency department patients with breathlessness for any reason. When these scores were calculated, the patient's fever, pulse, systolic blood pressure, respiratory rate, oxygen saturation, support oxygen requirement, and patient's Glaskow coma score (GCS) were used. Admittion or discharge to hospital, information on ICU admission and the final diagnosis were recorded. Continuous variables were expressed as median (lower quartile - upper quartile) and categorical variables as frequency (percent). Results: 746 patients were enrolled in the study. The mean age of the patients was 60.7 ± 18.0 years and 403 (54%) were male. All 3 scoring systems were useful, even if the patients predicted hospitalization. The EAA values of the MEWS, NEWS and CREWS scores in the prediction of hospital admission were; 0.795 (95% CI 0.673-0.748, p <0.001), 0.783 (95% CI 0.749-0.818, p <0.001) and 0.781 (95% CI 0.746-0.816, p <0.001). When these values were evaluated between themselves, the areas under the curve of NEWS and CREWS scores were statistically higher than those of MEWS (p = 0.007 for MEWS - NEWS and p = 0.005 for MEWS - CREWS). There was no statistically significant difference between the areas under NEWS and CREWS curves (p = 0.469). The cut-off values providing optimum sensitivity and specificity values were 3 for NEWS and 5 for NEWS and CREWS. All three scoring systems were useful, even when predicting in-hospital mortality in patients' hospitalizations. Predicting mortality MEWS, NEWS CREWS score and AUC values, respectively; 0.776 (95% CI 0.696-0.857, p <0.001), 0.839 (95% CI 0.780-0.899, p <0.001) and 0.851 (95% CI 0.793-0.908, p <0.001). There was no statistically significant difference between the areas under the curve of MEWS, NEWS and CREWS scores (p = 0,334 for MEWS - NEWS, p = 0,244 for MEWS - CREWS, and p = 0,184 for NEWS - CREWS). The cut-off values providing optimal sensitivity and specificity values were 4 for NEWS and 8 for NEWS and CREWS. Outcome: All three scores NEWS ve CREWS, MEWS were significant to predict hospital admission and mortality. NEWS and CREWS were statistically more significant than MEWS, and no significant difference was found between these two scores.
Açıklama
Anahtar Kelimeler
Acil servis, Emergency service, Nefes darlığı, Breathlessness,, MEWS, NEWS, CREWS
Kaynak
WoS Q Değeri
Scopus Q Değeri
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Künye
Güven, M. (2017). Acil servise nefes darlığı şikayeti ile başvuran hastalarda risk skorlama sistemlerinin prognostik değeri. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahili Tıp Bilimleri Acil Tıp Anabilim Dalı, Konya.
