Analysis of risk factors of mortality in abdominal trauma

BACKGROUND: The present study aims to analyze blunt and penetrating abdominal traumas that were evaluated in our emergency department, the treatment approaches and risk factors of mortality.
METHODS: Six hundred and sixty-four patients were admitted to our emergency department for surgical evaluation for trauma between January 2009 and April 2019. After the exclusion of dead on arrival, patients with missing data and patients without abdominal trauma were excluded from this study. Hundred and thirteen patients with abdominal trauma admitted to our department were evaluated in this study. Demographic, clinical, prognostic and mortality related factors were retrospectively analyzed.
RESULTS: The mean age of the patients was 36.08±16.1 years. There were 90 male patients. Eighty patients (70.8%) had blunt abdominal trauma (BAT). Twenty-eight patients (24.7%) had isolated liver and two patients (1.7%) had isolated spleen injury. Combined liver and spleen injury was found in two patients (1.7%). Twenty-two (19.4%) patients had mortality. Causes of mortality were an irreversible hemorrhagic shock (40.9%) and central nervous system (13.6%) injuries. BAT was the main mechanism of injury in patients with mortality (86.4% versus 67%; p<0.001). The frequency of retroperitoneal injury was significantly higher in patients with mortality (50% versus 16.5%, p<0.001). The frequency of extra-abdominal injury in patients with mortality was higher (68.1% versus 49.4%; p=0.047). Mean arterial pressure at admission was found to be significantly lower in patients with mortality (67±26.8 mmHg versus 84.3±17 mmHg; p=0.02). The number of packed erythrocytes transfused in patients with mortality was higher (8.8±8.6 versus 3.3±5.9 units; p=0.047). Mean international normalized ratio (INR) was significantly higher in patients with mortality (4.3±7.1 versus 2.7±4; p=0.016). Mean lactate dehydrogenase level was higher in patients with mortality (1685.7±333.8 versus 675.8±565.3 IU/mL; p<0.001). Mean alanine aminotransferase (ALT) was significantly higher in patients with mortality (430±619 versus 244±448 IU/mL; p<0.001). Mean alkaline phosphatase (ALP) level in patients with mortality was higher (76.9±72.8 versus 67.3±27.8 IU/mL; p=0.003). The presence of retroperitoneal injury and ALT >516 IU/mL were independent risk factors o mortality.
CONCLUSION: We have found certain laboratory variables to increase in patients with mortality. These are related to the severity of trauma. Retroperitoneal injury and increased ALT levels being risk factors of mortality is the most important finding of this study. Our results can guide other centers in the evaluation of trauma patients, and high-risk groups can be identified.

Abdominal travmada mortaliteyi etkileyen risk faktörlerinin analizi

AMAÇ: Bu çalýþmanýn amacý, acil servisimizde deðerlendirilen künt ve penetran karýn travmalarý ve bunlara yönelik gerçekleþtirilen tedavi yaklaþýmlarý ile mortalite için risk faktörlerini incelemektir.
GEREÇ VE YÖNTEM: Ocak 2009–Nisan 2019 tarihleri arasýnda acil servisimize baþvuran ve travma nedeniyle cerrahi konsültasyonu yapýlan 664 hasta çalýþma için deðerlendirildi. Baþvuru anýnda gerçekleþen ölümler, verileri eksik olan hastalar ve karýn travmasý saptanmayan hastalar çalýþmaya dahil edilmedi. Çalýþmaya abdominal travmalý 113 hasta alýndý. Demografik, klinik, prognostik ve mortalite ile iliþkili faktörler geriye dönük olarak incelendi.
BULGULAR: Hastalardaki yaþ ortalamasý 36.08±16.1 yýldý. Bunlardan 90’ý erkekti. Seksen hastada (%70.8) künt karýn travmasýnýn (KKT) mevcut olduðu gözlendi. Yimi sekiz hastada (%24.7) izole karaciðer ve iki hastada (%1.7) dalak yaralanmasý vardý. Kombine karaciðer ve dalak yaralanmasýnýn iki hastada (%1.7) görüldü. Yirmi iki (%19.4) hastada mortalite geliþti. Mortalite nedenlerini geri dönüþümsüz hemorajik þok (%40.9) ve merkezi sinir sistemi (%13.6) yaralanmalarý oluþturmaktaydý. KKT mortal seyreden grupta ana yaralanma mekanizmasýný oluþturmaktaydý (%86.4 ve %67, p<0.001). Retroperitoneal yaralanma sýklýðý mortal seyreden hastalarda anlamlý olarak daha yüksekti (%50 ve %50, %16, p<0.001). Mortal seyreden hastalarda ekstra abdominal yaralanma sýklýðý daha yüksekti (%49 ve %68.1; p=0.047). Yatýþ sýrasýndaki ortalama arter basýncý mortal seyreden hastalarýnda anlamlý olarak düþük bulundu (67±26.8 mmHg ve 84.3±17 mmHg; p=0.02). Mortal seyreden hastalarda transfüze edilen eritrosit miktarý daha fazlaydý (8.8±8.6 ve 3.3±5.9 ünite; p=0.047). Ortalama uluslararasý normalleþtirilmiþ oraný (INR) mortal seyreden hastalarda anlamlý derecede yüksekti (4.3±7.1 ve 2.7±4; p=0.016). Mortal seyreden hastalarda ortalama laktat dehidrogenaz daha yüksekti (1685.7±333.82 ve 675.8±565.3 IU/mL; p<0.001). Ortalama alanin amino transferaz (ALT) düzeyi mortal seyreden hastalarda anlamlý olarak daha yüksekti (430±619 ve 244±448 IU/mL; p<0.001). Mortal seyreden hastalarda ortalama alkalen fosfataz (ALP) düzeyi daha yüksekti (76.9±72.8 ve 67.3±27.8 IU/mL; p=0.003). Retroperitoneal yaralanma ve ALT >519 IU/mL varlýðýnýn mortalite açýsýndan baðýmsýz risk faktörleri olduklarý bulundu.
TARTIÞMA: Mortal seyreden hasta grubunda bazý laboratuvar deðiþkenlerinin arttýðýný ve bunlarýn travmanýn ciddiyeti ile ilgili olduðu görüldü. Retroperitoneal yaralanma ve artmýþ ALT düzeyleri mortalite açýsýndan baðýmsýz risk faktörü olup, bu bulgu çalýþmanýn en önemli bulgusu olarak karþýmýza çýkmaktadýr. Mevcut çalýþma bulgularýmýz travma hastalarýnýn deðerlendirilmesinde diðer merkezlere rehberlik edebileceði ve yüksek riskli gruplarý tanýmlamada da kullanýlabilir.