Genel durum bozukluğu ile acil servise başvuran hastaların değerlendirilmesi ve hotel, WPS, REMS skorlarının bu hastalarda mortaliteyi öngörme düzeylerinin karşılaştırılması
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Tarih
2022
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Yayıncı
Düzce Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş ve Amaç: Genel durum bozukluğu triyaj sürecinde sık görülen bir şikayettir. Genel durum bozukluğu, sağlık ve esenlikte spesifik olmayan bir düşüşü tanımlar ve acil servisteki yaşlı hastalarda yaygındır. Bu çalışmada, acil servise genel durum bozukluğu şikayeti ile başvuran hastaların genel değerlendirilmesinin yapılması ve bu hastaların mortalitelerini öngörebilecek skorlama sistemlerinin prognostik değerinin karşılaştırılması amaçlanmıştır. Gereç ve Yöntem: Bu çalışma Düzce Üniversitesi Sağlık Uygulama ve Araştırma Hastanesi acil servisine 01.03.2021-01.06.2021 tarihleri arasında genel durum bozukluğu şikayeti ile başvuran ve çalışmaya gönüllü olarak katılan 137 hasta üzerinde tek merkezli ve prospektif olarak gerçekleştirilmiştir. Acil servise genel durum bozukluğu şikayeti ile gelen hastaların ateş, nabız, tansiyon, ortalama arter basıncı, oksijen satürasyonu, solunum sayısı, EKG, bağımsız ayakta duramama, GKS, yaş ve cinsiyeti sorgulanmıştır. Hastaların vital bulgularının yanı sıra tanımlayıcı demografik özellikleri de not edilmiştir. Bunun yanında hastanın; Glasgow Koma Skalası (GKS), HOTEL skoru, Hızlı Acil Tıp Skoru (REMS), Worthing Fizyolojik Skorlama Sistemi (WPS) değerlendirilmiştir. GDB ile başvuran hastaların 1 aylık mortalite durumları, MV ihtiyaçları ve YBÜ ihtiyaçları not edildi. İstatistiksel değerlendirmede Pearson Ki Kare Testi, Yates Düzeltmesi, Fisher's Exact Testi, Bağımsız Örnekler T Testi, Mann Whitney U Testi, Tek Yönlü Varyans Analizi (ANOVA), Kruskal Wallis H Testi, Univariate ve Multivariate model olarak binary lojistik regresyon analizi uygulanmıştır ve HOTEL, REMS, WPS skorlarının mortaliteyi belirlemedeki değerini ölçmek için Receiver Operating Characteristic (ROC) eğrileri çizilmiştir. İstatistiksel anlamlılık düzeyi p<0,05 alınmıştır. Bulgular: Çalışmaya katılan toplamda 137 hastanın yaş ortalaması 75,13 ± 13,99 olarak tespit edilmiş olup hastaların %50,4'ü (n=69) erkektir. Genel durum bozukluğu şikayetiyle olan başvuruların; %64,2'si (n=88) hafta içi, %88,3'ü (n=121) ambulans ile ve %67,2'si (n=92) kırmızı triyaj şeklinde olmuştur. Exitus durumlarına göre sonlanım değişkeni farklılık göstermektedir (p=0,039). Exitus olanların %33,3'ü (n=24) taburcu olurken exitus olmayanların %47,7'si (n=31) taburcu olmuştur. Mortalite durumlarına göre HOTEL skorları farklılık göstermektedir (p=0,004). 1 ay içerisinde mortalite gerçekleşenlerde HOTEL skoru ortanca değeri 2 iken, yaşayanlarda 2 olarak bulunmuştur. 1 ay içerisinde mortalite gerçekleşenlerin REMS skoru yaşayanların skorundan anlamlı şekilde yüksek bulunmuştur (p=0,007). Mortalite durumuna göre WPS skorları açısından farklılık görülmemiştir (p=0,425). Exitus durumlarına etki eden risk faktörleri univariate ve multivariate model olarak binary lojistik regresyon analizi ile incelenmiştir. Univariate analiz sonucunda Exitus durumlarında hiçbir faktörün, bağımsız risk faktörü olmadığı elde edilmiştir (p>0,005). Exitus olma durumuna göre HOTEL değeri üzerinden yapılan ROC analizine göre kesme değeri (cut-off) 1 olarak bulunmuştur. Bu cut-off değerindeki duyarlılık %78,08, özgüllük ise %43,75 olarak bulunmuştur. Exitus olma durumuna göre REMS değeri üzerinden yapılan ROC analizine göre cut-off değeri 8 olarak bulunmuştur. Bu cut-off değerindeki duyarlılık %47,95, özgüllük ise %71,87 olarak bulunmuştur. HOTEL skorunun öngörme düzeyinin (AUC=0,644), REMS skorunun (AUC=0,635) düzeyinden yüksek olduğu görülmüştür. Aynı zamanda exitus olma durumuna göre WPS değeri üzerinden yapılan ROC analizinde anlamlı farklılık görülmemiştir (p=0,337; AUC=0,547). Sonuç: Bu çalışma, genel durum bozukluğu ile başvuran hastaların ölüm riskinin yüksek olduğunu göstermektedir. Acil serviste triyaj planlanırken bu durum dikkate alınmalıdır. Aynı zamanda genel durum bozukluğu olan hastalarda mortalitenin tahmininde hem HOTEL hem de REMS skorlama sistemlerinin iyi prognostik değere sahip olduğu gösterilmiştir. Her ne kadar HOTEL skorunun AUC değeri REMS skorunun AUC değerinden daha fazla olsa da bu farklılığın çok az olduğu görülmüştür. Anahtar Kelimeler: Genel durum bozukluğu, acil servis, HOTEL, WPS, REMS
