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The Evaluation of The Factors Affecting Mortality in Trauma Patients Admitted to The Emergency Department

Year 2020, Volume: 3 Issue: 3, 76 - 80, 30.09.2020

Abstract

Aim: Trauma is still one of the leading causes of death in developing countries of the world. It often affects people in the younger age group and causes serious manpower loss. The aim of our study is to determine the factors affecting mortality in addition to the characteristics of patients who admitted to the emergency department of our university hospital due to trauma between 2011-2018 and to contribute to the trauma data of our country.

Material and Methods: Our study was a retrospective study evaluating the patients aged 18 and over who admitted to the Emergency Department of an University Hospital due to trauma between 01.01.2011 and 01.12.2018 and were accepted as exitus. Patients' age, gender, type of trauma, admission date to hospital (day, month, year, hour), admission type, transportation type, blood pressure (systolic-diastolic), heart rate, Glasgow Coma Score, injury site, injury type, blood alcohol level , survival time and place of death were recorded.

Results: According to the type of trauma, the most frequent type of trauma was traffic accident (33.5%) and the least frequent was accepted as drowning (0.6%). The highest number of patient admissions were found in September (13.4%) and the least in December (5.8%). 18.9% of the patients were accepted ex in the emergency room, 74.6% in intensive care unit and 6.5% in other (operating rooms, clinics) places. There was a significant difference in terms of the survival time of the patients between the admission methods and the survival time of the referred patients was found to be significantly higher than the others.
Conclusion: As the duration of the patients in emergency department with multitrauma requiring a multidisciplinary approach increases, morbidity and mortality rates were found to be increased. It could be concluded that these periods can be shortened by establishing trauma teams and centers that work in coordination with the health services policies of our country.Regarding this,increasing the survival rate of patients while reducing the rate of morbidity due to trauma is targeted.

References

  • Brunett PH, Cameron PA. Trauma. In Tintinalli JE, Stapczynski JS, Ma OJ, Cline DM, Cydulka RK, Meckler GD, editors. Tintinalli’s Emergency Medicine A comprehensive study guide. 7th ed. New York: Mc Graw Hill; 2011;1671-76.
  • Minino AM, Heron MP, Smith BL. Deaths and death rates for the 10 leading causes of death in specified age groups: United States, preliminary 2004-Con. Nat Vital Stat Rep 2006; 54: 28-9.
  • World Health Organization. Global burden of disease. www.who.int/healthinfo/global burden disease/en/ (Accessed on May 01, 2019).
  • Feliciano, David, Mattox, et al. Trauma, 6th, McGraw-Hill, New York 2008.
  • CDC. National estimates of the ten leading causes of nonfatal injuries, Centers for Disease Control and Prevention 2004. www.cdc.gov/injury/wisqars.html (Accessed on May 01, 2019).
  • Mackenzie EJ, Rivara FP, Jurkovich GJ, et al. The National Study on Costs and Outcomes of Trauma. J Trauma 2007;63:S54-67.
  • Global Status on Road Safety 2015, World Health Organization, http://www.who.int/violence injury prevention/road safety status/2015/ (Accessed on May 01, 2019).
  • Evans JA, van Wessem KJ, McDougall D, et al. Epidemiology of traumatic deaths: comprehensive population-based assessment. World J Surg 2010;34:158-63.
  • MacKenzie EJ, Rivara FP, Jurkovich GJ, et al. A national evaluation of the effect of trauma-center care on mortality. N Engl J Med 2006;354:366-78.
  • Christmas AB, Reynolds J, Wilson AK, et al. Morbid obesity impacts mortality in blunt trauma. Am Surg 2007;73:1122-5.
  • Perel P, Prieto-Merino D, Shakur H, et al. Predicting early death in patients with traumatic bleeding: development and validation of prognostic model. BMJ 2012; 345:e5166.[PMID: 22896030].
  • Teixeira PG, Inaba K, Hadjizacharia P, et al. Preventable or potentially preventable mortality at a mature trauma center. J Trauma 2007;63:1338-47.
  • Teixeira PG, Inaba K, Salim A, et al. Preventable morbidity at a mature trauma center. Arch Surg 2009;144:536-41.
  • Demetriades D, Kimbrell B, Salim A, et al. Trauma deaths in a mature urban trauma system: is "trimodal" distribution a valid concept? J Am Coll Surg 2005;201:343-8.
  • Ali Ali B, Lefering R, Fortún Moral M, et al. Mortality in severe trauma patients attended by emergency services in Navarre, Spain: validation of a new prediction model and comparison with the Revised Injury Severity Classification Score II. Emergencias 2018;30(2):98-104.
  • Khan A, Zafar H, Naeem SN, et al. Transfer delay and in-hospital mortality of trauma patients in Pakistan. Int J Surg. 2010;8(2):155-158. doi:10.1016/j.ijsu.2009.10.012
  • Pekdemir M, Çete Y, Eray O ve ark. Travma hastalarının epidemiyolojik özelliklerinin araştırılması. Ulus Travma Derg 2000;6:250-4.
  • Lefering R, et al. Epidemiology of in-hospital trauma deaths. Eur J Trauma Emerg S 2012;38:3-9.
  • Trajano AD, Pereira BM, Fraga GP. Epidemiology of in-hospital trauma deaths in a Brazilian university hospital. BMC Emerg Med 2014;14:22-31.

