Bir üniversite hastanesi erişkin acil servisine başvuran toraks travma vakalarının incelenmesi
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Tarih
2024
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Yayıncı
Necmettin Erbakan Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş
Travmatik yaralanmalar tüm dünyada yaygın izlenen ölüm nedenleri arasındadır. Travma hastalarının yaklaşık 1/5'i basit kot kırıklarından kalbin penetran yaralanmalarına veya trakeobronşiyal yaralanmaya kadar değişen şiddette göğüs travması geçirmektedir. Toraks travmalarına bağlı mortalitenin kafa travmasından sonra ikinci sırada yer alması, ilk tedavinin önemini vurgulamaktadır. Toraks travmasının epidemiyolojisi üzerine yapılan çalışmalar, travma etiyolojisi, demografik özellikler ve hastane sonlanımı gibi travma karakteristiklerinde farklı bölgesel özellikler bildirmiştir. Çalışmamızın amacı, toraks travması ile başvuran ve radyolojik görüntülemelerinde toraks bölgesinde patoloji saptanan hastaların demografik özelliklerini, travma mekanizmalarını, yaralanma nedenlerini, eşlik eden yaralanmaları ve tedavi yaklaşımlarını değerlendirmek ve prognoz üzerinde etkili olabilecek faktörleri incelemektir.
Gereç ve yöntem
Bu çalışmaya 1 Ocak 2022 ile 31 Aralık 2023 tarihleri arasında Acil Servise travma ile başvuran ve radyolojik görüntüleme tetkiklerinde torasik bölgede patoloji saptanan 482 hasta retrospektif olarak dahil edildi. Hastaların demografik özellikleri, travma mekanizması, travma tipi, eşlik eden yaralanmaları, acil servis ve hastane sonlanımları değerlendirildi. Hastane sonlanımını etkileyen faktörler multivaryant analizlerde değerlendirildi.
Bulgular
Hastaların yaş ortalaması 45,5 ± 18,1 yıl (18-92 yıl) idi. Hastaların %74,3'ü erkek, %25,7'si kadındı. Erkek/kadın oranı 2,9/1 idi. Olguların çoğunda travma künt travma (%91,1) şeklindeydi. En yaygın travma mekanizmaları sırasıyla araç içi trafik kazası (%51,5), düşme (%18,0) ve araç dışı trafik kazası (%17,4) idi. En sık görülen yaralanmalar kot kırığı (%66,2), akciğer kontüzyonu (%45,2), pnömotoraks (%36,3), ekstremite yaralanması (%31,7), hemotoraks (%22,8), kafa-yüz kemiği kırığı (%22,2) ve pelvis kırığı (%21) idi. Ayrıca hastaların %17,8'inde lomber, %14,1'inde torasik ve %10'unda servikal omurga kırığı vardı. Dolayısıyla, hastaların %32,4'ünde omurga kırığı vardı. Ekstratorasik yaralanma sıklığı %78,8 idi. Hastanede kalış süresi median 5 gündü (0-150 gün). Acil sonlanım olguların %64,9’unda YBÜ, %22,8’inde servis, %4,4’ünde taburcu, %3,7’sinde kendi isteği ile taburcu, %2,5’inde exitus, %1,7’sinde dış merkeze sevk şeklindeydi. Hastaların hastane sonlanımı ise %81,3’ünde taburcu, %10,0’unda exitus, %6,0’sında kendi isteği ile taburcu, %2,7’sinde dış merkeze sevk şeklindeydi. Toraks travmalarında cinsiyet, travma tipi ve hastane sonuçlarına göre demografik özellikler, eşlik eden yaralanmalar ve travma mekanizmalarında farklılıklar gözlendi. Multivaryant analizlerde, acil serviste entübasyon (OR: 151, p<0.001), pelvik kırık (OR: 3.7, p=0.012), yaş (OR: 1.0, p<0.001) ve hastanede kalış süresinin (OR: 0.96, p=0.006) hastane içi mortalite ile ilişkili olduğu izlendi.
Sonuç
Hastanemizde toraks travmaları dördüncü dekatta yaygın izlendiği, erkek hakimiyetinde olduğu, en yaygın mekanizma motorlu taşıt kazası ve künt yaralanmalar olduğu görüldü. Toraks yaralanmaları içerisinde kot kırıkları akciğer kontüzyonu ve pnömotoraks yaygın idi. Olguların %80’inde ekstratorasik yaralanma mevcuttu. Hastane içi mortalite oranı %10 idi. Toraks travması, kötü prognozu ve yüksek prevalansı nedeniyle önemini korumaktadır. Acil servis hekimlerinin toraks travmasının epidemiyolojik özelliklerinin farkında olması travma yönetimine katkı sağlayabilir.
