Penetran abdominal ate�li silah yaralanmas� olan Suriyeli m�lteci �ocuklarda mortalite ve morbidite i�in risk fakt�rleri: Bir y�ll�k deneyim

Tu�at, Mustafa; �zmen, �smail; Demirta�, Mehmet Semih; Ate�, Can; �zt�rk, Ayse Bet�l; Kank�l��, Naz�m Abdulkadir; Ba�ar, Dilek

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Penetran abdominal ate�li silah yaralanmas� olan Suriyeli m�lteci �ocuklarda mortalite ve morbidite i�in risk fakt�rleri: Bir y�ll�k deneyim [Ulus Travma Acil Cerrahi Derg]

Ulus Travma Acil Cerrahi Derg. 2023; 29(9): 1051-1060 | DOI: 10.14744/tjtes.2023.70658

Penetran abdominal ate�li silah yaralanmas� olan Suriyeli m�lteci �ocuklarda mortalite ve morbidite i�in risk fakt�rleri: Bir y�ll�k deneyim

Mustafa Tu�at¹, �smail �zmen², Mehmet Semih Demirta�³, Can Ate�⁴, Ayse Bet�l �zt�rk¹, Naz�m Abdulkadir Kank�l��⁵, Dilek Ba�ar⁶
¹Aksaray �niversitesi, T�p Fak�ltesi, �ocuk Cerrahisi Anabilim Dal�, Aksaray, T�rkiye
²Kilis Devlet Hastanesi, �ocuk Cerrahisi, Kilis, T�rkiye
³Aksaray �niversitesi, T�p Fak�ltesi, �ocuk Sa�l�� ve Hastal�klar�, Aksaray, T�rkiye
⁴Aksaray �niversitesi, T�p Fak�ltesi, Biyoistatistik ve Medikal �nformatik Anabilim Dal�, Aksaray, T�rkiye
⁵Aksaray �niversitesi, T�p Fak�ltesi, �roloji Anabilim Dal�, Aksaray, T�rkiye
⁶Trabzon Kanuni E�itim Ara�t�rma Hastanesi, �ocuk Cerrahisi, Trabzon, T�rkiye

AMA�: �ocuklarda ate�li silahlar nedeniyle meydana gelen bat�n yaralanmalar�, geli�en teknoloji ve ameliyat tekniklerine ra�men y�ksek komplikas-yon ve mortaliteye sahip travmalard�r. Bu �al��mada, Suriye�deki sivil sava� sonucu �ocuklarda meydana gelen y�ksek h�zl� mermi ve �arapnel kaynakl� meydana gelen penetran abdominal ate�li silah yaralanmalar�nda mortalite ve komplikasyona etki eden fakt�rler de�erlendirilmi�tir.
GERE� VE Y�NTEM: Bu �al��ma Kilis Devlet hastanesinde Ocak 2016-�ubat 2017 tarihleri aras�nda penetran abdominal ate�li silah yaralanmas� sonucu ba�vuran 53 hasta ile vaka serisi olarak yap�lm��t�r. T�rkiye�nin Suriye ile s�n�r ili olan Kilis�deki devlet hastanesine Suriye�deki i� sava� sonucu penetran abdominal ate�li silah yaralanmas�na u�rayan ve hastanemize transvers edilip ameliyat edilen 6 ay-17 ya� aras� hastalar de�erlendirmeye al�nd�. Hastalar�n sosyodemografik bilgileri, cerrahiye kadar ge�en s�re, yaralanan abdominal organ say�s�, yaralanmaya neden olan ate�li silah tipi, b�y�k damar yaralanmas� ve ekstremite yaralanmas� e�lik etmesi, laparatomiye ek olarak torakotomi gerektiren toraks yaralanmas� varl��, kolostomi uygulanmas�, penetran abdominal travma indeksi, pediatrik travma skoru ve �ok durumu de�erlendirildi.
BULGULAR: �al��mam�zda penetran abdominal travma indeksi�nin y�ksek olmas�n�n istatistiksel olarak komplikasyon ve mortalite oranlar�n� artt�r-d�� bulunmu�tur (p<0.001, p=0.002). Ayr�ca pediatrik travma skoru�nun d��k olmas�n�n komplikasyon geli�imini ve mortaliteyi istatistiksel olarak artt�rd�� tespit edilmi�tir (p=0.001, p<0.00). PTS>8 olan hastalar�n hi�birinde mortalite g�zlenmemi� olup, PTS≤8 olan hastalarda %27.3 oran�nda mortalite g�zlenmi� ve bu sonucun istatistiksel olarak anlaml� oldu�u tespit edilmi�tir (p=0.003). �ok tablosunun mortaliteyi anlaml� olarak artt�rd�� ve �ok tablosunda olmayan hi�bir hastan�n hayat�n� kaybetmedi�i tespit edilmi�tir (p<0.001). �al��mam�zda yaralanan intraabdominal organ say�s�n�n artmas�n�n hem komplikasyon hem de mortalite �zerinde istatistiksel olarak anlaml� �ekilde etkili oldu�u belirlendi (p<0.001, p=0.002). SONU�: Penetran abdominal ate�li silah yaralanmas� olan �ocuk hastalarda penetran abdominal travma indeksi ve pediatrik travma skorunun mortalite ve morbiditeyi �ng�rmede etkin oldu�u tespit edilmi�tir. �at��ma alanlar�nda h�zl� ve etkin �ekilde ilk m�dahalenin yap�ld�ktan sonra uygun transportun sa�lanmas� bu hasta grubunda olduk�a �nemlidir.