Acil Servise Travma Nedeniyle Başvuran Hastalarda Mortaliteye Etki Eden Faktörlerin Değerlendirilmesi

Year 2020, Volume: 3 Issue: 3, 76 - 80, 30.09.2020

Abstract

Amaç: Travma dünyanın gelişmekte olan ülkelerinde halen en önde gelen ölüm nedenlerinden biridir. Genellikle genç yaş grubundaki insanları etkilenmekte ve ciddi işgücü kaybına da neden olmaktadır. Çalışmamızın amacı, 2011-2018 tarihleri arasında üniversitemiz acil servisine travma nedeniyle başvuran ve eksitus kabul edilen hastaların başvuru özelliklerine ek olarak mortaliteye etkili faktörleri saptamak ve ülkemiz travma verilerine katkıda bulunmaktır.

Gereç ve Yöntemler: Çalışmamız 01.01.2011 ile 01.12.2018 tarihleri arasında bir Üniversite Hastanesi Acil Servisine travma sebebi ile başvurup sonrasında eksitus kabul edilen 18 yaş ve üzeri olguların retrospektif olarak değerlendirilmesi ile gerçekleştirilmiştir. Hastaların yaş, cinsiyet, travma tipi, hastaneye başvuru tarihleri (gün, ay, yıl, saat), başvuru şekli, ulaşım şekli, kan basıncı(sistolik-diastolik), nabız, Glasgow Koma Skoru, yaralanma bölgesi, yaralanma tipi, kan alkol düzeyi, sağ kalım süresi, ölüm yeri kayıt altına alınmıştır.
Bulgular: Travma oluş şekline göre en sık olarak araç içi trafik kazası (%33,5), en az ise suda boğulma (%0,6) meydana gelmiştir. Hasta başvuruların aylara göre dağılımı bakıldığında; en çok hasta başvurusu Eylül ayında (%13,4), en az hasta başvurusu ise Aralık ayında (%5,8) olmuştur. Hastaların %18,9’u acil serviste, %74,6’sı yoğun bakımda ve %6,5’i diğer (ameliyathane, servis) yerlerde eksitus olarak kabul edilmiştir. Başvuru şekilleri arasında hastaların sağ kalım süreleri bakımından anlamlı fark olup sevkli hastaların sağ kalım süresi diğerlerine göre anlamlı olarak yüksek saptanmıştır.

Sonuç: Multitravmalı ve multidisipliner yaklaşım gerektiren hastaların acil serviste kalış süresi uzadıkça morbitite ve mortalite oranları da uzayan bu sürelerle birlikte artmaktadır. Ülkemizin sağlık hizmetleri politikalarına uygun koordineli çalışan travma takımları ve merkezleri oluşturularak bu sürelerin kısaltılabileceği öngörülmektedir. Böylece travmaya bağlı morbidite oranı azaltılırken hastaların sağ kalım oranının arttırılması hedeflenmektedir.

