Acil Servise Bilinç Bozukluğu ile Başvuran Hastaların Değerlendirilmesi

Ozet Acil servis basvurularinin %3-5’i bilinc bozuklugu nedeniyledir. Bunlarin cogu hayati tehlike de dogurabilecek bir nedene bagli olabileceginden bu rakam hic de azimsanamayacak olcudedir. Bu calismanin amaci, bilinc bozuklugu sikâyetiyle acil servise basvuran travmaya maruz kalmamis hastalarin demografik ve epidemiyolojik ozelliklerinin bilinc bozukluguyla iliskisini degerlendirmektir . Bu calismada 1 Ocak 2013 -31 Mayis 2013 tarihleri arasinda Medeniyet Universitesi Goztepe Egitim Arastirma Hastanesi Acil Servisi’ne nontravmatik bilinc bozuklugu sikayetiyle basvuran olgular, retrospektif olarak degerlendirildi. Calismanin sonunda olgular, norolojik nedenli ve norolojik olmayan nedenli bilinc bozuklugu olmak uzere iki gruba ayrildi. Gruplar; yas, cinsiyet, bilinc bozuklugunun baslama zamani, hastaneye basvuru yapana kadar gecen sure, bilinc bozuklugunun siddeti, eslik eden semptomlar, laboratuvar parametreleri ve norolojik muayene bulgularina gore karsilastirildi. Calismaya 309 hasta dâhil edildi. Olgularin 162’si erkek (%52.4), 147’si kadindi (%47.6). Erkek/kadin orani 1.1 idi. Hastalarin 139’unda (%45) norolojik nedenler, 170’inde (%55) norolojik olmayan nedenler saptandi. Hastalar yas gruplarina ayrildiginda, 65 yas ustu grup calismaya alinan hastalarin toplaminin %49.8’ini olusturdu. Bilinc bozuklugu baslangicindan sonraki ilk iki saat icerisinde hastaneye basvuran hastalarda norolojik sebeplerin olusturdugu grup istatiksel olarak anlamli derecede yuksekti. Norolojik sebepler icerisinde en sik epilepsi ve beyin damar hastaliklari, norolojik olmayan gruptaysa en sik sistemik-organik disfonksiyona bagli etkenler saptandi. Bu calismada bilinc bozuklugu sikayetiyle acil servise basvuran hastalarda norolojik olmayan nedenlerin daha sik oldugu goruldu. Semptomlardaki ani baslangic, fokal semptomlar ve nobet; bilinc bozuklugu etyolojisinde norolojik sebeplerin varliginin daha muhtemel oldugunu gosterdi. Anahtar kelimeler: Acil Servis, Bilinc bozuklugu, Norolojik nedenler, Norolojik olmayan nedenler Abstract 3-5% of emergency admissions are due to consciousness disorders. This percentage cannot be ignored for the reason that most of them may be linked to a cause that could endanger life.The purpose of this study is to investigate the relationship between demographic and epidemiological characteristics of the patients, who apply to emergency service with the complaint of consciousness disorders not related with trauma, with consciousness disorders. In this study, the cases of consciousness disorders not related with trauma, which were admitted to the Emergency Service of Medeniyet University Goztepe Training and Research Hospital, are retrospectively assessed between 01/01/2013 and 31/05/2013.  As a result of this study, the cases are categorized as neurological and non-neurological consciousness disorders. The groups are compared according to their age group, gender, the start date of the consciousness deficiency, the time until hospital admission, the severity of the consciousness deficiency, accompanying symptoms, laboratory parameters, and neurological examination evidences. 309 patients were included in this study.  52.4 % of the cases were men and 47.6 % of them were women. The proportion of men against women was 1.1. It was found out that 45 % of the patients’ consciousness disorders were caused by neurological reasons and 55 % of them were caused by non-neurological reasons. The patients were divided into age groups: 18-45, 45-65 and above 65. The patients, whose age is above 65, formed 49.8 % of the group. Within the patients, who applied to the hospital within the two hours after consciousness disorders started, the group of neurological cause was statistically significantly higher than the group of non-neurological cause.  The reasons detected in the consciousness disorders caused by neurological reasons were mostly epilepsy and cerebrovascular diseases and in the non-neurological group the detections were mostly related to systemic-organic dysfunctions. In this study, non-neurological causes were observed more frequently in the patients, who were admitted to the emergency service, with consciousness disorders. Sudden onset of symptoms, mean arterial pressure height, focal symptoms and seizures showed that the presence of neurological reasons is more likely to be in the etiology of consciousness disorders. Keywords: Consciousness disorders, Emergency service, Neurological reasons, Non-neurological reasons