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

Kaynakça

1. 1. Turgut K, Gür A, Güven T, Oğuztürk H. Evaluation of factors related to mortality caused by firearm injury: a retrospective analysis from Malatya, Turkey. Arch Iran Med. 2019;22(2):80-4. PMID: 30980643
2. 2. Aygün M, Tulay CM. Atypical trajectory of gunshot injury. Ulus Travma Acil Cerrahi Derg. 2014;20(6): 452-4. doi: 10.5505/tjtes.2014.16680
3. 3. 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 Derg. 2015;21(4): 248-55. doi: 10.5505/tjtes.2015.64495
4. 4. Meral O, Sağlam C, Güllüpınar B, Aktürk ÖE, Beden S, Parlak İ. Investigation of firearm injury cases presented to training and research hospital’s emergency service. Ulus. Travma Acil Cerrahi Derg. 2020;26(1): 74-79. doi: 10.14744/tjtes.2019.08949
5. 5. Aspelund AL, Patel MQ, Kurland L, McCauld M, van Hoving DJ. Evaluating trauma scoring systems for patients presenting with gunshot injuries to a district-level urban public hospital in Cape Town, South Africa. Afr J Emerg Med. 2019;9(4):193-96. doi: 10.1016/j.afjem.2019.07.004
6. 6. Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974;2:81-4. doi: 10.1016/s0140-6736(74)91639-0
7. 7. Ünlü AR, Ülger F, Dilek A, Barış S, Murat N, Binnur Sarıhasan B. Yoğun bakımda izlenen travma hastalarında “revizetravma skoru” ve “travma ve yaralanma şiddeti skoru’’nun prognoz ile ilişkisinin değerlendirilmesi. Türk Anest Rean Der. 2012;40(3):128-35.
8. 8. Baker SP, O’Neill B, Haddon W Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14:187-96. PMID: 4814394

9. 9. Champion HR, Sacco WJ, Copes WS, Gann DS, Gennarelli TA, Flanagan ME. A revision of the Trauma Score. J Trauma. 1989; 29: 623-9. DOİ: 10.1097/00005373-198905000-00017
10. 10. Boyd CR, Tolson MA, Copes WS. Evaluating trauma care: the TRISS method. Trauma Score and the Injury Severity Score. J Trauma. 1987;27:370-8. PMID: 3106646
11. 11. Abghari M, Monroy A, Schubl S, Davidovitch R, Egol K. Outcomes following low-energy civilian gunshot wound trauma to the lower extremities: results of a standard protocol at an urban trauma center. Iowa Orthop. J. 2015;35:65-9. PMID: 26361447
12. 12. Volgas DA, Stannard JP, Alonso JE. Current orthopaedic treatment of ballistic injuries. Injury 2005;36(3):380-6. doi: 10.1016/j.injury.2004.08.038
13. 13. Köksal O, Ozdemir F, Bulut M, Aydin S, Almacioğlu ML, Ozgüç H. Comparison of trauma scoring systems for predicting mortality in firearm injuries. Ulus Travma Acil Cerrahi Derg. 2009;15(6):559-64. PMID: 20037873.
14. 14. Global Burden of Disease 2016 Injury Collaborators, Naghavi M, Marczak LB, et al. Global mortality from firearms, 1990-2016. JAMA. 2018;320(8):792-814. doi: 10.1001/jama.2018.10060.
15. 15. Branas CC, Han S, Wiebe DJ. Alcohol use and firearm violence. Epidemiol Rev. 2016;38(1):32-45. doi: 10.1093/epirev/mxv010
16. 16. Cukier W, Eagen SA. Gun violence. Curr Opin Psychol. 2017;19:109-12. doi: 10.1016/j.copsyc.2017.04.008
17. 17. Zafar H, Rehmani R, Raja AJ, Ali A, Ahmed M. Registry based trauma outcome: perspective of a developing country. Emerg Med J. 2002;19:391-94. doi: 10.1136/emj.19.5.391
18. 18. Söderlund N, Zwi AB. Traffic-related mortality in industrialized and less developed countries. Bull World Health Organ. 1995;73(2):175-82. PMID: 7743588
19. 19. Norouzi V, Feizi I, Vatankhah S, Majid P. Calculation of the probability of survival for trauma patients based on trauma score and the injury severity score model in Fatemi hospital in Ardabil. Arch Trauma Res. 2013;2(1):30-5. doi: 10.5812/atr.9411
20. 20. Lefering R. Trauma score systems for quality assessment. Eur J Trauma. 2002;28(2):52-63. doi: 10.1007/s00068-002-0170-y
21. 21. Nathens AB, Brunet FP, Maier RV. Development of trauma systems and effect on outcomes after injury. Lancet. 2004;363(9423):1794-801. doi: 10.1016/S0140-6736(04)16307-1
22. 22. Engelmann EWM, Roche S, Maqungo S, Naude D, Held M. Treating fractures in upper limb gunshot injuries: The Cape Town experience. Orthop Traumatol Surg Res. 2019;105(3):517-22. doi: 10.1016/j.otsr.2018.11.002
23. 23. Atılgan K, Er ZC. Evaluation of peripheral vascular injuries treated with surgery: A retrospective cohort study. J Surg Med. 2020;4(5):371-3. doi: 10.28982/josam.729546
24. 24. Dorlac WC, DeBakey ME, Holcomb JB, et al. Mortality from isolated civilian penetrating extremity injury. J Trauma. 2005;59(1):217-22. doi: 10.1097/01.ta.0000173699.71652.ba
25. 25. de Anda H, Dibble T, Schlaepfer C, Foraker R, Mueller K. A cross-sectional study of firearm injuries in emergency department patients. Mo Med. 2018;115(5):456-62. PMID: 30385996
26. 26. Peleg K, Aharonson-Daniel L, Stein M, Michaelson M, Kluger Y, Simon D, et al. Gunshot and explosion injuries: characteristics, outcomes, and implications for care of terror-related injuries in Israel. Ann Surg. 2004;239:311-8. doi: 10.1097/01.sla.0000114012.84732.be
27. 27. Cowey A, Mitchell P, Gregory J, Maclennan I, Pearson R. A review of 187 gunshot wound admissions to a teaching hospital over a 54-month period: training and service implications. Ann R Coll Surg Engl. 2004;86:104-07. doi: 10.1308/003588404322827482
28. 28. Asensio JA, Arroyo H Jr, Veloz W, Forno W, Gambaro E, Roldan GA, et al. Penetrating thoracoabdominal injuries: ongoing dilemma – which cavity and when? World J Surg. 2002; 26: 539-43. DOI: 10.1007/s00268-001-0147-8