Hastane Öncesi Acil Sağlık Hizmeti Birimine Başvuran Pediatrik Adli Olguların İncelenmesi: Retrospektif Değerlendirme

Abstract

Amaç: Bu araştırmanın amacı hastane öncesi sağlık hizmeti birimine başvuran pediatrik adli olguların demografik, epidemiyolojik sonuçlarını belirlemektir. Materyal ve Method: Retrospektif tipte gerçekleştirilen bu araştırma Türkiye’nin kuzeydoğusunda bulunan bir ilin Hastane Öncesi Acil Sağlık Hizmeti Biriminde gerçekleştirildi. Hastane Öncesi Acil Sağlık Hizmeti Birimine 01.10.2021-30.09.2022 tarihinde 0-18 yaş aralığındaki başvurular incelenerek adli olgu kapsamında yer alanlar araştırmaya dahil edilmiştir. Veriler “Adli Pediatrik Olguların Değerlendirme Formu” ile retrospektif olarak toplandı. Verilerin analizinde tanımlayıcı istatistikler (standart sapma, ortalama değer, frekans ve yüzde) ve ki-kare testi kullanıldı. Bulgular: Hastane öncesi acil sağlık hizmetine başvuran 9685 pediatrik olgunun %7,1’i (689) adli olgular olup, yaş ortalaması 11,42±5,61 idi. Olguların %63,9’unu erkek, %50,2 sini 13-18 yaş grubu %71,7’sini kentsel bölgeden başvurular oluşturmaktadır. Olguların %63,7’sini trafik kazası, %12,6’sını ilaç intoksikasyonu, %11,3’üni yaralanmalar ve %7,5’ini düşme oluşturmaktadır. Başvuruların %85,5’inin triyaj kodu sarı olup, en yoğun başvuru ayı %13,9 ile Ağustos ayıdır. Başvuru nedeni ile yaş grupları karşılaştırıldığında, 13-18 yaş grubunda yaralanma şikâyeti ile başvuran hastaların başvuru nedeni diğer yaş gruplarına göre istatistiki olarak anlamlıdır (p˂0.001). Sonuç: Bu araştırma bildiğimiz kadarıyla ülkemizde hastane öncesi acil sağlık hizmetlerinde pediatrik adli olgu prevelansı bildiren ilk çalışmadır. Pediatrik adli olguların büyük bir çoğunluğunu trafik kazaları oluşturmakla birlikte ilaç intoksikasyonu, yaralanmalar ve düşmeler görülmektedir. Pediatrik grupta meydana gelen adli olgular alınacak önleyici ve koruyucu tedbirlerle öngörülebilir ve önlenebilir.

Keywords

• Pediatri
• adli hemşirelik
• acil sağlık hizmetleri

Ethical Statement

Araştırmanın her aşamasında Helsinki Deklerasyonu prensiplerine bağlı kalınmıştır.

Evaluation of Pediatric Forensic Cases Referring to the Hospital Pre-arrival Emergency Health Service Units: A Retrospective Evaluation

Abstract

Objective: The aim of this study is to determine the demographic and epidemiological results of pediatric forensic cases admitted to the pre-hospital health care unit. Material and Methods: This retrospective study was conducted in the Prehospital Emergency Health Service Unit of a province located in the northeastern part of Turkey. Applications between the ages of 0-18 to the Pre-Hospital Emergency Health Service Unit between 01.10.2021-30.09.2022 were examined and those within the scope of forensic cases were included in the research. Data were collected retrospectively with the "Forensic Pediatric Cases Evaluation Form". Descriptive statistics (standard deviation, mean value, frequency and percentage) and chi-square test were used to analyze the data. Results: Of the 9685 pediatric cases admitted to prehospital emegency care, 7.1% (689) were forensic cases and the mean age was 11.42±5.61 years. 63.9% of the cases are male, 50.2% are in the 13-18 age group, and 71.7% are from urban areas. 63.7% of the cases are traffic accidents, 12.6% are drug intoxication, 11.3% are injuries and 7.5% are falls. The triage code of 85.5% of applications is yellow, and the busiest application month is August with 13.9%. When the application reason and age groups are compared, the reason for application of patients complaining of injury in the 13-18 age group is statistically significant compared to other age groups (p = 0.001). Conclusion: To the best of our knowledge, this is the first study reporting the prevalence of paediatric forensic cases in prehospital emergency health services in Turkey. Although the majority of pediatric forensic cases are traffic accidents, drug intoxication, injuries and falls are also seen. Forensic cases occurring in the pediatric group can be predicted and prevented by taking preventive and protective measures.

