Acil servise başvuran geriatrik hastalarda klinik kırılganlıkölçeği, fraıl ölçeği ve news-2'nin acil servis sonlanımı vehastane içi mortalite ile ilişkisinin araştırılması
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Tarih
2024
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç
Bu çalışmanın amacı, acil servise başvuran 65 yaş ve üstü hastalarda "Klinik
Kırılganlık Ölçeği", "FRAIL ölçeği ve Ulusal Erken Uyarı Sistemi-2 (NEWS-2)
skorunu kullanarak kırılganlığın ve hastane içi sonlanımın değerlendirilmesi ve bu
ölçeklerin kısa dönem (30 gün) mortalite tahminlerini incelemektir.
Gereç ve yöntem
Bu prospektif kesitsel çalışma Necmettin Erbakan Üniversitesi Tıp Fakültesi
Hastanesi Acil Servisinde 15 Kasım 2023 – 28 Şubat 2024 tarihleri arasında
gerçekleştirilmiştir. Bu tarihlerde acil servise travma dışı nedenlerle başvuran, bilinci
açık Glasgow Koma Skalası 15 olan 65 yaş ve üzeri 1010 olgu çalışmaya dahil
edilmiştir. Olguların Acil Servis başvurularında Klinik Kırılganlık Ölçeği, FRAIL
Ölçeği ve NEWS-2 skorları kaydedilmiştir.
Bulgular
Olguların yaş ortalaması 75,12±6,82 yıl ve %53,2’si erkekti. Klinik Kırılganlık
Ölçeği’ne göre olguların %49,9’u kırılgan iken, FRAIL Ölçeği’ne göre olguların
%56,1’i kırılgandı. NEWS-2 skoruna göre hastaların %25,8’i 5 ve üzeri puana sahipti.
Olguların %37,2’si servise, %16,4’ü yoğun bakım ünitesine yatırıldı. Acil servise ilk
başvuru sonrasında olgulardan Klinik Kırılganlık Ölçeğine göre kırılgan saptanan
hastaların %10,5’i, kırılgan olmayan hastaların ise %2’si 30 gün içinde mortalite ile
sonlandı. FRAIL ölçeğine göre kırılgan saptanan hastaların %9,5’i, pre-kırılgan
hastaların %2,2’si 30 gün içinde mortalite ile sonlandı. NEWS-2 skoru 7 ve üzeri olan
hastalarda 30 günlük mortalite oranı %15, 5-6 olan hastalarda %11,7 ve 0-4 olan
hastalarda %3,9 idi. Yapılan ROC analizine göre hastane içi mortaliteyi tahminde en iyi
performans sıralamasının Klinik Kırılganlık Ölçeği, NEWS-2 ve FRAIL Ölçeği olduğu
tespit edildi (Eğri altında kalan alanlar 0,760 – 0,709 – 0,677). Youden indeksine göre
kesim değerleri Klinik Kırılganlık Ölçeği için 6, FRAIL Ölçeği için 3 ve NEWS-2
puanı için 3 olarak tespit edildi.
Sonuç
Acil servise başvuran yaşlı hastalarda, Klinik Kırılganlık Ölçeği, FRAIL Ölçeği
ve NEWS-2 skoru hastane içi mortalitede (30 günlük) ve hastaneye yatışta
belirleyicidir. Otuz günlük mortalitenin öngörülmesinde ise, Klinik Kırılganlık Ölçeği
skoru FRAIL ve NEWS-2 skorundan daha başarılıdır.
