MEW skoru ve Perfüzyon İndeksi parametrelerinin kritik hastaların belirlenmesindeki değerinin araştırılması- prospektif bir çalışma

Year 2023, Volume: 45 Issue: 4, 495 - 503, 20.07.2023

Agit Akgül , Rezan Karaali , Zeynep Karakaya

https://doi.org/10.20515/otd.1242841

Abstract

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.

Keywords

Kritik hasta, Acil, Modifiye erken uyarı skoru, Perfüzyon indeksi, Triyaj

Investigation of the value of MEW score and Perfusion Index parameters in identifying critically ill patients- a prospective study

Abstract

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.

Keywords

critically ill, emergency, modified early warning score, perfusion index, triage

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