Multitravma hastalarında yaralanma şiddet skoru, ters şok indeksi ve laktat seviyesinin yoğun bakımda kalış süresi ve mortaliteyi öngörmedeki değerinin karşılaştırılması
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Tarih
2022
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Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Travma; 45 yaşın altındaki bireylerde kanser ve kardiyovasküler hastalıklardan sonra üçüncü en sık ölüm nedenidir. Travmaların yaklaşık %5-7’si prognozu kötü olan, ağır veya multiple travma şeklinde sınıflandırılmaktadır. Multiple travma hastalarında amaç sağ kalımın en üst seviyeye çıkarılmasıdır. Bu nedenle zaman multiple travma hastalarının yönetiminde belirleyici bir faktördür. Travma şiddetinin belirlenmesinde çeşitli yöntem ve skorlamalar kullanılmaktadır. Bu çalışmanın amacı; acil servise multiple travma nedeniyle kabul edilen hastalarda Yaralanma Şiddet Skoru (Injury Severity Score) (ISS), Ters Şok İndeksi (Reverse Shock Index) (RSI) ve serum laktat seviyelerinin yoğun bakım ünitesine (YBÜ) kabul ve mortalitedeki belirleyiciliğinin değerlendirilmesidir.
Gereç ve Yöntem
Bu prospektif çalışmaya 1 Ekim 2020 ile 1 Ekim 2021 tarihleri arasında, acil servise multiple travma nedeniyle başvuran hastalar dahil edildi. Hastaların yaş, cinsiyet, travma mekanizması, YBÜ kabulü, YBÜ kalış süresi, hastanede kalış süresi ve hastane içi mortalite verileri kayıt altına alındı. Tüm hastaların ISS ve RSI skorları hesaplandı. Hastaların acil servise başvurusunda istenen kan örneklerinden serum laktat seviyeleri değerlendirildi.
Bulgular
Yirmi beş hasta (%21,9) kadın, 89 hasta (%78,1) erkek olmak üzere toplam 114 hasta çalışmaya dahil edildi. Hastaların ortalama yaşı 44,5 ± 18,2 yıldı (18-87 yıl). En sık izlenen travma mekanizmaları sırasıyla; 83 hastada (%72,8) motorlu taşı kazaları, 26 hastada (%22,8) düşme idi. Hastaların %72,8’i (n=83) YBÜ’ye kabul edildi. Hastane içi mortalite %10,5 (n=12) idi. YBÜ’ye kabul edilen hastaların ISS skorları (p<0,001) ve serum laktat seviyeleri (p<0,001) daha yüksekti. Benzer şekilde kaybedilen hastaların ISS skoru (p<0,001) ve serum laktat seviyesi (p=0,003) daha yüksekti. Ancak, YBÜ’ye kabul edilen veya kaybedilen hastalarda RSI skorları farklılık göstermedi. ISS, RSI ve serum laktat seviyeleri, YBÜ kalış süresi ve hastanede kalış süresi ile korelasyon gösterdi. Multiple travma hastalarında mortalite tahmininde ISS skorunun (cut-off >34 için) sensitivitesi %75, spesifitesi %94,1, serum laktat
IV
seviyesinin ise (cut-off ≥5 mmol/l için) sensitivitesi %50, spesifitesi %91,1, RSI skorunun (cut-off ≤0.76 için) sensitivitesi %33,3, spesifitesi %95,1 idi. YBÜ kabulünde ISS skorunun (cut-off>14 için) sensitivitesi %79,5, spesifitesi %80,6, serum laktat seviyesinin (cut-off>2.1 mmol/l için) sensitivitesi %69,9, spesifitesi %74,2, RSI skorunun (cut-off<1,3 için) ise sensitivitesi %43,4, spesifitesi %83,9 idi.
Sonuç
Multiple travma tüm ülkeleri ilgilendiren ciddi mortalite nedenidir. Her yıl binlerce insan multitravma nedeniyle sağlıklarını ya da hayatlarını kaybetmektedir. Bulgularımız ISS skoru ve serum laktat seviyesinin, hastane içi mortalite ve yoğun bakım ihtiyacını öngörmede güçlü belirleyiciler olduğuna işaret etmektedir.
