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Yaşlı Acil Servis Hastaları Sonuçlarının Tahmininde Ulusal Erken Uyarı Skoru ve Perfüzyon İndeksinin Kullanımı

Yıl 2023, Cilt: 33 Sayı: 1, 36 - 40, 28.02.2023
https://doi.org/10.54005/geneltip.1177467

Öz

Amaç: Vital değerler, bir hastanın durumunu değerlendirmek için en önemli parametrelerdir ve National Early Warning Score, hastanın durumunun ne kadar acil olduğunu tahmin etmek için vital parametrelerle değerlendirilmesine yardımcı olur. Perfüzyon indeksi, bir hastanın periferik dokusundaki pulsatil kan akışının pulsatil olmayan/statik kan akışına oranıdır. Bu çalışmada National Early Warning Score ile perfüzyon indeksi arasındaki ilişkiyi ve acil servise başvuran yaşlı hastaların sonlanımlarını tahmin etmede National Early Warning Score ve perfüzyon indeksinin yararlı olup olmadığını değerlendirmeyi amaçladık.

Yöntemler: Bu prospektif kesitsel çalışmada, acil servise travma dışı nedenlerle başvuran yaşlı hastaları değerlendirdik. National Early Warning Score, perfüzyon indeksi ve hastaların acil servis sonlanımları kaydedildi.

Sonuçlar: Toplam 967 hasta (%55 kadın, ortalama yaş=74.8) kaydedildi. Hastaların başvuru anındaki National Early Warning Score ile perfüzyon indeksi arasında anlamlı, negatif bir korelasyon vardı (p < 0.001). Hastaneye yatırılan hastalar taburcu edilenlere göre daha yüksek National Early Warning Score ve daha düşük perfüzyon indeksi değerlerine sahipti (her ikisi içinde p < 0.001). Yoğun bakım ünitesine yatırılan hastalarda, servise yatırılanlara göre önemli ölçüde daha yüksek National Early Warning Score ve daha düşük perfüzyon indeksi değerleri vardı (her ikisi içinde p < 0.001).

Tartışma: National Early Warning Score ve perfüzyon indeksi, acil serviste kritik durumdaki yaşlı hastaları ayırt etmek için kullanılabilecek faydalı araçlardır.

