Çocuk acil servisimize başvuran zehirlenme olgularımızın retrospektif değerlendirilmesi
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Tarih
2020
Yazarlar
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Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Çocuk Acil Servise başvuran ve zehirlenme tanısı ile izlenen vakaların sosyodemografik, klinik ve laboratuvar bulgularını retrospektif olarak incelemeyi ve literatür ile karşılaştırmayı amaçladık. Böylelikle bölgesel zehirlenme profilimizi oluşturup erken tanı ve tedavi yaklaşımları konusunda farkındalığı arttırarak pediyatrik zehirlenmelerin önlenebilmesine katkıda bulunmayı hedefledik. Yöntem: Ocak 2016 ve Mayıs 2020 tarihleri arasında, Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi Çocuk Acil Servis'e başvuran ve zehirlenme tanısıyla izlenen 0-18 yaş arası 472 vakanın klinik ve epidemiyolojik verileri retrospektif olarak tarandı ve incelendi. Hastalar 0-12 ay, 13-48 ay, 49 ay-13 yaş ve 13 yaş üzeri olacak şekilde dört ayrı yaş grubuna ayrıldı. Bulgular: Zehirlenme etkeninin alım yolunun çoğunlukla enteral olduğu (%87,1) ve kaza sonucu zehirlendiği (%95,1), %12,9'nun inhalasyon yoluyla zehirlendiği (n = 61) belirlendi. 19'unun özkıyım maksadıyla (%4,0), 4 olgunun ise (%0,9) madde kötüye kullanımı sonucunda zehirlendiği belirlendi. Çocuklarda majör zehirlenme etkeni kostik veya koroziv maddelerin olduğu (%42,80), bunu ilaçların ve diğer maddelerin takip ettiği görüldü (%30,5 ve %26,7). Zehirlenme etkenleri ile cinsiyet, başvuru yılları, izlem yeri ve mortalite karşılaştırıldığında anlamlı bir fark bulunmadı (p>0,05). İlaçlar en sık kış ve ilkbahar aylarında zehirlenme etkeni iken, kostik/koroziv maddeler en sık ilkbahar ve sonbahar aylarında idi (p = 0,0055). Hastalar çoğunlukla çocuk acil gözlemde izlendi (%96,8) ve izlem süresi ortalama 20,1 saatti. Özkıyım amacıyla ilaç alan 13 yaşında bir kız çocuğu ve kaza sonucu karbonmonoksite maruz kalan iki erkek çocuğu exitus oldu. Zehirlenme etkeni ve alım nedeni dağılımları arasında yaş grubu açısından anlamlı farklar izlendi (p<0,0001). 0-12 ay ve 13-48 ay çocuklarda kaza sonucu majör zehirlenme etkenin kostik/koroziv maddeler (sırasıyla %48 ve %33,7) olduğu, 49 ay-13 yaş çocuklarda ise kaza sonucu majör etkenin ilaç dışı maddeler (%32,5) olduğu belirlendi. 13 yaş üzeri çocuklarda majör etkenin ilaçlar olduğu (%18,1), 19'unun özkıyım amacıyla ve 4'nün madde kötüye kullanımıyla kendini zehirlediği tespit edildi. 0-12 ay (%42,4) ve 13 yaş üzeri (%21,3) çocukların zehirlenme sıklığının pandemi esnasında, öncesine kıyasla anlamlı derecede arttığı belirlendi (p = 0,0424). 13-48 ay (%22,7) ve 49 ay-13 yaş (%13,6) çocukların zehirlenme sıklığının ise pandemi öncesine kıyasla anlamlı derecede düştüğü saptandı (p = 0,0424) Sonuç: Çocukluk çağı zehirlenmeleri nadir bir sağlık sorunu değildir ve genellikle kaza sonucu meydana gelmektedir. Kostik/koroziv maddeler ve farmasötikler zehirlenmenin en yaygın nedenleridir. Bu maddelerin ve reçeteli ilaçların evde bulundurulmasının ve uygun şekilde saklanmasının sorumluluğu ebeveynlere ait olmalıdır. Zehirlenmenin önlenmesi için erken başvuru ve ön müdahale konusunda toplumun eğitilmesi gereklidir. Ayrıca hekimler tarafından Zehir Danışma Merkezinin telefon ile aranması ve merkezin önerilerinin uygulanması da mortalite ve morbidite oranını azaltacaktır.
