Acil servise başvuran 1 yaş altı pediatrik travmalı hastaların geriye yönelik incelenmesi
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Tarih
2020
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Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Pediatrik travmalarda epidemiyolojik incelemeler sonucunda bir çoğunun rastlantısal olmadığı, çocukluk çağı travmaları başta olmak üzere genelinin kaza nedenli önlenebilir bir hastalık olduğu saptanmıştır. Kaza nedenlerinin bilimsel olarak araştırılması gerektiği, bu nedenlerin sebeplerine karşı önlemler alınabileceği düşünülmektedir. Travma sonrası hastaların en sık ve ilk başvuru yaptığı yer acil servislerdir. Acil servislerdeki multidisipliner ve sistematik yaklaşımlar travmaya bağlı ölüm ve sakatlıkların azaltılmasında çok önemlidir. Sağlık sisteminin üzerindeki yükün hafifletilmesi içinde kritik öneme sahiptir. Yaş grupları ayrıntılı incelendiğinde özellikle 1 yaş altı pediatrik hastalarda mortalite ve kazanılmış engellilik üzerinde birçok faktörün etkili olduğu bilinmektedir, bu nedenle çalışmamızda 1 yaş altı pediatrik yaş grubundaki travma ile başvuran hastalar üzerinde etkilerinin olabileceğini düşündüğümüz verileri inceledik. Çalışmamızın amacı, yoğun çalışan üçüncü basamak bir hastanenin acil servis kliniği olarak tedavi ve takibini yaptığımız 1 yaş altı travma hastalarının karakteristiğini sunmak, travma skorlarının risk faktörlerini analiz etmek, bu veriler yoluyla kliniğimizin ve hastanemizin travma sağaltım yönetimini uluslararası verilerle karşılaştırmak ve hasta yönetiminin iyileştirilmesine katkı sağlayacak tedbirleri almaktı.
Materyal ve Metot: Ege Üniversitesi Tıp Fakültesi Erişkin Acil Servisine 1 Mart 2017 ile 31 Aralık 2019 tarihleri arasında başvuran 1 yaş altı pediatrik travma hastalarının hastane elektronik dosya kayıt sistemi verileri geriye yönelik olarak analiz edildi. Hastaların verilerine ICD-10 tanı kodları kullanılarak hastane kayıt sisteminden ulaşılmıştır. Ege Üniversitesi Tıp Fakültesi Tıbbi Araştırmalar Etik Kuruldan 28.05.2020 tarih ve 20-5.1T/62 numaralı karar ile onay alındıktan sonra çalışmaya başlanmıştır. Çalışmaya, 1 Mart 2017 ile 31 Aralık 2019 tarihleri arasında fakültemiz erişkin acil servisine başvuran 2321 hastadan 2174 pediatrik travma hastası dahil edildi. Çalışmaya dahil edilme kriterleri; 1 yaş altı tüm pediatrik travma hastaları. Çalışmadan dışlanma kriterleri; 1 yaş ve üzeri başvuran pediatrik travma hastaları, onamı alınmamış hastalar, adli vaka değerlendirilmesi olan travma dışı çocuk hastalar (boğulma, suicid, intoksikasyon), 1 yaş ve üzeri yaralanma dışı bir nedenle acil servise başvuran pediatrik hastalardır. Dosya bilgilerinde eksiklik olan veya dosya bilgilerine ulaşılamayan hastalar çalışma dışı bırakılmıştır.
Bulgular: Hastaların n=1143’ü (%52,6) erkek, n=1029’u (%47,4) kızdı. Çalışmaya alınan hastaların ay olarak yaş ortalaması; medyan ay 7 (minimum 1; maksimum 12) olarak saptandı. En fazla hastanın Haziran, Temmuz, Ağustos aylarında başvuru yaptığı görüldü. Travma mekanizmaları arasında puset, kundak, bebek arabasından düşme %46 ile en büyük yüzdeyi oluştururken, bunu sırasıyla %27,8 ile olduğu seviyeden düşmeler ve %13,9 ile basit çarpma/incinmelerin izlediği görüldü. En sık başvuru şekli olan ayaktan başvuruların (n=949) %46,3’ünün puset, kundak ve bebek arabasından düşme mekanizması ile olduğu görüldü. 2. sık başvuru şekli olan 112 acil servis ambulans ile başvuruların ise (n=24) %37,5’inin araç içi trafik kazası ile olduğu saptandı. Fizik muayene dışında tanılamada radyoloji en sık kullanılan yöntemdi. Travmaya maruz kalınan vücut bölgelerinden en sık kafa travması (n:1698, %80,5) ile başvuru yapıldığı görüldü. 2. sırada ekstremite travması (n:431, %20,4) yer almaktaydı. Çalışmamızda tüm travma mekanizmalarının geneline bakıldığında en sık rastlanan yaralanma tipi yumuşak doku travması (n=1663 %78,4) olarak bulundu. Acil servis sonlanışlarının analizi incelendiğinde en sık taburculuk (n=1800 %83,5), 2. Sıklıkta ise izinsiz terk (n=258 %12) ile olduğu görüldü, ölüm saptanan hasta tespit edilmedi. Yatış yapılma oranı %3,7 ile en çok çocuk hastalıkları ve acil servis kliniğine (%66,7) yapıldığı saptandı. Skorlama sistemlerinin travma yaklaşımı ve tedavisinde mortaliteyi ve travma ciddiyetini ön görmeleri açısından önem taşıdığı görüldü.
