Gerçekten Acil Olan Olgular mı Acil Servise Başvuruyor: Bir Pandeminin Gösterdikleri

Year 2023, , 25 - 31, 08.03.2023

Seyran Bozkurt Babuş , Çağrı Safa Buyurgan , Ataman Köse , Akif Yarkaç , Gülhan Temel , Hakan Aytan

https://doi.org/10.54996/anatolianjem.1177098

Abstract

Amaç: COVID-19 salgınının dünya çapında büyük sağlık ve toplumsal etkileri oldu. COVID-19 pandemisinin acil servis başvurularındaki göreceli değişikliği tanımlamak ve acil servise (AS) başvuran hastaların profilini ortaya çıkarmak amaçlandı.

Gereç ve Yöntemler: Pandeminin belirli bir dönemi olan 11.03.2020-23.04.2020 tarihleri arası ve ona denk düşen pandemik olmayan 11.03.2019-23.04.2019 tarihleri arasında AS’e başvuran 18 yaş ve üstü hastaların verileri retrospektif olarak inecelendi. İki dönemde AS’e başvuran hastaların sıklığı, sosyodemografik, klinik ve maliyet özellikleri karşılaştırıldı.

Bulgular: AS’e hasta başvuru oranı pandemi olmayan dönemde %69.6 iken, pandemi döneminde %30.4 olarak hesaplanmıştır (p<0.001). Pandemi olmayan dönemde 18-24 yaş (p<0.001), pandemi döneminde 45-64 ve ≥ 65 yaş gurubundaki hastaların başvuru oranlarının daha yüksek olduğu tespit edildi (p<0.001). Pandemi döneminde ambulansla transfer edilen hasta oranının (p<0.001), “çok acil” hasta başvuru oranının (p<0.001), konsültasyon (p<0.001) ve laboratuvar tetkik istenme oranlarının daha yüksek olduğu tespit edildi (p<0.001). Pandemi döneminde servis ve yoğun bakıma yatırılan hasta oranları daha fazlaydı (p<0.001). Pandemi olmayan dönemde ölüm oranı %0.7 iken, pandemi döneminde bu oran %1.6 tespit edildi (p<0.001). Pandemi olmayan dönemde başvuran hastalarda toplam fatura, pandemi döneminde başvuran hastalarda ise ortalama fatura tutarı daha yüksek tespit edildi (p<0.001). Pandemi döneminde başvuran hastaların ambulansla AS’e transfer edilme (OR 9.947, CI 8.65-11.44), çok acil triaj kategorisinde olma (OR 1.892, CI 1.712-2.09), hastanede ölüm (OR 2.263, CI 1.69-3.03) riskinin daha fazla olduğu ve toplam fatura tutarının her birimlik artış için 1.004 kat arttığı tespit edildi.

Sonuç: Pandemi dönemde AS’e genel hasta başvuru oranı ve acil olmayan başvuru oranları azalırken, “çok acil” olan hasta başvurusu, mortalite ve hasta başı maliyet artmıştır. Çalışmamızdan elde edilen bulgular acil servislerin yoğunluğunu azaltmak için gelecekteki müdahalelere rehberlik edebilir.

Keywords

Acil servis, COVID-19 pandemisi, hasta özellikleri, maliyet

Supporting Institution

yok

Project Number

yok

Do Really Urgent Cases Present to the Emergency Department: What a Pandemic Has Shown

Abstract

Aim: The COVID-19 pandemic has had significant health and social impacts globally. This study aimed to describe the variance in emergency department admissions during the COVID-19 pandemic and to reveal the profile of patients admitted to the emergency department (ED).

Material and Methods: Data from patients in the ED between 11.03.2020-23.04.2020, which is a period of the pandemic, and 11.03.2019-23.04.2019, which is the non-pandemic period, was retrospectively analyzed. The frequency, demographic and clinical characteristics, and financial costs of patients admitted to the ED in those two periods were compared.

Results: While the ratio of patients presenting to the emergency department was 69.6% in the non-pandemic period, it was calculated to be 30.4% in the pandemic period (p < 0.001). A higher admission rate was found in patients aged 18-24 years during the non-pandemic period and in patients aged 45-64 years and ≥ 65 years during the pandemic period (p<0.001). It was determined that the rate of patients transferred by ambulance (p<0.001), the rate of “very urgent” patient admission (p<0.001), and requirements for consultation (p<0.001) and laboratory tests were higher during the pandemic period (p<0.001). During the pandemic period, the rates of patients who needed hospitalization and admission to intensive care units (ICU) were higher (p<0.001). While the mortality rate was 0.7% in the non-pandemic period, this rate was 1.6% in the pandemic period (p<0.001). The total invoice amount was higher in patients who presented during the non-pandemic period, and the mean invoice amount was higher in patients who presented during the pandemic period (p < 0.001). Patients who presented during the pandemic period had a higher risk of being transferred to the emergency department by an ambulance (OR 9.947, CI 8.65–11.44), being in the very urgent triage category (OR 1.892, CI 1.712–2.09), in-hospital mortality (OR 2.263, CI 1.69–3.03), and the total invoice amount increased by 1.004 times for each unit increase.

Conclusion: Although overall and non-urgent patient visits to the ED during the pandemic period were found to be decreased, “very urgent” patient visits, mortality, and costs per patient were found to be increased.

Keywords

Emergency department, COVID-19 pandemic, cost, patient characteristics

Project Number

yok

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