The evaluation of 250 patients with thoracoabdominal injuries

BACKGROUND: Prognostic factors affecting mortality and morbidity in thoracoabdominal injuries were evaluated. METHODS: Two hundred and fifty patients (227 males, 23 females; mean age 30.1±5.11; range 15 to 71 years) who had been exposed to thoracoabdominal injuries and underwent laparotomy between June 1996 and November 2005 were investigated retrospectively. Patients were assessed according to age, sex, trauma-operation interval, shock, hospitalization period, number of injured organs, blood transfusion, timing of closed thorax drainage, thoracotomy, Abdominal Trauma Index, Injury Severity Score, Abbreviated Injury Score, Revised Trauma Score, and complications. RESULTS: Mortality and morbidity ratios were 15.6% and 53.5%, respectively. The factors effective on mortality were trauma-operation interval ≥3 hours (p=0.03), presence of shock (p=0.03), increase in the rate of blood transfusion (p=0.001), injured organ number ≥3 (p=0.001), and not performing early-term closed thorax drainage (p=0.005). Trauma-operation interval <3 (p=0.02), increase in the rate of blood transfusion (p=0.02), injured organ number ≥3 (p=0.001), and not performing early-term closed thorax drainage (p=0.005) were the factors effective on morbidity.
CONCLUSION: It was determined that trauma-operation period ≥3 hours, number of injured organs ≥3, and increased number of blood transfusions increased both mortality and morbidity. However, presence of shock increased only mortality. On the other hand, application of closed thorax drainage within a reasonable time period was determined to decrease mortality and morbidity.

Torakoabdominal yaralanma: 250 hastanýn deðerlendirilmesi

AMAÇ: Torakoabdominal yaralanmalarda morbidite ve mortaliteyi etkileyen prognostik faktörler deðerlendirildi. GEREÇ-YÖNTEM: Haziran 1996-Kasým 2005 tarihleri arasýnda torakoabdominal yaralanmaya maruz kalan ve laparotomi uygulanan 250 hasta (227 erkek, 23 kadýn; ort. yaþ 30,1±5,11; daðýlým 15-71) geriye dönük olarak incelendi. Hastalar yaþ, cinsiyet, travma operasyon entervali, þok, yatýþ süresi, yaralanan organ sayýsý, kan transfüzyonu, kapalý toraks drenajý, torakotomi, abdominal travma indeksi, yaralanma þiddet skoru, kýsaltýlmýþ yaralanma ölçeði, revize edilmiþ travma skoru ve komplikasyonlara göre deðerlendirildi. BULGULAR: Genel mortalite oraný %15,6, morbidite oraný ise %53,5 idi. Mortaliteye etkili faktörler, travma operasyon entervali ≥3 saat (p=0,03), þok mevcudiyeti (p=0,003), kan transfüzyon sayýsýnýn artmasý (p=0,001), yaralanan organ sayýsýnýn ≥3 olmasý (p=0,001) ve erken dönem kapalý toraks drenajý yapýlmamasý (p=0,008) idi. Travma operasyon entervali <3 saat (p=0,02), kan transfüzyon sayýsýnýn artmasý (p=0,02), yaralanan organ sayýsýnýn ≥3 olmasý (p=0,001) ve erken dönem kapalý toraks drenajý yapýlmamasý (p=0,005) morbiditeye etkili faktörlerdi. SONUÇ: Travma operasyon entervalinin üç saatten fazla olmasý, yaralanan yandaþ organ sayýsýnýn üçten fazla olmasý ve kan transfüzyon sayýsýnýn artmasýnýn mortalite ve morbiditeyi artýrdýðý saptandý, fakat þok mevcudiyetinin sadece mortaliteyi artýrdýðý gözlendi. Diðer tarafdan kapalý toraks drenajýnýn uygun zamanda uygulanmasýnýn mortalite ve morbiditeyi azalttýðý saptandý.