{"id":518,"date":"2023-07-31T15:41:57","date_gmt":"2023-07-31T12:41:57","guid":{"rendered":"https:\/\/tatd.org.tr\/geriatri\/?p=518"},"modified":"2023-07-31T15:41:58","modified_gmt":"2023-07-31T12:41:58","slug":"geriatrik-hastanin-acil-servis-basvurusundaki-triyaji","status":"publish","type":"post","link":"https:\/\/tatd.org.tr\/geriatri\/genel\/geriatrik-hastanin-acil-servis-basvurusundaki-triyaji\/","title":{"rendered":"Geriatrik Hastan\u0131n Acil Servis Ba\u015fvurusundaki Triyaj\u0131"},"content":{"rendered":"\n

Acil Servislerde yakla\u015f\u0131k %25 oran\u0131nda ya\u015fl\u0131 hasta ba\u015fvurusu bildirilmektedir. Son y\u0131llarda acil servislerin ve hasta bak\u0131m\u0131n\u0131n ya\u015fl\u0131 hastalara g\u00f6re uyarlanmas\u0131 gerekti\u011fi vurgulanmaktad\u0131r (1). Geriatrik hasta y\u00f6netiminin di\u011fer yeti\u015fkinlere g\u00f6re farklar\u0131; hayati riski belirleyen, kritik hastal\u0131\u011f\u0131n \u00f6zelliklerini maskeleyen ila\u00e7lar\u0131n s\u0131kl\u0131\u011f\u0131 ve artm\u0131\u015f komorbiditeleridir. Ayr\u0131ca, ya\u015fl\u0131 yeti\u015fkinler genellikle non-spesifik \u015fikayetleri olan, bilin\u00e7 de\u011fi\u015fikli\u011fine, ek hastal\u0131klar\u0131 ve \u00e7oklu ila\u00e7 kullan\u0131m\u0131na sahip ve mortalite oranlar\u0131 daha y\u00fcksek olan hastalard\u0131r (2). T\u00fcm bunlar nedeniyle, bu hastalar yetersiz triyaj riski alt\u0131ndad\u0131r ve bu risk ya\u015f ile artmaktad\u0131r (3).<\/p>\n\n\n\n

Triyaj kelime anlam\u0131 ile ayr\u0131\u015ft\u0131rmak, se\u00e7mek ve \u00f6ncelik tan\u0131makt\u0131r. Acil servislerde kritik hastay\u0131 tan\u0131mak erken tedaviyi ba\u015flamak i\u00e7in ba\u015fvuru an\u0131ndan hastan\u0131n sonlan\u0131m\u0131na kadar s\u00fcregelen bir triyaj hali mevcuttur (4). Acil servise ba\u015fvuran hastalar\u0131n \u00f6nceli\u011fini belirlemek, mevcut kaynaklar\u0131 verimli bir \u015fekilde planlamak, ge\u00e7erli ve g\u00fcvenilir bir triyaj sistemi gerektirir. \u201cUndertriage\u201d<\/em>, yetersiz derecede d\u00fc\u015f\u00fck bir triyaj seviyesini tan\u0131mlar, belirlenmi\u015f yetersiz triyaj oranlar\u0131 i\u00e7in bir e\u015fik yoktur ancak %10\u2019dan az olmas\u0131 beklenmektedir. Ya\u015fl\u0131 hastalar yetersiz triyaj i\u00e7in risk alt\u0131ndad\u0131rlar (5).<\/p>\n\n\n\n

Triyaj sistemleri olarak t\u00fcm d\u00fcnyada yayg\u0131n olarak Acil Durum \u015eiddet \u0130ndeksi (ESI) ve Manchester Triage Skoru (MTS) kullan\u0131lmaktad\u0131r. Ancak kronik hastal\u0131klar\u0131, vital parametrelerin g\u00fcvenilir olmay\u0131\u015f\u0131, triyaj skorlama sistemlerinin ya\u015fl\u0131 hastalarda yeterli olamayabilece\u011fini d\u00fc\u015f\u00fcnd\u00fcrmektedir. N\u00fcfusun ya\u015flanmas\u0131, kronik ve karma\u015f\u0131k bak\u0131m gerektiren ya\u015fl\u0131 hastalar\u0131n say\u0131s\u0131 artt\u0131k\u00e7a sa\u011fl\u0131k bak\u0131m sistemlerini yeni algoritmalar geli\u015ftirmeye zorlamaktad\u0131r.<\/p>\n\n\n\n

