Barthel ile Uluslararası Düşme Etkinlik Ölçeklerinin acil servise travma veya travma dışı sebeplerle başvuran 65 yaş üstü hastalar arasında karşılaştırılması
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Dosyalar
Tarih
2020
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
AMAÇ: Düşme toplumlarda tıbbi ve ekonomik sonuçlar açısından büyük bir halk sağlığı
sorunu olmakla birlikte, yaşlılarda düşmeye bağlı bağımlılık artmıştır, yeti kaybı ve ölüm
oranı yüksek oranda görülmektedir. Barthel ile Uluslararası düşme etkinlik ölçeği
hesaplamalarındaki hedef hastanın düşme olasılığını belirlemek ve erken önlem almaktır. 65
yaş üstü düşmeye bağlı travmaların %70’i yaralanma ile sonuçlanır. Travma sonrası görülen
en sık morbidite ekstremite yaralanmaları, yumuşak doku yaralanmaları, intrakraniyal
kanamadır. Bu süreçlerin hepsi hastada hareket kaybı, korku ve güvensizliğe bağlı hareket
kaybı, uzun süren hastanede yatma gereksinimleri, bakım evlerine sevk edilme ve ölüm ile
sonuçlanır.
YÖNTEM: Ege Üniversitesi Tıp Fakültesi Acil servisine 01.07.2019-01.01.2020 tarihleri
arasında başvuran 65 yaş üstü olan ve dahil olma kriterlerini karşılayan hastalar çalışmaya
dahil edilmiş. Travma öyküsü olan ve olmayan olmak üzere iki ayrı hasta grubu çalışmaya
alınmıştır. Travma öyküsü olan hastalar basit düşme ile sınırlandırılmış olup; travma dışı
hastalar kontrol grup olarak adlandırılmıştır. Bilinci kapalı olan ya da değerlendirilmeye
uygun olmayan hastalar, serebrovasküler olay sekeli olan hastalar, travmanın basit düşme
dışındaki diğer sebeplerine sahip olan hastalar ve son 1 yıl içerisinde düşme nedenli acil
servis başvurusu olan hastalar çalışmaya dahil edilmemiştir. Barthel ve Uluslararası Düşme
Etkinlik Ölçeği kullanılarak hastaların düşme skorları hesaplanmıştır.
BULGULAR: Toplamda 257 hasta çalışmaya dahil edilmiştir. Hastaların yaşlarının ortalama
değeri 77,71 ± 8,212 ; minimum değeri 65 ± 8,212 ve maksimum değeri 101 ± 8,212 ’dir.
Toplam kadın hasta sayısı 131 (%51,0) iken, toplam erkek hasta sayısı 126 (%49,0)’ dır. Tüm
hasta gruplarında erkek ve kadınların yaşları arasında istatiksel olarak anlamlı farklılık
bulunmamaktadır (p=0,055). Basit düşme grubunda 132 (%51,4) ve kontrol grubunda 125
(%48,6) hasta dahil olma kriterlerini karşıladığından çalışmaya alınmış olup, 2 hasta
çalışmaya dahil olma kriterlerini karşılamadığından çalışmadan çıkarılmıştır. Basit düşme ile
gelen erkek hasta sayısı 61 (%46,2); kadın hasta sayısı 71 (%53,8)’dir. Kontrol grubunda
erkek hasta sayısı 65 (%52); kadın hasta sayısı 60 (%48)’dir. Kontrol ve düşen hasta
gruplarında erkeklerin ve kadınların yaşları arasında istatistiksel olarak anlamlı farklılık
bulunmamaktadır (p=0,447 ve 0,071; sırasıyla). Yaşlı hastalarda düşme sonrası en sık görülen yaralanma minor travma-yumuşak doku
travmasıdır Diğerleri sırasıyla alt ekstremite fraktürü; üst ekstremite fraktürü; kafa travması;
vertebra travması; toraks travması; maksillofasiyal travma; servikal travma’dır.
