Kesici-delici aletlerle oluşan toraks ve batın yaralanmalarında mortaliteye etkili faktörler (660 vakalık seri)
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Tarih
2017
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info:eu-repo/semantics/openAccess
Özet
Kesici-delici alet (KDA) yaralanmaları tüm dünyada olduğu gibi ülkemizde de önemli mortalite ve morbidite nedenleri arasındadır. Bu çalışmayı, toraks ve batına olan KDA yaralanmalı hastalarda mortaliteye etkili faktörleri tespit etmek amacıyla planladık. Dicle Üniversitesi Tıp Fakültesi Acil Tıp Kliniği'ne Şubat 2003 ile Temmuz 2006 arasında toraks ve batına olan KDA yaralanması nedeniyle başvuran 660 hastanın kayıtları geriye dönük olarak incelendi. Çalışmaya dâhil edilen hastaların %97.7 (n=645)'si yaşadı, %2.3 (n=15)'ü öldü. Hastaların (634'ü erkek, 26'sı kadın) yaş ortalaması; 24.21±10.8 (4?72) idi. KDA yaralanmalarında en sık göğüs bölgesinin yaralandığını, en sık tek yaralanmanın olduğunu, en sık ek organ yaralanmasının üst ekstremite olduğunu, hastaların büyük çoğunluğunun acil gözlemde takip ve tedavisinin yapıldığını tespit ettik. Çalışmamızdaki veriler univariate istatistiksel analizle değerlendirildi. Hastalarımızın büyük çoğunluğunu 11?30 yaş arası genç ve genç erişkinler oluşturmaktaydı (P=0.000). En sık şiddet nedeniyle yaralanmaların olduğunu tespit ettik (P=0.000). Hastalarımızın çoğu ilkbahar ve yaz mevsiminde başvurdu (P=0.000). En sık kesici-delici aletlerin kullanıldığını tespit ettik (P=0.000). Yaralanmaların saat (12:00?24:00) arasında daha sık olduğunu bulduk (P=0.000). Akciğer yaralanması (P=0.003), KTD'den >1500 cc kan gelmesi (P=0.000), acil torakotomi varlığı (P=0.000), kalp yaralanması (P=0.000), perikardiyal effüzyon varlığı (P=0.000), sol ventrikül yaralanması (P=0.000) ve torakal büyük damar yaralanması (P=0.000) torakal yaralanmalarda, ince barsak yaralanması (P=0.002), kalın barsak yaralanması (P=0.000), böbrek yaralanması (P=0.020), pankreas yaralanması (P=0.000), retroperitoneal hematom varlığı (P=0.009), batın içi kanamanın >2000 cc'den olması (P=0.000) ve abdominal büyük damar yaralanması (P=0.000) ise abdominal yaralanmalarda, mortaliteyi tahmin etmede univariate istatistiksel analizle etkili faktörler olarak bulduk. Çalışmamızda; geç başvuru (P=0.001), gecikmiş operasyon süresi (P=0.02), GKS'nin 3?7 olması (P=0.000), GKS'nin 8?12 olması (P=0.04), başvuruda derin anemi varlığı (P=0.000), başvuruda şok varlığı (P=0.000), multiple kan transfüzyonu (P=0.000), İSS'nin ³ 25 olması (P=0.000), PATİ'nin ³ 25 olması (P=0.000) ve düşük RTS (P=0.000)`nin univariate istatistiksel analizle mortalite üzerinde anlamlı etkisinin olduğunu tespit ettik. Gecikmiş operasyon süresi (P=0.02) , başvuruda şok varlığı (P=0.000), PATİ'nin ³ 25 olması (P=0.000), GKS'nin 3?7 olması (P=0.000), GKS'nin 8?12 olması (P=0.04) ve İSS'nin ³ 25 olması (P=0.000) Logistic Regression (Backward Stepwise Wald) metodunu kullanarak multivariate analizle değerlendirildi. Multivariate analizde, hastaların mortalitesini tahmin etmede kullanılabilecek olan parametre başvuru esnasında şok varlığıdır (OR=0.106, CI=0.012?0.902, P=0.040).