Literat\u00fcr incelendi\u011finde geriatrik hasta triyaj\u0131nda; Kanada Triyaj ve Keskinlik \u00d6l\u00e7e\u011fi (CTAS), Manchester Triyaj Sistemi (MTS) ve Acil Durum \u015eiddet \u0130ndeksi (ES\u0130<\/a>), Ulusal Erken Uyar\u0131 Skoru (NEWS) gibi \u00f6l\u00e7eklerin s\u0131kl\u0131kla kullan\u0131ld\u0131\u011f\u0131n\u0131 g\u00f6r\u00fclmektedir (5,6). <\/p>\n\n\n\n

K\u0131r\u0131lgan ya\u015fl\u0131 hastalar\u0131n y\u00fcksek mortalite risk ta\u015f\u0131d\u0131\u011f\u0131n\u0131n kan\u0131tlanmas\u0131 ile acil serviste triyaj arac\u0131 olarak kullan\u0131m\u0131n\u0131 g\u00fcndeme getirmi\u015ftir. Klinik K\u0131r\u0131lganl\u0131k Skoru (CFS) triyaj\u0131 belirlemede s\u0131kl\u0131kla \u00e7al\u0131\u015fmalara dahil edilmektedir. Benzer \u015fekilde ya\u015fl\u0131 hasta tarama ara\u00e7lar\u0131 olan Risk Alt\u0131ndaki Ya\u015fl\u0131lar\u0131n Belirlenmesi (ISAR), Triyaj Risk Tarama Arac\u0131 (TRST) ile triyajda kritik hasta belirlenmeye \u00e7al\u0131\u015f\u0131lm\u0131\u015ft\u0131r. <\/p>\n\n\n\n

Kanada Triyaj ve Keskinlik \u00d6l\u00e7e\u011fi (CTAS), <\/strong>h\u0131zl\u0131 hasta de\u011ferlendirmede do\u011fru ve g\u00fcvenilir bir ara\u00e7 olarak kabul edilmektedir. G\u00fcvenilirli\u011fi ve ge\u00e7erlili\u011fi hem \u00e7ocuklarda hem de yeti\u015fkinlerde kan\u0131tlanm\u0131\u015ft\u0131r. Ya\u015fl\u0131 hastalar i\u00e7in ge\u00e7erlili\u011fi y\u00fcksek bulunmu\u015ftur. \u00d6zellikle \u015fiddeti kategorize etmek ve acil hayat kurtar\u0131c\u0131 m\u00fcdahaleye ihtiya\u00e7 duyan ya\u015fl\u0131 hastalar\u0131 tan\u0131mak i\u00e7in yararl\u0131 bir ara\u00e7t\u0131r. Yap\u0131lan bir \u00e7al\u0131\u015fma CTAS \u00f6l\u00e7e\u011finin, ya\u015fl\u0131 hastalar\u0131n ciddiyeti ve kaynak kullan\u0131m\u0131 belirlemede g\u00fc\u00e7l\u00fc oldu\u011funu g\u00f6stermektedir. 65 ya\u015f \u00fcst\u00fc ya\u015fl\u0131 hastalarda CTAS d\u00fczeyi \u2264 2 ile acil hayat kurtar\u0131c\u0131 m\u00fcdahale kullan\u0131m\u0131 %97,9 duyarl\u0131k ve %89,2 \u00f6zg\u00fcll\u00fc\u011fe sahip olup, acil hayat kurtar\u0131c\u0131 m\u00fcdahale i\u00e7in y\u00fcksek \u00f6ng\u00f6r\u00fclebilirli\u011fe sahiptir (7). CTAS uygularken ya\u015fl\u0131 hastalar\u0131n de\u011fi\u015fen fiziksel \u00f6zellikleri (kardiovask\u00fcler, pulmoner ve termoreg\u00fclatuvar) dikkate almay\u0131 vurgulamaktad\u0131r. A\u011fr\u0131 karakterinin ve \u00f6zellikle skorlar\u0131n\u0131n gen\u00e7 eri\u015fkinlere g\u00f6re daha d\u00fc\u015f\u00fck oldu\u011fu bilinmelidir. Ciddi patolojiler hafif \u015fikayetler ile prezante olabilirler. Bilin\u00e7 d\u00fczeyinin, d\u00fc\u015fme ve travma y\u00f6n\u00fcnden ve polifarmasi a\u00e7\u0131s\u0131ndan de\u011ferlendirilmesi gereklili\u011fi ve t\u00fcm bunlar\u0131n ya\u015fl\u0131 hastalar\u0131n triyaj\u0131nda \u00f6nemli basamak oldu\u011fu belirtilmektedir (5). <\/p>\n\n\n\n

