Pediatrik travmalı hastalarda mortaliteye etkili faktörler (Retrospektif çalışma)
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Tarih
2017
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info:eu-repo/semantics/openAccess
Özet
Gelişmemiş ve gelişmekte olan ülkelerde 1?4 yaş döneminde ölüm sebepleri arasında travma, enfeksiyondan sonra ikinci sırayı alırken, bu ülkelerde 4 yaş sonrası ve gelişmiş ülkelerde 1?14 yaş arası dönemde ilk sırayı (%52)almaktadır. Multitravmaya bağlı ölümler hala ana bir halk sağlığı konusu olup etkisini azaltmak için olan eforlar çok önemlidir. Çalışmamızda Mart 2003 ile Aralık 2006 arasında Güneydoğu Anadolu bölgesinde yüksekten düşme, yanık, kesici delici alet yaralanması, ateşli silah yaralanması, araç içi ve araç dışı trafik kazası nedeniyle Dicle Üniversitesi Tıp Fakültesi Acil Servisimize başvuran pediatrik yaş grubundaki (0?15 yaş) 1658 hastaya ait veri geriye dönük olarak analiz edildi ve ardışık olarak çalışmaya alındı. Bölgemizde üniversite hastanesi acil servisine özellikle yaz aylarında daha yoğun olmak üzere çeşitli nedenlerle (yüksekten düşme, araç içi ve araç dışı trafik kazası, yanık, ateşli silah yaralanması ve diğer nedenler) travmaya maruz kalan hastalar başvurmakta ve bu hastaların önemli bir kısmının prognozu mortal veya morbid seyretmektedir. Bu hastalarda mortalite üzerinde birçok faktör etkili olmaktadır. Bu nedenle çalışmamızda pediatrik yaş grubundaki travmalı hastalarda mortalite üzerine etkilerinin olabileceğini düşündüğümüz yaş, cinsiyet, başvuru zamanı, olayın oluş şekli, yaralanan vücut bölgelerini, hastanede kalış sürelerini, tedavi şekillerini, travma skorlamalarını (GKS (Glasgow koma skoru), ISS (Injury Severity Score), RTS (Revised Trauma Score), TRISS (Trauma Injury Severity Score), (PTS) Pediatric Trauma Score ) araştırmayı amaçladık. Hastalar sağ kalanlar grup 1 (n=1551) ve ölenler grup 2 (n=107) olmak üzere iki gruba ayrıldı. Çalışmaya alınan 1658 hastanın %70,5'i (n=1169) erkek, %29,5'i (n=489) kadındı. Travmaya maruz kalan 1658 hastanın 107'i (%6.46) ex oldu. Ortalama yaş ex grubunda 6,75 ? 0,397 (0?15), sağ kalan grupta ise 7.00 ? 0,99 (0?15) idi. Univariate istatistiksel analizler neticesinde mortalite üzerinde anlamlı etkisinin olduğunu tespit ettiğimiz: İSS (P=0,000), RTS (P=0,000), PTS (P=0,000), TRİSS (P=0,000), yatış süresi (P=0,880), erkek cinsiyet (P=0,028), yüksekten düşme (P=0,072), KDAY (P=0,013), batın yaralanması (P=0,034), toraks yaralanması (P=0,034), geç başvuru (P=0,000) ve medikal tedavi (P=0,000) uygulanmasını logistic regression (Backward Wald) metodunu kullanarak multivariate analizle değerlendirdik. Düşük RTS skoru [OR(Odds Ratio)=1,565,CI=1,297?1,889,P<0.05],yüksekten düşme (OR= 0,637, CI=0,408?0,995,P<0.05),geç başvuru (OR=2,035, CI=1,267?3,267,P<0.05) ve medikal tedavi (OR=0,451, CI=0,273-,0,744, P<0.05) travmalı hastalarda mortalite üzerinde etkili faktörler olarak bulundu.
