NÖROÞÝRURJÝDE TRAVMA PRATÝÐÝ, PROSPEKTÝF EPÝDEMÝYOLOJÝK ÇALIÞMA

1.11.1996-31.10.1997 tarihleri arasýnda Ýstanbul Týp Fakültesi Ýlk ve Acil Yardým Anabilim Dalý'na kranyal-spinal travma nedeniyle baþvuran ve Nöroþirurji Anabilim Dalý'ndan konsültasyon istenerek yatýrýlan hastalar prospektif olarak deðerlendirildi. Acil birimine baþvuran 2520 olgudan 459'u yatýrýldý. Bunlarýn 120'si (%26) kadýn, 339'u (%74) erkekti. Yaþ daðýlýmýna bakýldýðýnda en fazla yoðunluðun 0-16 (%51) yaþ grubunda bulunduðu dikkati çekiyordu. Hastalarýn %44'ü doðrudan acil birime baþvururken, %66'sý baþka bir saðlýk kuruluþundan sevk edilmiþlerdi. Olgularýn %44'ü 08-16, %46'sý 16-24 ve %10'u 24-08 saatlerinde arasýnda baþvurmuþlardý. Travma nedenleri incelendiðinde %45 ile düþmenin ilk sýrada yer aldýðý, bunu %42 ile trafik kazalarýnýn izlediði dikkati çekti. Hastalarýn %15'inde politravma vardý. Giriþ Glasgow koma skalasýna (GKS) göre yapýlan deðerlendirmede %60'ý GKS-.14-15, %26'sý 9-13 ve %14'ü 8 ve altýndaydý. Hastalarýn %9Gsý kranyal, %3'ü spinal ve %1'i kranyal ve spinal birlikte yaralanmalardý. Ameliyat edilen 88 (%19) hastanýn, %34 ü epidural hematom, %20 si subdural hematomdu. Acil birimine giriþ ile tam arasýndaki süre %78'inde 0-2 saat, % l '/sinde 2-4 saat arasýndaydý. Ameliyata alýnan hastalarýn %81'i taný konduktan sonraki ilk dört saat içinde ameliyat edildi. Hastalarýn Glasgow Çýkýþ Skalasýna göre deðerlendirildiðinde %75'inde tam iyileþme, %7sinde orta derecede sakatlýk, %4'iinde ciddi derecede sakatlýk ve %13'ünde ölüm saptandý.

TRAUMA PRACTICE IN NEUROSURGERY - A PROSPECTIVE EPIDEMIOLOGIC STUDY

The patients admitted to the Accident and Emergency Department of the Medical Faculty of Istanbul for craniospinal trauma between 1/11/1996 and 31/10/1997 were prospectively evaluated. From 2520 patients that were consultated by Neurosurgery Department at the Emergency Department 459 patients were admitted to the wards. From this group 120 (%26) were women and 339 (%74) were men. Regarding the age distribution the patients between 0-16 ages consisted the major group (%51). %66 of the cases were referred from other medical facilities, whereas %44 of the appliances were directly made to our Emergency Department. %44 of the cases were admitted between the hours 08-16, %46 between 16-24 and%10 between 24-08. Regarding the causes of trauma falls (% 45) were in the first place followed by motor vehicle accidents (%42). %15 of the cases had trauma more than in one system. When the cases were compared regarding the Glasgow Coma Scale (GCS) at admission, %60 were between GCS 14-15, %26 were between GCS 9-13 and%14 were under GCS 8. %96 of the patients had cranial injuries, %3 had spinal injuries and %1 had both. From the operated 88 patients %34 were epidural hematoma and %20 were subdural hematoma. The time interval between admission and diagnosis in %78 of the cases were 0-2 hours and in%17 of the cases 2-4 hours. %81 of the operated patients were operated on in four hours after the diagnosis was made. Regarding the outcome scale %75 were good, % 7 were moderate disabled, %4 were severely disabled and %13 were death.