Introduction and Object: General condition disorder is a common complaint in the triage process. General condition disorder describes a nonspecific decline in health and well-being and is common in elderly patients in the emergency room. In this study, it was aimed to evaluate the patients who admitted to the emergency department with the complaint of general condition disorder and to compare the prognostic value of the scoring systems that can predict the mortality of these patients. Materials and Methods: This study was carried out as a single center and prospective on 137 patients who admitted to the emergency service of Düzce University Health Practice and Research Hospital between 01.03.2021 and 01.06.2021 with the complaint of general condition disorder and participated in the study voluntarily. The patient who came to the emergency department with the complaint of general condition disorder was questioned in terms of fever, pulse, blood pressure, mean arterial pressure, oxygen saturation, respiratory rate, ECG, inability to stand independently, GCS, age, gender (The descriptive demographic characteristics of the patients were noted as well as their vital signs.). In addition, the patient; Glasgow Coma Scale (GCS), HOTEL score, Rapid Emergency Medicine Score (REMS), Worthing Physiological Scoring System (WPS) were evaluated. The 1-month mortality status, MV needs and ICU needs of the patients admitting with GCD were noted. In statistical evaluation, Pearson Chi-Square Test, Yates Correction, Fisher's Exact Test, Independent Samples T Test, Mann Whitney U Test, One-Way Analysis of Variance (ANOVA), Kruskal Wallis H Test, Univariate and Multivariate model binary logistic regression analysis were applied and HOTEL, Receiver Operating Characteristic (ROC) curves were drawn to measure the value of REMS and WPS scores in determining mortality. Statistical significance level was taken as p<0.05. Results: The average age of the 137 patients participating in the study was 75.13 ± 13.99 years, and 50.4% (n=69) of the patients were male. Admitting with complaints of general condition disorder; 64.2% (n=88) were on weekdays, 88.3% (n=121) were by ambulance, and 67.2% (n=92) were red triage. The surrogate endpoint differs according to the exitus status (p=0.039). While 33.3% (n=24) of those with exitus were discharged, 47.7% (n=31) of those who did not exitus were discharged. HOTEL scores differ according to mortality status (p=0.004). While the median value of the HOTEL score was 2 in those who died within 1 month, it was 2 in those who survived. The REMS score of those who died within 1 month was found to be significantly higher than the score of those who survived (p=0.007). There was no difference in WPS scores according to mortality status (p=0.425). The risk factors affecting the exitus status were analyzed by binary logistic regression analysis as univariate and multivariate models. As a result of the univariate analysis, it was found that no factor was an independent risk factor in Exitus cases (p>0.005). According to the ROC analysis made over the HOTEL value according to the exitus status, the cut-off point was found to be 1. The sensitivity at this cut-off point was 78.08%, and the specificity was 43.75According to the ROC analysis made over the REMS value according to the exitus status, the cut-off point was found to be 8. The sensitivity at this cut-off point was 47.95%, and the specificity was 71.87%. The predictive level of the HOTEL score (AUC=0.644) was found to be higher than the level of the REMS score (AUC=0.635). At the same time, there was no significant difference in the ROC analysis performed on the WPS value according to the exitus status (p=0.337; AUC=0.547). Conclusions: This study shows that patients presenting with a general condition disorder have a high risk of death. This should be taken into account when planning triage in the emergency department. At the same time, it has been shown that both HOTEL and REMS scoring systems have good prognostic value in estimating mortality in patients with general condition disorder. Although the AUC value of the HOTEL score was higher than the AUC of the REMS score, this difference was observed to be very small. Keywords: General condition disorder, emergency department, HOTEL, WPS, REMS
