Öz
Amaç: Bu çalışmanın amacı, CLUE protokolünün COVID-19 triajındaki etkinliğini değerlendirmektir
Gereç ve Yöntem: Bu prospektif, gözlemsel çalışmaya nefes darlığı nedeniyle acil servise başvuran oksijen saturasyonu %95' in altında olan ve revers transkripsiyon polimeraz zincir reaksiyonu (RT-PCR) testleri ile COVID-19 tanısı konan hastalar dahil edildi. CLUE protokolü doğrultusunda çalışmaya dahil edilen hastalara akciğer ultrasonu (LUS) uygulandı ve yine protokol kapsamında hastalara 0 ile 36 arasında değişen LUS skorları verildi. Hastalar takibe alındı ve acil servisten çıkış, servise yatış, yoğun bakıma yatış veya çıkış klinik sonuçları kaydedildi. Taburculuk, yoğun bakıma yatış ve ölümleri öngören LUS puanları için sınır değerlerinin hesaplanmasında ROC analizi kullanıldı.
Bulgular: Çalışmaya yaş ortalaması 63 ± 18 yıl olan 45 hasta dahil edildi. Hastaların 15' i (% 33) ayakta tedavi olmak üzere taburcu edildi, 12' si (% 27) servise, 18' i (% 40) yoğun bakım ünitesine yatırıldı. Toplam 15 (% 33) hastada ölüm meydana geldi. LUS puanının 3’ ün altın olması taburculuk için % 97 duyarlı ve % 80 spesifik, 10’ un üzerinde olması yoğun bakım ünitesine kabul için % 94 duyarlı ve % 78 spesifikti ve 11’ in üzerinde olması mortalite için % 93 duyarlı ve % 87 spesifik olarak bulundu. Regresyon analizine göre LUS skorunun 10’ un üzerinde olması yoğun bakım ihtiyacı için, 3’ ün altında olması taburculuk için ve 11’ in üzerinde olması ise mortalite için bağımsız bir risk faktörü olarak bulunmuştur.
Sonuç: CLUE protokolü, COVID-19 triajında radyasyon içermeyen ve laboratuvar testleri gerektirmeyen yararlı bir yatak başı testi olabilir.
Anahtar Kelimeler
Kaynakça
- 1. Halacli B, Kaya A, Topeli A. Critically-ill COVID-19 patient. Turk J Med Sci. 2020 Apr 21;50(SI-1):585-591. doi: 10.3906/sag-2004-122. PMID: 32293831; PMCID: PMC7195980.
- 2. Veldhuis L, Ridderikhof ML, Schinkel M, van den Bergh J, Beudel M, Dormans T et al. Early warning scores to assess the probability of critical illness in patients with COVID-19. Emerg Med J. 2021 Dec;38(12):901-905. doi: 10.1136/emermed-2020-211054.
- 3. Martín-Rodríguez F, Martín-Conty JL, Sanz-García A, Rodríguez VC, Rabbione GO, Cebrían Ruíz I et al.Early Warning Scores in Patients with Suspected COVID-19 Infection in Emergency Departments. J Pers Med. 2021 Mar 2;11(3):170. doi: 10.3390/jpm11030170.
- 4. Zhang J, Meng G, Li W, Shi B, Dong H, Su Z et al.Relationship of chest CT score with clinical characteristics of 108 patients hospitalized with COVID-19 in Wuhan, China. Respir Res. 2020 Jul 14;21(1):180. doi: 10.1186/s12931-020-01440-x.
- 5. Yang R, Li X, Liu H, Zhen Y, Zhang X, Xiong Q, Luo Y, Gao C, Zeng W. Chest CT Severity Score: An Imaging Tool for Assessing Severe COVID-19. Radiol Cardiothorac Imaging. 2020 Mar 30;2(2):e200047. doi: 10.1148/ryct.2020200047. PMID: 33778560; PMCID: PMC723.
- 6. Shrestha GS, Weeratunga D, Baker K. Point-of-Care Lung Ultrasound in Critically ill Patients. Rev Recent Clin Trials. 2018 Jan 31;13(1):15-26. doi: 10.2174/1574887112666170911125750. PMID: 28901850.
- 7. Allinovi M, Parise A, Giacalone M, Amerio A, Delsante M, Odone A, Franci A, Gigliotti F, Amadasi S, Delmonte D, Parri N, Mangia A. Lung Ultrasound May Support Diagnosis and Monitoring of COVID-19 Pneumonia. Ultrasound Med Biol. 2020 Nov;46(11):2908-2917.
- 8. Farias LPG, Fonseca EKUN, Strabelli DG, Loureiro BMC, Neves YCS, Rodrigues TP, Chate RC, Nomura CH, Sawamura MVY, Cerri GG. Imaging findings in COVID-19 pneumonia. Clinics (Sao Paulo). 2020 Jun 22;75:e2027. doi: 10.6061/clinics/2020/e2027.
