Acil Serviste Çocuklarda Düşme Olgularının Yönetimi: 261 Çocuk Olgunun Analizi

Year 2021, Volume: 23 Issue: 3, 547 - 558, 31.12.2021

Mustafa Enes Demirel , Guleser Akpinar

https://doi.org/10.24938/kutfd.970072

Abstract

Amaç: Çocuklarda düşme, acil servisler üzerinde önemli bir yük oluşturmakta ve hastanede kalış süresinde uzama ile artan maliyetler gibi olumsuz sonuçlara neden olabilmektedir. Bu çalışmanın amacı, bir acil serviste çocuklarda düşme olgularının yönetim sonuçlarının değerlendirilmesidir.

Gereç ve Yöntemler: Düşme kaynaklı yaralanma nedeniyle acil servisimize başvuran pediatrik hastalar; yaş ve cinsiyet gibi demografik veriler, Glasgow Koma Skalası, Injury Severity Score skorları, başvuru zamanları, yaralanma bölgesi, tanı, konsülte edilen bölüm, yatış verilen bölüm, hastanede kalış süresi ve maliyetler açısından değerlendirilmiş ve analiz edilmiştir. Acil servisteki ilk yönetim sonrasında gerekli görülen hastalar diğer bölümlerle konsülte edilerek sevk edilmiştir.

Bulgular: Çalışmaya 261 çocuk dahil edildi. Başvurular en sık yaz mevsiminde, Ağustos ayında ve Cumartesi günleri yapılmıştır. Çocuklarda en sık konulan tanılar kırık ve yumuşak doku hasarıdır. En sık yaralanan vücut bölgeleri baş-boyun bölgesi ve ekstremitelerdir. En sık konsültasyon yapılan bölümler beyin ve sinir cerrahisi ile ortopedi ve travmatolojidir. Toplam 101 çocuğa (%38.7) yatış verilmiştir. Hastaların medyan Injury Severity Score değeri 3 ve medyan Glasgow Koma Skalası değeri 15 (8-15) olarak bulunmuştur. Medyan tedavi maliyeti 278.8₺ olarak saptanmıştır. Medyan hastanede kalış süresi 31 (çeyrekler arası aralık, 21-63.5) (çeyrekler arası aralık için 2 sayısal değer verilmeli) saattir. Hastanede kalış süresi ile maliyetler arasında güçlü bir pozitif ilişki saptanmıştır (r=0.629, p<0.001).

Sonuç: Çocuk yaş grubu düşmeye bağlı yaralanmalar, acil servisin iş yükünü artıran, sağlık sistemi ve toplum için önemli bir yük oluşturan ve maliyeti artıran yaygın olaylardır. Elde ettiğimiz sonuçlar, beklendiği gibi kalış süresi ile tedavi maliyetleri arasında çok güçlü bir ilişki olduğunu göstermektedir.

Keywords

Düşme, çocuklar, acil servis, hastanede kalma süresi, maliyet

MANAGEMENT OF PEDIATRIC FALLS IN AN EMERGENCY DEPARTMENT: ANALYSIS OF 261 PEDIATRIC CASES

Abstract

Objective: Pediatric falls cause a significant burden for emergency departments and have negative patient outcomes such as prolonged length of stay and increased costs. The objective of this study was to evaluate results of the management of pediatric fall cases in an emergency department.

Material and Methods: Pediatric patients who presented to our emergency department due to falling injury were evaluated and analyzed according to the demographic data, including age and gender, Glasgow Coma Scale, Injury Severity Score time of presentation, site of injury, diagnosis, department of consultation, department of hospitalization, length of stay and cost. After the initial management in the emergency department, patients were consulted and referred to other departments, if deemed necessary.

Results: A total of 261 children were included in the study. Hospital admissions were most frequently made in summer, in August and on Saturdays. The children were most diagnosed by fractures followed by soft tissue trauma. The most injured body part was the head-neck region followed by extremities. The most frequently consulted departments included neurosurgery and orthopedics and traumatology. A total of 101 (38.7%) children were hospitalized. The median Injury Severity Score value of the patients was found as 3 and the median Glasgow Coma Scale value was found as 15 (8-15). The median treatment cost was found to be ₺278.8. The median length of stay was found as 31 (interquartile range, 21-63.5) (interquartile range için 2 sayısal değer verilmeli) hours. A strong positive correlation was found between length of stay and costs (r=0.629, p<0.001).

Conclusion: Pediatric age group fall injuries are common events that increase the workload of the emergency department and create a significant burden and cost for the health system and society. Our results show that, as expected, there is a very strong relationship between length of stay and treatment costs.

Keywords

Fall, children, emergency department, length of stay, cost

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