Ulus Travma Acil Cerrahi Derg. 2015; 21(6): 477-483 | DOI: 10.5505/tjtes.2015.43077

Künt travma sonucu yaralanan hastalarýn çok yönlü analizi ve mortaliteye etkili faktörler

Adnan Özpek¹, Metin Yücel¹, Ýbrahim Atak¹, Gürhan Baþ¹, Orhan Alimoðlu^2
1Ümraniye Eðitim Ve Araþtýrma Hastanesi, Genel Cerrahi Kliniði, Ýstanbul
²Medeniyet Üniversitesi Týp Fakültesi, Genel Cerrahi Anabilim Dalý, Ýstanbul

AMAÇ: Bu çalýþmada künt travmaya baðlý yaralanma nedeniyle kliniðimize yatýrarak tedavi ettiðimiz hastalarýn çok yönlü analizini ve mortaliteye etkili faktörleri belirlemeyi amaçladýk.
GEREÇ VE YÖNTEM: Ocak 2009 ile Ocak 2013 tarihleri arasýnda, künt travmaya baðlý yaralanma nedeniyle kliniðimize yatýrarak tedavi ettiðimiz 237 hasta geriye dönük olarak incelendi. Hastalar yaþ, cinsiyet, travmanýn þekli, yaralanma bölgeleri, Yaralanma Þiddet Skoru (ISS), Revize Edilmiþ Travma Skoru (RTS), FAST sonuçlarý, hemodinamik durum, transfüzyon gereksinimi, uygulanan tedavi yöntemi, tedavi sonuçlarý ve mortalite yönünden analiz edildi.
BULGULAR: Hastalarýn 187’si (%78.9) erkek, 50’si (%21.1) kadýn, yaþ ortalamasý 36.9±16.9 (3–81 yýl) idi. Hastalarýn 131’inde (%55.3) torakal, 110’unda (%46.4) abdominal, 96’sýnda (%40.5) pelvis ve ekstremite, 34’ünde (%14.3) baþ ve boyun, 26’sýnda (%11) maksillofasyal, 24’ünde (%10.1) ise cilt ve cilt altý yumuþak doku yaralanmasý mevcuttu. Hemodinamik instabilite nedeniyle 33, peritonit bulgularý nedeniyle 12 hasta olmak üzere toplam 45 (%19) hasta ameliyat edildi. Hastalarýn 26’sýnda (%11) mortalite görüldü ve bunlarýn 10’unda (%38.5) instabil pelvis kýrýðý bulunmaktaydý. Packing gereken hastalarda %75, packing gerekmeyenlerde %33.3; hemodinamisi instabil hastalarda %60.6, hemodinamisi stabil olanlarda %8.3 ve FAST (+) hastalarda %20.5, FAST (–) hastalarda %3.4 mortalite belirlendi (p<0.05). Hastalarýn tümünde ortalama ISS deðeri 18.4, RTS deðeri 7.30, transfüzyon gereksinimi 1.6 Ü. olarak hesaplanýrken; ölen hastalarda ise ayný sýrayla 44.6, 4.22 ve 7.8 Ü. olarak hesaplandý (p<0.05).
TARTIÞMA: Künt travmalar genellikle birden fazla anatomik bölgede yaralanmaya neden olmakta; torakal, abdominal ve pelvik bölge yaralanmalarý sýklýkla birbirine eþlik etmektedir. Abdominal solid organ yaralanmalarýnýn büyük kýsmý nonoperatif olarak takip ve tedavi edilebilmektedir. Çalýþma sonuçlarýmýz ISS, RTS, FAST sonucu, hemodinamik instabilite, packing ve transfüzyon gereksiniminin mortalite riskini belirlemede istatistiksel olarak deðerli olduðunu göstermektedir.

Anahtar Kelimeler: Künt travma, mortalite; multitravma; Revize Edilmiþ Travma Skoru; transfüzyon; Yaralanma Þiddet Skoru.

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Multivariate analysis of patients with blunt trauma and possible factors affecting mortality

Adnan Özpek¹, Metin Yücel¹, Ýbrahim Atak¹, Gürhan Baþ¹, Orhan Alimoðlu^2
1Department Of General Surgery, Umraniye Training And Research Hospital, Istanbul
²Department Of General Surgery, Medeniyet University Faculty Of Medicine, Istanbul

BACKGROUND: This study aimed to investigate the signs and prognosis of the patients hospitalized due to blunt trauma injuries and identify possible factors that affect mortality.
METHODS: Between January 2009 and January 2013, a total of 237 patients admitted with blunt trauma injury were retrospectively analyzed. The age and gender of the patients, type of the trauma, injury site, Injury Severity Scores (ISS), Revised Trauma Scores (RTS), Focused Assessment with Sonography in Trauma (FAST) results, hemodynamic status, need for transfusion, treatment modalities, treatment outcomes, and mortality rates were recorded.
RESULTS: Of the patients, 187 (78.9%) were male, 50 (21.1%) were female and mean age was 36.9±16.9 years (3–81 years). Of the patients, 131 (55.3%) suffered thoracic injuries, 110 (46.6%) abdominal injuries, 96 (40.5%) pelvic and limb injuries, 34 (14.3%) head and neck injuries, 26 (11%) maxillofacial injuries, and 24 (10.1%) skin and subcutaneous tissue injuries. Forty-five patients (19%), including 33 patients with hemodynamic instability and 12 patients with peritonitis-related signs, were operated on. Mortality was seen in 26 patients (11%), including 10 (38.5%) with unstable pelvic fractures. Mortality rates; in patients with packing performed was 75%, in patients without any need for packing was 33.3%, in patients with hemodynamic instablity was 60.6%, in hemodynamically stable patients was 8.3% and in FAST (+) patients was 20.5%, in FAST(–) patients was 3.4% (p<0.05).
CONCLUSION: Blunt trauma often presents with multi-trauma involving more than one anatomical structure of the body. Thoracic, abdominal, and pelvic injuries usually accompany blunt trauma. The majority of abdominal solid organ injuries are followed nonoperatively. Our study results show that ISS, RTS, FAST result, hemodynamic unstability, packing requirment, and need for transfusion are statistically invaluable in identifying the mortality risk.

Keywords: Blunt trauma, Injury Severity Score; mortality; multi-trauma; Revised Trauma Score; transfusion.

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