FACTORS EFFECTING MORTALITY IN PENETRATING ABDOMINAL TRAUMA

Between January 1990-January 1995, 521 patients were operated for penetrating abdominal injury in Dicle University Hospital. This study was planned to identify causes of mortality and factors directly related to mortality in 61 patients who died. Patients were evaluated for age, sex, cause of trauma, interval between injury and operation, presence of shock, associated visceral and vascular injuries, Penetrating Abdominal Trauma Index (PATI) and number of transfusions. Relations between these factors and mortality was searched. There were 459 (88.1%) male and 62 (11.9%) female. Mortality in 352(67.6%) gunshot wounds and 169(32.4%) stab wounds were 15,6% and 3.6%, respectively. If the number of injured abdominal organ was more than 3, mortality was increased, especially if it was more than 5, mortality was 34.5%. Mortality was increased if PATI was more than 36, and it was found 35% when PATI was more than 55. In our series, we found the cause of mortality in the first 48 hours as irreversible shock and coagulopathy. The other factors increasing mortality were more than four organ injured, associated cranial and vascular injuries. We found that PATI is a useful scoring system for evaluation of severity of abdominal trauma and estimation of morbidity, and also, it may help in estimating mortality.

PENETRAN ABDOMÝNAL TRAVMALARDA MORTALÝTEYE ETKÝLÝ FAKTÖRLER

D.Ü. T. F Genel Cerrahi Anabilim Dalýnda Ocak-1990 ile Ocak-1995 tarihleri arasýnda penetran abdominal travma nedeni ile 521 olguya cerrahi tedavi yapýldý. Çalýþma, kaybedilen 61 olguda mortalite nedenleri ve mortalite ile direkt iliþkili f aktörlerin belirlenmesi amacý ile planlandý. Olgular yaþ, cins, travma etkeni, yaralanma-operasyon intervali, þok varlýðý, yandaþ organ ve damar yaralanmalarý, Penetran Abdominal Travma Ýndeksi (PATI), kan transfüzyonu sayýsý açýsýndan deðerlendirildi. Bu faktörler ile mortalite arasýndaki iliþki araþtýrýldý. Olgularýmýzýn 459 (%88.1)'u erkek, 62 (%11.9)'si kadýndý. ASY'na maruz, kalan 352 (%67.6) olguda mortalite oraný %15.6 iken; KDY'na maruz, kalan 169 (%32.4) olguda bu oran %3.6 idi. Yaralanan abdominal organ sayýsý 3'ün üzerinde olan olgularda mortalitenin arttýðý, 5'in üzerinde ise mortalitenin %34.5'e kadar çýktýðý görüldü. PATI ile mortalite arasýndaki iliþki incelendiðinde, 36'nýn üzerinde mortalite oranýnýn arttýðý, 55'in üzerinde ise bu oranýn %35 olduðu belirlendi. Serimizde, penetran abdominal travmalarda ilk 48 saat içindeki ölümlerin temel sebebinin irreverzibl sok ve koagülopati olduðu; bunun yanýnda 4'ten fazla intraabdominal organ yaralanmasý, eþlik eden kranial ve damar yaralanmalarýnýn mortaliteyi arttýran önemli faktörler olduðu saptandý. PATI'nin abdominal travma þiddeti ve morbiditenin belirlenmesinde kullanýþlý bir skorlama sistemi olduðu, ayrýca mortalitenin belirlenmesinde de yardýmcý olabileceði belirlendi.