Fatih TANRIVERDİ, Servan GÖKHAN, Gül PAMUKÇU GÜNAYDIN, Çağdaş YILDIRIM, Ayhan ÖZHASENEKLER, Gülhan KURTOĞLU ÇELİK, Seda FİDAN, Alp ŞENER

GERİATRİK TRAVMA HASTALARINDA REVİZE TRAVMA SKORUNUN DEĞERLENDİRİLMESİ

Amaç: Geriatrik popülasyonda yaş ile değişen fizyoloji ile birlikte travmaya verilen vücut yanıtı dadeğişmektedir. Skorlama sistemleri birçok hasta grubu ve hastalık üzerinde hastane yatışı gerekliliği ve prognoz tahmini açısından çalışılmaktadır. Bu çalışmada acil servise travma ile başvuran 65 yaş üstü hastaların demografik özelliklerinin belirlenmesini ve travmanın oluş şekli ile birlikte Revize Travma Skoru (RTS) değerlendirilmesini amaçladık.Materyal ve Metot: Çalışma prospektif, kesitsel bir çalışmadır. 01/12/2017- 31/05/2018 tarihleri arasında bir üniversite hastanesi acil servisine başvuran 65 yaş ve üzeri travma hastaları çalışmaya dahil edildi. Hastaların demografik verileri, vital bulguları, fizik muayene bulguları, görüntüleme, laboratuvar sonuçları, eritrosit süspansiyonu (ES) ihtiyacı, hasta sonlanımları ve hastane içi ve 28 günlük mortaliteleri kayıt edildi. Tüm hastaların RTS skorları hesaplandı.Bulgular: Çalışma döneminde acil servise 4898 geriatrik hasta başvurdu. Çalışmaya 229 hasta dahil edildi. Hastalarının 153’ ü (%66,81) kadın olup yaş ortancası 79 (IQR 72-86) bulundu. En sık komorbid hastalık hipertansiyondu (n=109, %47,59). En sık yumuşak doku travması (YDT) (31.87%) ve ikinci sırada femur/kalça kırığı (23,58%) yer aldığı görüldü. Hastaların RTS ortancası 12 olarak bulundu. RTS skorlarına göre hastalar karşılaştırıldığında düşük olan grupta Alzheimer/demans, geçirilmiş inme varlığı, eritrosit süspansiyonu ihtiyacının ve mortalite oranının daha fazla olduğu görüldü (sırasıyla, p

EVALUATION OF REVISED TRAUMA SCORE IN GERIATRIC TRAUMA PATIENTS

Objectives: In this study, we aimed to determine the demographic characteristics of trauma patients ≥ 65 years and to evaluate the relation between RTS scores together with the type of trauma. Materials and Methods: This is a prospective, cross-sectional study. Trauma patients aged ≥65 who applied to the emergency department between 01/12 / 2017- 31/05/2018 were included in the study. Demographic data, vital signs, physical examination findings, imaging, laboratory results, erythrocyte suspension (ES) requirement, patient outcomes, and in-hospital and 28-day mortality were recorded. RTS scores of all patients were calculated. Results: During the study period, 229 of 4898 geriatric patients who applied to the emergency department with trauma were included in our study. 153 (66.81%) of the study patients were women and the median age was 79 (IQR 72-86). The most common comorbid disease was hypertension (n = 109, 47.59%). The most common complaint was a fall. The median RTS of the patients was 12. Soft tissue trauma (YDT) (31.87%) and femur/ hip fracture (23.58%) were the most common final diagnoses. In the group with lower RTS scores Alzheimer/ dementia, presence of previous stroke, erythrocyte suspension requirement and mortality rate were higher (p

