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Delici – Kesici Alet Yaralanmalarının Demografik Özellikleri

Year 2023, Volume: 5 Issue: 1, 32 - 37, 01.03.2023
https://doi.org/10.38175/phnx.1225008

Abstract

AMAÇ: Travma hastalarında fizyolojik durumunun erken belirlenmesi uygulanacak tedavi yöntemlerinin hızlıca hayata geçirilmesi için yol gösterecek objektif kanıtlar yeterince bulunmamaktadır. Çalışmamızda literatür bilgileri eşliğinde kliniğimize delici kesici alet yaralanması nedeni ile başvuran olguları retrospektif olarak inceleyerek demografik özelliklerini, travma skorlarını ve laboratuvar sonuçlarını karşılaştırmayı amaçladık.
GEREÇ VE YÖNTEM: 1 Ocak 2015 ile 31 Aralık 2016 tarihleri arasında acil servise başvuran delici kesici alet yaralanmaları retrospektif olarak incelendi. Çalışmaya alınma kriterlerine uygun 305 hastanın kaydına ulaşıldı. Çalışmaya alınan olgularda TA, nabız, solunum sayısı, GKS, RTS, ISS, NISS skorlmaları, hemoglobin, laktat, baz açığı ve şok indeksi değerleri hesaplandı. Bu hesaplanan değerlerle kan transfüzyonu ve cerrahi girişim ilişkisi istatistiksel olarak ele alındı. İstatistiksel yöntem SPSS kullanıldı. P<0.05 anlamlı kabul edildi. Veriler için ve Mann Whitney U testi ve pearson X2 testi kullanıldı.
BULGULAR: Acil servise başvuran 305 DKAY olan hasta bu çalışmaya alındı. Olguların çoğu erkek’ (%90,8) ti. Düşük GKS, RTS skorları ve yüksek ISS, NISS skorları cerrahi girişim yapılan ve eksitus olan olguları belirlemede anlamlı bulundu. En sık yaralanan bölge ekstremite bölgesiydi. En yüksek ölüm oranına sahip yaralanma bölgesi baş ve boyun yaralanmalarıydı. Kan transfüzyonunu öngörmede Şİ ≥1 olaması, artmış laktat değeri, artmış baz açığı ve düşük hemoglobin değerleri anlamlı bulundu. Baz açığı cerrahi girişim yapılan ve eksitus olan olguları belirlemede önemli bir prediktör olduğu istatistiksel olarak ispatlandı. Yüksek laktat değerleri cerrahi girişim yapılan hastayı belirlemede anlamsız olduğu görüldü. Yüksek laktat değerleri eksitus olan olgularda anlamlı olarak yüksek bulunmuştur.
SONUÇ: Yaptığımız çalışmadaki sonuçlar literatürdeki diğer çalışmamalarla benzerlik göstermekle birlikte cerrahi girişim yapılacak olguları belirlemede kullanılacak diğer fizyolojik skorlama sistemlerinin yanında artmış baz açığı değeri de acil servis hekimlerini delici-kesici alet yaralanmalarındaki cerrahi girişim yapılan ve eksitus olan olguları belirlemede yardımcı olacak objektif bir test olarak değerlendirilmiştir. Cerrahi girişimi öngörmede NISS, mortaliteyi öngörmede RTS skoru en güçlü skorlama sistemi olmuşlardır.

