Eray CİNAR, Kubilay INAN, Ozgur Omer YİLDİZ

Künt Toraks Travmalarında Travma Skorlaması ile Klinik Analiz

Amaç: Künt toraks travmaları acil servislerde göğüs cerrahlarının sık karşılaştıkları travma türüdür. Bu Klinik durumlar acil girişim gerektirecek düzeyde olabilir. Amacımız künt toraks travmalarının klinik gidişatında göğüs travma skorlama sisteminin etkinliğini tartışmaktır. Materyal ve Metot: Ocak 2017–2019 yılları arasında göğüs cerrahisi kliniğinde yatarak tedavi uygulanan künt toraks travmalı hastalar incelendi. Olgular yaş, cinsiyet, taravma türü, cerrahi müdahale yapılıp yapılmadığı, yatış süreleri ve göğüs travma skorlaması (CTS) parametreleri (kontüzyon, kot fraktürü, yaş) ile değerlendirildi. Bulgular: Değerlendirilen 140 hastanın 111’i (%79,3) erkek, 29’u (%20,7) kadın olup yaş ortalaması 49,3 (12–93) olarak tespit edildi. Olgular yaş, kontüzyon ve kot fraktürü parametreleri kullanılarak hesaplanan CTS’ye göre göre analiz edildi. Travma skorlamasının 2 ile 7 arasında değiştiği (ort.3,49+1,49) görüldü. Artan yaş ile kaburga kırığı sayısı arasında istatistiksel olarak anlamlı bir ilişki olduğu görüldü (p=0,004). Yaş arttıkça hemotoraks ve pnömotoraks olasılığının arttığı da gözlendi (sırasıyla p=0,016, p=0,016). Kontüzyon oranı ne kadar yüksekse hemotoraks olasılığının da o kadar yüksek olduğu belirlendi (p=0,03). Kot fraktürü sayısı arttıkça hemotoraks ve pnömotoraks olasılığının arttığı ve ilişkinin istatistiksel olarak anlamlı olduğu görüldü (sırasıyla p=0,009, p=0,018). CTS skoru ile hemotoraks ve pnömotoraks patolojileri arasında istatistiksel olarak anlamlı bir ilişki tespit edildi (sırasıyla p=0,001, p=0,008). Ancak CTS skoru ile yatış süresi ve komplikasyon arasında (sırasıyla p=0,612, p=0,612) bir ilişki gözlenmedi. Sonuç: Travma skorlama sistemleri klinisyenlere yol gösteren için bir erken uyarı sistemi görevi görür. Bununla birlikte, değişen ve gelişen sağlık sistemleri ve birçok klinik parametre, tüm travma skorlarında olduğu gibi izole torasik travmalı hastaların klinik seyrini tahmin etmek için kullanılan CTS’ninde modifikasyonunu gerektirmektedir.

Anahtar Kelimeler:

travma, künt göğüs travması, travma skorlaması

Clinical Analysis with Trauma Scoring in Blunt Thoracic Trauma

Aim: Thoracic surgeons frequently encounter blunt thoracic traumas at the emergency ward. The clinical findings of such cases may require immediate action. The aim of the study is to discuss the efficiency of trauma scoring in the clinical course of blunt thoracic trauma. Material and Method: Inpatients with blunt thoracic trauma who received care at the department of thoracic surgery between January 2017–2019 were analyzed. The cases were assessed based on gender, trauma type, surgical intervention, length of stay, and chest trauma scoring (CTS) (contusion, rib fracture, age) parameters. Results: 111 (79.3%) of the 140 patients assessed were male, and 29 (20.7%) were female, and the average age was 49.3 (12–93). The patients were analyzed based on the chest trauma scoring calculated using the age, contusion, and rib fracture parameters. It was concluded that the trauma scoring varied between 2 and 7 (mean score 3.49+1.49). There was a statistically significant relationship between the increasing age and the number of rib fractures (p=0.004). An increased possibility of hemothorax and pneumothorax as the age increases was also observed (p=0.016, p=0.016, respectively). It was determined that the higher the contusion rate was, the higher was the possibility of hemothorax (p=0.03). It was observed that as the number of rib fractures increased, the possibility of hemothorax and pneumothorax increased and the relationship was statistically significant (p=0.009, p=0.018, respectively). A statistically significant relationship between CTS score and pathologies of hemothorax and pneumothorax was identified (p=0.001, p=0.008, respectively). However, no relationship between the CTS score and length of stay (p=0.612, p=0.612, respectively) was observed. Conclusion: The trauma scoring systems indeed act as an early warning system for the clinicians. However, the changing and developing health systems and many clinical parameters require modification in CTS, which is used to predict the clinical course of patients with isolated thoracic trauma, as in all trauma scores.

Keywords:

trauma, blunt thoracic trauma, trauma scoring,

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