Travma Hastalarında Akut Batın Analizi: Mortalite Faktörleri ve COVID-19 Pandemisinin Yatışlar Üzerindeki Etkisi

Öz

Amaç: Travmaya bağlı akut batın gelişen hastaların analizi ile mortaliteyi etkileyen faktörlerin değerlendirilmesi ile COVID-19 pandemi sürecinin hasta başvurularına etkisini incelemektir. Yöntem: Çalışma retrospektif olarak 01.01.2019-31.12.2023 (5 yıl) tarihleri arasında ikinci basamak bir sağlık kuruluşunun acil servisine başvuran ve travmaya sekonder acil cerrahi batın gelişen, yatırılarak tedavi altına alınan hastaların analizi ile yapıldı. Çalışmaya tüm yaş grupları dâhil edildi. Hastalarda demografik veriler, travma tipi, tedavi tipi, yaralanan bölge, laboratuar verileri, hastanede yatış süresi ve mortalite durumu analiz edildi. Travma tipine göre yaralanan bölgelerin karşılaştırmalı analizi yapıldı. Taburcu olan ve ölümle sonlanan hastaların verileri karşılaştırıldı. Veri toplama işlemleri ise hastane elektronik verileri üzerinden yapıldı. Bulgular: Çalışmada 123 hasta değerlendirildi. Hastaların %78.9’u erkekti. Yaş ortalaması 36.43±14.81 olup en sık hasta yatışı 21- 40 yaş aralığındaydı (%60.2). Acil servise başvuru anında Glaskow Koma Skoru en sık 11-15 (%83) aralığında oldu. En fazla trafik kazası nedeniyle başvuru olduğu görüldü (%40.7). Travma sonrası en fazla batın içinde birden fazla organ ya da bölgede yaralanma olduğu görüldü (%28.5). Hastaların %65,9’una cerrahi işlem uygulandı. Hastanede ortalama yatış süresi 7.14±5.40 gün oldu. Eksitus olan vakalarda başvuru anında hemoglobin düzeyi ve trombosit düzeyinin anlamlı derecede düşük olduğu görüldü (p<0.05). Mortalite oranı %9.8’di. Sonuç: Karın travmalı hastalarda yaralanmanın tipi, başvuru anında gözlenen Glaskow Koma Skoru ve laboratuar verileri mortaliteyi öngörmede etkili olmaktadır. Özellikle künt travmalı hastalarda ve multi travmalı vakalarda karın içinde meydana gelen yaralanmanın daha sinsi şekilde ilerleyebileceği ve atlanabileceği unutulmamalıdır.

Anahtar Kelimeler

• Acil Servis
• Künt Abdominal Travma
• Penetran Abdominal travma
• Mortalite

Analysis of Acute Abdomen in Trauma Patients: Mortality Factors and Impact of the COVID-19 Pandemic on Admissions

Öz

Objective: To analyze the patients who developed acute abdomen due to trauma, to evaluate the factors affecting mortality and to examine the impact of the COVID-19 pandemic process on patient admissions. Method: The study was conducted retrospectively by analyzing the patients who applied to the emergency department of a secondary healthcare institution between 01.01.2019-31.12.2023 (5 years) and developed an emergency surgical abdomen secondary to trauma and were hospitalized and treated. All age groups were included in the study. Demographic data, type of trauma, type of treatment, site of injury, laboratory data, length of hospitalization and mortality status were analyzed. Comparative analysis of the injured regions according to the type of trauma was performed. Data of patients who were discharged and those who died were compared. Data collection was performed through hospital electronic data. Results: The study evaluated 123 patients. The majority of patients were male (%78.9). The mean age was 36.43±14.81 years and the most common age range was 21-40 years (60.2%). At the time of presentation to the emergency department, the most common Glasgow Coma Score was 11-15 (83%). The most common reason for presentation was traffic accident (40.7%). Post-traumatic injuries to more than one organ or region in the abdomen were most common (28.5%). Surgical procedures were performed in 65.9% of the patients. The mean duration of hospitalization was 7.14±5.40 days. Hemoglobin and platelet levels were found to be significantly lower at the time of admission in the patients who died (p<0.05). Mortality rate was 9.8%. Conclusion: In patients with abdominal trauma, the type of injury, Glasgow Coma Score at admission and laboratory data are effective in predicting mortality. It should be kept in mind that especially in patients with blunt trauma and in cases of multiple trauma, intra-abdominal injuries may progress more insidiously and may be missed.

Anahtar Kelimeler

• Emergency Department
• Blunt Abdominal Trauma
• Penetrating Abdominal Trauma
• Mortality

