Ulus Travma Acil Cerrahi Derg. 2023; 29(9): 1051-1060 | DOI: 10.14744/tjtes.2023.70658

Risk factors for mortality and morbidity in Syrian refugee children with penetrating abdominal firearm injuries: an 1-year experience

Mustafa Tuþat¹, Ýsmail Özmen², Mehmet Semih Demirtaþ³, Can Ateþ⁴, Ayse Betül Öztürk¹, Nazým Abdulkadir Kankýlýç⁵, Dilek Baþar^6
1Department of Pediatric Surgery, Faculty of Medicine, Aksaray University, Aksaray-Türkiye
²Department of Pediatric Surgery, Kilis State Hospital, Kilis-Türkiye
³Department of Pediatrics, Aksaray University, Faculty of Medicine, Aksaray-Türkiye
⁴Department of Biostatistics and Medical Informatics, Aksaray University, Faculty of Medicine, Aksaray-Türkiye
⁵Department of Urology, Aksaray University, Faculty of Medicine, Aksaray-Türkiye
⁶Department of Pediatric Surgery, Trabzon Kanuni Training and Research Hospital, Trabzon-Türkiye

BACKGROUND: Despite improvements in technology and surgical techniques, abdominal injuries caused by firearms in children are traumatic with high complication rates and mortality. In this study, factors affecting mortality and complications in penetrating abdominal firearm injuries caused by high-velocity bullets and shrapnel in children as a result of the civil war in Syria were evaluated.
METHODS: This study was conducted as a case series with 53 patients admitted to Kilis State Hospital with penetrating abdominal firearm injuries between January 2016 and February 2017. Patients aged between 6 months and 17 years who suffered penetrating abdominal firearm injuries (PAFI) as a result of the civil war in Syria in the state hospital in Kilis Türkiye border province with Syria and were transferred to our hospital and operated on were included in the evaluation. Patients’ sociodemographic information, time to surgery, number of abdominal organs injured, type of firearm causing injury, presence of large vessel injury and extremity injury, presence of thoracic injury requiring thoracotomy in addition to laparotomy, colostomy, penetrating abdominal trauma index, pediatric trauma score (PTS), and shock status were evaluated.
RESULTS: In our study, it was found that a high penetrating abdominal trauma index significantly increased complication rates and mortality (P<0.001 and P=0.002, respectively). In addition, it was found that lower PTSs significantly increased the development of complications and mortality (P=0.001 and P<0.001, respectively). Mortality was not observed in any of the patients with a PTS>8, whereas mortality was observed in 27.3% of patients with a PTS≤8, and this result was statistically significant (P=0.003). Shock sig-nificantly increased mortality, and no patient who was not in shock died (P<0.001). In our study, it was determined that the increase in the number of injured intra-abdominal organs had a significant effect on both complications and mortality (P<0.001 and P=0.002, respectively).
CONCLUSION: The penetrating abdominal trauma index and PTS were found to be effective in predicting mortality and morbidity in pediatric patients with PAFI. It is crucial in this patient group to provide appropriate transport after the first intervention is done rapidly and effectively in conflict zones.

Keywords: Child, firearm injury, morbidity; mortality; penetrating abdominal injury.

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Penetran abdominal ateþli silah yaralanmasý olan Suriyeli mülteci çocuklarda mortalite ve morbidite için risk faktörleri: Bir yýllýk deneyim

Mustafa Tuþat¹, Ýsmail Özmen², Mehmet Semih Demirtaþ³, Can Ateþ⁴, Ayse Betül Öztürk¹, Nazým Abdulkadir Kankýlýç⁵, Dilek Baþar^6
1Aksaray Üniversitesi, Týp Fakültesi, Çocuk Cerrahisi Anabilim Dalý, Aksaray, Türkiye
²Kilis Devlet Hastanesi, Çocuk Cerrahisi, Kilis, Türkiye
³Aksaray Üniversitesi, Týp Fakültesi, Çocuk Saðlýðý ve Hastalýklarý, Aksaray, Türkiye
⁴Aksaray Üniversitesi, Týp Fakültesi, Biyoistatistik ve Medikal Ýnformatik Anabilim Dalý, Aksaray, Türkiye
⁵Aksaray Üniversitesi, Týp Fakültesi, Üroloji Anabilim Dalý, Aksaray, Türkiye
⁶Trabzon Kanuni Eðitim Araþtýrma Hastanesi, Çocuk Cerrahisi, Trabzon, Türkiye

