Acil Serviste Yaralanmaların Demografik Analizi ve Niyetselliği

Öz

Amaç: Bu çalışma ile yaralanmalar sonucu acil servise başvuran hastaların epidemiyolojik özelliklerini araştırmak ve Türkiye’de ilk kez yaralanmaların niyetsellik (kasıtlı, kasıtsız) açısından dağılımı değerlendirmek amaçlandı. Gereç ve Yöntem: Acil servise iki yıllık sürede yaralanma nedeniyle başvuran 18 yaş üstü tüm adli olgular prospektif olarak analiz edildi. Bulgular: Olguların 10.393’ü (%67,39) erkek ve 5.029’u (%32.61) kadın hastadan oluşmaktaydı. Olguların büyük çoğunluğunun 18-45 (n= 11.128, %82,8) yaş aralığında olduğu saptandı. Yaralanmalara en sık trafik kazaları (3.407, %22,1), zehirlenmeler (2.947, %19,1), düşmeler (2.279, %14,8), darplar (2.202, %14,3) ve kesici delici alet yaralanmaları (2.052, %13,3) neden olmaktadır. Acil servise en sık eylül ayında (1.649, %10,7) ve sonbaharda (4.499, %29,2) başvurulmaktadır. Kasıtlı yaralanmalar tüm yaralanmaların %36,1’ini (n=5.555) oluştururken kişiler arası şiddet bunun %18,7’sini (n=2.877) ve kendine zarar verme %17,4’ünü (n=2.678) oluşturmaktadır. Kasıtsız yaralanmalar tüm yaralanmaların %63,3’ünü oluştururken trafik kazaları, düşmeler ve delici kesici aletle yaralanmalar sırasıyla %22,1 (n=3.404), %14,7 (n=2.262) ve %8,5’ini (n=1.310) oluşturmaktadır. Ekstremiteler yaralanmalar sonucu (7.336, %53,7) en çok etkilenen vücut bölgeleridir. Sonuç: Yaralanmalar en çok üretken çağdaki genç erişkinleri etkilemektedir. Kasıtlı yaralanmalar tüm yaralanmaların üçte birini oluşturmaktadır. Niyetselliğin değerlendirilmesi yaralanmalarda altta yatan nedenlerin ve önleyici girişimlerin belirlenmesinde yol gösterici olabilir.

Anahtar Kelimeler

• yaralanmalar
• kasıtlı
• kasıtsız
• acil tıp
• adli tıp

Demographic Analysis and Intentionality of Injuries in the Emergency Service

Öz

Objectives: In this study, it was aimed to investigate the epidemiological characteristic of the patients admitted to the emergency department as a result of injuries and evaluate the distribution of the injuries according to intentionality (intentional, unintentional) for the first time in Turkey. Material and Method: All forensic cases over the age of 18 who were admitted due to injuries in two years were analyzed prospectively. Results: 10.393 (67,39%) of the cases were male and 5.029 (32.61%) were female patients. Most of the cases were found to be between the ages of 18-45 (n = 11.128, 82.8%). The most frequent injuries were traffic accidents (3.407, 22,1%), intoxications (2.947, 19,1%), falls (2.279, 14,8%), assaults (2.202, 14,3%), cutting/stabbing injuries (2.052, 13,3%). The most common admission to the emergency department were in September (1.649, 10,7%) and in autumn (4.499, 29,2%). Intentional injuries constitute 36.1% (n=5.555) of all injuries, while interpersonal violence accounts for 18.7% (n = 2.877) and self-harm 17.4% (n = 2.678). Unintentional injuries constitute 63.3% of all injuries, while traffic accidents, falls and cutting/stabbing/ injuries accounts 22.1% (n = 3.404), 14.7% (n =2.262), and 8.5% (n = 1.310) respectively. Extremities were the most affected body part (n = 7.336, 53.7%,) due to injuries. Conclusion: Injuries most commonly affect young adults in the productive age. Intentional injuries account for one-third of all injuries. Assessment of intentionality can be a guide in the determination of the underlying causes and the preventive interventions of injuries.

Anahtar Kelimeler

• injuries
• intentional
• unintentional
• emergency medicine
• forensic medicine

Kaynakça

1. Norton R, and Olive K. Injuries. New Engl J Med. 2013;368(18): 1723-1730.
2. Hay SI, Abajobir AA, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, et al. Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 . countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390(10100): 1260-1344.
3. Fincancı KŞ. Adli olguya yaklaşım. İ.Ü. Cerrahpaşa Tıp Fakültesi Sürekli Tıp Eğitimi Etkinlikleri Yeni Yasalar Çerçevesinde Hekimlerin Hukuki ve Cezai Sorumluluğu, Tıbbi Malpraktis ve Adli Raporlar›n Düzenlenmesi Sempozyum Dizisi . 2006, İstanbul, Cilt 48, s. 92-103.
4. Nicol A, Knowlton LM, Schuurman N, Matzopoulos R, Zargaran E, Cinnamon J, et al. Trauma surveillance in Cape Town, South Africa: an analysis of 9236 consecutive trauma center admissions. Jama Surg. 2014;149(6): 549-556.
5. Cohen L, Miller T, Sheppard MA, Gordon E, Gantz T, Atnafou R. Bridging the gap: bringing together intentional and unintentional injury prevention efforts to improve health and well being. J Safety Res. 2003;34(5): 473-483.
6. Turgut K, Sariha, ME, Colak C, Güven T, Gür A, Gürbüz S. Falls from height: A retrospective analysis. World J Emerg Med. 2018;9(1): 46.
7. Gawryszewski VP, Rodrigues EMS. The burden of injury in Brazil, 2003. Sao Paulo Med J. 2006;124(4): 208-213.
8. Han SU, Kim SP, Kim SH, Cho GC, Kim MJ, Lee JS, et al. Gender and Intentionality disparities in the Epidemiology and outcomes of falls from Height in Korean adults. J Trauma Inj. 2019;32(4): 226-237.

