Ateþli silah yaralanmalarýnýn ikinci basamak bir saðlýk kuruluþunda travma skorlama sistemleri ile deðerlendirilmesi

AMAÇ: Travma hastalarýnda skorlama sistemleri yaygýn olarak kullanýlmaktadýr ve travma hastalarýnýn bakýmýnda oldukça önemlidir. Bu çalýþmada, travma merkezi olmayan bir hastaneye ateþli silah yaralanmasý nedeniyle getirilen hastalarýn, skorlama sistemleri ile deðerlendirilmesi ve travma merkezinde tedavi olmasý gereken hastalarýn tanýmlanmasýnda skorlama sistemlerinin etkinliðinin araþtýrýlmasý amaçlandý.
GEREÇ VE YÖNTEM: Ocak 2010–Aralýk 2019 tarihleri arasýnda ateþli silah yaralanmasý nedeni ile Hakkari Yüksekova Devlet Hastanesi’ne getirilen hastalar geriye dönük olarak araþtýrýldý. On altý yaþ ve üzeri hastalar çalýþmaya alýndý. Hayatýný kaybetmiþ olarak hastaneye getirilen hastalar ve hastanede kardiyopulmoner resüsitasyona yanýt alýnmayan hastalar çalýþma dýþý býrakýldý. Ayrýca ayaktan basit týbbi müdahale yapýlan hastalarda hasta grubuna dahil edilmedi. Hastalar, demografik olarak deðerlendirildi. Travma hastalarýnýn deðerlendirilmesinde yaygýn olarak kullanýlan travma skorlama sistemlerinin mortalite öngörüsü incelendi. Ayrýca travma merkezlerinde tedavi olmasý gereken hastalarýn tanýmlanmasýnda skorlama sistemlerinin etkinliði araþtýrýldý.
BULGULAR: Çalýþmada %96.9’u erkeklerden oluþan 331 hasta deðerlendirildi. Hasta grubu genç hastalardan oluþtu ve yaþ median deðeri 27 (IQR, 24–29) yýl olarak bulundu. Yetmiþ dört (%22.4) hasta taný ve tedavi için travma konusunda referans olan hastanelere yönlendirildi. Toplam 46 (%13.9) hastada mortalite geliþti. Hastalarda Glasgow Koma Skoru, Yaralanma Ciddiyeti Skoru, Revize Travma Skoru, Yeni Travma Skoru ve Revize Travma Yaralanma Ciddiyeti Skoru mortalite öngörüsü için etkin bulundu ve skorlama sistemleri birbirleri ile korelesyon gösterdi. Ancak travma merkezinde tedavi olmasý gereken hastalarýn ayýrýmýnda skorlama sistemleri etkin bulunmadý.
TARTIÞMA: Skorlama sistemleri ateþli silah yaralanmasý olan hastalarýn mortalite tahmininde anlamlýdýr. Ancak travma merkezine yönlendirilmesi gerekli hastalarýn ayýrýmýnda travma skorlama sistemleri etkin bulunmamýþtýr.

Evaluation of firearm injuries by trauma scoring systems in a secondary health care institution

BACKGROUND: Scoring systems are widely used in trauma patients and are very important in the care of trauma patients. The objective of this study was to investigate the effectiveness of scoring systems in evaluating the patients who were brought to a hospital without a trauma center due to firearm injuries (FIs) using scoring systems, and the efficacy of these systems in identifying patients who should be treated in a trauma center.
METHODS: Patients brought to Hakkari Yüksekova State Hospital due to FIs between January 2010 and December 2019 were retrospectively investigated. Patients aged 16 and over were included in the study. Patients who were brought to the hospital while deceased and those who did not respond to cardiopulmonary resuscitation in the hospital were excluded from the study. In addition, patients who underwent simple outpatient medical intervention were not included in the patient group. Patients were evaluated demographically. The mortality predictions of trauma scoring systems, which are widely used in the evaluation of trauma patients, were examined. In addition, the effectiveness of scoring systems in identifying patients who should be treated in trauma centers was investigated.
RESULTS: In the study, 331 patients, 96.9% of whom were male, were evaluated. The patient group consisted of young patients and the median age was 27 (IQR, 24–29) years. A total of 74 (22.4%) patients were referred to trauma referral hospitals for diagnosis and treatment. Mortality occurred in 46 (13.9%) patients. Glasgow coma scale, injury severity score (ISS), revised trauma score, new trauma score, and trauma revised ISS were found effective for predicting mortality in patients, and scoring systems were correlated with each other. However, scoring systems were not found effective in distinguishing patients who should be treated in a trauma center.
CONCLUSION: Scoring systems are significant in predicting mortality of patients with gunshot wounds. However, trauma scoring systems have not been found to be effective in distinguishing patients who require referral to a trauma center.