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Öğe Characteristics and outcomes of critically ill children transported by ambulance in a Turkish prehospital system: a multicenter prospective cohort study(Turkish J Pediatrics, 2021) Saz, Eylem Ulas; Turan, Caner; Anil, Murat; Bal, Alkan; Gokalp, Gamze; Yilmaz, Hayri Levent; Tekin, DenizBackground. The most underdeveloped area in the care of critically-ill-children (CIC) is the prehospital period. Appropriate prehospital assessment and life-saving-interventions (LSI) of this population are challenging and require dedicated resources to ensure the best outcomes. We aimed to determine the characteristics and outcomes of CIC transported to the Turkish Pediatric Emergency Departments (EDs). The frequency and distribution of LSI administered by prehospital providers on route and in the EDs were also investigated. Methods. This prospective study was conducted at 4 metropolitan cities and 9 tertiary pediatric EDs between August 2014-August 2015. A survey based study evaluated all CC who were brought by ambulance to the participant EDs. CIC were defined as a patient who requires LSI or needs intensive care admission for any reason. Patient demographics, clinical features, reason for transport, performed procedures in the ambulance or ED were sought. Finally, the short-term outcomes of transported CIC and transport-associated risks were analyzed. Results. During the study period, a total 2094 children were brought by ambulance to all participant EDs. Only 227 (10.8%) of them were critically-ill. Emergency Medical Services (EMS) providers were less likely to perform procedures in CIC if they were staffed with paramedics (p<0.001). Most procedures were performed on children aged one or older (p<0.001). No procedure was performed in the ambulance for nearly one fourth of patients who received LSI in the EDs. If the EMS did not have a physician, prehospital providers were less likely to provide immediate LSIs (p<0.001). CIC were more likely referred from secondary/tertiary care hospitals. The short-term mortality rate was higher if the ambulance was staffed by only paramedics. Conclusion. This study demonstrated that Turkish prehospital pediatric emergency care is deficient. We offer a clinical overview of pediatric emergencies to aid EMS directors, policymakers, and ED directors in planning the care of CIC.Öğe The Comparison of Children Who Were Diagnosed with COVID-19 in the First and the Second Waves of the SARS-CoV-2 Pandemic(Aves, 2021) Turan, Caner; Basa, Elif Gokce; Elitez, Duygu; Yilmaz, Ozlem; Gumus, Ece; Anil, MuratObjective: To compare the clinical and laboratory findings and short-term outcomes of those children diagnosed with COVID-19 in the first and second waves of the SARS-CoV-2 pandemic. Methods: A retrospective study was conducted at a suburban community hospital during a 1-year period. All children who were less than 18 years of age and confirmed with COVID-19 were included in the study population. The demographics, clinical features, laboratories, treatments given, hospitalizations, and outcomes were analyzed. Results: A total of 198 patients were enrolled; median age was 9.3 years. One-hundred four patients were diagnosed with COVID-19 disease in the first wave and 94 (47.5%) patients were diagnosed in the second wave of the pandemic. Those patients who were diagnosed with COVID-19 in the first wave of the pandemic were significantly younger than those in the second wave (medians: 2.7 years vs. 15 years respectively, P <.001). Intra-familial contact was detected in 66.4% vs. 33.6% in the first and second waves of the pandemic, respectively (P <.001). Asymptomatic patients were higher in the second wave than in the first wave (P <.001). Additionally, moderate-to-critically ill patients were significantly higher in the first wave than in the second wave (P <.001). The rate of multisystem inflammatory syndrome (MIS-C) cases was 0.32% in this study. Conclusion: In children, COVID-19 disease affected older children, there was less intra-familial contact and the severity of the disease was milder in the second wave of the pandemic in comparison to the first wave. MIS-C was encountered in the second wave of the pandemic.