Laparotomi uygulanan künt karın travmalı hastalarda prognostik faktörler ve travma skorlama sistemlerinin prognostik değeri

Amaç: Bu çalışmanın amacı, laparotomi uygulanan künt karın travmalı olgularda prognozu etkileyen faktörleri ve travma puanlama sistemlerinin prognostik değerini saptamaktır.Gereç ve Yöntem: 1 Ocak 1998 ile 31 Aralık 2005 tarihleri arasında laparotomi uygulanan 151 künt karın travmalı olgu retrospektif olarak incelendi. Travma ve Yaralanma Şiddet Puanı (TYŞP), APACHE II, Yaralanma Şiddet puanı (YŞP), Düzeltilmiş travma puanı (DTP), Travma puanı (TP), Circulation , Respiration , Abdomen , Motorn and Speech (CRAMS) ve Glasgow koma ölçütü için tüm hastaların travma skorları hesaplanarak hasta sonlanımları açısından karşılaştırıldı.Bulgular: En sık travma şekli trafik kazaları (%73.4), en sık yaralanan organ dalaktı (%36.5). Hastaların 54 (%34.8)’ünde postoperatif major cerrahi komplikasyon gelişti ve 37 (%24.5) hasta öldü. Hasta sonlanımlarını tahminde Travma ve Yaralanma Şiddet Puanı, APACHE II, Yaralanma Şiddet puanı, Düzeltilmiş travma puanı, Travma puanı, CRAMS ve Glasgow koma ölçütünün doğruluk oranları sırasıyla %92, %87, %80, %72, %69, %68 ve %66 olarak bulundu. Sonuç: Laparotomi uygulanan künt karın travmalı hastalarda Travma ve yaralanma Şiddet puanı ve APACHE II hasta sonlanımını tahminde en iyi sistemler olarak bulunurken 55 üzeri yaş, 6 üniteden fazla kan tranfüzyonu, travma ile operasyon arasındaki sürenin 12 saatten uzun olması ve postoperatif komplikasyon gelişimi bağımsız prognostik faktörler olarak saptandı.

Anahtar Kelimeler:

Künt karın travması, travma puanlama sistemleri, prognostik faktörler

Prognostic factors in blunt abdominal trauma patients undergoing laparotomy and prognostic value of trauma scoring systems

Purpose: The aim of this study was determining the prognostic factors in patients treated surgically after blunt abdominal trauma and evaluating the prognostic values of trauma scoring systems.Materials and Methods: Of the 151 blunt abdominal trauma patients admitted and had laparotomy during 1st January 1998 and 31st December 2005 were reviewed retrospectively. Trauma and injury severity score (TRISS), Acute Physiology and Chronic Health Evaluation II (APACHE II), Injury severity score (ISS), Trauma score (TS), Revised trauma score (RTS), CRAMS and Glasgow coma scale (GCS) scores were calculated for all patients and compared as predictors of patient outcomes. Results: The most common pattern of trauma was traffic accident injuries (73.4%) with the spleen being the most affected organ (36.5%). Major surgical complication developed in 54 (34.8%) patients postoperatively and 37 (24.5%) patients died. The accuracy rate of Trauma and injury severity score, Acute Physiology and Chronic Health Evaluation II, Injury severity score, Revised trauma score, Trauma score, CRAMS and Glasgow coma scale to predict the patient outcomes was found as 92%, 87%, 80%, 72%, 69%, 68% and 66%, respectively. Conclusion: Among patients with blunt abdominal trauma treated surgically, Trauma and injury severity score and Acute Physiology and Chronic Health Evaluation II were found to be the best systems in prediction of patient outcomes, while age over 55, transfusion over 6 units, the time interval of more than 12 hours between trauma and operation and the development of postoperative complications were determined as independent prognostic factors

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