Kaynakça

  • References 1. Cooper RJ, Schriger DL, Flaherty HL, Lin EJ, Hubbell KA. Effect of vital signs on triage decisions. Ann Emerg Med. 2002 Mar 1;39(3):223–32.
  • 2. Vergara P, Forero D, Bastidas A, Garcia JC, Blanco J, Azocar J, et al. Validation of the National Early Warning Score (NEWS)-2 for adults in the emergency department in a tertiary-level clinic in Colombia: Cohort study. Medicine (Baltimore) [Internet]. 2021 Oct 10 [cited 2022 Sep 4];100(40):e27325. Available from: /pmc/articles/PMC8500632/
  • 3. Royal College of Physicians. National Early Warning Score (NEWS): Standardising the assessment of acute-illness severity in the NHS. Report of a working party. Printed in Great Britain, London: RCP, 2012. URL: https://www.rcplondon.ac.uk/projects/outputs/national-early-warning-score-news Accessed: 01.9.2022
  • 4. Hargrove J, Nguyen HB. Bench-to-bedside review: Outcome predictions for critically ill patients in the emergency department [Internet]. Vol. 9, Critical Care. BioMed Central; 2005 [cited 2020 Jun 5]. p. 376–83. Available from: http://ccforum.biomedcentral.com/articles/10.1186/cc3518
  • 5. Smith GB, Prytherch DR, Meredith P, Schmidt PE, Featherstone PI. The ability of the National Early Warning Score (NEWS) to discriminate against patients at risk of early cardiac arrest, unanticipated intensive care unit admission, and death. Resuscitation. 2013 Apr 1;84(4):465–70.
  • 6. Kim SH, Choi HS, Jin ES, Choi H, Lee H, Lee SH, et al. Predicting severe outcomes using national early warning score (NEWS) in patients identified by a rapid response system: a retrospective cohort study. Sci Reports 2021 111 [Internet]. 2021 Sep 9 [cited 2022 Sep 4];11(1):1–8. Available from: https://www.nature.com/articles/s41598-021-97121-w
  • 7. Goldman JM, Petterson MT, Kopotic RJ, Barker SJ. Masimo signal extraction pulse oximetry. J Clin Monit Comput. 2000;16(7):475–83.
  • 8. Lima A, Bakker J. Noninvasive monitoring of peripheral perfusion. Vol. 31, Intensive Care Medicine. Intensive Care Med; 2005. p. 1316–26.
  • 9. Kaçmaz Ö, Gökdemir GŞ, OZEL M, Gökdemir MT. Clinical Assessment of Perfusion Index in Patients Presenting to the Emergency Department with Non-ST-segment Elevation Myocardial Infarction and Unstable Angina Pectoris. J Harran Univ Med Fac [Internet]. 2022 Apr 28 [cited 2022 May 5];19(1):184–8. Available from: https://dergipark.org.tr/en/pub/hutfd/issue/69378/1067974
  • 10. Rasmussen PS, Aasvang EK, Olsen RM, Haahr-Raunkjaer C, Elvekjaer M, Sørensen HBD, et al. Continuous peripheral perfusion index in patients admitted to hospital wards – An observational study. Acta Anaesthesiol Scand [Internet]. 2021 Feb 1 [cited 2022 Sep 4];65(2):257–65. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/aas.13711
  • 11. Savastano S, Baldi E, Contri E, De Pirro A, Sciutti F, Compagnoni S, et al. Post-ROSC peripheral perfusion index discriminates 30-day survival after out-of-hospital cardiac arrest. Intern Emerg Med 2020 162 [Internet]. 2020 Jul 10 [cited 2022 Sep 4];16(2):455–62. Available from: https://link.springer.com/article/10.1007/s11739-020-02430-z
  • 12. Akdur G, Daş M, Bardakci O, Akman C, Sıddıkoğlu D, Akdur O, et al. Prediction of mortality in COVID-19 through combing CT severity score with NEWS, qSOFA, or peripheral perfusion index. Am J Emerg Med. 2021 Dec 1;50:546–52
  • 13. Kahn JH, Magauran B. Trends in Geriatric Emergency Medicine. Vol. 24, Emergency Medicine Clinics of North America. W.B. Saunders; 2006. p. 243–60.
  • 14. Pirneskoski J, Harjola VP, Jeskanen P, Linnamurto L, Saikko S, Nurmi J. Critically ill patients in the emergency department may be characterized by low amplitude and high variability of amplitude of pulse photoplethysmography. Scand J Trauma Resusc Emerg Med. 2013 Jun 24;21(1):48–48.
  • 15. Abbott TEF, Torrance HDT, Cron N, Vaid N, Emmanuel J. A single-center cohort study of National Early Warning Score (NEWS) and near-patient testing in acute medical admissions. Eur J Intern Med. 2016 Nov 1;35:78–82.
  • 16. Shaw J, Fothergill RT, Clark S, Moore F. Can the prehospit1. Shaw J, Fothergill RT, Clark S, Moore F. Can the prehospital National Early Warning Score identify patients most at risk from subsequent deterioration? Emerg Med J. 2017 Aug 1;34(8):533–7. al National Early Warning Score identifies patients. Emerg Med J. 2017 Aug 1;34(8):533–7.
  • 17. Alam N, Vegting IL, Houben E, van Berkel B, Vaughan L, Kramer MHH, et al. Exploring the performance of the National Early Warning Score (NEWS) in a European emergency department. Resuscitation. 2015 May 1;90:111–5.
  • 18. Armagan E, Yilmaz Y, Olmez OF, Simsek G, Gul CB. Predictive value of the modified Early Warning Score in a Turkish emergency department. Eur J Emerg Med [Internet]. 2008 Dec 1 [cited 2020 Jun 5];15(6):338–40. Available from: http://journals.lww.com/00063110-200812000-00007
  • 19. Lima A, Jansen TC, Van Bommel J, Ince C, Bakker J. The prognostic value of the subjective assessment of peripheral perfusion in critically ill patients. Crit Care Med. 2009;37(3):934–8.
  • 20. Acar, Y. A., Yamane, L., Cinar, O., Cevik, E., Kilic, S., Yasar, M. Perfusion Index from Pulse Oximetry Predicts Mortality and Correlates with Illness Severity Scores in Intensive Care Unit Patients. Acta Medica Mediterranea 2015;3 :237-47.