Manchester Triyaj Sistemi (MTS); <\/strong>hastalar\u0131n \u015fik\u00e2yet ve semptomlar\u0131na g\u00f6re s\u0131n\u0131flayan bir skorlamad\u0131r. T\u00fcm hastalar\u0131n dahil edildi\u011fi \u00e7al\u0131\u015fmada acil servis triyaj\u0131nda etkili oldu\u011fu g\u00f6sterilmi\u015f olsa da ya\u015fl\u0131 hastalarda k\u00f6t\u00fc performans g\u00f6sterdi\u011fi belirtilmektedir (8). MTS’nin ya\u015fl\u0131 hastalarda acil servis kaynak kullan\u0131m\u0131, acil servis kal\u0131\u015f s\u00fcresi, hastaneye yat\u0131\u015f ve hastane i\u00e7i mortalite ile ili\u015fkili olmas\u0131na ra\u011fmen, MTS’nin hastane i\u00e7i mortaliteyi \u00f6ng\u00f6rme yetene\u011fi ya\u015fl\u0131 hastalarda 18-64 ya\u015f aras\u0131 hastalara g\u00f6re daha k\u00f6t\u00fc oldu\u011fu bildirilmektedir (9). <\/p>\n\n\n\n

Acil Durum \u015eiddet \u0130ndeksi (ES\u0130); <\/strong>5 kademeli acil servis triyaj sistemidir. Mortalite, hastaneye yat\u0131\u015f, acil serviste kal\u0131\u015f s\u00fcresini belirlemede etkili oldu\u011fu bildirilmektedir. Ya\u015fl\u0131 hastalarda 3 g\u00fcnl\u00fck mortalite ve hastaneye yat\u0131\u015flar\u0131n belirlenmesinde etkili iken 30 g\u00fcnl\u00fck mortalite belirlemede etkinli\u011fi d\u00fc\u015f\u00fck bulunmu\u015ftur (6,10). Ya\u015fl\u0131 hastalar\u0131n benzer ESI indeksleri olan gen\u00e7 eri\u015fkinlere oranla acil servis kullan\u0131m\u0131, ba\u015fvuru oranlar\u0131 ve k\u0131sa d\u00f6nem mortalitelerinin fazla oldu\u011fu g\u00f6sterilmi\u015ftir. Bu bulgular ya\u015fl\u0131 hasta riskini belirlemede daha fazla bilgiye ihtiyac\u0131 oldu\u011funu d\u00fc\u015f\u00fcnd\u00fcrebilir. Sadece ya\u015f de\u011fil k\u0131r\u0131lganl\u0131k gibi ya\u015fl\u0131 hastalar\u0131n mortalite ve morbiditesini art\u0131ran klinik de\u011ferlendirmelerin eklenmesi uygun olabilir denilmektedir (10).<\/p>\n\n\n\n

Acil durum \u015fiddet indeksinin (ESI) hayat kurtar\u0131c\u0131 prosed\u00fcrlere ihtiya\u00e7 duyan ya\u015fl\u0131 eri\u015fkinlerin de\u011ferlendirildi\u011fi \u00e7al\u0131\u015fmada yar\u0131s\u0131ndan daha az\u0131n\u0131 tan\u0131mlad\u0131\u011f\u0131n\u0131 g\u00f6stermi\u015ftir. ESI’ nin acil hayat kurtar\u0131c\u0131 tedaviye ihtiya\u00e7 duyacak ya\u015fl\u0131 hastalar\u0131 tahmin etmede yararl\u0131 olmad\u0131\u011f\u0131, duyarl\u0131l\u0131\u011f\u0131n\u0131n %42.3 ve \u00f6zg\u00fcll\u00fc\u011f\u00fcn\u00fcn %99.2 oldu\u011fu saptanm\u0131\u015ft\u0131r. Bu bulgular ESI’n\u0131n acil hayat kurtar\u0131c\u0131 tedaviye ihtiya\u00e7 duyan ya\u015fl\u0131 hastalar\u0131 yetersiz triyaj yapabilece\u011fini g\u00f6sterir (11).<\/p>\n\n\n\n

