Analysis of risk factors of mortality in abdominal trauma
Yıl: 2020 Cilt: 26 Sayı: 1 Sayfa Aralığı: 43 - 49 Metin Dili: İngilizce DOI: 10.14744/tjtes.2019.12147 İndeks Tarihi: 10-11-2020
Analysis of risk factors of mortality in abdominal trauma
Öz: BACKGROUND: The present study aims to analyze blunt and penetrating abdominal traumas that were evaluated in our emergencydepartment, the treatment approaches and risk factors of mortality.METHODS: Six hundred and sixty-four patients were admitted to our emergency department for surgical evaluation for traumabetween January 2009 and April 2019. After the exclusion of dead on arrival, patients with missing data and patients without abdominal trauma were excluded from this study. Hundred and thirteen patients with abdominal trauma admitted to our department wereevaluated in this study. Demographic, clinical, prognostic and mortality related factors were retrospectively analyzed.RESULTS: The mean age of the patients was 36.08±16.1 years. There were 90 male patients. Eighty patients (70.8%) had bluntabdominal trauma (BAT). Twenty-eight patients (24.7%) had isolated liver and two patients (1.7%) had isolated spleen injury. Combined liver and spleen injury was found in two patients (1.7%). Twenty-two (19.4%) patients had mortality. Causes of mortality werean irreversible hemorrhagic shock (40.9%) and central nervous system (13.6%) injuries. BAT was the main mechanism of injury inpatients with mortality (86.4% versus 67%; p<0.001). The frequency of retroperitoneal injury was significantly higher in patients withmortality (50% versus 16.5%, p<0.001). The frequency of extra-abdominal injury in patients with mortality was higher (68.1% versus49.4%; p=0.047). Mean arterial pressure at admission was found to be significantly lower in patients with mortality (67±26.8 mmHgversus 84.3±17 mmHg; p=0.02). The number of packed erythrocytes transfused in patients with mortality was higher (8.8±8.6 versus3.3±5.9 units; p=0.047). Mean international normalized ratio (INR) was significantly higher in patients with mortality (4.3±7.1 versus2.7±4; p=0.016). Mean lactate dehydrogenase level was higher in patients with mortality (1685.7±333.8 versus 675.8±565.3 IU/mL;p<0.001). Mean alanine aminotransferase (ALT) was significantly higher in patients with mortality (430±619 versus 244±448 IU/mL;p<0.001). Mean alkaline phosphatase (ALP) level in patients with mortality was higher (76.9±72.8 versus 67.3±27.8 IU/mL; p=0.003).The presence of retroperitoneal injury and ALT >516 IU/mL were independent risk factors o mortality.CONCLUSION: We have found certain laboratory variables to increase in patients with mortality. These are related to the severityof trauma. Retroperitoneal injury and increased ALT levels being risk factors of mortality is the most important finding of this study.Our results can guide other centers in the evaluation of trauma patients, and high-risk groups can be identified.
Anahtar Kelime: Abdominal travmada mortaliteyi etkileyen risk faktörlerinin analizi
Öz: AMAÇ: Bu çalışmanın amacı, acil servisimizde değerlendirilen künt ve penetran karın travmaları ve bunlara yönelik gerçekleştirilen tedavi yaklaşımları ile mortalite için risk faktörlerini incelemektir. GEREÇ VE YÖNTEM: Ocak 2009–Nisan 2019 tarihleri arasında acil servisimize başvuran ve travma nedeniyle cerrahi konsültasyonu yapılan 664 hasta çalışma için değerlendirildi. Başvuru anında gerçekleşen ölümler, verileri eksik olan hastalar ve karın travması saptanmayan hastalar çalışmaya dahil edilmedi. Çalışmaya abdominal travmalı 113 hasta alındı. Demografik, klinik, prognostik ve mortalite ile ilişkili faktörler geriye dönük olarak incelendi. BULGULAR: Hastalardaki yaş ortalaması 36.08±16.1 yıldı. Bunlardan 90’ı erkekti. Seksen hastada (%70.8) künt karın travmasının (KKT) mevcut olduğu gözlendi. Yimi sekiz hastada (%24.7) izole karaciğer ve iki hastada (%1.7) dalak yaralanması vardı. Kombine karaciğer ve dalak yaralanmasının iki hastada (%1.7) görüldü. Yirmi iki (%19.4) hastada mortalite gelişti. Mortalite nedenlerini geri dönüşümsüz hemorajik şok (%40.9) ve merkezi sinir sistemi (%13.6) yaralanmaları oluşturmaktaydı. KKT mortal seyreden grupta ana yaralanma mekanizmasını oluşturmaktaydı (%86.4 ve %67, p<0.001). Retroperitoneal yaralanma sıklığı mortal seyreden hastalarda anlamlı olarak daha yüksekti (%50 ve %50, %16, p<0.001). Mortal