Blast etkiyle kafa travması gelişen olgularda eşlik eden travmalar mortaliteyi etkiler mi?

Öz

Giriş/Amaçlar: Günümüz savaşlarında askerlerden çok siviller savaş mağduru olmaktadır. Savaşla ilgili ölümlerin çoğu sivillerde meydana gelmekte ve en çok etkilenenler ise çocuklar olmaktadır. Savaş alanındaki askeri yaralanmalar genellikle penetran olmakla birlikte, patlama etkisindeki künt travmalar da sivil yaralanmalarda sık görülmektedir. Bu çalışmada, savaşta patlamalı kafa travması geçiren çocuklarda torasik ve abdominal travma sıklığı incelenmiştir. Metod: Savaşta patlamalı kafa travması geçiren 25 pediatrik hasta retrospektif olarak incelendi. Bulgular: Hastaların 16'sı erkek, 9'u kadındı. Ortalama yaş 9,4±5,0 idi. Hastaların hepsinde kafa travması vardı. Travma tiplerine bakıldığında, %84,0'ında karma travma (kafa, göğüs, karın) ve %16,0'ında sadece kafa travması vardı. Kafa travması dışındaki travma durumları incelendiğinde, en sık görülen travma %60,0 ile akciğer kontüzyonu iken, bunu %32,0 ile serbest abdominal sıvı takip etti. Sonuç: Bomba etkisinden kaynaklanan patlama yaralanmaları, tüm vücudu etkileyen yüksek ölüm oranına sahip yaralanmalardır. Gelişme çağında, çocuklar savaş ve terörizmin odak noktasıdır ve bu da ölüm oranlarını artırır. Bu tür yaralanmalarda, yalnızca dış kesiklerin olduğu kısımlar değil, tüm vücut hasar açısından dikkatlice incelenmelidir

Anahtar Kelimeler

• Blast travma
• Mortalite
• Çocuk

Do accompanying traumas affect mortality in cases of blast-induced head trauma?

Öz

Background/Aims: Today's wars are more likely to be civilian war victims than soldiers. Most war-related deaths occur in civilians, and children are the most affected. While military injuries on the battlefield are generally penetrating, blunt traumas with blast effects are also common in civilian injuries. This study examined the frequency of thoracic and abdominal trauma in children who suffered blast head trauma in war Methods: 25 pediatric patients who suffered blast head trauma in war were retrospectively examined. Results: 16 of the patients were male and 9 were female. The mean age was 9.4±5.0. All patients had head trauma. In terms of trauma type, 84.0% had mixed trauma (head, chest, abdomen) and 16.0% had only head trauma. When we analyzed trauma conditions other than head trauma, pulmonary contusion was the most common trauma with 60.0%, followed by free abdominal fluid with 32.0%. Conclusions: Blast injuries due to bomb effects are injuries with high mortality rates that involve the entire body. In the developing age, children are the focal point of war and terrorism, which increases mortality rates. In such injuries, not only the parts with external lacerations but the entire body should be carefully examined for damage.

Anahtar Kelimeler

• Blast trauma
• Mortality
• Children

Kaynakça

1. 1. Hinsley DE, Rosell PA, Rowlands TK, Clasper JC. Penetrating missile injuries during asymmetric warfare in the 2003 Gulf conflict. Br J Surg. 2005;92(5):637-42.
2. 2. Scope A, Farkash U, Lynn M, Abargel A, Eldad A. Mortality epidemiology in low-intensity warfare: Israel Defense Forces' experience. Injury. 2001;32(1):1-3.
3. 3. Santa Barbara J. Impact of war on children and imperative to end war. Croat Med J. 2006;47(6):891-4.
4. 4. Volgas DA, Stannard JP, Alonso JE. Ballistics: a primer for the surgeon. Injury. 2005;36(3):373-9.
5. 5. Santucci RA, Chang YJ. Ballistics for physicians: myths about wound ballistics and gunshot injuries. J Urol. 2004;171(4):1408-14.
6. 6. Milwood Hargrave J, Pearce P, Mayhew ER, Bull A, Taylor S. Blast injuries in children: a mixed-methods narrative review. BMJ Paediatr Open. 2019;3(1):e000452.
7. 7. Arriola VD, Rozelle JW. Traumatic Brain Injury in United States Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Hispanic Veterans-A Review Using the PRISMA Method. Behav Sci (Basel). 2016;6(1):3.
8. 8. Phillips YY. Primary blast injuries. Ann Emerg Med. 1986;15(12):1446-50.

9. 9. Owens BD, Kragh JF Jr, Wenke JC, Macaitis J, Wade CE, Holcomb JB. Combat wounds in operation Iraqi Freedom and operation Enduring Freedom. J Trauma. 2008;64(2):295-9.
10. 10. Bilukha OO, Brennan M, Anderson M, Tsitsaev Z, Murtazaeva E, Ibragimov R. Seen but not heard: injuries and deaths from landmines and unexploded ordnance in Chechnya, 1994-2005. Prehosp Disaster Med. 2007;22(6):507-12.
11. 11. Stansbury LG, Lalliss SJ, Branstetter JG, Bagg MR, Holcomb JB. Amputations in U.S. military personnel in the current conflicts in Afghanistan and Iraq. J Orthop Trauma. 2008;22(1):43-6.
12. 12. Stapczynski JS. Blast injuries. Ann Emerg Med. 1982;11(12):687-94. 13.Hadden WA, Rutherford WH, Merrett JD. The injuries of terrorist bombing: a study of 1532 consecutive patients. Br J Surg. 1978;65(8):525-31.
13. 14. Cooper GJ, Maynard RL, Cross NL, Hill JF. Casualties from terrorist bombings. J Trauma. 1983;23(11):955-67. 15.Hill JF. Blast injury with particular reference to recent terrorist bombing incidents. Ann R Coll Surg Engl. 1979;61(1):4-11.
14. 16. Peleg K, Aharonson-Daniel L, Michael M, Shapira SC; Israel Trauma Group. Patterns of injury in hospitalized terrorist victims. Am J Emerg Med. 2003;21(4):258-62.
15. 17. de Ceballos JP, Turégano-Fuentes F, Perez-Diaz D, Sanz-Sanchez M, Martin-Llorente C, Guerrero-Sanz JE. 11 March 2004: The terrorist bomb explosions in Madrid, Spain--an analysis of the logistics, injuries sustained and clinical management of casualties treated at the closest hospital. Crit Care. 2005;9(1):104-11.
16. 18. Turégano-Fuentes F, Pérez-Diaz D, Sanz-Sánchez M, Alfici R, Ashkenazi I. Abdominal blast injuries: different patterns, severity, management, and prognosis according to the main mechanism of injury. Eur J Trauma Emerg Surg. 2014;40(4):451-60.
17. 19. Eastridge BJ, Salinas J, Wade CE, Blackbourne LH. Hypotension is 100 mm Hg on the battlefield. Am J Surg. 2011;202(4):404-8.