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TRAUMA PATIENTS WITH SOLID ORGAN INJURY: RESULTS FROM A BORDER TOWN HOSPITAL IN TURKEY
Ahmet Cem Dural1, Candas Ercetin2, Tugan Tezcaner3, Mahir Kirnap4, Nazli Ferhan Sayit5, Esin Kabul Gurbulak6, Bunyamin Gurbulak7, Hakan Yigitbas21Bakırkoy Dr. Sadi Konuk Training and Research Hospital, General Surgery, Istanbul, Turkey2Bagcilar Training and Research Hospital, General Surgery, Istanbul,Turkey
3Baskent University Faculty of Medicine, General Surgery Department, Ankara, Turkey
4Baskent University Faculty of Medicine, General Surgery Department, Ankara,Turkey
5Nizip State Hospital, General Surgery, Gaziantep,Turkey
6Sisli Etfal Training and Research Hospital, General Surgery, Istanbul,Turkey
7Arnavutkoy State Hospital, General Surgery, Istanbul,Turke
8Bagcilar Training and Research Hospital, General Surgery, Istanbul,Turkey
Introduction: We aimed to categorize retrospectively trauma patients by using an anatomical (Injury Severity Score - ISS) and a physiological (Revised Trauma Score - RTS) scoring system in our center, which is established near the east border of Turkey where the specialists are working temporarily during their compulsory medical service. Material and methods: Twenty-five trauma patients who admitted in Igdir Government Hospital with Abbreviated Injury Scale (AIS) scores >3 who has undergone life saving surgery due to a hemodynamically unstable solid organ injury between September 2010 to September 2011 were evaluated retrospectively. The ?2 test was used for categorical variables, the Student t test was used for comparisons of continuous variables. The Mann-Whitney U test was used for other nonparametric quantitative data. A P value less than 0.05 was considered statistically significant. Results: Mean age of the patients was 32.4 years (19-64) and male/female ratio was 19/6. The most frequently detected trauma mechanism was traffic accident (n=12). The most frequently injured solid organ was liver (n=14). The mean initial ISS was 23.6±19.9 and RTS was 6.7±1.8. ISS was higher than 60 pts in four patients, in parallel with their lower mean RTS scores (3.1±1.8) (p<0.05). The mortality rate of this subgroup was 100% (p<0.001). Overall, 7 (28%) of patients had multiple traumas with a mortality rate of 57.1%, while in 4 of them all three body cavities were traumatized. Conclusion: In our level II trauma center which does not have full availability specialties, personnel and equipment; health care, transfer and management of the severe trauma patients who couldn’t be referred to major trauma centers were accomplished properly in accordance with surgical treatment algorithms and trauma scores of the patients. Treatment results of our patients appear to be similar to those reported in the current literature.
Keywords: Injury Severity Score; Revised Trauma Score; Multitrauma.SOLİD ORGAN YARALANMALI TRAVMA HASTALARI: TÜRKİYE’NİN BİR SINIR İLİ HASTANESİNİN SONUÇLARI
Ahmet Cem Dural1, Candas Ercetin2, Tugan Tezcaner3, Mahir Kirnap4, Nazli Ferhan Sayit5, Esin Kabul Gurbulak6, Bunyamin Gurbulak7, Hakan Yigitbas21Bakırkoy Dr. Sadi Konuk Training and Research Hospital, General Surgery, Istanbul, Turkey2Bagcilar Training and Research Hospital, General Surgery, Istanbul,Turkey
3Baskent University Faculty of Medicine, General Surgery Department, Ankara, Turkey
4Baskent University Faculty of Medicine, General Surgery Department, Ankara,Turkey
5Nizip State Hospital, General Surgery, Gaziantep,Turkey
6Sisli Etfal Training and Research Hospital, General Surgery, Istanbul,Turkey
7Arnavutkoy State Hospital, General Surgery, Istanbul,Turke
8Bagcilar Training and Research Hospital, General Surgery, Istanbul,Turkey
Giriş: Türkiye’nin doğu sınırında yeralan, uzmanlarının çoğu devlet hizmet yükümlülüğü kapsamında geçici süre ile çalışan hastanemize başvuran travma olgularının anatomik (Yaralanma Ciddiyet Skoru - YCS) ve fizyolojik (Revize Travma Skoru - RTS) skorlama sistemlerine değerlendirilmesi amaçlandı. Yöntem ve Gereç: Eylül 2010 – 2011 arasında Iğdır Devlet Hastanesi’ne travma nedeniyle getirilen, Kısaltılmış Yaralanma Ölçeği (KYÖ) >3, solid organ yaralanması saptanmış ve hemodinamik instabilite nedeniyle cerrahi uygulanan olgular retrospektif olarak değerlendirildi. Kategorik veriler ?2 testi, sürekli değişkenler student t testi, non parametrik veriler Mann Whittney U testi kullanılarak analiz edildi. P değerinin 0,05’ten düşük olması istatistiksel anlamlı kabul edildi. Bulgular: Yirmi beş olgunun yaş ortalaması 32,4 (19-64) olup, erkek/kadın oranı 19/6 idi. Trafik kazası (n=12) en sık travma mekanizması, karaciğer en sık yaralanan solid organdı (n=14). Ortalama YCS 23,6±19,9 ve RTS 6,7±1,8 idi. YCS 60’ın üzerinde olan dört olguda buna paralel olarak ortalama RTS’nin düşük olduğu saptandı (3,1±1,8) (p<0,05). Bu subgrupta mortalite %100’dü (p<0.001). Tüm olguların 7’sinde (%28) multitravma olup mortalite %57,1 idi, bu dört olguda da üç boşluğu etkileyen multitravma mevcuttu. Sonuç: Tam donanımlı travma merkezi kapsamında sayılmayan II. seviye acil hizmeti sunan hastanemizde kısıtlı imkanlara rağmen, üst merkezlere sevki edilemeyecek ciddi travma olgularının cerrahi algoritmalara uygun ve travma skorları ile örtüşecek şekilde bakım, sevk ve idaresinin yapıldığı görülmüştür. Tedavi sonuçları mevcut literatür ile benzer bulunmuştur.
Anahtar Kelimeler: Yaralanma Ciddiyet Skoru;Revize Travma Skoru;Multitravma.Manuscript Language: English