Investigation of the Relationship between Early Warning Scores and Clinical Course in Patients Presenting to the Emergency Department with Hematuria

Öz

This study aimed to investigate the relationship between the the Modified Early Warning Score, the National Early Warning Score 2, the Rapid Emergency Medicine Score (REMS), and the Emergency Department Triage Early Warning Score, and shock index at presentation to the emergency department in patients with hematuria presenting to the emergency department, and mortality on days 28 and 90. Patients presenting with hematuria to a single-center, tertiary emergency department were retrospectively analyzed. Mortality on days 28 and 90 after the emergency department discharge was analyzed. A total of 179 patients were included in the study. The median age of the patients was 69 years [Inter Quartile Range (IQR), 25-75: 61-79)], and 137 (76.5%) were male. In the receiver operating characteristic analysis (ROC) performed for the 28- and 90-day mortality prediction values of the patients, only the REMS score was found to be statistically significant. The area under the curve (AUC) value of the REMS score for 28-day mortality prediction was 0.740 [95% Confidence interval (CI) (0.538-0.943)], (p<0.05), and the AUC value of the REMS score for 90-day mortality prediction was 0.685 [(95% CI 0.541-0.828), (p<0.05)]. When the REMS score was set at a cutoff value of 6.5 for 28-day mortality prediction, the sensitivity was 71.4% and the specificity was 73.3%. When the cutoff value was set at 5.5 for 90-day mortality prediction, the sensitivity was 90.9% and the specificity was 45.2%. We found that REMS is superior to other early warning scores in predicting short- and medium-term mortality. These findings support the routine use of REMS in emergency departments, contributing to timely and effective intervention for patients at high risk of mortality.

Anahtar Kelimeler

• Early Warning Scores
• Hematuria
• Mortality

Acil Servise Hematüri ile Başvuran Hastalarda Erken Uyarı Skorları ile Klinik Seyir Arasındaki İlişkinin Araştırılması

Öz

Bu çalışmanın amacı, acil servise başvuran hematürili hastalarda başvuru esnasında, Modified Early Warning Skor, National Early Warning Skor 2, Rapid Emergency Medicine Skor (REMS), Emergency Department Triage Early Warning Skorları ve şok indeksinin ile bu hastalarda 28. ve 90. günlerde meydana gelen mortalite durumu arasındaki ilişkiyi araştırmaktır. Tek merkezli, 3. basamak bir acil servise hematüri ile başvuran hastalar retrospektif olarak incelendi. Acil servis sonlanımından sonra 28. ve 90. Günlerdeki mortalite durumları incelendi. Çalışmaya toplam 179 hasta dahil edildi. Hastaların, ortanca yaşı 69 [Inter Quartile Range (IQR) ,25-75: 61-79] yıl ve 137’si (%76,5) erkek olarak saptandı. Hastaların, 28 ve 90 günlük mortalite tahmini değerleri için yapılan receiver operating characteristic (ROC) analizinde sadece REMS skorunun istatistiksel olarak anlamlı olduğu saptandı. 28 günlük mortalite tahmini için REMS skorunun eğri altındaki alan (AUC) değeri, 0,740 [%95 Güven Aralığı (GA) (0,538-0,943), (p<0,05)], 90 günlük mortalite tahmini için REMS skorunun AUC değeri, 0,685 [(%95 GA 0,541-0,828), (p<0,05)] olarak saptandı. REMS skorunun 28 günlük mortalite tahmininde kesim değeri 6,5 olduğunda sensitivitesi %71,4, spesifitesi %73,3, 90 günlük mortalite tahmininde ise kesim değeri 5,5 olduğunda sensitivitesi %90,9, spesifitesi %45,2 olarak saptandı. REMS’ in kısa ve orta vadeli mortaliteyi öngörmede diğer erken uyarı skorlarından üstün olduğunu saptadık. Bu bulgular, REMS’ in acil servislerde rutin kullanımını destekleyerek, yüksek mortalite riski taşıyan hastaların zamanında ve etkili müdahale almasına katkı sağlayabilir.

Anahtar Kelimeler

• Erken Uyarı Skorları
• Hematüri
• Mortalite

Kaynakça

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