Bir Sevk Hastanesindeki Çocuk Yoğun Bakım Ünitesinde Diyabetik Ketoasidozun Hastane Öncesi Bakımı ve Teletıpın Faydası

Giriş: Bu çalışmada diyabetik ketoasidoz (DKA) nedeniyle çocuk yoğun bakım ünitesine (ÇYBÜ) başvuran hastalarda başvuru şeklinin (ambulans/poliklinik) ve teletıp kullanımının etkilerinin araştırılması amaçlandı. Gereç ve Yöntem: Ocak 2019 ile Aralık 2021 tarihleri arasında ÇYBÜ'de DKA tanısı ile yatan hastaların incelendiği retrospektif gözlemsel bir çalışmadır. Demografik özellikler, başvuru türü (ambulans/ayakta tedavi kliniği), teletıp kullanımı, klinik bulgular ve sonuçlar kaydedildi. Gruplar (ambulans/ayakta tedavi ve teletıp uygulanan/uygulanmayan) arasında hastalığın şiddeti, komplikasyonları ve ÇYBÜ'de kalış süresi karşılaştırıldı. Bulgular: Çalışmaya 144 hasta dahil edildi. Hastaların %51,4'ü erkekti ve ortanca yaş 13,0 yıldı (aralık, 2-18 yıl). Hastaların %45,1'i ambulansla ÇYBÜ'ye nakledildi. Ambulans ve teletıp kullanımı yeni tanı alan ve genç yaşta daha fazlaydı (sırasıyla p<0,001 ve p=0,0014). Hastaların 56'sında (%38,8) teletıp kullanıldı. Glasgow koma skalası (13-13/13-13), PRISM III (8-9/9-8), ortalama HbA1c düzeyi (12,2-12,0) ve komplikasyonlar (p= 0,35) açısından anlamlı fark yoktu. Ambulans ve teletıp kullanan ve kullanmayan gruplar arasında başvuru süreleri. 66 (%45,8) hastada herhangi bir komplikasyon gelişmedi ve çalışmada mortalite yaşanmadı. Sonuç: ÇYBB'ye başvuran DKA'lı hastaların hastane öncesi bakımına ilişkin literatürde yeterli veri bulunmamaktadır. Bu çalışmada hastane öncesi bakım ve sonuçlar arasında anlamlı bir fark olmamasına rağmen komplikasyon oranının düşük olmasının teletıp ile ilgili olabileceğini düşünüyoruz.

Anahtar Kelimeler:

Hastane öncesi bakım, teletıp, diyabetik ketoasidoz, çocuk yoğun bakım ünitesi.

The Prehospital Care of Diabetic Ketoacidosis in a Referral Hospital Pediatric Intensive Care Unit and the Utility of Telemedicine

Background/Aims: This study aimed to investigate the effects of the type of admission (ambulance/outpatient clinic) and telemedicine use in patients admitted to the pediatric intensive care unit (PICU) with diabetic ketoacidosis (DKA). Material and Methods: A retrospective observational study designed in a referral PICU between January 2019 and December 2021. Demographic characteristics, type of admission (ambulance/outpatient clinic), the utility of telemedicine, clinical manifestations, and outcomes were recorded. The severity of the disease, complications, and length of stay in the PICU were compared between the groups (ambulance/outpatient and telemedicine applied/none-applied). Results: 144 patients were included in the study. 51.4% of patients were male, and the median age was 13.0 years (range, 2-18 years). 45.1% of patients were transferred to the PICU by ambulance. Ambulance and telemedicine use was higher in newly diagnosed and younger age (p<0.001 and p=0.0014, respectively). Telemedicine was used in 56 (38.8%) patients. There was no significant difference in terms of Glasgow coma scale (13-13/13-13), PRISM III (8-9/9-8), mean HbA1c level (12.2-12.0), and complications (p= 0.35) at the time of admission between the groups that used and did not use ambulance and telemedicine. 66 (45.8%) patients did not develop any complications and there was no mortality in the study. Conclusions: There is not enough data in the literature on the prehospital care of DKA patients admitted to PICU. Although there was no significant difference between prehospital care and outcomes in this study, we think that the low complication rate is related to telemedicine.

Keywords:

Prehospital care, telemedicine, diabetic ketoacidosis, pediatric intensive care unit.,

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