Öğe The first national data of Turkish pre-hospital emergency care for children: Epidemiology, clinical characteristics, and outcomes(Sage Publications Ltd, 2020) Turan, Caner; Saz, Eylem Ulas; Anil, Murat; Bal, Alkan; Gokalp, Gamze; Yilmaz, Hayri Levent; Yurtseven, AliBackground and Objectives: the emergency medical service system is designed to ensure rapid identification and transport of patients from the field to emergency departments. This study aims to examine pediatric patients' clinical characteristics and reasons for ambulance use in Turkey. Life-saving interventions and non-life-saving interventions performed during transport and patients' outcomes following transport were also investigated. Methods: This is a prospective-multicentric study conducted at four metropolitan cities and nine tertiary pediatric emergency departments. This survey-based study evaluated all children brought by ambulance to emergency departments. Patient demographics, clinical features, triage levels, procedures performed in the ambulance or emergency department, and final outcomes were sought. Results: A total of 2094 patients were transported during the study period. Only a minority of ambulances were physician staffed (16.5%), and 72% of the patients were delivered to pediatric emergency departments without notification calls. Although notification calls were more likely given for particularly critically ill children, for non-urgent conditions transfer calls were less common (60.8% vs 23.5%, respectively; p < 0.001). A majority of transports were performed for trauma patients (20.5%), neurological issues (20%), and toxicological emergencies (13.8%). While parents prefer using the ambulances for medical emergencies, physicians prefer it for mainly traumatic and toxicological emergencies. in total, 65% of the patients received at least one intervention, and 18 patients needed immediate life-saving interventions (intubation, cardiopulmonary resuscitation, etc.) but they did not receive it. Mortality occurred in nine patients. If the health care providers were paramedics, they were more likely avoided by performing any intervention in critically ill children (p < 0.001). A majority of the procedures performed in children were older than 12 months (p < 0.001). Conclusion: This study presents comprehensive epidemiological and outcome data for pediatric patients transported by the national emergency medical service system in Turkey. Non-urgent calls were more likely made by parents, physicians avoided making NCs, and paramedics also avoided performing any intervention when they were transporting children.Öğe First step toward a better trauma management: Initial results of the Northern Izmir Trauma Registry System for children(Turkish Assoc Trauma Emergency Surgery, 2019) Oztan, Mustafa Onur; Anil, Murat; Anil, Ayse Berna; Yaldiz, Demet; Uz, Ilhan; Turgut, Ali; Kose, Isil; Acar, Kerim; Sofuoglu, Turhan; Akbulut, GokhanBACKGROUND: Trauma is an important health problem in children, and improvement in trauma care on the national level is possible only through the knowledge gathered from trauma registry systems. This information is not available in our country, because there is no current trauma registry system in the hospitals. Our aim in this paper is to explain the trauma registry system we have developed and to present the first year's data. METHODS: The planned trauma registry system was integrated into the emergency department registry system of 14 hospitals in the Izmir province. The data of pediatric patients with multiple trauma have been recorded automatically through the registry system. Demographics, vital signs, mechanism, the type of trauma, anatomical region, Injury Severity Score (ISS), Pediatric Trauma Score (PTS), Glasgow Coma Scale (GCS) score, the length of hospital stay, and the need for blood transfusion/endotracheal intubation/surgery/hospitalization were evaluated by the patient transfer status and outcome. RESULTS: At the end of one year, a total of 356 pediatric major trauma patients were included in the study. The most common type of trauma was blunt trauma (91.9%), and the most common mechanism was vehicle-related traffic accident (28.1%). In the group with the Glasgow Outcome Scale <= 3; the age was greater, ISS was higher, and PTS was lower. Motorcycle accidents, sports injuries, and penetrating injuries were more frequent in this group. All scores were significantly different between direct and transferred patients. The referral time to the hospital of the transferred patients was longer than directly admitted patients, but the results were not different. CONCLUSION: Pediatric major trauma is an important cause of mortality and morbidity, and our trauma registry system, which is a successful example abroad, is insufficient in our country. We hope that the trauma registry system we planned and the pilot application we started will be expanded to include other hospitals throughout the country with the aim of developing a national registry system.Öğe International Epidemiological Differences in Acute Poisonings in Pediatric Emergency Departments(Lippincott Williams & Wilkins, 2019) Mintegi, Santiago; Azkunaga, Beatriz; Prego, Javier; Qureshi, Nadeem; Dalziel, Stuart R.; Arana-Arri, Eunate; Acedo, Yordana; Martinez-Indart, Lorea; Urkaregi, Arantza; Salmon, Nerea; Benito, Javier; Kuppermann, Nathan; Benito, Javier; Waisman, Yehezkel; Osmond, Martin; Johnson, David; Chamberlain, James; Macias, Charles G.; Kharbanda, Anupam; Babl, Franz E.; Dalziel, Stuart; Sutter, Mark; Cohen, Daniel; Lloyd, Julia; Duffy, Elizabeth; Mahajan, Prashant; Wang, George Sam; Bradin, Stuart A.; Ramirez, Jose; Stephenson, Samuel; Carison, Anna; Craig, Simon; Graudins, Andis; Cheek, John; Dalziel, Stuart R.; Bonish, Megan; Van de Voorde, Patrick; Idrissi, Said Hachimi; Petrovska, Alexandra; Mercier, Jean Christophe; Morin, Laurence; Cheron, Gerard; Szabo, Eva; Nagy, Richard; Bognar, Zsolt; Simon, Gabor; Balla, Gyorgy; Juhasz, Eva; Martin, Ciara; Koshy, Rincy; Mc Namara, Roisin; Waisman, Yehezkel (Hezi); Amir, Lisa; Da Dalt, Liviana; Moretti, Carlo; Norbedo, Stefania; Salvatore, Renna; Debbia, Carla; Arrighini, Alberto; Botarelli, Patrizia; Pisani, Mara; Ponticiello, Eduardo; Tipo, Enzo; Moll, Henriette; Bilhota, Xavier; Garrido, Ana; Gata, Lia; Macao, Patricia; Lima, Sofia Costa; Araujo e Sa, Gabriela; Almeida, Sofia; Gafencu, Mihai; Babeu, Alina; Moldovan, Diana; Mitrofan, Daniela Maria; Humayor Yanez, Francisco Javier; Andres Andres, Ana Gloria; del Campo Munoz, Tomas; Mendivil, Rocio; Baena Olomi, Irene; Fabrega i Sabate, Jordi; Iturralde Orive, Itziar; Roca, Andreu; Fernandez, Ramon; Jorda Lope, Ana; Canduela, Victor; Mesa, Sofia; Garcia-Vao Bel, Carlos; Barasoain Millan, Alberto; Herrero, Laura; Campos Calleja, Carmen; Carlos Molina, Juan; Garcia Herrer, Ma Angeles; Canduela, Carlos; Bello Gutierrez, Pablo; Velasco, Roberto; Martinez Sanchez, Lidia; Martinez Mengual, Laura; Rodriguez Suarez, Julian; Mintegi, Santiago; Salmon, Nerea; Munoz Bernal, Jose Angel; Lopez Avila, Javier; Vazquez Lopez, Paula; May, Elena; Cozar Olmo, Juan; Lopez Corominas, Victoria; Tallon Garcia, Maria; Crespo Ruperez, Esther; Perez Saez, Amalia; Sancosmed Ron, Monica; Velasco Puyo, Pablo; Mesa, Judith; Pociello, Neus; Galan Mercado, Maria; Seiler, Michelle; Gasser, Celine Rey-Bellet; Pittet, Anne; Gervaix, Alain; Manzano, Sergio; Saz, Eylem Ulas; Yurtseven, Ali; Anil, Murat; Oguz, Sinan; Tekin, Deniz; Kurt, Funda; Ryan, Mary; Hoyle, Abi; Lyttle, Mark D.; Potter, Sarah; Babakhanlou, RodrickBackground and Objective: Identifying international differences in the epidemiology of acute poisonings in children may help in improving prevention. We sought to evaluate the international epidemiological differences in acute poisonings in children presenting to emergency departments (EDs) from 8 different global regions. Methods: This was an international multicenter cross-sectional prospective study including children younger than 18 years with acute poisonings presenting to 105 EDs in 20 countries was conducted. Data collection started at each ED between January and September 2013, and continued for 1 year. Results: During the study period, we registered 363,245 pediatric ED presentations, of which 1727 were for poisoning (0.47%; 95% confidence interval, 0.45%-0.50%), with a significant variation in incidence between the regions. Full data