Acil servise başvuran hastalarda Ulusal Erken Uyarı Skoru'nun Sağlık Bakanlığı Triyaj Skoru'nun hasta mortalite, morbidite ve güvenli taburculuk açısından karşılaştırılması
Yükleniyor...
Tarih
2020
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç
Bu çalışmada Acil Servise ayaktan veya hastane öncesi sistemleri kullanarak başvuran 18 yaş üstü hasta grubunda, Avustralya Triaj Skoru (ATS) ve Sağlık Bakanlığı (SB) Triaj Değerlendirmesi, Ulusal Erken Uyarı Skoru (NEWS) ile mortalite, morbidite ve güvenli taburculuk açısından karşılaştırılması amaçlandı.
Yöntem
Çalışma analitik - kesitsel olarak planlandı. Çalışmanın evrenini 11.10.2019-15.10.2019 tarihleri arasında Ege Üniversitesi Tıp Fakültesi Acil Servis’e başvuran hastalar oluşturdu. Hastaların vital bulguları alınarak ATS, NEWS ve SB Triyaj değerlendirilmesi kaydedildi. Veriler SPSS 22.0 for Windows programında analiz edildi. Verilerin analizinde tanımlayıcı istatistikler ve tek değişkenli analizler (Kruskal Wallis testi, Ki-Kare testi ve Tek Yönlü Varyans Analizi) kullanıldı. Mortalite için Kaplan-Meier ve Cox Regresyon Analizleri yapıldı.
Bulgular
Çalışmaya alınan 1695 hastanın, %3,1’i çeşitli sebeplerle (dışlama kriterleri, çalışmadan ayrılmak istemeleri gibi) çalışmadan çıkarıldı. Değerlendirmeye alınan 1642 hastanın Sağlık Bakanlığı Triyajına göre en sık %56,6 (n=930) sarı kategoride, ATS’ye göre en sık %40,8 (n=670) Kategori 3’te, % 93,2’si (n=1531) NEWS düşük risk kategorisinde olduğu saptandı.
Çalışmada 7 günlük mortalite oranı %1,2 (n=19) olarak saptandı.SB Triyaj Değerlendirmesi, ATS ve NEWS’in ilk 7 gün içerisindeki sağkalımı öngörmede, sırasıyla duyarlılıkları %94.7, %84.2 ve %57.9 ; özgüllükleri ise %36.7, %52.6 ve %80.8 saptandı (p=0,003; p=0,002; p<0,001). Sonlanım durumlarına göre, %86’sının (n=1412) acil servisten taburcu edildiği, %5,6’sının (n=92) hastaneye yatırıldığı, %5,5’inin (n=91) tedavi reddi ile acil servisten ayrıldığı, %2,6’sının (n=42) sevk edildiği, %0,3’ünün (n=5) acil serviste izlem esnasında ex olduğu görüldü. Çalışmaya alınan hastalarda morbidite oranı %5,2 (n=86) saptandı. Bu hastaların %29’unun (n=25) solunum cihazı desteği ihtiyacı olduğu, %15’inde (n=13) entübasyon ihtiyacı olduğu, %15’inde (n=13) inotrop ihtiyacı olduğu görüldü. Morbidite gelişen grupta gelişmeyen gruba göre 13.5 kat daha fazla ölüm riski olduğu saptandı (p<0,001). SB, ATS ve NEWS’in sakatlığı öngörmede, sırasıyla duyarlılıkları %98.8, %95.3 ve %65.1 ; özgüllükleri ise %38.3, %54.8 ve %82.8 saptandı (p<0,001; p<0,001; p<0,001).
Çalışmada ATS Hekim-Hemşire ve SB Triyajı Hekim-Hemşire arasındaki uyum düşük veya önemsiz kategorisinde değerlendirildi (p<0,001; p<0,001; Kappa 0,17 Kappa 0,19).
