Evaluation of clinical findings and blood gas parameters for severity assessment in patients with dyspnea complaint in the emergency department

Aim: Our aim in this study is to determine seriousness of illness of patients who applied emergency department with complaints of dyspnea and to examine the effectiveness of OCS-9 (objective classification scale) to predict outcomes of hospitalized patients. Materials and Method: Patients over 18 years old who applied Manisa Celal Bayar University Medical Faculty Hafsa Sultan Hospital Emergency Medicine Department with complaints of respiratory distress between January 2015 and August 2017 participated in the study. An approval from Ethical Committee at University was obtained for the study. Information of the patients were retrosceptively scanned through information management system of the hospital. Upon analyzing patient files, blood gas parameters were evaluated. Patients below 18-year-old and those with respiratory distress whose blood gas had not been taken, hospital referred patients and pregnants were not included in the study. In order to calculate OCS-9 value of the patients with complaints of dyspnea, we used three important parameters (Ph, Base excess and lactate level) in blood gas. Data were calculated as mean, standard deviation (SD) and percentage. Clinical parameters and blood gas parameters (OCS points) were compared to result situations (discharge, hospitalization, intensive care, exitus). Results: 373 patients participated in the study 249 of whom (68,8%) were male. Mean age of the patients was 68,2+15,03. Comorbidity did not appear in 175 (46,9%) of the patients. Hypertension with 23,9% and COPD with 22,5% lead comorbid illnesses respectively. Mean age, SBP, DBP, PCO2, Base excess levels were higher in patients with comorbidities compared to the ones without comorbidities; while SpO2, pH, PO2, HCO3, lactate levels were lower in patients with comorbidities. Mean pH of blood gases taken from the patients was 7,4+0,1 while mean of base excess was 0,36+5,6 and lactate 1,99+1,6. In our study, the difference between the OCS-9 scores of the patients who complained of severe dyspnea (1,59+1,5) and who did not (1,02+1,3) was statistically significant. (p<0,001). OCS-9 score increases proportionally with respiratory rate and hearth rate while decreases with SpO2. Conclusion: The mean OSC-9 scores of patients who were discharged from the emergency department or admitted to service was statistically significantly lower than the ones who were admitted to the intensive care unit. When taking cut-off value of OCS-9 score as 1, sensivity and specifity in prediction of exitus and intensive care were found as 46,9% and 77,07% respectively. Findings of our study showed that using OCS-9 score in emergency department is an effective method in determining which units to hospitalize patients and predicting patient prognosis. Key Words: Dyspnea, Emergency Department, Objective Classification Scale-9.