MEW skoru ve Perfüzyon İndeksi parametrelerinin kritik hastaların belirlenmesindeki değerinin araştırılması- prospektif bir çalışma
Öz
Kalabalık acil servislerde kritik hastaları diğerlerinden ayırmak ve erken müdahaleyi sağlamak için triyaj ve skorlama sistemleri geliştirilmiştir. Hastaların triyajında Perfüzyon indeksinin faydasını ve Modifiye Erken Uyarı skoru(MEWS) ile karşılaştırma ve kombinasyon halinde mortalite ile ilişkisini belirlemeyi amaçladık. Bu tek merkezli ve prospektif bir çalışmadır. Çalışmaya acil serviste sarı veya kırmızı triyaj kodu alan hastalar dahil edildi. MEWS puanları hasta verilerinden hesaplanmıştır. Perfüzyon indeksi değeri, problu bir Masimo® cihazı kullanılarak ölçüldü. Hastaların sonuçları ve bir aylık mortalite durumları kaydedildi. Çalışmaya 397 hasta dahil edildi. Acil servisten taburcu edilen hastalarda ortalama perfüzyon indeksi ve modifiye erken uyarı skoru sırasıyla 4,05 (± 2,67) ve 1,99, acil serviste ölen hastalarda sırasıyla 1,12 (± 0,97) ve 7,5 idi. Son olarak MEWS değeri perfüzyon indeksine eklenmiş ve oluşturulan modelin mortaliteye etkisi değerlendirilmiştir. Bu durumda yeni model, %98,6 hassasiyet ve %45,1 özgüllük ile %91,7 doğru sınıflandırma oranına sahipti. Nagelkerke'nin 0,434 olan R2'si, modelin bağımlı değişkeni (mortalite) açıklamada %43,4 oranında etkili olduğunu öne sürdü. Perfüzyon indeksi ve modifiye erken uyarı skorunun birlikte kullanılması kritik hastaların belirlenmesinde daha yüksek güvenilirlik sağladığından müdahale konusunda erken karar vermek ve mortaliteyi önlemek mümkün olacaktır.
Anahtar Kelimeler
Kritik hasta Acil Modifiye erken uyarı skoru Perfüzyon indeksi Triyaj
Kaynakça
- 1. Fernandes CM, Tanabe P, Gilboy N, Johnson LA, McNair RS, Rosenau AM, Sawchuk P, Thompson DA, Travers DA, Bonalumi N, Suter RE. Five-level triage: a report from the ACEP/ENA Five-level Triage Task Force. J Emerg Nurs. 2005;31:39-50.
- 2. Chen W, Linthicum B, Argon NT, Bohrmann T, Lopiano K, Mehrotra A, Travers D, Ziya S. The effects of emergency department crowding on triage and hospital admission decisions. Am J Emerg Med. 2020;38:774-9. 3. Lauridsen S. Emergency care, triage, and fairness. Bioethics 2020;34:450-8.
- 4. Morgan, R. J. M., F. Williams, M. M. Wright. "An early warning scoring system for detecting developing critical illness. Clin Intensive Care 8.2 1997: 100.
- 5. Stenhouse C, Coates S, Tivey M, Allsop P, Parker T. Prospective evaluation of a modified Early Warning Score to aid earlier detection of patients developing critical illness on a general surgical ward [Abstract]. Br J Anaesth 1999;84:663P.
- 6. Shaikh MA, Punshi A, Talreja ML, Rasheed T, Bader N, Zuberi BF. Comparison of within 7 Day All-Cause Mortality among HDU Patients with Modified Early Warning Score of ≥5 with those with Score of <5. Pak J Med Sci. 2021;37:515-9.
- 7. Subbe CP, Kruger M, Rutherford P, Gemmel L. Validation of a modified Early Warning Score in medical admissions. QJM. 2001;94:521-6.
- 8. Lima A, Bakker J. Noninvasive monitoring of peripheral perfusion. Intensive Care Med. 2005;31:1316-26.
- 9. Elshal MM, Hasanin AM, Mostafa M, Gamal RM. Plethysmographic Peripheral Perfusion Index: Could It Be a New Vital Sign? Front Med (Lausanne). 2021;8:651909.
