๊ณ ๋ น ์‘๊ธ‰ํ™˜์ž ์œ„ํ—˜์ธตํ™” / Geriatric emergency risk stratification

์ •์˜

๊ณ ๋ น ์‘๊ธ‰ํ™˜์ž์—์„œ ๊ธฐ์กด ์‘๊ธ‰์‹ค ์ง„๋‹จยท์œ„ํ—˜์ธตํ™”ยทํ‡ด์› ๊ฒฐ์ • ์•Œ๊ณ ๋ฆฌ์ฆ˜์ด ์ Š์€ ํ™˜์ž์™€ ๋™์ผํ•˜๊ฒŒ ์•ˆ์ „ํ•œ์ง€ ํ‰๊ฐ€ํ•˜๋Š” ์ ‘๊ทผ์ด๋‹ค.

์ž„์ƒ ํ•ต์‹ฌ

ํ•ต์‹ฌ ์งˆ๋ฌธ์€ ๋‹จ์ˆœํ•œ ๋‚˜์ด ๋น„๊ต๊ฐ€ ์•„๋‹ˆ๋ผ โ€œ๊ณ ๋ น์—์„œ ๊ธฐ์กด ์˜์‚ฌ๊ฒฐ์ •์ด ์•ˆ์ „ํ•œ๊ฐ€?โ€์ด๋‹ค. ๊ณ ๋ น๊ตฐ์—์„œ๋Š” ์ฆ์ƒ, ํ™œ๋ ฅ์ง•ํ›„, ๊ฒ€์‚ฌ ์„ฑ๋Šฅ, risk score ์„ฑ๋Šฅ, disposition, outcome์ด ๋‹ฌ๋ผ์งˆ ์ˆ˜ ์žˆ๋‹ค. Frailty, delirium, polypharmacy, nursing home residence, ADL decline, cognitive impairment ๊ฐ™์€ ๊ณ ๋ น ํŠน์ด ์ธ์ž๋ฅผ ์ถ”๊ฐ€๋กœ ๊ณ ๋ คํ•œ๋‹ค.

์ง„๋‹จ

์—ฐ๊ตฌ ํ”„๋ ˆ์ž„์€ common ED presentation์—์„œ ์‹œ์ž‘ํ•ด ๊ธฐ์กด algorithm์˜ ์„ฑ๋Šฅ๊ณผ calibration์„ ๊ณ ๋ น๊ตฐ์—์„œ ๊ฒ€์ฆํ•˜๋Š” ๊ฒƒ์ด๋‹ค. qSOFA, NEWS2, HEART, Wells, PERC, syncope score ๋“ฑ ๊ธฐ์กด ๋„๊ตฌ์˜ ๊ณ ๋ น๊ตฐ ์„ฑ๋Šฅ ํ‰๊ฐ€๊ฐ€ ํ•ต์‹ฌ ์ถ•์ด๋‹ค.

์น˜๋ฃŒ

์ž„์ƒ ์ ์šฉ ๋ชฉํ‘œ๋Š” ๊ณ ๋ น ๋งž์ถคํ˜• diagnostic strategy, risk model, disposition pathway๋ฅผ ๊ฐœ๋ฐœํ•˜๊ณ  ์ „ํ–ฅ์ ์œผ๋กœ ๊ฒ€์ฆํ•˜๋Š” ๊ฒƒ์ด๋‹ค. Intervention ํ›„๋ณด๋Š” frailty/delirium screening, geriatric pathway, follow-up clinic, admission decision support์ด๋‹ค.

์ถœ์ฒ˜

ACEP geriatric ED ์ž๋ฃŒ๊ฐ€ raw ์ž๋ฃŒ์—์„œ ๊ทผ๊ฑฐ๋กœ ์–ธ๊ธ‰๋˜์—ˆ๋‹ค.

๐ŸŒฑ ์ถœ์ฒ˜ raw


๋ณธ ๋ฌธ์„œ๋Š” ํ•™์Šตยท์ฐธ๊ณ ์šฉ์ด๋ฉฐ ์‹ค์ œ ์ง„๋ฃŒ ๊ฒฐ์ •์€ ์ž„์ƒ์˜์˜ ํŒ๋‹จ์ž…๋‹ˆ๋‹ค.