Acil serviste geriatrik travma hastalarının görüntüleme örüntülerindeki değişiklikler

Year 2022, Volume: 47 Issue: 2, 682 - 688, 30.06.2022

Eldar Guliyev Erhan Akpınar Emre Ünal , Mehmet Mahir Kunt , Ruhi Onur , Bulent Erbil

Abstract

Amaç: Bu çalışmada, acil servise başvuran geriatrik travma hastalarının görüntüleme tetkikleri ve bulgularını analiz etmeyi amaçlanmıştır.
Gereç ve Yöntem: Ardışık beş yıllık periyotlarda, rastgele seçilen 300 hastalık iki grup karşılaştırıldı. Birinci ve ikinci beş yıllık dönemde başvuran hastalar sırasıyla grup I ve II olarak kaydedildi. Her iki grup yaş, cinsiyet, başvuru nedeni, komorbidite, Revize Travma Skoru (RTS), Glasgow Koma Skalası (GKS), radyolojik bulgular ve radyolojik inceleme sayısı, Doz-Uzunluk Çarpımı değerleri ve hastanede kalış süresi açısından detaylı olarak incelendi ve gruplar arası karşılaştırma yapıldı.
Bulgular: Grup II'de direkt grafi ve BT tetkiki yapılan hasta sayısı ile toplam grafi ve BT tetkiki sayısı grup I'e göre daha fazlaydı. BT taramaları, grup I'deki hastaların %49'unda ve grup II'deki hastaların %55'inde travma ile ilişkili bulgular açısından negatifti. Travma ile ilişkili radyolojik bulguları olan hastalarda, travmaya bağlı majör bulgular açısından gruplar arasında anlamlı bir fark gözlenmedi. Ancak, BT'de travmaya bağlı minör bulgular grup II'de daha sıktı.
Sonuç: Görüntüleme testlerinin istenme oranı zaman içerisinde artmış olsa da, majör travmayı düşündüren veya daha uzun yatış gerektiren görüntüleme bulguları açısından gruplar arasında fark saptanmadı. Bu durum, defansif tıbba yönelimin bir sonucu olarak yıllar içinde artmış radyolojik tetkik kullanımı ile ilişkili olabilir.

Keywords

Acil servis , bilgisayarlı tomografi , travma , geriatri , defansif tıp

Changes in imaging patterns of geriatric trauma patients in emergency department

Abstract

Purpose: We aimed to analyze imaging tests and findings in a series of geriatric trauma patients admitted to emergency department (ED) at different time intervals.
Materials and Methods: Two groups of 300 randomly selected patients over consecutive five-year periods were compared. Patients admitted in the first and second five-year periods were recorded as group I and II, respectively. A comprehensive comparison was carried out between two groups regarding the age, sex, reason for admission, comorbidities, Revised Trauma Score (RTS), Glasgow Coma Scale (GCS), radiological findings and number of radiological examinations, dose length product (DLP) values and duration of hospital stay.
Results: The number of patients who underwent X-ray and CT examinations and total number of X-rays and CT scans in group II was higher than those in group I. CT scans were negative for a trauma-related finding in 49% of patients in group I and 55% of patients in group II. In patients with radiological evidence of trauma, no significant difference was observed between two groups regarding the major trauma related change. However, the trauma-related minor findings on CT were more common in group II than in group I.
Conclusion: Despite the increasing use of imaging tests, there was no difference in imaging findings suggesting major trauma or requiring a longer inpatient stay. This may be related to the increasing use of radiological examinations over the years as a result of the orientation towards defensive medicine.

Keywords

Emergency Service , Hospital , computed tomography , trauma , geriatric , defensive practice , imaging

References

• Referans1 Cohen DB, Rinker C, Wilberger JE. Traumatic brain injury in anticoagulated patients. J Trauma. 2006;60(3):553-7.
• Referans2 Lavoie A, Ratte S, Clas D, Demers J, Moore L, Martin M, et al. Preinjury warfarin use among elderly patients with closed head injuries in a trauma center. J Trauma. 2004;56(4):802-7.
• Referans3 Richmond TS, Kauder D, Strumpf N, Meredith T. Characteristics and outcomes of serious traumatic injury in older adults. J Am Geriatr Soc. 2002;50(2):215-22.
• Referans4 Sadro CT, Sandstrom CK, Verma N, Gunn ML. Geriatric Trauma: A Radiologist's Guide to Imaging Trauma Patients Aged 65 Years and Older. Radiographics. 2015;35(4):1263-85.
• Referans5 Chen J, Majercik S, Bledsoe J, Connor K, Morris B, Gardner S, et al. The prevalence and impact of defensive medicine in the radiographic workup of the trauma patient: a pilot study. Am J Surg. 2015;210(3):462-7.
• Referans6 Lambert L, Foltan O, Briza J, Lambertova A, Harsa P, Banerjee R, et al. Growing number of emergency cranial CTs in patients with head injury not justified by their clinical need. Wien Klin Wochenschr. 2017;129(5-6):159-63.
• Referans7 Panella M, Rinaldi C, Leigheb F, Knesse S, Donnarumma C, Kul S, et al. Prevalence and costs of defensive medicine: a national survey of Italian physicians. J Health Serv Res Policy. 2017;22(4):211-7.
• Referans8 Studdert DM, Mello MM, Sage WM, DesRoches CM, Peugh J, Zapert K, et al. Defensive medicine among high-risk specialist physicians in a volatile malpractice environment. JAMA. 2005;293(21):2609-17.
• Referans9 Gupta M, Schriger DL, Hiatt JR, Cryer HG, Tillou A, Hoffman JR, et al. Selective use of computed tomography compared with routine whole body imaging in patients with blunt trauma. Ann Emerg Med. 2011;58(5):407-16 e15.
• Referans10 Long B, April MD, Summers S, Koyfman A. Whole body CT versus selective radiological imaging strategy in trauma: an evidence-based clinical review. Am J Emerg Med. 2017;35(9):1356-62.
• Referans11 Miller RA, Sampson NR, Flynn JM. The prevalence of defensive orthopaedic imaging: a prospective practice audit in Pennsylvania. J Bone Joint Surg Am. 2012;94(3):e18.
• Referans12 Chawla A, Gunderman RB. Defensive medicine: prevalence, implications, and recommendations. Acad Radiol. 2008;15(7):948-9.
• Referans13 Asha S, Curtis KA, Grant N, Taylor C, Lo S, Smart R, et al. Comparison of radiation exposure of trauma patients from diagnostic radiology procedures before and after the introduction of a panscan protocol. Emerg Med Australas. 2012;24(1):43-51.
• Referans14 Ahmadinia K, Smucker JB, Nash CL, Vallier HA. Radiation exposure has increased in trauma patients over time. J Trauma Acute Care Surg. 2012;72(2):410-5.