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Abstract(s)
Os doentes após darem entrada nos serviços de Urgência podem ver a sua situação clínica
a ser agravada durante ou após a observação médica, sem que haja grandes alterações
facilmente percecionadas pelas equipas multidisciplinares. Por estas razões, surgiu a
necessidade de uma solução de deteção precoce de deterioração aguda do estado geral
de doentes durante a observação clínica.
Os Early Warning Scores são protocolos de atuação que visam melhorar a deteção e o
tempo de resposta perante situações de deterioração clínica em adultos ou crianças, (4)
para os Serviços de Urgências, Equipas de Emergências Pré-hospitalar e Equipas de
Emergência Intra-Hospitalar. Estes foram criados com a premissa de que a deteção
tardia, a circunstância e a resposta da equipa clínica comprometem os outcomes de saúde
em pessoas com doença aguda. Assim, surgem para uniformizar um conjunto de medidas
para diagnosticar e para comunicar rapidamente a deterioração do estado de doentes
numa linguagem comum.
A evidência científica atual mostra que os Aggregate Weighted Scoring System, como o
Modified Early Warning Score, VitalPAC™ Early Warning Score e National Early
Warning Score, parecem ser mais eficazes que os Single Parameter Systems. Destes
scores agregados, o National Early Warning Score é sucessivamente demonstrado como
o melhor sistema de deteção, inclusivamente para o Serviço de Urgência.
Atualmente, existe uma nova tendência – em crescimento - que passa pela conjugação
de scores fisiológicos com algum tipo de critério metabólico. A literatura aponta para
conjugação com valores séricos de lactato, d-dímeros, cálcio, entre outros. O National
Early Warning Score-Recetor do Ativador de Plasminogénio do Tipo Uroquinase
Solúvel surge como um forte candidato.
Perante um elevado número de possibilidades de biomarcadores disponíveis para esta
fusão, surge o desafio de aumentar a capacidade dos scores fisiológicos sem, ao mesmo
tempo, os tornar complexos e de cálculo demorado, de modo a garantir a sua
aplicabilidade nos Serviços de Urgências. Nestas condições, todos estes têm limitações,
desde especificidade para patologias cardiovascular, sepsis e Pancreatite Aguda (lactato,
d-dímeros e cálcio) à demora no cálculo do score (Recetor do Ativador de Plasminogénio
do tipo Uroquinase Solúvel e Pro-adrenomedulina medio-regional), pelo que serão
necessários mais estudos para se encontrar o biomarcador que cumpra todos os critérios.
Patients after being admitted to the Emergency Departments can have their clinical situation being aggravated during or after medical observation, without major changes perceived by multidisciplinary teams. For these reasons, the need arose for a solution for the early detection of acute detioration in the general condition of patients during clinical observation. Early Warning Scores are action protocols that aim to improve detection and response time of clinical deterioration in adults or children, for the Emergency Services, Prehospital Emergency Teams and In-Hospital Emergency Teams. These were created with the premise that late detection, the circumstance and the responde of the clinical team compromise the health outcomes in people with acute illness. Thus, they appear to standarize a set of measures to diagnose and rapidly communicate the deterioration of the patients’ condition in a common language. Current scientific evidence shows that Aggregate Weighted Scoring System, such as the Modified Early Warning Score, VitalPAC™ Early Warning Score and National Early Warning Score, appear to be more effective than Single Parameter Systems. Of these aggregated scores, National Early Warning Score is successively demonstrated as the best detection system, even for the emergency department. Currently, there is a new trend in growth that envolves the combination of physiological scores with some type of metabolic criteria. The literature points to conjugation with sérum values of lactate, d-dimers, calcium amog others. The National Early Warning Score – Soluble Urokinase-type Plasminogen Activator Receptor emerges as a strong candidate. Given the high number of possibilities of biomarkers available for this fusion, the challenge arises to increase the capacity of physiological scores without, at the same time, making them complex and time-consuming, in order to guarantee their applicability in the Emergency Services. In these conditions, all of these have limitations, from specificity for cardiovascular pathologies, sepsis and Acute Pancreatitis (lactate, d-dimers and calcium) to the delay in the calculation of the score (Soluble Urokinase-type Plasminogen Activator Receptor and Mid-Regional Pro-Adrenomedullin), so further studies are needed to find the biomarker that meets all the criteria.
Patients after being admitted to the Emergency Departments can have their clinical situation being aggravated during or after medical observation, without major changes perceived by multidisciplinary teams. For these reasons, the need arose for a solution for the early detection of acute detioration in the general condition of patients during clinical observation. Early Warning Scores are action protocols that aim to improve detection and response time of clinical deterioration in adults or children, for the Emergency Services, Prehospital Emergency Teams and In-Hospital Emergency Teams. These were created with the premise that late detection, the circumstance and the responde of the clinical team compromise the health outcomes in people with acute illness. Thus, they appear to standarize a set of measures to diagnose and rapidly communicate the deterioration of the patients’ condition in a common language. Current scientific evidence shows that Aggregate Weighted Scoring System, such as the Modified Early Warning Score, VitalPAC™ Early Warning Score and National Early Warning Score, appear to be more effective than Single Parameter Systems. Of these aggregated scores, National Early Warning Score is successively demonstrated as the best detection system, even for the emergency department. Currently, there is a new trend in growth that envolves the combination of physiological scores with some type of metabolic criteria. The literature points to conjugation with sérum values of lactate, d-dimers, calcium amog others. The National Early Warning Score – Soluble Urokinase-type Plasminogen Activator Receptor emerges as a strong candidate. Given the high number of possibilities of biomarkers available for this fusion, the challenge arises to increase the capacity of physiological scores without, at the same time, making them complex and time-consuming, in order to guarantee their applicability in the Emergency Services. In these conditions, all of these have limitations, from specificity for cardiovascular pathologies, sepsis and Acute Pancreatitis (lactate, d-dimers and calcium) to the delay in the calculation of the score (Soluble Urokinase-type Plasminogen Activator Receptor and Mid-Regional Pro-Adrenomedullin), so further studies are needed to find the biomarker that meets all the criteria.
Description
Keywords
Acute Deterioration Early Warning Score Emergency Department National Early Warning Score Physiological Deterioration