Retrospective Evaluation of Falls From Height Cases Admitted to the Pre-Hospital Emergency Healthcare System

Yıl 2024, Cilt: 7 Sayı: 3, 127 - 132, 28.09.2024

Ramiz Yazıcı

https://doi.org/10.54996/anatolianjem.1523059

Öz

Aim: The aim of this study is to analyze the demographic characteristics, timing aspects (time of occurrence, emergency response time, ambulance arrival time), and hospital arrival times in pre-hospital cases of falls in Ankara.

Material and Methods: This cross-sectional observational epidemiological study examined data from patients who received pre-hospital emergency care due to fall-related trauma in Ankara between January 1, 2019, and December 31, 2023. Patients were identified through calls made to the central 112 Call Center and documented in the Emergency Health Automation System. Demographic details, injury epidemiology (ICD-10 codes, injury mechanism, incident timing), and emergency response times (command response time, time from ambulance dispatch to scene arrival, transport time) were collected.

Results: This study includes 16,136 patients, of whom 6,346 are female and 9,790 are male, with an average age of 38.3 ± 24.3 years. The predominant ICD-10 diagnosis codes are W03, W10, W12, W13, W14, W17, Y30, and X80. The year 2019 saw the highest number of incidents (n=4,014), with a decrease observed in 2020 (n=2,790). The highest number of falls occurred in July, while the lowest was in February, with the fewest falls reported in winter and the most in summer throughout the five years. Most incidents occurred between 08:00 and 15:59 (n=8,366), followed by 16:00 to 23:59 (n=6,456); 1,314 incidents occurred between 00:00 and 07:59. Falls occurred most frequently during working hours (61.9%, n=9,983). The average command center response time was 216.4 ± 203.6 seconds, station response time was 39.6 ± 47.8 seconds, and transport time was 371.6 ± 249.9 seconds. Most patients were transported to Training and Research Hospital (n=7,827), followed by State Hospital (n=3,422), University Hospital (n=2,210), and Private Hospital (n=249). Secondary transfers were mostly related to Training and Research Hospital (n=1,387), primarily for specialist needs (n=1,165). There were 32 patients who received on-scene intervention and 231 patients who died. Significantly increased response times were observed from 2019 to 2023 (p<0.001).

Conclusion: Future research focusing on pre-hospital factors affecting mortality rates in fall victims could enhance triage strategies, thereby reducing the burden on tertiary healthcare facilities. Prevention of falls is crucial in reducing deaths associated with this traumatic injury.

Anahtar Kelimeler

Falls from height, prehospital emergency care, emergency medical services

Etik Beyan

The study was conducted in accordance with the Declaration of Helsinki and approved by the ethics committee permission of the Medical Research Scientific and Ethical Evaluation Board of Ankara Bilkent City Hospital (Approved no: TABED 2-24-295 and date: 12/06/2024).

Destekleyen Kurum

The author declared that this study has received no financial support.

Teşekkür

There is no person, instution or company to acknowledgement.

Hastane Öncesi Acil Sağlik Hizmetlerine Başvuran Yüksekten Düşme Vakalarinin Retrospektif Değerlendirmesi

Öz

Amaç: Bu çalışmanın amacı, Ankara'da düşme sonucu meydana gelen olaylara yönelik hastane öncesi vakalarında demografik özellikleri, zamanlama yönlerini (olayın meydana gelme zamanı, acil müdahale süresi, ambulans varış süresi) ve hastane varış sürelerini analiz etmektir.

Gereç ve Yöntemler: Bu kesitsel gözlemsel epidemiyolojik çalışma, 1 Ocak 2019 - 31 Aralık 2023 tarihleri arasında Ankara'da düşme sonucu travma nedeniyle hastane öncesi acil bakım alan hastaların verilerini incelemiştir. Hastalar, merkezi 112 Çağrı Merkezi'ne yapılan çağrılar sonucunda Acil Sağlık Otomasyon Sistemi'nde tanımlanmıştır. Demografik detaylar, yaralanma epidemiyolojisi (ICD-10 kodları, yaralanma mekanizması, olay zamanlaması) ve acil yanıt süreleri (komuta reaksiyon süresi, ambulans gönderiminden olay yerine varma süresi, taşıma süresi) toplanmıştır.

Bulgular: Bu çalışma, 16.136 hasta içermektedir; bunların 6.346'sı kadın ve 9.790'ı erkektir ve yaş ortalaması 38,3 ± 24,3 yıldır. Hakim ICD-10 tanı kodları W03, W10, W12, W13, W14, W17, Y30 ve X80'dir. Olayların en yoğun olduğu yıl 2019'dur (n=4.014), 2020'de ise azalma gözlenmiştir (n=2.790). En fazla düşme olayı Temmuz ayında görülürken, en az Şubat ayında gerçekleşmiştir, beş yıl boyunca yaz aylarında ve kış aylarında en az düşme olayı bildirilmiştir. Olayların çoğunluğu 08:00-15:59 saatleri arasında meydana gelmiştir (n=8.366), bunu 16:00-23:59 saatleri arasında gerçekleşenler takip etmiştir (n=6.456); 1.314 vakada ise olay 00:00-07:59 saatleri arasında gerçekleşmiştir. Düşmelerin %61,9'u (n=9.983) çalışma saatlerinde gerçekleşmiştir. Komuta merkezi reaksiyon süresi ortalama 216,4 ± 203,6 saniye, istasyon reaksiyon süresi 39,6 ± 47,8 saniye ve taşıma süresi 371,6 ± 249,9 saniyedir. Hastaların çoğu Eğitim ve Araştırma Hastanesi’ne taşınmıştır (n=7.827), onu devlet hastanesi (n=3.422), Üniversite Hastanesi (n=2.210) ve Özel Hastane (n=249) izlemiştir. İkincil transferler genellikle Eğitim ve Araştırma Hastanesi ile ilgili olup (n=1.387), bunların çoğu uzman ihtiyacı için yapılmıştır (n=1.165). Olay yerinde müdahale alan 32 hasta ve hayatını kaybeden 231 hasta bulunmaktadır. 2019'dan 2023'e kadar önemli ölçüde artan cevap süreleri gözlemlenmiştir (p<0,001).

Sonuç: Düşme kurbanlarında mortalite oranlarını etkileyen hastane öncesi faktörlere odaklanan gelecekteki araştırmalar, triyaj stratejilerini daha da geliştirerek üçüncü basamak sağlık tesislerinin yükünü azaltabilir. Sonuç olarak, düşmelerin önlenmesi, bu travmatik yaralanma ile ilişkili ölümleri azaltmada temel öneme sahiptir.

Anahtar Kelimeler

Yüksekten düşme, hastane öncesi acil bakım, acil sağlık hizmetleri

Kaynakça

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