İnönü Üniversitesi Tıp Fakültesi Acil Tıp Anabilim dalına başvuran pelvik travmalı hastaların değerlendirilmesi
Küçük Resim Yok
Tarih
2018
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
İnönü Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
İnönü Üniversitesi Tıp Fakültesi Acil Tıp Anabilim Dalına Başvuran Pelvik Travmalı Hastaların Değerlendirilmesi Giriş ve amaç: Pelvik yaralanma ile acil servise başvuran hastalar retrospektif olarak incelenerek bu hastaların travma mekanizmaları, pelvis kırıklarının sınıflaması, kanama oranları, tedavileri, mortalite ve morbiditeleri incelenmiştir. Materyal ve Metod: Bu çalışma, 01.01.2015 ile 31.12.2017 tarihleri arasında İnönü Üniversitesi Tıp Fakültesi Acil Tıp Anabilim Dalı'na başvuran pelvis travmalı hastaların dosyalarının retrospektif olarak hastane kayıt sisteminden incelenmesiyle yapılmıştır. Toplam 232 pelvik kırığı olan erişkin ve çocuk hastalar incelenmiştir. Bulgular: Bu çalışmada, trafik kazaları (%50) ve düşmeler (%37) en sık pelvik yaralanma nedeniydi. Hastaların yaş ortalamaları 39±22 ve %65 erkek cinsiyetti. Ölen grupta ortanca GKS 4 (3 ile 15) ve ortanca ISS 51 (25 ile 75) bulundu. Hastaların 87'sine (%38) cerrahi uygulandı. Hastaların ortalama hastane yatış süreleri 8±9 gün idi ve ölen grup ile yaşayan grup arasında istatistiksel olarak anlamlı fark yoktu. Ölen grupta ortalama hemoglobin değeri ve ortalama hemotokrit değerleri yaşayan gruptan daha düşüktü. Yine, ölen grupta, ortalama aPTT ve INR değerleri, ortalama kan glukoz düzeyi, ortalama kan kreatinin düzeyi ve ortalama kan bilirubin düzeyleri yaşayan gruptan daha yüksekti. Hastaların 163'ünde (%70) pelvis kırığı dışında başka bir sistem yaralanması da tespit edildi. Ölen grupta travmatik beyin hasarı, göğüs travması, abdominal travma ve genitoüriner yaralanma yaşayan gruptan daha yüksek oranlarda bulundu. Ek olarak ölen hastalarda hemorajik şok ve koagülopati daha yüksek oranlardaydı. Young-Burgess sınıflamasına göre sırasıyla en sık 102 (%44) hastada LC1, 54 (%23) hastada LC2 ve 49 (%21) hastada LC3 tipi kırık mevcuttu. Ölen grupta LC3 ve APC1 tipi kırık yaşayan gruptan daha yüksekti. Pelvis kanaması olan hastalarda en sık kırık tipi sırasıyla 22 (%9) hastada LC3, 11'inde (%5) LC2, ve 10'unda (%4) kombine tip kırık tespit edildi. Ayrıca, LC3, APC1 ve LC3 ile VS'in beraber olduğu pelvis kırıklarında hemorajik şok gelişme riski yüksekti. LC1, LC3 ve APC1 tipi kırıkların neden olduğu kanamalarda acile başvuru sırasında koagülopati yüksek oranda tespit edildi. Bu çalışmada en sık ölüm nedeni travmatik beyin hasarı (%4), beyin hasarı ile birlikte kanama (%3) ve kanama (%2) olarak bulundu. Tek başına pelvis kırığına bağlı kanama sadece %1 hastada görüldü. Ancak travmatik beyin hasarı ve kanama nedeni ile ölenlerdeki kanamanın kaynağı pelvisti. Sonuç: Pelvik kırıkları hayati tehdit eden ciddi yaralanmalardır. Bu nedenle acil servislerde hızlıca değerlendirilmeli, erken tanı konulmalı ve erkenden hemodinamik stabilizasyon sağlanmalıdır. Pelvik kırıklı hastalarda başka sistem yaralanması da olabileceği akılda tutulmalı ve bu hastalarda ek yaralanmalarda araştırılmalıdır. Anahtar kelimeler: Acil, Pelvis, Pelvis fraktürü, Young-Burgess
Evaluation of Pelvic Trauma Patients Who were Admitted to Emergency Department Background and aim: Patients who were admitted to the emergency department with pelvic injury were reviewed retrospectively to investigate the trauma mechanisms, classification of pelvic fractures, hemorrhage, treatment, mortality and morbidity. Materials and Methods: This study was performed retrospectively from the hospital registry system of patients with pelvic injury who admitted to emergency department (ED) between 1 January, 2015 and 31 December, 2017. A total of 232 patients with pelvic fractures were investigated. Results: Traffic accidents (50%) and falls (37%) were the most common cause of pelvic injury in this study. The mean age of the patients was 39 ± 22 and 65% were male. Median GCS was 4 (3 to 15) and median ISS was 51 (25 to 75) in the non-survivors. Surgery was performed in 87 patients (38%). The mean duration of hospitalization of the patients was 8 ± 9 days and there was no statistically significant difference between the non-survivors and the survivors. The mean hemoglobin value and mean hematocrit values were lower in the non-survivors than the survivors. Additionally, the mean aPTT and INR values in the non-survivors group were higher than the mean blood glucose, mean blood creatinine, and mean blood bilirubin levels. Another system injury was detected in 163 (70%) of all patients. The non-survivors