Şenay Bengin ERTEM, Nilüfer AYLANÇ, Murat DAŞ, Okan BARDAKÇI

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ACİL SERVİSE BAŞVURAN HASTALARDA PULMONER BT ANJİOGRAFİ TETKİKİNİN TANI VERİMLİLİĞİNİN DEĞERLENDİRİLMESİ

ÖZ Amaç: Acil servislerde ileri görüntüleme yöntemleri giderek artan oranlarda kullanılmaya başlamıştır. Bu hızlı artış beraberinde; hem söz konusu görüntüleme yöntemlerinin tanı verimliliğinin düşük olması olasılığını; hem de bu metotlara bağlı gelişebilecek olası zararları gündeme getirmiştir. Bu konuda acil servislerde pulmoner emboliden (PE) şüphelenilen hastalarda ileri görüntüleme yöntemlerinden pulmoner bilgisayarlı tomografi anjiografi (pulmoner BTA) kullanımı özellikle ön plana çıkmaktadır. Akut PE dünya genelinde önemli bir morbidite ve mortalite nedenidir Biz bu çalışmada Çanakkale Onsekiz Mart Üniversitesi Hastanesi Acil Servisi’ne başvuran ve PE ön tanısı ile pulmoner BTA tetkiki istenen hastalarda pulmoner BTA tetkikinin tanı verimliliğini araştırmayı amaçladık. Gereç ve Yöntem: Çalışma, Çanakkale Onsekiz Mart Üniversitesi Klinik Araştırmalar Etik Kurulu’ndan onay alındıktan sonra Ocak 2016 ile Haziran 2018 ayları arasında acil servise başvuran ve PE ön tanısı ile pulmoner BTA tetkiki istenen hastaların radyolojik görüntülerinin ve medikal kayıtlarının retrospektif olarak incelenmesi yöntemiyle yapıldı. Çalışmaya alınan hastaların klinik bilgileri iki acil servis hekimi tarafından, radyolojik görüntüleri iki radyolog tarafından kör bir şekilde incelendi. Çalışma verileri SPSS 19 paket programı kullanılarak analiz edildi. Sayısal değişkenlerin karşılaştırmasında Mann Whitney U testi kategorik değişkenlerin karşılaştırmasında Ki-Kare testi kullanıldı. İstatistiksel verilerin yorumunda p<0,05 anlamlı olarak kabul edildi. Bulgular: Bu çalışmada Ocak 2016- Haziran 2018 ayları arasında acil servise başvuran ve PE ön tanısı ile pulmoner BTA çekilen toplam 233 hasta tespit edildi. Hastaların 11’i artefaktlar nedeniyle pulmoner BTA görüntü kalitesi yetersiz olduğu için çalışma dışında bırakıldılar. Geriye kalan 222 hastaya ait veriler analiz edildi. Hastaların 19’unda (%8,6) PE pozitif (Grup-1); 203 hasta (% 91.4) Pulmoner emboli negatif (Grup-2) olarak saptandı. Ayrıca PE tespit edilmeyen (Grup-2) hastalardan ikisinde (%0.9) herhangi bir patoloji izlenmedi ve normal olarak raporlandı. Her iki grupta da hastaların acil servise en sık nefes darlığı ikinci sıklıkla göğüs ağrısı, şikayetleri ile başvurdukları görüldü. Hastaların D-Dimer değerleri tüm hastalarda normalin üstünde olmakla beraber; grup-1’de grup-2’ye göre daha yüksek bulundu (Grup-1’de 6.42 ± 8.02 µg/L; grup-2’de 2.38 ± 1.99 µg/L N: <0.5 µg/L); ancak bulgu istatistiksel olarak anlamlı değildi (p> 0.05; Tablo-2) PE tespit edilen (Grup-1) hastalarda trombosit sayısı ve laktat değeri PE tespit edilmeyen (Grup-2) hastalara göre daha yüksek (sırasıyla 341.71±146.23, 263.72±107.28 hücre/ml; 5.93±6.97, 2.22±2.07 mg/dL ), olmakla birlikte düşük, orta ya da yüksek düzeyde trombosit ve düşük ya da yüksek düzeyde laktat grupları ile PE tespit edilen (Grup-1) ve PE tespit edilmeyen (Grup-2) grupları arasında istatistiksel anlamlı farklılık bulunmadı (p>0.05). (Tablo-3 ve 4) PE tespit edilen (Grup-1) hastalarda klor değeri PE tespit edilmeyen (Grup-2) hastalara göre daha düşük (sırasıyla 94.92±5.38, 99.41±5.15 mmol/L) bulundu. Düşük, orta ya da yüksek düzeyde klor grupları ile PE tespit edilen (Grup-1) ve PE tespit edilmeyen (Grup-2) grupları arasında istatistiksel anlamlı olarak farklılık elde edildi (p<0.05). PE tespit edilen (Grup-1) hastalarda yüksek düzeyde klor saptanmadı. Ayrıca düşük düzeyde klor PE tespit edilen (Grup-1) hastalarda PE tespit edilmeyen (Grup-2) gruba göre daha fazla hastada izlendi. Hastaların hastane bilgi sistemi üzerindeki dosyalarından klinik karar kuralları (KKK) parametrelerine ait bazı verilere ulaşılamadı. Sonuç: Sonuç olarak, PE ön tanısı ile istenen pulmoner BTA’nın tanısal verimliliğini, literatürle uyumlu olarak düşük (%8.6) bulduk. Ancak tetkikin doğruluğunu ve performansını arttırmak için ileri çalışmalara ihtiyaç olduğunu düşünmekteyiz. Anahtar Kelimeler: Acil servis, Pulmoner emboli, Pulmoner BT anjiografi
Anahtar Kelimeler:

