Acil servise başvuran yetişkin hastalarda sigara içme prevalansını ve ekonomik boyutunu saptama çalışması

Abstract

Bu çalışma erişkin acil servis bölümüne başvuranlarda sigara içmenin klinik ve ekonomik önemini belirlemek amacıyla yapıldı. Veriler prospektif olarak toplandı. Acil servise Nisan-Kasım 2011 tarihleri arasında başvuran Glaskow koma Skoru (GKS) >14 olan 4000, GKS? 14 156 hastaya sosyodemografik özellikleri, sigara içme alışkanlıkları, Fagerstrom nikotin bağımlılık testi ve sigarayı bırakma ile ilgili istekleri soruldu. Hastalar takip edilerek, acil servis hizmet bedelleri ve tanıları ICD-10 kodlamasına göre kaydedildi. Çalışma 1974 (%47.5) erkek, 2182 (%52.5) kadın 4156 kişide yapıldı.Yaş ortalaması 45.5 ± 20.1 idi. Hastaların %31.42 ü sigara kullanmaktaydı. Sigara kullananların 430' unun (%32.9) kadın, 876' sının (%67.1) erkek; kullanmayanların 1752' sinin (%61.5) kadın, 1098' inin (%38.5) erkekti. Sigara içenlerin 847' si (%69.2) sigarayı bırakmak istemekteydi. Fagerstrom bağımlılık derecesine göre 304' ü (%24.8) çok düşük , 371' i (%30.3) düşük, 215' i (%17.6) orta, 291' i (%23.8) yüksek, 43' ü (%3.5) çok yüksek bağımlı olarak saptandı. Sigara kullanımı ile GKS arasında anlamlı ilişki bulundu (X2=33.612; p=0.000<0.05). GKS? 14 olanların 1224' ünün (%30.6) sigara kullanan, 2776' sının (%69.4) sigara kullanmayan; GKS ? 14 olanların 82' sinin (%52.6) sigara kullanan, 74' ünün (%47.4) sigara kullanmayan olduğu görüldü. Hastaların 3383' ü (%82.0) taburcu oldu, 448' i (%10.9) servise, 271' i (%6,6) yoğunbakıma yatırıldı. 3' ü (%0,1) acil servisi izinsiz terk etti. 15' i (%0.4) tedaviyi reddetti. 1' i (%0.0) sevkedildi ve 7' si (%0.2) öldü. Sigara kullanan hastaların acil servis hizmet bedeli ortalamaları (x=92.788), sigara kullanmayanlarınkinden (x=73.920) yüksek bulundu. Alkol ile sigara kullanımı arasında anlamlı ilişki bulundu (X2=537.022; p=0.000<0.05). Sigara kullanan hastaların 359' unun (%27.5) alkol kullandığı, 947' sinin (%72.5) kullanmadığı; sigara kullanmayan hastaların 95' inin (%3.3) alkol kullandığı, 2755' inin (%96.7) kullanmadığı görüldü. Acil servise başvuran hastaların önemli kısmını sigara içenlerin oluşturması nedeniyle, acil servis hekimlerinin sigara bırakma çalışmaları içine alınmaları önemlidir.Anahtar Kelimeler: acil servis, sigara, fagerstrom, hizmet bedeli

This reserach was carried out in order to identify clinical and economical importance of cigarette smoking for patients in emergency medicine department. Research data was collected prospectively from April to November 2011 from patients who were conculted in emergency medicine deparment . 4000 of them were GKS?14 and 156 were GKS ?14. They were asked about sociademographic characteristics, cigarette smoking habits, fagerstrom nicotin addiction test and smoking give up motivation. Patients were tracked and their emergency department fees and diagnosis were recorded according to ICD-10 coding. Research was carried on 4156 people. 1974( 47.5 %) of them were male and 2182 (52.5 %) of them were female. Age average of the patients was 45.5+_20.1. 31.42 % of the patients were smoking cigarette. 430 (32.9 %) of smokers were female and 876 (67.1 %) of them were male. 1752 (61.5 %) of non-smokers were female and 1098 (38.5 %) of them were male. 847 (69.2 %) of smokers wanted to quit smoking. According to Fagerstorm addiction scale 304 (24.8 %) of them were very low, 371 ( 30.3 %) of them were low, 215 (17.6 %) of them were moderate, 291 ( 23.8 %) of them were high and 43 (3.5 %) of them were very high addicts. Cigarette smoking and GKS were found to be related. (X2=33.612; p=0.000<0.05). 1224 (30.6 %) of GKS? 14 were smokers and 2776 (69.4 %) of them were non-smokers. 82 ( 52.6 %) of GKS ? 14 were smokers and 74 ( 47.4 %) of them were observed to be non-smokers. 3383 (82.0 %) of the patients were discharged.448 (10.9 %) of them were admitted to other services and 271 (6.6 %) to intensive care unit. 3 (0.1 %) of the patients left emergency service without permission and 15 ( 0.4 %) of them disapproved medical care in hospital. 1 (0.0 %) of them was sent to other medical center and 7 (0.2 %) were exitus. Average of the emergency service fees of smoking patients (x=92.788) was found to be higher than that of non-smoking patients. Meaningful relationship was found between cigarette and alcohol addiction. (X2=537.022; p=0.000<0.05). It was found that 359 (27.5 %) of smoking patients were also using alcohol and 947 (72.5 %) of them were not. 95 (3.3 %) of non-smokers were using alcohol and 2755 (72.5 %) of them were not. Since significant part of the patients applying to emergency services are smokers, emergency medicine doctors should be involved in leave-off cigarette programmes.Key words: emergency medicine department, cigarette,fagerstrom,service fee