Evaluation of Forensic Cases in the Pediatric Intensive Care Unit

Objectives: Traffic accidents, falls, assaults, occupational accidents, intoxications, burns, electric shock, lightning strike, all cases of asphyxia, penetrating and firearm injuries, suspected or definite cases of sexual abuse, and suicide attempts should be evaluated in the forensic category. In this study, we aimed to present our intensive care experiences in forensic cases.
Methods: We retrospectively evaluated forensic cases admitted to our Pediatric Intensive Care Unit between 1 February 2017 and 1 September 2018.
Results: This study included 153 children, 65 (42.5%) boys and 88 (57.5%) girls. The forensic causes of hospitalizations in the intensive care unit included drug intoxication with a rate of 54.9%, followed by suicide attempts with 24.2%, falling from a high place with 5.2%, child abuse with 5.2%, pedestrian (out-of-vehicle) traffic accidents with 2.6%, drowning in water with 2.6%, road (in-vehicle) traffic accidents with 2%, electric shocks with 2%, and CO (carbon monoxide) poisoning with 1.3%. The drug intoxication was caused by drugs prescribed to the mother and the child with a rate of 40.6% and 27.1%, respectively. Analgesic anti-inflammatory drugs (33.1%) and antidepressant drugs (22.3%) were identified as major causes of intoxication. In addition, paracetamol was the most common cause of intoxication, with a rate of 21.9% among all intoxication cases and 72.5% in the analgesic group. Amitriptyline was the most common agent in the antidepressant group (59.2%). The admission rate to the intensive care unit between 08: 00 and 14: 00 was 35.1% for suicide attempts and 16.4% for non-suicide attempts, with a statistically significant difference (p=0.025; p<0.05, respectively).
Conclusion: Drug intoxications had the highest rate of forensic cases followed in our pediatric intensive care unit. The majority of these intoxications (69.4%) arose from accidental drug ingestion. Therefore, we believe that there may be a significant decrease in the number of hospitalizations of forensic cases associated with drug intoxications in pediatric intensive care units by preventing children’s access to drugs.

Çocuk yoðun bakýmda takip edilen adli olgularýn deðerlendirilmesi

Giriþ: Trafik kazalarý, düþmeler, darp olgularý, iþ kazalarý, intoksikasyonlar, yanýklar, elektrik ve yýldýrým çarpmalarý, her türlü asifiksi olgularý, delici kesici ve ateþli silah yaralanmalarý, istismar olgularý veya þüphesi ve intihar giriþimleri adli olgu olarak deðerlendirilmelidir. Bu çalýþmamýzda adli olgularda çocuk yoðun bakým deneyimimizi sunmayý amaçladýk.
Yöntemler: Çocuk Yoðun Bakým Ünitemize 1 Þubat 2017 – 1 Eylül 2018 tarihleri arasýnda kabul edilen adli olgular geriye dönük olarak deðerlendirildi.
Bulgular: Çalýþmamýza 65’i (%42.5) erkek ve 88’i (%57.5) kýz olmak üzere toplam 153 çocuk dahil edildi. Yoðun bakým yatýþlarýnýn %54,9’unun adli nedenini ilaç intoksikasyonu oluþtururken, %24.2’sini özkýyým giriþimleri, %5.2’sini yüksekten düþme, %5.2’sini çocuk istismarý, %2.6’sýný araç dýþý trafik kazasý, %2.6’sýný suda boðulma, %2’sini araç içi trafik kazasý, %2’sini elektrik çarpmasý ve %1.3’ünü CO (karbonmonoksit) zehirlenmesi oluþturdu. Ýlaç intoksikasyonlarýna neden olan ilaçlarýn %40.6’sýnýn çocuðun annesine ait olduðu, %27.1’inin ise çocuðun kendisine ait olduðu saptandý. Ýntoksikasyon olgularýnýn %33.1’i analjezik–antiinflamatuar ilaçlarla, %22.3’ü antidepresan ilaçlarla meydana geldiði, bu olgularda saptanan en sýk ilacýn parasetamol olup tüm intoksikasyon olgularýndaki oraný %21.9, analjezik grubunda ise %72.5 olarak saptandý. Antidepresan ilaçlar grubunda ise en sýk etken amitriptilin (%59.2) olarak bulundu. Özkýyým giriþimlerinin yoðun bakýma kabul saatinin 08: 00-14: 00 arasýnda olma oraný (%35.1), özkýyým giriþimi olmayanlardan (%16.4) istatistiksel olarak anlamlý düzeyde yüksek bulundu (p: 0.025; p<0.05).
Sonuç: Çocuk yoðun bakým ünitemizde izlenen adli olgularda en sýk hasta grubunu ilaç zehirlenmeleri oluþturdu. Bu zehirlenmelerin büyük çoðunluðu (%69.4) kaza ile alým sonucu gerçekleþti. Bu nedenle çocuklarýn ilaçlara eriþiminin engellenmesinin, ilaç zehirlenmelerine baðlý çocuk yoðun bakým adli olgu yatýþlarýný önemli ölçüde azaltacaðýný düþünmekteyiz. (SETB-2019-04-069)