Sonuç: Travmalı olgulara olay yerinde ve acil servislerde hızlı ve doğru müdahaleler hayat kurtarıcı niteliktedir. Hasta triyajının hastane öncesi dönemde hızlı ve en uygun travma merkezlerine transferlerinin yapılması çok önemlidir. Skorlama sistemlerinin travma yaklaşımı ve tedavisinde mortaliteyi ve travma ciddiyetini ön görmeleri açısından klinisyenlerin erken dönemde bu sistemlere duyarlı olmaları gerektiği düşünülmektedir. Hastane öncesi dönemde çocuklar için güvenli bir çevre oluşturulması yaralanma kontrolünde en önemli yaklaşımdır. Çocukların daha sık bulunduğu çevrelerde ve evde güvenlik için gerekli düzenlemeler yapılmalıdır. Toplumun kazalar ve yaralanmalar konusunda eğitilmesi, acil servislere hasta nakil ve ilk yardım birimleri ile sağlık kurumlar arasında sürekli koordinasyonun sağlanması da çok önemlidir. Ayrıca, devlet tarafından desteklenmiş, sağlık profesyonellerince oluşturulan yaralanmalara karşı korunma programları ile yasal düzenlemeler yaralanmanın kontrolünde etkin olacaktır.
Aim: Epidemiological examinations in pediatric traumas determined that most of them are not coincidental and preventable diseases due to accidents, especially childhood trauma. It is thought that the causes of the accidents should be investigated scientifically and measures can be taken against the causes. Emergency departments are the most common and first referral places for patients after trauma. Multidisciplinary and systematic approaches in emergency departments are very important in reducing deaths and injuries due to trauma. Multidisciplinary and systematic approaches are also critical to alleviate the burden on the healthcare system. When age groups are examined in detail, it is known that many factors affect mortality and acquired disability, especially in pediatric patients under the age of 1, therefore, in our study, we examined the data that may have effects on patients admitted with trauma in the pediatric age group under 1 year old. The aim of our study is to present the characteristics of trauma patients under 1 year of age, who we treat and follow up as an emergency department clinic of a busy tertiary hospital, to analyze the risk factors of trauma scores, to compare the trauma treatment management of our clinic and our hospital with international data and to contribute to the improvement of patient management was to take measures. Material and Method: The hospital electronic file registration system data of pediatric trauma patients under the age of 1 who admitted to Ege University Faculty of Medicine Adult Emergency Service between March 1, 2017 and December 31, 2019 were analyzed retrospectively. The data of the patients were obtained from the hospital registry system using ICD-10 diagnostic codes. The study was initiated after the approval of the Ege University Faculty of Medicine Medical Research Ethics Committee with the decision dated 28.05.2020 and numbered 20-5.1T / 62. 2174 pediatric trauma patients out of 2321 patients who applied to our faculty adult emergency service between March 1, 2017 and December 31, 2019 were included in the study. Inclusion criteria in the study; All pediatric trauma patients under 1 year of age. Exclusion criteria from the study; Pediatric trauma patients who were the age of 1 year or older, patients whose consent was not taken, non-traumatic pediatric patients with forensic case evaluation, pediatric patients who were admitted to the emergency department for a reason other than injury, 1 year and older. Patients who had missing file information or whose file information could not be reached were excluded from the study. Results: n = 1143 (52.6%) of the patients were male, n = 1029 (47.4%) were female. Average age in months of the patients included in the study; The median month was 7 (minimum 1, maximum 12). It was determined that the highest number of patients applied in June, July and August. Among the trauma mechanisms, falling from stroller constituted the largest percentage with 46%, followed by falls from the same level with percentage of 27.8% and simple bumps / injuries with the percentage of 13.9%, respectively. It was seen that 46.3% of the outpatient applications (n = 949), the most common application form, were the mechanism of falling from strollers, swaddles and push chair. It was determined that 37.5% of the 112 emergency medical service applicants (n = 24), which is the second most common form of application, were due to an in-vehicle traffic accident. In the second rank was extremity trauma (n: 431, 20.4%). When looking at all trauma mechanisms in general in our study, the most common injury type was found to be soft tissue trauma (n = 1663, 78.4%). When the analysis of the outcomes of the emergency service was examined, it was seen that the most common was discharge (n = 1800 83.5%) and the second frequency was with unauthorized abandonment (n = 258, 12%). No patient with death was detected. The rate of hospitalization was found to be 3.7%, with the highest rate of transfer to the pediatric and emergency department (66.7%). Scoring systems were found to be important in terms of predicting mortality and severity of trauma in the approach and treatment of trauma. Conclusion: Fast and accurate interventions for traumatic cases at the scene and in emergency services are life-saving. It is very important to transfer the patient triage to the most appropriate trauma centers in the pre-hospital period. It is thought that clinicians should be sensitive to scoring systems in the early period of trauma to predict mortality and trauma severity in the approach and treatment of trauma. Creating a safe environment for children in the pre-hospital period is the most important approach in injury control. Necessary arrangements should be made for safety at home and in environments where children are more common. It is also very important to educate the society about accidents and injuries, to ensure continuous coordination between emergency services and first aid units and health institutions. In addition, protection programs and legal regulations supported by the state and created by health professionals will be effective in the control of injuries.
