{"id":2137,"date":"2016-06-27T00:00:00","date_gmt":"2016-06-26T21:00:00","guid":{"rendered":"https:\/\/tatd.org.tr\/tatdus\/2020\/02\/27\/stone-plus-acil-serviste-renal-kolik-hastalarimizda-klinik-olasilik-skorlamasi-ile-birlikte-yatak-basi-usg-kullanimi-tomografi-cekim-sayisini-azaltabilir-mi\/"},"modified":"2022-03-02T17:06:14","modified_gmt":"2022-03-02T14:06:14","slug":"stone-plus-acil-serviste-renal-kolik-hastalarimizda-klinik-olasilik-skorlamasi-ile-birlikte-yatak-basi-usg-kullanimi-tomografi-cekim-sayisini-azaltabilir-mi","status":"publish","type":"post","link":"https:\/\/tatd.org.tr\/tatdus\/2016\/06\/27\/stone-plus-acil-serviste-renal-kolik-hastalarimizda-klinik-olasilik-skorlamasi-ile-birlikte-yatak-basi-usg-kullanimi-tomografi-cekim-sayisini-azaltabilir-mi\/","title":{"rendered":"STONE PLUS: Acil Serviste Renal Kolik Hastalar\u0131m\u0131zda Klinik Olas\u0131l\u0131k Skorlamas\u0131 ile Birlikte Yatak Ba\u015f\u0131 USG Kullan\u0131m\u0131 Tomografi \u00c7ekim Say\u0131s\u0131n\u0131 Azaltabilir mi?"},"content":{"rendered":"\r\n<div class=\"wp-block-group\">\r\n<div class=\"wp-block-group__inner-container is-layout-flow wp-block-group-is-layout-flow\">\r\n<p class=\"is-layout-flow wp-block-quote-is-layout-flow\">Renal kolik d\u00fc\u015f\u00fcn\u00fclen hastada enfeksiyon varl\u0131\u011f\u0131n\u0131n tespiti, ek \u00fcrolojik acil giri\u015fimin \u00f6ng\u00f6r\u00fclmesi ve renal kolik d\u0131\u015f\u0131nda alternatif \u00f6nemli tan\u0131n\u0131n atlanmamas\u0131 risk y\u00f6netiminde en \u00f6nemli konular&#8230; Bu \u00e7al\u0131\u015fma temel olarak \u015f\u00fcpheli renal kolik hastalar\u0131nda d\u00fc\u015f\u00fck, orta ve y\u00fcksek olas\u0131l\u0131k ayr\u0131m\u0131 i\u00e7in performans\u0131 \u015f\u00fcpheli olmakla birlikte \u00f6nerilebilen STONE (Sex-Timing-Origin-Nausea-Erythrocytes) skorlamas\u0131n\u0131 (Tablo1) yatak ba\u015f\u0131 ultrasonografi (point-of-care limited USG; PLUS) ile kombine etti\u011fimizde skorlaman\u0131n performans\u0131n\u0131 artt\u0131rabilir miyiz sorusuna yan\u0131t aram\u0131\u015f. Prospektif dizayn edilen ara\u015ft\u0131rma may\u0131s 2011 ve \u015fubat 2013 tarihleri aras\u0131nda iki ayr\u0131 merkezde ger\u00e7ekle\u015ftirilmi\u015f.<\/p>\r\n<\/div>\r\n<\/div>\r\n\r\n\r\n\r\n<p>P (Population): Acil servise yan a\u011fr\u0131s\u0131 ile ba\u015fvurup renal kolik \u015f\u00fcphesi ile bir protokol \u00e7er\u00e7evesinde kontrasts\u0131z abdomen ve pelvik tomografi \u00e7ekilen t\u00fcm hastalar \u00e7al\u0131\u015fmaya dahil edilmi\u015f. \u00c7al\u0131\u015fmaya kat\u0131lmay\u0131 kabul etmeyen veya bir nedenle onam formu al\u0131namayan, gebe, mahkum, ana dili \u0130ngilizce olmayan hastalar \u00e7al\u0131\u015fma d\u0131\u015f\u0131 b\u0131rak\u0131lm\u0131\u015flar. Ara\u015ft\u0131rma s\u00fcresince uygun toplam 2091 hastadan 835 hasta \u00e7al\u0131\u015fmaya dahil olmu\u015f.<\/p>\r\n\r\n\r\n\r\n<p>I (\u0130ntervention): T\u00fcm hastalar i\u00e7in STONE skorlamas\u0131na g\u00f6re semptomatik ta\u015f olas\u0131l\u0131\u011f\u0131 belirlenmi\u015f. Yan\u0131 s\u0131ra hastalarda yatak ba\u015f\u0131 USG ile hidronefroz ciddiyeti, ta\u015f varl\u0131\u011f\u0131 ve lokalizasyonu ve yan\u0131 s\u0131ra g\u00f6r\u00fclebilirse \u00fcreteral jet ak\u0131m varl\u0131\u011f\u0131 not edilmi\u015f, sonuca ile STONE-PLUS risk alg\u0131s\u0131 de\u011ferlendirilmi\u015f.<\/p>\r\n\r\n\r\n\r\n<p>C (Comparison): Her bir hastan\u0131n kontrasts\u0131z pelvik abdominal BT g\u00f6r\u00fcnt\u00fcleri al\u0131nm\u0131\u015f ve semptomatik ta\u015f ve akut alternatif \u00f6nemli tan\u0131 varl\u0131\u011f\u0131 not edilmi\u015f.