- 10. Yataklı Sağlık Tesislerinde Acil Servis Hizmetlerinin Uygulama Usul Ve Esaslari Hakkinda Tebliğ 13.09.2022 Sayı : 31952. https://www.resmigazete.gov.tr/eskiler/2022/09/20220913-5.htm
- 11. Oskay A, Eray O, Dinç SE, Aydın AG, Eken C. Prognosis of Critically ill patients in the ED and value of perfusion index measurement: a cross-sectional study. Am J Emerg Med. 2015;33:1042-4.
- 12. Rad-G Pulse Oximeter kullanıcı el kitabı. https://techdocs.masimo.com/globalassets/techdocs/pdf/lab-10818b.pdf
- 13. Hasanin A, Mukhtar A, Nassar H. Perfusion indices revisited. J Intensive Care. 2017;5:24.
- 14. Lima AP, Beelen P, Bakker J. Use of a peripheral perfusion index derived from the pulse oximetry signal as a noninvasive indicator of perfusion. Crit Care Med. 2002;30:1210-3.
- 15. He H, Long Y, Liu D, Wang X, Zhou X. Clinical classification of tissue perfusion based on the central venous oxygen saturation and the peripheral perfusion index. Crit Care. 2015;19:330.
- 16. Savastano S, Baldi E, Contri E, De Pirro A, Sciutti F, Compagnoni S, Fracchia R, Primi R, Frigerio L, Gentile FR, Visconti LO, Palo A. Post-ROSC peripheral perfusion index discriminates 30-day survival after out-of-hospital cardiac arrest. Intern Emerg Med. 2021;16:455-62.
- 17. 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. 2008;15:338-40
- 18. Bhatnagar M, Sirohi N, Dubey AB. Prediction of hospitaloutcome in emergencymedicaladmissionsusingmodifiedearlywarningscore (MEWS): Indianexperience. J FamilyMed Prim Care. 2021;10:192-198.
- 19. Maftoohian M, Assarroudi A, Stewart JJ, Dastani M, Rakhshani MH, Sahebkar M. Evaluating the Use of a Modified Early Warning Score in Predicting Serious Adverse Events in Iranian Hospitalized Patients: A Prognostic Study. J Emerg Nurs. 2020;46:72-82.
Investigation of the value of MEW score and Perfusion Index parameters in identifying critically ill patients- a prospective study
Öz
Triage and scoring systems have been developed to differentiate critical patients from others and to ensure early intervention in crowded emergency departments. We aimed to determine the utility of the perfusion index in the triage of patients, and its association with mortality in comparison and combination with the Modified Early Warning score. This was a single-center and prospective study. The study included patients who received yellow or red triage code in emergency department. The modified Early Warning scores were calculated from patients data. The perfusion index value was measured using a Masimo® device with probe. The outcomes of the patients and one-month mortality were recorded. 397 patients were included in the study. Mean perfusion index and Modified Early Warning score was 4.05 (± 2.67) and 1.99, respectively in patients discharged from the emergency department, 1.12 (± 0.97) and 7.5, respectively in patients deceased at the emergency department. Finally, the Modified Early Warning score was added to the perfusion index and the effect of the created model on mortality was evaluated. In this case, the new model had an accurate classification rate of 91.7%, with a sensitivity of 98.6% and a specificity of 45.1%. Nagelkerke’s R2 of 0.434 suggested that the model was effective in explaining the dependent variable (mortality) at a rate of 43.4%. It would be possible to make early decisions on intervention and prevent mortality since the combined use of perfusion index and Modified Early Warning score provide higher reliability in identifying critical patients.
Anahtar Kelimeler
critically ill emergency modified early warning score perfusion index triage
Kaynakça
- 1. Fernandes CM, Tanabe P, Gilboy N, Johnson LA, McNair RS, Rosenau AM, Sawchuk P, Thompson DA, Travers DA, Bonalumi N, Suter RE. Five-level triage: a report from the ACEP/ENA Five-level Triage Task Force. J Emerg Nurs. 2005;31:39-50.