References

  • TÜİK sağlık ve sosyal istatistikleri 2016 Yaşa bağlı ölüm nedenleri istatistik verileri. Erişim adresi: https://data.tuik.gov.tr/Bulten/Index?p=Olum-Istatistikleri-2016-24649.
  • Durdu T, Kavalcı C, Yılmaz MS, Karakılıç ME, Arslan ED, Ceyhan MA. Acil Servisimize Başvuran Travma Vakalarının Analizi. Journal of Clinical and Analytical Medicine. 2014;5(3):182-185.
  • J Tintinalli, J. Stapczynski, O. John Ma, D Cline, R Cydulka, G Meckler. Tintinalli's Emergency Medicine: A Comprehensive Study Guide, Seventh Edition 2010.
  • Köksal Ö, Özdemir F, Bulut M, Eren Ş. Uludağ Üniversitesi Tıp Fakültesi Hastanesi Acil Servis’ine Başvuran Delici Kesici Alet Yaralanmalı Olguların Analizi. Uludağ Üniversitesi Tıp Fakültesi Dergisi. 2009;35(2):63-67.
  • Stevenson M, Segui-Gomez M, Lescohier I, Di Scala C, McDonald-Smith G. An overview of the injury severity score and the new injury severity score. Injury Prevention. 2001;7:10–13.
  • Ormstad K, Karlsson T, Enkler L, Low B, Raj J. Patterns in sharp force fatalities- a compreherensive forensic medical study. Journal of Forensic Sciences. 1986;31:529-42.
  • Güloğlu C, Aldemir M, Yağmur Y. Acil servislerin önemli sosyo-kültürel bir problemi: kesici-delici alet yaralanmaları. Akademik acil tıp dergisi. 2003;1(2):28-32.
  • Macpherson AK, Schull MJ. Penetrating trauma in Ontario emergency departments: a population-based study. Canadian Journal of Emergency Medicine. 2007; 9(1):16-20.
  • Yıldız M, Bozdemir MN, Kılıcaslan I, Ateşçelik M, Gürbüz S, Mutlu B, et al. The elderly trauma: the two years experience of a university-affiliated emergency department. European Review for Medical Phalmacological Sciences. 2012;16:62-7.
  • Vikram U. Deshmukh, Mrunal N. Ketkar, and Erach K. Bharucha. Analysis of Trauma Outcome Using the TRISS Method at a Tertiary Care Centre in Pune. Indian Journal of Surgeons. 2012;74(6):440–444.
  • Karaca MA, Kartal ND, Erbil B, Öztürk E, Kunt MM, Şahin TT, et al. Evaluation of gunshot wounds in the emergency department. Ulus Travma Acil Cerrahi Dergisi. 2015;21:4.
  • Orhon R, Eren ŞH, Karadayı Ş, Korkmaz İ, Coşkun A, Eren M, et al. Comparison of trauma scores for predicting mortality and morbidity on trauma patients. Ulus Travma Acil Cerrahi Dergisi. 2014;20:4.
  • Ohmori T, Kitamura T, Ishihara J, Onishi H, Nojima T, Yamamoto K, et al. Early predictors for massive transfusion in older adult severe trauma patients. Injury. 2017;48(5):1006-1012.
  • Chen J, Benov A, Nadler R, Darlington DN, Cap AP, Lipsky AM, et al. Prehospital Blood Transfusion During Aeromedical Evacuation of Trauma Patients in Israel: The IDF CSAR Experience. Military Medicine. 2017;182(1):47-52.
  • George MJ, Burchfield J, MacFarlane B, Wang YW, Cardenas JC, White NJ, el al. Multiplate and TEG platelet mapping in a population of severely injured trauma patients. Transfusion Medicine. 2018;28(3):224-230.
  • Rau CS, Wu SC, Spencer CH, Pao-Jen K, Shiun-Yuan H, Chen YC, et al. Prediction of Massive Transfusion in Trauma Patients with Shock Index, Modified Shock Index, and Age Shock Index. International Journal of Environmental Research and Public Health. 2016;13:683.
  • Brooke M, Yeung L, Miraflor E, Garcia A, Victorino GP; Lactate predicts massive transfusion in hemodynamically normal patients. The Journal Surgical Research. 2016;204(1):139-44.
  • Folkert IW, Sims CA, Pascual JL, Allen SR, Kim PK, Schwab CW, et al. Initial venous lactate levels in patients with isolated penetrating extremity trauma: a retrospective cohort study. Europan Journal Trauma Emergency Surgery. 2015;41(2):203-9.
  • Soni KD, Mahindrakar S, Gupta A, Kumar S, Sagar S, Jhakal A. Comparison of ISS, NISS, and RTS score as predictor of mortality in pediatric fall. Burns and Trauma. 2017;5:25.
  • Dunham MP, Sartorius B, Laing GL, Bruce JL, Clarke DL. A comparison of base deficit and vital signs in the early assessment of patients with penetrating trauma in a high burden setting. Injury. 2017;48(9):1972-1977.

