The role of trauma scoring systems and serum lactate level in predicting prognosis in thoracic trauma

BACKGROUND: Chest trauma constitutes 10% of admissions due to trauma and causes 25–50% of trauma-related deaths. It is important to evaluate the level of thoracic trauma in patients accurately and early, start the correct treatment, predict the need for intensive care and mortality, and prevent complications that may develop. In this study, the predictive efficiency of the serum lactate level, shock index, and scoring systems regarding the prognosis in patients with major thoracic trauma were compared.
METHODS: The files of the 683 patients who applied to the emergency department of our hospital due to trauma, between 2014 and 2020, were analyzed retrospectively. Patients with isolated thoracic trauma were included in the study.
RESULTS: A total of 683 patients were included in the study. Of the patients, 34 (5%) were in the non-survivor group and 649 (95%) were in the survivor group. There was no statistically significant difference between the systolic blood pressure, diastolic blood pressure, pulse rate, respiratory rate, or shock index in either group (p>0.05). The Glasgow Come Scale (GCS) score in the non-survivor group was significantly lower than that in the survivor group (p=0.000). The lactate level, revised trauma score (RTS), injury severity score (ISS), and New ISS (NISS) in the non-survivor group were significantly higher than those in the survivor group. A significant difference was found in terms of age, lactate level, and the GCS, RTS, ISS, and NISS (p<0.05). In logistic regression analysis, it was found that a 1 unit increase in the lactate value increased the mortality rate by 1.19 times in terms of the effect of the trauma scores and numerical change in the lactate level on mortality.
CONCLUSION: In patients with thoracic trauma, the NISS may be a useful factor that can be used in emergency rooms when a quick decision is required. However, increases in blood lactate levels during patient follow-up may also be a blood parameter that the clinician should pay attention to. In addition, further studies should be conducted on scoring in patients with thoracic trauma.

Torasik travmada prognoz tahmininde travma puanlama sistemelerinin rolü ve serum laktat düzeyi

AMAÇ: Toraks travmalarý, travmaya baðlý baþvurularýn %10’unu oluþturmakta ve travmaya baðlý ölümlerin %25–%50’sine neden olmaktadýr. Hastalarda göðüs travmasýnýn düzeyini doðru ve erken deðerlendirmek, doðru tedaviye baþlamak, yoðun bakým ihtiyacýný ve mortaliteyi tahmin etmek ve geliþebilecek komplikasyonlarý önlemek önemlidir. Bu çalýþmada majör torasik travmalý hastalarda serum laktat düzeyi, þok indeksi ve skorlama sistemlerinin prognozla ilgili prediktif etkinliði karþýlaþtýrýldý.
GEREÇ VE YÖNTEM: 2014–2020 yýllarý arasýnda hastanemiz acil servisine travma nedeniyle baþvuran 683 hastanýn dosyalarý geriye dönük olarak incelendi. Ýzole göðüs travmasý olan hastalar çalýþmaya dahil edildi.
BULGULAR: Çalýþmaya toplam 683 hasta dahil edildi. Hastalarýn 34’ü (%5) sað kalmayan grupta, 649’u (%95) sað kalan gruptaydý. Her iki grupta da sistolik kan basýncý, diyastolik kan basýncý, nabýz hýzý, solunum hýzý veya þok indeksi arasýnda istatistiksel olarak anlamlý bir fark yoktu (p>0.05). Hayatta kalmayan gruptaki GCS skoru, hayatta kalan grubunkinden anlamlý derecede düþüktü (p=0.000). Hayatta kalmayan gruptaki laktat seviyesi ve RTS, ISS ve NISS, hayatta kalanlar grubundakilerden önemli ölçüde daha yüksekti. Yaþ, laktat seviyesi ve GCS, RTS, ISS ve NISS açýsýndan anlamlý bir fark bulundu (p<0.05). Lojistik regresyon analizinde, laktat deðerindeki 1 birimlik artýþýn, travma skorlarýnýn ve laktat düzeyindeki sayýsal deðiþikliðin mortaliteye etkisi açýsýndan ölüm oranýný 1.19 kat artýrdýðý bulunmuþtur.
TARTIÞMA: Torasik travmalý hastalarda, NISS hýzlý bir karar alýnmasý gerektiðinde acil servislerde kullanýlabilecek yararlý bir faktör olabilir. Ancak hasta takibi sýrasýnda kan laktat düzeylerindeki artýþlar da klinisyenin dikkat etmesi gereken bir kan parametresi olabilir. Ek olarak, torasik travmalý hastalarda skorlama konusunda ileri çalýþmalar yapýlmalýdýr.