Acil servise başvuran travma hastalarında rutin tetkiklerin gerekliliğinin analizi
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Date
2009
Authors
Çevik, Şebnem Eren
Journal Title
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Publisher
Uludağ Üniversitesi
Abstract
Bu çalışmanın amacı acil servise major travma nedeniyle başvuran Glasgow Koma Skalası (GKS):15, Gözden Geçirilmiş Travma Skoru (RTS):12 olan hastalarda rutin tetkiklerin gerekliliğinin ve tanısal değerinin analizidir.Çalışmaya 1 Şubat-30 Haziran 2009 tarihleri arasında Uludağ Üniversitesi Tıp Fakültesi Hastanesi Acil Servisi' ne araç içi trafik kazası (AİTK), araç dışı trafik kazası (ADTK) veya yüksekten düşme nedeniyle başvuran 15?65 yaş arası, GKS:15, RTS:12 olan ve oluş mekanizmasına göre major travma kriterlerine uyan 103 hasta alınmıştır. Çalışmada dışlanma kriterleri şunlardır: GKS<15 veya RTS<12 olması, <15 veya >65 yaştaki hastalar, alkollü olgular . Araştırmaya alınan hastaların verileri acil tıp asistanı tarafından doldurulan "Travmalı Hasta Değerlendirme Formu" kullanılarak toplanmıştır.Çalışmaya alınan hastaların yaş ortalaması 35±12.97'dir. Hastaların %30.1 (n=31)'i kadın, %69.9 (n=72)'u erkek hastadır. Hastaların %72.8 (n=75)'i AİTK, %12.6 (n=13) ADTK, %14.6 (n=15) yüksekten düşme nedeniyle başvurmuştur. 96 hastadan hemogram, 83 hastadan idrar analizi, 96 hastadan acil profil, 102 hastadan ön-arka akciğer grafisi, 103 hastadan yan servikal grafi, 99 hastadan pelvik grafi ve 80 hastadan abdomen ultrasonografi (USG) istenmiştir. Hemogram ve servikal yan grafi hariç diğer tetkiklerin istem nedenleri ile sonuçları arasında anlamlı fark ortaya çıkmıştır.Major travma genç ve orta yaş grubunda ölüm ve kalıcı sakatlığa neden olan en önemli sağlık sorunlarından biridir. İleri Travma Yaşam Desteği (Advanced Trauma Life Support-ATLS) protokollerine göre major travma tanımı fizik bulgulara ve yaralanma mekanizmasına göre yapılmaktadır. ATLS major travma hastalarının tanısında bir takım rutin tetkikleri önermektedir. Ancak günümüzde bu rutin tetkiklerin gerekliliği tartışılmaya başlanmıştır. Bizim çalışmamızda da bu konu ele alınmıştır ve gelecekte yapılacak çalışmalara bir fikir oluşturulmaya çalışılmıştır.
The goal of this study is to analyze the necessity and diagnostic value of routine tests in patients who apply to the emergency department with major trauma and have Glascow Coma Scale (GCS):15, Revised Trauma Score (RTS):12.The study includes 103 patients, aged between 15 and 65 years, who applied to the Uludağ University Faculty of Medicine Emergency Department because of motor vehicle crashes, pedestrian injury or falling from high level during the time period from February 1 to June 30, 2009 and who were classified as major trauma patient according to mechanism of injury (GCS:15, RTS:12). The exclusion criteria are the following: GKS<15 and/or RTS>12; age <15 or >65 years, cases intoxicated with alcohol. The data is collected by emergency department physician using "Trauma Patient Assesment Form".The average age of the patients who are accepted to the study is 35±12.97. 30% of the patients (n=31) are female, 69.9% of the patients (n=72) are male. 72.8% of the patients (n=75) applied for motor vehicle crashes, 12.6% of the patients (n=13) applied for pedestrian injury, 14.6% of the patients (n=15) applied for falling from high level. Tests requested from the patients are hemogram from 96 patients, urine analysis from 83 patients, emergency profile from 96 patients, anterior-posterior lung X-ray from 102 patients, lateral cervical X-ray from 103 patients, pelvic X-ray from 99 patients and abdomen ultrasonography from 80 patients. Except from hemogram and lateral cervical X-ray, significant difference appeared between the request reasons and results of the other tests.Major trauma is one of the most important health problems that cause death and permanent disability in young and middle age group. According to the Advanced Trauma Life Support (ATLS) protocols, the definition of the major trauma is made according to the physical findings and mechanism of injury. ATLS suggests several routine tests for the diagnosis of major trauma patients. However, today the necessity of these tests is being discussed. This subject is discussed in our study as well and attempts are made to form ideas for future work.
The goal of this study is to analyze the necessity and diagnostic value of routine tests in patients who apply to the emergency department with major trauma and have Glascow Coma Scale (GCS):15, Revised Trauma Score (RTS):12.The study includes 103 patients, aged between 15 and 65 years, who applied to the Uludağ University Faculty of Medicine Emergency Department because of motor vehicle crashes, pedestrian injury or falling from high level during the time period from February 1 to June 30, 2009 and who were classified as major trauma patient according to mechanism of injury (GCS:15, RTS:12). The exclusion criteria are the following: GKS<15 and/or RTS>12; age <15 or >65 years, cases intoxicated with alcohol. The data is collected by emergency department physician using "Trauma Patient Assesment Form".The average age of the patients who are accepted to the study is 35±12.97. 30% of the patients (n=31) are female, 69.9% of the patients (n=72) are male. 72.8% of the patients (n=75) applied for motor vehicle crashes, 12.6% of the patients (n=13) applied for pedestrian injury, 14.6% of the patients (n=15) applied for falling from high level. Tests requested from the patients are hemogram from 96 patients, urine analysis from 83 patients, emergency profile from 96 patients, anterior-posterior lung X-ray from 102 patients, lateral cervical X-ray from 103 patients, pelvic X-ray from 99 patients and abdomen ultrasonography from 80 patients. Except from hemogram and lateral cervical X-ray, significant difference appeared between the request reasons and results of the other tests.Major trauma is one of the most important health problems that cause death and permanent disability in young and middle age group. According to the Advanced Trauma Life Support (ATLS) protocols, the definition of the major trauma is made according to the physical findings and mechanism of injury. ATLS suggests several routine tests for the diagnosis of major trauma patients. However, today the necessity of these tests is being discussed. This subject is discussed in our study as well and attempts are made to form ideas for future work.
Description
Keywords
Major travma, Rutin tetkikler, İstem nedeni, Hedefe yönelik tetkik, Major trauma, Routine tests, Reason for requirement, Target oriented test
Citation
Çevik, Ş. E. (2009). Acil servise başvuran travma hastalarında rutin tetkiklerin gerekliliğinin analizi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.