Pandemi Hastanesinin Acil Servisine Başvuran Hastaların Analizi: Bir Retrospektif Türkiye Çalışması

Yıl 2022, Sayı: 19, 76 - 85, 30.06.2022

Hakan Aydın Attila Beştemir Göksu Bozdereli Berikol Halil Doğan

https://doi.org/10.46218/tshd.1106381

Cited By: 3

Öz

Pandemi hastanesinin acil servisine başvuran hastaların analizi: Bir retrospektif Türkiye çalışması

Öz
Giriş: Tüm dünyada COVID-19 pandemisi ve uygulanan politikaların sağlık sistemi ve sağlık arama davranışı üzerinde doğrudan ve dolaylı etkileri olduğu gözlemlenmiştir. Bu çalışmanın amacı bir pandemi hastanesinin acil servisine başvuran vakaları analiz etmek ve pandemi döneminin sağlık hizmetlerine ve uygunsuz ambulans kullanımına etkisini araştırmaktır.
Metod: Bu tek merkezli, gözlemsel, retrospektif çalışmaya, Prof. Dr. Murat Dilmener Acil Durum Hastanesinin acil servisine (AS) 05 Ocak-05 Nisan 2021 tarihleri arasında başvuran COVID-19 hastaları alındı. Ambulans ile başvurun vakaların demografik özellikleri, yaşamsal belirtileri ve sonlanımları incelendi. Sonuçlar kendi imkanlarıyla başvuran vakaların (kontrol grubu) verileriyle karşılaştırıldı.
Bulgular: Çalışmaya 2958 vaka dahil edildi. Hastaların yaş ortancası 45 yıl ve %53’ü kadındı. Hastaların %45.3’ü ambulans ile AS’e başvurdu. Charlson Komorbidite Indeksi açısından kendi imkanıyla ve ambulans ile başvuran hastalar arasında istatistiksel bir ilişki saptanmadı (CKI=0, p=0.238; CKI=1-2, p=0.399; CKI≥ 3, P=0.124). Ambulansla gelen hastalarda nabız hızı 60-90/dk arasında olanların oranı %88.6, SpO2'si %95 ve üzerinde olanların oranı ise %66.1 idi. Ambulans ile başvuranları %62.3’ü kendi imkanlarıyla başvuranların %70.1’i AS’ten taburcu edildi (p<0.001).
Sonuç: COVID-19 pandemisinde uygulanan kısıtlama politikaları uygunsuz ambulans kullanımında artışa neden olabilir. Çalışmamız sonuçları itibariyle, sağlık politikaları ve kısıtlama önlemlerinde tibbi sosyal hizmet alanlarının göz önünde bulundurulmasına katkı sağlayacaktır.
Anahtar kelimeler: Acil Sağlık Hizmetleri, Acil servis, Uygunsuz Ambulans kullanımı, Pandemi hastanesi, Tibbi sosyal hizmetler

Analysis of patients visit to the emergency department of a pandemic hospital: A retrospective study from Turkey.
Abstract
Introduction: All over the world, it has been observed that the COVID-19 pandemic and the policies implemented have direct and indirect effects on the health system and health-seeking behaviour. The aim of this study is to analyze the cases visiting the emergency department of a pandemic hospital and to investigate the effect of the pandemic period on health services and inappropriate ambulance use.
Method: This single-center, observational, retrospective study included COVID-19 patients who visited the emergency department (ED) of Prof Dr Murat Dilmener Emergency Hospital between 05 January and 05 April 2021. The demographic characteristics, vital signs and outcomes of the ambulance admissions were examined. The results were compared with the data of those who visited with their own means (control group).
Result: The median age of the patients was 45 years and 53% were women. The rate of ED visits by ambulance was 45.3%. In terms of Charlson Comorbidity Index, there was no statistical relationship between patients visiting by their own means and by ambulance (CKI=0, p=0.238; CKI=1-2, p=0.399; CKI≥ 3, P=0.124). In patients visiting by ambulance, the rate of patients with a pulse rate of 60-90/min was 88.6%, and the rate of those with an SpO2 of 95% or more was 66.1%. The rate of discharge from ED was 62.3% for those who visited by ambulance, and 70.1% for those who visited on their own (p<0.001).
Conclusion: Restriction policies implemented during the COVID-19 pandemic may lead to an increase in inappropriate ambulance use. As a result of our study, it will contribute to the consideration of medical social work areas in health policies and restriction measures.
Keywords: Emergency Medical Services, Emergency department, Ambulance misuse, Pandemic hospital, Medical social services