Trauma is the third leading cause of death overall after cardiovascular diseases and cancer and the leading cause in the population under 45 years of age. Approximately 5-7% of traumas are classified as severe/multiple trauma with a poor prognosis.The aim is to maximize survival in multiple traumas.Time thus becomes a determining factor in the management of the multiple trauma patient. Various methods and scoring are used to determine the severity of trauma.The aim of this study was to investigate the accuracy of Injury Severity Score (ISS), Reverse Shock Index (RSI) and serum lactate levels in predicting mortality and intensive care unit (ICU) admission in patients admitted to emergency department (ED) with multiple trauma. Material and Methods Patients admitted to the emergency department due to multiple trauma between October 1, 2020 and October 1, 2021 were included in this prospective study. Age, gender, trauma mechanism, ICU admission, ICU stay, length of hospital stay and in-hospital mortality data of the patients were recorded. ISS and RSI scores of all patients were calculated. Serum lactate levels were evaluated from the blood samples requested at the time of admission to the emergency department. Results A total of 114 patients were included in the study, of which 25 (21.9%) were female and 89 (78.1%) were male. The mean age of the patients was 44.5 ± 18.2 years (18-87 years). The most common trauma mechanisms were motor vehicle accidents in 83 (72.8%) patients and falls in 26 (22.8%) patients, respectively. 72.8% (n=83) of the patients were admitted to the ICU. In-hospital mortality was 10.5% (n=12). Those admitted to the ICU had higher ISS scores (p<0.001) and serum lactate levels (p<0.001). Similarly, patients who died had higher ISS scores (p<0.001) and serum lactate levels (p=0.003). However, RSI scores were similar in VI ICU admissions (p=0.588) and deceased patients (p=0.524). ISS, RSI and serum lactate levels were correlated with ICU length of stay and length of hospital stay. In the predicting mortality in patients with multiple trauma, the ISS score (cut-off>34) had a sensitivity of 75% and a specificity of 94.1%, serum lactate level (cut-off ≥5 mmol/l) had a sensitivity of 50%, specificity of 91.1%, RSI score (cut-off ≤0.76) had a sensitivity of 33.3%, specificity of 95.1%. In the predicting ICU admission, the ISS score (cut-off>14) had a sensitivity of 79.5% and a specificity of 80.6%, serum lactate level (cut-off ≥2.1 mmol/l) had a sensitivity of 69.9%, specificity of 74.2%, RSI score (cut-off<1,3) had a sensitivity of 43.4%, specificity of 83.9%. Conclusion Multiple trauma is a serious cause of mortality that concerns all countries. Every year, thousands of people lose their health or their lives due to multitrauma. Our findings indicate that the ISS score and serum lactate level are strong predictors of in-hospital mortality and the need for intensive care.
Trauma is the third leading cause of death overall after cardiovascular diseases and cancer and the leading cause in the population under 45 years of age. Approximately 5-7% of traumas are classified as severe/multiple trauma with a poor prognosis.The aim is to maximize survival in multiple traumas.Time thus becomes a determining factor in the management of the multiple trauma patient. Various methods and scoring are used to determine the severity of trauma.The aim of this study was to investigate the accuracy of Injury Severity Score (ISS), Reverse Shock Index (RSI) and serum lactate levels in predicting mortality and intensive care unit (ICU) admission in patients admitted to emergency department (ED) with multiple trauma. Material and Methods Patients admitted to the emergency department due to multiple trauma between October 1, 2020 and October 1, 2021 were included in this prospective study. Age, gender, trauma mechanism, ICU admission, ICU stay, length of hospital stay and in-hospital mortality data of the patients were recorded. ISS and RSI scores of all patients were calculated. Serum lactate levels were evaluated from the blood samples requested at the time of admission to the emergency department. Results A total of 114 patients were included in the study, of which 25 (21.9%) were female and 89 (78.1%) were male. The mean age of the patients was 44.5 ± 18.2 years (18-87 years). The most common trauma mechanisms were motor vehicle accidents in 83 (72.8%) patients and falls in 26 (22.8%) patients, respectively. 72.8% (n=83) of the patients were admitted to the ICU. In-hospital mortality was 10.5% (n=12). Those admitted to the ICU had higher ISS scores (p<0.001) and serum lactate levels (p<0.001). Similarly, patients who died had higher ISS scores (p<0.001) and serum lactate levels (p=0.003). However, RSI scores were similar in VI ICU admissions (p=0.588) and deceased patients (p=0.524). ISS, RSI and serum lactate levels were correlated with ICU length of stay and length of hospital stay. In the predicting mortality in patients with multiple trauma, the ISS score (cut-off>34) had a sensitivity of 75% and a specificity of 94.1%, serum lactate level (cut-off ≥5 mmol/l) had a sensitivity of 50%, specificity of 91.1%, RSI score (cut-off ≤0.76) had a sensitivity of 33.3%, specificity of 95.1%. In the predicting ICU admission, the ISS score (cut-off>14) had a sensitivity of 79.5% and a specificity of 80.6%, serum lactate level (cut-off ≥2.1 mmol/l) had a sensitivity of 69.9%, specificity of 74.2%, RSI score (cut-off<1,3) had a sensitivity of 43.4%, specificity of 83.9%. Conclusion Multiple trauma is a serious cause of mortality that concerns all countries. Every year, thousands of people lose their health or their lives due to multitrauma. Our findings indicate that the ISS score and serum lactate level are strong predictors of in-hospital mortality and the need for intensive care.
Açıklama
Anahtar Kelimeler
Multiple travma, Yaralanma Şiddet Skoru, Ters Şok İndeksi, Laktat, Mortalite, Multiple trauma, Injury Severity Score, Reverse Shock Index, Lactate, Mortality
Kaynak
WoS Q Değeri
Scopus Q Değeri
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Künye
Demirayak, Ö. F. (2022). Multitravma hastalarında yaralanma şiddet skoru, ters şok indeksi ve laktat seviyesinin yoğun bakımda kalış süresi ve mortaliteyi öngörmedeki değerinin karşılaştırılması. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Acil Tıp Anabilim Dalı, Konya.