Hastaları yaşlarına göre 3 kategoriye (65-74, 75-84 ve 85 yaş üstü) ayırdığımızda Uluslararası
düşme skoru, basit düşme ve kontrol grup hastaları arasında ayrı ayrı kıyaslandığında yaş
grupları arasında istatistiksel olarak anlamlı fark bulunmuştur (Pearson X², p ≤0,0010,
p=0,009). Benzer şekilde hastaları yaşlarına göre 3 kategoriye (65-74, 75-84 ve 85 yaş üstü)
ayırdığımızda Barthel düşme skoru düşmeyi öngörmede, basit düşme ve kontrol grubundaki
hastalar arasında kıyaslandığında istatistiksel olarak anlamlı fark bulunmuştur (Pearson X²,
p=0,000,p=0,030).
SONUÇ: Barthel indeksi ve Uluslararası düşme skoru bizim çalışmamızda 65 yaş üstü
hastalarda düşmeyi ön görememiştir. Her iki skor basit düşme ve kontrol grubu hastaları
arasında uygulandığında istatistiksel olarak anlamlı fark bulunamamıştır ve birbirleriyle
kıyaslandığında birbirlerinden üstün değildir. Ancak hasta gruplarını yaş aralıklarına göre 3
kategoriye (65-74, 75-84 ve 85 yaş üstü) ayırdığımızda, basit düşme ve kontrol grubu
hastaları arasında bakıldığında 75-84 yaş aralığındaki hastaların skorları basit düşme
grubunda istatistiksel olarak anlamlı yüksek çıkmıştır.
PURPOSE Falling is a major public health problem in terms of medical and economic consequences in the societies, the dependence on the fall has increased in the elderly, and the rate of disability and death is high. The purpose in Barthel and International fall effectiveness scale calculations is to determine the probability of the patient falling and take early precautions. Seventy-percent of fall-related traumas result in injury at people over age of 65. The most common post-traumatic morbidity is limb injuries, soft tissue injuries, intracranial hemorrhage. All of these processes result in loss of motion in the patient, loss of motion due to fear and insecurity, long hospitalization requirements, referral to nursing homes and death. METHOD: Patients over 65 years old who applied the Ege University Faculty of Medicine Emergency Department between 01.07.2019-01.01.2020 and fulfilled the inclusion criteria were included in the study. Two separate patient groups, with and without trauma history, were included in the study. Patients with a history of trauma are limited to simple falls; nontraumatic patients were named as control group. Patients who were unconscious or not suitable for evaluation, patients with cerebrovascular event sequences, patients with other causes of trauma other than simple fall, and patients with emergency applications due to fall within the last 1 year were not included in the study. The falling scores of the patients were calculated using Barthel and the International Fall Efficacy Scale. FINDINGS: A total of 257 patients were included in the study. The average age of the patients was 77.71 ± 8.212; the minimum value is 65 ± 8.212 and the maximum value is 101 ± 8.212. While the total number of female patients is 131 (51.0%), the total number of male patients is 126 (49.0%). There was no statistically significant difference between the ages of men and women in all patient groups (p=0.055). Since 132 (51.4%) patients in the post-fall in elderly patients and 125 (48.6%) patients in the control group met the inclusion criteria, 2 patients were excluded from the study because they did not meet the inclusion criteria. The number of male patients coming with falling is 61 (46.2%); the number of female patients is 71 (53.8%). The number of male patients in the control group was 65 (52%); the number of female patients is 60 (48%). There was no statistically significant difference between the ages of men and women in the control and falling patient groups (p=0.447 and 0.071, respectively). Minor trauma-soft tissue trauma is the most common injury after fall in elderly patients .Others are lower extremity fracture ; upper limb fracture ; head injury ; vertebral trauma ; thoracic trauma; maxillofacial trauma ; cervical trauma. When we divide the patients into 3 categories (65-74, 75-84 and over 85) according to their age, a statistically significant difference was found between the age groups when compared with the international fall score, falling patients and control group patients (Pearson X², p ≤0.0010 , p=0.009). Similarly, when we divide the patients into 3 categories (65-74, 75-84 and over 85) according to their age, a statistically significant difference was found in predicting the fall score of Barthel compared to the patients in the falling patients and control group patients (Pearson X², p=0,000, p=0.030). RESULT: In our study, Barthel index and International fall score could not predict falling in patients over 65 years of age. When both scores were applied between falling patients and control group patients, no statistically significant difference was found and they were not superior to each other compared to each other. However, when we divide the patient groups into 3 categories (65-74, 75-84 and over 85) according to their age ranges, the scores of patients in the 75-84 age group were statistically significantly higher in the falling patients group.