Anahtar Kelimeler

acil sağlık hizmetleri, acil servis, uygunsuz ambulans kullanımı, pandemi hastanesi, tıbbi sosyal hizmetler

Destekleyen Kurum

yok

Proje Numarası

yok

Teşekkür

yok

Kaynakça

• Al-Wathinani, A., Hertelendy, A. J., Alhurishi, S., Mobrad, A., Alhazmi, R., Altuwaijri, M., ... & Goniewicz, K. (2020, December). Increased emergency calls during the COVID-19 pandemic in Saudi Arabia: a national retrospective study. In Healthcare, 9(1), 14. doi: 10.3390/healthcare9010014
• Aydin, H., & Doğan, H. (2022). COVID-19 outbreak impact on discharge against medical advice from the ED: A retrospective study. The American Journal of Emergency Medicine, 57, 21-26.
• Baldi, E., Sechi, G. M., Mare, C., Canevari, F., Brancaglione, A., Primi, R., ... & Savastano, S. (2020). COVID-19 kills at home: the close relationship between the epidemic and the increase of out-of-hospital cardiac arrests. European heart journal, 41(32), 3045-3054. doi: 10.1093/eurheartj/ehaa508
• Canbaz, H., Beştemir, A., Surel, A. (2021). Türkiye‘de COVID-19 ile Enfekte olan Solid Organ Nakilli Hastaların Acil Servis ve Hastane Başvurularının İncelenmesi. Tıbbi Sosyal Hizmet Dergisi, 18, 66-81. Doi: 10.46218/tshd.1020720
• Cao, Y., Li, Q., Chen, J., Guo, X., Miao, C., Yang, H., ... & Li, L. (2020). Hospital emergency management plan during the COVID‐19 epidemic. Academic Emergency Medicine, 27(4), 309-311. doi: 10.1111/acem.13951
• CDC, National Center for Health Statistics. Excess deaths associated with COVID-19. Atlanta, GA: US Department of Health and Human Services, CDC, National Center for Health Statistics; 2020. Access date: 11 Feb 2022, https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm
• Czeisler, M. É., Marynak, K., Clarke, K. E., Salah, Z., Shakya, I., Thierry, J. M., ... & Howard, M. E. (2020). Delay or avoidance of medical care because of COVID-19–related concerns—United States, June 2020. Morbidity and mortality weekly report, 69(36), 1250. doi: 10.15585/mmwr.mm6936a4
• Dami, F., & Berthoz, V. (2020). Lausanne medical dispatch centre’s response to COVID-19. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 28(1), 1-3. doi: 10.1186/s13049-020-00735-8
• Dey, A., Majumdar, P., Saha, A., & Sahu, S. (2021). COVID-19 pandemic lockdown-induced altered sleep/wake circadian rhythm, health complaints and stress among traffic police personnel in India. Chronobiology international, 38(1), 140-148. doi:10.1080/07420528.2020.1831524
• Demirbilek, Y., Pehlivantürk, G., Özgüler, Z. Ö., & Meşe, E. A. (2020). COVID-19 outbreak control, example of ministry of health of Turkey. Turkish journal of medical sciences, 50(SI-1), 489-494. doi: 10.3906/sag-2004-187
• Dikmen, A. U., KINA, M. H., Özkan, S., & İlhan, M. N. (2020). COVID-19 epidemiyolojisi: Pandemiden ne öğrendik. Journal of biotechnology and strategic health research, 4, 29-36. doi: 10.34084/bshr.715153
• Ebrahim, S. H., Ahmed, Q. A., Gozzer, E., Schlagenhauf, P., & Memish, Z. A. (2020). Covid-19 and community mitigation strategies in a pandemic. Bmj, 368. doi: 10.1136/bmj.m1066
• Ejaz, H., Alsrhani, A., Zafar, A., Javed, H., Junaid, K., Abdalla, A. E., ... & Younas, S. (2020). COVID-19 and comorbidities: Deleterious impact on infected patients. Journal of infection and public health, 13(12), 1833-1839. doi: 10.1016/j.jiph.2020.07.014
• Friedman, J., Calderón-Villarreal, A., Bojorquez, I., Hernández, C. V., Schriger, D. L., & Hirashima, E. T. (2020). Excess out-of-hospital mortality and declining oxygen saturation: the sentinel role of emergency medical services data in the COVID-19 crisis in Tijuana, Mexico. Annals of emergency medicine, 76(4), 413-426. doi: 10.1016/j.annemergmed.2020.07.035