were obtained for 1688 presentations. Most poisonings (1361 [80.6%]) occurred at home with either ingestion (1504 [89.0%]) or inhalation of the toxin (126 [7.6%]). Nonintentional exposures accounted for 1157 poisonings (68.5%; mainly in South America and Eastern Mediterranean region), with therapeutic drugs (494 [42.7%]), household products (310 [26.8%]), and pesticides (59 [5.1%]) being the most common toxins. Suicide attempts accounted for 233 exposures (13.8%; mainly in the Western Pacific region and North America), with therapeutic drugs (214 [91.8%], mainly psychotropics and acetaminophen) being the most common toxins. Significant differences between regions were found in both types of poisonings. Recreational poisonings were more common in Europe and Western Pacific region. No patient died. Conclusions: There are substantial epidemiological differences in acute poisonings among children in different countries and regions of the globe. International best practices need to be identified for prevention of acute poisonings in childhood.Öğe A Rare Cause of Metabolic Acidosis Fatal Transdermal Methanol Intoxication in an Infant(Lippincott Williams & Wilkins, 2016) Bal, Zumrut Sahbudak; Can, Fulya Kamit; Anil, Ayse Berna; Bal, Alkan; Anil, Murat; Gokalp, Gamze; Yavascan, Onder; Aksu, NejatOral methanol intoxication is common, but dermal intoxication is rare. We report a previously healthy 19-month-old female infant admitted to the emergency department (ED) with vomiting and tonicclonic seizure. On physical examination, she was comatose and presented signs of decompensated shock with Kussmaul breathing. Her left thigh was edematous, with purple coloration. Methanol intoxication was suspected due to high anion gap metabolic acidosis (pH, 6.89; HCO3, <3 meq/L) and exposure to spirit-soaked bandages (%96 methanol) for 24 hours and 3 days. The patient's serum methanol level was 20.4 mg/dL. She was treated with fomepizole and continuous venovenous hemodialysis (CVVHD) in the pediatric intensive care unit, and methanol levels decreased to 0 mg/dL after 12 hours. During follow-up, massive edema and subarachnoid hemorrhage in the occipital lobe were detected by computed tomography of the brain. The patient died after 7 days. Although methanol intoxication occurs predominantly in adults, it must be considered in children with high-anion gap metabolic acidosis. This case report demonstrates that fatal transdermal methanol intoxication can occur in children, and it is the second report in the English literature of transdermal methanol intoxication in an infant.Öğe Significance of Postnatal Follow-up of Infants with Vesicoureteral Reflux Having Antenatal Hydronephrosis(Iranian Scientific Society Medical Entomology, 2010) Kangin, Murat; Aksu, Nejat; Yavascan, Onder; Anil, Murat; Kara, Orhan Deniz; Bal, Alkan; Kamit, FulyaObjective: To evaluate the frequency of urinary tract infections (UTIs) and degree of renal parenchymal damage as well as the parameters of growth, development and nutritional status in antenatal hydronephrosis cases with vesicoureteral reflux (VUR). Methods: Infants, whose antenatal ultrasonography (US) showed a fetal renal pelvic diameter of 5 mm or greater were investigated. Of the 277 infants with antenatal HN, 36 [56 renal units (RUs)] were diagnosed with VUR. All cases with VUR were evaluated in terms of the frequency of UTIs, scars appearing on (99m)Technetium-dimercaptosuccinic acid scan (DMSA), growth and development [height and weight standard deviation scores (HSDS and WSDS)], and nutritional status [relative weight (RW)]. Statistical evaluation was performed using the Chi-squared test. Findings: Of these 36 patients with VUR, 25 (69.4%) were males and 11 (30.6%) females. Of the 56 RUs, 48 (85.7%) had severe VUR Grade III). The mean duration of postnatal follow-up was 37.8 +/- 24.50 months. The annual UTI frequency was found to be 1.25 +/- 0.83 episodes/year. Of these 36 infants, 32 (88.8%) recovered from VUR following either medical (17 patients, 47.2%) or surgical (15 patients, 41.6%) treatment. The initial DMSA showed parenchymal defects in 16 (44.4%) RUs, and 4 RUs showed recovery in the final DMSA. Although statistically insignificant (P>0.05), initial growth and development (HSDS: -0.17 +/- 0.86; WSDS: 0.00 +/- 0.14) and nutritional status (RW: 98.19 +/- 8.81) values gradually improved (0.05 +/- 1.06, 0.06 +/- 1.071 and 101.97 +/- 14.85, respectively). Conclusion: Postnatal early diagnosis and appropriate management of VUR in infants with antenatal hydronephrosis can prevent the occurrence of frequent UTIs, renal scarring and malnutrition, enabling normal growth and development.