Ulus Travma Acil Cerrahi Derg. 2007; 13(3): 192-198

Türk Ceza Kanunu’ndaki “yaþamý tehlikeye sokan yaralanma” kavramý ile travma skor sistemlerinin karþýlaþtýrýlmasý

Recep Fedakar¹, Ahmet Hüsamettin Aydýner¹, Ýlker Ercan^2
1Uludað Üniversitesi Týp Fakültesi, Adli Týp Anabilim Dalý, Bursa
²Uludað Üniversitesi Týp Fakültesi, Biyoistatistik Anabilim Dalý, Bursa

AMAÇ: Bu çalýþmada Türk Ceza Kanunu’nda tanýmlanan “Yaþamý tehlikeye sokan yaralanma” kavramýnýn deðerlendirilmesinde uluslararasý travma çalýþmalarýnda kullanýlan, GCS (Glasgow Coma Scale), RTS (Revised Trauma Score), ISS (Injury Severity Score), NISS (New Injury Severity Score) ve TRISS (Trauma and Injury Severity Score) skorlama sistemlerinin doðruluðunun karþýlaþtýrýlmasý ve kullanýlabilirliðinin kontrol edilmesi amaçlanmýþtýr.
GEREÇ-YÖNTEM: 2003 yýlýnda, Uludað Üniversitesi Týp Fakültesi Hastanesi Acil Servisi’ne kabul edilen 627 travma hastasýnýn, yaþ, cins, travma tipi, yaralanma tipi ve lokalizasyonu, GCS, RTS, ISS, NISS ve TRISS deðerleri ile yaþamý tehlikeye sokan yaralanma olup olmadýðý incelenmiþtir.
BULGULAR: Olgularýn % 35.2’sinde yaþamý tehlikeye sokan yaralanma saptanmýþtýr. GCS, RTS, ISS, NISS ve TRISS deðerlerinin, yaþamý tehlikeye sokan yaralanma kararý verilen hastalara uygunluðu sýrasýyla, %74.8, %76.9, %88.7, %86.6, %68.6 saptanmýþtýr. En iyi uygunluk cut-off noktasý 14, sensitivite %79.6, spesifite %93.6 ile ISS sisteminde saptanmýþtýr. Resmi olarak yaþamý tehlikeye sokan yaralanma olarak karar verilen izole olarak kafatasýnda lineer kýrýk bulunan tüm olgularda ISS 5, NISS 6 ve GCS (15), RTS (7.8408) ve TRISS (%100) sisteminde en iyi deðerleri olan skorlar saptanmýþtýr.
SONUÇ: GCS, RTS ve TRISS ile karþýlaþtýrýldýðýnda, yaþamý tehlikeye sokan yaralanma kararýnýn verilmesinde ISS ve NISS en uygun travma skorlama sistemleri olarak görülmektedir ve Türk Ceza Kanunu’ndaki yaþamý tehlikeye sokan yaralanma kararýnýn deðerlendirilmesinde kullanýlabilecek, kabul edilebilir skorlar olabilir.

Anahtar Kelimeler: Adli Týp, adli rapor, Türk Ceza Kanunu, yaþamý tehlikeye sokan yaralanma, travma skoru.

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A comparison of “life threatening injury” concept in the Turkish Penal Code and trauma scoring systems

Recep Fedakar¹, Ahmet Hüsamettin Aydýner¹, Ýlker Ercan^2
1Department Of Forensic Medicine, Uludag University Medical Faculty, Bursa, Turkey
²Department Of Biostatistics, Uludag University Medical Faculty, Bursa, Turkey

Background. To compare accuracy and to check the suitability of the Glasgow Coma Scale (GCS), the Revised Trauma Score (RTS), the Injury Severity Score (ISS), the New Injury Severity Score (NISS) and the Trauma and Injury Severity Score (TRISS), the scoring systems widely used in international trauma studies, in the evaluation of the “life threatening injury” concept established by the Turkish Penal Code.
Methods. The age, sex, type of trauma, type and localizations of wounds, GCS, RTS, ISS, NISS and TRISS values, the decision of life threatening injury of 627 trauma patients admitted to Emergency Department of the Uludag University Medical School Hospital in year 2003 were examined.
Results. A life-threatening injury was present in 35.2% of the cases examined. GCS, RTS, ISS, NISS and TRISS confirmed the decision of life threatening injury with percentages of 74.8%, 76.9%, 88.7%, 86.6% and 68.6%, respectively. The best association was determined with ISS in the cut-off point 14 with 79.6% sensitivity and 93.6% specificity. All of the cases with sole linear skull fracture officially decided as life threatening injury had an ISS of 5, a NISS of 6 and the best scores of GCS (15), RTS (7.8408), and TRISS (100%).

Keywords: Forensic medicine, medico-legal report; Turkish Penal Code; life threatening injury; trauma scoring.

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ATIF KOPYALA