Demographic Characteristics of Penetrating and Cutting Tool Injuries

Year 2023, Volume: 5 Issue: 1, 32 - 37, 01.03.2023
https://doi.org/10.38175/phnx.1225008

Abstract

Objective: There is not enough objective evidence for the early identification of the physiological condition and the rapid application of treatment in trauma patients. The aim of the study is retrospectively review the cases applied to our clinic with the knowledge of the literature and to compare the demographic characteristics, trauma scores and laboratory results with the literature data.
Materials and Methods: Patients who admitted to the emergency department by penetrating and cutting tool injury between 01.10.2015 and 31.12.2016 were retrospectively reviewed. We reached to records of 305 patients who were meeting study criteria. Blood pressure, heart rate, respiration rate, GCS, RTS, ISS, NISS scores, hemoglobin, lactate, base deficit and shock index values were calculated. When evaluating the results obtained in this study, SPSS for Windows 17.0 program was used for statistical analysis. P <0.05 was considered significant. Mann Whitney U test and Pearson X2 test were used for the data.
Results: 500 patients admitted to emergency service with penetrating and cutting tool injury were included in this study. Most of the cases were male (%90.8). Low GCS, RTS scores and high ISS, NISS scores were statistically significant in determining patients who underwent surgery and died. The most injured area was the extremity region. The injuries with the highest mortality rate were head and neck injuries. SI ≥ 1, increased lactate value, increased baseline clearance and low hemoglobin values were statistically significant in prediction of blood transfusion. It is statistically proved that base deficit is an important predictor in determining the patients wiho underwent surgery and died. High lactate levels were found to be insignificant in determining the patient undergoing surgery. High lactate levels were found significantly higher in cases with exitus.
Conclusion: The results of our study are similar to other studies in the literature, but in addition to other physiological scoring systems to be used in identifying patients to underwent surgical intervention, the increased baseline value was also assessed as an objective test to help emergency physicians to determine the patients with penetrating and cutting tool injury who performed surgery and died. The NISS score to predict surgical intervention and the RTS score to predict mortality were the strongest scoring systems.

