Toraks travmalı olgularda mortaliteye etkili faktörler
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Date
2008
Authors
Emircan, Şadiye
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Genel vücut travması geçiren olgularda toraks travması kafa travmalarından sonra en sık ölüm nedenidir. Toraks yaralanmaları solunum fizyolojisini özellikle de oksijenasyonu etkilediğinden tüm vücut sistemlerini ilgilendiren komplikasyonlara neden olabilmektedir ve genellikle yandaş sistem yaralanmaları ile birliktedir. Çalışmanın amacı toraks yaralanması olan genel vücut travmasına maruz kalmış hastaların epidemiyolojik özelliklerini belirlemek, acil servisimize getirildiklerinde durumlarını analiz etmek, fizyolojik, anatomik risk faktörlerinin mortaliteyle olan ilişkisini saptamak ve şiddetli travmanın erken tanınmasını sağlamaktır.Bu çalışmada genel vücut travmasına maruz kalmış toraks travmalı 371 olgu retrospektif olarak incelenmiştir. Olguların epidemiyolojik özellikleri belirlenerek acil servise ilk başvuru durumları analiz edilmiş, olgular mortalite gelişimi açısından değerlendirilmiştir. Ölen ve yaşayan olgular; yaş, cinsiyet, travma mekanizması, başvuru anında ölçülen sistolik kan basıncı değeri (TA), başvuru anındaki solunum karakteri, eşlik eden yaralanmalar, toraks patolojisi, travma skorları, tedavi yaklaşımları (cerrahi-konservatif), açısından karşılaştırılmıştır. Trauma Reevised Score-Injury Severity Score (TRISS) metodu kullanılarak olguların yaşama olasılıkları ve beklenmeyen ölüm oranları saptanmıştır.Mortalite oranı %22.6 (85 olgu)'dır. Univaryans analizde yaş, hipotansiyon varlığı, patolojik solunum patterni, künt yaralanma olması, yandaş yaralanma varlığı, karın travması olması, yüksek ISS, düşük GKS, RTS, TRISS mortaliteye etkili faktörler olarak bulunmuştur. Lojistik regresyon analizinde, künt yaralanma (p:0,00. OR:5,32), TRISS<85 (p:0,000..,OR:11,5), ISS>22(p:0.00.., OR:6,27) ve GKS<13(p:0.00.., OR:5,03) olması bağımsız prognostik faktörler olarak bulunmuştur. Mortaliteyi göstermede en güçlü faktör TRISS olarak bulunmuştur. TRISS analizinde yaşama olasılığı %50' nin üzerinde olan 307 olgudan 34'ü ölmüştür.Sonuç olarak ciddi toraks travmalı hastaya yaklaşım bir çok bölümün ortaklaşa çalışmasını gerektiren bir ekip işidir. Mortaliteye etkili bulunan faktörlerin varlığında toraks travmalı hastalar yüksek risk grubu olarak değerlendirilip, tanı ve tedavide agresif olunmalıdır. TRISS modeline dayalı olarak yapılacak olgu analizleri hasta bakımında yapılacak yanlışları daha iyi ortaya koyacak ve bunların düzeltilmesine olanak sağlayacaktır.
Thorax trauma is the second most frequent cause of death after head trauma, in general body trauma cases. As thorax traumas affect respiratory physiology and especially oxygenation, they may result in complications affecting all body systems and they usually have accompanying injuries. The purpose of this study is to define the epidemiologic properties of patients that have been subject to thorax injuries and general body traumas, analyze their condition when they are brought to our emergency department, to determine the correlation of physiological and anatomical risk factors with the mortality rate, and to ensure early diagnosis of severe trauma. 371 trauma cases that had been subject to general body trauma have been retrospectively examined in this study. Epidemiological properties of the cases have been determined, their initial conditions during initial admission to emergency department have been analyzed, and cases have been assessed in terms of mortality developments. Dead and surviving cases have been compared in terms of age, gender, trauma mechanism, systolic blood pressure (SBP) as measured at emergency admissions, respiration type at the time of application, adherent injuries, thorax pathology, trauma scores and treatment approaches. Survival probabilities and unexpected mortality rates have been computed using Trauma Revised Score-Injury Severity Score (TRISS) methodology. Mortality rate was 22.6%. Univariance analysis revealed that hypotension, age, pathologic respiration pattern, blunt injury, accompanying injury, abdominal trauma, high injury Severity Score (ISS), low Glascow Coma Scale (GCS), Revised Trauma Score (RTS), TRISS were the factors affecting mortality. In logistic regression analysis, presence of blunt injuries (p:0,00. OR:5,32), TRISS<85 (p:0,000..,OR:11.5), ISS>22(p:0.00.., OR:6,27) and GCS<13(p:0.00.., OR:5,03) have been found to be independent prognostic factors. Strongest factor indicating mortality has found to be TRISS. 34 out of 307 cases that have survival probability of over 50% have died. As a result, handling a patient with severe thorax trauma is a task that requires cooperation between several departments. In presence of factors affecting mortality, patients with thorax trauma should be evaluated as being of high risk group and therefore diagnosis and treatment strategies must be aggressive. Case analysis based on TRISS model shall further reveal the mistakes that may be made in patient care and may improve patient care.
Thorax trauma is the second most frequent cause of death after head trauma, in general body trauma cases. As thorax traumas affect respiratory physiology and especially oxygenation, they may result in complications affecting all body systems and they usually have accompanying injuries. The purpose of this study is to define the epidemiologic properties of patients that have been subject to thorax injuries and general body traumas, analyze their condition when they are brought to our emergency department, to determine the correlation of physiological and anatomical risk factors with the mortality rate, and to ensure early diagnosis of severe trauma. 371 trauma cases that had been subject to general body trauma have been retrospectively examined in this study. Epidemiological properties of the cases have been determined, their initial conditions during initial admission to emergency department have been analyzed, and cases have been assessed in terms of mortality developments. Dead and surviving cases have been compared in terms of age, gender, trauma mechanism, systolic blood pressure (SBP) as measured at emergency admissions, respiration type at the time of application, adherent injuries, thorax pathology, trauma scores and treatment approaches. Survival probabilities and unexpected mortality rates have been computed using Trauma Revised Score-Injury Severity Score (TRISS) methodology. Mortality rate was 22.6%. Univariance analysis revealed that hypotension, age, pathologic respiration pattern, blunt injury, accompanying injury, abdominal trauma, high injury Severity Score (ISS), low Glascow Coma Scale (GCS), Revised Trauma Score (RTS), TRISS were the factors affecting mortality. In logistic regression analysis, presence of blunt injuries (p:0,00. OR:5,32), TRISS<85 (p:0,000..,OR:11.5), ISS>22(p:0.00.., OR:6,27) and GCS<13(p:0.00.., OR:5,03) have been found to be independent prognostic factors. Strongest factor indicating mortality has found to be TRISS. 34 out of 307 cases that have survival probability of over 50% have died. As a result, handling a patient with severe thorax trauma is a task that requires cooperation between several departments. In presence of factors affecting mortality, patients with thorax trauma should be evaluated as being of high risk group and therefore diagnosis and treatment strategies must be aggressive. Case analysis based on TRISS model shall further reveal the mistakes that may be made in patient care and may improve patient care.
Description
Keywords
Toraks travması, Mortalite, Prognostik faktörler, Travma skorları, TRISS metodu, Thorax trauma, Mortality, Prognostic factors, Trauma scores, TRISS method
Citation
Emircan, Ş. (2008). Toraks travmalı olgularda mortaliteye etkili faktörler. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.