Hızlı Arama
Travma skorlamasına farklı yaklaşım
Haluk İnce1, Nurhan İnce2, Korhan Taviloğlu3, Recep Güloğlu31İstanbul Üniversitesi İstanbul Tıp Fakültesi Adli Tıp Anabilim Dalı, İstanbul2İstanbul Üniversitesi İstanbul Tıp Fakültesi Halk Sağlığı Anabilim Dalı, İstanbul
3İstanbul Üniversitesi İstanbul Tıp Fakültesi Genel Cerrahi Anabilim Dalı, İstanbul
AMAÇ: Travma nedeniyle hayatını kaybeden olguların Acil Cerrahi ve Travma Merkezine (ACTM) gelişteki Yaralanma Ağırlık Skoru (YAS) ile otopsi esnasındaki YAS karşılaştırıldı. Yaralanma Ağırlık Skoru 14 puanın altında (önlenebilir ölümler olarak tanımlanan) olgular araştırılarak sonuçların diğer ülkelerdeki verilerle karşılaştırılması amaçlandı.
GEREÇ-YÖNTEM: Çalışma 1 Ocak 2000 ile 31 Aralık 2002 tarihleri arasında İstanbul Tıp Fakültesi ACTM ile Adli Tıp Kurumu’nda gerçekleştirildi. Üç yıllık bir dönemde travma nedeniyle ölen ve otopsisi yapılabilen 160 olgu incelendi.
BULGULAR: Otopsi sırasında saptanan YAS değeri 14’ün altında olan (önlenebilir ölüm) olgularının oranı %3 (n=4), YAS değeri 16-66 olan (önlenmesi muhtemel ölüm) olguların oranı %96, YAS değeri 75 olan (ölümün önlenemez olduğu) olgu oranı %1 (n=1) olarak bulundu. Acil Cerrahi ve Travma Merkezine gelişlerde ise bu oranlar; YAS değeri 14’ün altında olan %12 (n=19), YAS değeri 16-66 olan %68 (n=109), YAS değeri 75 olan %20 (n=32) idi. Otopsi sırasında hesaplanan YAS değeri ile ACTM’ye gelişlerinde saptanan YAS değerleri arasında zayıf da olsa bir ilinti saptandı (r=0.16; p=0.04).
SONUÇ: Travmalı hastalarda YAS değerlendirmesinin kullanılmasında birtakım güçlükler vardır. Ölüme katkısı olan alkol, ilaç kullanımı gebelik gibi fizyolojik değişiklikler YAS’da gösterilmemektedir. YAS’ın güncellenerek geliştirilmesi gereklidir. Bu sayede kliniklerin bakım kalitesinin değerlendirilmesi ve travma merkezlerinin standardizasyonu daha doğru yapılabilir.
A different approach to trauma scoring
Haluk İnce1, Nurhan İnce2, Korhan Taviloğlu3, Recep Güloğlu31İstanbul Üniversitesi İstanbul Tıp Fakültesi Adli Tıp Anabilim Dalı, İstanbul, Turkey2İstanbul Üniversitesi İstanbul Tıp Fakültesi Halk Sağlığı Anabilim Dalı, İstanbul, Turkey
3İstanbul Üniversitesi İstanbul Tıp Fakültesi Genel Cerrahi Anabilim Dalı, İstanbul, Turkey
BACKGROUND: We have compared the Injury Severity Score (ISS) at admission to Emergency Surgery and Trauma Center (ES&TC) with the ISS during autopsy. Cases with ISS less than 14 (defined as preventable deaths) were evaluated and the results were compared with those in other countries.
METHODS: The study was performed between January 1, 2000 and December 31, 2002 at Istanbul Medical Faculty TS&ES and the Turkish Council of Forensic Medicine. The 160 autopsies of trauma deaths which could have been performed within this three year period were evaluated.
RESULTS: The average age of trauma victims in the study was 32,9±15,6 (r=1-79); the majority of victims were males 78,1% (n=125). In four autopsies (3%) ISS were rated as “preventable death” (ISS ≤14). The severely injured (ISS: 16-66) patients with lower survival rates were 96% (n=155). In addition, one case (1%) had an ISS score of 75. In clinical evaluations, ISS scores were found to be between 16-66 (68%), 75 (20%, n=32), and ≤14 (12%; n=19).
CONCLUSION: Although it is widely used, difficulties in the applications of ISS still exist. Alcohol, drug, pregnancy and the presence of underlying diseases are the factors contributing to death but not being reflected by ISS. Moreover a difficulty exists in the evaluation of anatomical injuries which are not accompanied by physiological changes. ISS should be improved according to updates. In this way, evaluation of clinics care quality and standardization of trauma centers can be done more accurrately.
BACKGROUND: We have compared the Injury Severity Score (ISS) at admission to Emergency Surgery and Trauma Center (ES&TC) with the ISS during autopsy. Cases with ISS less than 14 (defined as preventable deaths) were evaluated and the results were compared with those in other countries.
METHODS: The study was performed between January 1, 2000 and December 31, 2002 at Istanbul Medical Faculty TS&ES and the Turkish Council of Forensic Medicine. The 160 autopsies of trauma deaths which could have been performed within this three year period were evaluated.
RESULTS: The average age of trauma victims in the study was 32,9±15,6 (r=1-79); the majority of victims were males 78,1% (n=125). In four autopsies (3%) ISS were rated as “preventable death” (ISS ≤14). The severely injured (ISS: 16-66) patients with lower survival rates were 96% (n=155). In addition, one case (1%) had an ISS score of 75. In clinical evaluations, ISS scores were found to be between 16-66 (68%), 75 (20%, n=32), and ≤14 (12%; n=19).
CONCLUSION: Although it is widely used, difficulties in the applications of ISS still exist. Alcohol, drug, pregnancy and the presence of underlying diseases are the factors contributing to death but not being reflected by ISS. Moreover a difficulty exists in the evaluation of anatomical injuries which are not accompanied by physiological changes. ISS should be improved according to updates. In this way, evaluation of clinics care quality and standardization of trauma centers can be done more accurrately.
Makale Dili: Türkçe