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Öğe Acil Serviste Çocuklarda Düşme Olgularının Yönetimi: 261 Çocuk Olgunun Analizi(Kırıkkale Üniversitesi, 2021) Demirel, Mustafa Enes; Akpinar, GuleserAmaç: Çocuklarda düşme, acil servisler üzerinde önemli bir yük oluşturmakta ve hastanede kalış süresinde uzama ile artan maliyetler gibi olumsuz sonuçlara neden olabilmektedir. Bu çalışmanın amacı, bir acil serviste çocuklarda düşme olgularının yönetim sonuçlarının değerlendirilmesidir.Gereç ve Yöntemler: Düşme kaynaklı yaralanma nedeniyle acil servisimize başvuran pediatrik hastalar; yaş ve cinsiyet gibi demografik veriler, Glasgow Koma Skalası, Injury Severity Score skorları, başvuru zamanları, yaralanma bölgesi, tanı, konsülte edilen bölüm, yatış verilen bölüm, hastanede kalış süresi ve maliyetler açısından değerlendirilmiş ve analiz edilmiştir. Acil servisteki ilk yönetim sonrasında gerekli görülen hastalar diğer bölümlerle konsülte edilerek sevk edilmiştir.Bulgular: Çalışmaya 261 çocuk dahil edildi. Başvurular en sık yaz mevsiminde, Ağustos ayında ve Cumartesi günleri yapılmıştır. Çocuklarda en sık konulan tanılar kırık ve yumuşak doku hasarıdır. En sık yaralanan vücut bölgeleri baş-boyun bölgesi ve ekstremitelerdir. En sık konsültasyon yapılan bölümler beyin ve sinir cerrahisi ile ortopedi ve travmatolojidir. Toplam 101 çocuğa (%38.7) yatış verilmiştir. Hastaların medyan Injury Severity Score değeri 3 ve medyan Glasgow Koma Skalası değeri 15 (8-15) olarak bulunmuştur. Medyan tedavi maliyeti 278.8? olarak saptanmıştır. Medyan hastanede kalış süresi 31 (çeyrekler arası aralık, 21-63.5) (çeyrekler arası aralık için 2 sayısal değer verilmeli) saattir. Hastanede kalış süresi ile maliyetler arasında güçlü bir pozitif ilişki saptanmıştır (r=0.629, p<0.001).Sonuç: Çocuk yaş grubu düşmeye bağlı yaralanmalar, acil servisin iş yükünü artıran, sağlık sistemi ve toplum için önemli bir yük oluşturan ve maliyeti artıran yaygın olaylardır. Elde ettiğimiz sonuçlar, beklendiği gibi kalış süresi ile tedavi maliyetleri arasında çok güçlü bir ilişki olduğunu göstermektedir.Öğe Characteristics of Pediatric Forensic Cases Caused by Blunt General Body Trauma Evaluated in the Emergency Department: A Single Center Experience(2022) Akpınar, Güleser; Demirel, Mustafa EnesObjective: In this study we aimed to evaluate and analyse demographic features, presentations characteristics, and management approaches in paediatric forensic cases presenting to an emergency department.Materials and Methods: A total of 518 children aged between 0-18 years, who presented to the emergency department of hospital between 2011 and 2020 due to traffic accidents, falls and violence, were included. Demographic information such as age, gender, reason for admission, time of admission, diagnosis, body region of the injury, and consultation and treatment results were included in the study.Results: The median age was 12 years and 67.6% were boys. The median age was significantly lower in the patients who presented due to falls. The patients most presented to the emergency department in the summer months (August) and on Saturdays. The most diagnosis was in soft tissue injury (STI) (50.6%), followed by bone fracture / dislocation injury (42.1%). STI was higher in the violence group compared to others. The most injured body part was the head/neck region (37.8%). The most consulted department was neurosurgery (39.4%). The mortality rate was 4.4%.Conclusion: For emergency specialists, it is important to have sufficient information about demographic and clinical features of paediatric forensic patients for a more efficient physical examination and management.Öğe Mortality Rate and Prognostic Factors in Neonatal Tetanus: A 3-Year Analysis of Cases Presented to Turkey-Somalia Mogadishu Training and Research Hospital(Georg Thieme Verlag Kg, 2020) Gudeloglu, Elif; Demirel, Mustafa EnesObjective The aim of this study was to evaluate mortality rate and prognostic factors in neonatal tetanuscasespresented toTurkey-Somalia Mogadishu Training and Research Hospital Methods A total of 35 neonatal tetanus cases presented to Turkey-Somalia Mogadishu Training and Research Hospital between 2014 and 2017 were included in this prospective observational study. Data on demographic, clinical and maternal obstetric characteristics, and laboratory findings including complete blood count and blood biochemistry were recorded in each patient. Study parameters were evaluated with respect to survivorship status, while multiple logistic regression analysis was performed to determine independent predictors of increased mortality risk. Results Overall, mortality occurred in 22 (62.9%) of 35 neonates diagnosed with neonatal tetanus. Tetanus prophylaxis was absent in the majority of neonates, regardless of survivorship status (100.0% in nonsurvivors vs. 84.6% in survivors, p = 0.131). In nonsurvivor versus survivor groups, significantly higher likelihood of constipation (50.0 vs. 7.7%, p = 0.002), contracture (81.8 vs. 46.2%, p = 0.035), and ventilator support (95.4 vs. 53.8%, p = 0.006) as well as