Multipl kot kırıklarında pulmoner morbiditeyi tahmin etmede toraks travma skorlarının etkinliği

Abstract

Amaç: Künt toraks travmalarına bağlı multipl kot kırıkları ciddi ağrıya neden olur, iyleşmesi uzun zaman alır ve hastanın morbidite ve mortalite riskleriyle yakından ilişkilidir. Çalışmamızda multipl kot kırığı olan hastalarda Torasik Travma Şiddet Skoru (TTSS), Göğüs Travma Skoru (CTS), Kot Kırığı Skoru (RFS) ve Kot Skorunun (Rs) hastane ve yoğun bakım yatış süresi, morbidite ve mortaliteyi tahmin etmedeki etkinliğini saptamayı amaçladık. Gereç ve Yöntem: Çalışmaya Ağustos 2020 ile Ağustos 2022 tarihleri arasında, künt travma sonucu multipl kot kırıkları nedeniyle kliniğimizde yatırılarak tedavi edilen 122 hasta dahil edildi. Hastaların yaş, cinsiyet, travma şekli, kot kırığı sayısı, pulmoner parankim ve plevral patolojiler, hastane ve yoğun bakım yatış süresi, pulmoner morbidite ve mortalite bilgileri hastane elektronik kayıt sistemi ve dosya arşivinden elde edildi. Hastane yatış süresi, yoğun bakım yatış süresi, pulmoner morbidite ve mortalite ile TTSS, CTS, RFS ve Rs arasındaki ilişki istatistiksel olarak değerlendirildi. Bulgular: TTSS ile yoğun bakımda yatış süresi, pulmoner morbidite ve mortalite arasında istatistiksel olarak anlamlı ilişki saptanırken, hastane yatış süresi ile arasında anlamlı ilişki saptanmadı. CTS ile hastane yatış süresi ve pulmoner morbidite arasında istatistiksel olarak anlamlı ilişki saptanırken, yoğun bakım yatış süresi ve mortalite ile arasında anlamlı ilişki saptanmadı. RFS ile pulmoner morbidite arasında istatistiksel olarak anlamlı ilişki saptanırken, hastanede yatış süresi, yoğun bakımda yatış süresi ve mortalite ile arasında anlamlı ilişki saptanmadı. Rs ile hastanede yatış süresi, yoğun bakımda yatış süresi, pulmoner morbidite ve mortalite arasında istatistiksel olarak anlamlı ilişki saptanmadı. Sonuç: Ciddi ekstratorasik yaralanması olmayan multipl kot kırığı hastalarında morbidite ve mortaliteyi tahmin etmede, hastanın yaşını ve pulmoner durumunu da skorlayan TTSS ve CTS’nin diğer toraks travma skorlamalarına göre daha etkin olduğu kanaatindeyiz.

Keywords

• Kot kırığı
• travma
• Skor

Multipl kot kırıklarında pulmoner morbiditeyi tahmin etmede toraks travma skorlarının etkinliği

Abstract

Multiple rib fractures due to blunt thoracic traumas cause severe pain, take a long time to heal, and are closely associated with serious morbidity and mortality risk. In our study, we aimed to determine the effectiveness of Thoracic Trauma Severity Score (TTSS), Chest Trauma Score (CTS), Rib Fracture Score (RFS) and Rib Score (Rs) in predicting hospital and intensive care hospital stay, morbidity and mortality in patients with multiple rib fractures. Between August 2020 and August 2022, 122 patients hospitalized in our clinic for multiple rib fractures as a result of blunt trauma were included in the study. Patients' age, gender, trauma type, number of rib fractures, pulmonary parenchyma and pleural pathologies, hospital and intensive care unit length of stay, pulmonary morbidity and mortality were obtained from the hospital electronic record system and file archive. The relationship between length of hospital stay, length of stay in intensive care unit, pulmonary morbidity and mortality with TTSS, CTS, RFS and Rs were evaluated statistically. While there was a statistically significant relationship between TTSS and the length of stay in the intensive care unit, pulmonary morbidity and mortality, no significant relationship was found between the length of hospital stay. While a statistically significant relationship was found between CTS and hospitalization time and pulmonary morbidity, no significant relationship was found between intensive care unit length of stay and mortality. While a statistically significant relationship was found between RFS and pulmonary morbidity, no significant relationship was found between length of hospital stay, length of stay in the intensive care unit, and mortality. No statistically significant correlation was found between Rs and length of hospital stay, length of stay in the intensive care unit, pulmonary morbidity and mortality. We believe that TTSS and CTS, which also score the patient's age and pulmonary status, are more effective than other thorax trauma scoring systems in predicting morbidity and mortality in patients with multiple rib fractures without serious extrathoracic injury.