References

  • Brunett PH, Cameron PA. Trauma. In Tintinalli JE, Stapczynski JS, Ma OJ, Cline DM, Cydulka RK, Meckler GD, editors. Tintinalli’s Emergency Medicine A comprehensive study guide. 7th ed. New York: Mc Graw Hill; 2011;1671-76.
  • Minino AM, Heron MP, Smith BL. Deaths and death rates for the 10 leading causes of death in specified age groups: United States, preliminary 2004-Con. Nat Vital Stat Rep 2006; 54: 28-9.
  • World Health Organization. Global burden of disease. www.who.int/healthinfo/global burden disease/en/ (Accessed on May 01, 2019).
  • Feliciano, David, Mattox, et al. Trauma, 6th, McGraw-Hill, New York 2008.
  • CDC. National estimates of the ten leading causes of nonfatal injuries, Centers for Disease Control and Prevention 2004. www.cdc.gov/injury/wisqars.html (Accessed on May 01, 2019).
  • Mackenzie EJ, Rivara FP, Jurkovich GJ, et al. The National Study on Costs and Outcomes of Trauma. J Trauma 2007;63:S54-67.
  • Global Status on Road Safety 2015, World Health Organization, http://www.who.int/violence injury prevention/road safety status/2015/ (Accessed on May 01, 2019).
  • Evans JA, van Wessem KJ, McDougall D, et al. Epidemiology of traumatic deaths: comprehensive population-based assessment. World J Surg 2010;34:158-63.
  • MacKenzie EJ, Rivara FP, Jurkovich GJ, et al. A national evaluation of the effect of trauma-center care on mortality. N Engl J Med 2006;354:366-78.
  • Christmas AB, Reynolds J, Wilson AK, et al. Morbid obesity impacts mortality in blunt trauma. Am Surg 2007;73:1122-5.
  • Perel P, Prieto-Merino D, Shakur H, et al. Predicting early death in patients with traumatic bleeding: development and validation of prognostic model. BMJ 2012; 345:e5166.[PMID: 22896030].
  • Teixeira PG, Inaba K, Hadjizacharia P, et al. Preventable or potentially preventable mortality at a mature trauma center. J Trauma 2007;63:1338-47.
  • Teixeira PG, Inaba K, Salim A, et al. Preventable morbidity at a mature trauma center. Arch Surg 2009;144:536-41.
  • Demetriades D, Kimbrell B, Salim A, et al. Trauma deaths in a mature urban trauma system: is "trimodal" distribution a valid concept? J Am Coll Surg 2005;201:343-8.
  • Ali Ali B, Lefering R, Fortún Moral M, et al. Mortality in severe trauma patients attended by emergency services in Navarre, Spain: validation of a new prediction model and comparison with the Revised Injury Severity Classification Score II. Emergencias 2018;30(2):98-104.
  • Khan A, Zafar H, Naeem SN, et al. Transfer delay and in-hospital mortality of trauma patients in Pakistan. Int J Surg. 2010;8(2):155-158. doi:10.1016/j.ijsu.2009.10.012
  • Pekdemir M, Çete Y, Eray O ve ark. Travma hastalarının epidemiyolojik özelliklerinin araştırılması. Ulus Travma Derg 2000;6:250-4.
  • Lefering R, et al. Epidemiology of in-hospital trauma deaths. Eur J Trauma Emerg S 2012;38:3-9.
  • Trajano AD, Pereira BM, Fraga GP. Epidemiology of in-hospital trauma deaths in a Brazilian university hospital. BMC Emerg Med 2014;14:22-31.
There are 19 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Original Articles
Authors

Ahmet Çifçi 0000-0003-2122-0339

Vahide Aslıhan Durak 0000-0003-0836-7862

Şahin Aslan This is me 0000-0001-7327-4342

Publication Date September 30, 2020
Published in Issue Year 2020 Volume: 3 Issue: 3

Cite

AMA Çifçi A, Durak VA, Aslan Ş. Acil Servise Travma Nedeniyle Başvuran Hastalarda Mortaliteye Etki Eden Faktörlerin Değerlendirilmesi. Anatolian J Emerg Med. September 2020;3(3):76-80.