Acil cerrahi yanýk ünitesinde tedavi edilen çocuklarda yaþamsal tehlike tanýmýnýn ve ihmalin adli týp açýsýndan irdelenmesi

AMAÇ
Çalýþmanýn amacý, acil servis yanýk ünitesinde tedavi edilen çocuklarýn sosyo-demografik özelliklerini ortaya koyarak, bu olgularda gerekli hekim yaklaþýmýný tartýþmak ve yaþamsal tehlike kriterleri taþýyan ve taþýmayan hastalarýn prognozlarýný karþýlaþtýrmaktýr.
GEREÇ VE YÖNTEM
Çalýþma 14.10.2004 - 31.12.2006 tarihleri arasýnda, tanýmlayýcý epidemiyolojik yöntemle, acil cerrahi servisi yanýk ünitesine gelen 0-18 yaþ grubundaki olgularda (n=136) gerçekleþtirilmiþtir. Hazýrlanan yarý yapýlandýrýlmýþ bir görüþme formu ile yanýklý hastalara iliþkin bilgiler toplanmýþtýr. Veriler istatistiksel olarak deðerlendirilmiþtir.
BULGULAR
Olgularýn %66,2’si (n=90) erkek, %33,8’i (n=46) kadýndýr. Yaþ ortalamasý 3,9±4,1 yýl, ortalama yanýk yüzdesi 22,47±17,37 olarak hesaplanmýþtýr. Yanýk nedenleri arasýnda ilk sýrayý %77,2 oranla (n=105) suda haþlanmalar almaktadýr. Yanýk yüzdesi %20’nin altýnda olan olgularda %6,3 (n=6) oranýnda, %20’nin üzerinde olan olgularda %61 (n=25) oranýnda ölüm görülmüþtür (p=0,0001). I. derece yanýklý olgularýn %21’inde (n=25) ölüm gerçekleþirken, II.-III. derece yanýk olgularýnýn %35,3’ünde (n=6) ölüm meydana gelmiþtir (p=0,189). Yaþamsal tehlike taþýyan olgularda ölüm oranlarý, yaþamsal tehlike taþýmayan olgularda karþýlaþýlan ölüm oranlarýndan istatistiksel olarak anlamlýlýk gösterecek biçimde yüksek bulunmuþtur (p=0,033).
SONUÇ
Çocuklarda yanýk yüzdesinin geniþliði prognoz için çok belirleyicidir. Tüm yanýk olgularýnýn ihmal/istismar gibi deðerlendirilerek çocuklarýn güvence altýna alýnmasý önemli bir koruyucu hekimlik uygulamasý olacaktýr.

Evaluation of “life-threatening” definition and negligence in children treated in the emergency surgery service burn unit (from the viewpoint of forensic medicine)

BACKGROUND
The aim of this study is to outline the sociodemographic and traumatic characteristics of children who were referred to the Burn Unit of Emergency Service with burn injuries, to discuss the doctors’ approach to these cases, and to compare the prognosis of patient groups with and without life-threat.
METHODS
This epidemiological study was carried out between 14 October 2004 and 31 December 2006 and included a total of 134 pediatric patients aged between 0-18 years. A semi-structured questionnaire form was designed to obtain the information from the study population. The obtained data were statistically evaluated.
RESULTS
66.2% (n=90) of the cases were male and 33.8% (n=46) were female. The mean age of the study population was 3.9±4.1 years and the mean percentage of burned body area was 22.47±17.37. The main cause of burn was scalding with hot water, with a frequency of 77.2% (n=105). When the percentage of burn area of the body was lower than 20%, the mortality was 6.3% (n=6), whereas it was 61% (n=25) when the burn area exceeded 20% of the body (p=0.0001). While the mortality was 21.0% (n=25) among the cases with first-degree burns, it was 35.3% (n=6) among those with second- and third-degree burns (p=0.189). Mortality ratio among the cases with life-threat was higher than those without life-threat, and this difference was statistically significant (p=0.033).

CONCLUSION
Extent of burn is a determinative factor for prognosis in children. Evaluation of all burn cases in children should be approached as cases of neglect/abuse; protection of these children in this manner will serve as an important practice of preventive medicine.