Nadir YALÇIN, Mehmet Akif GÖKTAŞ, Ersin GÜMÜŞ

Gastrointestinal endoskopik prosedürlerde pediatrik düşme riski değerlendirme aracının kullanımı: Prospektif bir çalışma

Giriş ve Amaç: Bu çalışmanın amacı endoskopi işlemi uygulanan çocuk hastalarda Humpty Dumpty Düşme Ölçeği ile düşme riskini ve düşme riskini etkileyen faktörleri belirlemektir. Gereç ve Yöntem: Prospektif tanımlayıcı özellikteki bu çalışma büyük bir üçüncü basamak pediatri hastanesinde yapıldı. Hastaların demografik özellikleri, endoskopi tipi, endoskopik işlemlerin süresi, uygulanan sedasyonun tipi, anestezi sırasında uygulanan ilaçların dozları ve işlem sonrası Humpty Dumpty Düşme Ölçeği skorları ile ilgili veriler toplandı. Grup içi farklılıkları ve hasta sonuçlarını etkileyen bağımsız faktörleri belirlemek için post-hoc ve lojistik regresyon analizleri yapıldı. Bulgular: Ortalama (standart sapma) yaşları 11.16 (5.32) olan 192 pediatrik hastaya (%54.2’si kız) tanısal gastrointestinal endoskopi yapıldı. İşlemler sırasında en sık uygulanan sedatifler midazolam (%98.9), propofol (%96.9), fentanil (%63.0) ve ketamin (%34.9) olarak saptandı. Humpty Dumpty Düşme Ölçeği'ne göre 148 (%77.1) hasta düşme açısından yüksek riske sahipti. Hastaların hiçbirinde endoskopik işlemler sonrası düşme gözlenmedi. Düşme açısından yüksek riskli olmayı belirleyen prediktif faktörler incelendiğinde, aynı prosedürel sedasyon altında özofagogastroduodenoskopi ve kolonoskopinin eş zamanlı olarak uygulanmasının, sadece özofagogastroduodenoskopi uygulamasına kıyasla düşme açısından yüksek riskli olmayı 5.2 kat artırdığı görüldü (p = 0.047). Sonuç: Bildiğimiz kadarıyla bu çalışma, Humpty Dumpty Düşme Ölçeği'nin prosedürel sedasyon altında gastrointestinal endoskopi yapılan pediatrik hastalarda düşme riskinin öngörülmesinde kullanılmasını değerlendiren ilk çalışmadır. Hastaların %77.1'i düşmeler açısından yüksek riskli bulunmasına rağmen, alınan önlemler nedeniyle endoskopi işlemlerinden sonra herhangi bir düşme olayı yaşanmamıştır. Sonuçlarımız, sedasyon altında gastrointestinal endoskopi yapılan pediatrik hastaların düşme riskinde artış olduğunu ve mutlaka önleyici tedbirler alınması gerektiğini göstermektedir.

Anahtar Kelimeler:

Humpty Dumpty Düşme Ölçeği, düşme riski, özofagogastroduodenoskopi, kolonoskopi, sedatifler, çocuklar

The use of pediatric fall risk assessment tool in gastrointestinal endoscopic procedures: A prospective study

Background and Aims: The aim of this study is to evaluate the fall risk with Humpty Dumpty Fall Scale and determine related risk factors in pediatric patients undergoing gastrointestinal endoscopy. Materials and Methods: A prospective descriptive study was conducted in a large tertiary pediatric hospital. Patients' demographics, type of endoscopy, duration of endoscopic procedures, type of procedural sedation, doses of administered drugs during anesthesia, and post-procedure Humpty Dumpty Fall Scale scores were collected. Post-hoc and logistic regression analyses were performed to identify within-group differences and independent predictors of patient outcomes. Results: One hundred ninety-two pediatric patients (54.2% female) with a mean (standard deviation) age of 11.16 (5.32) years were admitted for a diagnostic gastrointestinal endoscopy. During procedures, the most commonly administered sedatives were midazolam (98.9%), propofol (96.9%), fentanyl (63.0%), and ketamine (34.9%). According to the Humpty Dumpty Fall Scale, 148 (77.1%) patients had a high risk for falls. No falls after endoscopic procedures was observed in the patients. When the predictive factors determining being at high-risk for falls were examined, the simultaneous application of esophagogastroduodenoscopy and colonoscopy under the same procedural sedation increases the risk of being high-risk 5.2 times compared to the performing esophagogastroduodenoscopy alone (p = 0.047). Conclusion: To the best of our knowledge, this is the first study evaluating the use of Humpty Dumpty Fall Scale to predict falls in pediatric patients undergoing gastrointestinal endoscopy with procedural sedation. Although 77.1% of the patients were found to be at high risk for falls, there was no fall event after the endoscopic procedures due to precautionary measures. Our results indicate that pediatric patients undergoing gastrointestinal endoscopy with sedation are at increased risk of falling and preventive measures should be taken.

Keywords:

Humpty Dumpty Fall Scale, fall risk, esophagogastroduodenoscopy, colonoscopy, sedatives, children,

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