Use of National Early Warning Score and Perfusion Index in Predicting Outcomes of Elderly Emergency Department Patients

Yıl 2023, Cilt: 33 Sayı: 1, 36 - 40, 28.02.2023
https://doi.org/10.54005/geneltip.1177467

Öz

Objectives: Vitals are the most important parameters for assessing a patient’s status and the National Early Warning Score helps to assess vitals to predict how urgent a patient’s condition is. The perfusion index is the ratio of the pulsatile blood flow to the non-pulsatile/static blood flow in a patient’s peripheral tissue. We aimed to investigate the relationship between the National Early Warning Score and perfusion index in the courses and evaluate whether NEWS and PI are useful in predicting outcomes of older patients in an Emergency Department.
Method: In this prospective cross-sectional study, we evaluated non-traumatized older patients admitted to an Emergency Department. National Early Warning Score, perfusion index, and patients’ Emergency Department outcomes were recorded.
Results: A total of 967 patients (55% female, mean age=74.8) were enrolled. The initial National Early Warning Score of the patients had a significant, negative correlation with perfusion index (p < 0.001). Patients admitted to the hospital had higher National Early Warning Score and lower perfusion index values than those discharged (both p < 0.001). Patients admitted to an ICU had significantly higher National Early Warning Score and lower perfusion index values than those admitted to the medical floor (both p < 0.001).
Conclusion: The National Early Warning Score and the perfusion index are useful instruments to distinguish critically ill older patients in an Emergency Department.

