Ambulansla Taşınan Acil Servis Hastalarında Mortalite Öngörüsü: Karşılaştırmalı Retrospektif Kohort Çalışması
Öz
Giriş: Acil servislerde doğru ve zamanında triyaj, kritik hastaların belirlenmesini kolaylaştırarak bakım kalitesini artırır ve sağlık hizmeti kaynaklarının etkin kullanımını teşvik eder. Bu çalışmada, hastaneye ulaşmadan önce, ambulans ortamında elde edilen verilere dayanarak hesaplanan seçilmiş skorlama sistemlerinin kullanılabilirliğini değerlendirmeyi amaçladık.
Yöntemler: Bu retrospektif kohort çalışma, tek merkezde yürütüldü ve Haziran 2024 boyunca ambulansla acil servise getirilen 1.676 hasta dahil edildi. Her hasta için Rapid Emergency Medicine Score (REMS), Rapid Acute Physiology Score (RAPS), Şok İndeksi (SI) ve Glasgow Koma Skalası ile çarpılmış revize şok indeksi (rSIGCS) hesaplandı. Her bir skorlama sisteminin öngörü doğruluğunu değerlendirmek için receiver operating characteristic (ROC) eğrisi analizi kullanıldı. Ek olarak, mortalite ile ilişkili bağımsız risk faktörlerini belirlemek amacıyla çok değişkenli lojistik regresyon analizi gerçekleştirildi.
Bulgular: REMS, 24 saatlik mortaliteyi öngörmede en yüksek ayırt edici gücü gösterdi ve c-istatistik değeri 0.897 (95% GA: 0.881–0.911) idi. rSIGCS de iyi bir performans sergiledi; c-istatistik değeri 0.843 (95% GA: 0.824–0.860) idi. REMS ile rSIGCS arasında istatistiksel olarak anlamlı bir fark gözlenmedi (p = 0.216, DeLong testi), bu da her iki skorlama sisteminin de prehospital ortamda erken mortalite öngörüsü açısından etkili araçlar olabileceğini göstermektedir.
Sonuç: Bu çalışma, REMS ve rSIGCS’nin ambulansla acil servise taşınan travma dışı hastalarda erken mortaliteyi öngörmede etkili araçlar olduğunu ortaya koymuştur.
Anahtar Kelimeler
Kaynakça
- Kenny JF, Chang BC, Hemmert KC. Factors Affecting Emergency Department Crowding. Emerg Med Clin North Am. 2020;38:573-587.
- Sartini M, Carbone A, Demartini A, et al. Overcrowding in Emergency Department: Causes, Consequences, and Solutions-A Narrative Review. Healthcare (Basel). 2022;10:1625.
- Ghaffarzad A, Vahed N, Shams Vahdati S, Ala A, Jalali M. The Accuracy of Rapid Emergency Medicine Score in Predicting Mortality in Non-Surgical Patients: A Systematic Review and Meta-Analysis. Iran J Med Sci. 2022;47:83-94.
- Groening M, Wilke P. [Triage, screening, and assessment of geriatric patients in the emergency department]. Med Klin Intensivmed Notfmed. 2020;115:8-15.
- Rhee KJ, Fisher CJ, Willitis NH. The Rapid Acute Physiology Score. Am J Emerg Med. 1987;5:278-82.
- Olsson T, Terent A, Lind L. Rapid Emergency Medicine score: a new prognostic tool for in-hospital mortality in nonsurgical emergency department patients. J Intern Med. 2004;255:579-87.
- Lemeshow S, Teres D, Klar J, Avrunin JS, Gehlbach SH, Rapoport J. Mortality Probability Models (MPM II) based on an international cohort of intensive care unit patients. JAMA. 1993;270:2478-86.
- Olsson T, Lind L. Comparison of the rapid emergency medicine score and APACHE II in nonsurgical emergency department patients. Acad Emerg Med. 2003;10:1040-8.
