Ulusal Travma Ve Acil Cerrahi Dergisi-Turkish Journal of Trauma & Emergency Surgery最新文献

Background: Burns are a global health problem, especially in low- and middle-income countries. The use of models to predict mortality is more common in developed countries. In northern Syria, internal unrest has continued for 10 years. A lack of infrastruc-ture and difficult living conditions increase the incidence of burns. This study in northern Syria contributes to the predictions of health services provided in conflict regions. The first objective of this study specific to northwestern Syria was to assess and identify risk factors in the burn victim population hospitalized as emergencies. The second objective was to validate the three well-known burn mortality prediction scores to predict mortality: the Abbreviated Burn Severity Index (ABSI) score, Belgium Outcome of Burn Injury (BOBI) score, and revised Baux score.

Methods: This was a retrospective analysis of the database of patients admitted to the burn center in northwestern Syria. Patients who were admitted to the burn center as emergencies were included in the study. Bivariate logistic regression analysis was performed to compare the effectiveness of the three included burn assessment systems in determining the risk of patient death.

Results: A total of 300 burn patients were included in the study. Of them, 149 (49.7%) were treated in the ward, and 46 (15.3%) in the intensive care unit; 54 (18.0%) died, and 246 (82.0%) survived. The median revised Baux scores, BOBI scores, and ABSI scores of the deceased patients were significantly higher than those of the surviving patients (p=0.000). The cut-off values for the revised Baux, BOBI, and ABSI scores were set at 105.50, 4.50, and 10.50, respectively. For predicting mortality at these cut-off values, the revised Baux score had a sensitivity of 94.4% and a specificity of 91.9%, and the ABSI score had a sensitivity of 68.8% and a specificity of 99.6%. However, the cut-off value of the BOBI scale, calculated as 4.50, was found to be low (27.8%). The low sensitivity and negative predictive value of the BOBI model suggest that it was a weaker predictor of mortality than the others.

Conclusion: The revised Baux score was successful in predicting burn prognosis in northwestern Syria, a post-conflict region. It is reasonable to assume that the use of such scoring systems will be beneficial in similar post-conflict regions where limited opportunities exist.

Background: The aim of this study was to examine the effect of systemic immunoinflammatory index (SII), calculated on presentation to the emergency department (ED), on the prediction of clinical outcomes of patients who were diagnosed with acute pancreatitis (AP).

Methods: This research was designed as a single-center, cross-sectional, and retrospective study. Adult patients who were diag-nosed with AP in the ED between October 2021 and October 2022 in the tertiary care hospital, whose diagnostic and therapeutic procedures were complete in the data recording system, have been included in the study.

Results: Mean age, respiratory rate, and length of stay of the non-survivors were significantly higher than the mean of the survivors (t-test, p=0.042, p=0.001, and p=0.001, respectively). Mean SII score of the patients with fatal outcome was higher than the survivors (t-test, p=0.001). ROC analysis of the SII score to predict mortality revealed that the area under the curve was found to be 0.842 (95%CI 0.772-0.898), and the Youden index was 0.614, (p=0.001). When the cutoff value of the SII score in determining mortality is 1243, the sensitivity of the score was found to be 85.0%, specificity 76.4%, positive predictive value 37.0%, and negative predictive value 96.9%.

Conclusion: SII score was statistically significant in estimating mortality. SII calculated on presentation to the ED can be a useful scoring system to predict the clinical outcomes of patients who were admitted to the ED and were diagnosed with AP.

Background: Earthquakes are natural disasters that threaten human life and cause loss of life and property in a very short time. In our study, we aim to carry out the medical analysis of the earthquake victims who came to our hospital after the Earthquake in the Aegean Sea and to share our clinical experiences.

Methods: We retrospectively analyzed patients the medical data records of earthquake victims brought to our hospital or the injured who applied due to the Aegean Sea earthquake. Patients demographic data, their complaints and diagnoses, hour of admission, their clinical courses, hospital arrangements (admission, discharge, and transfer), time spent until the operation, anesthesia methods, surgical intervantions, intensive care needs, crush syndrome, presence of acute renal failure, number of dialysis, mortality, and mor-bidity were reviewed.

