Hüseyin ACAR, Adnan YAMANOĞLU, Cüneyt ARIKAN, Serkan BİLGİN, Pınar Yeşim AKYOL, Ahmet KAYALI, Zeynep KARAKAYA

COVID-19 triajında CLUE protokolünün etkinliği

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.

Effectiveness of the CLUE protocol in COVID-19 triage

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.

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