- Tang W, Zha ML, Zhang WQ, Hu SQ, Chen HL. APACHE scoring system and pressure injury risk for intensive care patients: A systematic review and meta-analysis. Wound Repair Regen. 2022;30:498-508.
- T.C. Sağlık Bakanlığı Kamu Hastaneleri Genel Müdürlüğü, Genel Sağlık İstatistikleri.. Available at: https://www.saglik.gov.tr/TR-84930/saglik-istatistikleri-yilliklari.html. Accessed April 2, 2025
- Schneider S, Zwemer F, Doniger A, Dick R, Czapranski T, Davis E. Rochester, New York: a decade of emergency department overcrowding. Acad Emerg Med. 2001;8:1044-50.
- Authors, Mason J, Secord S, MacDougall D. Interventions Intended to Alleviate Emergency Department Overcrowding: CADTH Horizon Scan. Canadian Agency for Drugs and Technologies in Health; 2023. http://www.ncbi.nlm.nih.gov/books/NBK598239/. Accessed April 2, 2025.
- Ustaalioğlu İ, Ak R, Öztürk TC, Koçak M, Onur Ö. Investigation of the usability of the REMS, RAPS, and MPM II0 scoring systems in the prediction of short-term and long-term mortality in patients presenting to the emergency department triage. Ir J Med Sci. 2023;192:907-913.
- Wei X, Ma H, Liu R, Zhao Y. Comparing the effectiveness of three scoring systems in predicting adult patient outcomes in the emergency department. Medicine (Baltimore). 2019;98:e14289.
- Goodacre S, Turner J, Nicholl J. Prediction of mortality among emergency medical admissions. Emerg Med J. 2006;23:372-375.
- Akoglu H. User’s guide to sample size estimation in diagnostic accuracy studies. Turk J Emerg Med. 2022;22:177-185.
- GlobalTrafficScorecard.https://inrix.com/scorecard-city/?city=Ankara&index=27 Accessed April 2, 2025.
- Katayama Y, Kitamura T, Nakao S, et al. Telephone Triage for Emergency Patients Reduces Unnecessary Ambulance Use: A Propensity Score Analysis With Population-Based Data in Osaka City, Japan. Front Public Health. 2022;10:896506.
- Borg K, Dumas D, Andrew E, et al. Ambulances are for emergencies: shifting behaviour through a research-informed behaviour change campaign. Health Research Policy and Systems. 2020;18:9.
- Olsson M, Svensson A, Andersson H, et al. Educational intervention in triage with the Swedish triage scale RETTS©, with focus on specialist nurse students in ambulance and emergency care - A cross-sectional study. Int Emerg Nurs. 2022;63:101194.
- Conti A, Sacchetto D, Putoto G, et al. Implementation of the South African Triage Scale (SATS) in a New Ambulance System in Beira, Mozambique: A Retrospective Observational Study. Int J Environ Res Public Health. 2022;19:10298.
- Wallgren UM, Sjölin J, Järnbert-Pettersson H, Kurland L. Performance of NEWS2, RETTS, clinical judgment and the Predict Sepsis screening tools with respect to identification of sepsis among ambulance patients with suspected infection: a prospective cohort study. Scand J Trauma Resusc Emerg Med. 2021;29:144.
- Garkaz O, Rezazadeh F, Golfiroozi S, et al. Predicting the 28-Day Mortality of Non-Trauma Patients using REMS and RAPS; a Prognostic Accuracy Study. Arch Acad Emerg Med. 2022;10:e52.
- Şirin I, Sanalp Menekşe T, Akkoca M. Reverse shock index multiplied by simplified motor score as an indicator of clinical outcomes in patients with abdominal trauma in the emergency department: a retrospective cohort study. Ulus Travma Acil Cerrahi Derg. 2025;31:332-40.
- Wu MY, Hou YT, Chung JY, Yiang GT. Reverse shock index multiplied by simplified motor score as a predictor of clinical outcomes for patients with COVID-19. BMC Emerg Med. 2024;24:26.
