2019-2022 Yılları Arasında Mevsim ve Hava Koşullarının Çocuk Acil Servis Ziyaretleri Üzerindeki Etkisi: Tek Merkezli Bir Çalışma

Öz

Amaç: Bu çalışmanın amacı çevresel faktörlerin, özellikle olumsuz hava koşullarının, çocuk acil servis ziyaretlerinin oranı üzerindeki etkisini incelemektir. Yöntemler: Pediatrik ve acil tıpta uzmanlaşmış üçüncü basamak bir hastanede retrospektif bir analiz yapıldı. Partikül madde (PM10) ve nitrojen oksit (NOX) seviyeleri, sıcaklık, rüzgar hızı ve yağış gibi çevresel faktörlere ilişkin veriler resmi Türk kaynaklarından toplandı ve bir yıl boyunca pediatrik acil servis yatışlarıyla ilişkilendirildi. Yatışlar mevsimsel olarak kategorize edildi ve analiz edilen değişkenler arasında hasta demografisi, ziyaret ayrıntıları, tanı ve sonuçlar yer aldı ve geniş bir yelpazedeki koşullar için ICD-10 kodları kullanıldı. Bulgular: 2019-2022 yılları arasında yapılan retrospektif bir çalışmada 15 yaşından küçük 126.364 pediatrik hasta incelendi. Mevsimsel değişim kaydedildi ve en yüksek yatış sayısı 2022 sonbaharında gerçekleşti. Su ve hava kirliliği dönemlerinde yatışlar önemli ölçüde azaldı ve en büyük düşüş 2021 pandemi yılında görüldü. Pandemi sonrası dönemde ziyaret sayısında keskin bir artış oldu. Üst solunum yolu enfeksiyonları tüm vakaların %47'sini oluşturuyordu ve acil servis ziyaretlerinin önde gelen nedeniydi. Hastaların çoğu (%99) ayaktan, sadece %1'i ambulansla geldi. %0,2 oranında daha üst düzey bakıma sevk edilmesi gerekti, acil servis ziyaretlerinin %3'ü hastane yatışlarıyla sonuçlandı ve bunların %5'i yoğun bakım gerektirdi. Ziyaret sıklığı çevresel faktörlerle ilişkiliydi ve olumsuz hava koşullarında daha az ziyaret meydana geldi (P<,001). Aşırı hava koşulları veya kirlilik olayları sırasında bile, üst solunum yolu enfeksiyonları baskın tanı olmaya devam etti; bu da çevresel faktörlerin bu durumların aciliyetini azaltmadığını gösteriyor. Sonuç: Bu çalışma, özellikle çocukların daha sıcak hava nedeniyle daha fazla açık hava aktivitesine katıldığı yaz aylarında çevresel faktörlerin çocuk acil servis ziyaretlerini etkilediğini buldu. Elde edilen sonuçlarla, sağlık sistemleri kaynakları tahsis edebilir ve acil sağlık hizmetleri altyapısının dayanıklılığını artırma amacıyla çocuklara yönelik bakım sunumunu optimize eden yanıt stratejileri geliştirebilir.

Anahtar Kelimeler

• Pediatrik Acil Tıp
• Çevresel Sağlık Etkisi
• Hava Kalitesi ve Çocuk Sağlığı
• Pediatri Acil Servisine Kabulde Mevsimsel Değişim
• Pediatrik Sağlık Hizmeti Kullanım Modelleri

The Impact of Weather and Air Conditions on Pediatric Emergency Department Visits in 20192022: A Single-Center Study