- 9. Manivel V, Lesnewski A, Shamim S, Carbonatto G, Govindan T. CLUE: COVID-19 lung ultrasound in emergency department. Emerg Med Australas. 2020 Aug;32(4):694-696. doi: 10.1111/1742-6723.13546. Epub 2020 Jun 16. PMID: 32386264; PMCID: PMC7273052.
- 10. Jiang F, Deng L, Zhang L, Cai Y, Cheung CW, Xia Z. Review of the Clinical Characteristics of Coronavirus Disease 2019 (COVID-19). J Gen Intern Med. 2020 May;35(5):1545-1549. doi: 10.1007/s11606-020-05762-w.
- 11. Lichter Y, Topilsky Y, Taieb P, Banai A, Hochstadt A, Merdler I et al.Lung ultrasound predicts clinical course and outcomes in COVID-19 patients. Intensive Care Med. 2020 Oct;46(10):1873-1883. doi: 10.1007/s00134-020-06212-1.
- 12. Ji L, Cao C, Gao Y, Zhang W, Xie Y, Duan Y et al.Prognostic value of bedside lung ultrasound score in patients with COVID-19. Crit Care. 2020 Dec 22;24(1):700. doi: 10.1186/s13054-020-03416-1.
- 13. Pokeerbux MR, Yelnik CM, Faure E, Drumez E, Bruandet A, Labreuche J et al.National early warning score to predict intensive care unit transfer and mortality in COVID-19 in a French cohort. Int J Clin Pract. 2021 Jun;75(6):e14121. doi: 10.1111/ijcp.14121.
- 14. Liang W, Liang H, Ou L, Chen B, Chen A, Li C et al. Development and Validation of a Clinical Risk Score to Predict the Occurrence of Critical Illness in Hospitalized Patients With COVID-19. JAMA Intern Med. 2020;180(8):1081-1089.
- 15. Armiñanzas C, Arnaiz de Las Revillas F, Gutiérrez Cuadra M, Arnaiz A, Fernández Sampedro M, González-Rico C et al.Usefulness of the COVID-GRAM and CURB-65 scores for predicting severity in patients with COVID-19. Int J Infect Dis. 2021 Jul;108:282-288.
- 16. Zhou S, Chen C, Hu Y, Lv W, Ai T, Xia L. Chest CT imaging features and severity scores as biomarkers for prognostic prediction in patients with COVID-19. Ann Transl Med. 2020 Nov;8(21):1449. doi: 10.21037/atm-20-3421
Öz
Purpose: The purpose of this study was to evaluate the effectiveness of the CLUE protocol in COVID-19 triage.
Materials and Methods: Patients who presented to the emergency department due to dyspnea with oxygen saturation below 95 % and were diagnosed with COVID-19 by reverse transcription polymerase chain reaction (RT-PCR) tests were included in this prospective, observational study. Patients included in the study underwent lung ultrasound (LUS) in the light of the CLUE protocol, and were accordingly given LUS scores of between 0 and 36, also within the scope of the protocol. Patients were placed under observation, and clinical outcomes of discharge from the emergency department, admission to the ward, and admission to intensive care or discharge were recorded. ROC analysis was applied in the calculation of threshold values for LUS scores predicting discharge, admission to intensive care, and mortality.
Results: Forty-five patients with a mean age of 63 ± 18 years were included in the study. Fifteen patients (33 %) were treated on an outpatient basis and discharged, while 12 (27 %) were admitted to the ward and 18 (40 %) to the intensive care unit. Mortality occurred in 15 (33 %) patients. An LUS score lower than 3 was 97 % sensitive and 80 % specific for discharge, a score greater than 10 was 94 % sensitive and 78 % specific for admission to the intensive care unit, and a score higher than 11 was 93 % sensitive and 87 % specific for mortality. Based on regression analysis, an LUS score higher than 10 emerged as an independent risk factor for intensive care requirement, a score lower than 3 for discharge, and a score over 11 for mortality.
Conclusion: The CLUE protocol may be a useful bedside test in COVID-19 triage, and one that does not involve radiation or require laboratory tests.
Anahtar Kelimeler
Kaynakça
- 1. Halacli B, Kaya A, Topeli A. Critically-ill COVID-19 patient. Turk J Med Sci. 2020 Apr 21;50(SI-1):585-591. doi: 10.3906/sag-2004-122. PMID: 32293831; PMCID: PMC7195980.
- 2. Veldhuis L, Ridderikhof ML, Schinkel M, van den Bergh J, Beudel M, Dormans T et al. Early warning scores to assess the probability of critical illness in patients with COVID-19. Emerg Med J. 2021 Dec;38(12):901-905. doi: 10.1136/emermed-2020-211054.
