Characteristics of Trauma Patients Admitted to a Tertiary Care University Hospital Emergency Service: One year Cross-sectional Analysis

Öz

ABSTRACT Introduction Trauma is a important cause of mortality and morbidity in the world. Lay out and prevent the causes of trauma will significantly affect the quality of patient care and the quality of patients' lives. The purpose of this study is to identify the characteristics of trauma patients who refer to the emergency room and assess the mortality impact of pathologies that patients have. Material and Methods In this study, 14423 trauma patients who admitted to tertiary care emergency department between January 1, 2019 and December 31, 2019 were retrospectively evaluated by using the hospital information management system. The trauma types of these patients were evaluated together with their radiological imaging, and their effects on hospital discharge, hospitalization and survival were evaluated. The analysis of the data obtained has reached by SPSS and MEDCALC program. Results It was determined that 8948 (62%) of 14423 patients included in our study were male and 5475 (38%) were female. It was found that the median age of the patients was 24 (IQR:25). 1680 (11.6%) of patients had head trauma, spinal trauma in 203 (1.4%), thorax trauma in 461 (3.2%), abdomen trauma in 209 (1.5%), and extremity related trauma in 4157 (28.8%) patients were found in the study. In our study, 12630 (87.6%) were discharged from the emergency department, 1747 (12.1%) were hospitalized, 16 (0.111%) died in the emergency room, and 30 (0,2%) of patients were transferred to another hospital. 1747 patients who were hospitalized, 40 (53.8%) of them were operated at least once during their hospitalization. 43 patients (2.4%) died after hospitalization. When the effects of the pathologies of the patients included in the study on mortality were evaluated; presence of scalp incisions, ventricular hemorrhage, subarachnoid hemorrhage, spinal fracture, rib fracture, lung contusion, presence of intra-abdominal fluid were statistically significant with mortality. Conclusion Knowing the epidemiological characteristics, current trauma and trauma mechanisms of trauma patients with a significant share in emergency services admissions will be important in predicting morbidity and mortality. Comprehensive and multicenter studies are needed more to increase the quality of patient care and to effect morbidity and mortality.

Anahtar Kelimeler

• Emergency service
• Trauma
• Epidemiology.

Üçüncü Basamak Üniversite Hastanesi Acil Servisine Başvuran Travma Hastalarının Özellikleri: Bir Yıllık Kesit Analizi

Öz

Giriş Travma, tüm dünyada önemli bir morbidite ve mortalite sebebidir. Bu nedenle, travma hastalarının acil servis başvuruları büyük bir önem arz etmektedir. Travmanın önlenebilir nedenlerini ortaya koymak ve engellemek, hasta bakım kalitesini arttırmak, hastaların yaşam kalitelerine önemli ölçüde etki edecektir. Bu çalışmanın amacı, acil servise başvuran travma hastalarının özelliklerini belirleyip, hastaların sahip olduğu patolojilerin mortaliteye etkisini değerlendirmektir. Gereç ve Yöntem Bu çalışmada; 1 Ocak 2019 ve 31 Aralık 2019 tarihleri arasında üçüncü basamak acil servisimize başvuran 14423 travma hastası, hastane bilgi yönetim sistemi kullanılarak retrospektif olarak değerlendirilmiştir. Elde edilen verilerin analizinde SPSS ve MEDCALC programından yararlanılmıştır. Bulgular Çalışmamıza alınan 14423 hastanın 8948’inin (%62) erkek, 5475’inin (%38) kadın olduğu saptanmıştır. Hastaların ortanca yaş değerinin 24 (IQR:25) olduğu sonucuna varılmıştır. Hastaların 1680’inde (%11,6) kafa travması, 203’ünde (%1,4) spinal travma, 461’inde (%3,2) toraks travması, 209’unda (%1,5) abdomen travması, 4157’sinde (%28,8) ekstremite travması ile ilgili patoloji saptanmıştır. Çalışmaya dahil edilen hastaların 12630’u (%87,6) acil servisten taburcu edilmiş, 1747’sinin (%12,1) hastaneye yatışı gerçekleşmiş, 16’sı (%0,111) acil serviste hayatını kaybetmiş, 30’u (%0,2) başka hastaneye sevk edilmiştir. Hastaneye yatırılan 1747 hastanın 940’ı (%53,8) yatışları süresince en az bir defa opere edilmişlerdir. Hastaneye yatan hastaları 43’ü (%2,4) ise yatışından sonra hayatını kaybetmiştir. Çalışmaya dahil edilen hastaların sahip olduğu patolojilerin mortaliteye etkisi değerlendirildiğinde; skalp kesilerinin olması, ventriküler hemoraji, subaraknoid hemoraji, spinal fraktür, kot fraktürü, akciğer kontüzyonu, batın içi serbest sıvı varlığı istatistiksel açıdan mortalite ile ilişkili bulunmuştur. Sonuç Acil servis başvuruları arasında önemli bir paya sahip olan travma hastalarının epidemiyolojik özelliklerinin, mevcut travmaların ve travma mekanizmalarının bilinmesi hastalarda yol açabilecek morbidite ve mortaliteyi öngörmede büyük ölçüde yol gösterecektir. Hasta bakım kalitesini artırabilmek, morbidite ve mortaliteye etki edebilmek için daha kapsamlı ve çok merkezli çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