Stab wounds are important causes of mortality and morbidity in our country as it has been all over the world. We planned this study in order to determine the effective factors on mortality on the patients exposed to stab wounds of thorax and abdomen. We retrospectively reviewed the hospital records of 660 patients admitted to Emergency Department of Dicle University, between February 2003 and July 2006. In our study; 97.7% (n=645) of the patients were alive, while 2.3% (n=15) died. The mean age was 24.21±10.8 (4?72) years (634 male-26 female). The most frequently injured region of the body was thorax, most frequently injuries were single injuries, the most frequent extra organ injury as to the upper extremity in stab wounds. Most of the patients were followed and treated in emergency department. The data in our study was evaluated with univariety analysis. We found that most frequent injury age in our patients was 11-30 and included younger adults (P=0.000). Most of the patients were admitted to our department in spring and summer (P=0.000). Most frequently, injuries were caused of violence (P=0.000). Most frequently used instruments were incisive and perforating instruments (P=0.000). The injuries were more common between 12:00?24:00 hours (P=0.000). In univariety analysis we found lung injury (P=0.003), tube thoracostomy output more then 1500 cc (P=0.000), emergency thoracotomy (P=0.000), cardiac injury (P=0.000), pericardial effusion (P=0.000), left ventricular injuries (P=0.000), thoracic great vessel injury (P=0.000), small bowel injuries (P=0.002), injuries of colon (P=0.000), renal injury (P=0.020), injuries of pancreas (P=0.000), existence of retroperitoneal hematomas (P=0.009), intraabdominal hemorrhagea more then 2000 cc (P=0.000) and abdominal great vessel injury (P=0.000) were the factors that were predictive on mortality in injury of thorax and abdomen. Our study showed that delayed admission time (P=0.001), delayed operation time (P=0.02), GCS 3-7 (P=0.000), GCS 8-12 (P=0.04), serious anemia during admission (P=0.000), existence of shock on admission (P=0.000), multiple blood transfusion (P=0.000), ISS ³ 25 (P=0.000), PATI ³ 25 (P=0.000) and low RTS (P=0.000) were found to be significant factors in predicting mortality. Delayed operation time (P=0.02), existence of shock on admission (P=0.000), PATI ³ 25 (P=0.000), GCS 3?7 (P=0.000), GCS 8?12 (P=0.04) and ISS ³ 25 (P=0.000) found in univariety analysis were analised with multivariety analysis by using Logistic Regression (Backward Stepwise Wald) method. Multivariate analysis showed that existence of shock during admission is the parameter that can be used in predicting the mortality of patients (OR=0.106, CI=0.012?0.902, P=0.040).
Stab wounds are important causes of mortality and morbidity in our country as it has been all over the world. We planned this study in order to determine the effective factors on mortality on the patients exposed to stab wounds of thorax and abdomen. We retrospectively reviewed the hospital records of 660 patients admitted to Emergency Department of Dicle University, between February 2003 and July 2006. In our study; 97.7% (n=645) of the patients were alive, while 2.3% (n=15) died. The mean age was 24.21±10.8 (4?72) years (634 male-26 female). The most frequently injured region of the body was thorax, most frequently injuries were single injuries, the most frequent extra organ injury as to the upper extremity in stab wounds. Most of the patients were followed and treated in emergency department. The data in our study was evaluated with univariety analysis. We found that most frequent injury age in our patients was 11-30 and included younger adults (P=0.000). Most of the patients were admitted to our department in spring and summer (P=0.000). Most frequently, injuries were caused of violence (P=0.000). Most frequently used instruments were incisive and perforating instruments (P=0.000). The injuries were more common between 12:00?24:00 hours (P=0.000). In univariety analysis we found lung injury (P=0.003), tube thoracostomy output more then 1500 cc (P=0.000), emergency thoracotomy (P=0.000), cardiac injury (P=0.000), pericardial effusion (P=0.000), left ventricular injuries (P=0.000), thoracic great vessel injury (P=0.000), small bowel injuries (P=0.002), injuries of colon (P=0.000), renal injury (P=0.020), injuries of pancreas (P=0.000), existence of retroperitoneal hematomas (P=0.009), intraabdominal hemorrhagea more then 2000 cc (P=0.000) and abdominal great vessel injury (P=0.000) were the factors that were predictive on mortality in injury of thorax and abdomen. Our study showed that delayed admission time (P=0.001), delayed operation time (P=0.02), GCS 3-7 (P=0.000), GCS 8-12 (P=0.04), serious anemia during admission (P=0.000), existence of shock on admission (P=0.000), multiple blood transfusion (P=0.000), ISS ³ 25 (P=0.000), PATI ³ 25 (P=0.000) and low RTS (P=0.000) were found to be significant factors in predicting mortality. Delayed operation time (P=0.02), existence of shock on admission (P=0.000), PATI ³ 25 (P=0.000), GCS 3?7 (P=0.000), GCS 8?12 (P=0.04) and ISS ³ 25 (P=0.000) found in univariety analysis were analised with multivariety analysis by using Logistic Regression (Backward Stepwise Wald) method. Multivariate analysis showed that existence of shock during admission is the parameter that can be used in predicting the mortality of patients (OR=0.106, CI=0.012?0.902, P=0.040).
Açıklama
Anahtar Kelimeler
Abdomen, Abdomen, Faktör analizi, Factor analysis, Göğüs, Thorax, Yaralar-bıçak, Wound-stab, Ölüm oranı, Mortality