Introduction and Object: General condition disorder is a common complaint in the triage process. General condition disorder describes a nonspecific decline in health and well-being and is common in elderly patients in the emergency room. In this study, it was aimed to evaluate the patients who admitted to the emergency department with the complaint of general condition disorder and to compare the prognostic value of the scoring systems that can predict the mortality of these patients. Materials and Methods: This study was carried out as a single center and prospective on 137 patients who admitted to the emergency service of Düzce University Health Practice and Research Hospital between 01.03.2021 and 01.06.2021 with the complaint of general condition disorder and participated in the study voluntarily. The patient who came to the emergency department with the complaint of general condition disorder was questioned in terms of fever, pulse, blood pressure, mean arterial pressure, oxygen saturation, respiratory rate, ECG, inability to stand independently, GCS, age, gender (The descriptive demographic characteristics of the patients were noted as well as their vital signs.). In addition, the patient; Glasgow Coma Scale (GCS), HOTEL score, Rapid Emergency Medicine Score (REMS), Worthing Physiological Scoring System (WPS) were evaluated. The 1-month mortality status, MV needs and ICU needs of the patients admitting with GCD were noted. In statistical evaluation, Pearson Chi-Square Test, Yates Correction, Fisher's Exact Test, Independent Samples T Test, Mann Whitney U Test, One-Way Analysis of Variance (ANOVA), Kruskal Wallis H Test, Univariate and Multivariate model binary logistic regression analysis were applied and HOTEL, Receiver Operating Characteristic (ROC) curves were drawn to measure the value of REMS and WPS scores in determining mortality. Statistical significance level was taken as p<0.05. Results: The average age of the 137 patients participating in the study was 75.13 ± 13.99 years, and 50.4% (n=69) of the patients were male. Admitting with complaints of general condition disorder; 64.2% (n=88) were on weekdays, 88.3% (n=121) were by ambulance, and 67.2% (n=92) were red triage. The surrogate endpoint differs according to the exitus status (p=0.039). While 33.3% (n=24) of those with exitus were discharged, 47.7% (n=31) of those who did not exitus were discharged. HOTEL scores differ according to mortality status (p=0.004). While the median value of the HOTEL score was 2 in those who died within 1 month, it was 2 in those who survived. The REMS score of those who died within 1 month was found to be significantly higher than the score of those who survived (p=0.007). There was no difference in WPS scores according to mortality status (p=0.425). The risk factors affecting the exitus status were analyzed by binary logistic regression analysis as univariate and multivariate models. As a result of the univariate analysis, it was found that no factor was an independent risk factor in Exitus cases (p>0.005). According to the ROC analysis made over the HOTEL value according to the exitus status, the cut-off point was found to be 1. The sensitivity at this cut-off point was 78.08%, and the specificity was 43.75According to the ROC analysis made over the REMS value according to the exitus status, the cut-off point was found to be 8. The sensitivity at this cut-off point was 47.95%, and the specificity was 71.87%. The predictive level of the HOTEL score (AUC=0.644) was found to be higher than the level of the REMS score (AUC=0.635). At the same time, there was no significant difference in the ROC analysis performed on the WPS value according to the exitus status (p=0.337; AUC=0.547). Conclusions: This study shows that patients presenting with a general condition disorder have a high risk of death. This should be taken into account when planning triage in the emergency department. At the same time, it has been shown that both HOTEL and REMS scoring systems have good prognostic value in estimating mortality in patients with general condition disorder. Although the AUC value of the HOTEL score was higher than the AUC of the REMS score, this difference was observed to be very small. Keywords: General condition disorder, emergency department, HOTEL, WPS, REMS
Açıklama
Anahtar Kelimeler
Genel durum bozukluğu, acil servis, HOTEL, WPS, REMS, General condition disorder, emergency department, HOTEL, WPS, REMS, İlk ve Acil Yardım, Emergency and First Aid