Predicting Mortality in Ambulance-Transported Emergency Department Patients: A Comparative Retrospective Cohort Study
Öz
Introduction: Accurate and timely triage in emergency departments facilitates the identification of critically ill patients, thereby improving the quality of care and promoting the efficient use of healthcare resources. In this study, we aimed to assess the utility of selected scoring systems calculated using prehospital data obtained in the ambulance setting, with a focus on their applicability before hospital arrival.
Methods: This retrospective cohort study was conducted at a single center and included 1,676 patients who were brought to the emergency department via ambulance over the course of June 2024. For each patient, the Rapid Emergency Medicine Score (REMS), Rapid Acute Physiology Score (RAPS), Shock Index (SI), and the revised Shock Index multiplied by the Glasgow Coma Scale (rSIGCS) were calculated. To evaluate the predictive accuracy of each scoring system, receiver operating characteristic (ROC) curve analysis was employed. Additionally, multivariable logistic regression analysis was conducted to determine independent risk factors associated with mortality.
Results: The REMS demonstrated the highest discriminatory power for predicting 24-hour mortality, with c-statistics value of 0.897 (95% CI: 0.881–0.911). The rSIGCS also showed good performance, with c-statistics value of 0.843 (95% CI: 0.824–0.860). No statistically significant difference was observed between REMS and rSIGCS (p = 0.2166, DeLong test), suggesting that both scoring systems may serve as effective tools for early mortality prediction in the prehospital setting.
Conclusion: This study found that both REMS and rSIGCS are effective tools for predicting early mortality among non-trauma patients transported to the emergency department by ambulance.
Anahtar Kelimeler
Etik Beyan
Approval was obtained from Ankara Etlik City Hospital Ethics Committee (Approval No: AEŞH-BADEK-2025-0229, Date: February 26, 2025).
Teşekkür
None
Kaynakça
- Kenny JF, Chang BC, Hemmert KC. Factors Affecting Emergency Department Crowding. Emerg Med Clin North Am. 2020;38:573-587.
- Sartini M, Carbone A, Demartini A, et al. Overcrowding in Emergency Department: Causes, Consequences, and Solutions-A Narrative Review. Healthcare (Basel). 2022;10:1625.
- Ghaffarzad A, Vahed N, Shams Vahdati S, Ala A, Jalali M. The Accuracy of Rapid Emergency Medicine Score in Predicting Mortality in Non-Surgical Patients: A Systematic Review and Meta-Analysis. Iran J Med Sci. 2022;47:83-94.
- Groening M, Wilke P. [Triage, screening, and assessment of geriatric patients in the emergency department]. Med Klin Intensivmed Notfmed. 2020;115:8-15.
- Rhee KJ, Fisher CJ, Willitis NH. The Rapid Acute Physiology Score. Am J Emerg Med. 1987;5:278-82.
- Olsson T, Terent A, Lind L. Rapid Emergency Medicine score: a new prognostic tool for in-hospital mortality in nonsurgical emergency department patients. J Intern Med. 2004;255:579-87.
- Lemeshow S, Teres D, Klar J, Avrunin JS, Gehlbach SH, Rapoport J. Mortality Probability Models (MPM II) based on an international cohort of intensive care unit patients. JAMA. 1993;270:2478-86.
- Olsson T, Lind L. Comparison of the rapid emergency medicine score and APACHE II in nonsurgical emergency department patients. Acad Emerg Med. 2003;10:1040-8.
- Tang W, Zha ML, Zhang WQ, Hu SQ, Chen HL. APACHE scoring system and pressure injury risk for intensive care patients: A systematic review and meta-analysis. Wound Repair Regen. 2022;30:498-508.