seyreden hastalarda ekstra abdominal yaralanma sıklığı daha yüksekti (%49 ve %68.1; p=0.047). Yatış sırasındaki ortalama arter basıncı mortal seyreden hastalarında anlamlı olarak düşük bulundu (67±26.8 mmHg ve 84.3±17 mmHg; p=0.02). Mortal seyreden hastalarda transfüze edilen eritrosit miktarı daha fazlaydı (8.8±8.6 ve 3.3±5.9 ünite; p=0.047). Ortalama uluslararası normalleştirilmiş oranı (INR) mortal seyreden hastalarda anlamlı derecede yüksekti (4.3±7.1 ve 2.7±4; p=0.016). Mortal seyreden hastalarda ortalama laktat dehidrogenaz daha yüksekti (1685.7±333.82 ve 675.8±565.3 IU/mL; p<0.001). Ortalama alanin amino transferaz (ALT) düzeyi mortal seyreden hastalarda anlamlı olarak daha yüksekti (430±619 ve 244±448 IU/mL; p<0.001). Mortal seyreden hastalarda ortalama alkalen fosfataz (ALP) düzeyi daha yüksekti (76.9±72.8 ve 67.3±27.8 IU/mL; p=0.003). Retroperitoneal yaralanma ve ALT >519 IU/mL varlığının mortalite açısından bağımsız risk faktörleri oldukları bulundu. TARTIŞMA: Mortal seyreden hasta grubunda bazı laboratuvar değişkenlerinin arttığını ve bunların travmanın ciddiyeti ile ilgili olduğu görüldü. Retroperitoneal yaralanma ve artmış ALT düzeyleri mortalite açısından bağımsız risk faktörü olup, bu bulgu çalışmanın en önemli bulgusu olarak karşımıza çıkmaktadır. Mevcut çalışma bulgularımız travma hastalarının değerlendirilmesinde diğer merkezlere rehberlik edebileceği ve yüksek riskli grupları tanımlamada da kullanılabilir
Anahtar Kelime: Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
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| APA | Gonultas F, KUTLUTÜRK K, GÖK A, BARUT B, SAHIN T, YILMAZ S (2020). Analysis of risk factors of mortality in abdominal trauma. , 43 - 49. 10.14744/tjtes.2019.12147 |
| Chicago | Gonultas Fatih,KUTLUTÜRK Koray,GÖK Ali Fuat Kaan,BARUT Bora,SAHIN TEVFIK TOLGA,YILMAZ Sezai Analysis of risk factors of mortality in abdominal trauma. (2020): 43 - 49. 10.14744/tjtes.2019.12147 |
| MLA | Gonultas Fatih,KUTLUTÜRK Koray,GÖK Ali Fuat Kaan,BARUT Bora,SAHIN TEVFIK TOLGA,YILMAZ Sezai Analysis of risk factors of mortality in abdominal trauma. , 2020, ss.43 - 49. 10.14744/tjtes.2019.12147 |
| AMA | Gonultas F,KUTLUTÜRK K,GÖK A,BARUT B,SAHIN T,YILMAZ S Analysis of risk factors of mortality in abdominal trauma. . 2020; 43 - 49. 10.14744/tjtes.2019.12147 |
| Vancouver | Gonultas F,KUTLUTÜRK K,GÖK A,BARUT B,SAHIN T,YILMAZ S Analysis of risk factors of mortality in abdominal trauma. . 2020; 43 - 49. 10.14744/tjtes.2019.12147 |
| IEEE | Gonultas F,KUTLUTÜRK K,GÖK A,BARUT B,SAHIN T,YILMAZ S "Analysis of risk factors of mortality in abdominal trauma." , ss.43 - 49, 2020. 10.14744/tjtes.2019.12147 |
| ISNAD | Gonultas, Fatih vd. "Analysis of risk factors of mortality in abdominal trauma". (2020), 43-49. https://doi.org/10.14744/tjtes.2019.12147 |
| APA | Gonultas F, KUTLUTÜRK K, GÖK A, BARUT B, SAHIN T, YILMAZ S (2020). Analysis of risk factors of mortality in abdominal trauma. Ulusal Travma ve Acil Cerrahi Dergisi, 26(1), 43 - 49. 10.14744/tjtes.2019.12147 |
| Chicago | Gonultas Fatih,KUTLUTÜRK Koray,GÖK Ali Fuat Kaan,BARUT Bora,SAHIN TEVFIK TOLGA,YILMAZ Sezai Analysis of risk factors of mortality in abdominal trauma. Ulusal Travma ve Acil Cerrahi Dergisi 26, no.1 (2020): 43 - 49. 10.14744/tjtes.2019.12147 |
| MLA | Gonultas Fatih,KUTLUTÜRK Koray,GÖK Ali Fuat Kaan,BARUT Bora,SAHIN TEVFIK TOLGA,YILMAZ Sezai Analysis of risk factors of mortality in abdominal trauma. Ulusal Travma ve Acil Cerrahi Dergisi, vol.26, no.1, 2020, ss.43 - 49. 10.14744/tjtes.2019.12147 |
| AMA | Gonultas F,KUTLUTÜRK K,GÖK A,BARUT B,SAHIN T,YILMAZ S Analysis of risk factors of mortality in abdominal trauma. Ulusal Travma ve Acil Cerrahi Dergisi. 2020; 26(1): 43 - 49. 10.14744/tjtes.2019.12147 |
| Vancouver | Gonultas F,KUTLUTÜRK K,GÖK A,BARUT B,SAHIN T,YILMAZ S Analysis of risk factors of mortality in abdominal trauma. Ulusal Travma ve Acil Cerrahi Dergisi. 2020; 26(1): 43 - 49. 10.14744/tjtes.2019.12147 |
| IEEE | Gonultas F,KUTLUTÜRK K,GÖK A,BARUT B,SAHIN T,YILMAZ S "Analysis of risk factors of mortality in abdominal trauma." Ulusal Travma ve Acil Cerrahi Dergisi, 26, ss.43 - 49, 2020. 10.14744/tjtes.2019.12147 |
| ISNAD | Gonultas, Fatih vd. "Analysis of risk factors of mortality in abdominal trauma". Ulusal Travma ve Acil Cerrahi Dergisi 26/1 (2020), 43-49. https://doi.org/10.14744/tjtes.2019.12147 |