Öğe Simultaneous Detection of Respiratory Viruses and Influenza A Virus Subtypes Using Multiplex PCR(Ankara Microbiology Soc, 2014) Cicek, Candan; Bayram, Nuri; Anil, Murat; Gulen, Figen; Pullukcu, Husnu; Saz, Eylem Ulas; Telli, Canan; Cok, GurselThis study was conducted to investigate the respiratory viruses and subtyping of influenza A virus when positive by multiplex PCR in patients with flu-like symptoms, after the pandemic caused by influenza A (H1N1)pdm09. Nasopharyngeal swab samples collected from 700 patients (313 female, 387 male; age range: 24 days-94 yrs, median age: 1 yr) between December 2010 - January 2013 with flu-like symptoms including fever, headache, sore throat, rhinitis, cough, myalgia as defined by the World Health Organization were included in the study. Nucleic acid extractions (Viral DNA/RNA Extraction Kit, iNtRON, South Korea) and cDNA synthesis (RevertAid First Strand cDNA Synthesis Kits, Fermentas, USA) were performed according to the manufacturer's protocol. Multiplex amplification of nucleic acids was performed using DPO (dual priming oligonucleotide) primers and RV5 ACE Screening Kit (Seegene, South Korea) in terms of the presence of influenza A (INF-A) virus, influenza B (INF-B) virus, respiratory syncytial virus (RSV), and the other respiratory viruses. PCR products were detected by automated polyacrylamide gel electrophoresis using Screen Tape multiple detection system. Specimens which were positive for viral nucleic acids have been further studied by using specific DPO primers, FluA ACE Subtyping and RV15 Screening (Seegene, South Korea) kits. Four INF-A virus subtypes [human H1 (hH1), human H3 (hH3), swine H1 (sH1), avian H5 (aH5)] and 11 other respiratory viruses [Adenovirus, parainfluenza virus (Ply) types 1-4, human bocavirus (HBoV), human metapneumovirus (HMPV), rhinovirus types A and B, human coronaviruses (HCoV) OC43, 229E/NL63] were investigated with those tests. In the study, 53.6% (375/700) of the patients were found to be infected with at least one virus and multiple respiratory virus infections were detected in 15.7% (59/375) of the positive cases, which were mostly (49/59, 83%) in pediatric patients. RSV and rhinovirus coinfections were the most prevalent (18/29, 62.7%) dual infections. The distribution of 436 respiratory viruses identified from 375 patients were as follows; 189 (43.3%) RSV, 93 (21.4%) rhinovirus, 86 (19.8%) INF-A, seven (1.6%) INF-B, 22 (5%) PIV types 1-3, 14 (3.2%) HMPV, 11(2.5%) HCoV, nine (2%) HBoV, and five (1.2%) adenovirus. Fifty-five (64%) out of 86 INF-A viruses were subtyped as hH3, 24 (27.9%) were sH1 and seven (8.1%) were hH1. Avian 115 was not detected in any samples. The overall prevalence rates of INF-A, INF-B, RSV and other respiratory viruses were 12%, 1%, 27%, and 14.6%, respectively. RSV was the most prevalent respiratory agent in pediatric (161/313, 51%) cases, while INF-A virus in adult (24/62, 38.7%) patients. Influenza viruses were detected as responsible pathogens in 13.3% (93/700) of the patients with flu-like symptoms. Among the cases, a 1-month-old baby was infected with three virus strains (INF-A hH1+INF-A sH1+HCoV OC43) and a 82-year-old patient was infected with two INF-A virus subtypes (hH3 + sH1). INF-A viruses were mostly detected (79/86) in winter period, from December to March. INF-A virus sH1, was the most prevalent subtype in flu cases till February 2011 (22/86), after replaced by INF-A virus hH3. Beginning from February 2012, a significant increase observed in the cases infected with INF-A virus subtype hH3 (39/86). In conclusion, the identification and surveillance of influenza virus types and subtypes circulating in populations have importance both for epidemiological data and selection of vaccine strains.