Results: A total of 152 patients were brought to our hospital due to the earthquake. The most intense period of admission to the emergency department was the 1st 24-36 h. Mortality rate was found to be higher depending on the increase of age. While the most common cause of admission for the mortal earthquake survivors was to be trapped in the wreckage, the survivors applied for other reasons as well such as falling down. The most common type of fracture observed in survivors was the lower extremity fractures.

Conclusion: Epidemiological studies can make an important contribution to the management and organization of the future earthquake-related injuries by healthcare institutions.

Background: Maintenance of epineural integrity is very important for nerve healing. Reports on the use of substances consid-ered to have positive effects on nerve healing in experimental nerve defect models are increasing. The present study assessed the effects of sub-epineural hyaluronic acid injection in a rat sciatic nerve defect model that was created while maintaining epineural integrity.

Methods: The study included 40 Sprague Dawley rats. The rats were randomly divided into a control group and three experimental groups (10 rats in each group). In the control group, the sciatic nerve was dissected and no additional surgery was performed. In experimental group 1, the sciatic nerve was transected in the middle, and then, primary repair was performed. In experimental group 2, a 1-cm defect was created while preserving the epineurium, and then, the defect was repaired with end-to-end suturing of the pre-served epineurium. In experimental group 3, the surgical procedure for experimental group 2 was performed, and then, sub-epineural hyaluronic acid injection was carried out. Functional and histological evaluations were performed.

Results: On functional evaluation, there was no statistically significant difference among the groups during the 12-week follow-up period. On histological evaluation, nerve recovery was poorer in experimental group 2 than in experimental groups 1 and 3 (p<0.05).

Conclusion: Although the functional analysis did not reveal any significant results, the histological findings suggest that hyaluronic acid increases the regeneration capacity of axons through its anti-fibrotic and anti-inflammatory effects.

Background: This study aimed to examine whether two different doses of dexamethasone (DXM), which is a corticosteroid, and amifostine (AMI), which reduces cumulative tissue toxicity induced by cisplatin in advanced-stage cancer patients, have ameliorative effects on pathologic changes associated with cardiac contusion (CC) induced in rats.

Methods: Forty-two Wistar albino rats were equally divided into six groups (n=7): C, CC, CC+AMI 400, CC+AMI 200, CC+AMI+DXM, and CC+DXM. Tomography images and electrocardiographic analyzes were performed, mean arterial pressure was measured from the carotid artery, and blood and tissue samples were obtained for histopathological and biochemical analyses after trauma-induced CC.

Results: While the total oxidant status and disulfide parameters in the cardiac tissue and serum were significantly higher (p<0.05), the total antioxidant status, total thiol, and native thiol parameters were significantly lower (p<0.01) in rats with trauma-induced CC. The most frequently observed finding in the electrocardiography analyze was ST elevation.

Conclusion: According to evaluation based on histological, biochemical, and electrocardiographic examinations, we believe that only 400 mg/kg dose of AMI or DXM can be effective in the treatment of myocardial contusion in rats. Evaluation based on histological findings.

Background: Gastrointestinal anastomotic leak (GAL) is a major cause of morbidity and mortality after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). The aim of this study is to determine the risk factors associated with GAL in peritoneal metastases (PM) surgery.

Methods: Patients who underwent CRS and HIPEC with gastrointestinal anastomosis were included. Charlson Comorbidity Index (CCI) and Eastern Cooperative Oncology Group (ECOG) performance status were used to assess preoperative condition of the patients. GAL was recorded as gastrointestinal extralumination diagnosed clinically, radiologicaly, or during reoperation.