<\/p>\r\n\r\n\r\n\r\n<p>O (Outcome): Birincil sonu\u00e7; semptomatik ta\u015f ve BT\u2019de akut alternatif \u00f6nemli bulgu varl\u0131\u011f\u0131. STONE ile d\u00fc\u015f\u00fck olas\u0131l\u0131k verilmi\u015f hastada orta-ciddi hidronefroz varl\u0131\u011f\u0131 durumunda semptomatik ta\u015f i\u00e7in +LR 21.6 (%95 CI 4.2-111) saptanm\u0131\u015f. BT\u2019de akut \u00f6nemli alternatif tan\u0131 (apandisit, kolesistit, divertik\u00fclit vb) alan 54 hastan\u0131n 11\u2019inde (%20) hidronefroz varm\u0131\u015f. Alternatif \u00f6nemli tan\u0131s\u0131 olan hastalar\u0131n 12\u2019si (%22) STONE ile d\u00fc\u015f\u00fck olas\u0131l\u0131k alm\u0131\u015f.<\/p>\r\n\r\n\r\n\r\n<p>\u0130kincil sonu\u00e7; Litotripsi, \u00fcreteral stent ve cerrahi olarak ta\u015fa m\u00fcdahaleyi kapsayan \u00fcrolojik giri\u015fim (90 g\u00fcn i\u00e7inde) yap\u0131lm\u0131\u015f olmas\u0131; STONE ile d\u00fc\u015f\u00fck olas\u0131l\u0131k verilmi\u015f hastada orta-ciddi hidronefroz varl\u0131\u011f\u0131 durumunda \u00fcrolojik giri\u015fim i\u00e7in +LR 23 (%95 CI 4.3-117) saptanm\u0131\u015f.<\/p>\r\n\r\n\r\n\r\n<p>Ara\u015ft\u0131rmac\u0131lar \u00e7al\u0131\u015fma sonucu STONE ile orta olas\u0131l\u0131kl\u0131 ve orta-ciddi hidronefroz tespit edilen hastalar\u0131 y\u00fcksek risk grubu hastalar gibi y\u00f6netmeyi \u00f6neriyor; olas\u0131l\u0131kl\u0131 tan\u0131 nefrolithiazisdir ve BT ta\u015f boyut ve lokalizasyonu g\u00f6rmek isteniyorsa sa\u011flan\u0131r. D\u00fc\u015f\u00fck STONE skorlu herhangi bir d\u00fczeyde hidronefrozu olan veya orta olas\u0131l\u0131k skoruna sahip hidronefrozu olmayan veya hafif hidronefrozlu hastalarda ise BT \u00f6neriyor ve neticede STONE-PLUS de\u011ferlendirmesinin renal kolik hastalar\u0131nda BT \u00e7ekilme ihtiyac\u0131n\u0131 azaltabilece\u011fini iddia ediyor.<\/p>\r\n\r\n\r\n\r\n<p><strong>Yazan ne eklemek ister?<\/strong><\/p>\r\n\r\n\r\n\r\n<p>\u201cKlinik alg\u0131\u201d demek ister\u2026 \u00c7ok karma\u015f\u0131k olmayan, hekimin klinik alg\u0131s\u0131ndan daha hassas, uygulamas\u0131 kolay ve de g\u00fcvenilirli\u011fi y\u00fcksek (validasyonu sa\u011flam) skorlamalar gereksiz tetkiki (artt\u0131rmak yerine) azalt\u0131yor. Ama evet, elbette bu alg\u0131y\u0131 olu\u015ftururken yatak ba\u015f\u0131 USG cand\u0131r\u2026<\/p>\r\n\r\n\r\n\r\n<p><strong>Kaynak:\u00a0<\/strong>Daniels B, Gross CP, Molinaro A, Singh D, Luty S, Jessey R, et al. STONE PLUS: Evaluation of Emergency Department Patients With Suspected Renal Colic, Using a Clinical Prediction Tool Combined With Point-of-Care Limited Ultrasonography. Ann. Emerg. Med. 2016:67(4);439-448<\/p>\r\n<p><a href=\"http:\/\/dx.doi.org\/10.1016\/j.annemergmed.2015.10.020.\" target=\"_blank\" rel=\"noreferrer noopener\">10.1016\/j.annemergmed.2015.10.020.<\/a><\/p>\r\n","protected":false},"excerpt":{"rendered":"<p>Renal kolik d\u00fc\u015f\u00fcn\u00fclen hastada enfeksiyon varl\u0131\u011f\u0131n\u0131n tespiti, ek \u00fcrolojik acil giri\u015fimin \u00f6ng\u00f6r\u00fclmesi ve renal kolik d\u0131\u015f\u0131nda alternatif \u00f6nemli tan\u0131n\u0131n atlanmamas\u0131 risk y\u00f6netiminde&hellip;<\/p>\n","protected":false},"author":1529,"featured_media":2138,"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":[19,12],"tags":[105],"class_list":["post-2137","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-literatur-ozetleri-surekli-yayinlar","category-surekli-yayinlar","tag-uriner-sitem-usg"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/posts\/2137","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/users\/1529"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/comments?post=2137"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/posts\/2137\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/media\/2138"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/media?parent=2137"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/categories?post=2137"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/tatdus\/wp-json\/wp\/v2\/tags?post=2137"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}