Ulus Travma Acil Cerrahi Derg. 2023; 29(1): 68-72 | DOI: 10.14744/tjtes.2022.94475

Abdominal travmalý hastalar için kullanýlan travma skor sistemlerinin analizi

Youngjin Jang¹, Heungman Jun^2
1Ulsan Üniversitesi Týp Fakültesi, Asan Týp Merkezi, Cerrahi Anabilim Dalý, Seul-Kore Cumhuriyeti
²Kore Üniversitesi Anam Hastanesi, Kore Üniversitesi Týp Fakültesi, Cerrahi Anabilim Dalý, Seul-Güney Kore

AMAÇ: Bu çalýþmada, abdominal travmasý olan hastalarda Yaralanma Þiddet Skoru (ISS), Klinik Abdominal Skorlama Sistemi (CASS), Yeni Yaralanma Þiddet Skoru (NISS) dahil olmak üzere çeþitli travma skor sistemleri ile laparotomi, hastane içi mortalite (IHM) ve uzun hastanede kalýþ süresi (LS) dahil klinik sonuçlar arasýndaki korelasyonlar araþtýrýlmýþtýr.
GEREÇ VE YÖNTEM: Ocak 2009 ile Aralýk 2019 tarihleri arasýnda abdominal travma geçiren 749 hastanýn verileri geriye dönük olarak incelendi. Týbbi kayýtlardan elde edilen veriler arasýnda yaþ, cinsiyet, baþlangýç yaþamsal bulgular, travma tipi ve mekanizmasý, hastanede kalýþ süresi, laparotomi ve hastane içi mortalite (IHM) yer almaktadýr. Yaralanmýþ organlar ve derecelerine ait bilgiler bilgisayarlý tomografi kullanýlarak toplandý. Skor sistemi ile klinik sonuçlar arasýndaki korelasyonlar, Alýcý Çalýþma Karakteristikleri (ROC) eðrisinin Eðri Altýndaki Alaný (AUC) kullanýlarak analiz edildi. BULGULAR: Hastalarýn ortalama yaþý 40.14±19.47 yýldý. Yedi yüz dört hastada (%94.0) en sýk travma tipi künt travma, 475 hastada (%63.4) ise trafik kazasý en sýk görülen nedendi. Yaralanmýþ organlar arasýnda karaciðer (%45.1) ve dalak (%25.1) mevcuttu. Toplam 179 hastaya (%23.9) laparotomi uygulanmýþ ve 35 hastada (%4.6) IHM bildirilmiþti. ISS, NISS ve CASS için ROC’nin AUC’si laparotomi ile anlamlý þekilde iliþkiliydi (0.682; p=0.001, 0.713; p=0.001; 0.845; p=0.001). AUC’ler, IHM için istatistiksel olarak anlamlýlýk gösterdi (0.606; p=0.034, 0.626; p=0.012, 0.701; p=0.001). Uzun hastanede kalýþ süresi (LS) için AUC’ler 0.554 (p=0.041), 0.549 (p=0.062) ve 0.581 (p=0.002) idi.
TARTIÞMA: Klinik Abdominal Skorlama Sistemi (CASS), abdominal travmalý hastalarda laparotomi, IHM ve LS’yi öngörmek için mükemmeldir. Yeni Yaralanma Þiddet Skoru (NISS), laparotomi ve IHM’yi öngörmek için ISS’den daha uygundur.

Anahtar Kelimeler: Hastane içi mortalite, klinik abdominal skorlama sistemi; travma skor sistemleri; yaralanma þiddet skoru; yeni yaralanma þiddet skoru.

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Analysis of trauma scoring system for patients with abdominal trauma

Youngjin Jang¹, Heungman Jun^2
1Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul-Republic of Korea
²Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul-Korea-South

BACKGROUND: This study investigated the correlations between several trauma scoring systems, including the injury severity score (ISS), clinical abdominal scoring system (CASS), new injury severity score (NISS), and clinical outcomes, including laparotomy, in-hospital mortality (IHM), and long hospital stay (LS) in patients with abdominal trauma.
METHODS: Data of 749 patients with abdominal trauma between January 2009 and December 2019 were reviewed retrospectively. Data from medical records included age, sex, initial vital signs, type and mechanism of trauma, hospital stay, laparotomy, and IHM. Injured organs and grades were collected using computed tomography. Correlations between the scoring system and clinical outcomes were analyzed using the area under Curves (AUC) of the receiver operating characteristic (ROC) curve.
RESULTS: The mean age of the patients was 40.14±19.47 years. Blunt trauma was the most common type of trauma in 704 patients (94.0%), and traffic accident was the most common mechanism in 475 (63.4%). Injured organs included liver (45.1%) and spleen (25.1%). A total of 179 patients (23.9%) underwent laparotomy and IHM was reported in 35 (4.6%). The AUC of ROC for ISS, NISS, and CASS was significantly associated with laparotomy (0.682; p=0.001, 0.713; p=0.001; 0.845; p=0.001). The AUCs showed significant for IHM (0.606; p=0.034, 0.626; p=0.012, 0.701; p=0.001). The AUCs for LS were 0.554 (p=0.041), 0.549 (p=0.062), and 0.581 (p=0.002).
CONCLUSION: The CASS is excellent for predicting laparotomy, IHM, and LS in patients with abdominal trauma. The NISS is more appropriate than the ISS for predicting laparotomy and IHM.

Keywords: Clinical abdominal scoring system, in-hospital mortality; injury severity score; new injury severity score; trauma scoring systems.

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