Keywords

• Rib fracture
• Trauma
• Skore

References

1. 1. Kaewlai R, Avery LL, Asrani AV, Novelline RA. Multidetector CT of blunt thoracic trauma. Radiographics 2008;28:1555-1570.
2. 2. Holcomb JB, McMullin NR, Kozar RA, Lygas MH, Moore FA. Morbidity from rib fractures increases after age 45. J Am Coll Surg 2003;196:549-555.
3. 3. Liman ST, Kuzucu A, Tastepe AI, Ulasan GN, Topcu S. Chest injury due to blunt trauma. Eur J Cardiothorac Surg 2003;23:374-378.
4. 4. Battle CE, Hutchings H, Evans PA. Risk factors that predict mortality in patients with blunt chest wall trauma: a systematic review and meta-analysis. Injury 2012;43:18-27.
5. 5. Flagel BT, Luchette FA, Reed RL, et al. Half-a-dozen ribs: the breakpoint for mortality. Surgery 2005;138:717-723. 6. Chien CY, Chen YH, Han ST, Blaney GN, Huang TS, Chen KF. The number of displaced rib fractures is more predictive for complications in chest trauma patients. Scand J Trauma Resusc Emerg Med 2017;25:19.
6. 7. Pape H-C, Remmers D, Rice J, Ebisch M, Krettek C, Tscherne H. Appraisal of early evaluation of blunt chest trauma: development of a standardized scoring system for initial clinical decision making. J Trauma Acute Care Surg 2000;49:496-504.
7. 8. Lien YC, Chen CH, Lin HC. Risk factors for 24-hour mortality after traumatic rib fractures owing to motor vehicle accidents: a nationwide population-based study. Ann Thorac Cardiovasc Surg 2009;88:1124-1130.
8. 9. Lee RB, Bass SM, Morris Jr JA, Mackenzie EJ. Three or more rib fractures as an indicator for transfer to a Level I trauma center: a population-based study. J Trauma Acute Care Surg 1990;30:689-694.

9. 10. Chen J, Jeremitsky E, Philp F, Fry W, Smith RS. A chest trauma scoring system to predict outcomes. Surgery 2014;156:988-993.
10. 11. Easter A. Management of patients with multiple rib fractures. Am J Crit Care. 2001;10:320.
11. 12. Chapman BC, Herbert B, Rodil M, et al. RibScore: a novel radiographic score based on fracture pattern that predicts pneumonia, respiratory failure, and tracheostomy. J Trauma Acute Care Surg. 2016;80:95-101.
12. 13. Mommsen P, Zeckey C, Andruszkow H, Weidemann J, Frömke C, Puljic P, van Griensven M, Frink M, Krettek C, Hildebrand F. Comparison of different thoracic trauma scoring systems in regards to prediction of post-traumatic complications and outcome in blunt chest trauma. J Surg Res 2012;176(1):239-247.
13. 14. Daurat A, Millet I, Roustan J-P, et al. Thoracic Trauma Severity score on admission allows to determine the risk of delayed ARDS in trauma patients with pulmonary contusion. Injury 2016;47:147-153.
14. 15. Pressley CM, Fry WR, Philp AS, Berry SD, Smith RS. Predicting outcome of patients with chest wall injury. Am J Surg 2012;204:910-913.
15. 16. Seok J, Cho HM, Kim HH, Kim JH, Huh U, Kim HB, Leem JH, Wang IJ. Chest Trauma Scoring Systems for Predicting Respiratory Complications in Isolated Rib Fracture.J Surg Res 2019;244:84-90.
16. 17. Maxwell CA, Mion LC, Dietrich MS. Hospitalized injured older adults: clinical utility of a rib fracture scoring system. J Trauma Nurs 2012;19:168-174.