significantly lower hemoglobin (14.45 +/- 2.06 vs. 17.15 +/- 1.77, p = 0.003) and potassium (3.50 +/- 0.86 vs. 4.14 +/- 0.93, p = 0.003) levels and neutrophil (3.34 +/- 1.75 vs. 4.47 +/- 1.08, p = 0.047, white blood cell (WBC) (5.54 +/- 2.30 vs. 7.78 +/- 1.70, p = 0.003) and platelet (median [min-max] 133.5 [68-332] versus 196 [123-550], p = 0.006) counts were noted. Presence of contracture (odds ratio [OR]: 14.525, 95% confidence interval [CI]: 1.398-150.870, p = 0.025) and ventilator support (OR: 22.282, 95% CI: 1.269-391.131, p = 0.034) was the independent determinants of increased risk of mortality. Conclusion Our findings emphasize high mortality in neonatal tetanus cases in Somalia along with lack of maternal tetanus prophylaxis in majority of cases. Presence of contractures and ventilator support were significant determinants of poor survival, while factors such as constipation, lower hemoglobin, and potassium levels and lower neutrophil, WBC and platelet counts were also more common among nonsurvivors, albeit not found to be associated with mortality risk in the multivariate analysis.Öğe The effect of white blood cell and platelet values on mortality in patients with abdominal aortic aneurysm(Acil Tıp Uzmanları Derneği, 2023) Demirel, Mustafa Enes; Kormaz, Ufuk Turan Kürşat; Çetin, Ömer; Güldal, Hatice; Boğan, MustafaObjective: In this study, we aimed to investigate the relationship between preoperative inflammatory markers, length of hospital stay, and mortality in patients with abdominal aortic aneurysm (AAA) who underwent surgical repair. Methods: A total of 83 patients diagnosed with AAA were included in the study. A complete blood count (CBC) was performed on the first visit (pre-op 0-1 hour) in all patients. Non-ruptured cases (AAA) and ruptured cases (AAA-R) were compared. Results: 14.5% (n=12) of the patients died. Higher White blood cells and neutrophils were obtained in patients who died than in surviving patients (respectively, p=0.0002, p=0.001). Higher WBC and NALP in AAA-R patients were determined. Conclusion: WBC and Neu's values were higher in AAA patients who died post-operatively and who were detected rupture pre-operatively but PLT and HB values were similar. Normal or near-normal HB and PLT values that will be seen in the first examination of AAA cases in the emergency department may mislead clinicians or cause them to display a more optimistic attitude.Öğe Venöz erişim portu yerleştirilmesi sonrası sıradışı bir kateter malpozisyonu: Kateter ucu sağ aksiller vende lokalize(Fatih BAŞAK, 2019) Yüksel, Ahmet; Velioğlu, Yusuf; Demirel, Mustafa Enes; Uçaroğlu, Erhan RenanTamamen implante edilebilir venöz erişim port cihazları, tekrarlayan kemoterapi uygulamaları, kan örneklemesi, intravenöz hidrasyon ve parenteral nütrisyon için kanser hastalarında veya kronik hastalarda son yıllarda giderek daha fazla kullanılmaktadır. Tamamen implante edilebilir venöz erişim port cihazlarının yerleştirilmesi sırasında kateter malpozisyonu da dahil olmak üzere birçok potansiyel komplikasyon gelişebilir. Kateter malpozisyonu, tamamen implante edilebilir venöz erişim port yerleştirilmesinin daha az tarif edilmiş ancak önemli bir komplikasyonudur. Bu makalede, 47 yaşında bir kadın hastada tamamen implante edilebilir venöz erişim portu yerleştirilmesi sonrası gelişen sıradışı bir kateter malpozisyonu olgusu sunuldu. Bildiğimiz kadarıyla, bu olgu tamamen implante edilebilir venöz erişim portu yerleştirilmesi sonrası kateter ucunun sağ aksiller ven içinde konumlandığı literatürdeki ilk rapordur.Öğe The way back home: The invisible burden of the emergency healthcare services(Public Library Science, 2024) Demirel, Mustafa Enes; Ozcelik, Aysenur; Bogan, Mustafa; Katipoglu, BurakAmbulance services around the world vary according to regional, cultural and socioeconomic conditions. Many countries apply different health policies locally. In Turkey, transportation from hospital to home has started to form an important part of ambulance services in recent years. The increase in the number of patients whose treatment has been completed and waiting to be referred may hinder the work of the emergency services. The aim of this study was to examine the costs, indications, and impact on workload of patients sent home by ambulance. Patients were divided into two groups according to the reasons for referral. The distance to home, transport time and cost were calculated according to the reasons for transport. Patients who were transferred to other clinics or hospitals by ambulance were excluded from the study. The findings showed that the hospital-to-home transfer rate during the study period was 11.4%. Although 9.7% of all cases transferred from our hospital to home were due to social indications, these cases accounted for 16.26% of the total costs. These results suggest that providing home transport services to selected patient groups for medical reasons should be seen as part of the treatment. However, the indications for home transport should not be exceeded and an additional burden should not be placed on the fragile health service.