Results: Among 362 patients who were analyzed, the median age was 54 years, 72.6% were female, and the most common histopathologies were ovarian cancer (37.8%) and colorectal (36.2%) cancer. The median Peritoneal Cancer Index was 11 and 80.1% of the patients underwent complete cytoreduction. A single anastomosis was performed in 293 (80.9%) patients, two anastomoses in 51 (14.1%) and three anastomoses in 18 (5%) patients. Diverting stoma was performed in 43 (11.8%) patients. GAL was seen in 38 (10.5%) patients. Smoking (p<0.001), ECOG performance status (p=0.014), CCI score (p=0.009), pre-operative albumin level (p=0.010), and number of resected organs (p=0.006) were significantly associated factors with GAL. Independent risk factors for GAL were smoking (Odds Radio [OR]: 6.223, confidence interval [CI]: 2.814-13.760; p<0.001), CCI score ≥7 (OR: 4.252, CI: 1.590-11.366; p=0.004), and pre-operative albumin level ≤3.5 g/dl (OR: 3.942, CI: 1.534-10.130; p=0.004).

Conclusion: Patient-related factors such as smoking, comorbidity, and pre-operative nutritional status had an impact on anasto-motic complications. Proper patient selection and prediction of an index patient requiring a prehabilitation program with a high level of care are essential prerequisites to obtaining lower anastomotic leak rates and improving outcomes in PM surgery.

Background: Acute kidney injury (AKI) is one of the common complications, associated with high mortality and morbidity in patients with burn injuries. This study aimed to determine the frequency of AKI development, its affective factors, and mortality rates according to kidney disease improving global outcomes (KDIGO) criteria in the burn patients.

Methods: The study included patients who are hospitalized for at least 48 h and aged >18 years, whereas patients with a renal transplant, chronic renal failure, undergoing hemodialysis, <18 years of age, with a glomerular filtration rate of <15 on admission, and toxic epidermal necrolysis was excluded from the study. KDIGO criteria were used to evaluate the occurrence of AKI. Burn mech-anism, total body surface area, inhalation injury respiratory tract burn, fluid replacement at 72 h with Parkland Formula, mechanical ventilator support, inotrope/vasopressor support, intensive care unit, lenght of stay, mortality, abbreviated burn severity index (ABSI), acute physiology, and chronic health evaluation II (APACHE II) ve Sequential organ failure assessment (SOFA) were recorded.

Results: A total of 48 patients were included in our study, of which 26 (54.2%) developed AKI (+), whereas 22 (45.8%) did not (-). The mean total burn surface area was 47.30% in the AKI (+) group and 19.88% in the AKI (-) group. Mean scores of ABSI, II (APACHE II), and SOFA, the mechanical ventilation and inotrope/vasopressor support and the presence of sepsis were significantly higher in the AKI (+). No mortality was determined in the AKI (-) group, whereas 34.6% in the AKI (+) group which was significantly high.

Conclusion: AKI was related to high morbidity and mortality in patients with burns. Using KDIGOs, classification in daily fol-low-up is useful in early diagnosis.

Background: Mole guns are handmade destructive tools used in the fight against harmful rodents in agricultural areas. Acciden-tal triggering of these tools at the wrong time can result in major hand injuries that impair hand functionality and cause permanent hand disability. This study aims to draw attention to the fact that mole gun injuries cause severe loss of hand functionality and that these tools should be considered within the scope of firearms.

Methods: Our study is a retrospective, observational cohort study. The demographic characteristics of the patients, the clinical features of the injury, and the surgical methods applied were recorded. The severity of the hand injury was assessed by the Modified Hand Injury Severity Score. The Disabilities of Arm, Shoulder, and Hand Questionnaire was used to evaluate the upper extremity-re-lated disability of the patient. The patients' hand grip strength and palmar and lateral pinch strengths, and functional disability scores were compared with healthy controls.

Results: Twenty-two patients with mole gun hand injuries were included in the study. The mean age of the patients was 63.0±16.9 (22-86), and all but one were male. Dominant hand injury was found in more than half of the patients (63.6%). More than half of the patients had major hand injuries (59.1%). The functional disability scores of the patients were significantly higher than the controls, and the grip strengths and palmar pinch strengths were significantly lower.

Conclusion: Even after years from the injury, our patients had hand disabilities, and their hand strengths were lower than that of the controls. Public awareness should be raised on this issue, and mole guns should be prohibited and considered in the scope of firearms.