- 2. Chen W, Linthicum B, Argon NT, Bohrmann T, Lopiano K, Mehrotra A, Travers D, Ziya S. The effects of emergency department crowding on triage and hospital admission decisions. Am J Emerg Med. 2020;38:774-9. 3. Lauridsen S. Emergency care, triage, and fairness. Bioethics 2020;34:450-8.
- 4. Morgan, R. J. M., F. Williams, M. M. Wright. "An early warning scoring system for detecting developing critical illness. Clin Intensive Care 8.2 1997: 100.
- 5. Stenhouse C, Coates S, Tivey M, Allsop P, Parker T. Prospective evaluation of a modified Early Warning Score to aid earlier detection of patients developing critical illness on a general surgical ward [Abstract]. Br J Anaesth 1999;84:663P.
- 6. Shaikh MA, Punshi A, Talreja ML, Rasheed T, Bader N, Zuberi BF. Comparison of within 7 Day All-Cause Mortality among HDU Patients with Modified Early Warning Score of ≥5 with those with Score of <5. Pak J Med Sci. 2021;37:515-9.
- 7. Subbe CP, Kruger M, Rutherford P, Gemmel L. Validation of a modified Early Warning Score in medical admissions. QJM. 2001;94:521-6.
- 8. Lima A, Bakker J. Noninvasive monitoring of peripheral perfusion. Intensive Care Med. 2005;31:1316-26.
- 9. Elshal MM, Hasanin AM, Mostafa M, Gamal RM. Plethysmographic Peripheral Perfusion Index: Could It Be a New Vital Sign? Front Med (Lausanne). 2021;8:651909.
- 10. Yataklı Sağlık Tesislerinde Acil Servis Hizmetlerinin Uygulama Usul Ve Esaslari Hakkinda Tebliğ 13.09.2022 Sayı : 31952. https://www.resmigazete.gov.tr/eskiler/2022/09/20220913-5.htm
- 11. Oskay A, Eray O, Dinç SE, Aydın AG, Eken C. Prognosis of Critically ill patients in the ED and value of perfusion index measurement: a cross-sectional study. Am J Emerg Med. 2015;33:1042-4.
- 12. Rad-G Pulse Oximeter kullanıcı el kitabı. https://techdocs.masimo.com/globalassets/techdocs/pdf/lab-10818b.pdf
- 13. Hasanin A, Mukhtar A, Nassar H. Perfusion indices revisited. J Intensive Care. 2017;5:24.
- 14. Lima AP, Beelen P, Bakker J. Use of a peripheral perfusion index derived from the pulse oximetry signal as a noninvasive indicator of perfusion. Crit Care Med. 2002;30:1210-3.
- 15. He H, Long Y, Liu D, Wang X, Zhou X. Clinical classification of tissue perfusion based on the central venous oxygen saturation and the peripheral perfusion index. Crit Care. 2015;19:330.
- 16. Savastano S, Baldi E, Contri E, De Pirro A, Sciutti F, Compagnoni S, Fracchia R, Primi R, Frigerio L, Gentile FR, Visconti LO, Palo A. Post-ROSC peripheral perfusion index discriminates 30-day survival after out-of-hospital cardiac arrest. Intern Emerg Med. 2021;16:455-62.
- 17. 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. 2008;15:338-40
- 18. Bhatnagar M, Sirohi N, Dubey AB. Prediction of hospitaloutcome in emergencymedicaladmissionsusingmodifiedearlywarningscore (MEWS): Indianexperience. J FamilyMed Prim Care. 2021;10:192-198.
- 19. Maftoohian M, Assarroudi A, Stewart JJ, Dastani M, Rakhshani MH, Sahebkar M. Evaluating the Use of a Modified Early Warning Score in Predicting Serious Adverse Events in Iranian Hospitalized Patients: A Prognostic Study. J Emerg Nurs. 2020;46:72-82.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | ORİJİNAL MAKALELER / ORIGINAL ARTICLES |
| Yazarlar | |
| Yayımlanma Tarihi | 20 Temmuz 2023 |
| Yayımlandığı Sayı | Yıl 2023 Cilt: 45 Sayı: 4 |