COVID-19 pandemisinin tıbbi tavsiyeye aykırı taburcu edilmelere etkisi: geriye dönük bir çalışma

Abstract

Giriş: Bu çalışma, COVID-19 pandemisinin acil serviste (AS) taburcu olmadan hastaneden ayrılma (DAMA) insidansı üzerindeki etkisini değerlendirmeyi ve pandemi öncesi ile pandemi dönemlerindeki DAMA hastalarının klinik ve demografik özelliklerini karşılaştırmayı amaçlamaktadır. Yöntemler: Bu retrospektif, gözlemsel ve kesitsel çalışma, COVID-19 salgını sırasında pandemi merkezi olarak belirlenen İstanbul, Türkiye'deki üçüncü basamak bir hastanenin acil servisinde yürütülmüştür. Çalışmaya, 1 Mart 2020 ile 1 Mart 2021 tarihleri arasında acil servise başvuran ve DAMA olarak sınıflandırılan hastalar dahil edilmiştir. Aynı dahil edilme ve dışlanma kriterleri kullanılarak, pandemi öncesi dönemi temsil eden bir kontrol grubu oluşturulmuştur (1 Mart 2018 – 1 Mart 2019). Bulgular: Pandemi döneminde hastanemizdeki toplam acil servis başvuru sayısı, pandemi öncesi döneme kıyasla %19,4 oranında azalırken, DAMA vaka sayısı %28,4 oranında artmıştır. DAMA vakaları arasında, pandemi döneminde yaşlı hasta oranında artış gözlemlenmiştir. Ayrıca, gece vardiyalarında gerçekleşen DAMA vakalarının oranında da istatistiksel olarak anlamlı bir artış saptanmıştır (%38,0 vs. %55,5; p < 0,001). Pandemi döneminde DAMA hastaları arasında hipertansiyon (%19,8 vs. %6,3; p < 0,001) ve diabetes mellitus (%16,2 vs. %7,7; p = 0,001) prevalansı anlamlı şekilde artmıştır. Ayrıca, kardiyoloji (%8,9 vs. %4,2; p = 0,011) ve enfeksiyon hastalıkları (%8,4 vs. %2,7; p < 0,001) konsültasyonu istenen hasta oranlarında da artış gözlenmiştir. Sonuçlar: COVID-19 pandemisi, acil serviste DAMA oranlarında anlamlı bir artışa yol açmıştır. Bu artış, özellikle yaşlı hastalar, diyabet ve hipertansiyon öyküsü olan bireyler ile kardiyoloji veya enfeksiyon hastalıkları konsültasyonu istenen hastalar arasında daha belirgin olmuştur.

Keywords

• tıbbi tavsiyeye aykırı taburcu etme
• acil servis
• hasta taburcu etme
• COVID-19

Supporting Institution

yok

Effect of the COVID-19 pandemic on discharges against medical advice: a retrospective study

Abstract

Aims: This study aims to evaluate the impact of the COVID-19 pandemic on the incidence of discharge against medical advice (DAMA) in the emergency department (ED) and to compare the clinical and demographic characteristics of DAMA patients between the pre-pandemic and pandemic periods. Methods: This retrospective, observational, cross-sectional study was conducted in the ED of a tertiary care hospital in Istanbul, Turkey, which was designated as a pandemic center during the COVID-19 outbreak. The study included patients who presented to the ED between March 1, 2020, and March 1, 2021, and were classified as DAMA. A control group representing the corresponding pre-pandemic period (March 1, 2018-March 1, 2019) was established using the same inclusion and exclusion criteria. Results: During the pandemic period, the total number of ED visits at our hospital decreased by 19.4% compared to the pre-pandemic period, while the number of DAMA cases increased by 28.4%. Among DAMA cases, an increase in the proportion of elderly patients was observed during the pandemic. There was also a statistically significant rise in the proportion of DAMA cases occurring during night shifts (38.0% vs. 55.5%; p<0.001). Furthermore, during the pandemic, the prevalence of hypertension (19.8% vs. 6.3%; p<0.001) and diabetes mellitus (16.2% vs. 7.7%; p=0.001) among DAMA patients increased significantly. The proportion of patients for whom cardiology (8.9% vs. 4.2%; p=0.011) and infectious diseases (8.4% vs. 2.7%; p<0.001) consultations were requested also showed increase during the pandemic period. Conclusion: COVID-19 pandemic led to a significant increase in the rate of DAMA in the ED. This increase was particularly pronounced among elderly patients, individuals with a history of diabetes or hypertension, and those for whom cardiology or infectious disease consultations were requested.

Keywords

• Discharge against medical advice
• emergency department
• patient discharge
• COVID-19

Supporting Institution

No

Ethical Statement

Ethics Committee Approval This study was approved by the ………. Ethics Committee (Date: 02.04.2025, Decision No: 2025/6). All procedures were conducted in accordance with ethical guidelines and the principles of the Declaration of Helsinki. Informed Consent All patients signed and free and informed consent form. Conflict of Interest Statement The authors have no conflicts of interest to declare. Financial Disclosure The authors declared that this study has received no financial support. Author Contributions All of the authors declare that they have all participated in the design, execution, and analysis of the paper, and that they have approved the final version.

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