Hastaların acil serviste ortalama sonlanım süresi 0,26 gün saptandı (6,2 saat; min 0,01 – maks 5,26). Yatış olan grupta 0,58 (0,06 – 5,26), sevk olan grupta 0,81 (0,01 – 4,37), exitus olan grupta 1,22 (0,01 – 4,37) saptandı.
Çalışmada 24 saat içerisinde tekrar acil servise başvuran hastaların(n=63), %96,8’inin (n=61) NEWS kategorilerinin düşük grupta değerlendirildiği görüldü.
Sonuç
Acil Servislerde genel hasta yaklaşımı açısından bakıldığında sağkalımı ve sakatlığı öngörmede SB Triyaj Değerlendirmesinin en yüksek sensivitede olduğu görülmüştür. NEWS skorlamasının morbiditeyi ve mortaliteyi öngörmede spesifitesinin SB ve ATS’ye göre daha yüksek olduğu saptanmıştır. Acil servisten güvenli taburculuk açısından daha güncel triyaj algoritma veya skorlamaları için daha fazla çalışma yapılması literatüre katkı sağlayacaktır.
Aim In this study, it was aimed to compare the Australian Triage Score (ATS) and the Ministry of Health (MoH) Triage Assessment, National Early Warning Score (NEWS) in terms of mortality, morbidity and safe discharge in the patient group over the age of 18 who were admitted to the Emergency Department using outpatient or pre-hospital systems. Material and Method The study was planned as analytical - cross-sectional. The universe of the study consisted of the patients who applied to the Emergency Department of Ege University between 11.10.2019-15.10.2019. Vital signs of the patients were taken and ATS, NEWS and MoH Triage assessments were recorded. The data were analyzed using SPSS 22.0 for Windows program. Descriptive statistics and univariate analysis (Kruskal Wallis test, Chi-Square test and One Way Analysis of Variance) were used in the analysis of the data. Kaplan-Meier and Cox Regression Analyzes were performed for mortality. Results 1695 patients were included in the study and %3,1 (n=53) of these patients were excluded from the study for various reasons (exclusion criteria, such as their wish to leave the study). According to the MoH Triage 56.6% (n = 930) were in the yellow category, to the ATS 40.8% (n = 670) were in Category 3, and to the NEWS 93.2% (n = 1531) was found to be in the low risk category. The 7-day mortality rate was found to be 1.2% (n = 19) in the study. MoH Triage Assessment predicted the survival of ATS and NEWS in the first 7 days, respectively, their sensitivities were 94.7%, 84.2% and 57.9%; Its specificities were 36.7%, 52.6% and 80.8% (p = 0.003; p = 0.002; p <0.001). According to their outcome, 86% (n = 1412) were discharged from the emergency service, 5.6% (n = 92) were hospitalized, 5.5% (n = 91) left the emergency service with refusal of treatment, It was observed that 2.6% (n = 42) were referred and 0.3% (n = 5) died during follow-up in the emergency department. The morbidity rate was 5.2% (n = 86) in the patients included in the study. It was observed that 29% (n = 25) of these patients needed respiratory support, 15% (n = 13) needed intubation, and 15% (n = 13) needed vasopressors. It was found that there was a 13.5 times higher risk of death in the group with morbidity compared to the group without morbidity (p <0.001). The sensitivities of MoH, ATS and NEWS in predicting disability were 98.8%, 95.3% and 65.1%, respectively; Its specificities were 38.3%, 54.8% and 82.8% (p <0.001; p <0.001; p <0.001). In the study, the agreement between ATS Physician-Nurse and MoH Triage Physician-Nurse was evaluated in the low or unimportant category (p <0.001; p <0.001; Kappa 0.17 Kappa 0.19). The mean duration of the patients in the emergency department was determined to be 0.26 days (6.2 hours; min 0.01 - max 5.26). It was found to be 0.58 (0.06 - 5.26) in the hospitalized group, 0.81 (0.01 - 4.37) in the referred group, and 1.22 (0.01 - 4.37) in the deceased group. In the study, it was observed that the NEWS categories of 96.8% (n = 61) of the patients (n = 63) who applied to the emergency service again within 24 hours were evaluated in the low group. Conclusion In terms of general patient approach in Emergency Departments, it was seen that the MOH Triage Assessment had the highest sensitivity in predicting survival and disability. The specificity of NEWS scoring in predicting morbidity and mortality was found to be higher than MoH and ATS. More studies for more up-to-date triage algorithm or scoring in terms of safe discharge from the emergency department will contribute to the literature.