Klinik K\u0131r\u0131lganl\u0131k Skoru (CFS); <\/strong>ya\u015fl\u0131 hastalar\u0131n prognozunu, hastanede kal\u0131\u015f s\u00fcresini, fonksiyonel gerilemeyi ve mortaliteyi belirlemede etkili bulunmu\u015ftur. <\/strong>Bu hali ile triyajda kullan\u0131m\u0131 g\u00fcndeme gelmi\u015f ve \u00e7al\u0131\u015fmalarda de\u011ferlendirilmi\u015ftir. Yap\u0131lan \u00e7al\u0131\u015fmalarda yan etki ve mortalite i\u00e7in destekleyici oldu\u011funu d\u00fc\u015f\u00fcnd\u00fcr\u00fcc\u00fc bulgular saptanm\u0131\u015ft\u0131r (12). Bir \u00e7al\u0131\u015fma ise triyajda direk kullan\u0131m\u0131n\u0131n \u00f6zellikle CFS> 5 hastalar i\u00e7in sensitivitenin %43,61 olmas\u0131 nedeniyle yetersiz triyaj olabilece\u011fi d\u00fc\u015f\u00fcnd\u00fcrmektedir (13). Yine de her iki \u00e7al\u0131\u015fma daha geni\u015f kapsaml\u0131 \u00e7al\u0131\u015fmalara ihtiya\u00e7 duyuldu\u011funu vurgulamaktad\u0131r.<\/p>\n\n\n\n

Ulusal Erken Uyar\u0131 Skoru (NEWS); <\/strong>2012 y\u0131l\u0131nda NEWS olarak tan\u0131t\u0131lan 2017 y\u0131l\u0131nda ise konf\u00fczyonun eklenmesi ile NEWS2 olarak yenilenmi\u015ftir. Vital parametrelerin yan\u0131 s\u0131ra bilin\u00e7 d\u00fczeyini de\u011ferlendirmeyi i\u00e7erir. <\/strong>NEWS2, 30 g\u00fcnl\u00fck mortaliteyi ve YB\u00dc\u2019ye yat\u0131\u015f\u0131 tahmin etmede istatistiksel olarak anlaml\u0131d\u0131r, ancak do\u011fruluk a\u00e7\u0131s\u0131ndan zay\u0131ft\u0131r (6). Di\u011fer bir \u00e7al\u0131\u015fmada NEWS2\u2019nin klinik karar vermede d\u00fc\u015f\u00fck bir role sahip olaca\u011f\u0131 belirtilmektedir (14).<\/p>\n\n\n\n

Risk Alt\u0131ndaki Ya\u015fl\u0131lar\u0131n Belirlenmesi (ISAR) ve Triyaj Risk Tarama Arac\u0131 (TRST); <\/strong>acil servis mortalitesini belirlemesi \u00fczerine yap\u0131lan bir \u00e7al\u0131\u015fmada yeterli bulunsa da, var olan deliryum, polifarmasi gibi ya\u015fl\u0131l\u0131\u011fa ba\u011fl\u0131 durumlar\u0131n eklenmesinin riski belirmede daha uygun oldu\u011fu belirtilmektedir (15-17).<\/p>\n\n\n\n

