Ulus Travma Acil Cerrahi Derg. 2022; 28(5): 579-584 | DOI: 10.14744/tjtes.2022.17329

Can ionized calcium levels and platelet counts used for estimating the prognosis of pediatric trauma patients admitted to the emergency surgery intensive care?

Kemalettin Koltka¹, Mehmet ilhan², Ali Fuat Kaan Gök², Kayýhan Günay², Cemalettin Ertekin^2
1Department of Anesthesiology, Ýstanbul University Ýstanbul Faculty of Medicine, Ýstanbul-Turkey
²Department of General Surgery, Ýstanbul University Ýstanbul Faculty of Medicine, Ýstanbul-Turkey

BACKGROUND: Injury is the leading cause of death for pediatric population older than 1 year of age and 95% of those deaths are from the low- and middle-income countries. Most of those injured pediatric patients are treated in general hospitals. In designated trauma centers, the outcomes of severely injured patients are better. Scoring systems used frequently in intensive care units (ICUs) to make triage easier and to estimate prognosis. However, some of the scores may require additional expensive and sometimes time consuming tests. The purpose of the present study was to compare the usefulness of several scoring systems with initial ionized calcium levels and platelet counts to predict prognosis of pediatric trauma patients admitted to the emergency surgery department.
METHODS: This retrospective study was performed at a tertiary university hospital. The patients’ ages, genders, trauma etiologies, types of trauma, time of trauma, transport place (primary or secondary), duration of stay in the ICU and in the hospital, mortality rates, initial ionized calcium levels (Ca+2), initial platelet counts, and data of several trauma scores (GCS, RTS, ISS, TRISS, and PTS) were analyzed.
RESULTS: One hundred and fourteen pediatric trauma patients were admitted to the ICU. The mean age was 77.8±54 months. Most of them were male, falls were the primary mechanism of injury, and head trauma was the most common pattern of injury. The mortality rate was 15.8%, and the admission values for Ca+2, platelet counts, GCS, RTS, TRISS, and PTS had been found higher for patients who survived, while ISS scores were higher for those who had died.
CONCLUSION: It was found that pediatric patients admitted to the ICU were younger than 10 years, of whom most of them were male. Falls were the most common mechanism of injury, and head trauma was present in most of the pediatric patients admitted to the ICU. Initial Ca+2 levels and platelet counts can be used along with the trauma scoring systems in predicting mortality and overall survey regarding pediatric trauma patients.

Keywords: Ca+2 levels, intensive care unit, pediatric trauma; platelet counts; trauma scores.

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Acil cerrahi yoðun bakýma kabul edilen pediyatrik travma hastalarýnýn prognozunun tahmininde iyonize kalsiyum düzeyleri ve trombosit sayýlarý kullanýlabilir mi?

Kemalettin Koltka¹, Mehmet ilhan², Ali Fuat Kaan Gök², Kayýhan Günay², Cemalettin Ertekin^2
1Ýstanbul Üniversitesi Ýstanbul Týp Fakültesi, Anesteziyoloji Anabilim Dalý, Ýstanbul
²Ýstanbul Üniversitesi Ýstanbul Týp Fakültesi, Genel Cerrahý̇ Anabilim Dalý, Ýstanbul

AMAÇ: Yaralanma, bir yaþýndan büyük pediyatrik popülasyon için önde gelen ölüm nedenidir ve bu ölümlerin %95’i düþük ve orta gelirli ülkelerden gelmektedir. Yaralanan pediyatrik hastalarýn çoðu 1. basamak hastanelerde tedavi edilmektedir. Belli travma merkezlerinde, aðýr yaralý hastalarýn sonuçlarý daha iyidir. Yoðun bakým ünitelerinde (YBÜ) puanlama sistemleri triyaj iþlemini kolaylaþtýrmak ve prognozu tahmin etmek amacýyla sýklýkla kullanýlmaktadýr. Ancak bazý puanlama sistemleri ek, pahalý ve zaman alýcý testler gerektirebilmektedir. Bu çalýþmanýn amacý, acil cerrahi servisine baþvuran pediyatrik travma hastalarýnýn prognozunu öngörmek için baþlangýçtaki iyonize kalsiyum seviyeleri ve trombosit sayýlarý ile bazý skorlama sistemlerini karþýlaþtýrmaktý.
GEREÇ VE YÖNTEM: Bu geriye dönük çalýþma, üçüncü basamak bir üniversite hastanesinde yapýldý. Hastalarýn yaþ, cinsiyet, travma etiyolojileri, travma tipleri, travma zamaný, nakil yeri (birincil veya ikincil), yoðun bakýmda ve hastanede kalýþ süreleri, ölüm oranlarý, baþlangýçtaki iyonize kalsiyum düzeyleri (Ca+2), baþlangýç trombosit sayýlarý ve çeþitli travma skorlarýnýn (GCS, RTS, ISS, TRISS ve PTS) verileri analiz edildi.
BULGULAR: Yüz on dört pediyatrik travma hastasý yoðun bakým ünitesine yatýrýldý. Ortalama yaþ 77.8±54 aydý. Hastalarýn çoðunluðu erkekti, düþme birincil yaralanma etiyolojisiydi ve kafa travmasý en yaygýn yaralanma þekliydi. Mortalite oraný %15.8 olup, Ca+2, trombosit sayýlarý, GCS, RTS, TRISS ve PTS deðerleri hayatta kalanlarda daha yüksek bulunurken, ISS skorlarý ölenlerde daha yüksek bulundu.
TARTIÞMA: Yoðun bakýma alýnan çocuk hastalarýn çoðunun 10 yaþýndan küçük olduðu ve erkek olduðu belirlendi. Düþme en yaygýn yaralanma etiyo-lojisiydi ve yoðun bakým ünitesine kabul edilen pediyatrik hastalarýn çoðunda kafa travmasý mevcuttu. Pediyatrik travma hastalarýna iliþkin mortalite ve prognozun belirlenmesinde travma skorlama sistemleri ile birlikte baþlangýç Ca+2 seviyeleri ve trombosit sayýlarý kullanýlabilir.

Anahtar Kelimeler: Ca+2 seviyeleri, pediatrik travma, travma skorlarý; trombosit sayýsý; yoðun bakým ünitesi.

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