References

  • TÜİK sağlık ve sosyal istatistikleri 2016 Yaşa bağlı ölüm nedenleri istatistik verileri. Erişim adresi: https://data.tuik.gov.tr/Bulten/Index?p=Olum-Istatistikleri-2016-24649.
  • Durdu T, Kavalcı C, Yılmaz MS, Karakılıç ME, Arslan ED, Ceyhan MA. Acil Servisimize Başvuran Travma Vakalarının Analizi. Journal of Clinical and Analytical Medicine. 2014;5(3):182-185.
  • J Tintinalli, J. Stapczynski, O. John Ma, D Cline, R Cydulka, G Meckler. Tintinalli's Emergency Medicine: A Comprehensive Study Guide, Seventh Edition 2010.
  • Köksal Ö, Özdemir F, Bulut M, Eren Ş. Uludağ Üniversitesi Tıp Fakültesi Hastanesi Acil Servis’ine Başvuran Delici Kesici Alet Yaralanmalı Olguların Analizi. Uludağ Üniversitesi Tıp Fakültesi Dergisi. 2009;35(2):63-67.
  • Stevenson M, Segui-Gomez M, Lescohier I, Di Scala C, McDonald-Smith G. An overview of the injury severity score and the new injury severity score. Injury Prevention. 2001;7:10–13.
  • Ormstad K, Karlsson T, Enkler L, Low B, Raj J. Patterns in sharp force fatalities- a compreherensive forensic medical study. Journal of Forensic Sciences. 1986;31:529-42.
  • Güloğlu C, Aldemir M, Yağmur Y. Acil servislerin önemli sosyo-kültürel bir problemi: kesici-delici alet yaralanmaları. Akademik acil tıp dergisi. 2003;1(2):28-32.
  • Macpherson AK, Schull MJ. Penetrating trauma in Ontario emergency departments: a population-based study. Canadian Journal of Emergency Medicine. 2007; 9(1):16-20.
  • Yıldız M, Bozdemir MN, Kılıcaslan I, Ateşçelik M, Gürbüz S, Mutlu B, et al. The elderly trauma: the two years experience of a university-affiliated emergency department. European Review for Medical Phalmacological Sciences. 2012;16:62-7.
  • Vikram U. Deshmukh, Mrunal N. Ketkar, and Erach K. Bharucha. Analysis of Trauma Outcome Using the TRISS Method at a Tertiary Care Centre in Pune. Indian Journal of Surgeons. 2012;74(6):440–444.
  • Karaca MA, Kartal ND, Erbil B, Öztürk E, Kunt MM, Şahin TT, et al. Evaluation of gunshot wounds in the emergency department. Ulus Travma Acil Cerrahi Dergisi. 2015;21:4.
  • Orhon R, Eren ŞH, Karadayı Ş, Korkmaz İ, Coşkun A, Eren M, et al. Comparison of trauma scores for predicting mortality and morbidity on trauma patients. Ulus Travma Acil Cerrahi Dergisi. 2014;20:4.
  • Ohmori T, Kitamura T, Ishihara J, Onishi H, Nojima T, Yamamoto K, et al. Early predictors for massive transfusion in older adult severe trauma patients. Injury. 2017;48(5):1006-1012.
  • Chen J, Benov A, Nadler R, Darlington DN, Cap AP, Lipsky AM, et al. Prehospital Blood Transfusion During Aeromedical Evacuation of Trauma Patients in Israel: The IDF CSAR Experience. Military Medicine. 2017;182(1):47-52.
  • George MJ, Burchfield J, MacFarlane B, Wang YW, Cardenas JC, White NJ, el al. Multiplate and TEG platelet mapping in a population of severely injured trauma patients. Transfusion Medicine. 2018;28(3):224-230.
  • Rau CS, Wu SC, Spencer CH, Pao-Jen K, Shiun-Yuan H, Chen YC, et al. Prediction of Massive Transfusion in Trauma Patients with Shock Index, Modified Shock Index, and Age Shock Index. International Journal of Environmental Research and Public Health. 2016;13:683.
  • Brooke M, Yeung L, Miraflor E, Garcia A, Victorino GP; Lactate predicts massive transfusion in hemodynamically normal patients. The Journal Surgical Research. 2016;204(1):139-44.
  • Folkert IW, Sims CA, Pascual JL, Allen SR, Kim PK, Schwab CW, et al. Initial venous lactate levels in patients with isolated penetrating extremity trauma: a retrospective cohort study. Europan Journal Trauma Emergency Surgery. 2015;41(2):203-9.
  • Soni KD, Mahindrakar S, Gupta A, Kumar S, Sagar S, Jhakal A. Comparison of ISS, NISS, and RTS score as predictor of mortality in pediatric fall. Burns and Trauma. 2017;5:25.
  • Dunham MP, Sartorius B, Laing GL, Bruce JL, Clarke DL. A comparison of base deficit and vital signs in the early assessment of patients with penetrating trauma in a high burden setting. Injury. 2017;48(9):1972-1977.
There are 20 citations in total.

Details

Primary Language Turkish
Subjects Emergency Medicine
Journal Section Research Articles
Authors

Ali Şahin 0000-0003-0215-8410

Eren Usul 0000-0003-3980-6768

Yıldız Yıldırımer 0000-0001-6437-5870

Emrah Arı 0000-0003-4006-380X

Ali Halıcı 0000-0003-1392-4694

Engin Deniz Arslan 0000-0002-0155-6903

Publication Date March 1, 2023
Submission Date December 27, 2022
Acceptance Date January 20, 2023
Published in Issue Year 2023 Volume: 5 Issue: 1

Cite

Vancouver Şahin A, Usul E, Yıldırımer Y, Arı E, Halıcı A, Arslan ED. Delici – Kesici Alet Yaralanmalarının Demografik Özellikleri. Phnx Med J. 2023;5(1):32-7.

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