Anahtar Kelimeler: �ocuk, penetran abdominal yaralanma, ate�li silah yaralanma; mortalite; morbidite.

Risk factors for mortality and morbidity in Syrian refugee children with penetrating abdominal firearm injuries: an 1-year experience

Mustafa Tu�at¹, �smail �zmen², Mehmet Semih Demirta�³, Can Ate�⁴, Ayse Bet�l �zt�rk¹, Naz�m Abdulkadir Kank�l��⁵, Dilek Ba�ar⁶
¹Department of Pediatric Surgery, Faculty of Medicine, Aksaray University, Aksaray-T�rkiye
²Department of Pediatric Surgery, Kilis State Hospital, Kilis-T�rkiye
³Department of Pediatrics, Aksaray University, Faculty of Medicine, Aksaray-T�rkiye
⁴Department of Biostatistics and Medical Informatics, Aksaray University, Faculty of Medicine, Aksaray-T�rkiye
⁵Department of Urology, Aksaray University, Faculty of Medicine, Aksaray-T�rkiye
⁶Department of Pediatric Surgery, Trabzon Kanuni Training and Research Hospital, Trabzon-T�rkiye

BACKGROUND: Despite improvements in technology and surgical techniques, abdominal injuries caused by firearms in children are traumatic with high complication rates and mortality. In this study, factors affecting mortality and complications in penetrating abdominal firearm injuries caused by high-velocity bullets and shrapnel in children as a result of the civil war in Syria were evaluated.
METHODS: This study was conducted as a case series with 53 patients admitted to Kilis State Hospital with penetrating abdominal firearm injuries between January 2016 and February 2017. Patients aged between 6 months and 17 years who suffered penetrating abdominal firearm injuries (PAFI) as a result of the civil war in Syria in the state hospital in Kilis T�rkiye border province with Syria and were transferred to our hospital and operated on were included in the evaluation. Patients� sociodemographic information, time to surgery, number of abdominal organs injured, type of firearm causing injury, presence of large vessel injury and extremity injury, presence of thoracic injury requiring thoracotomy in addition to laparotomy, colostomy, penetrating abdominal trauma index, pediatric trauma score (PTS), and shock status were evaluated.
RESULTS: In our study, it was found that a high penetrating abdominal trauma index significantly increased complication rates and mortality (P<0.001 and P=0.002, respectively). In addition, it was found that lower PTSs significantly increased the development of complications and mortality (P=0.001 and P<0.001, respectively). Mortality was not observed in any of the patients with a PTS>8, whereas mortality was observed in 27.3% of patients with a PTS≤8, and this result was statistically significant (P=0.003). Shock sig-nificantly increased mortality, and no patient who was not in shock died (P<0.001). In our study, it was determined that the increase in the number of injured intra-abdominal organs had a significant effect on both complications and mortality (P<0.001 and P=0.002, respectively).
CONCLUSION: The penetrating abdominal trauma index and PTS were found to be effective in predicting mortality and morbidity in pediatric patients with PAFI. It is crucial in this patient group to provide appropriate transport after the first intervention is done rapidly and effectively in conflict zones.

Keywords: Child, firearm injury, morbidity; mortality; penetrating abdominal injury.

Sorumlu Yazar: Mustafa Tu�at, T�rkiye
Makale Dili: �ngilizce

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