| Abstract | Cilj istraživanja: Tijekom 2005. i 2015. godine utvrditi te usporediti stupanj opterećenosti HNP-a u KBC-u Split; također, usporediti dobne i spolne karakteristike pacijenata te uraditi usporednu analizu najčešćih radnih dijagnoza i medicinske obrade koja je uslijedila naknadno.
Materijali i metode: U ovo retrospektivno istraživanje uključeni su pacijenti oba spola pregledani na Hitnom neurološkom prijemu KBC-a Split u vremenu od 01. siječnja do 31. prosinca 2005. godine te od 01. siječnja do 31. prosinca 2015. godine. Prikupljeni su podatci iz protokola Hitnog neurološkog prijema Kliničkog bolničkog centra Split te su uključivali: dob, spol, dijagnozu, odluku o slijedećem postupku te vrstu konzilijarnog pregleda ukoliko je isti postojao; također su prikupljeni i sat, dan u tjednu i mjesec prijema. Za analizu podataka koristili su se Medcalc aplikacija i Microsoft Office.
Rezultati: U 2015. godini postoji 1,5 puta veće opterećenje HNP-a nego u 2005. godini. Žene u obje godine zauzimaju veći udio među pacijentima te je još 2015. godine nastao dodatan porast udjela žena, za 4,6% (P<0,0001). Porast broja pacijenata jedino je statistički značajan u drugom kvartalu 2015. godine (P=0,0271). Ponedjeljak je najopterećeniji dan u tjednu s obzirom na broj pacijenata, a vikendom je opterećenje najmanje na HNP-u tijekom i 2005. i 2015. godine. Postoji porast udjela pacijenata koji dolaze utorkom na HNP za 1,6% (P=0,0132). Muškarci četvrkom dolaze češće na HNP tijekom 2015. godine nego što su dolazili četvrkom 2005. godine (porast od 1,86%; P=0,0407). Nedjeljom se u 2015. godini javlja blagi pad udjela pacijenata za 1,7% u usporedbi s 2005. godinom (P=0,002). Najopterećenije vrijeme tijekom dana je od 13 do 18 sati, pri čemu u 2015. godini taj dio dana postaje opterećeniji za 2% (P=0,0213). Najmanje pacijenata dolazi u vremenu od ponoći do 6 sati ujutro tijekom obje godine, a u 2015. se u tom dijelu dana javlja i dodatni pad od 3,9% (P<0,0001). U 2015. godini postoji porast udjela pacijenata poslanih na ambulantnu obradu za 21,2% (P <0,0001), pri čemu postoji pad hospitalizacija od 18,7% i pad konzilijarnih od 2,5%; smanjen je i udio hospitalizacija u JIL (za 8,61%). Broj pacijenata s dijagnozom moždanog udara je narastao, ali njegov udio u radnim dijagnozama 2015. godine se smanjio za 1,7% (P=0,0224) u usporedbi s 2005. godinom. Ističe se skok lumbosakralnog sindroma za 7 % u 2015. godini (P<0,0001). Radna dijagnoza TIA-e pada za 2,4% (P<0,0001) kao i epilepsija koja pada za 2,5%(P<0,0001). Udio pacijenata s krizom svijesti je narastao za 2,9% (P<0,0001). Između prosječnih dobi pacijenata 2005. i 2015. godine ne postoje statistički značajne razlike.
Zaključci: Daljni rast opterećenosti HNP-a može se očekivati s obzirom na starenje populacije i ravoj turizma u Splitsko-dalmatinskoj županiji te su potrebne promjene u vidu većeg broja zaposlenih na HNP-u. Dodatno povećano nepotrebno opterećenje HNP-a ukazuje na potrebu za poboljšanjima u vidu bolje i lakše dostupnosti primarne zdravstvene zaštite te promjene u trijaži. Ističe se i potreba za informiranjem i educiranjem ljudi o zdravstvenim problemima i funkcioniranju zdravstva. Porast udjela dijagnoza lumbosakralnog sindroma i boli u donjem dijelu leđa navodi potrebu za epidemiološkim mjerama. Broj moždanih udara i TIA-e rastao je apsolutno, ali ne i relativno (pri čemu udio TIA-e čak i pada), međutim, daljnje mjere prevencije su itekako poželjne. |
| Abstract (english) | Objectives: To determine and to compare the degree of the Emergency Neurology Department (END) overcrowding in the years of 2005 and 2015. To compare the age and sex characteristics of the patients and to make the comparative analysis of the most common diagnoses and patient processings that came afterwards.
Material and Methods: This retrospective study included both sex patients that were examined in the Emergency Neurology Department at University Hospital Centre Split from January 1st till the December 31st 2005 and from January 1st till the December 31st 2015. The data that was collected from the END protocols included: patient's age, sex, diagnosis, medical decision on next procedure and the information about the type of the other specialist examination, if it was one; also the data about the hour, day of the week and the month of the arrival were collected. Medcalc application and Microsoft Office were used for data analysis.
Results: This study has found 1.5 times higher overcrowding of the END in the year 2015 than it was in 2005. In both years the percentage of the women is higher than the one of the men and in 2015 there is a growth of 4.6% in the proportion of women (P<0.0001). The increase of the number of the patients is statistically significant only in the second quarter of 2015 (P=0.0271). Monday is the busiest day of the week when it comes to the number of the patients, while the weekends are the least busy in both years (2005 and 2015). The percentage of the patients that are coming to the END at Tuesdays has risen by 1.6% (P=0.0132). Men are arriving to the END at Thursdays more often during 2015 than they did during 2005 (1.86% more; P=0.0407). A slight drop of 1.7% of patients occured at Sunday during 2015 when compared with Sunday 2005 (P=0.002). The busiest part of the day is from 1 pm till 6 pm and that part of the day gets even busier in 2015, up to 2% more than in 2005 (P=0.0213). The lowest number of the patients was arriving from midnight till 6 am during both of the years and there is even a slight drop of 3,9% in that time of the day in 2015 (P<0.0001). During 2015 a very high increase of 21.2% is found in the ambulatory processed patients (P<0.0001), which is followed by a decrease of the hospitalizations by 18.7% and the decrease of the other specialists examinations by 2.5%; the percentage of intensive care unit (ICU) hospitalizations has also decreased (by 8.61%). The number of patients with stroke diagnosis rose, but it’s share in the other diagnoses in 2015 fell by 1.7% (P =0.0224) when compared with 2005. A high increase of lumbosacral syndrome by 7% in 2015 has been found by this study (P <0.0001). The percentage of TIA diagnosis fell by 2.4% (P <0.0001) as did the diagnosis of epilepsy which fell by 2.5% (P<0.0001). The share of patients with temporary loss of consciousness rose by 2.9% (P<0.0001). There is no statistically significant difference when the average ages are compared between the years of 2005 and 2015.
Conclusions: Further increase of the END overcrowding is to be expected due to the aging of the population and the tourism development in the County of Splitsko-dalmatinska and therefore the changes in the form of more employees at END are needed. Further increase of unnecessary overcrowding at END points at the need for the improvements of the primary health system and it's availability and it also points at the need for triage system changes. The education and informing people about health issues and health care functioning is wanted. Epidemiological measures are needed when it comes to the increase in the percentage of lumbosacral syndrome and low back pain diagnoses. The absolute number of strokes and TIAs rose, but relative numbers didn't (the percentage of TIA even fell), however, further prevention measures are wanted. |
