Yoğun bakım hastalarında Deliryum tanısında kullanılan; yoğun bakım hastalarında Deliryum tahmin modeli versiyon 1-2, yoğun bakım hastalarında Deliryum için erken öngörü modeli ve yoğun bakım Deliryum tarama kontrol listesi araçlarının etkinliklerinin karşılaşılaştırılması
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Tarih
2022
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Trakya Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Çalışmamızda yoğun bakım hastalarında deliryum tahmin modeli olan Pre-deliric ve E-pre-deliric tahmin modellerinin etkinliğini Yoğun Bakım Deliryum Tarama Kontrol Listesi ile karşılaştırdık; yoğun bakım hastaları için kullanılabilirliklerini ve cut-off değerlerini saptamayı amaçladık. Kasım 2017 - Haziran 2019 tarihleri arasında Trakya Üniversitesi Tıp Fakültesi Anesteziyoloji ve Reanimasyon Yoğun Bakım Kliniğine başvuran ve kriterleri karşılayan 250 hasta çalışmaya dahil edildi. Hastalar günde 2 defa Yoğun Bakım Deliryum Tarama Kontrol Listesi ile değerlendirilerek aldıkları en yüksek puana göre sınıflandırıldı ( ?4 puan deliryum pozitif, yatış süresince sıfır puan deliryum negatif). Hastaların yaş, cinsiyet, tanı, kronik hastalık varlığı, başvuru kategorisi, travma öyküsü, resüsitasyon kullanımı, sedasyon kullanımı, mekanik ventilatör kullanımı, yoğun bakım ve hastane yatış süresi, hastane mortalitesi, Akut Fizyoloji ve Kronik Sağlık Değerlendirme Puanı-II, tehlikeli davranışları kaydedildi. E-pre-deliric, Pre-deliric versiyon-1 ve versiyon-2 skorları hesaplandı. Çalışmaya alınan olguların %55,6’sı erkekti. Yaş ortalaması 60.6 ± 18.7 idi. Erkeklerde ve ileri yaşta deliryum daha sık gözlendi. Hastaların Akut Fizyoloji ve Kronik Sağlık Değerlendirme Puanı-II ortalaması; 17.0 ± 9.1 idi ve skoru yüksek olanlarda deliryum daha sık görüldü. Acil başvuran, travma öyküsü olan, üre veya kreatinin değerleri yüksek olan, sedasyon uygulanan, mekanik ventilatör tedavisi alan hastalarda deliryum daha çok saptandı. Deliryum gelişen hastaların yoğun bakım ve hastanede kalış süresi daha uzun, mortalitesi daha yüksekti. Pre-deliric versiyon-1 için cut-off değeri >%38 (AUROC=1), Pre- deliric versiyon-2 için cut-off değeri % >%22 (AUROC=1), E-Pre-deliric için, cut-off değeri >%28 (AUROC=1) olarak belirlendi. Çalışmamız sayesinde ilk defa Pre-deliric ve E-pre-deliric tahmin modellerinin Yoğun Bakım Deliryum Tarama Kontrol Listesi ile kalibrasyonu sağlanmış ve her iki model kendi aralarında karşılaştırılmıştır. Bu modellerin geçerliliği ve güvenilirliği desteklenmiş, kullanışlı olduğu görülmüş, cut –off değerleri belirlenmiştir.
In our study, we compared the effectiveness of the Pre-deliric and E-pre-deliric models, which are the delirium prediction models in intensive care unit, with Intensive Care Delirium Screening Checklist; we aimed to determine their usability and cut-off values for intensive care patients. In the study, 250 patients who were admitted to Trakya University Faculty of Medicine, Anesthesiology and Reanimation Intensive Care Clinic between November 2017 - June 2019 and met the criteria were included. The patients were classified according to the highest score they received by evaluating twice a day with Intensive Care Delirium Screening Checklist (?4 points delirium positive, during hospitalization zero points delirium negative). Patients age, gender, diagnosis, presence of chronic disease, application category, trauma history, applying resuscitation, sedation use, mechanical ventilator use, intensive care and hospitalization time, hospital mortality, Acute Physiology and Chronic Health Assessment Score-II, dangerous behaviors were recorded. E-pre-deliric, Pre-deliric version-1 and version- 2 scores were calculated. In the study, 55.6% of the cases included were male. The mean age was 60.6 ± 18.7. Delirium was more common in patients who were men, older age, urgent applicants, had a history of trauma, had high urea or creatinine values, received sedation and mechanical ventilation. The mean Acute Physiology and Chronic Health Assessment Score-II was 17.0 ± 9.1 and delirium was more common in those with high scores. Intensive care and hospital stay of patients who developed delirium was longer and their mortality was higher. The cut-off value for Pre-deliric version-1 was >38% (AUROC=1) and the cut-off value for Pre-deliric version-2 was >22% (AUROC=1). For the E-Pre-deliric, the cut-off value was >28% (AUROC=1). Through our study, the Pre-deliric and E-pre-deliric models were calibrated with Intensive Care Delirium Screening Checklist for the first time and both models were compared between themselves. Validity and reliability of these models were supported, they were found to be useful, and cut-off values were determined.
In our study, we compared the effectiveness of the Pre-deliric and E-pre-deliric models, which are the delirium prediction models in intensive care unit, with Intensive Care Delirium Screening Checklist; we aimed to determine their usability and cut-off values for intensive care patients. In the study, 250 patients who were admitted to Trakya University Faculty of Medicine, Anesthesiology and Reanimation Intensive Care Clinic between November 2017 - June 2019 and met the criteria were included. The patients were classified according to the highest score they received by evaluating twice a day with Intensive Care Delirium Screening Checklist (?4 points delirium positive, during hospitalization zero points delirium negative). Patients age, gender, diagnosis, presence of chronic disease, application category, trauma history, applying resuscitation, sedation use, mechanical ventilator use, intensive care and hospitalization time, hospital mortality, Acute Physiology and Chronic Health Assessment Score-II, dangerous behaviors were recorded. E-pre-deliric, Pre-deliric version-1 and version- 2 scores were calculated. In the study, 55.6% of the cases included were male. The mean age was 60.6 ± 18.7. Delirium was more common in patients who were men, older age, urgent applicants, had a history of trauma, had high urea or creatinine values, received sedation and mechanical ventilation. The mean Acute Physiology and Chronic Health Assessment Score-II was 17.0 ± 9.1 and delirium was more common in those with high scores. Intensive care and hospital stay of patients who developed delirium was longer and their mortality was higher. The cut-off value for Pre-deliric version-1 was >38% (AUROC=1) and the cut-off value for Pre-deliric version-2 was >22% (AUROC=1). For the E-Pre-deliric, the cut-off value was >28% (AUROC=1). Through our study, the Pre-deliric and E-pre-deliric models were calibrated with Intensive Care Delirium Screening Checklist for the first time and both models were compared between themselves. Validity and reliability of these models were supported, they were found to be useful, and cut-off values were determined.
Açıklama
Anahtar Kelimeler
Deliryum, ICDSC, Pre-deliric, E-predeliric, Yoğun bakım, Delirium, Intensive care