Keywords

• Pediatric
• forensic nursing
• emergency medical services

Ethical Statement

The principles of the Declaration of Helsinki were adhered to at every stage of the research.

References

1. Arslan İ, Demir Kİ. Evaluation of forensic cases presented to the pediatric emergency department. Turk J Emerg Med. 2020;22(3):137-142. doi: 10.4103/2452-2473.348432.
2. Taplak AS, Tubaş F, Polat S. A retrospectıve records-based cohort of 1,082 pedıatrıc forensıc cases presentıng to the emergency department. Internatıonal Nursıng. 2020;46(3):373-383. https://doi.org/10.1016/j.jen.2020.02.009
3. Yardımcı Ö, Hazar G, Sercan I. The approach of prehospital health care personnel working at emergency stations towards forensic cases. Turkish Journal of Emergency Medicine. 2015;15 (3):131- 135. https://doi.org/10.1016/j.tjem.2015.11.007
4. Rominger AH, Smith MJ, Stevenson MD. Emergency medical services system utilization over the last 10 years: what predicts transport of children?. Pediatric emergency care. 2015;31(5):321-326. doi: 10.1097/PEC.0000000000000419
5. Shah MN, Cushman JT, Davis CO, Bazarian JJ, Auinger P, Friedman B. The epidemiology of emergency medical services use by children: an analysis of the national hospital ambulatory medical care survey. Prehosp Emerg Care. 2008;12(3):269–276. doi: 10.1080/10903120802100167
6. Demir O, Aydin K, Turan F, Yurtseven A, Erbil B, Gulalp B. (2013). Analysis of pediatric forensic cases presented to emergency department. Turk Pedıatrı Arsıvı-Turkısh Archıves Of Pedıatrıcs. 2013;48(3):235-240. DOI: 10.4274/tpa.266
7. Okoye CN, Okoye MI. Forensic epidemiology of childhood deaths in Nebraska, USA. J Forensic Leg Med. 2011;18(8):366-374. doi:10.1016/j.jflm.2011.07.013
8. Ito E, Hitosugi M, Maruo Y, et al. Availability of death review of children using death certificates and forensic autopsy results. Leg Med (Tokyo). 2023;60:102156. doi:10.1016/j.legalmed.2022.102156