- 3. Martín-Rodríguez F, Martín-Conty JL, Sanz-García A, Rodríguez VC, Rabbione GO, Cebrían Ruíz I et al.Early Warning Scores in Patients with Suspected COVID-19 Infection in Emergency Departments. J Pers Med. 2021 Mar 2;11(3):170. doi: 10.3390/jpm11030170.
- 4. Zhang J, Meng G, Li W, Shi B, Dong H, Su Z et al.Relationship of chest CT score with clinical characteristics of 108 patients hospitalized with COVID-19 in Wuhan, China. Respir Res. 2020 Jul 14;21(1):180. doi: 10.1186/s12931-020-01440-x.
- 5. Yang R, Li X, Liu H, Zhen Y, Zhang X, Xiong Q, Luo Y, Gao C, Zeng W. Chest CT Severity Score: An Imaging Tool for Assessing Severe COVID-19. Radiol Cardiothorac Imaging. 2020 Mar 30;2(2):e200047. doi: 10.1148/ryct.2020200047. PMID: 33778560; PMCID: PMC723.
- 6. Shrestha GS, Weeratunga D, Baker K. Point-of-Care Lung Ultrasound in Critically ill Patients. Rev Recent Clin Trials. 2018 Jan 31;13(1):15-26. doi: 10.2174/1574887112666170911125750. PMID: 28901850.
- 7. Allinovi M, Parise A, Giacalone M, Amerio A, Delsante M, Odone A, Franci A, Gigliotti F, Amadasi S, Delmonte D, Parri N, Mangia A. Lung Ultrasound May Support Diagnosis and Monitoring of COVID-19 Pneumonia. Ultrasound Med Biol. 2020 Nov;46(11):2908-2917.
- 8. Farias LPG, Fonseca EKUN, Strabelli DG, Loureiro BMC, Neves YCS, Rodrigues TP, Chate RC, Nomura CH, Sawamura MVY, Cerri GG. Imaging findings in COVID-19 pneumonia. Clinics (Sao Paulo). 2020 Jun 22;75:e2027. doi: 10.6061/clinics/2020/e2027.
- 9. Manivel V, Lesnewski A, Shamim S, Carbonatto G, Govindan T. CLUE: COVID-19 lung ultrasound in emergency department. Emerg Med Australas. 2020 Aug;32(4):694-696. doi: 10.1111/1742-6723.13546. Epub 2020 Jun 16. PMID: 32386264; PMCID: PMC7273052.
- 10. Jiang F, Deng L, Zhang L, Cai Y, Cheung CW, Xia Z. Review of the Clinical Characteristics of Coronavirus Disease 2019 (COVID-19). J Gen Intern Med. 2020 May;35(5):1545-1549. doi: 10.1007/s11606-020-05762-w.
- 11. Lichter Y, Topilsky Y, Taieb P, Banai A, Hochstadt A, Merdler I et al.Lung ultrasound predicts clinical course and outcomes in COVID-19 patients. Intensive Care Med. 2020 Oct;46(10):1873-1883. doi: 10.1007/s00134-020-06212-1.
- 12. Ji L, Cao C, Gao Y, Zhang W, Xie Y, Duan Y et al.Prognostic value of bedside lung ultrasound score in patients with COVID-19. Crit Care. 2020 Dec 22;24(1):700. doi: 10.1186/s13054-020-03416-1.
- 13. Pokeerbux MR, Yelnik CM, Faure E, Drumez E, Bruandet A, Labreuche J et al.National early warning score to predict intensive care unit transfer and mortality in COVID-19 in a French cohort. Int J Clin Pract. 2021 Jun;75(6):e14121. doi: 10.1111/ijcp.14121.
- 14. Liang W, Liang H, Ou L, Chen B, Chen A, Li C et al. Development and Validation of a Clinical Risk Score to Predict the Occurrence of Critical Illness in Hospitalized Patients With COVID-19. JAMA Intern Med. 2020;180(8):1081-1089.
- 15. Armiñanzas C, Arnaiz de Las Revillas F, Gutiérrez Cuadra M, Arnaiz A, Fernández Sampedro M, González-Rico C et al.Usefulness of the COVID-GRAM and CURB-65 scores for predicting severity in patients with COVID-19. Int J Infect Dis. 2021 Jul;108:282-288.
- 16. Zhou S, Chen C, Hu Y, Lv W, Ai T, Xia L. Chest CT imaging features and severity scores as biomarkers for prognostic prediction in patients with COVID-19. Ann Transl Med. 2020 Nov;8(21):1449. doi: 10.21037/atm-20-3421
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Klinik Tıp Bilimleri |
| Bölüm | Araştırma |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Haziran 2022 |
| Kabul Tarihi | 2 Mayıs 2022 |
| Yayımlandığı Sayı | Yıl 2022 Cilt: 47 Sayı: 2 |
