High velocity missile-related colorectal injuries: In-theatre application of injury scores and their effects on ostomy rates

BACKGROUND: Treatment of colorectal injuries (CRIs) remains a significant cause of morbidity and mortality. The aim of the present study was to analyze treatment trends of Turkish surgeons and effects of the American Association for the Surgery of Trauma (AAST), Injury Severity (ISS), and Penetrating Abdominal Trauma Index (PATI) scoring systems on decision-making processes and clinical outcomes.
METHODS: Data regarding high velocity missile (HVM)-related CRIs were retrospectively gathered. Four patient groups were included: Group 1 (stoma), Group 2 (no stoma in primary surgery), Group 2a (conversion to stoma in secondary surgery), and Group 2b (remaining Group 2 patients).
RESULTS: Groups 1, 2, 2a, and 2b included 39 (66%), 20 (34%), 6 (30%), and 14 (70%) casualties, respectively. Ostomies were performed in casualties with significantly higher AAST scores (p<0.001). However, PATI and ISS scores were not decisive factors in the performance of ostomy (p=0.61; p=0.28, respectively). Ostomy rates of civilian and military surgeons were 62% and 68%, respectively (p=0.47). Receiver operating characteristic (ROC) analysis showed that AAST score was a more accurate guide for performing ostomy, with sensitivity and specificity rates of 80% and 92.9%, respectively.
CONCLUSION: Clinical significance of diversion in HVM-related CRIs remains. Stomas were associated with lower complication rates and significantly higher AAST colon/rectum injury scores.

Yüksek kinetik enerjili parça tesirine baðlý kolorektal yaralanmalar: Cerrahi esnasýnda skorlama sistemlerinin uygulanmasý ve ostomi oranlarý üzerine etkisi

AMAÇ: Kolorektal yaralanmalar halen önemli bir mortalite ve morbidite nedenidir. Çalýþmanýn amacý Türk cerrahlarýn tedavi kararý konusunda American Association for the Surgery of Trauma (AAST) kolon/rektum yaralanma skoru, Injury Severity Score (ISS) ve Penetrating Abdominal Trauma Index (PATI) skorlarýný kullanmaya eðilimlerini ve mevcut klinik sonuçlarýný analiz etmektir.
GEREÇ VE YÖNTEM: Dört yýllýk bir periyot içerisinde yüksek kinetik enerjili silahlarýn neden olduðu kolorektal yaralanmalý hastalarýn verileri geriye dönük olarak toplandý. Ýlk ameliyatta ostomi açýlanlar grup 1, açýlmayanalar grup 2, sonradan ostomi açýlanlar grup 2a ve hiç ostomi açýlmayanlar grup 2b olarak belirlendi.
BULGULAR: Otuz dokuz (%66) hastaya ilk ameliyatta ostomi açýlmýþ, 20 (%34) hastaya açýlmamýþtý. Ýlk ameliyatta ostomi açýlmayan altý (%30) hastaya daha sonra ostomi açýlýrken, 14 (%70) hastaya hiç ostomi açýlmamýþtý. Belirgin þekilde AAST skorlarý yüksek olan hastalara ostomi açýldýðý görüldü (p<0.001). Fakat PATI ve ISS skorlarý ostomi açma konusunda belirleyici olmamýþtý (p=0.61, p=0.28). Sivil ve askeri cerrahlarýn ostomi oranlarý sýrasýyla %62 ve %68 olarak bulundu (p=0.47). Receiver operating characteristic (ROC) analizine göre AAST skorunun ostomi açma konusunda daha belirleyici olduðu görüldü.
TARTIÞMA: Yüksek kinetik enerjili silahlarla meydana gelen ateþli silah yaralanmalarýnda diversiyon halen önemini korumaktadýr. Diversiyon uygulamasý ve sonrasýnda gözlenen daha düþük komplikasyon oranlarý AAST skoru yüksekliði ile iliþkili bulundu.