Acil Serviste COVID-19 Hastalarının Prognozunu Tahmin Etmek İçin Erken Uyarı Puanlama Sistemlerinin Kullanımı
Öz
Amaç: Pandemi ile birlikte artan acil servis (AS) başvuruları ve yoğun bakım (YBÜ) ihtiyacı, hızlı ve doğru karar verme ihtiyacını doğurmuştur. Erken uyarı skorları (EUS) bu konuda acil serviste faydalı olabilir. Bu çalışma, EUS'nin COVID-19 hastalarının mortalitesini ve YBÜ ihtiyacını öngörmedeki etkinliğini değerlendirmek için yapıldı.
Gereç ve yöntem: Bu retrospektif gözlemsel çalışma, acil servise sunulan ve daha sonra COVID-19 nedeniyle genel servise veya yoğun bakım ünitesine kabul edilen deneklerle gerçekleştirildi. Pozitif RT-PCR'si olan ≥18 yaşındaki denekler çalışmaya dahil edildi. Acil servise başvuru anında kalp veya solunum durması yaşayan veya entübe olan denekler ve hamile kadınlar çalışmadan çıkarıldı. MEWS, NEWS, NEWS-2, REMS ve qSOFA skorları hastaların ilk başvurudaki verileri kullanılarak hesaplandı. Bu skorlama sistemlerinin mortalite ve YBÜ ihtiyacı ile ilişkisini inceledik.
Bulgular: Çalışmaya katılan 600 hastanın 60'ı (10%) yoğun bakıma alınırken, 222 (37%) hasta öldü. Puanlama sistemlerinin YBÜ yatışını öngörmedeki negatif tahmin değerleri sırasıyla 0.95, 0.98, 0.97, 0.96 ve 0.96 ve mortaliteyi tahmin etmede sırasıyla 0.61, 0.67, 0.67, 0.66 ve 0.61 idi. Değerlendirilen tüm skorlar, COVID-19 hastalarında YBÜ ihtiyacı ve mortalitenin önemli belirleyicileriydi.
Tartışma: Değerlendirilen tüm puanlama sistemleri başarılıydı; ancak NEWS ve NEWS-2 hem YBÜ ihtiyacı hem de mortalite açısından en yüksek prediktif değere sahipti.
Anahtar Kelimeler
Destekleyen Kurum
yok
Proje Numarası
yok
Kaynakça
- 1. Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72314 Cases From the Chinese Center for Disease Control and Prevention. JAMA 2020;323:1239-1242.
- 2. Wu C, Chen X, Cai Y et al. Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA Intern Med 2020;180:934-943.
- 3. Wang D, Hu B, Hu C et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA 2020;323:1061-1069.
- 4. Çınaroğlu OS, Efgan MG, Payza U. The relationship of lactate clearance with mortality in COVID-19 pneumonia. Ann Clin Anal Med 2022;13:85-88.
- 5. Çınaroğlu OS, Efgan MG, Payza U. A New Predictor of Mortality in COVID-19 Pneumonia: The BUN/Lymphocyte Ratio. Forbes J Med. 2023; 4: 89-94.
- 6. Efgan MG, Payza U, Çınaroğlu OS, Acar H, Kayalı A. A Comparison of BUN/Albumin Ratio with PSI and CURB-65 for Predicting Mortality in COVID-19 Pneumonia in the Emergency Department. İstanbul Med J 2022; 23: 296-300.
- 7. Kostakis I, Smith GB, Prytherch D, Meredith P, Price C, Chauhan A. The performance of the National Early Warning Score and National Early Warning Score 2 in hospitalised patients infected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Resuscitation. 2021;159:150-157. doi: 10.1016/j.resuscitation.2020.10.039.
- 8. Lyons PG, Edelson DP, Churpek MM. Rapid response systems. Resuscitation 2018;128:191-197.
- 9. Sandroni C, D’ArrigoS, Antonelli M. Rapid response systems: are they really effective? Crit Care 2015;19:104.