Background: The early identification of severe acute pancreatitis (AP) remains a great challenge in clinical practice and novel predictors are needed to complement available scoring systems. This study aimed to investigate utility of Ranson score, and computed tomography severity index (CTSI) and C-reactive protein (CRP) criteria in determination of risk prognostic status in AP.

Methods: A total of 104 patients with AP (median age: 71.5 (range, 21-102) years, (59.6% were males) were included in this cross-sectional study. Patients were divided into two groups according to risk prognostic status including good prognosis (n=67) and poor prognosis (n=37) groups, based on presence of at least one of the poor prognostic criteria including Ranson score ≥3, presence of pseudocyst and necrotizing fluid collection on ultrasonography or computed tomography imaging and CRP levels >15 mg/L. Data on patient demographics, etiology of AP, smoking, blood biochemistry and hemogram findings and inflammatory markers including CRP (mg/L), mean platelet volume (fL), neutrophil-lymphocyte ratio, and platelet-lymphocyte ratio were recorded.

Results: Overall, 37 (35.6) patients with at least one these criteria comprised the poor prognosis group. Most of patients were considered to be in the poor prognosis group based on CTSI only (35.1%), CTSI + CRP (18.9%), and CTSI + Ranson (16.2%). Overall, 6 (5.8%) patients died, and all of them were in the poor prognosis group (p=0.002). Patients with poor versus good prognosis had significantly higher median (min-max) values for creatinine (1 [0.57-10.0] vs. 0.76 [0.5-8.4] mg/dL, p=0.004) and urea (48.0 [9.0-247.0] vs. 27.0 [10.0-111.0] mg/dL, p<0.001), and lower albumin values (3.5 [2.4-4.3] vs. 3.6 [2.7-4.6] g/L, p=0.021). Kappa values indicated presence of a moderate agreement between CTSI and CRP (kappa: 0.408), a fair agreement between CTSI and Ranson (kappa: 0.312), and a none to slight agreement between Ranson and CRP (kappa: 0.175). CTSI was able to discriminate all 6 patients (100.0%) with mortality, whereas Ranson and CRP each discriminated only 2 (33.3%) of 6 patients with mortality.

Conclusion: Our findings suggest a stronger individual prognostic value of CTSI alone, rather than CRP or Ranson score alone, in risk stratification of AP patients for severity of disease and related mortality risk on the day of admission, whereas emphasize the likelihood of using CRP or Ranson score complementary to CTSI to enable further identification of poor prognostic status.

Background: Abdominal pain is one of the most common reasons for admission to the pediatric emergency clinic. The appropriate evaluation of clinical and laboratory clues to make the correct diagnosis is of great importance in terms of directing the treatment medically or surgically and preventing unnecessary investigations. The aim of our study was to evaluate the contribution of high-volume enema application among pediatric patients with abdominal pain in terms of clinical and radiological findings.

Methods: Among the pediatric patients who applied to the pediatric emergency clinic of our hospital between January 2020 and July 2021 with abdominal pain, those who had intense gas stool image on abdominal X-ray and abdominal distension on physical examination and who underwent high-volume enema treatment were included in the study. The physical examination and radiological findings of these patients were evaluated.

Results: During the study period, 7819 patients were admitted to the pediatric emergency outpatient clinic with abdominal pain. Classic enema was performed in 3817 of these patients who had a dense gaseous stool image and abdominal distention on abdominal X-ray graphy. Defecation occurred in 3498 (91.6%) of 3817 patients who underwent classical enema, and the complaints regressed after enema. High-volume enema was applied to 319 (8.4%) patients who did not find relief with classical enema. Complaints of 278 (87.1%) patients regressed after the high-volume enema. Control ultrasonography (US) was performed in the remaining 41 (12.9%) patients, 14 (34.1%) patients were diagnosed with appendicitis. US results of 27 (65.9%) patients who had repeated US were evaluated as normal.

Conclusion: High volume enema treatment is an effective and safe method in children with abdominal pain who are unresponsive to classical enema application in the pediatric emergency department.