Kaynakça

1. French LK, Gordy S, O. John Ma. Abdominal trauma. In Tintinalli JE, Stapczynski JS, Ma OJ, Yealy DM, Meckler GD, Cline DM (eds): Emergency Medicine a comprehensive study guide. 8th ed. New York: The Mac Graw Hill Companies, 2015.
2. Isenhour JL, Marx J. Advances in abdominal trauma. Emerg Med Clin N Am. 2007; 25: 713-33.
3. Poletti PA, Mirvis SE, Shanmuganathan K, Takada T, Killeen KL, et al. Blunt abdominal trauma patients: can organ injury be excluded without performing computed tomography? J Trauma. 2004; 57: 1072-81.
4. Mama N, Jemni H, Achour AN, Sidiya OC, Kadri K, Gaha M et al. Abdominal trauma imaging. Derkel F, Editor. Abdominal surgery. Intech, Open access. 2012.Doi: 10.5772/50426
5. Ozkan S. Abdominal Injuries. Emergency medicine in all aspects: Diagnosis, treatment and practice book. Ed: Zeynep Kekec. 3rd Edition, Academic Medical Bookstore, 2013, p:859-66.
6. El Wakeel AM, Habib RM, Ali AN. Role of CT in Evaluation of blunt abdominal trauma. International Journal of Medical Imaging. 2015; 3: 89-93.
7. Ntundu SH, Herman AM, Kishe A, Babu H, Jahanpour OF, Msuya D, et al. Patterns and outcomes of patients with abdominal trauma on operative management from northern Tanzania: a prospective single centre observational study. BMC Surg. 2019;19: 69.
8. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020; 15; 395 (10223): 497-506.

9. San I, Usul E, Bekgöz B, Korkut S. Effects of COVID-19 Pandemic on emergency medical services. Int J Clin Pract. 2021; 75(5): e13885.
10. Acar E, Ozkan S, Genc S, Altun S. Evaluation of adult abdominal trauma patients and intra-abdominal solid organ injuries. Phnx Med J. 2020; 2(2):90-7.
11. Tekesir K, Basak F, Sisik A, Caliskan YK. Epidemiology of trauma with analysis of 138.352 patients: Trends of a single center, Haydarpasa Numune Med J. 2019; 59(2): 181-5.
12. Ozpek A, Yucel M, Atak I, Bas G, Alimoglu O. Multivariate analysis of patients with blunt trauma and possible factors affecting mortality. Ulus Trauma Emergency Surg. 2015; 21:6: 477-83.
13. Akdeniz S, Okur MH, Goya C. Demographic, clinical and laboratory results of patients with blunt liver trauma: A retrospective review of 2006-2016. Dicle Med J. 2020; 47(2): 366-76.
14. Yasak IH, Giden R. Investigation of children with solid organ damage after blunt abdominal trauma. Journal of Harran University Faculty of Medicine. 2022; 19(3): 600-4.
15. Salimi J, Ghodsi M, Zavvarh MN, Khaji A. Hospital management of abdominal trauma in Tehran, Iran: a review of 228 patients. Chin J Traumatol. 2009; 12: 259-62.
16. Demetriades D, Hadjizacharia P, Constantinou C, Brown C, Inaba K, Rhee P, et al. Selective non operative management of penetrating abdominal solid organ injuries. Ann Surg. 2006; 244: 620-8.
17. Yanar H, Ertekin C, Taviloglu K, Kabay B, Bakkaloglu H, Guloglu R. Nonoperative treatment of multiple intra-abdominal solid organ injury after blunt abdominal trauma. The Journal of Trauma 2008; 4: 943-8.
18. Dodiyi-Manuel A, Jebbin NJ, Igwe PO. Abdominal injuries in university of port harcourt teaching hospital. Niger J Surg 2015; 21:18-20.
19. Kurt F, Acele S, Sezer C. Penetrating stab wounds to the abdomen: Results in our secondary care center. J For Med 2020; 34(2):62-8.
20. Saylam N, Uyanık B, Buz M, Buyukyılmaz T, Demir Y, Algedik Gürsoy D. Gunshot wounds due to a terrorist attack. Anatolian J Emerg Med. Mart 2019; 2(1): 18-23.
21. Gonultas F, Kutluturk K, Gok AFK, Barut B, Sahin TT, Yilmaz S. Analysis of risk factors of mortality in abdominal trauma. Ulus Trauma Emergency Surg. 2020; 26(1): 43-9.
22. Guven O, Demireller M, Kurt BF, Yesil O. The effect of the COVID-19 pandemic on emergency department forensic applicatıons: a study in Turkey’s western border. HMJ. 2023; 3(3): 16-23.
23. Bilgic I, Gelecek S, Akgun AE, Ozmen MM. Predictive value of liver transaminases levels in abdominal trauma. Am J Emerg Med. 2014; 32: 705-8.
24. Akbalık S. Analysis of Patients Applying to the Emergency Department with Gunshot Wounds, Master's thesis, Bezmialem Vakif University, Institute of Health Sciences, Department of Disaster Management, Disaster Management Master's Program, Istanbul, 2022.
25. Raza M, Abbas Y, Devi V, Prasad KV, Rizk KN, Nair PP. Non operative management of abdominal trauma-a 10 years review. World J Emerg Surg. 2013; 8: 14.
26. Girgin S, Gedik E, Tacyılmaz IH. Evaluation of surgical methods applied in kunt liver trauma. Ulus Trauma Emergency Surg. 2006; 12: 35-42.
27. Koksal O, Ozdemir F, Bulut M, Aydin S, Almacıoglu ML, Ozguc H. Comparison of trauma scoring systems for predicting mortality in firearm injuries. Ulus Trauma Emergency Surg. 2009; 15: 559-64.
28. Duzgun AP, Ozmen MM, Salyam B, Coşkun F. Factors influencing mortality in traumatic ruptures of diaphragm. Ulus Trauma Emergency Surg. 2008; 14: 132-8.
29. Aldemir M, Tacyıldız I, Girgin S. Predicting factors for mortality in the penetrating abdominal trauma. ActaChirBelg 2004; 104: 429-34.