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    Analysis of maxillofacial traumas in an emergency clinic
    (Kuwait Medical Assoc, 2019) Irmak, Nurten Ayse; Demir, Mustafa Volkan; Kanbay, Sibel; Demir, Tuba Ozturk
    Objective: To examine epidemiology, fracture pattern and the relation between fracture pattern and Duke facial trauma severity index in patients admitted for maxillofacial traumas Design: Retrospective study Setting: Emergency Department, Ankara Numune Education and Research Hospital, Turkey Subjects: Four hundred and twenty-eight patients who presented with a diagnosis of maxillofacial trauma Intervention: Medical treatment of patients with maxillofacial trauma Main outcome measure: Epidemiology, fracture pattern and the relation between fracture pattern and Duke facial trauma severity index Results: Of the 428 patients, 185 cases with at least one fracture of the maxillofacial bones were included in the study, 147 (79.5%) males and 38 (20.5%) females. Distribution of gender showed significant difference (p < 0.001). Age range was 8 - 90 years and average age was 38.69 +/- 14.6 years. The most frequent cause of maxillofacial trauma was violence. The most frequent age range was 21 - 30 years old (28.6%, n = 53). The most frequent cause of maxillofacial trauma was violence in male cases and traffic accidents in female cases. There was a statistically significant relationship between gender and etiology (chi-square test, p < 0.003). There were a total of 268 facial fractures in the cases. Nasal bone fractures (21%) were the most common fractures. Violence was the most common cause of nasal bone, orbital floor and medial wall, zygomatic arch and Le-Fort II fractures. Falling was the most common cause of frontal sinus, zygomaticomaxillar complex and maxillary sinus fractures. The most detected fracture was isolated upper midface fractures (51.4%). There was a statistically significant relationship between upper midface fractures and violence (Z test, p < 0.001). There was also a statistically significant difference between midface fractures and violence and falling (Z test, p < 0.002). Conservative treatment was applied to 66.5% of the cases and surgical treatment was applied to 33.5% of the cases. Conclusion: Maxillofacial fractures were significantly more common in males in the third decade of life, in the nasal bone, were caused by violence and treated with conservative treatments.
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    Potential Risk Factors for In-Hospital Mortality in Patients with Moderate-to-Severe Blunt Multiple Trauma Who Survive Initial Resuscitation
    (Hindawi Ltd, 2018) Yucel, Neslihan; Demir, Tuba Ozturk; Derya, Serdar; Oguzturk, Hakan; Bicakcioglu, Murat; Yetkin, Funda
    Introduction. The aim was to identify risk factors that influence in-hospital mortality for patients with moderate-to-severe blunt multiple trauma (BMT) who survive initial resuscitation. Methods. The prospective study involved 195 adult patients with BMT who were admitted to a referral hospital's emergency department (ED) betweenMay 1, 2015, and May 31, 2016. Results. Forty-three (22%) of the 195 patients died in hospital. Multivariate analysis identified low blood pH (odds ratio [OR] 6.580, 95% confidence interval [CI] 1.12-38.51), high serumlactate level (OR 1.041, 95% CI 1.01-1.07), high ISS (OR 1.109, 95% CI 1.06-1.16), high APACHE II score (OR 1.189, 95% CI 1.07-1.33), traumatic brain injury (TBI) (OR 4.358, 95% CI 0.76-24.86), severe hemorrhage (OR 5.314, 95% CI 1.07-26.49), and coagulopathy (OR 5.916, 95% CI 1.17-29.90) as useful predictors of acute in-hospital mortality. High ISS (OR 1.047, 95% CI 1.02-1.08), TBI (OR 8.922, 95% CI 2.57-31.00), sepsis (OR 4.956, 95% CI 1.99-12.36), acute respiratory distress syndrome (ARDS) (OR 8.036, 95% CI 1.85-34.84), respiratory failure (OR 9.630, 95% CI 2.64-35.14), renal failure (OR 74.803, 95% CI 11.34-493.43), and multiple organ failure [MOF] (OR 10.415, 95% CI 4.48-24.24) were risk factors for late in-hospital mortality. High Glasgow Coma Scale (GCS) was a good predictor for survival at 2, 7, and 28 or more days of hospitalization (OR 0.708 and 95% CI 0.56-0.09; OR 0.835 and 95% CI 0.73-0.95; OR 0.798 and 95% CI 0.71-0.90, resp.). Conclusion. Several factors signal poor short-term outcome for patients who present to the ED with moderate-to-severe BMT: low blood pH, high serum lactate level, presence of TBI, severe hemorrhage, coagulopathy, organ failure (respiratory, renal, and MOF), and ARDS. For this patient group, ISS and APACHE II scores might be helpful for stratifying by mortality risk, and GCS might be a good predictor for survival.
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    Potential risk factors for ın-hospital mortality in patients with moderate-to-severe blunt multipletrauma who survive ınitial resuscitation
    (Hındawı ltd, adam house, 3rd flr, 1 fıtzroy sq, london, w1t 5hf, england, 2018) Yucel, Neslihan; Demir, Tuba Ozturk; Derya, Serdar; Oguzturk, Hakan; Bicakcioglu, Murat; Yetkin, Funda
    Introduction. The aim was to identify risk factors that influence in-hospital mortality for patients with moderate-to-severe blunt multiple trauma (BMT) who survive initial resuscitation. Methods. The prospective study involved 195 adult patients with BMT who were admitted to a referral hospital's emergency department (ED) betweenMay 1, 2015, and May 31, 2016. Results. Forty-three (22%) of the 195 patients died in hospital. Multivariate analysis identified low blood pH (odds ratio [OR] 6.580, 95% confidence interval [CI] 1.12-38.51), high serumlactate level (OR 1.041, 95% CI 1.01-1.07), high ISS (OR 1.109, 95% CI 1.06-1.16), high APACHE II score (OR 1.189, 95% CI 1.07-1.33), traumatic brain injury (TBI) (OR 4.358, 95% CI 0.76-24.86), severe hemorrhage (OR 5.314, 95% CI 1.07-26.49), and coagulopathy (OR 5.916, 95% CI 1.17-29.90) as useful predictors of acute in-hospital mortality. High ISS (OR 1.047, 95% CI 1.02-1.08), TBI (OR 8.922, 95% CI 2.57-31.00), sepsis (OR 4.956, 95% CI 1.99-12.36), acute respiratory distress syndrome (ARDS) (OR 8.036, 95% CI 1.85-34.84), respiratory failure (OR 9.630, 95% CI 2.64-35.14), renal failure (OR 74.803, 95% CI 11.34-493.43), and multiple organ failure [MOF] (OR 10.415, 95% CI 4.48-24.24) were risk factors for late in-hospital mortality. High Glasgow Coma Scale (GCS) was a good predictor for survival at 2, 7, and 28 or more days of hospitalization (OR 0.708 and 95% CI 0.56-0.09; OR 0.835 and 95% CI 0.73-0.95; OR 0.798 and 95% CI 0.71-0.90, resp.). Conclusion. Several factors signal poor short-term outcome for patients who present to the ED with moderate-to-severe BMT: low blood pH, high serum lactate level, presence of TBI, severe hemorrhage, coagulopathy, organ failure (respiratory, renal, and MOF), and ARDS. For this patient group, ISS and APACHE II scores might be helpful for stratifying by mortality risk, and GCS might be a good predictor for survival.