9. Mahrous MM, Muhammad MA, Kotb NA, Elattar HMS, Elrewieny NM. Medicolegal study of Egyptian suspicious childhood deaths during 2020-2021. J Forensic Leg Med. 2023;94:102472. doi:10.1016/j.jflm.2022.102472
10. TUİK [İnternet]. Türkiye İstatistik Kurumu Haber Bülteni İstatistiklerle Çocuk 2022 [Erişim tarihi: 20 Haziran 2023]. Erişim linki: TÜİK Kurumsal (tuik.gov.tr)
11. Ong AC, Low SG, Vasanwala FF. Childhood Injuries in Singapore: Can Local Physicians and the Healthcare System Do More to Confront This Public Health Concern?. Int J Environ Res Public Health. 2016;13(7):718. doi:10.3390/ijerph13070718
12. Keten A. Death in childhood and adolescence: Accident!. J Family Med Prim Care. 2020;9(8):3807-3809. doi:10.4103/jfmpc.jfmpc_465_20
13. Forward KE, Loubani E. Predictable and preventable: historical and current efforts to ımprove child ınjury prevention. Curr Pediatr Rev. 2018;14(1):48-51. doi:10.2174/1573396313666171010111722
14. Akgül E, Yildirim A, Akdur O. Trauma and ıntentional ınjury characteristics of pediatric forensic cases applying to emergency room. Journal Of Clınıcal And Analytıcal Medıcıne. 2016;7(5): 668-671.
15. Baldwin G, Sleet D, Gilchris J, Degutis L. Fulfilling a promise: the national action plan for child injury prevention. Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention. 2012;18(3):207. doi:https://doi.org/10.1136/injuryprev-2012-040402
16. Yilmaz G, Alemdar DK. Evaluation of pediatric forensic cases admitted to the emergency department in turkey: a retrospective analysis. J Forensic Nurs. 2021;17(1):E1-E8. doi:10.1097/JFN.0000000000000309
17. ASOS [İnternet]. Acil Sağlık Otomasyon Sistemi ©2022 2021 [Erişim tarihi: 15 Şubat 2023]. Erişim linki:https://asos.saglik.gov.tr/Authentication/Login?ReturnUrl=%2f
18. Aslan R, Şahinöz S, Şahinöz T. Determination of START triage skill and knowledge levels of Prehospital Emergency Medical Staff: A cross sectional study. Int Emerg Nurs. 2021;56:101004. doi:10.1016/j.ienj.2021.101004
19. Bolat A. Evaluation of forensic cases admitted to the pediatric emergency department. Journal of Health Sciences and Medicine. 2023;6(1):111-115. doi:10.32322/jhsm.1197015
20. Aydın M, Şahin CU. Evaluation of forensic cases admitted to the emergency department: a retrospective analysis. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi. 2023;12(3): 882-888. doi:10.37989/gumussagbil.1320941
21. Yazar A, Akın F, Türe E, Odabaş D. Çocuk acil kliniğine başvuran adli vakaların değerlendirilmesi. Dicle Tıp Dergisi. 2017;44(4):345-353. doi:10.5798/dicletip.362395
22. Ringen AH, Baksaas-Aasen K, Skaga NO, Wisborg T, Gaarder C, Naess PA. Close to zero preventable in-hospital deaths in pediatric trauma patients - An observational study from a major Scandinavian trauma center. Injury. 2023;54(1):183-188. doi:10.1016/j.injury.2022.07.043
23. Träff H, Hagander L, Salö M. Association of transport time with adverse outcome in paediatric trauma. BJS Open. 2021;5(3):zrab036. doi:10.1093/bjsopen/zrab036
24. KorkmazT, Erkol Z, Kahramansoy N. Evaluation of Pediatric Forensic Cases in Emergency Department: Haseki Tıp Bülteni. 2014; 52(4):271-277. doi:10.4274/haseki.1712
25. Töro K, Szilvia F, György D, et al. Fatal traffic injuries among children and adolescents in three cities. J Forensic Sci. 2011;56(3):617-620. doi:10.1111/j.1556-4029.2010.01674.x
26. O'Donovan S, van den Huevel C, Baldock M, Byard RW. Factors involved in the assessment of paediatric traffic injuries and deaths. Med Sci Law. 2018;58(4):210-215. doi:10.1177/0025802418790857
27. Demirel M, Akpınar G. Characteristics of pediatric forensic cases caused by blunt general body trauma evaluated in the emergency department: a single center experience. Online Turkish Journal of Health Sciences. 2022;7(3):384-390. doi:10.26453/otjhs.1052904
28. Søreide K, Krüger AJ, Ellingsen CL, Tjosevik KE. Pediatric trauma deaths are predominated by severe head injuries during spring and summer. Scand J Trauma Resusc Emerg Med. 2009;17:3. doi:10.1186/1757-7241-17-3
29. Donma MM, Tayfur İ, Erdem MN, Demirkol M, Topçu B, Donma O. Acil servise başvuran pediatrik travma hastalarında cinsiyet farklılığının değerlendirilmesi. Namık Kemal Tıp Dergisi (International Journal of Basic and Clinical Medicine).2017;5(1):16-25.
30. Aygin D, Açıl H. Çocuk acil ünitesine başvuran 0-18 yaş arası zehirlenme olgularının incelenmesi. Ş. EEAH Tıp Bülteni. 2014;48(1): 27-33. DOI: 10.5350/SEMB2014480105
31. Bozlu G, Kuyucu N. Çocuk acil servise son 5 yılda gelen zehirlenmeler: 1734 olgunun değerlendirilmesi. Adli Tıp Bülteni.2018;23(2):106-109. doi: 10.17986/blm.2018238625
32. Matalova P, Buchta M, Drietomska V, et.al. Acute drug intoxication in childhood: a 10-year retrospective observational single-centre study and case reports. Biomedical Papers of the Medical Faculty of Palacky University in Olomouc. 2023;167(3):1-9. https://doi.org/10.3390/jpm13010106 33. Soave PM, Curatola A, Ferretti, S, Raitano V, Conti G, Gatto A. et.al. (2022). Acute poisoning in children admitted to pediatric emergency department: a five-years retrospective analysis. Acta bio-medica: Atenei Parmensis. 2022; 93(1):e2022004. https://doi.org/10.23750/abm.v93i1.11602