9. T.C Sağlık Bakanlığı, Sağlık İstatistikleri Yılığı 2017. https://dosyasb.saglik.gov.tr/Eklenti/31096,turkcesiydijiv1pdf.pdf?0 Accessed Nov 11 2019.
10. Demircan A, Keleş A, Guerbuez N, Bildik F, Aygencel ŞG, Doğan NÖ, et al. Forensic emergency medicine-six-year experience of 13823 cases in a university emergency department. Turk J Med Sci. 2008;38(6): 567-5.
11. Sogut O, Sayhan MB, Gokdemir MT, Boleken ME, Al B, Kose R, et al. Analysis of hospital mortality and epidemiology in trauma patients: a multi-center study. J Curr Surg. 2011;1(1): 19-24.
12. World Health Organization. The world health report: 1999: making a difference. World Health Organization, 1999. https://www.who.int/whr/1999/en/whr99_en.pdf?ua=1 Accessed Nov 2019.
13. Akbaba M, Nazlican E, Demirhindi H, Sütoluk Z, Gökel Y. Etiological and demographical characteristics of acute adult poisoning in Adana, Turkey. Hum Exp Toxicol. 2007;26(5): 401-406.
14. Stomp W, Fidler V, ten Duis HJ, Nijsten MW. Relation of the weather and the lunar cycle with the incidence of trauma in the Groningen region over a 36-year period. J Trauma Acute Care Surg. 2009;67(5): 1103-1108.
15. Rotstein Z, Wilf-Miron R, Lavi B, Shahar A, Gabbay U, Noy S. The dynamics of patient visits to a public hospital ED: a statistical model. Am J Emerg Med. 1997;15(6): 596-599.
16. Korkmaz T, Kahramansoy N, Erkol Z, Saricil F, Kilci A. Evaluation of the forensic patients presenting to the emergency department and legal reports/Acil Servise Basvuran adli Olgularin ve Duzenlenen Adli Raporlarin Degerlendirilmesi. Med Bull Haseki. 2012;50(1): 14-21.
17. GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for. for the Global Burden of Disease Study 2017. Lancet. 2018;392: 1789–858.
18. Prekker ME, Miner JR, Rockswold EG, Biros MH. The prevalence of injury of any type in an urban emergency department population. J Trauma Acute Care Surg. 2009;66(6): 1688-1695.
19. Turkish Statistical Enstitue. http://www.tuik.gov.tr/UstMenu.do?metod=temelist Accessed: 28 Jan 2020.
20. Turkish Statistical Enstitute. http://www.tuik.gov.tr/PreTablo.do?alt_id=1051 28 Jan 2020.
21. Aygencel G, Karamercan M, Ergin M, Telatar G. Review of traffic accident cases presenting to an adult emergency service in Turkey. J Forensic Leg Med. 2008;15(1): 1-6.
22. Puvanachandra P, Hoe C, Özkan T, Lajunen T. Burden of road traffic injuries in Turkey. Traffic Inj Prev. 2012;13(1): 64-75.
23. Özkan T, Lajunen T. Why are there sex differences in risky driving? The relationship between sex and gender‐role on aggressive driving, traffic offences, and accident involvement among young Turkish drivers. Aggress Behav. 2005;31(6): 547-558.
24. Esiyok B, Korkusuz I, Canturk G, Alkan HA, Karaman AG, Hamit HI. Road traffic accidents and disability: A cross-section study from Turkey. Disabil Rehabil. 2005;27(21): 1333-1338.
25. World Health Organization. Falls. Jan 16, 2018. http://www.who.int/news-room/factsheets/detail/falls Accessed 7 May 2020.
26. World Health Organization, Global Status Report on Violence Prevention 2014. https://www.who.int/violence_injury_prevention/violence/status_report/2014/en/ Accessed 21 Dec 2019.
27. World Health Organization. Global status report on road safety 2018. World Health Organization, https://www.who.int/violence_injury_prevention/road_safety_status/2018/en/ Accessed 17 Dec 2019.
28. Gawryszewski VP, Silva MMAD, Malta DC, Kegler SR, Mercy JA, Mascarenhas MDM, et al. Violence-related injury in emergency departments in Brazil. Rev Panam Salud Publica. 2008;24: 400-408.
29. Özcan N, İkincioğulları D. Ulusal zehir danışma merkezi 2008 yılı çalışma raporu özeti. Turk Hij Tecr Biyol Derg. 2009;66(ER-3): 29-58.
30. Satar S, Seydaoglu G. Analysis of acute adult poisoning in a 6-year period and factors affecting the hospital stay. Adv Ther. 2005;22(2): 137-147.
31. Kahramansoy N, Erkol H, Kurt F, Gürbüz N, Bozgeyik M, Kıyan A. Analysis of trauma patients in a rural hospital in Turkey. Turk J Trauma Emerg Surg. 2011;17(3): 231-237.