PURPOSE Falling is a major public health problem in terms of medical and economic consequences in the societies, the dependence on the fall has increased in the elderly, and the rate of disability and death is high. The purpose in Barthel and International fall effectiveness scale calculations is to determine the probability of the patient falling and take early precautions. Seventy-percent of fall-related traumas result in injury at people over age of 65. The most common post-traumatic morbidity is limb injuries, soft tissue injuries, intracranial hemorrhage. All of these processes result in loss of motion in the patient, loss of motion due to fear and insecurity, long hospitalization requirements, referral to nursing homes and death. METHOD: Patients over 65 years old who applied the Ege University Faculty of Medicine Emergency Department between 01.07.2019-01.01.2020 and fulfilled the inclusion criteria were included in the study. Two separate patient groups, with and without trauma history, were included in the study. Patients with a history of trauma are limited to simple falls; nontraumatic patients were named as control group. Patients who were unconscious or not suitable for evaluation, patients with cerebrovascular event sequences, patients with other causes of trauma other than simple fall, and patients with emergency applications due to fall within the last 1 year were not included in the study. The falling scores of the patients were calculated using Barthel and the International Fall Efficacy Scale. FINDINGS: A total of 257 patients were included in the study. The average age of the patients was 77.71 ± 8.212; the minimum value is 65 ± 8.212 and the maximum value is 101 ± 8.212. While the total number of female patients is 131 (51.0%), the total number of male patients is 126 (49.0%). There was no statistically significant difference between the ages of men and women in all patient groups (p=0.055). Since 132 (51.4%) patients in the post-fall in elderly patients and 125 (48.6%) patients in the control group met the inclusion criteria, 2 patients were excluded from the study because they did not meet the inclusion criteria. The number of male patients coming with falling is 61 (46.2%); the number of female patients is 71 (53.8%). The number of male patients in the control group was 65 (52%); the number of female patients is 60 (48%). There was no statistically significant difference between the ages of men and women in the control and falling patient groups (p=0.447 and 0.071, respectively). Minor trauma-soft tissue trauma is the most common injury after fall in elderly patients .Others are lower extremity fracture ; upper limb fracture ; head injury ; vertebral trauma ; thoracic trauma; maxillofacial trauma ; cervical trauma. When we divide the patients into 3 categories (65-74, 75-84 and over 85) according to their age, a statistically significant difference was found between the age groups when compared with the international fall score, falling patients and control group patients (Pearson X², p ≤0.0010 , p=0.009). Similarly, when we divide the patients into 3 categories (65-74, 75-84 and over 85) according to their age, a statistically significant difference was found in predicting the fall score of Barthel compared to the patients in the falling patients and control group patients (Pearson X², p=0,000, p=0.030). RESULT: In our study, Barthel index and International fall score could not predict falling in patients over 65 years of age. When both scores were applied between falling patients and control group patients, no statistically significant difference was found and they were not superior to each other compared to each other. However, when we divide the patient groups into 3 categories (65-74, 75-84 and over 85) according to their age ranges, the scores of patients in the 75-84 age group were statistically significantly higher in the falling patients group.
Açıklama
Anahtar Kelimeler
Yaşlı, Geriatrik Sendrom, Düşme, Düşme Komplikasyonları, Barthel İndeksi, Uluslar Arası Düşme Etkinlik Skoru, Old, Geriatric Syndrome, Fall, Fall Complications, Barthel Index, International Fall Effectiveness Scale Scores
