Factors affecting mortality in patients with multitrauma which were treated in intensive care unit

Year 2013, , 177 - 182, 01.06.2013

Ali Dur Sedat Koçak Başar Cander Ertan Sönmez Cemil Civelek

https://doi.org/10.5798/diclemedj.0921.2013.02.0251

Abstract

Objective: The aim of this study was to evaluate multiple trauma patients hospitalized in intensive care unit (ICU) of an emergency department at a university hospital. Methods: The study was performed between January 2006 and January 2009 with 138 patients in the emergency intensive care unit. Those patients who die within 6 hours after trauma and the patients with chronic renal failure, chronic liver failure, chronic heart failure and metastatic cancers were excluded to this study. Trauma etiology, duration of intensive care and mechanical ventilation, support therapies, trauma scores and mortality rates were determined. Data were evaluated by statistical methods. Results: The mean age of the patients was 31±21.8 (range 1-80) years. Of these patients, 112 (81.2%) were male and 26 (18.8%) were female. The most common etiologies of multitrauma were car occupant\'s accidents (40.6%) and pedestrian\'s accidents (37%). Mean length of stay at mechanical ventilation and length of stay in ICU were 2.2 days (0-30 days) and 5.3 days (1-30 days), respectively. Totally 56 (43.5%) patients were ventilated mechanically, 34 (26.4%) patients received nutritional support and 22 (14.5%) were given inotropic agents. Mortality rate of these papatients were 50%, 44.1% and 77.7% respectively. The multitrauma patients, who mechanically ventilated, supported by inotropic and nutritional therapy had higher mortality rate than other patients. Conclusion: The most common cause of multitrauma injuries were motor vehicle accidents, especially for young males. Trauma scores at admission, complications related to mechanical ventilation, inotropic and nutritional support therapies affected to morbidity and mortality in ICU trauma centers.

Keywords

Emergency departments, multitrauma, intensive care unit

Yoğun bakım biriminde izlenen çoklu travma hastalarında mortaliteye etki eden faktörler

Abstract

Amaç: Bu çalışmanın amacı, bir üniversite hastanesinin acil yoğun bakım biriminde takip edilen çoklu travma hastalarının değerlendirilmesidir. Yöntemler: Çalışmaya Ocak 2006- Ocak 2009 tarihleri arasında fakültemizin acil yoğun bakım biriminde takip edilen çoklu travma hastaları alındı. Travma sonrası ilk altı saat içinde hayatını kaybedenler, kronik böbrek yetmezliği, kronik karaciğer hastalığı, konjestif kalp yetersizliği ve metastatik kanser hastaları çalışma dışı bırakıldı. Travmanın nedeni, yoğun bakım ve mekanik ventilatörlerde kalış süreleri, aldığı destek tedaviler, travma skorları ve mortalite oranları belirlendi. Elde edilen bulgular istatistiksel olarak değerlendirildi. Bulgular: Çalışmaya alınan hastaların yaş ortalaması 31±21.82 (aralık 1-80) yıl idi. Hastaların 112\'si (%81.2) erkek 26\'sı (%18.8) kadın idi. Çoklu travmanın en sık nedenleri araç içi trafik kazaları (%40.6) ve araç dışı trafik kazaları (%37) idi. Ortalama yoğun bakımda ve mekanik ventilatörde kalış süreleri sırasıyla 5.3 gün (1-30 gün) ve 2.2 gün (0- 30 gün) idi. Hastalardan 56\'sı (%43.5) mekanik ventilatör desteği alırken, 34 (%26.4) hastanın beslenme desteği aldığı ve 22 (%14.5) hastanın inotrop desteği aldığı belirlenmiştir. Bu hastaların mortalite oranları sırasıyla %50, %44.1 and %77.7 idi. Mekanik ventilasyondaki, inotrop ve beslenme desteği alan çoklu travma hastalarındaki mortalite oranları tüm hastalardaki mortalite oranlarından yüksek bulunmuştur. Sonuç: Çoklu travma yaralanmalarının en sık nedeni motorlu araç kazaları olup, özellikle genç erkekleri etkilemektedir. Hastaların mekanik ventilasyon, inotrop ve beslenme desteği ile ilgili komplikasyonlar travma yoğun bakım merkezlerindeki ölüm ve sakatlıklar üzerinde etkili olmaktadır.

Keywords

Acil servis, çoklu travma, yoğun bakım ünitesi

References

• Eachempati SR, Reed RL 2nd, St Louis JE et al. “The Demo- graphics of Trauma in 1995” Revisited: An Assessment of the Accuracy and Utility of Trauma Predictions. J Trauma 1998;45:208-214.
• 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;28-29.
• Işık HS, Bostancı U, Yıldız O, et al. Retrospective analysis of 954 adult patients with head injury: an epidemiological study. Ulus Travma Acil Cerrahi Derg 2011;17:46-50.
• Committee on Medical Aspects of Automotive Safety: rating the severity of tissue damage: The Abbreviated scale. J Am Med Assoc 1971;215:277-280.
• Aldrian S, Koenig F, Weninger P, Ve´csei V, Nau T. Char- acteristics of polytrauma patients between 1992 and 2002: What is changing? : Injury. Int J Care Injured 2007;38:1059- 1064.
• Wafaisade A, Wutzler S, Lefering R, et al. Drivers of acute coagulopathy after severe trauma: a multivariate analysis of 1 987 patients. Emerg Med J 2010;27:934-939.
• Keel M, Trenz O. Pathophysiology of Polytrauma Injury. Int J Care Injured 2005;36:691-709.
• Teasdale G, Jennet B. Assesment of coma and impaired con- sciousness. A practical scale. Lancet 1974:81-84.
• Matis G, Birbilis T. The Glasgow Coma Scale-a brief review. Past, present, future: Acta Neurol Belg 2008;108:75-89.
• Zhao XJ, Kong LW, DU DY et al. Analysis on care outcome of patients with polytrauma and coma, Chongqing 400014, China. Chin J Traumatol 2007;10:53-58.
• Pamerneckas A, Macas A, Blazgys A, et al. The treatment of multiple injuries: prehospital emergency aid. Medicina (Kaunas) 2006;42:395-400.
• Hermans MA, Leffers P, Jansen LM, et al. The value of the Mortality in Emergency Department Sepsis (MEDS) score, C reactive protein and lactate in predicting 28-day mortality of sepsis in a Dutch emergency department. Emerg Med J 2012;29:295-300.
• Cumming J, Purdue GF, Hunt JL, et al. Objective Esti- mates of the incidence and consequences of multiple Or- gan Dysfunction and Sepsis after Burn Trauma. J Trauma 2001:50;510-515.
• Knaus W, Draper E, Wagner DP, et al. APACHE II: a se- verity of disease classification system. Crit Care Med 1985;13:818-829.
• Regel G, Lobenhoffer P, Grotz M, et al. Treatment results of patients with multiple trauma: an analysis of 3406 cases treated between 1972 and 1991 at a German level 1 trauma center. J Trauma 1995;38: 70-78.
• Taylor MD, Tracy K, Meyer W, et al. Trauma in the Elderly: Intensive Care Unit Resource Use and Outcome. J. Trauma 2002;53:407-414.
• Marik PE, Zaloga GP. Immunonutrition in critically ill pa- tients: a systematic review and analysis of the literature: Intensive Care Med 2008;34:1980-1990.