Acil servise başvuran kritik yaşlı hastalarda kısa dönem mortalite tahmininde risk skorlarının karşılaştırılması
Comparison of risk scores in the estimation of short-term mortality of critically ill elder patients admitted to the emergency department
Yazar: OSMAN KAYA
Danışman: PROF. DR. ÖZLEM KÖKSAL
Bursa Uludağ Üniversitesi / Tıp Fakültesi / Acil Tıp Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2022
Konu: Acil Tıp = Emergency Medicine
Dizin: Acil servis-hastane = Emergency service-hospital ; Acil tıp = Emergency medicine ; Mortalite = Mortality ; Risk faktörleri = Risk factors ; Yaşlılar = Aged ; Ölçekler = Scales

Özet:
Amaç: Bu yapılan çalışmanın amacı acil servise başvuran 65 yaş ve
üzerindeki hastaların "National Early Warning Score (NEWS)", "Rapid
Emergency Medicine Score (REMS)", "VITALPAC Early Warning Score
(ViEWS)" ve "Emergency Department Triage Early Warning Score
(TREWS)" skorlarını kullanarak kısa dönem mortalite tahminlerini
incelemektir.
Metod: Bu prospektif çalışma Bursa Uludağ Üniversitesi Tıp Fakültesi
Acil Servisinde 16 Nisan 2022 – 31 Aralık 2022 tarihleri arasında
gerçekleştirilmiştir. Bu tarihlerde Acil Servise travma dışı nedenlerle
başvuran 65 yaş ve üzeri 311 olgu çalışmaya dahil edilmiştir. Olguların
Acil servis başvurularında NEWS, REMS, VİEWS ve TREWS skorları
kaydedilmiştir.
Bulgular: Hastaların yaş ortalaması 75,05±7,18 yıl idi. En sık başvuru
nedeni %36,3'lük oranı ile nefes darlığı oldu. Başvurularda erkek
cinsiyet daha fazla olarak görüldü ve en sık ek hastalık kronik kalp
hastalığı idi. Manchester Triyaj Skoruna (MTS) bakıldığında %39,2'si
kırmızı, %60,8'i turuncu kategorideydi. Hastaların %46'ı taburcu edildi,
%25'i kliniğe yatırıldı, %26'sı yoğun bakım ünitesine yatırıldı, %3'ü ise
tedaviyi red ile acil servisten ayrıldı. Hastaların %87,5'i 30 günün
sonunda yaşıyorken %12,5'i exitus olduğu görüldü. MTS skoru kırmızı
olanlarda, oksijen desteği verilenlerde mortalite belirgin
yüksekti(p<0,001). AVPU skalasında Alert olarak değerlendirilen
hastalarda mortalite daha düşüktü(p<0,001). NEWS skorunun kesim
noktası 6 olarak kabul edildiğinde sensitivitesi %50,0, spesifitesi
%89,89, VİEWS skorunun kesim noktası 3 olarak kabul edildiğinde
sensitivitesi %65,89, spesifitesi %71,16, TREWS skorunun kesim
noktası 8 olarak kabul edildiğinde sensitivitesi %36,84, spesifitesi
93,26, REMS skorunun kesim noktası 5 olarak kabul edildiğinde
sensitivitesi %89,47, spesifitesi %25,84 olarak bulundu. NEWS,
TREWS ve VİEWS skorlarının artmış mortalite ile ilişkili olduğu
görüldü(p<0,001).
Sonuç: Acil servise başvurusu olan yaşlı hastalarda kısa dönem
mortalite tahmininde NEWS, TREWS ve VİEWS skorlarının
kullanılabilmektedir.
Anahtar Kelimeler: Acil servis, yaşlılık, NEWS, VİEWS, TREWS

Abstract:
Aim: The aim of this study was to investigate the short-term mortality of
critically ill elder patients who were admitted to the emergency department
using the National Early Warning Score (NEWS), Rapid Emergency Medicine
Score (REMS), VITALPAC Early Warning Score (ViEWS) and Emergency
Department Triage Early Warning Score (TREWS).
Methods: This prospective study was conducted in Bursa Uludag University
Faculty of Medicine Emergency Medicine Department between 16 April 2022
and 31 December 2022. At that time, 311 cases aged 65 years and older who
applied to the Emergency Department with non-traumatic causes were
included in the study. NEWS, REMS, VIEWS and TREWS scores were
recorded in the Emergency Department admission time.
Results: The mean age of the patients was 75.05±7.18 years. The most
common etiological cause for admission was shortness of breath with a rate
of 36.3%.The male gender was more common and the most common disease
was chronic heart disease. According to the Manchester Triage Skore (MTS),
39.2% were in the red category and 60.8% were in the orange category. 46%
of the patients were discharged, 25% were admitted to the clinical wards, 26%
were admitted to the intensive care unit, and 3% refused treatment and left the
emergency room. While 87.5% of the patients were alive at the end of 30 days,
12.5% were exitus. Mortality was significantly higher in those with red MTS
scores and those given oxygen supplementation (p<0.001). Mortality was
lower in patients who were evaluated as alert on the AVPU scale (p<0.001).
When the cut-off point of the NEWS score was accepted as 6, its sensitivity
IX
was 50.0%, its specificity was 89.89%, its sensitivity was 65.89% when the
cutting point of the VIEWS score was accepted as 3, its specificity was 71.16%,
its sensitivity was 36.84% when the cutting point of the TREWS score was
accepted as 8, its specificity was 93.26%, and its sensitivity was 89.47% when
the cutting point of the REMS score was accepted as 5, and its specificity was
25.84%. NEWS, TREWS and VIEWS scores were associated with increased
mortality (p<0.001).
Conclusion: NEWS, TREWS and VIEWS scores can be used to estimate
short-term mortality in elderly patients admitted to the emergency department.
Keywords: Emergency department, elder , NEWS, VIEWS, TREWS