Öz

Objective: This study aimed to explore the impact of environmental factors, specifically adverse weather conditions, on the rate of pediatric emergency department visits. Methods: A retrospective analysis was performed at a tertiary care hospital specializing in pediatric and emergency medicine. Data on environmental factors, including particulate matter (PM10) and nitrogen oxide (NOX) levels, temperature, wind speed, and precipitation, were collected from official Turkish sources and correlated with pediatric emergency department admissions over a year. Admissions were categorized seasonally, and analyzed variables included patient demographics, visit details, diagnosis, and outcomes, utilizing ICD-10 codes for a broad range of conditions. Results: A retrospective study from 2019 to 2022 investigated 126,364 pediatric patients aged < 15 years. Seasonal variation was noted, with the highest number of admissions in the fall of 2022. Admissions significantly decreased during periods of water and air pollution, with the most substantial decline seen during the pandemic year of 2021. During the post-pandemic period, there was a sharp increase in the number of visits. Upper respiratory tract infections (URTIs) constitute 47% of all cases and are the leading cause of emergency department visits. The majority of patients (99%) walked, whereas only 1% arrived by ambulance. (0.2%) required referral to higher-level care, and 3% of emergency visits resulted in hospital admissions, of which 5% required intensive care. The frequency of visits was correlated with environmental factors, with fewer visits occurring during adverse weather conditions (P<.001). URTIs remained the predominant diagnosis, even during extreme weather or pollution events, suggesting that such environmental factors did not diminish the urgency of these conditions. Conclusion: This study found that environmental factors influence child emergency room visits, particularly during summer when children engage in more outdoor activities due to warmer weather. Based on the results obtained, health systems are able to allocate resources and formulate response strategies that enhance the provision of care for children, thereby increasing the resilience of the emergency health services infrastructure.

Anahtar Kelimeler

• Pediatric Emergency Medicine
• Environmental Health Impact
• Air Quality and Child Health
• Seasonal Variation in PED Admissions
• Pediatric Healthcare Utilization Patterns

Kaynakça

1. Pehlivanturk-Kizilkan M, Ozsezen B, Batu ED. Factors Affecting Nonurgent Pediatric Emergency Department Visits and Parental Emergency Overestimation. Pediatric Emergency Care. 2022;38(6):264-8. doi: 10.1097/PEC.0000000000002723
2. Ersel M, Karcıoğlu Ö, Yanturalı S, Yürüktümen A, Sever M, Tunç M.A. Emergency Department utilization characteristics and evaluation for patient visit appropriateness from the patients’ and physicians’ point of view. Turkish Journal of Emergency Medicine. 2006;6(1):25-35.
3. Kearl Z, Vogel J. Urban extreme heat, climate change, and saving lives: lessons from Washington state. Urban climate. 2023; 47:101392. doi:10.1016/j.uclim.2022.101392
4. Sharifi A, Pathak M, Joshi C, He B-J. A systematic review of the health co-benefits of urban climate change adaptation. Sustainable Cities and Society. 2021; 74:103190. doi:10.1016/j.scs.2021.103190
5. Hoffmann B. Air pollution in cities: Urban and transport planning determinants and health in cities. Integrating human health into urban and transport planning: A framework. 2019:425-41. doi:10.1007/978-3-319-74983-9_21
6. Erbas B, Akram M, Dharmage SC, et al. The role of seasonal grass pollen on childhood asthma emergency department presentations. Clinical and experimental allergy: journal of the British Society for Allergy and Clinical Immunology. 2012;42(5):799-805. doi:10.1111/j.1365-2222.2012.03995.x
7. Drayna P, McLellan SL, Simpson P, Li SH, Gorelick MH. Association between rainfall and pediatric emergency department visits for acute gastrointestinal illness. Environ Health Perspect. 2010;118(10):1439-43. doi:10.1289/ehp.0901671
8. Josseran L, Caillère N, Brun-Ney D, et al. Syndromic surveillance and heat wave morbidity: a pilot study based on emergency departments in France. BMC medical informatics and decision making. 2009; 9:14. doi:10.1186/1472-6947-9-14