- 10. Jarvis S, Kovacs C, Briggs J et al. Can binary early warning scores perform as well as standard early warning scores for discriminating a patient’s risk of cardiac arrest, death or unanticipated intensive care unit admission? Resuscitation 2015;93:46-52.
- 11. Nannan Panday RS, Minderhoud TC, Alam N, Nanayakkara PWB. Prognostic value of early warning scores in the emergency department (ED) and acute medical unit (AMU): A narrative review. Eur J Intern Med 2017;45:20-31.
- 12. Olsson T, Terent A, Lind L. Rapid Emergency Medicine score: a new prognostic tool for in-hospital mortality in nonsurgical emergency department patients. J Intern Med 2004;255:579-587.
- 13. McGinley A, Pearse R. A national early warning score for acutely ill patients. BMJ 2012;345:e5310.
- 14. Subbe CP, Kruger M, Rutherford P, Gemmel L. Validation of a modified Early Warning Score in medical admissions. QJM. 2001;94:521-526.
- 15. Covino M, Sandroni C, Santoro M et al. Predicting intensive care unit admission and death for COVID-19 patients in the emergency department using early warning scores. Resuscitation. 2020;156:84-91.
- 16. Smith GB, Prytherch DR, Meredith P, Schmidt PE, Featherstone PI. The ability of the National Early Warning Score (NEWS) to discriminate patients at risk of early cardiac arrest, unanticipated intensive care unit admission, and death. Resuscitation. 2013;84:465-470.
- 17. Smith GB, Redfern OC, Pimentel MA et al. The National Early Warning Score 2 (NEWS2). Clin Med (Lond). 2019 May;19:260.
- 18. Zhou B, Thao TTN, Hoffmann D et al. SARS-CoV-2 spike D614G change enhances replication and transmission. Nature 2021; 592:122-127.
- 19. Huang C, Wang Y, Li X et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506.
- 20. Vincent JL, Moreno R, Takala J H et al. The SOFA (Sepsis-Related Organ Failure Assessment) score to describe organ dysfunction/failure. Intensive Care Med. 1996;22:707–710.
Use of Early Warning Scoring Systems to Predict the Prognosis of COVID-19 Patients in the Emergency Department
Öz
Aim: Increased emergency department (ED) admissions and the need for intensive care unit (ICU) brought with the pandemic has led to the need to make fast and accurate decisions. Early warning scores (EWS) may be useful in ED in this regard. This study was performed to evaluate the effectiveness of EWS in predicting mortality and need for ICU of patients with COVID-19.
Materials and methods: This retrospective observational study was performed with subjects presented to the ED and were later admitted to a general ward or to the ICU because of COVID-19. Subjects aged ≥18 years with positive RT-PCR were included in the study. Subjects experienced a cardiac or respiratory arrest or intubated at the time of presentation to the ED and pregnant women were excluded from the study. MEWS, NEWS, NEWS-2, REMS, and qSOFA scores were calculated using patients’ data on first presentation. We examined the association of these scoring systems with mortality and need for ICU.
Results: While 60(10%) of the 600 patients participating in the study were admitted to the ICU, 222(37%) patients died. The scoring systems’ negative predictive values for predicting ICU admission were 0.95, 0.98, 0.97, 0.96, and 0.96 respectively and for predicting mortality were 0.61, 0.67, 0.67, 0.66, and 0.61 respectively. All scorings assessed were significant predictors of the need for ICU and mortality in patients with COVID-19.
Conclusions: All evaluated scoring systems were successful; however, NEWS and NEWS-2 had the highest predictive value both for the need for ICU and mortality.
Anahtar Kelimeler
Early warning score Emergency medicine COVID-19 prognosis mortality
Proje Numarası
yok
Kaynakça
- 1. Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72314 Cases From the Chinese Center for Disease Control and Prevention. JAMA 2020;323:1239-1242.