- T.C. Sağlık Bakanlığı Kamu Hastaneleri Genel Müdürlüğü, Genel Sağlık İstatistikleri.. Available at: https://www.saglik.gov.tr/TR-84930/saglik-istatistikleri-yilliklari.html. Accessed April 2, 2025
- Schneider S, Zwemer F, Doniger A, Dick R, Czapranski T, Davis E. Rochester, New York: a decade of emergency department overcrowding. Acad Emerg Med. 2001;8:1044-50.
- Authors, Mason J, Secord S, MacDougall D. Interventions Intended to Alleviate Emergency Department Overcrowding: CADTH Horizon Scan. Canadian Agency for Drugs and Technologies in Health; 2023. http://www.ncbi.nlm.nih.gov/books/NBK598239/. Accessed April 2, 2025.
- Ustaalioğlu İ, Ak R, Öztürk TC, Koçak M, Onur Ö. Investigation of the usability of the REMS, RAPS, and MPM II0 scoring systems in the prediction of short-term and long-term mortality in patients presenting to the emergency department triage. Ir J Med Sci. 2023;192:907-913.
- Wei X, Ma H, Liu R, Zhao Y. Comparing the effectiveness of three scoring systems in predicting adult patient outcomes in the emergency department. Medicine (Baltimore). 2019;98:e14289.
- Goodacre S, Turner J, Nicholl J. Prediction of mortality among emergency medical admissions. Emerg Med J. 2006;23:372-375.
- Akoglu H. User’s guide to sample size estimation in diagnostic accuracy studies. Turk J Emerg Med. 2022;22:177-185.
- GlobalTrafficScorecard.https://inrix.com/scorecard-city/?city=Ankara&index=27 Accessed April 2, 2025.
- Katayama Y, Kitamura T, Nakao S, et al. Telephone Triage for Emergency Patients Reduces Unnecessary Ambulance Use: A Propensity Score Analysis With Population-Based Data in Osaka City, Japan. Front Public Health. 2022;10:896506.
- Borg K, Dumas D, Andrew E, et al. Ambulances are for emergencies: shifting behaviour through a research-informed behaviour change campaign. Health Research Policy and Systems. 2020;18:9.
- Olsson M, Svensson A, Andersson H, et al. Educational intervention in triage with the Swedish triage scale RETTS©, with focus on specialist nurse students in ambulance and emergency care - A cross-sectional study. Int Emerg Nurs. 2022;63:101194.
- Conti A, Sacchetto D, Putoto G, et al. Implementation of the South African Triage Scale (SATS) in a New Ambulance System in Beira, Mozambique: A Retrospective Observational Study. Int J Environ Res Public Health. 2022;19:10298.
- Wallgren UM, Sjölin J, Järnbert-Pettersson H, Kurland L. Performance of NEWS2, RETTS, clinical judgment and the Predict Sepsis screening tools with respect to identification of sepsis among ambulance patients with suspected infection: a prospective cohort study. Scand J Trauma Resusc Emerg Med. 2021;29:144.
- Garkaz O, Rezazadeh F, Golfiroozi S, et al. Predicting the 28-Day Mortality of Non-Trauma Patients using REMS and RAPS; a Prognostic Accuracy Study. Arch Acad Emerg Med. 2022;10:e52.
- Şirin I, Sanalp Menekşe T, Akkoca M. Reverse shock index multiplied by simplified motor score as an indicator of clinical outcomes in patients with abdominal trauma in the emergency department: a retrospective cohort study. Ulus Travma Acil Cerrahi Derg. 2025;31:332-40.
- Wu MY, Hou YT, Chung JY, Yiang GT. Reverse shock index multiplied by simplified motor score as a predictor of clinical outcomes for patients with COVID-19. BMC Emerg Med. 2024;24:26.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Acil Tıp |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 28 Temmuz 2025 |
| Gönderilme Tarihi | 18 Nisan 2025 |
| Kabul Tarihi | 21 Mayıs 2025 |
| Yayımlandığı Sayı | Yıl 2025 Cilt: 6 Sayı: 2 |
Kaynak Göster
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