AMAÇ: Çocuklarda ateþli silahlar nedeniyle meydana gelen batýn yaralanmalarý, geliþen teknoloji ve ameliyat tekniklerine raðmen yüksek komplikas-yon ve mortaliteye sahip travmalardýr. Bu çalýþmada, Suriye’deki sivil savaþ sonucu çocuklarda meydana gelen yüksek hýzlý mermi ve þarapnel kaynaklý meydana gelen penetran abdominal ateþli silah yaralanmalarýnda mortalite ve komplikasyona etki eden faktörler deðerlendirilmiþtir.
GEREÇ VE YÖNTEM: Bu çalýþma Kilis Devlet hastanesinde Ocak 2016-Þubat 2017 tarihleri arasýnda penetran abdominal ateþli silah yaralanmasý sonucu baþvuran 53 hasta ile vaka serisi olarak yapýlmýþtýr. Türkiye’nin Suriye ile sýnýr ili olan Kilis’deki devlet hastanesine Suriye’deki iç savaþ sonucu penetran abdominal ateþli silah yaralanmasýna uðrayan ve hastanemize transvers edilip ameliyat edilen 6 ay-17 yaþ arasý hastalar deðerlendirmeye alýndý. Hastalarýn sosyodemografik bilgileri, cerrahiye kadar geçen süre, yaralanan abdominal organ sayýsý, yaralanmaya neden olan ateþli silah tipi, büyük damar yaralanmasý ve ekstremite yaralanmasý eþlik etmesi, laparatomiye ek olarak torakotomi gerektiren toraks yaralanmasý varlýðý, kolostomi uygulanmasý, penetran abdominal travma indeksi, pediatrik travma skoru ve þok durumu deðerlendirildi.
BULGULAR: Çalýþmamýzda penetran abdominal travma indeksi’nin yüksek olmasýnýn istatistiksel olarak komplikasyon ve mortalite oranlarýný arttýr-dýðý bulunmuþtur (p<0.001, p=0.002). Ayrýca pediatrik travma skoru’nun düþük olmasýnýn komplikasyon geliþimini ve mortaliteyi istatistiksel olarak arttýrdýðý tespit edilmiþtir (p=0.001, p<0.00). PTS>8 olan hastalarýn hiçbirinde mortalite gözlenmemiþ olup, PTS≤8 olan hastalarda %27.3 oranýnda mortalite gözlenmiþ ve bu sonucun istatistiksel olarak anlamlý olduðu tespit edilmiþtir (p=0.003). Þok tablosunun mortaliteyi anlamlý olarak arttýrdýðý ve þok tablosunda olmayan hiçbir hastanýn hayatýný kaybetmediði tespit edilmiþtir (p<0.001). Çalýþmamýzda yaralanan intraabdominal organ sayýsýnýn artmasýnýn hem komplikasyon hem de mortalite üzerinde istatistiksel olarak anlamlý þekilde etkili olduðu belirlendi (p<0.001, p=0.002). SONUÇ: Penetran abdominal ateþli silah yaralanmasý olan çocuk hastalarda penetran abdominal travma indeksi ve pediatrik travma skorunun mortalite ve morbiditeyi öngörmede etkin olduðu tespit edilmiþtir. Çatýþma alanlarýnda hýzlý ve etkin þekilde ilk müdahalenin yapýldýktan sonra uygun transportun saðlanmasý bu hasta grubunda oldukça önemlidir.

Anahtar Kelimeler: Çocuk, penetran abdominal yaralanma, ateþli silah yaralanma; mortalite; morbidite.

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