- 2. Wu C, Chen X, Cai Y et al. Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA Intern Med 2020;180:934-943.
- 3. Wang D, Hu B, Hu C et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA 2020;323:1061-1069.
- 4. Çınaroğlu OS, Efgan MG, Payza U. The relationship of lactate clearance with mortality in COVID-19 pneumonia. Ann Clin Anal Med 2022;13:85-88.
- 5. Çınaroğlu OS, Efgan MG, Payza U. A New Predictor of Mortality in COVID-19 Pneumonia: The BUN/Lymphocyte Ratio. Forbes J Med. 2023; 4: 89-94.
- 6. Efgan MG, Payza U, Çınaroğlu OS, Acar H, Kayalı A. A Comparison of BUN/Albumin Ratio with PSI and CURB-65 for Predicting Mortality in COVID-19 Pneumonia in the Emergency Department. İstanbul Med J 2022; 23: 296-300.
- 7. Kostakis I, Smith GB, Prytherch D, Meredith P, Price C, Chauhan A. The performance of the National Early Warning Score and National Early Warning Score 2 in hospitalised patients infected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Resuscitation. 2021;159:150-157. doi: 10.1016/j.resuscitation.2020.10.039.
- 8. Lyons PG, Edelson DP, Churpek MM. Rapid response systems. Resuscitation 2018;128:191-197.
- 9. Sandroni C, D’ArrigoS, Antonelli M. Rapid response systems: are they really effective? Crit Care 2015;19:104.
- 10. Jarvis S, Kovacs C, Briggs J et al. Can binary early warning scores perform as well as standard early warning scores for discriminating a patient’s risk of cardiac arrest, death or unanticipated intensive care unit admission? Resuscitation 2015;93:46-52.
- 11. Nannan Panday RS, Minderhoud TC, Alam N, Nanayakkara PWB. Prognostic value of early warning scores in the emergency department (ED) and acute medical unit (AMU): A narrative review. Eur J Intern Med 2017;45:20-31.
- 12. Olsson T, Terent A, Lind L. Rapid Emergency Medicine score: a new prognostic tool for in-hospital mortality in nonsurgical emergency department patients. J Intern Med 2004;255:579-587.
- 13. McGinley A, Pearse R. A national early warning score for acutely ill patients. BMJ 2012;345:e5310.
- 14. Subbe CP, Kruger M, Rutherford P, Gemmel L. Validation of a modified Early Warning Score in medical admissions. QJM. 2001;94:521-526.
- 15. Covino M, Sandroni C, Santoro M et al. Predicting intensive care unit admission and death for COVID-19 patients in the emergency department using early warning scores. Resuscitation. 2020;156:84-91.
- 16. Smith GB, Prytherch DR, Meredith P, Schmidt PE, Featherstone PI. The ability of the National Early Warning Score (NEWS) to discriminate patients at risk of early cardiac arrest, unanticipated intensive care unit admission, and death. Resuscitation. 2013;84:465-470.
- 17. Smith GB, Redfern OC, Pimentel MA et al. The National Early Warning Score 2 (NEWS2). Clin Med (Lond). 2019 May;19:260.
- 18. Zhou B, Thao TTN, Hoffmann D et al. SARS-CoV-2 spike D614G change enhances replication and transmission. Nature 2021; 592:122-127.
- 19. Huang C, Wang Y, Li X et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506.
- 20. Vincent JL, Moreno R, Takala J H et al. The SOFA (Sepsis-Related Organ Failure Assessment) score to describe organ dysfunction/failure. Intensive Care Med. 1996;22:707–710.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Orjinal Araştırma |
| Yazarlar | |
| Proje Numarası | yok |
| Yayımlanma Tarihi | 31 Mayıs 2023 |
| Kabul Tarihi | 30 Mayıs 2023 |
| Yayımlandığı Sayı | Yıl 2023 Cilt: 13 Sayı: 3 |