Acil servis, Pulmoner emboli, Pulmoner BT anjiografi

EVALUATION OF THE DIAGNOSTIC EFFICIENCY OF PULMONARY CT ANGIOGRAPHY EXAMINATION AT EMERGENCY DEPARTMENT

Purpose: The use of advanced medical imaging in the emergency department (ED) has increased substantially. With this rapid increase; the possibility of both the low diagnostic efficiency of these imaging methods; as well as the possible damages that may occur due to these methods. In this regard, the use of pulmonary computed tomography angiography (pulmonary CTA), which is one of the advanced imaging methods in patients with suspected pulmonary embolism (PE), stands out. Acute PE is an important cause of morbidity and mortality worldwide. In this study, we aimed to investigate the diagnostic efficiency of pulmonary CTA in patients who applied to Çanakkale Onsekiz Mart University Hospital Emergency Service and requested pulmonary CTA with a pre-diagnosis of PE. Material -method: After ethics committee approval this study was carried out by retrospectively examining the radiological images and medical records of patients who were admitted to Çanakkale Onsekiz Mart University Emergency Department between January 2016 and June 2018, and requested pulmonary CTA examination with a pre-diagnosis of PE, The clinical information of the patients included in the study were examined by two emergency room doctors; and radiological images by two radiologist blindly. Study data were analyzed using SPSS 19 package program. Mann Whitney U test was used for comparison of numerical variables and Chi-Square test was used for comparison of categorical variables. İn the interpretation os statistical data, p< 0.05 was considered significant. Results: İn this study, a total of 233 patients who were admitted to the emergency department between January 01 2016- June 01 2018 and had pulmonary CTA with a pre-diagnosis of PE were identified. Eleven of the patients were excluded from the study because of insufficient pulmonary CTA image quality due to artifacts. The data of the remaining 222 patients were analyzed. While pulmonary embolisim was found in 19 (8.6%) patients (Group-1), pulmonary embolisim was not found in 203 (91.4%) patients (Group-2). No pathology was observed in two (0.9%) of the patients without embolism and reported as normal. İn both groups, the patients most frequently applied to the emergency department with complaints of shortness of breath and secondly, chest pain. Although the D-Dimer values of the patients were above normal in all patients; found higher in group-1 than group-2 (6.42 ± 8.02 µg/L in Group-1; 2.38 ± 1.99 µg/L in Group-2 N:< 0.5 µg/L). However, the finding was not statistically significant (p> 0.05; Table-2). Platelet count and lactate value was higher in patients with PE (Group-1) compared to patients without PE (Group-2) (341.71 ± 146.23, 263.72 ± 107.28 cells / ml; 5.93 ± 6.97, 2.22 ± 2.07 mg / dL, respectively) However, no statistically significant difference was found between the low, medium or high level platelet and low or high level lactate groups and the groups with PE (Group-1) and those without PE (Group-2). (p> 0.05; Table-3-4). Chlorine value was found to be lower in patients with PE (Group-1) compared to patients without PE (Group-2) (94.92 ± 5.38, 99.41 ± 5.15 mmol / L, respectively). A statistically significant difference was found between low, medium or high chlorine groups and PE (Group-1) and PE (Group-2) groups (p <0.05). In addition, patients with low chlorine PE (Group-1) were observed in more patients than the group without PE (Group-2). (Table-5) Some data on clinical decision rules (CDS) parameters could not be accessed from the patients' files on the hospital information system. Conclusions: As a result, we found the diagnostic efficiency of pulmonary CTA required with PE pre-diagnosis to be low (8.6%), consistent with the literature. However, we think that further studies are needed to increase the accuracy and performance of the examination. Key Words: Emergency Department, Pulmonary embolisms, Computed tomographic pulmonary angiograpy
Keywords:

Emergency Department, Pulmonary embolisms, Computed tomographic pulmonary angiograpy,

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Akdeniz Tıp Dergisi-Cover
  • Yayın Aralığı: Yılda 3 Sayı
  • Başlangıç: 2015
  • Yayıncı: Akdeniz Üniversitesi Tıp Fakültesi
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