Kaynakça

  • References 1. Cooper RJ, Schriger DL, Flaherty HL, Lin EJ, Hubbell KA. Effect of vital signs on triage decisions. Ann Emerg Med. 2002 Mar 1;39(3):223–32.
  • 2. Vergara P, Forero D, Bastidas A, Garcia JC, Blanco J, Azocar J, et al. Validation of the National Early Warning Score (NEWS)-2 for adults in the emergency department in a tertiary-level clinic in Colombia: Cohort study. Medicine (Baltimore) [Internet]. 2021 Oct 10 [cited 2022 Sep 4];100(40):e27325. Available from: /pmc/articles/PMC8500632/
  • 3. Royal College of Physicians. National Early Warning Score (NEWS): Standardising the assessment of acute-illness severity in the NHS. Report of a working party. Printed in Great Britain, London: RCP, 2012. URL: https://www.rcplondon.ac.uk/projects/outputs/national-early-warning-score-news Accessed: 01.9.2022
  • 4. Hargrove J, Nguyen HB. Bench-to-bedside review: Outcome predictions for critically ill patients in the emergency department [Internet]. Vol. 9, Critical Care. BioMed Central; 2005 [cited 2020 Jun 5]. p. 376–83. Available from: http://ccforum.biomedcentral.com/articles/10.1186/cc3518
  • 5. Smith GB, Prytherch DR, Meredith P, Schmidt PE, Featherstone PI. The ability of the National Early Warning Score (NEWS) to discriminate against patients at risk of early cardiac arrest, unanticipated intensive care unit admission, and death. Resuscitation. 2013 Apr 1;84(4):465–70.
  • 6. Kim SH, Choi HS, Jin ES, Choi H, Lee H, Lee SH, et al. Predicting severe outcomes using national early warning score (NEWS) in patients identified by a rapid response system: a retrospective cohort study. Sci Reports 2021 111 [Internet]. 2021 Sep 9 [cited 2022 Sep 4];11(1):1–8. Available from: https://www.nature.com/articles/s41598-021-97121-w
  • 7. Goldman JM, Petterson MT, Kopotic RJ, Barker SJ. Masimo signal extraction pulse oximetry. J Clin Monit Comput. 2000;16(7):475–83.
  • 8. Lima A, Bakker J. Noninvasive monitoring of peripheral perfusion. Vol. 31, Intensive Care Medicine. Intensive Care Med; 2005. p. 1316–26.
  • 9. Kaçmaz Ö, Gökdemir GŞ, OZEL M, Gökdemir MT. Clinical Assessment of Perfusion Index in Patients Presenting to the Emergency Department with Non-ST-segment Elevation Myocardial Infarction and Unstable Angina Pectoris. J Harran Univ Med Fac [Internet]. 2022 Apr 28 [cited 2022 May 5];19(1):184–8. Available from: https://dergipark.org.tr/en/pub/hutfd/issue/69378/1067974
  • 10. Rasmussen PS, Aasvang EK, Olsen RM, Haahr-Raunkjaer C, Elvekjaer M, Sørensen HBD, et al. Continuous peripheral perfusion index in patients admitted to hospital wards – An observational study. Acta Anaesthesiol Scand [Internet]. 2021 Feb 1 [cited 2022 Sep 4];65(2):257–65. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/aas.13711
  • 11. Savastano S, Baldi E, Contri E, De Pirro A, Sciutti F, Compagnoni S, et al. Post-ROSC peripheral perfusion index discriminates 30-day survival after out-of-hospital cardiac arrest. Intern Emerg Med 2020 162 [Internet]. 2020 Jul 10 [cited 2022 Sep 4];16(2):455–62. Available from: https://link.springer.com/article/10.1007/s11739-020-02430-z
  • 12. Akdur G, Daş M, Bardakci O, Akman C, Sıddıkoğlu D, Akdur O, et al. Prediction of mortality in COVID-19 through combing CT severity score with NEWS, qSOFA, or peripheral perfusion index. Am J Emerg Med. 2021 Dec 1;50:546–52
  • 13. Kahn JH, Magauran B. Trends in Geriatric Emergency Medicine. Vol. 24, Emergency Medicine Clinics of North America. W.B. Saunders; 2006. p. 243–60.
  • 14. Pirneskoski J, Harjola VP, Jeskanen P, Linnamurto L, Saikko S, Nurmi J. Critically ill patients in the emergency department may be characterized by low amplitude and high variability of amplitude of pulse photoplethysmography. Scand J Trauma Resusc Emerg Med. 2013 Jun 24;21(1):48–48.
  • 15. Abbott TEF, Torrance HDT, Cron N, Vaid N, Emmanuel J. A single-center cohort study of National Early Warning Score (NEWS) and near-patient testing in acute medical admissions. Eur J Intern Med. 2016 Nov 1;35:78–82.
  • 16. Shaw J, Fothergill RT, Clark S, Moore F. Can the prehospit1. Shaw J, Fothergill RT, Clark S, Moore F. Can the prehospital National Early Warning Score identify patients most at risk from subsequent deterioration? Emerg Med J. 2017 Aug 1;34(8):533–7. al National Early Warning Score identifies patients. Emerg Med J. 2017 Aug 1;34(8):533–7.
  • 17. Alam N, Vegting IL, Houben E, van Berkel B, Vaughan L, Kramer MHH, et al. Exploring the performance of the National Early Warning Score (NEWS) in a European emergency department. Resuscitation. 2015 May 1;90:111–5.
  • 18. Armagan E, Yilmaz Y, Olmez OF, Simsek G, Gul CB. Predictive value of the modified Early Warning Score in a Turkish emergency department. Eur J Emerg Med [Internet]. 2008 Dec 1 [cited 2020 Jun 5];15(6):338–40. Available from: http://journals.lww.com/00063110-200812000-00007
  • 19. Lima A, Jansen TC, Van Bommel J, Ince C, Bakker J. The prognostic value of the subjective assessment of peripheral perfusion in critically ill patients. Crit Care Med. 2009;37(3):934–8.
  • 20. Acar, Y. A., Yamane, L., Cinar, O., Cevik, E., Kilic, S., Yasar, M. Perfusion Index from Pulse Oximetry Predicts Mortality and Correlates with Illness Severity Scores in Intensive Care Unit Patients. Acta Medica Mediterranea 2015;3 :237-47.
Toplam 20 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Klinik Tıp Bilimleri
Bölüm Original Article
Yazarlar

Mehmet Ozel 0000-0002-4797-7017

Emine Gaffari 0000-0002-0598-143X

Hakan Topacoglu 0000-0003-0441-7455

Özgür Karcıoğlu 0000-0002-8814-6164

Yayımlanma Tarihi 28 Şubat 2023
Gönderilme Tarihi 30 Eylül 2022
Yayımlandığı Sayı Yıl 2023 Cilt: 33 Sayı: 1

Kaynak Göster

Vancouver Ozel M, Gaffari E, Topacoglu H, Karcıoğlu Ö. Use of National Early Warning Score and Perfusion Index in Predicting Outcomes of Elderly Emergency Department Patients. Genel Tıp Derg. 2023;33(1):36-40.