• Gormeli Kurt, N., & Gunes, C. (2020). How has Covid‐19 pandemic affected crowded emergency services?. International Journal of Clinical Practice, 74(12), e13624. doi: 10.1111/ijcp.13624
• Hartnett, K. P., Kite-Powell, A., DeVies, J., Coletta, M. A., Boehmer, T. K., Adjemian, J., & Gundlapalli, A. V. (2020). Impact of the COVID-19 pandemic on emergency department visits—United States, January 1, 2019–May 30, 2020. Morbidity and Mortality Weekly Report, 69(23), 699. doi: 10.15585/mmwr.mm6923e1
• İlhan, B., Berikol, G. B., & Dogan, H. (2021). Impact of COVID-19 outbreak on emergency visits and emergency consultations: a cross-sectional study. Cureus, 13(3). doi: 10.7759/cureus.14052
• Jacobs, A. K., Ali, M., Best, P. J., Bieniarz, M., Cohen, M. G., French, W. J., ... & American Heart Association. (2020). Temporary emergency guidance to STEMI systems of care during the COVID-19 pandemic: AHA’s mission: Lifeline. Circulation (New York, NY), 142(3), 199-202. doi: 10.1161/CIRCULATIONAHA.120.048180
• Jaffe, E., Strugo, R., Bin, E., Blustein, O., Rosenblat, I., Alpert, E. A., & Sonkin, R. (2020). The role of emergency medical services in containing COVID-19. The American Journal of Emergency Medicine, 38(7), 1526-1527. doi: 10.1016/j.ajem.2020.04.023
• Laukkanen, L., Lahtinen, S., Liisanantti, J., Kaakinen, T., Ehrola, A., & Raatiniemi, L. (2021). Early impact of the COVID-19 pandemic and social restrictions on ambulance missions. European journal of public health, 31(5), 1090-1095. doi: 10.1093/eurpub/ckab065
• Perlini, S., Canevari, F., Cortesi, S., Sgromo, V., Brancaglione, A., Contri, E., ... & Palo, A. (2020). Emergency department and out-of-hospital emergency system (112—AREU 118) integrated response to coronavirus disease 2019 in a Northern Italy centre. Internal and emergency medicine, 15(5), 825-833. doi: 10.1007/s11739-020-02390-4
• Sekine, I., Uojima, H., Koyama, H., Kamio, T., Sato, M., Yamamoto, T., ... & Yamagami, H. (2020). Impact of non‐pharmaceutical interventions for the COVID‐19 pandemic on emergency department patient trends in Japan: a retrospective analysis. Acute Medicine & Surgery, 7(1), e603. doi: 10.1002/ams2.603
• Şan, İ., Usul, E., Bekgöz, B., & Korkut, S. (2021). Effects of COVID‐19 pandemic on emergency medical services. International Journal of Clinical Practice, 75(5), e13885. doi: 10.1111/ijcp.13885
• Şimşek, D. Ö. (2018). Triaj sistemlerine genel bakış ve Türkiye’de acil servis başvurularını etkileyen faktörlerin lojistik regresyon ile belirlenmesi. Sosyal Güvence, (13), 84-115. doi: 10.21441/sguz.2018.66
• Oseran, A. S., Nash, D., Kim, C., Moisuk, S., Lai, P. Y., Pyhtila, J., ... & Wasfy, J. H. (2020). Changes in hospital admissions for urgent conditions during COVID-19 pandemic. Am J Manag Care, 26(8), 327-328.
• Thornton, J. (2020). Covid-19: A&E visits in England fall by 25% in week after lockdown. BMJ, 369, m1401. doi: 10.1136/bmj.m1401
• Thu, T. P. B., Ngoc, P. N. H., & Hai, N. M. (2020). Effect of the social distancing measures on the spread of COVID-19 in 10 highly infected countries. Science of the Total Environment, 742, 140430. doi: 10.1016/j.scitotenv.2020.140430
• World Health Organization. Coronavirus disease 2019 (COVID-19) situation report–51. Access date: 22 Aug 2020, https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports
• World Health Organization. Living guidance for clinical management of COVID-19: Living guidance. Access date: 01. Apr 2022, https://www.who.int/publications/i/item/WHO-2019-nCoV-clinical-2021-2
• Yin, T., Li, Y., Ying, Y., & Luo, Z. (2021). Prevalence of comorbidity in Chinese patients with COVID-19: systematic review and meta-analysis of risk factors. BMC infectious diseases, 21(1), 1-13. doi: 10.1186/s12879-021-05915-0