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1. Aschkenasy M. T, Rothenhaus T.C. Trauma and falls in the elderly. Emerg Med Clin N Am. 2006;24:413-32.
2. Aygencel G, Karamercan A, Akinci E, Demircan A, Keles A. Metabolic syndrome and its association with ischemic cerebrovascular disease. Adv Ther. 2006;23(3):495-501.
3. Cerreta F, Eichler HG, Rasi G. Drug policy for an aging population--the European Medicines Agency's geriatric medicines strategy. N Engl J Med 2012; 367:1972.
4. Lustenberger T, Talving P, Schnüriger B, et al. Impact of advanced age on outcomes following damage control interventions for trauma. World J Surg 2012; 36:208.
5. McLean AJ, Le Couteur DG. Aging biology and geriatric clinical pharmacology. Pharmacol Rev 2004; 56:163.
6. Emektar E, Corbacioglu SK, Dagar S, Uzunosmanoglu H, Safak T, Cevik Y. Prognostic Value of the Neutrophil-Lymphocyte and Platelet-Hip fracture, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, one-year mortalityLymphocyte Ratios in Predicting One-Year Mortality in Patients with Hip Fractures and Aged Over 60 Years.
7. Brooks SE, Peetz AB. Based Care of Geriatric Trauma Patients. Surg Clin North Am. 2017 Oct;97(5):1157-74.
8. Keller JM, Sciadini MF, Sinclair E, O'Toole RV. Geriatric trauma: demographics, injuries, and mortality. J Orthop Trauma 2012; 26:e161.
9. Joyce MF, Gupta A, Azocar RJ. Acute trauma and multiple injuries in the elderly population. Curr Opin Anaesthesiol. 2015 Apr;28(2):145-50.
10. Champion HR, Sacco WJ, Carnazzo AJ, Copes W, Fouty WJ. Trauma score. Crit Care Med. 1981;9:672– 6.
11. Champion HR, Sacco WJ, Copes WS, Gann DS, Gennarelli TA, Flanagan ME. A revision of the Trauma Score. J Trauma. 1989;29:623–9.
12. Ali Rıza Ü, Fatma Ü, Ahmet D, Sibel B, Naci M, Binnur S. Yoğun Bakımda İzlenen Travma Hastalarında “Revize Travma Skoru” ve “Travma ve Yaralanma Şiddeti Skoru’’nun Prognoz ile İlişkisinin Değerlendirilmesi.Türk Anest Rean Der Dergisi 2012; 40(3):128-135 doi:10.5222/JTAICS.2012.128
13. Rocha AFB, Sá MVBO, Elihimas Junior UF. Hyponatremia in elderly patients with fragility fractures of the proximal femur: a cross-sectional study. J Bras Nefrol. 2019 Oct-Dec;41(4):51825.
14. Gankam Kengne F, Andres C, Sattar L, Melot C, Decaux G. Mild hyponatremia and risk of fracture in the ambulatory elderly. QJM 2008;101:583‐8.
15. Cumming K, Hoyle GE, Hutchison JD, Soiza RL. Prevalence, Incidence and Etiology of Hyponatremia in Elderly Patients with Fragility Fractures. J Clin Med Res 2015;7:45‐51.
16. Ghodsi SM, Roudsari BS, Abdollah M et al. Fall-related injuries in the elderly in tehran. Injury 2003; 34: 809-14. 83).
17. Liberman M, Mulder DS, Sampalis JS. İncreasing volume of patients at level I trauma centers: Is there a need for triage modification in elderly patients with injuries of low severity? Can J Surg 2003;46:446-52.
18. Akkose Aydin S, Bulut M, Fedakar R, Ozgurer A, Ozdemir F. Trauma in the elderly patients in Bursa. Ulus Travma Acil Cerrahi Derg. Jul 2006;12(3):230-4.
19. Orhon R, Eren SeH, Karadayı Su, Korkmaz Il, Coşkun A, Eren M, Katrancıoğlu N. Comparison of trauma scores for predicting mortality and morbidity on trauma patients. Ulus Travma Acil Cerrahi Derg. July 2014;20(4):258.
20. Hannah F Watts, Yaniv Kerem, and Erik B Kulstad. Evaluation of the revised trauma and injury severity scores in elderly trauma patients.J Emerg Trauma Shock. 2012 Apr-Jun; 5(2): 131–4.
21. Grossman MD, Miller D, Scaff DW, Arcona S. When is an elder old? Effect of preexisting conditions on mortality in geriatric trauma.J Trauma. 2002 Feb;52(2):242-6.
22. Morris JA, MacKenzie EJ, Edelstein SL. The effect of preexisting conditions on mortality in trauma patients. JAMA. 1990;263:1942– 6.
23. Valeriani L. Management of demented patients in emergency department. Int J Alzheimers Dis. 2011 5;2011:840312.
24. Cumming K, Hoyle GE, Hutchison JD, Soiza RL. Prevalence, incidence and etiology of hyponatremia in elderly patients with fragility fractures. PLoS One. 2014;9:e88272. 2