Introduction The aim of this study was to evaluate frailty and in-hospital outcome using the "Clinical Frailty Scale", "FRAIL scale” and “National Early Warning System-2 (NEWS-2)” score in patients aged 65 years and older who presented to the emergency department and to examine the short-term (30-day) mortality predictions of these scales. Material and methods This prospective cross-sectional study was conducted at the emergency department of Necmettin Erbakan University Faculty of Medicine Hospital between November 15, 2023 and February 28, 2024. During these period, 1010 patients aged 65 and over, who were admitted to the emergency department for non-traumatic reasons and were conscious and had a Glasgow Coma Scale score of 15, were included in the study. The patients' Clinical Frailty Scale, FRAIL Scale and NEWS-2 scores were recorded at admissions. Results The mean age of the cases was 75.12±6.82 years and 53.2% were male. According to the Clinical Frailty Scale, 49.9% of the cases were frail, while 56.1% of the cases were frail according to the FRAIL Scale. 25.8% of the patients had a NEWS-2 score of 5 and above. 37,2% of the cases were admitted to the ward, and 16,4% were admitted to the intensive care unit. After the first application to the Emergency Department, 10.5% of the patients who were determined to be frail according to the Clinical Frailty Scale, and 2.0% of the patients who were not frail died within 30 days. According to the FRAIL Scale, 9.5% of the patients who were determined to be frail and 2.2% of the pre-frail patients died within 30 days. The 30-day mortality rate was 15% in patients with NEWS-2 scores of 7 and above, 11.7% in patients with scores of 5-6 and 3.9% in patients with scores of 0-4. ROC analysis revealed that the best performance ranking in predicting in-hospital mortality was determined to be the Clinical Frailty Scale, NEWS-2, and FRAIL Scale, respectively (Areas under the curve: 0.760 – 0.709 – 0.677). According to the Youden index, the cut-off values were determined as 6 for the Clinical Frailty Scale, 3 for the FRAIL Scale, and 3 for the NEWS-2 score. According to the ROC curve of our analysis, all scales were evaluated as tests that can be used to predict mortality. Conclusion In elderly patients admitted to the emergency department, the Clinical Frailty Scale, FRAIL Scale and NEWS-2 score are predictive of in-hospital mortality (30-day) and hospitalization. In predicting 30-day mortality, the Clinical Frailty Scale score is more successful than the FRAIL and NEWS-2 scores.
Introduction The aim of this study was to evaluate frailty and in-hospital outcome using the "Clinical Frailty Scale", "FRAIL scale” and “National Early Warning System-2 (NEWS-2)” score in patients aged 65 years and older who presented to the emergency department and to examine the short-term (30-day) mortality predictions of these scales. Material and methods This prospective cross-sectional study was conducted at the emergency department of Necmettin Erbakan University Faculty of Medicine Hospital between November 15, 2023 and February 28, 2024. During these period, 1010 patients aged 65 and over, who were admitted to the emergency department for non-traumatic reasons and were conscious and had a Glasgow Coma Scale score of 15, were included in the study. The patients' Clinical Frailty Scale, FRAIL Scale and NEWS-2 scores were recorded at admissions. Results The mean age of the cases was 75.12±6.82 years and 53.2% were male. According to the Clinical Frailty Scale, 49.9% of the cases were frail, while 56.1% of the cases were frail according to the FRAIL Scale. 25.8% of the patients had a NEWS-2 score of 5 and above. 37,2% of the cases were admitted to the ward, and 16,4% were admitted to the intensive care unit. After the first application to the Emergency Department, 10.5% of the patients who were determined to be frail according to the Clinical Frailty Scale, and 2.0% of the patients who were not frail died within 30 days. According to the FRAIL Scale, 9.5% of the patients who were determined to be frail and 2.2% of the pre-frail patients died within 30 days. The 30-day mortality rate was 15% in patients with NEWS-2 scores of 7 and above, 11.7% in patients with scores of 5-6 and 3.9% in patients with scores of 0-4. ROC analysis revealed that the best performance ranking in predicting in-hospital mortality was determined to be the Clinical Frailty Scale, NEWS-2, and FRAIL Scale, respectively (Areas under the curve: 0.760 – 0.709 – 0.677). According to the Youden index, the cut-off values were determined as 6 for the Clinical Frailty Scale, 3 for the FRAIL Scale, and 3 for the NEWS-2 score. According to the ROC curve of our analysis, all scales were evaluated as tests that can be used to predict mortality. Conclusion In elderly patients admitted to the emergency department, the Clinical Frailty Scale, FRAIL Scale and NEWS-2 score are predictive of in-hospital mortality (30-day) and hospitalization. In predicting 30-day mortality, the Clinical Frailty Scale score is more successful than the FRAIL and NEWS-2 scores.
Açıklama
Anahtar Kelimeler
Acil servis, Emergency department, Kırılganlık, Frailty, Yaşlılık, Elderly, Mortality, Mortalite, NEWS-2
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Tatar, B. (2024). Acil servise başvuran geriatrik hastalarda klinik kırılganlıkölçeği, fraıl ölçeği ve news-2'nin acil servis sonlanımı vehastane içi mortalite ile ilişkisinin araştırılması. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Acil Tıp Anabilim Dalı, Konya.