Aim: Epidemiological examinations in pediatric traumas determined that most of them are not coincidental and preventable diseases due to accidents, especially childhood trauma. It is thought that the causes of the accidents should be investigated scientifically and measures can be taken against the causes. Emergency departments are the most common and first referral places for patients after trauma. Multidisciplinary and systematic approaches in emergency departments are very important in reducing deaths and injuries due to trauma. Multidisciplinary and systematic approaches are also critical to alleviate the burden on the healthcare system. When age groups are examined in detail, it is known that many factors affect mortality and acquired disability, especially in pediatric patients under the age of 1, therefore, in our study, we examined the data that may have effects on patients admitted with trauma in the pediatric age group under 1 year old. The aim of our study is to present the characteristics of trauma patients under 1 year of age, who we treat and follow up as an emergency department clinic of a busy tertiary hospital, to analyze the risk factors of trauma scores, to compare the trauma treatment management of our clinic and our hospital with international data and to contribute to the improvement of patient management was to take measures. Material and Method: The hospital electronic file registration system data of pediatric trauma patients under the age of 1 who admitted to Ege University Faculty of Medicine Adult Emergency Service between March 1, 2017 and December 31, 2019 were analyzed retrospectively. The data of the patients were obtained from the hospital registry system using ICD-10 diagnostic codes. The study was initiated after the approval of the Ege University Faculty of Medicine Medical Research Ethics Committee with the decision dated 28.05.2020 and numbered 20-5.1T / 62. 2174 pediatric trauma patients out of 2321 patients who applied to our faculty adult emergency service between March 1, 2017 and December 31, 2019 were included in the study. Inclusion criteria in the study; All pediatric trauma patients under 1 year of age. Exclusion criteria from the study; Pediatric trauma patients who were the age of 1 year or older, patients whose consent was not taken, non-traumatic pediatric patients with forensic case evaluation, pediatric patients who were admitted to the emergency department for a reason other than injury, 1 year and older. Patients who had missing file information or whose file information could not be reached were excluded from the study. Results: n = 1143 (52.6%) of the patients were male, n = 1029 (47.4%) were female. Average age in months of the patients included in the study; The median month was 7 (minimum 1, maximum 12). It was determined that the highest number of patients applied in June, July and August. Among the trauma mechanisms, falling from stroller constituted the largest percentage with 46%, followed by falls from the same level with percentage of 27.8% and simple bumps / injuries with the percentage of 13.9%, respectively. It was seen that 46.3% of the outpatient applications (n = 949), the most common application form, were the mechanism of falling from strollers, swaddles and push chair. It was determined that 37.5% of the 112 emergency medical service applicants (n = 24), which is the second most common form of application, were due to an in-vehicle traffic accident. In the second rank was extremity trauma (n: 431, 20.4%). When looking at all trauma mechanisms in general in our study, the most common injury type was found to be soft tissue trauma (n = 1663, 78.4%). When the analysis of the outcomes of the emergency service was examined, it was seen that the most common was discharge (n = 1800 83.5%) and the second frequency was with unauthorized abandonment (n = 258, 12%). No patient with death was detected. The rate of hospitalization was found to be 3.7%, with the highest rate of transfer to the pediatric and emergency department (66.7%). Scoring systems were found to be important in terms of predicting mortality and severity of trauma in the approach and treatment of trauma. Conclusion: Fast and accurate interventions for traumatic cases at the scene and in emergency services are life-saving. It is very important to transfer the patient triage to the most appropriate trauma centers in the pre-hospital period. It is thought that clinicians should be sensitive to scoring systems in the early period of trauma to predict mortality and trauma severity in the approach and treatment of trauma. Creating a safe environment for children in the pre-hospital period is the most important approach in injury control. Necessary arrangements should be made for safety at home and in environments where children are more common. It is also very important to educate the society about accidents and injuries, to ensure continuous coordination between emergency services and first aid units and health institutions. In addition, protection programs and legal regulations supported by the state and created by health professionals will be effective in the control of injuries.
Açıklama
Anahtar Kelimeler
Acil Servis, Pediatrik Travma, Kafa Travması, Skorlar, Emergency Service, Pediatric Trauma, Head Injury, Scores
