Acil servisten nöroşirurji kliniğine konsülte edilen hastaların analizi ve mortalitenin değerlendirilmesi

Öz

ÖZET Amaç: Acil servis başvuruları içerisindeki nöroşirürji konsültasyonlarını analiz ederek nöroşirürji ihtiyacı olan hastaların özelliklerinin ortaya konulması ve hastalarda mortalite analizinin yapılmasıdır. Gereç ve Yöntem: Çalışma retrospektif olarak ikinci basamak bir hastanenin acil servisinde yapılmıştır. Çalışmada 01.01.2023-31.12.2023 tarihleri arasında erişkin acil servisten nöroşirurji kliniğine konsülte edilen tüm hastalar değerlendirildi. Hastalarda demografik veriler, başvuru ve/veya kabul şikâyeti, teşhis, komorbit hastalık durumu, antikoagülan kullanımı, cerrahi işlem durumu, acil servise geliş anındaki Glaskow Koma Skoru, hastanede yatış süresi ve hastane içi mortalite durumu analiz edildi. Bulgular: Çalışmada 595 hasta değerlendirildi. Hastaların % 59,5’i erkeklerden oluşmakta olup yaş ortalaması 45,17±25,77 oldu. Hastalarda en sık görülen kabul şekli düşmeye bağlı genel vücut travması (%48,9) oldu. Hastalarda konulan teşhislere bakıldığında en sık izole lomber vertebra fraktürü (%15) olduğu görüldü. Kabul anında Glaskow Koma Skoru düşük olanlarda yoğun bakım yatışı, cerrahi işlem yapılma ve mortalite oranı anlamlı derecede daha yüksekti (p<0,05). Antikoagülan kullanımının intrakranyal kanama olanlarda anlamlı oranda yüksek olduğu görüldü (p=0,006). Kranyal kanama olana hastaların yatış süresi diğer vakalara göre anlamlı oranda daha yüksekti (p=0,000). Hastaların %9,4’üne (n=56) cerrahi işlem yapıldı. Toplamda acil serviste üç olmak üzere 45 hasta ölümle (% 7,6) sonlandı. Sonuç: Nöroşirurji konsültasyonları acil servis açısından son derece önemli olup patoloji saptanan hastaların büyük çoğunluğunun intrakranyal kanama ile spinal kord yaralanması gibi durumlara bağlı olarak morbidite ve mortalite açısından riskli hastalar olduğu görüldü.

Anahtar Kelimeler

• Acil Servis
• Nöroşiruji
• Kafa Travması
• Spinal Kord Yaralanması
• Mortalite

Analysis of patients consulted to the neurosurgery clinic from the emergency department and evaluation of mortality

Öz

ABSTRACT Objective: To analyze neurosurgical consultations in emergency department admissions, to reveal the characteristics of patients in need of neurosurgery and to analyze mortality in patients. Materials and Methods: The study was conducted retrospectively in the emergency department of a secondary care hospital. All patients consulted to the neurosurgery clinic from the adult emergency department between 01.01.2023-31.12.2023 were evaluated in the study. Demographic data, admission and/or admission complaint, diagnosis, comorbid disease status, anticoagulant use, surgical procedure status, Glasgow Coma Score at the time of arrival to the emergency department, duration of hospitalization and in-hospital mortality status were analyzed. Results: 595 patients were evaluated in the study. 59.5% of the patients were male and the mean age was 45.17±25.77 years. The most common type of admission was general body trauma due to fall (48.9%). The most common diagnosis was isolated lumbar vertebral fracture (15%). Intensive care unit hospitalization, surgical procedures and mortality rates were significantly higher in patients with a lower Glasgow Coma Score at admission (p<0.05). Anticoagulant use was significantly higher in patients with intracranial hemorrhage (p=0.006). The length of hospitalization was significantly higher in patients with cranial hemorrhage compared to other cases (p=0.000). Surgical procedures were performed in 9.4% of the patients (n=56). In total, 45 patients died (7.6%), including three in the emergency department. Conclusion: Neurosurgical consultations are extremely important in the emergency department and the majority of patients with pathology were found to be at risk for morbidity and mortality due to intracranial hemorrhage and spinal cord injury.

