Acil Servislerden Yoğun Bakım Ünitesine Kabul Edilen Yaşlı Erişkin Hastaların Sonuç Belirleyicileri

Year 2021, Volume: 8 Issue: 3, 189 - 194, 28.12.2021

Kamil Kokulu , Ekrem Taha Sert , Hüseyin Mutlu , Ayhan Sarıtaş

https://doi.org/10.47572/muskutd.829593

Abstract

Klinisyenler arasında yaşlı hastaların yoğun bakım ünitesine(YBÜ) kabulüne ilişkin kriterler konusunda fikir birliği bulunmamaktadır. Bu çalışmada, Acil servisten(AS) YBÜ’ye yatırılan yaşlı hastalarda AS’ye kabul sırasında değerlendirilen risk faktörlerinin mortaliteye etkisini belirlemeyi amaçladık. 1 Ocak 2019-31 Aralık 2019 tarihleri arasında YBÜ’ye kabul edilen 65 yaş ve üzeri hastalar retrospektif olarak alındı. Hastalar yaşlarına göre iki gruba ayrıldı: 65-74 yaş, 75 yaş ve üzeri. Klinik ve demografik verileri değerlendirilmiştir; hastalar yaş gruplarına göre analiz edildi. Risk faktörlerinin YBÜ’deki mortalitesine etkisi lojistik regresyon analizi kullanılarak belirlendi. Çalışmaya dahil edilen 839 hastanın %66.3'ü 65-74 yaş grubu, %33.7'si ≥75 yaş grubu idi. Hastaların %24.7’si (n=207) öldü. Mortaliteyi etkileyen risk faktörlerinin düşük ortalama arteriyel basınç (OR=0.98, 95%CI:0.97-0.99), düşük Glasgow Koma Skoru (OR=0.73, 95% CI:0.66-0.80), entübasyon ihtiyacı (OR=12.58, 95%CI:6.02–26.30), altta yatan bir kanser tanısı (OR = 7.23, 95% CI: 2.60-20.16), ve AS’de uzun kalış süresi (OR=1.65, 95% CI:1.46–1.87) olduğunu saptadık. Yaşın tek başına yoğun bakımda mortalite ile ilişkili olmadığını tespit ettik (p=0.122). Mortaliteyi etkileyen risk faktörleri göz önünde bulundurularak AS’den YBÜ’ye kabulü düşünülmelidir. 

Keywords

Acil Servis, Mortalite, Yaşlı Erişkin Hastalar, Yoğun Bakım Ünitesi

Determinants of Outcomes in Older Adult Patients Admitted to The Intensive Care Unit from The Emergency Department

Abstract

There is no consensus among clinicians on the criteria for admission of older adult patients to the intensive care unit (ICU). In this study, we aimed to determine the impact of risk factors assessed during admission to the emergency department (ED) in older adult patients admitted to the ICU from the ED on ICU mortality. Patients aged 65 years or older, who were admitted to the ICU between January 1, 2019, and December 31, 2019, were retrospectively evaluated. Patients were divided into two groups according to their age: 65–74 years old and 75 years and older. Clinical and demographic data were evaluated and patients were analyzed according to the age groups. The association of risk factors on ICU mortality was determined using logistic regression analysis. Of the 839 patients included in the study, 66.3% were in the 65–74 age group and 33.7% were in the ≥75 age group. A proportion of 24.7% of the patients (n=207) died. The risk factors associated with ICU mortality were low mean arterial pressure (OR=0.98, 95% CI:0.97-0.99), low Glasgow Coma Scale score (OR=0.73, 95% CI:0.66-0.80), intubation requirement (OR=12.58, 95% CI:6.02–26.30), underlying cancer diagnosis (OR = 7.23, 95% CI: 2.60-20.16), and long stay in the ED (OR=1.65, 95% CI:1.46–1.87).Age alone was not associated with ICU mortality (p=0.122). Admission to the ICU from the ED should consider the risk factors associated with ICU mortality. 

Keywords

Emergency Department, Intensive Care Unit, Older Adult Patients, Mortality

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