Escore de alerta precoce modificado: avaliação de pacientes traumáticos

Abstract

Objective: to identify the severity of patients admitted to an emergency trauma. Method: A cross-sectional and retrospective study with 115 trauma patients classifi ed as orange (Manchester System), from June 2013 to July 2014. The data were presented as mean and standard deviation, in addition to the Pearson Chi-square test, One-Way ANOVA and Tukey tests. Results: from the sample, 81.7% were male with mean age of 39.46+19.71 years. Higher incidence of major trauma (48.7%) and traumatic brain injury (37.4%). At the end of the outcome and MEWS, most cases that had score 1 to 3 were referred to the operating room and the ICU. Conclusion: the start point of MEWS was 2 to 3 points, with signifi cant increase in the severity of the situation of patients seen after 6 hours, and approximately half of the individuals underwent surgery, indicating that the scale is a good predictor of severity. Descriptors: Emergencies; Emergency Medical Services; Severity of Illness Index; Measures of Association; Exposure; Risk or Outcome. RESUMOObjetivo: identifi car a gravidade de pacientes admitidos em uma emergência de trauma. Método: estudo transversal e retrospectivo realizado com 115 pacientes com trauma, classifi cados como laranja (Sistema de Manchester), no período de junho de 2013 a julho de 2014. Os dados foram apresentados por média e desvio padrão, além dos testes Qui-quadrado de Pearson, One-Way ANOVA e Tukey. Resultados: da amostra, 81,7% eram do sexo masculino, com idade média de 39,46+19,71 anos. Maior ocorrência por trauma maior (48,7%) e traumatismo cranioencefálico (37,4%). No desfecho fi nal e MEWS, a maioria dos casos que obtiveram escore de 1 a 3 foi encaminhada ao centro cirúrgico e à CTI. Conclusão: o MEWS inicial foi de 2 a 3 pontos, havendo evolução signifi cativa do Box de gravidade dos pacientes atendidos após 6 horas, sendo que aproximadamente metade dos indivíduos avaliados sofreu intervenção cirúrgica, indicando que a escala é um bom preditivo de gravidade. Descritores: Emergência; Serviços Médicos de Emergência; Índice de Gravidade de Doença; Medidas de Associação; Exposição; Risco ou Desfecho. RESUMENObjetivo: identifi car la gravedad de los pacientes ingresados en un trauma de emergencia. Método: estudio transversal y retrospectivo realizado en 115 pacientes con traumatismos clasifi cados como naranja (sistema de triage Manchester) a partir de junio de 2013 hasta julio de 2014. Los datos se presentaron como media y desviación estándar, y prueba de chi-cuadrado Pearson, ANOVA de una vía y Tukey. Resultados: 81,7% de hombres, edad media 39,46+19,71 años. Mayor incidencia de traumatismos graves (48,7%) y lesión cerebral traumática (37,4%). En el resultado fi nal y MEWS (modifi ed early warning score -puntuación de alerta temprana modifi cada), la mayoría de los casos tenían una puntuación de 1-3 y se remitieron a la sala de operaciones y UCI (unidad de cuidados intensivos). Conclusión: la puntuación inicial MEWS fue de 2 a 3 puntos, con un aumento importante en la gravedad de la situación de lo...

Identification of Serious Adverse Events in Patients with Traumatic Brain Injuries, from Prehospital Care to Intensive-Care Unit, Using Early Warning Scores

“…Works analyzing the use of EWS in a prehospital setting are numerous [14,15,30,31] and more specifically concern the use of EWS in patients with trauma [32][33][34][35]. Studies that specifically analyse scores to predict the risk of deterioration in TBI are scarce.…”

Comunicação efetiva para a segurança do paciente: nota de transferência e Modified Early Warning Score

“…The use of this tool, before the in-hospital displacement, allows the identification of the worsening of the patient's health status, as well as helps in the clinical decision making by the team regarding the need for stabilization prior to transfer. When the transfer is necessary, even in the cases of modified MEWS, this should be conditioned to the accompaniment of trained multidisciplinary team (14) .…”

“…MEWS equal to four may be a predictor of clinical severity, mortality, the type of transport the patient needs and the use of ICU resources (8)(9)(10)(11)(12)(13)(14)(15)(16) . It is known that, daily, nursing is more closely related to the patient, being able to observe small changes in its clinical picture.…”

“…A higher MEWS score correlates with a higher risk of in-hospital death, cardiorespiratory arrest (CRP), and physiological deterioration, which also correlates with the increased need for hospitalization in intensive care units and longer hospital stays (8)(9)(10)(11)(12)(13)(14)(15)(16) , and survival after cardiac arrest was associated with low MEWS values at hospital admission (15) .…”

“…Studies have shown an increase in ICU admissions for early identification of this need, as well as the decrease in deaths due to CRP after adherence to the protocol in health services, as well as evidence of benefits in identifying poor prognosis (8)(9)(10)(11)(12)(13)(14)(15)(16) . For the medical team, the calculated MEWS shows in real time, through the graph of observations, the clinical decline of the user, even when the patient is not at the bedside.…”