• Acil Servis
• Travma
• Epidemiyoloji

Kaynakça

1. Department of Injuries and Violence Prevention Noncommunicable Diseases and Mental Health Cluster World Health Organization (Geneva). The Injury Chart Book (A graphical overview of the global burden of injuries) 2002. https://apps.who.int/iris/bitstream/handle/10665/42566/924156220X.pdf?sequence=1.
2. American College of Surgeons Committee on Trauma. Advanced Trauma Life Support (ATLS) Student Course Manual, 10th edition. Chicago; 2018.
3. DiMaggio C, Ayoung-Chee P, Shinseki M, Wilson C, Marshall G, Lee DC, Wall S, et al. Traumatic injury in the United States: In-patient epidemiology 2000-2011. Injury 2016; 47(7): 1393-403. doi: 10.1016/j.injury.2016.04.002
4. Akoglu H, Denizbasi A, Unluer EE, Guneysel O, Onur O. Demographic characteristics of trauma patients of the Emergency Department of Marmara University Hospital. Marmara Medical Journal 2005; 18(3): 113-22.
5. Marin JR, Weaver MD, Yealy DM, Mannix RC. Trends in visits for traumatic brain injury to emergency departments in the United States. JAMA 2014; 311(18): 1917-9. doi: 10.1001/jama.2014.3979
6. Martins ET, Linhares MN, Sousa DS, Schroeder HK, Meinerz J, Rigo LA, et al. Mortality in Severe Traumatic Brain Injury: A Multivariated Analysis of 748 Brazilian Patients from Florianópolis City. J Trauma Inj Infect Crit Care 2009; 67(1): 85-90. DOI: 10.1097/TA.0b013e318187acee
7. Lalwani S, Singh V, Trikha V, Sharma V, Kumar S, Bagla R, et al. Mortality profile of patients with traumatic spinal injuries at a level I trauma care centre in India. Indian J Med Res 2014; 140(1): 40-5. PMID: 25222776
8. Veysi VT, Nikolaou VS, Paliobeis C, Efstathopoulos N, Giannoudis PV. Prevalence of chest trauma, associated injuries and mortality: a level I trauma centre experience. Int Orthop 2009; 33(5): 1425-33. doi: 10.1007/s00264-009-0746-9

9. Beshay M, Mertzlufft F, Kottkamp HW, Reymond M, Schmid RA, Branscheid D, et al. Analysis of risk factors in thoracic trauma patients with a comparison of a modern trauma centre: a mono-centre study. World J Emerg Surg 2020; 45. https://doi.org/10.1186/s13017-020-00324-1
10. Lin FCF, Li RY, Tung YW, Jeng KC, Tsai SCS. Morbidity, mortality, associated injuries, and management of traumatic rib fractures. J Chin Med Assoc 2016; 79(6): 329-34. doi: 10.1016/j.jcma.2016.01.006
11. Arumugam S, Al-Hassani A, El-Menyar A, Abdelrahman H, Parchani A, Peralta R, et al. Frequency, causes and pattern of abdominal trauma: A 4-year descriptive analysis. J Emerg Trauma Shock 2015; 8(4): 193-8. doi: 10.4103/0974-2700.166590
12. Pimentel SK, Sawczyn GV, Mazepa MM, Goncalvez Da Rosa FG, Nars A, Collaco IA. Risk factors for mortality in blunt abdominal trauma with surgical approach. Revista do Colégio Brasileiro de Cirurgiões 2015; 42(4). https://doi.org/10.1590/0100-69912015004011
13. Bolandparvaz S, Yadollahi M, Abbasi HR, Anvar M. Injury patterns among various age and gender groups of trauma patients in southern Iran: A cross-sectional study. Medicine (Baltimore) 2017; 96(41): 7812. doi: 10.1097/MD.0000000000007812
14. DiMaggio CJ, Avraham JB, Lee DC, Frangos SG, Wall SP. The Epidemiology of Emergency Department Trauma Discharges in the United States. Acad Emerg Med 2017; 24(10): 1244-56. doi: 10.1111/acem.13223