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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  • 1. Treatment Surgery. Doherty GM, Editor. New York, NY: The McGrawHill Companies, 2010.
  • 2. 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.
  • 3. Pimentel SK, Sawczyn GV, Mazepa MM, da Rosa FG, Nars A, Collaço IA, et al. Risk factors for mortality in blunt abdominal trauma with surgical approach. [Article in English, Portuguese] Rev Col Bras Cir 2015;42:259−64.
  • 4. Aldemir M, Taçyildiz I, Girgin S. Predicting factors for mortality in the penetrating abdominal trauma. Acta Chir Belg 2004;104:429−34.
  • 5. da Costa LGV, Carmona MJC, Malbouisson LM, Rizoli S, Rocha-Filho JA, Cardoso RG, et al. Independent early predictors of mortality in polytrauma patients: a prospective, observational, longitudinal study. Clinics (Sao Paulo) 2017;72:461−8.
  • 6. 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.
  • 7. Ülkü A. Prognostic factors in blunt abdominal trauma patients undergoing laparotomy and prognostic value of trauma scoring systems. Cukurova Med J 2018;43:994−1001.
  • 8. Özpek A, Yücel M, Atak İ, Baş G, Alimoğlu O. Multivariate analysis of patients with blunt trauma and possible factors affecting mortality. Ulus Travma Acil Cerrahi Derg 2015;21:6:477−483.
  • 9. Malkomes P, Störmann P, El Youzouri H, Wutzler S, Marzi I, Vogl T, et al. Characteristics and management of penetrating abdominal injuries in a German level I trauma center. Eur J Trauma Emerg Surg 2019;45:315−21.
  • 10. Iflazoglu N, Ureyen O, Oner OZ, Tusat M, Akcal MA, et al. Complications and risk factors for mortality in penetrating abdominal firearm injuries: analysis of 120 cases. Int J Clin Exp Med 2015;8:6154−62.
  • 11. Harmston C, Ward JBM, Patel A. Clinical outcomes and effect of delayed intervention in patients with hollow viscus injury due to blunt abdominal trauma: a systematic review. Eur J Trauma Emerg Surg 2018;44:369−76.
  • 12. Gad MA, Saber A, Farrag S, Shams ME, Ellabban GM. Incidence, patterns, and factors predicting mortality of abdominal injuries in trauma patients. N Am J Med Sci 2012;4:129−34.
  • 13. Arikanoglu Z, Turkoglu A, Taskesen F, Ulger BV, Uslukaya O, Basol O, et al. Factors affecting morbidity and mortality in hollow visceral injuries following blunt abdominal trauma. Clin Ter 2014;165:23−6.
  • 14. Malinoski DJ, Patel MS, Yakar DO, Green D, Qureshi F, Inaba K, et al. A diagnostic delay of 5 hours increases the risk of death after blunt hollow viscus injury. J Trauma 2010;69:84−7.
  • 15. Vagnerova K, Koerner IP, Hurn PD. Gender and the injured brain. Anesth Analg 2008;107:201−14.
  • 16. Haddad SH, Yousef ZM, Al-Azzam SS, AlDawood AS, Al-Zahrani AA, AlZamel HA, et al. Profile, outcome and predictors of mortality of abdomino-pelvic trauma patients in a tertiary intensive care unit in Saudi Arabia. Injury 2015;46:94−9.
  • 17. 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;21:248−55.
  • 18. Datta G, Fuller BJ, Davidson BR. Molecular mechanisms of liver ischemia reperfusion injury: insights from transgenic knockout models. World J Gastroenterol 2013;19:1683−98.
  • 19. Baygeldi S, Karakose O, Özcelik KC, Pülat H, Damar S, Eken H, et al. Factors Affecting Morbidity in Solid Organ Injuries. Dis Markers 2016;2016:6954758.
  • 20. Peralta R, Vijay A, El-Menyar A, Consunji R, Afifi I, Mahmood I, et al. Early high ratio platelet transfusion in trauma resuscitation and its outcomes. Int J Crit Illn Inj Sci 2016;6:188−93.
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