Acil cerrahi yo�un bak�ma kabul edilen pediyatrik travma hastalar�n�n prognozunun tahmininde iyonize kalsiyum d�zeyleri ve trombosit say�lar� kullan�labilir mi?

Koltka, Kemalettin; ilhan, Mehmet; G�k, Ali Fuat Kaan; G�nay, Kay�han; Ertekin, Cemalettin

Cilt : 28 Say� : 5 Y�l : 2024

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Acil cerrahi yo�un bak�ma kabul edilen pediyatrik travma hastalar�n�n prognozunun tahmininde iyonize kalsiyum d�zeyleri ve trombosit say�lar� kullan�labilir mi? [Ulus Travma Acil Cerrahi Derg]

Ulus Travma Acil Cerrahi Derg. 2022; 28(5): 579-584 | DOI: 10.14744/tjtes.2022.17329

Acil cerrahi yo�un bak�ma kabul edilen pediyatrik travma hastalar�n�n prognozunun tahmininde iyonize kalsiyum d�zeyleri ve trombosit say�lar� kullan�labilir mi?

Kemalettin Koltka¹, Mehmet ilhan², Ali Fuat Kaan G�k², Kay�han G�nay², Cemalettin Ertekin²
¹�stanbul �niversitesi �stanbul T�p Fak�ltesi, Anesteziyoloji Anabilim Dal�, �stanbul
²�stanbul �niversitesi �stanbul T�p Fak�ltesi, Genel Cerrah�̇ Anabilim Dal�, �stanbul

AMA�: Yaralanma, bir ya��ndan b�y�k pediyatrik pop�lasyon i�in �nde gelen �l�m nedenidir ve bu �l�mlerin %95�i d��k ve orta gelirli �lkelerden gelmektedir. Yaralanan pediyatrik hastalar�n �o�u 1. basamak hastanelerde tedavi edilmektedir. Belli travma merkezlerinde, a��r yaral� hastalar�n sonu�lar� daha iyidir. Yo�un bak�m �nitelerinde (YB�) puanlama sistemleri triyaj i�lemini kolayla�t�rmak ve prognozu tahmin etmek amac�yla s�kl�kla kullan�lmaktad�r. Ancak baz� puanlama sistemleri ek, pahal� ve zaman al�c� testler gerektirebilmektedir. Bu �al��man�n amac�, acil cerrahi servisine ba�vuran pediyatrik travma hastalar�n�n prognozunu �ng�rmek i�in ba�lang��taki iyonize kalsiyum seviyeleri ve trombosit say�lar� ile baz� skorlama sistemlerini kar��la�t�rmakt�.
GERE� VE Y�NTEM: Bu geriye d�n�k �al��ma, ��nc� basamak bir �niversite hastanesinde yap�ld�. Hastalar�n ya�, cinsiyet, travma etiyolojileri, travma tipleri, travma zaman�, nakil yeri (birincil veya ikincil), yo�un bak�mda ve hastanede kal�� s�releri, �l�m oranlar�, ba�lang��taki iyonize kalsiyum d�zeyleri (Ca+2), ba�lang�� trombosit say�lar� ve �e�itli travma skorlar�n�n (GCS, RTS, ISS, TRISS ve PTS) verileri analiz edildi.
BULGULAR: Y�z on d�rt pediyatrik travma hastas� yo�un bak�m �nitesine yat�r�ld�. Ortalama ya� 77.8�54 ayd�. Hastalar�n �o�unlu�u erkekti, d��me birincil yaralanma etiyolojisiydi ve kafa travmas� en yayg�n yaralanma �ekliydi. Mortalite oran� %15.8 olup, Ca+2, trombosit say�lar�, GCS, RTS, TRISS ve PTS de�erleri hayatta kalanlarda daha y�ksek bulunurken, ISS skorlar� �lenlerde daha y�ksek bulundu.
TARTI�MA: Yo�un bak�ma al�nan �ocuk hastalar�n �o�unun 10 ya��ndan k��k oldu�u ve erkek oldu�u belirlendi. D��me en yayg�n yaralanma etiyo-lojisiydi ve yo�un bak�m �nitesine kabul edilen pediyatrik hastalar�n �o�unda kafa travmas� mevcuttu. Pediyatrik travma hastalar�na ili�kin mortalite ve prognozun belirlenmesinde travma skorlama sistemleri ile birlikte ba�lang�� Ca+2 seviyeleri ve trombosit say�lar� kullan�labilir.

Anahtar Kelimeler: Ca+2 seviyeleri, pediatrik travma, travma skorlar�; trombosit say�s�; yo�un bak�m �nitesi.

Can ionized calcium levels and platelet counts used for estimating the prognosis of pediatric trauma patients admitted to the emergency surgery intensive care?

Kemalettin Koltka¹, Mehmet ilhan², Ali Fuat Kaan G�k², Kay�han G�nay², Cemalettin Ertekin²
¹Department of Anesthesiology, �stanbul University �stanbul Faculty of Medicine, �stanbul-Turkey
²Department of General Surgery, �stanbul University �stanbul Faculty of Medicine, �stanbul-Turkey

BACKGROUND: Injury is the leading cause of death for pediatric population older than 1 year of age and 95% of those deaths are from the low- and middle-income countries. Most of those injured pediatric patients are treated in general hospitals. In designated trauma centers, the outcomes of severely injured patients are better. Scoring systems used frequently in intensive care units (ICUs) to make triage easier and to estimate prognosis. However, some of the scores may require additional expensive and sometimes time consuming tests. The purpose of the present study was to compare the usefulness of several scoring systems with initial ionized calcium levels and platelet counts to predict prognosis of pediatric trauma patients admitted to the emergency surgery department.
METHODS: This retrospective study was performed at a tertiary university hospital. The patients� ages, genders, trauma etiologies, types of trauma, time of trauma, transport place (primary or secondary), duration of stay in the ICU and in the hospital, mortality rates, initial ionized calcium levels (Ca+2), initial platelet counts, and data of several trauma scores (GCS, RTS, ISS, TRISS, and PTS) were analyzed.
RESULTS: One hundred and fourteen pediatric trauma patients were admitted to the ICU. The mean age was 77.8�54 months. Most of them were male, falls were the primary mechanism of injury, and head trauma was the most common pattern of injury. The mortality rate was 15.8%, and the admission values for Ca+2, platelet counts, GCS, RTS, TRISS, and PTS had been found higher for patients who survived, while ISS scores were higher for those who had died.
CONCLUSION: It was found that pediatric patients admitted to the ICU were younger than 10 years, of whom most of them were male. Falls were the most common mechanism of injury, and head trauma was present in most of the pediatric patients admitted to the ICU. Initial Ca+2 levels and platelet counts can be used along with the trauma scoring systems in predicting mortality and overall survey regarding pediatric trauma patients.

Keywords: Ca+2 levels, intensive care unit, pediatric trauma; platelet counts; trauma scores.

Sorumlu Yazar: Mehmet ilhan, T�rkiye
Makale Dili: �ngilizce

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