Objective: We aimed to examine, the socio-demographic, clinical and laboratory findings of the cases who admitted to the Pediatric Emergency Department and were followed up with diagnosis of poisoning and to compare with the literature, retrospectively. Hereby, we aimed to contribute to the prevention of pediatric poisonings by establishing our regional poisoning profile and increasing the awareness about early diagnosis and treatment approaches. Method: The clinical and epidemiological data of 472 cases between 0-18 years of age who admitted to Pediatric Emergency Service of Meram Medical Faculty of Necmettin Erbakan University between January 2016 and May 2020, and followed up with a diagnosis of poisoning were retrospectively reviewed and analyzed. The patients were divided into four different age groups as 0-12 months, 13-48 months, 49 months-13 years and over 13 years. Results: It was determined that the route of poisoning was mostly enteral (87.1%) and the case was accidental (95.1%), and 12.9% of all cases were poisoned by inhalation (n = 61). Nineteen of cases (4.0%) were suicidal poisoning and 4 cases (0.9%) were poisoned due to drug use. The major poisoning factor among children was caustic or corrosive substances (42.80%), followed by drugs and other substances (30.5% and 26.7%). No significant difference was found the poisoning factors were compared with gender, the year of application to hospital, monitoring location, and mortality (p> 0.05). Drugs were the most common reason of poisoning in winter and spring, while caustic / corrosive substances were most common in spring and autumn (p = 0.0055). The patients were mostly followed-up in pediatric emergency service (96.8%) and the mean follow-up time was 9.6 hours. A 13-year-old girl who took drugs for suicide and two boys who were accidentally exposed to carbon monoxide died. Significant differences were observed in distribution of poisoning factors and reasons of intake in terms of age group (p <0.0001). In children aged 0-12 months and 13-48 months, the major reason of poisoning was accidental and the agent was a caustic / corrosive substance (48% and 33.7%, respectively), and in children aged 49 months-13 years, the major agent was a non-drug substance due to accidental causes (32.5%). It was determined that the major agent in children over the age of 13 was drugs (18.1%), 19 of them had a suicidal attempt to poison and 4 of cases were poisoned due to drug use. It was determined that the poisoning incidence of children aged 0-12 months (42.4%) and over 13 years (21.3%) increased significantly during the pandemic compared to pre-pandemic period (p = 0.0424). The poisoning incidence of children aged 13-48 months (22.7%) and 49 months-13 years (13.6%) decreased significantly compared to the pre-pandemic period (p = 0.0424) Conclusion: Childhood poisoning is not a rare health problem and usually occurs accidentally. Caustic / corrosive substances and pharmaceuticals are the most common causes of poisoning. Parents should ensure that these substances and prescribed medicines are kept out of reach of chilldren at home and stored properly. The society should be educated about early admission and pre-intervention to prevent poisoning. In addition, calling the Poison Counseling Center and following the center's recommendations by physicians may reduce the mortality and morbidity rates in pediatric poisonings.
Objective: We aimed to examine, the socio-demographic, clinical and laboratory findings of the cases who admitted to the Pediatric Emergency Department and were followed up with diagnosis of poisoning and to compare with the literature, retrospectively. Hereby, we aimed to contribute to the prevention of pediatric poisonings by establishing our regional poisoning profile and increasing the awareness about early diagnosis and treatment approaches. Method: The clinical and epidemiological data of 472 cases between 0-18 years of age who admitted to Pediatric Emergency Service of Meram Medical Faculty of Necmettin Erbakan University between January 2016 and May 2020, and followed up with a diagnosis of poisoning were retrospectively reviewed and analyzed. The patients were divided into four different age groups as 0-12 months, 13-48 months, 49 months-13 years and over 13 years. Results: It was determined that the route of poisoning was mostly enteral (87.1%) and the case was accidental (95.1%), and 12.9% of all cases were poisoned by inhalation (n = 61). Nineteen of cases (4.0%) were suicidal poisoning and 4 cases (0.9%) were poisoned due to drug use. The major poisoning factor among children was caustic or corrosive substances (42.80%), followed by drugs and other substances (30.5% and 26.7%). No significant difference was found the poisoning factors were compared with gender, the year of application to hospital, monitoring location, and mortality (p> 0.05). Drugs were the most common reason of poisoning in winter and spring, while caustic / corrosive substances were most common in spring and autumn (p = 0.0055). The patients were mostly followed-up in pediatric emergency service (96.8%) and the mean follow-up time was 9.6 hours. A 13-year-old girl who took drugs for suicide and two boys who were accidentally exposed to carbon monoxide died. Significant differences were observed in distribution of poisoning factors and reasons of intake in terms of age group (p <0.0001). In children aged 0-12 months and 13-48 months, the major reason of poisoning was accidental and the agent was a caustic / corrosive substance (48% and 33.7%, respectively), and in children aged 49 months-13 years, the major agent was a non-drug substance due to accidental causes (32.5%). It was determined that the major agent in children over the age of 13 was drugs (18.1%), 19 of them had a suicidal attempt to poison and 4 of cases were poisoned due to drug use. It was determined that the poisoning incidence of children aged 0-12 months (42.4%) and over 13 years (21.3%) increased significantly during the pandemic compared to pre-pandemic period (p = 0.0424). The poisoning incidence of children aged 13-48 months (22.7%) and 49 months-13 years (13.6%) decreased significantly compared to the pre-pandemic period (p = 0.0424) Conclusion: Childhood poisoning is not a rare health problem and usually occurs accidentally. Caustic / corrosive substances and pharmaceuticals are the most common causes of poisoning. Parents should ensure that these substances and prescribed medicines are kept out of reach of chilldren at home and stored properly. The society should be educated about early admission and pre-intervention to prevent poisoning. In addition, calling the Poison Counseling Center and following the center's recommendations by physicians may reduce the mortality and morbidity rates in pediatric poisonings.
Açıklama
Anahtar Kelimeler
Çocukluk çağı, Mortalite, Zehirlenme, Etken, Childhood, Positive, Poisoning, Active
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Kesebir, F. (2020). Çocuk acil servisimize başvuran zehirlenme olgularımızın retrospektif değerlendirilmesi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Çocuk ve Ergen Psikiyatri Anabilim Dalı, Konya.
