Pulmoner Tromboemboli tanısında kullanılan klinik olasılık skorlama yöntemlerinin karşılaştırılması
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Tarih
2015
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info:eu-repo/semantics/closedAccess
Özet
Giriş: PTE; mortalite ve morbiditesi yüksek, tekrarlayabilen, bazen tanısı güç olan ve önlenebilir bir hastalıktır (42). Amaç: Bizim bu çalışmamızda; pulmoner tromboembolizm tanısında kullanılan çeşitli klinik olasılık skorlama yöntemlerinin değerini, hem yatan hastalarda ve hem de acil servise başvuranlarda belirlemek ve bunları birbirleriyle kıyaslamayı amaçladık. Materyal ve Metod: Bu çalışmada Şubat 2007- Ocak 2010 tarihleri arasında Dicle Üniversitesi Tıp Fakültesi Acil servisine veya göğüs hastalıkları polikliniğine ayaktan başvuran ve çeşitli kliniklerde yatan pulmoner tromboemboli şüphesi olan 207 hastanın PTE kayıt formları retrospektif olarak incelendi. Hastalar, yatan ve ayaktan hastalar şeklinde gruplandırıldı. Hastaların dosya verilerine dayanılarak Wells, Geneva ve Modifiye Geneva klinik olasılık skorlama yöntemleri ile puanlamaları yapıldı. Bu klinik olasılık skorlama yöntemleri arasında karşılaştırma yapıldı. Skorlama sistemlerinin ayırıcı eşik puanlarını bulmak için receiver operating characteristic (ROC) eğrileri kullanıldı. İstatistiksel analizler SPSS 15.0 programı ile yapıldı. Bulgular: PTE (+) 145 hastanın 62’si (%43) bayan, 83’ü(%57) erkek; PTE (–) 62 hastanın 27’si (%43) bayan, 35’i (%56) erkekti. PTE (+) ve PTE (–) hastalarda en sık saptanan semptomlar nefes darlığı ve göğüs ağrısıydı. Nefes darlığı PTE (-) hastalarda, göğüs ağrısı PTE (+) hastalarda yüksek oranda saptandı (p<0,001). Homans belirtisi ve DVT bulguları, PTE (+) hasta grubunda PTE (–) hasta grubuna göre anlamlı düzeyde yüksek saptandı (p<0,001). DVT öyküsü; PTE (+) hasta grubunda PTE (–) hasta grubuna göre istatistiksel olarak anlamlı düzeyde yüksek saptandı (p=0,02). Yatan ve ayaktan başvuran hasta yüzdeleri açısından PTE (+) ve PTE (-) hasta grupları karşılaştırıldığında istatistiksel olarak anlamlı bir farklılık saptanmadı (p=0,14). Skorlamalrın tanıya ulaşmadaki ayırıcı (eşik değer) değerlerinin saptanması ve birbirleriyle karşılaştırılması için ‘Receiver Operating Characteristic (ROC)’ eğrileri oluşturuldu ve eğri altında kalan (AUC, Area under the Curve) alanlar değerlendirildi. Yatan ve ayaktan başvuran hastaların ROC eğrilerinde her üç klinik skorlamanın eşik değerleri 5 olarak saptandı. Ayaktan başvuran hastalarda klinik olasılık skorlama yöntemlerinin ROC eğrileri karşılaştırıldığında Wells ve Modifiye Geneva skorlamalarında eğri altında kalan alanların Geneva skorlamasına göre istatistiksel olarak anlamlı derecede yüksek oldukları saptandı (p<0,001) ( AUC değerleri; Wells:0.78, Geneva:0,59, Modifiye Geneva:0.76). Yatan hastalarda klinik olasılık skorlama yöntemlerinin ROC eğrileri karşılaştırıldığında ise Modifiye Geneva skorlama yönteminde eğri altında kalan alan Wells ve Geneva skorlama yöntemine göre istatistiksel olarak anlamlı derecede yüksek saptandı (p<0,005) (AUC değerleri; Wells:0.70, Geneva:0.54, Modifiye Geneva:0,75). Sonuç: Her üç klinik olasılık skorlamanın ROC eğrilerinde, eğri altında kalan alanın en fazla Modifiye Geneva skorlamasında olduğu, daha sonra Wells’in yer aldığı, bu nedenle tanıya ulaşmada bu iki yöntemin Geneva’ya göre daha değerli olduğu belirlendi.