Aim In this study, it was aimed to compare the Australian Triage Score (ATS) and the Ministry of Health (MoH) Triage Assessment, National Early Warning Score (NEWS) in terms of mortality, morbidity and safe discharge in the patient group over the age of 18 who were admitted to the Emergency Department using outpatient or pre-hospital systems. Material and Method The study was planned as analytical - cross-sectional. The universe of the study consisted of the patients who applied to the Emergency Department of Ege University between 11.10.2019-15.10.2019. Vital signs of the patients were taken and ATS, NEWS and MoH Triage assessments were recorded. The data were analyzed using SPSS 22.0 for Windows program. Descriptive statistics and univariate analysis (Kruskal Wallis test, Chi-Square test and One Way Analysis of Variance) were used in the analysis of the data. Kaplan-Meier and Cox Regression Analyzes were performed for mortality. Results 1695 patients were included in the study and %3,1 (n=53) of these patients were excluded from the study for various reasons (exclusion criteria, such as their wish to leave the study). According to the MoH Triage 56.6% (n = 930) were in the yellow category, to the ATS 40.8% (n = 670) were in Category 3, and to the NEWS 93.2% (n = 1531) was found to be in the low risk category. The 7-day mortality rate was found to be 1.2% (n = 19) in the study. MoH Triage Assessment predicted the survival of ATS and NEWS in the first 7 days, respectively, their sensitivities were 94.7%, 84.2% and 57.9%; Its specificities were 36.7%, 52.6% and 80.8% (p = 0.003; p = 0.002; p <0.001). According to their outcome, 86% (n = 1412) were discharged from the emergency service, 5.6% (n = 92) were hospitalized, 5.5% (n = 91) left the emergency service with refusal of treatment, It was observed that 2.6% (n = 42) were referred and 0.3% (n = 5) died during follow-up in the emergency department. The morbidity rate was 5.2% (n = 86) in the patients included in the study. It was observed that 29% (n = 25) of these patients needed respiratory support, 15% (n = 13) needed intubation, and 15% (n = 13) needed vasopressors. It was found that there was a 13.5 times higher risk of death in the group with morbidity compared to the group without morbidity (p <0.001). The sensitivities of MoH, ATS and NEWS in predicting disability were 98.8%, 95.3% and 65.1%, respectively; Its specificities were 38.3%, 54.8% and 82.8% (p <0.001; p <0.001; p <0.001). In the study, the agreement between ATS Physician-Nurse and MoH Triage Physician-Nurse was evaluated in the low or unimportant category (p <0.001; p <0.001; Kappa 0.17 Kappa 0.19). The mean duration of the patients in the emergency department was determined to be 0.26 days (6.2 hours; min 0.01 - max 5.26). It was found to be 0.58 (0.06 - 5.26) in the hospitalized group, 0.81 (0.01 - 4.37) in the referred group, and 1.22 (0.01 - 4.37) in the deceased group. In the study, it was observed that the NEWS categories of 96.8% (n = 61) of the patients (n = 63) who applied to the emergency service again within 24 hours were evaluated in the low group. Conclusion In terms of general patient approach in Emergency Departments, it was seen that the MOH Triage Assessment had the highest sensitivity in predicting survival and disability. The specificity of NEWS scoring in predicting morbidity and mortality was found to be higher than MoH and ATS. More studies for more up-to-date triage algorithm or scoring in terms of safe discharge from the emergency department will contribute to the literature.
Açıklama
Anahtar Kelimeler
NEWS, Triyaj, Sağlık Bakanlığı, Avustralya Triyaj Skalası, NEWS, Triage, Ministry of Health, Australian Triage Scale
