Ulus Travma Acil Cerrahi Derg. 2019; 25(4): 361-368 | DOI: 10.14744/tjtes.2019.77250

Travmatik yaralanmalara baðlý mortaliteyle sonuçlanan durumlarda organ alýmlarýnýn haritalanmasý ve tahmini: Eþleþmiþ kohort analizi

Özgür Albuz
Keçiören Eðitim ve Araþtýrma Hastanesi, Genel Cerrahi Kliniði, Ankara-Türkiye

yoðun bakým merkezlerinde on sene boyunca travmaya baðlý yaralanmalardaki mortal seyreden hastalardaki organ tedariði sürecini deðerlendirerek travma sonrasý mortal sonuçlanan hastalardaki organ baðýþýndaki týbbi belirteçleri ortaya koymaktýr.
GEREÇ VE YÖNTEM: Geriye dönük olarak planlanan bu çalýþmada etik kurul onayýný takiben, acil cerrahi ünitesinde, ameliyathanede ve cerrahi yoðun bakýmda organ baðýþçýsý olan hastalarýn 2000–2011 yýllarý arasýndaki kayýtlarý incelendi. Hasta demografileri, baðýþlanan organlarýn daðýlýmlarý, entübasyon sahasý, hastaneye nakil þekli ile hasta yakýnlarýnýn organ baðýþýný kabulleri esnasýnda hastanýn bulunduðu servis, travma türü, yaralanma mekanizmasýyla þiddetleri incelendi. Sürekli deðiþkenler baðýmsýz gruplarda student t-test veya Mann-Whitney U-testiyle, ikili deðiþkenler Pearson ki-kare testiyle deðerlendirildi. Acil serviste (AS) hayatýný kaybeden ve kaybetmeyen olgular yaþ bakýmýndan 1: 3 eþleþtirmeyle kýyaslandý. Sonuçlar çoklu lojistik regresyonla deðerlendirildi.
BULGULAR: Sistolik kan basýncý (SKB) 90 mmHg’nin altýndaki hastalarla, penetran travma olgularý AS’ye organ baðýþý adayý olma olasýlýklarý çok daha yüksektir. Sýrasýyla (%68.2 ve %15.2, AOR: 4.59 [1.14, 18.40] [p<0.031]) ve %63.6 ve %37.9 (AOR: 6.25 [1.27–30.49] [p<0.024]). Beyin travmasý açýsýndan AIS ≥3 olmasýnýn ve 1500 cc veya daha fazla hastane kan ürünleri replasmaný yapýlan olgularda AS sonrasý organ baðýþçýsý olma olasýlýklarý daha yüksektir (%54.5 ve %97, AOR: 0.074 [0.014–0.548] [p<0.01]) ve (%10 ve %58.1, AOR: 0.098 [0.016-0.591], [p<0.01]).
TARTIÞMA: Travma sonrasý potansiyel organ vericileri belirlemede acil servise kabulde SKB’nin 90 mmHg altýnda olmasý ve ciddi penetran hasarlanmalar, beyin travmasý hasar skoru (AIS ≥3) ve 1500 cc üzeri kan ve kan ürünü replasmanlarýna göre potansiyel donörlerin belirlenmesinde daha öngördürücüdür.

Anahtar Kelimeler: Düzey I acil servis, organ tedarik süreci; öngörücü faktörler; travma sonrasý ölen organ baðýþçýsý.

---

Mapping and prediction of organ procurement in cases resulting in mortality due to traumatic injuries: A matched cohort analysis

Özgür Albuz
Department of General Surgery, Keçiören Training and Research Hospital, Ankara-Turkey

BACKGROUND: The prediction of posttraumatic potential organ donors is a complex process. The aim of this study is to evaluate the organ procurement process in trauma-related injuries and determine the medical markers in organ donors and posttraumatic mortal patients at the first level emergency, in emergency surgical service, and surgical intensive care departments.
METHODS: In this retrospective study, after the approval of the ethics committee, the records of the patients in the emergency surgery unit, the operating room, and the organ donors in surgical intensive care unit between the years 2000 January–2011 December were examined. Patient demographics, distribution of donated organs, intubation area, transfer to the hospital, patient’s service, trauma type, injury mechanism, and severity of the injury were examined. Continuous variables were evaluated with independent samples by the Student’s t-test or Mann-Whitney U test and binary variables with the Pearson Chi-Square test. The patients who lost their lives and survived in the emergency department (ED) were compared with an age ratio of 1: 3. Final results were evaluated by multiple logistic regression.
RESULTS: The patients with ≤90 mmHg systolic blood pressure (SBP) or penetrant serious injuries were more likely to be candidates for organ donation in ED, respectively; 68.2% vs. 15.2% [AOR: 4.59 (1.14, 18.40), p<0.031] and 63.6% vs. 37.9% (AOR: 6.25 [1.27–30.49] [p<0.024]). Patients with AIS head ≥3 and in-hospital blood replacement of 1500 cc or more, were more likely to be organ donors after ED: 54.5% vs. 97% (AOR: 0.074 [0.014 kan0.548], [p<0.01]) and 10% vs. 58.1% (AOR: 0.098 [0.016–0.591], p<0.01]).
CONCLUSION: In terms of predictive traits for organ procurement, a SBP of ≤90 mmHg and presence of serious penetrant injuries were found to be more predictive for organ transplantation than other factors such as AIS Head ≥3 or 1500 cc or more replacement of blood and blood products.

Keywords: Level I emergency department, organ procurement process; predictive factors; posttraumatic deceased donors.

---