Ulus Travma Acil Cerrahi Derg. 2019; 25(1): 46-54 | DOI: 10.5505/tjtes.2018.97345

Yoðun bakým ünitesine baþvuran toraks travmalý olgularýn prognostik deðerlendirmesi: On yýllýk sonuçlar

Mehtap Pehlivanlar Küçük¹, Ahmet Oðuzhan Küçük², Ýskender Aksoy³, Davut Aydýn¹, Fatma Ülger^1
1Ondokuz Mayýs Üniversitesi Týp Fakültesi, Anesteziyoloji ve Reanimasyon Anabilim Dalý, Yoðun Bakým Bilim Dalý, Samsun
²Karadeniz Teknik Üniversitesi Týp Fakültesi, Anesteziyoloji ve Reanimasyon Anabilim Dalý, Yoðun Bakým Bilim Dalý, Trabzon
³Ondokuz Mayýs Üniversitesi Týp Fakültesi, Acil Týp Anabilim Dalý, Samsun

AMAÇ: Çoklu travmalar ülkemizde ve dünyada özellikle genç eriþkinlerin ölüm nedenlerinin baþýnda gelmektedir. Bu çalýþmanýn amacý yoðun bakýmlarda takip edilmekte olan izole ya da diðer organ yaralanmalarý ile birlikte olan toraks travmalý olgularda mortalite için baðýmsýz prognostik faktörlerinin predikte edilmesidir.
GEREÇ VE YÖNTEM: Bu çalýþmada, 2007–2016 yýllarý arasýnda yoðun bakým ünitemizde takip edilmiþ olan toraks travmalý hastalarýn verileri geriye dönük olarak incelendi. Bu yýllar içerisinde yoðun bakým hasta kayýt sisteminde yer alan 8063 hasta arasýndan verilerine saðlýklý bir þekilde ulaþýlan 616 toraks travma hastasý saptandý. On sekiz yaþ altý olgular dýþlanarak kalan 564 hasta çalýþma grubu hastasý olarak belirlendi.
BULGULAR: Çalýþmaya alýnan 8063 hastanýn 616’sýnda (%7.6) toraks travmasý saptandý. Çalýþma kriterlerini saðlayan 564 çalýþma grubu hastasýnýn yaþ ortalamasý medyan (min-maks) 43 (18–87) idi. Hastalarýn 159’u (%28.1) mortalite ile sonlanýrken 405’i (%71.8) yoðun bakým ünitesinden taburcu edildi. Travma ve Yaralanma Þiddeti Skoru’nun (TRISS) mortalite takibi için, AUC deðeri: 0.922 (%95 CI: 0.899–0.946) idi. ROC analizine göre mortalite geliþme olasýlýðý için TRISS skoru 59.93 sýnýr kabul edildiðinde (Sensitivite; 0.88, Spesifisite: 0.87) olarak tespit edildi. Multivaryant lojistik regresyon analizinde mortaliteyi ön görmede her bir yaþ artýþ mortalitede 1.025 kat, santral sinir sistemi travmasý varlýðý mortalitede 2.147 kat, pulmoner kontüzyo varlýðý mortalitede 1.752 kat artýþla iliþkiliydi.
TARTIÞMA: Bu çalýþmanýn sonuçlarý ile toraks travma hastalarýnda ileri yaþ, pulmoner kontüzyon ve eþlik eden santral sinir sistemi travmasý yoðun bakým mortalitesini göstermede baðýmsýz birer risk faktörü olarak tanýmlanmýþtýr. Travma hastalarýnda en güncel skorlama sistemlerinden olan TRISS skoru da bu non-invaziv yaklaþýmýmýzý desteklemektedir.

Anahtar Kelimeler: Göðüs, hastane mortalite; toraks travma; torasik yaralanma; TRISS; yoðun bakým ünitesi.

---

Prognostic evaluation of cases with thoracic trauma admitted to the intensive care unit: 10-year clinical outcomes

Mehtap Pehlivanlar Küçük¹, Ahmet Oðuzhan Küçük², Ýskender Aksoy³, Davut Aydýn¹, Fatma Ülger^1
1Department of Anesthesiology and Reanimation, Division of Intensive Care Medicine, Ondokuz Mayýs University Faculty of Medicine, Samsun-Turkey
²Department of Anesthesiology and Reanimation, Division of Intensive Care Medicine, Faculty of Medicine Karadeniz Technical University, Trabzon-Turkey
³Department of Emergency Medicine, Ondokuz Mayýs University Faculty of Medicine, Samsun-Turkey

BACKGROUND: Multiple traumas are a leading cause of mortality among young adults worldwide. Thoracic trauma causes approximately 25% of all trauma-associated deaths. This study aims to determine the independent prognostic factors of mortality in cases with thoracic trauma (isolated or with accompanying organ injuries) who were admitted to the intensive care unit (ICU).
METHODS: We retrospectively reviewed data from patients with thoracic trauma who were admitted to our ICU between 2007 and 2016. After excluding pediatric patients (aged <18 years), the study sample included 564 cases. From the records, we collected the patients’ demographical data, comorbid diseases, primary trauma as an indication for ICU admission, other traumas accompanying thoracic trauma, type of thoracic injury, and therapeutic interventions. The study sample was divided into two subsets: survival and non-survival groups. These two groups were compared with regards to first ICU day laboratory results and intensive care scores, mechanical ventilation times, and ICU stay lengths.
RESULTS: Of the 8063 patients admitted to the ICU between 2007 and 2016, 616 (7.6%) had thoracic trauma. The median age (min–max) of the 564 patients eligible for this study was 43 (18–87) years. Mortality occurred in 159 (28.1%) cases, while 405 (71.8%) were discharged from the ICU. Multivariate regression analyses were also performed, in which every increment in age was associated with a 1.025-fold increase in the odds of mortality due to thoracic trauma. Additionally, the presence of central nervous system (CNS) trauma was associated with a 2.147-fold increase, and the presence of pulmonary contusion was associated with a 1.752-fold increase.
CONCLUSION: Results of this study indicate that advanced age, the presence of pulmonary contusion, and accompanying CNS trauma are independent predictors of mortality in patients with thoracic trauma in the ICU. Our non-invasive approach is further supported by the trauma and injury severity score (TRISS) scoring system, which is one of the latest scoring systems used in trauma cases.

Keywords: Hospital mortality, intensive care unit; thoracic injuries; thoracic trauma; TRISS; Trauma Severity Indices.

---

ATIF KOPYALA