Sonu\u00e7 olarak, triyaj hastane acil servislerinde temel bir prosed\u00fcrd\u00fcr. Ancak \u015fu anda ya\u015fl\u0131 hastalarda yeterince g\u00fcvenli ve etkili oldu\u011fu g\u00f6sterilen hi\u00e7bir ara\u00e7 yoktur. Acil servisler bunu dikkate almal\u0131 ve bu s\u0131n\u0131rlamalar\u0131 uygun olan triyaj ve triyaj sonras\u0131 bekleme s\u00fcresi izleme sistemleri kurulmal\u0131d\u0131r. Belki de en iyi \u00e7\u00f6z\u00fcm, yapay zekaya dayal\u0131, hastan\u0131n komorbiditeleri, k\u0131r\u0131lganl\u0131k de\u011ferlendirmesi, \u00f6nceki acil servis veya hastane kabulleri hakk\u0131ndaki mevcut sa\u011fl\u0131k veri kay\u0131tlar\u0131n\u0131 triyaj sistemlerinden elde edilen klasik verilerle an\u0131nda entegre eden ve t\u00fcm\u00fc acil servisteki a\u015f\u0131r\u0131 kalabal\u0131kla ilgili bilgilerle birle\u015ftiren yeni triyaj ara\u00e7lar\u0131 olu\u015fturmak olabilir (18).<\/p>\n\n\n\n