Anahtar Kelimeler

• Emergency Department
• Neurosurgery
• Head Trauma
• Spinal Cord Injury
• Mortality

Kaynakça

1. Burt CW, McCaig LF. Trends in hospital emergency department utilization: United States, 1992-99. Vital Health Stat 13. 2001; 150: 1-34.
2. McCaig LF, Burt CW. National hospital ambulatory medical care survey: 2002 Emergency department summary. Adv Data 2004; 18: 1-34.
3. Senguldur E, Selki K, Tuncer C, Demir MC. Emergency department neurosurgical consultations in a tertiary care hospital. Konuralp Medical Journal. 2023; 15(3): 412-6.
4. Park KB, Johnson WD, Dempsey RJ. Global Neurosurgery: The Unmet Need. World Neurosurg. 2016; 88: 32-5.
5. Cırak B, Guven MB, Isık S, Kıymaz N, Demir O. An epidemiologic study on trauma patients presenting to the emergency department. Ulus Trauma and Emergency Journal. 1999; 5: 157-9.
6. Karasu A, Sabancı PA, Cansever T, Hepgul KT, Imer M, Dolas I, et al. Epidemiological study in head injury patients. Ulus Trauma and Emergency Journal. 2009; 15: 159-63.
7. Markogiannakis H, Sanidas E, Messaris E, Koutentakis D, Alpantaki K, Kafetzakis A, et al. Predictors of in-hospital mortality of trauma patients injured in vehicle accidents. Ulus Trauma and Emergency Journal. 2008; 14: 125-31.
8. Witiw CD, Fehlings MG. Acute spinal cord injury. Clinical spine surgery. 2015;28(6):202-10.

9. Bonner S, Smith C. Initial management of acute spinal cord injury. Continuing Education in Anaesthesia, Critical Care & Pain. 2013; 13(6): 224-31.
10. Lyn-Sue J, Siram S, Williams D, Mezghebe H. Epidemiology of trauma deaths in an urban level-i trauma center predominantly among African Americans implications for prevention. J Natl Med Assoc. 2006;98:12.
11. Avcı S, Arslan ED, Buyukcam F. Retrospective evaluation of traumatic deaths in the emergency department. Sakarya Medical Journal. 2017; 7(1): 13-9.
12. Jayakumar N, Kennion O, Villabona AR, Paranathala M, Holliman D. Neurosurgical referral patterns during the coronavirus disease 2019 pandemic: A United Kingdom Experience. World Neurosurg. 2020; 144: 414-20.
13. Kelly DF, Becker DP. Advances in management of neurosurgical trauma: USA and Canada. World J Surg. 2001; 25(9): 1179-85.
14. Akgül M,Burulday V. Evaluation results of the cases applied to the emergency unit with cause of head trauma. Journal of Kirikkale University Faculty of Medicine. 2016; 18(3): 134-8.
15. Uras M. Factors affecting mortality and morbidity in traumatic spinal cord injury patients in the early period [Medical Specialty Thesis]. Samsun: Ondokuz Mayıs University, Faculty of Medicine; 2018.
16. Varma A, Hill EG, Nicholas J, Selassie A. Predictors of early mortality after traumatic spinal cord injury: a population-based study. Spine. 2010; 35(7): 778-83.
17. Sogut O, Al B. Prehospital approach and emergency department management in patients with head trauma. Journal of General Medicine. 2009; 19(2): 85-90.
18. Gomez PA, Lobato RD, Ortega JM, De La Cruz J. Mild head injury: differences in prognosis among patients with a Glasgow Coma Scale score of 13 to 15 and analysis of factors associated with abnormal CT findings. Br J Neurosurg. 1996; 10(5): 453-60.
19. Nguyen R, Fiest KM, McChesney J, Kwon C-S, Jette N, Frolkis AD, et al. The international incidence of traumatic brain injury: a systematic review and meta-analysis. Canadian journal of neurological sciences. 2016; 43(6): 774-85.
20. Catal Y. Evaluation of patients admitted to the medical faculty emergency department due to mild head trauma and using anticoagulants or antiplatelet drugs in terms of the risk of delayed intracranial hemorrhage [Medical Specialty Thesis]. Ankara: Ankara University Faculty of Medicine; 2020.
21. Swap C, Sidell M, Ogaz R, Sharp A. Risk of delayed intracerebral hemorrhage in anticoagulated patients after minor head trauma: the role of repeat cranial computed tomography. The Permanente Journal. 2016; 20(2): 14.
22. Arslan ED, Kaya E, Sonmez M, Kavalcı C, Solakoglu A, Yılmaz F et al. Assesment of Traumatic Deaths in a Level One Trauma Center in Ankara, Turkey. Eur J Trauma Emerg Surg. 2015; 41(3): 319-23.
23. Evans JA, Wessem KJP, McDougall D, Lee KA, Lyons T, Balogh ZJ. Epidemiology of Traumatic Deaths: Comprehensive Population- Based Assessment. World J Surg 2010; 34: 158-63.
24. Hamzeh B, Najafi F, Karamimatin B, Ahmadijouybari T, Salari A, Moradinazar M. Epidemiology of traffi c crash mortality in west of Iran in a 9 year period. Chinese J Traum 2016; 70-4