Acil servise ateşli silah yaralanması ile başvuran hastaların analizi

Öz

Amaç: Bu çalışmada, acil servise ateşli silah yaralanması ile başvuran hastaların klinik bulguları ve travma skorlarının hasta prognozu ve mortalitesine etkisinin incelenmesi amaçlanmıştır. Yöntemler: Ateşli silahla yaralanan hastalar geriye dönük olarak arşivden incelendi. Hastaların yaşı, cinsiyeti, acil servise başvuru zamanı, yaralı vücut bölgeleri, görüntü raporları, hastanede yatış durumu ve ölüm oranları analiz edildi. Tüm hastalar için Glaskow Koma Skalası (GKS), Revize Travma Skoru (RTS), Yaralanma Şiddet Skoru (ISS) ve Travma ve Yaralanma Şiddet Skoru (TRISS) oranları hastanın prognozunu öngörmesi amaçlı hesaplandı. Bulgular: Yaralanmaların çoğu (%50.8) ve en yüksek ölüm yüzdesi (%66.7) 16.01-24.00 saatleri arasında gerçekleşti. En sık görülen yaralanmaların alt ekstremite yaralanmaları (n:39, %63.9) ve üst ekstremite yaralanmaları (n: 29,%47.5) olduğu belirlendi. Ortalama GCS skoru 13±3.6, ortalama RTS 7.07±2.23, ortalama ISS 12.36±10.48 ve penetran travma için ortalama TRISS hayatta kalma olasılığı %88.59 idi. 18 hasta (% 29.5) acil servisten tedavi edilip taburcu edildi ve 19 hasta (% 31.2) servise, 9 hasta (% 14.8) yoğun bakım ünitesine yatırıldı. Hastaların çoğu Ortopedi ve Travmatoloji bölümünde hastaneye kaldırıldı. Mortalitesi olan hastalarda GKS, RTS ve TRISS hayatta kalan hastalara göre istatistiksel olarak anlamlı derecede düşüktü ve ISS istatistiksel olarak anlamlı derecede yüksekti (p = 0.000). Mortalite oranı %9.8 olarak saptandı Sonuç: Ateşli silah yaralanmaları özellikle baş, göğüs ve karın bölgesinde yüksek ölüm oranıyla ilişkili ciddi yaralanmalara neden olabilir. GKS, ISS, RTS ve TRISS travma skor sistemlerinin ateşli silah yaralanmalarında prognoz ve mortalite oranlarını tahmin etmede faydalı olacağını düşündürmektedir.

Anahtar Kelimeler

• Ateşli silah yaralanması
• Glaskow koma skalası
• Yaralanma şiddet skoru
• Revize travma skoru
• Travma ve yaralanma şiddet skoru

Analysis of patients admitted to the emergency department with gunshot wounds

Abstract

Background/Aim: The incidence and nature of gunshot wounds differ between countries, and they are a prominent cause of mortality and morbidity. The primary assessment and treatment of patients with gunshot wounds in the emergency department are often highly complex. In this study, we aimed to investigate the effect of clinical findings and trauma scores on patient prognosis and mortality of patients who applied to the emergency department with gunshot wounds. Methods: In this retrospective cohort study, records of patients with gunshot wounds were accessed from the archive. Patients' age, gender, time of admission to the emergency department, injured body regions, image reports, hospitalization status and mortality rates were analyzed. The Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), Injury Severity Score (ISS) and Trauma and Injury Severity Score (TRISS) rates were calculated for all patients to predict prognosis. Results: Most injuries (50.8%) and the highest mortality (66.7%) occurred between 16:01 and 24:00. The most common injuries were lower extremity injuries (63.9%) and upper extremity injuries (47.5%). The mean GCS, RTS, and ISS were 13 (3.6), 7.07 (2.23), and 12.36 (10.48), respectively, and the mean TRISS survival probability for penetrating trauma was 88.59%. Eighteen patients (29.5%) were treated and discharged from the emergency department, nineteen (31.2%) were admitted to the wards and 9 patients (14.8%), to the intensive care unit. In patients who died, GCS, RTS, and TRISS were significantly lower than in surviving patients, and the ISS was statistically significantly higher (P<0.001). Mortality rate was 9.8%. Conclusion: Gunshot wounds can cause serious injuries associated with high mortality, especially in the head, chest, and abdomen. GCS, ISS, RTS and TRISS trauma score systems will be useful in predicting prognosis and mortality rates in gunshot wounds.

Keywords

• Gunshot wounds
• Glasgow coma scale
• Injury severity score
• Revised trauma score
• Trauma and injury severity score

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