Acil servise başvuran kritik yaşlı hastalarda kısa dönem mortalite tahmininde risk skorlarının karşılaştırılması

Abstract

Amaç: Bu yapılan çalışmanın amacı acil servise başvuran 65 yaş ve üzerindeki hastaların “National Early Warning Score (NEWS)”, “Rapid Emergency Medicine Score (REMS)”, “VITALPAC Early Warning Score (ViEWS)” ve “Emergency Department Triage Early Warning Score (TREWS)” skorlarını kullanarak kısa dönem mortalite tahminlerini incelemektir. Metod: Bu prospektif çalışma Bursa Uludağ Üniversitesi Tıp Fakültesi Acil Servisinde 16 Nisan 2022 - 31 Aralık 2022 tarihleri arasında gerçekleştirilmiştir. Bu tarihlerde Acil Servise travma dışı nedenlerle başvuran 65 yaş ve üzeri 311 olgu çalışmaya dahil edilmiştir. Olguların Acil servis başvurularında NEWS, REMS, VİEWS ve TREWS skorları kaydedilmiştir. Bulgular: Hastaların yaş ortalaması 75,05±7,18 yıl idi. En sık başvuru nedeni %36,3’lük oranı ile nefes darlığı oldu. Başvurularda erkek cinsiyet daha fazla olarak görüldü ve en sık ek hastalık kronik kalp hastalığı idi. Manchester Triyaj Skoruna (MTS) bakıldığında %39,2’si kırmızı, %60,8’i turuncu kategorideydi. Hastaların %46’ı taburcu edildi, %25’i kliniğe yatırıldı, %26’sı yoğun bakım ünitesine yatırıldı, %3’ü ise tedaviyi red ile acil servisten ayrıldı. Hastaların %87,5’i 30 günün sonunda yaşıyorken %12,5’i exitus olduğu görüldü. MTS skoru kırmızı olanlarda, oksijen desteği verilenlerde mortalite belirgin yüksekti(p<0,001). AVPU skalasında Alert olarak değerlendirilen hastalarda mortalite daha düşüktü(p<0,001). NEWS skorunun kesim noktası 6 olarak kabul edildiğinde sensitivitesi %50,0, spesifitesi %89,89, VİEWS skorunun kesim noktası 3 olarak kabul edildiğinde sensitivitesi %65,89, spesifitesi %71,16, TREWS skorunun kesim noktası 8 olarak kabul edildiğinde sensitivitesi %36,84, spesifitesi 93,26, REMS skorunun kesim noktası 5 olarak kabul edildiğinde sensitivitesi %89,47, spesifitesi %25,84 olarak bulundu. NEWS, TREWS ve VİEWS skorlarının artmış mortalite ile ilişkili olduğu görüldü(p<0,001). Sonuç: Acil servise başvurusu olan yaşlı hastalarda kısa dönem mortalite tahmininde NEWS, TREWS ve VİEWS skorlarının kullanılabilmektedir.

Aim: The aim of this study was to investigate the short-term mortality of critically ill elder patients who were admitted to the emergency department using the National Early Warning Score (NEWS), Rapid Emergency Medicine Score (REMS), VITALPAC Early Warning Score (ViEWS) and Emergency Department Triage Early Warning Score (TREWS). Methods: This prospective study was conducted in Bursa Uludag University Faculty of Medicine Emergency Medicine Department between 16 April 2022 and 31 December 2022. At that time, 311 cases aged 65 years and older who applied to the Emergency Department with non-traumatic causes were included in the study. NEWS, REMS, VIEWS and TREWS scores were recorded in the Emergency Department admission time. Results: The mean age of the patients was 75.05±7.18 years. The most common etiological cause for admission was shortness of breath with a rate of 36.3%.The male gender was more common and the most common disease was chronic heart disease. According to the Manchester Triage Skore (MTS), 39.2% were in the red category and 60.8% were in the orange category. 46% of the patients were discharged, 25% were admitted to the clinical wards, 26% were admitted to the intensive care unit, and 3% refused treatment and left the emergency room. While 87.5% of the patients were alive at the end of 30 days, 12.5% were exitus. Mortality was significantly higher in those with red MTS scores and those given oxygen supplementation (p<0.001). Mortality was lower in patients who were evaluated as alert on the AVPU scale (p<0.001). When the cut-off point of the NEWS score was accepted as 6, its sensitivity was 50.0%, its specificity was 89.89%, its sensitivity was 65.89% when the cutting point of the VIEWS score was accepted as 3, its specificity was 71.16%, its sensitivity was 36.84% when the cutting point of the TREWS score was accepted as 8, its specificity was 93.26%, and its sensitivity was 89.47% when the cutting point of the REMS score was accepted as 5, and its specificity was 25.84%. NEWS, TREWS and VIEWS scores were associated with increased mortality (p<0.001). Conclusion: NEWS, TREWS and VIEWS scores can be used to estimate short-term mortality in elderly patients admitted to the emergency department.