group had higher frequencies of traumatic brain injury followed by abdominal trauma and genitourinary injury. In addition, hemorrhagic shock and coagulopathy were higher in the patients who died. According to Young-Burgess classification, the most common injury type was LC1 in 102 (44%) patients, LC2 in 54 (23%), and LC3 in 49 (21%), respectively. LC3 and APC1 type were significantly higher in the non-survivors group than the survivors group. The most frequent fracture type in patients with pelvic hemorrhage was LC3 in 22 (9%) patients, LC2 in 11 (5%), and combined type fracture in 10 (4%). In addition, the risk of hemorrhagic shock development was high in pelvic fractures with LC3, APC1 and LC3 and VS. During ED admission, coagulopathy was found to be high in LC1, LC3 and APC1 type fractures. The most common cause of death in this study was traumatic brain injury (4%), bleeding with brain injury (3%) and bleeding (2%). Bleeding due to pelvic fracture alone was occurred in only 1% of patients. However, the source of the bleeding was pelvic in traumatic brain injury and hemorrhage. Conclusion: Pelvic fractures are life-threatening serious injuries. Therefore, it should be evaluated quickly in ED, early diagnosis should be made and early hemodynamic stabilization should be provided. It should be kept in mind that another system injuries may be present in patients with pelvic fractures and they should be investigated in patients with additional injuries. Key words: Emergency, Pelvis, Pelvis fracture, Young-Burgess classification
Evaluation of Pelvic Trauma Patients Who were Admitted to Emergency Department Background and aim: Patients who were admitted to the emergency department with pelvic injury were reviewed retrospectively to investigate the trauma mechanisms, classification of pelvic fractures, hemorrhage, treatment, mortality and morbidity. Materials and Methods: This study was performed retrospectively from the hospital registry system of patients with pelvic injury who admitted to emergency department (ED) between 1 January, 2015 and 31 December, 2017. A total of 232 patients with pelvic fractures were investigated. Results: Traffic accidents (50%) and falls (37%) were the most common cause of pelvic injury in this study. The mean age of the patients was 39 ± 22 and 65% were male. Median GCS was 4 (3 to 15) and median ISS was 51 (25 to 75) in the non-survivors. Surgery was performed in 87 patients (38%). The mean duration of hospitalization of the patients was 8 ± 9 days and there was no statistically significant difference between the non-survivors and the survivors. The mean hemoglobin value and mean hematocrit values were lower in the non-survivors than the survivors. Additionally, the mean aPTT and INR values in the non-survivors group were higher than the mean blood glucose, mean blood creatinine, and mean blood bilirubin levels. Another system injury was detected in 163 (70%) of all patients. The non-survivors group had higher frequencies of traumatic brain injury followed by abdominal trauma and genitourinary injury. In addition, hemorrhagic shock and coagulopathy were higher in the patients who died. According to Young-Burgess classification, the most common injury type was LC1 in 102 (44%) patients, LC2 in 54 (23%), and LC3 in 49 (21%), respectively. LC3 and APC1 type were significantly higher in the non-survivors group than the survivors group. The most frequent fracture type in patients with pelvic hemorrhage was LC3 in 22 (9%) patients, LC2 in 11 (5%), and combined type fracture in 10 (4%). In addition, the risk of hemorrhagic shock development was high in pelvic fractures with LC3, APC1 and LC3 and VS. During ED admission, coagulopathy was found to be high in LC1, LC3 and APC1 type fractures. The most common cause of death in this study was traumatic brain injury (4%), bleeding with brain injury (3%) and bleeding (2%). Bleeding due to pelvic fracture alone was occurred in only 1% of patients. However, the source of the bleeding was pelvic in traumatic brain injury and hemorrhage. Conclusion: Pelvic fractures are life-threatening serious injuries. Therefore, it should be evaluated quickly in ED, early diagnosis should be made and early hemodynamic stabilization should be provided. It should be kept in mind that another system injuries may be present in patients with pelvic fractures and they should be investigated in patients with additional injuries. Key words: Emergency, Pelvis, Pelvis fracture, Young-Burgess classification
Açıklama
Anahtar Kelimeler
Ortopedi ve Travmatoloji, Orthopedics and Traumatology, İlk ve Acil Yardım
