The correlation between Injury Severity Score, vital signs, and hemogram values on mortality in firearm injuries

BACKGROUND: Several scoring systems have been and continue to be developed in numerous countries with the goal of quickly and accurately assessing the severity of trauma injuries. The aim of this study was to identify factors that help to determine the gravity of damage and to minimize it, in order to reduce mortality and morbidity. It is important that the criteria set for the determination of the severity of trauma are objective, measurable, and comparable. This study was an assessment of the contribution of vital signs, hemogram values, and trauma severity scores recorded at initial admission in the prediction of mortality in patients with firearm trauma wounds.
METHODS: This was a retrospective cohort study. Patients with gunshot injuries who were admitted to the emergency department (ED) of a single facility between December 2015 and March 2016 were included in the study. Statistical software was used to perform bivariate analyses using a t-test or the Mann-Whitney U test for continuous variables, depending on the distribution of variables, and logistic regression analysis was utilized to determine independent predictors of mortality after ED admission. A p value of <0.05 was considered statistically significant.
RESULTS: A total of 418 patients were included. A statistically significant difference was found between the white blood cell count, respiratory rate, Glasgow Coma Scale score, Abbreviated Injury Scale score, and the Injury Severity Score (ISS) of the patients who survived and those who died (p<0.05). The analysis also indicated that a systolic blood pressure below 90 mmHg and a heart rate above 100 beats/minute were independent variables in terms of the expectation of mortality.
CONCLUSION: The objective assessment of the ISS at admission to the ED is an important element in the calculation of hemoglobin requirements, mortality, and morbidity.

Ateþli silah yaralanmasý olgularýnda mortalite üzerine yaralanma þiddeti skoru (ISS), yaþamsal skorlar ve hemogram deðerleri arasýndaki korelasyonun etkisi

AMAÇ: Birçok ülkede kiþilerin maruz kaldýðý travmanýn þiddeti ve ortaya çýkan hasarý deðerlendirmek için bazý skorlama sistemleri geliþtirilmiþ ve geliþtirilmeye devam etmektedir. Burada amaç hastanýn hasar oranlarýný en iyi biçimde belirleyerek mortalite ve morbiditeye etki eden faktörleri saptayarak bunlarý en aza indirgemeye çalýþmaktýr. Travmanýn aðýrlýðýnýn tespiti için ortaya konulan kriterlerin ölçülebilir ve karþýlaþtýrýlabilir objektif kriterler olmasý önemlidir. Bu amaçla anatomik ve fizyolojik birçok puanlama sistemleri oluþturulmuþtur. Bu araþtýrmada acil servise ilk kabul anýndaki vital skorlarýn, hemogram deðerlerinin ve yaralanma þiddeti skorunun (ISS) mortaliteyi öngörmeye katkýsýný ortaya koymaktýr.
GEREÇ VE YÖNTEM: Bu çalýþma geriye dönük kohort çalýþmasý olarak tasarlandý. Aralýk 2015–Mart 2016 tarihleri arasýnda acil servisimize baþvuran ateþli silah yaralanmasý olan hastalar çalýþmaya alýndý. Deðiþkenlerin daðýlýmý açýsýndan sürekli deðiþkenler için t-testi veya Mann-Withney U-testi kullanýlarak ikili deðiþkenler analiz edildi. Acil servise kayýttan sonra baðýmsýz mortalite belirleyicilerini belirlemek için lojistik regresyon ve istatistiksel analiz için SPSS17.0 programý kullanýldý. P<0.05 deðeri istatistiksel olarak anlamlý kabul edildi.
BULGULAR: Toplam 418 hasta alýndý. Sað kalan ve ölen hastalar arasýnda beyaz kan hücresi (WBC), solunum hýzý, Glasgow Koma Skalasý (GCS), Kýsaltýlmýþ Yaralanma Skoru (AIS) ve ISS arasýnda istatistiksel olarak anlamlý bir fark bulundu (p<0.05). Sistolik kan basýncýnýn 90 mmHg’nin altýnda ve kalp atým hýzýnýn 100 atým/dk üzerinde olmasýnýn mortalite açýsýndan baðýmsýz deðiþkenler olduðu belirlendi.
TARTIÞMA: Acil servise kabul anýndaki ISS’nin objektif deðerlendirmesi, hemoglobin gereksinimi, mortalite ve morbiditeyi öngörmek için önemli bir unsurdur.