Research Information System
Thesis Type: Expertise In Medicine
Institution Of The Thesis: Gazi Üniversitesi, Tıp Fakültesi, Turkey
Approval Date: 2012
Student: SERKAN ATICI
Supervisor: BUKET DALGIÇ
Abstract:Diarrhea is a major health problem all over the world for the pediatric age group. Well defined guidelines for the diagnosis and treatment of acute diarrhea are available in the literature. However, patients usually are not followed as per these guidelines and made inappropriate hospitalized, unnecessary laboratory tests and treatments are applied. Our study included 342 acute diarrheal patients (156 females and 186 males). The study was performed 283 (82.7%) patients were admitted to the pediatric emergency department and 59 (17.3%) patients were admitted to general pediatric outpatient clinics (GPOC). The mean age was 52.2 ± 56.4 months. The most common complaint was diarrhea and vomiting (30.4%). Only 5% of patients had varying degrees of dehydration. Laboratory tests were requested from 257 (75.1%) patients and the most common requested test was (52.6%) stool wright examination. 71.3% of patients were discharged with only dietary advice and other medical treatments were applied 28.7% of the patients. The most applied medical treatment is intravenous fluid therapy (14.6%). Within the study direct medical cost analysis has been executed by using National Social Security Institution bills. The cost of the avarage case of acute diarrheal is 38,17 ± 22,23 ¨ (Turkish Liras) and the avarage cost of laboratory tests is 18,49 ± 16,14 ¨. The avarage cost of treatment in hospital is calculated as 4,39 ± 10,31 ¨. The cost of proper and improper laboratory and treatment costs are calculated as per current and well known guidelines. Proper and improper laboratory costs are 5,42 ± 9,82 ¨ and 13,04 ± 14,80 ¨, respectively. Proper and improper treatment in hospital costs are also calculated 3,96 ± 9,88 ¨ and 0,42 ± 3,48 ¨, respectively. Improper laboratory cost is correspond to 70% of all laboratory cost and improper treatment in hospital cost is correspond to 90% of all treatment in hospital. In our study, pediatric emergency and GPOC groups are compared in accordence with diagnostic, therapeutic management and direct medical cost. There was no significant difference between the two groups from the point of demographic characteristics (age, gender). Diarrhea complaint at the GCOP group is higher than pediatric emergency group. Vomit complaint at the pediatric emergency group is higher than GCOP. There was no significant difference between the two groups from the point of physical examination findings and degree of dehydration. CBC, CRP, serum uric acid levels, stool gram-wright test, stool RV antigen and stool culture tests were conducted at the GCOP group more than pediatric emergency group. Antibiotics and intravenous fluid therapy are executed at the emergency group more than GCOP group. Cost analysis of the two groups were compared and it is found that total hospital cost and proper treatment in hospital cost are similar. All other costs was higher in GCOP group. Total hospital cost in GCOP and pediatric emergency groups are 41,15 ± 19,44 ¨ and 37,54 ± 22,75 ¨ respectively. The medical costs can be reduced by following proper diagnostic and treatment management for acute diarrhea by health personals especially pediatricians.