Introduction Traumatic injuries are the leading cause of death globally. Approximately 1/5 of patients suffer from chest trauma of varying severity from simple rib fractures to penetrating injuries to the heart or tracheobronchial injury. Mortality is second only to head injury, highlighting the importance of initial treatment. Studies on the epidemiology of thoracic trauma have reported different regional characteristics with trauma characteristics including trauma etiology, demographic characteristics and outcome. The aim of our study was to evaluate the demographic characteristics, mechanisms of trauma, cause of injury, concomitant injuries and treatment approaches and to elucidate the factors that may have an effect on the prognosis of the patients who presented with thoracic trauma and whose radiologic imaging revealed pathology in the thoracic region. Material and methods This study included 482 patients who presented to the Emergency Department with trauma between January 1, 2022 and December 31, 2023 and who were found to have pathology in the thoracic region on radiological imaging examinations, retrospectively. Vital signs, trauma mechanism, type, concomitant injuries, emergency and hospital outcome were evaluated. Factors affecting hospital outcome were analyzed in multivariate analyses. Results The mean age of the patients was 45.5 ± 18.1 years (18-92 years). 74.3% of the patients were male and 25.7% were female. The male/female ratio was 2.9/1. Trauma was blunt trauma (91.1%) in the majority of cases. The most common trauma mechanisms were in-vehicle traffic accident (51.5%), fall (18.0%) and pedestrian traffic accident (17.4%), respectively. The most common injuries were rib fracture (66.2%), lung contusion (45.2%), pneumothorax (36.3%), extremity injury (31.7%), hemothorax (22.8%), cranio-facial fracture (22.2%) and pelvic fracture (21%). Moreover, 17.8% of the patients had lumbar, 14.1% thoracic and 10% cervical spine fractures. Therefore, 32.4% of the patients had spinal fractures. The frequency of extrathoracic injury was %78.8. The median length of hospital stay was 5 days (0-150 days). The emergency outcome was transferred to intensive care unit in 64.9%, ward in 22.8%, discharge in 4.4%, voluntary discharge in 3.7%, exitus in 2.5%, and referral to an external center in 1.7%. Hospital outcomes were discharge in 81.3%, exitus in 10.0%, voluntary discharge in 6.0%, and referral to an external center in 2.7%. Differences were observed in the demographic characteristics, associated injuries and mechanisms of trauma in thoracic traumas according to gender, type of trauma and hospital outcome. In multivariant analyses, intubation in emergency department (OR: 151, p<0.001), pelvic fracture (OR: 3.7, p=0.012), age (OR: 1.0, p<0.001), length of hospital stay (OR: 0.96, p=0.006) were related to in-hospital mortality. Conclusion İn our hospitals, it was observed that thoracic traumas were common in the fourth decade, were male-dominated and the most common mechanisms were motor vehicle accidents and blunt traumatizations. Among thoracic traumatizations rib fractures, lung confusion and pneumothorax were common. Extrathoracic traumatization was in existence in 80 % of the cases. The mortality rate in the hospital was 10% . Thoracic trauma remains important due to its poor prognosis and high prevalence. Emergency physicians' awareness of the epidemiologic features of thoracic trauma may contribute to trauma management.
Introduction Traumatic injuries are the leading cause of death globally. Approximately 1/5 of patients suffer from chest trauma of varying severity from simple rib fractures to penetrating injuries to the heart or tracheobronchial injury. Mortality is second only to head injury, highlighting the importance of initial treatment. Studies on the epidemiology of thoracic trauma have reported different regional characteristics with trauma characteristics including trauma etiology, demographic characteristics and outcome. The aim of our study was to evaluate the demographic characteristics, mechanisms of trauma, cause of injury, concomitant injuries and treatment approaches and to elucidate the factors that may have an effect on the prognosis of the patients who presented with thoracic trauma and whose radiologic imaging revealed pathology in the thoracic region. Material and methods This study included 482 patients who presented to the Emergency Department with trauma between January 1, 2022 and December 31, 2023 and who were found to have pathology in the thoracic region on radiological imaging examinations, retrospectively. Vital signs, trauma mechanism, type, concomitant injuries, emergency and hospital outcome were evaluated. Factors affecting hospital outcome were analyzed in multivariate analyses. Results The mean age of the patients was 45.5 ± 18.1 years (18-92 years). 74.3% of the patients were male and 25.7% were female. The male/female ratio was 2.9/1. Trauma was blunt trauma (91.1%) in the majority of cases. The most common trauma mechanisms were in-vehicle traffic accident (51.5%), fall (18.0%) and pedestrian traffic accident (17.4%), respectively. The most common injuries were rib fracture (66.2%), lung contusion (45.2%), pneumothorax (36.3%), extremity injury (31.7%), hemothorax (22.8%), cranio-facial fracture (22.2%) and pelvic fracture (21%). Moreover, 17.8% of the patients had lumbar, 14.1% thoracic and 10% cervical spine fractures. Therefore, 32.4% of the patients had spinal fractures. The frequency of extrathoracic injury was %78.8. The median length of hospital stay was 5 days (0-150 days). The emergency outcome was transferred to intensive care unit in 64.9%, ward in 22.8%, discharge in 4.4%, voluntary discharge in 3.7%, exitus in 2.5%, and referral to an external center in 1.7%. Hospital outcomes were discharge in 81.3%, exitus in 10.0%, voluntary discharge in 6.0%, and referral to an external center in 2.7%. Differences were observed in the demographic characteristics, associated injuries and mechanisms of trauma in thoracic traumas according to gender, type of trauma and hospital outcome. In multivariant analyses, intubation in emergency department (OR: 151, p<0.001), pelvic fracture (OR: 3.7, p=0.012), age (OR: 1.0, p<0.001), length of hospital stay (OR: 0.96, p=0.006) were related to in-hospital mortality. Conclusion İn our hospitals, it was observed that thoracic traumas were common in the fourth decade, were male-dominated and the most common mechanisms were motor vehicle accidents and blunt traumatizations. Among thoracic traumatizations rib fractures, lung confusion and pneumothorax were common. Extrathoracic traumatization was in existence in 80 % of the cases. The mortality rate in the hospital was 10% . Thoracic trauma remains important due to its poor prognosis and high prevalence. Emergency physicians' awareness of the epidemiologic features of thoracic trauma may contribute to trauma management.
Açıklama
Anahtar Kelimeler
Toraks travması, Thoracic trauma, Göğüs travması, Chest trauma, Acil servis, Emergency, Epidemiyoloji, Epidemiology
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Çimen, E. D. (2024). Bir üniversite hastanesi erişkin acil servisine başvuran toraks travma vakalarının incelenmesi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Acil Tıp Anabilim Dalı, Konya.