Introduction: Pulmonary embolism is a preventable disease that is sometime difficult to diagnosed, can be recurrent and has a high morbidity and mortality. Aim: In this study, we aimed to detect and compare the values of various clinical probability scoring methods in diagnosis of pulmonary thromboembolism, both in inpatients and the patients who appealed to emergency department. Materials and methods: In this study, registration forms of thromboembolism suspected 207 patients who were outpatients of Dicle University Medical Faculty Emergency Service and Chest Diseases Clinic and inpatients of various clinics were retrospectively analyzed between February 2007 - January 2010. Patients were separated as inpatients and outpatients into groups. Patients were scored by Wells, Geneva and Modified Geneva clinical probability scoring methods, according to their patient file datas. These clinical probability scoring methods were compared to each other. To find the differential threshold points of scoring systems, the Receiver Operating Characteristic (ROC) curves were used. Statistical analysis was performed with SPSS 15.0 program. Results: PTE (+) of 145 patients, 62 (43%) women, 83 (57%) male; PTE (-) of 62 patients 27 (43%) female and 35 (56%) were male. The most frequent symptom in PTE (+) and PTE (-) patients were shortness of breath and chest pain. Shortness of breath in PTE (-) patients and the chest pain in PTE (+) patients showed a high rate (p <0.001). Homans symptoms and signs of DVT were determined significantly higher in PTE (+) patients than PTE (-) group (p <0.001). DVT history were statistically determined significantly higher in PTE (+) patients than PTE (-) patient group (p = 0.02). When the PTE (+) and PTE (-) patient groups were compared in terms of percentage of inpatients and outpatients, no statistically difference was found (p = 0.14). To determine and compare the differential (threshold) values of scores towards diagnosis, Receiver Operating Characteristic (ROC) curves were performed and the under curve (AUC, Area under the Curve) areas were assessed. In the ROC curve of inpatients and outpatients, the threshold values of all three scoring methods were determined as 5. When the ROC curves of clinical probability scoring methods were compared in outpatients, it was determined that, the undercurve areas of Wells and Modified Geneva scoring methods were significantly larger when statistically compared with Geneva scoring method (p <0.001) (AUC values; Wells: 0.78, Geneva: 0.59, modified Geneva : 0.76). When the ROC curves of clinical probability scoring methods were compared in outpatients group, it was determined that, the undercurve areas of Modified Geneva scoring method was significantly higher when statistically compared with Wells and Geneva scoring methods (p<0.005) (AUC values; Wells: 0.70, Geneva: 0.54, Modified Geneva: 0.75). Conclusion: In the ROC curves of all three clinical probability scoring methods, it was seen that, the Modified Geneva scoring method has the largest undercurve area and secondly the Wells. So these two methods are determined more useful than Genova to reach the diagnosis.
Introduction: Pulmonary embolism is a preventable disease that is sometime difficult to diagnosed, can be recurrent and has a high morbidity and mortality. Aim: In this study, we aimed to detect and compare the values of various clinical probability scoring methods in diagnosis of pulmonary thromboembolism, both in inpatients and the patients who appealed to emergency department. Materials and methods: In this study, registration forms of thromboembolism suspected 207 patients who were outpatients of Dicle University Medical Faculty Emergency Service and Chest Diseases Clinic and inpatients of various clinics were retrospectively analyzed between February 2007 - January 2010. Patients were separated as inpatients and outpatients into groups. Patients were scored by Wells, Geneva and Modified Geneva clinical probability scoring methods, according to their patient file datas. These clinical probability scoring methods were compared to each other. To find the differential threshold points of scoring systems, the Receiver Operating Characteristic (ROC) curves were used. Statistical analysis was performed with SPSS 15.0 program. Results: PTE (+) of 145 patients, 62 (43%) women, 83 (57%) male; PTE (-) of 62 patients 27 (43%) female and 35 (56%) were male. The most frequent symptom in PTE (+) and PTE (-) patients were shortness of breath and chest pain. Shortness of breath in PTE (-) patients and the chest pain in PTE (+) patients showed a high rate (p <0.001). Homans symptoms and signs of DVT were determined significantly higher in PTE (+) patients than PTE (-) group (p <0.001). DVT history were statistically determined significantly higher in PTE (+) patients than PTE (-) patient group (p = 0.02). When the PTE (+) and PTE (-) patient groups were compared in terms of percentage of inpatients and outpatients, no statistically difference was found (p = 0.14). To determine and compare the differential (threshold) values of scores towards diagnosis, Receiver Operating Characteristic (ROC) curves were performed and the under curve (AUC, Area under the Curve) areas were assessed. In the ROC curve of inpatients and outpatients, the threshold values of all three scoring methods were determined as 5. When the ROC curves of clinical probability scoring methods were compared in outpatients, it was determined that, the undercurve areas of Wells and Modified Geneva scoring methods were significantly larger when statistically compared with Geneva scoring method (p <0.001) (AUC values; Wells: 0.78, Geneva: 0.59, modified Geneva : 0.76). When the ROC curves of clinical probability scoring methods were compared in outpatients group, it was determined that, the undercurve areas of Modified Geneva scoring method was significantly higher when statistically compared with Wells and Geneva scoring methods (p<0.005) (AUC values; Wells: 0.70, Geneva: 0.54, Modified Geneva: 0.75). Conclusion: In the ROC curves of all three clinical probability scoring methods, it was seen that, the Modified Geneva scoring method has the largest undercurve area and secondly the Wells. So these two methods are determined more useful than Genova to reach the diagnosis.
Açıklama
Anahtar Kelimeler
Pulmoner emboli, Pulmonary embolism, Tanı testleri, Diagnostic tests, Teşhis, Diagnosis, Pulmoner Tromboemboli, Pulmonary Thromboembolism