Kaynaklar<\/strong><\/p>\n\n\n\n

    \n
  1. American College of Emergency Physicians; American Geriatrics Society; Emergency Nurses Association; Society for Academic Emergency Medicine; Geriatric Emergency Department Guidelines Task Force. Geriatric emergency department guidelines. Ann Emerg Med. 2014 May;63(5):e7-25. doi: 10.1016\/j.annemergmed.2014.02.008<\/li>\n\n\n\n
  2. Bullard MJ, Melady D, Emond M; members of the CTAS National working group:; Musgrave E, Unger B, van der Linde E, Grierson R, Skeldon T, Warren D, Swain J. Guidance when Applying the Canadian Triage and Acuity Scale (CTAS) to the Geriatric Patient: Executive Summary. CJEM. 2017 Jul;19(S2):S28-S37. doi: 10.1017\/cem.2017.363. Erratum in: CJEM. 2017 Sep;19(5):415. PMID: 28756798.<\/li>\n\n\n\n
  3. Ruge, T., Malmer, G., Wachtler, C. et al. Age is associated with increased mortality in the RETTS-A triage scale. BMC Geriatr 2019;19:139 https:\/\/doi.org\/10.1186\/s12877-019-1157-4<\/a><\/li>\n\n\n\n
  4. Montano IH, de la Torre D\u00edez I, L\u00f3pez-Izquierdo R, Villamor MAC, Mart\u00edn-Rodr\u00edguez F. Mobile Triage Applications: A Systematic Review in Literature and Play Store. J Med Syst. 2021 Aug 13;45(9):86. doi: 10.1007\/s10916-021-01763-2.<\/li>\n\n\n\n
  5. Blomaard LC, Speksnijder C, Lucke JA, de Gelder J, Anten S, Schuit SCE, Steyerberg EW, Gussekloo J, de Groot B, Mooijaart SP. Geriatric Screening, Triage Urgency, and 30-Day Mortality in Older Emergency Department Patients. J Am Geriatr Soc. 2020 Aug;68(8):1755-1762. doi: 10.1111\/jgs.16427. Epub 2020 Apr 4. PMID: 32246476; PMCID: PMC7497167<\/li>\n\n\n\n
  6. Kemp K, Alakare J, Harjola VP, Strandberg T, Tolonen J, Lehtonen L, Castr\u00e9n M. National Early Warning Score 2 (NEWS2) and 3-level triage scale as risk predictors in frail older adults in the emergency department. BMC Emerg Med. 2020 Oct 28;20(1):83. doi: 10.1186\/s12873-020-00379-y. PMID: 33115446; PMCID: PMC7594283<\/li>\n\n\n\n
  7. Lee JY, Oh SH, Peck EH, Lee JM, Park KN, Kim SH, Youn CS. The validity of the Canadian Triage and Acuity Scale in predicting resource utilization and the need for immediate life-saving interventions in elderly emergency department patients. Scand J Trauma Resusc Emerg Med. 2011 Nov 3;19:68. doi: 10.1186\/1757-7241-19-68 PMID: 22050641; PMCID: PMC3223131<\/li>\n\n\n\n
  8. Zachariasse JM, Seiger N, Rood PP, Alves CF, Freitas P, Smit FJ, Roukema GR, Moll HA. Validity of the Manchester Triage System in emergency care: A prospective observational study. PLoS One. 2017 Feb 2;12(2):e0170811. doi: 10.1371\/journal.pone.0170811<\/li>\n\n\n\n
  9. Brouns SHA, Mignot-Evers L, Derkx F, Lambooij SL, Dieleman JP, Haak HR. Performance of the Manchester triage system in older emergency department patients: a retrospective cohort study. BMC Emerg Med. 2019 Jan 7;19(1):3. doi: 10.1186\/s12873-018-0217-y<\/li>\n\n\n\n
  10. Ginsburg AD, Oliveira J E Silva L, Mullan A, Mhayamaguru KM, Bower S, Jeffery MM, Bellolio F. Should age be incorporated into the adult triage algorithm in the emergency department? Am J Emerg Med. 2021 Aug;46:508-514. doi: 10.1016\/j.ajem.2020.10.075<\/li>\n\n\n\n
  11. Platts-Mills TF, Travers D, Biese K, McCall B, Kizer S, LaMantia M, Busby-Whitehead J, Cairns CB. Accuracy of the Emergency Severity Index triage instrument for identifying elder emergency department patients receiving an immediate life-saving intervention. Acad Emerg Med. 2010 Mar;17(3):238-43. doi: 10.1111\/j.1553-2712.2010.00670.x,<\/li>\n\n\n\n
  12. Elliott A, Taub N, Banerjee J, Aijaz F, Jones W, Teece L, van Oppen J, Conroy S. Does the Clinical Frailty Scale at Triage Predict Outcomes From Emergency Care for Older People? Ann Emerg Med. 2021 Jun;77(6):620-627. doi: 10.1016\/j.annemergmed.2020.09.006<\/li>\n\n\n\n
  13. Shrier W, Dewar C, Parrella P, Hunt D, Hodgson LE. Agreement and predictive value of the Rockwood Clinical Frailty Scale at emergency department triage. Emerg Med J. 2021 Dec;38(12):868-873. doi: 10.1136\/emermed-2019-208633<\/li>\n\n\n\n
  14. Vardy ER, Lasserson D, Barker RO, Hanratty B. NEWS2 and the older person. Clin Med (Lond). 2022 Nov;22(6):522-524. doi: 10.7861\/clinmed.2022-0426.<\/li>\n\n\n\n
  15. Rizka, A, Harimurti, K, Pitoyo, CW, Koesnoe, S. Comparison between the Identification of Seniors at Risk and Triage Risk Screening Tool in predicting mortality of older adults visiting the emergency department: Results from Indonesia. Geriatr. Gerontol. Int. 2020; 20: 47\u2013 51. https:\/\/doi.org\/10.1111\/ggi.13817<\/li>\n\n\n\n
  16. Loddo S, Costaggiu D, Palimodde A, Cogoni E, Putzu S, Serchisu L, Laconi R, Scuteri A, Mandas A Emergency department: risk stratification in the elderly Journal of Gerontology and Geriatrics 2021;63(3) doi: 10.36150\/2499-6564-N352<\/li>\n\n\n\n
  17. Pham, Khue D. BSN, RN; Lim, Fidelindo A. DNP, CCRN. The Impact of Geriatric-Specific Triage Tools Among Older Adults in the Emergency Department. Critical Care Nursing Quarterly 43(1):p 39-57, January\/March 2020. | DOI: 10.1097\/CNQ.0000000000000290<\/li>\n\n\n\n
  18. Puig-Campmany, M., Bl\u00e1zquez-Andi\u00f3n, M. & Ris-Romeu, J. Triage tools: a cautious (and critical) view towards their use in old patients. Eur Geriatr Med 2022;13:319\u2013322 https:\/\/doi.org\/10.1007\/s41999-021-00572-7<\/a><\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    Acil Servislerde yakla\u015f\u0131k %25 oran\u0131nda ya\u015fl\u0131 hasta ba\u015fvurusu bildirilmektedir. Son y\u0131llarda acil servislerin ve hasta bak\u0131m\u0131n\u0131n ya\u015fl\u0131 hastalara g\u00f6re uyarlanmas\u0131 gerekti\u011fi vurgulanmaktad\u0131r…<\/p>\n","protected":false},"author":1185,"featured_media":519,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[1,10014],"tags":[10020,10018],"class_list":["post-518","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-genel","category-akademik-blog-yazisi","tag-acil-tip","tag-geriatri"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts\/518","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/users\/1185"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/comments?post=518"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts\/518\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/media\/519"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/media?parent=518"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/categories?post=518"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/tags?post=518"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}