While in 1-4 year age group, the second most common reason of death after infection is trauma in undeveloped and developing countries. In these countries after 4 year age group and in 1-14 year age group in developed countries, trauma is the most common reason of death, the death caused by multitrauma is one of the main public health problems and the efforts for decreasing this problem is very important. In our study the data of 1658 pediatric patient suffering from falling events, burns, cutting and perforating instrument injuries, gunshot injuries, vehicle accidents admitted to Dicle University Hospital Emergency Department between march 2003 and December 2006 were analyzed and included to the study consecutively. In our region especially on summers people suffering from any reason of trauma is admitted to our university hospital and high mortality and morbidity is seen in an important part of these patients. Many factors effect on mortality in these patients. For this reason the facts that can be effective on mortality age, sex, admission time, type of trauma, location of the injury, duration of hospitalization, therapy methods and trauma scoring [GCS (Glascow coma score), ISS (injury severity score), RTS (revised trauma score), TRİSS (trauma injury severity score), PTS (pediatric trauma score) ] is researched in pediatric trauma patients. Patients were divided into two groups: the surveying group and the ex group.1658 patients were admitted to the study. Of they, 70.5 % (n=1169) were male, 29.5 % (n=489) were female. 107 (6.46 %) of 1658 patients has died. Mean age in ex group was 6.75 ? 0,397 (0?15), and 7.00 ? 0.99 (0?15) in surveying group. In the groups ISS(P=0.000), RTS (P=0.000), PTS (P=0.000), TRISS (P=0.000) duration of hospitalization (P=0.880), male gender (p=0.028), falls (P=0.072), penetrating injuries with sharp instruments (P=0.013), abdominal injuries (P=0.034), thorax injuries (p=0.034), delayed admission (P=0.000), and medical therapy (P=0.000) applications that we have found out to have meaningful difference on the mortality, we have evaluated by multivariate analysis using the method of logistic regression (Backward wald). The low RTS score [OR(Odds Ratio)=1.565, CI=1.297-1.889, P<0.05], falls (OR=0.637, CI=0.408-0.995, P=0.05), delayed admissions (OR=2,035, CI=1,267?3,267, P<0.05) and medical therapy (OR=0,451, CI=0,273-, 0,744, P<0.05) were found to be effective factors on mortality in trauma patients.
While in 1-4 year age group, the second most common reason of death after infection is trauma in undeveloped and developing countries. In these countries after 4 year age group and in 1-14 year age group in developed countries, trauma is the most common reason of death, the death caused by multitrauma is one of the main public health problems and the efforts for decreasing this problem is very important. In our study the data of 1658 pediatric patient suffering from falling events, burns, cutting and perforating instrument injuries, gunshot injuries, vehicle accidents admitted to Dicle University Hospital Emergency Department between march 2003 and December 2006 were analyzed and included to the study consecutively. In our region especially on summers people suffering from any reason of trauma is admitted to our university hospital and high mortality and morbidity is seen in an important part of these patients. Many factors effect on mortality in these patients. For this reason the facts that can be effective on mortality age, sex, admission time, type of trauma, location of the injury, duration of hospitalization, therapy methods and trauma scoring [GCS (Glascow coma score), ISS (injury severity score), RTS (revised trauma score), TRİSS (trauma injury severity score), PTS (pediatric trauma score) ] is researched in pediatric trauma patients. Patients were divided into two groups: the surveying group and the ex group.1658 patients were admitted to the study. Of they, 70.5 % (n=1169) were male, 29.5 % (n=489) were female. 107 (6.46 %) of 1658 patients has died. Mean age in ex group was 6.75 ? 0,397 (0?15), and 7.00 ? 0.99 (0?15) in surveying group. In the groups ISS(P=0.000), RTS (P=0.000), PTS (P=0.000), TRISS (P=0.000) duration of hospitalization (P=0.880), male gender (p=0.028), falls (P=0.072), penetrating injuries with sharp instruments (P=0.013), abdominal injuries (P=0.034), thorax injuries (p=0.034), delayed admission (P=0.000), and medical therapy (P=0.000) applications that we have found out to have meaningful difference on the mortality, we have evaluated by multivariate analysis using the method of logistic regression (Backward wald). The low RTS score [OR(Odds Ratio)=1.565, CI=1.297-1.889, P<0.05], falls (OR=0.637, CI=0.408-0.995, P=0.05), delayed admissions (OR=2,035, CI=1,267?3,267, P<0.05) and medical therapy (OR=0,451, CI=0,273-, 0,744, P<0.05) were found to be effective factors on mortality in trauma patients.
Açıklama
Anahtar Kelimeler
Mortalite, Mortality, Pediatri, Pediatrics, Travma, Trauma
