| Abstract | Cilj:
Utvrditi postoji li skraćenje u trajanju liječenja djece oboljele od upale pluća u 2010. i
2011. godini, uspoređujući s 1998., 1999., 2004. i 2005. godinom. U cilju razjašnjenja
mogućeg skraćenja liječenja, istražit ću pojedinosti liječenja djece s upalom pluća u
navedenim godinama.
Materijali i metode:
Retrospektivna analiza medicinske dokumentacije bolesnika liječenih od upale pluća u Klinici za dječje bolesti KBC Split u razdoblju od 2010. do 2011. god. Kao osnovu za unos podataka koristila sam tablicu, izrađenu u programu Microsoft
Office Excel 97 – 2003 u kojoj su bilježeni podaci iz prethodnog istraživanja (razdoblja
1998./1999. i 2004./2005. godine). Ujednačila sam način prikupljanja podataka na način kako
je to rađeno u prethodnim ispitivanjima. Populacija koju uzorak predstavlja su bolesnici do 18 godina starosti, hospitalizirani zbog upale pluća i bolesnici koji su tijekom hospitalizacije
preboljeli upalu pluća. Sveukupno je 2098 bolesnika uključeno u studiju. U statističkoj obradi
prikupljenih podataka koristila sam se neparametrijskim analitičkim postupcima (Kruskal–
Wallis test, Mann–Whitney test) i χ2 – test. Rezultati su smatrani statistički značajnim ako su
se razlikovali na razini statističke pogreške p < 0,05, a prikazani su grafički i tablično.
Rezultati:
U 2010. i 2011. godini uočava se smanjenje duljine hospitalizacije u danima u
usporedbi s ostalim godinama. Medijan dana hospitalizacije bio je 9 dana (IQR: 7,0 – 11,0).
Prethodnu antibiotsku terapiju nije primilo 52,5 % bolesnika. 2005. i 2010. godine uočljiv je
statistički značajan porast broja bolesnika koji nisu bili liječeni antibiotikom pred prijem. Broj
primijenjenih antibiotika prije hospitalizacije značajno utječe na trajanje hospitalizacije.
Bolesnici koji su liječeni s jednim ili dva antibiotika pred prijem u Kliniku, kraće borave
(medijan 9 dana) u bolnici od bolesnika koji nisu prethodno liječeni antibiotikom ili su
liječeni sa tri antibiotika (medijan 10 dana). Pred prijem i u bolnici najčešće je primjenjivana
terapija jednim antibiotikom, potom s dva, a najrjeđe s tri i više. Kod bolesnika koji su liječeni
jednim antibiotikom pred prijem, najčešće je primjenjivana skupina makrolida (33,7 %) i
penicilinskih antibiotika (33,1 %). Medijan duljine liječenja antibiotikom (dani) prije
hospitalizacije se mijenjao tijekom godina u smjeru skraćivanja duljine prethodnog liječenja.
Od bolesnika koji su u Klinici liječeni jednim antibiotikom, najčešće su upotrebljavani
cefalosporini treće generacije (72,0 %) te makrolidi (18,0 %). Pozitivan nalaz HK značajno
produžuje prosječno trajanje hospitalizacije. Najčešće su dijagnosticirane desnostrana (50,3
%) i lijevostrana (18,0 %) bronhopneumonija. Medijan dana hospitalizacije značajno se
razlikuje po dijagnozama.
Zaključak:
Ova studija je pokazala skraćenje duljine hospitalizacije te racionalizaciju
bolničkog liječenja djece od upale pluća u Klinici za dječje bolesti u 2010. i 2011. godini. |
| Abstract (english) | Aim: Determine whether there is a shortening of the duration of treatment of children
suffering from pneumonia in 2010th and 2011th year, compared with the 1998th, 1999th,
2004th and 2005th year. In order to clarify the possible shortening of treatment, I will explore
the details of the treatment of children with pneumonia in those years.
Methods: A retrospective analysis of medical records of patients treated for pneumonia at the
Pediatric’s Department of University Hospital Center Split in the period since 2010th to
2011th. As a basis for data entry I used a table, created in Microsoft Office Excel 97 – 2003,
which contained recorded data from previous studies (period 1998./1999. and 2004./2005.
year). I equalized a way of collecting data in a way that was done in previous studies. The
study population consisted of the patients under 18 years of age, hospitalized with pneumonia
and patients that suffered from pneumonia during hospitalization. In total, 2098 patients were
included in the study. For the statistical analysis of collected data I used a nonparametric
analytical tests (Kruskal–Wallis test, Mann–Whitney test) i χ2 – test. Results were considered
statistically significant if they differed on the level of p < 0.05, and are presented in graphs
and tables.
Results: In the 2010th and 2011th year, there is a reduction in length of hospitalization (in
days) compared to other years. Median days of hospitalization was 9 days (IQR: 7.0 to 11.0).
Antibiotic therapy prior to admission did not receive 52.5% of patients. In the 2005th and
2010th there is a apparent statistically significant increase in the number of patients who were
not treated with antibiotics before admission. Number of administered antibiotics prior to
hospitalization significantly affects the duration of hospitalization. Patients who were treated
with one or two antibiotics before admission to the Pediatric department had a shorter stay
(median 9 days) in the hospital in comparison to patients who were not previously treated
with antibiotics or were treated with three antibiotics (median 10 days). Before admission to
the hospital and during hospitalization, most commonly used antibiotic therapy is with one,
then two, and rarely with three or more antibiotics. In patients who were treated with one
antibiotic before admission, the most used groups are of macrolides (33.7%) and penicillin
antibiotics (33.1%). The median length of antibiotic treatment (days) before hospitalization
changed over the years in the direction of shortening the length of previous treatment. Of the
patients who were treated in the Pediatric department with one antibiotic, most commonly are
used third–generation cephalosporins (72.0%) and macrolides (18.0%). Positive findings of
HK significantly extend the average length of hospitalization. The right–sided (50.3%) and left–sided (18.0%) bronchopneumonia are usually diagnosed. Median days of hospitalization
significantly differed by diagnosis.
Conclusion: This study showed shortening the length of hospitalization and the rationalization
of hospital treatment of children with pneumonia in the Pediatric Department in the 2010th
and 2011th year. |