9. Zheng S, Wang M, Li B, et al. Gender, Age and Season as Modifiers of the Effects of Diurnal Temperature Range on Emergency Room Admissions for Cause-Specific Cardiovascular Disease among the Elderly in Beijing. Int J Environ Res Public Health. 2016;13(5). doi:10.3390/ijerph13050447
10. Byers N, Ritchey M, Vaidyanathan A, Brandt AJ, Yip F. Short-term effects of ambient air pollutants on asthma-related emergency department visits in Indianapolis, Indiana, 2007-2011. The Journal of asthma: official journal of the Association for the Care of Asthma. 2016;53(3):245-52. doi:10.3109/02770903.2015.1091006
11. Araos M, Austin SE, Berrang-Ford L, Ford JD. Public health adaptation to climate change in large cities: A global baseline. International Journal of Health Services. 2016;46(1):53-78. doi:10.1177/0020731415621458
12. Stone Jr B, Vargo J, Liu P, et al. Avoided heat-related mortality through climate adaptation strategies in three US cities. PloS One. 2014;9(6):e100852. doi:10.1371/journal.pone.0100852
13. Turkish Statistical Institute (TURKSTAT) - TÜİK. Statistics. Accessed June 7, 2024. https://www.tuik.gov.tr/Home/Index.
14. Ministry of Environment, Urbanisation and Climate Change. E-services. Accessed June 7, 2024. https://csb.gov.tr/en.
15. Enyuma CO, Anah MU, Pousson A, et al. Patterns of paediatric emergency admissions and predictors of prolonged hospital stay at the children emergency room, University of Calabar Teaching Hospital, Calabar, Nigeria. African health sciences. 2019;19(2):1910-23. doi:10.4314/ahs.v19i2.14
16. Al-Qahtani MH, Yousef AA, Awary BH, et al. Characteristics of visits and predictors of admission from a paediatric emergency room in Saudi Arabia. BMC emergency medicine. 2021;21(1):72. doi:10.1186/s12873-021-00467-7
17. Lee HJ, Jin MH, Lee JH. The association of weather on pediatric emergency department visits in Changwon, Korea (2005-2014). The Science of the total environment. 2016;551-552:699-705. doi:10.1016/j.scitotenv.2016.02.015
18. Liu C, Chen R, Sera F, et al. Ambient particulate air pollution and daily mortality in 652 cities. New England Journal of Medicine. 2019;381(8):705-15. doi: 10.1056/NEJMoa1817364
19. Kim Y, Choi Y-H, Kim MK, Paik HJ, Kim DH. Different adverse effects of air pollutants on dry eye disease: Ozone, PM2. 5, and PM10. Environmental Pollution. 2020;265:115039. doi:10.1016/j.envpol.2020.115039
20. Kim T-Y, Kim H, Yi S-M, Cheong J-P, Heo J. Short-term effects of ambient PM2. 5 and PM2. 5-10 on mortality in major cities of Korea. Aerosol and Air Quality Research. 2018;18(7):1853-62. doi:10.4209/aaqr.2017.11.0490
21. Kim K-H, Kabir E, Kabir S. A review on the human health impact of airborne particulate matter. Environment International. 2015; 74:136-43. doi:10.1016/j.envint.2014.10.005
22. Attia MW, Edward R. Effect of weather on the number and the nature of visits to a pediatric ED. The American Journal of Emergency Medicine. 1998;16(4):374-5. doi:10.1016/S0735-6757(98)90131-0
23. Almeida HS, Sousa M, Mascarenhas I, et al. The Dynamics of Patient Visits to a Public Hospital Pediatric Emergency Department: A Time-Series Model. Pediatr Emerg Care. 2022;38(1): e240-e5. doi: 10.1097/PEC.0000000000002235
24. Merrill CT, Owens PL, Stocks C. Emergency Department Visits for Adults in Community Hospitals from Selected States, 2005. In: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Agency for Healthcare Research and Quality (US), Rockville (MD) eds. PMID: 21755632; Feb 2008.
25. Sun R, Karaca Z, Wong HS. Trends in Hospital Emergency Department Visits by Age and Payer, 2006–2015. In: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Agency for Healthcare Research and Quality (US), Rockville (MD) eds. PMID: 30063311; March 2018: 238
26. Kurt BF, Güven O, Selçuk H. The Effect of the COVID-19 Pandemic on Emergency Department (ED) Admissions in the Only Hospital of City Center ED. Cureus. 2023;15(9): e44527. doi:10.7759/cureus.44527
27. Wilk P, Gunz A, Maltby A, et al. Extreme heat and paediatric emergency department visits in Southwestern Ontario. Paediatrics & Child Health. 2021;26(5):305-9. doi:10.1093/pch/pxaa096
28. Xu Z, Hu W, Su H, et al. Extreme temperatures and paediatric emergency department admissions. Journal Of Epidemiology and Community Health. 2014;68(4):304-11. doi:10.1136/jech-2013-202725