Geriatrik Popülasyonda Travma Analizi: Kesitsel Çalışma

Transkript

Geriatrik Popülasyonda Travma Analizi: Kesitsel Çalışma
<HQL7ÕS'HUJLVL0-104
Orijinal makale
Geriatrik Popülasyonda Travma Analizi:
.HVLWVHOdDOÕúPD
&HUHQùHQ7$15,.8/81, Yusuf TANRIKULU
2
2
1
(U]XUXP%|OJH(÷LWLPYH$UDúWÕUPD+DVWDQHVL$FLO7ÕS.OLQL÷L(5=8580
(U]XUXP%|OJH(÷LWLPYH$UDúWÕUPD+DVWDQHVL*HQHO&HUUDKL.OLQL÷L, ERZURUM
ÖZET
*LULú *HULDWULN \DúWDNL ELUH\OHU \DúODQPDQÕQ QHGHQ
ROGX÷XIL]\RSDWRORMLNGH÷LúLNOLNOHUHED÷OÕGDKDID]ODWUDYPDODUDPDUX]NDOPDNWDGÕUODU%XoDOÕúPDQÕQDPDFÕWUDYPDQHGHQL\OHDFLOHEDúYXUDQJHULDWULNKDVWDODUÕQGHPRJrafik özellikleri LOHDFLOVHUYLVWHNLWDQÕYHWHGDYLVUHoOHULni
DUDúWÕUPDNWÕU
Materyal ve Metot: dDOÕúPDPÕ] EDVDPDN ELU E|OJH
H÷LWLP DUDúWÕUPD KDVWDQHVLQLQ DFLO VHUYLVLQGH JHUoHNOHúWLULOGL YH oDOÕúPDGD 0D\ÕV -30 Nisan 2012
WDULKOHUL DUDVÕQGD DFLOLPL]H EDúYXUDQ JHULDWULN \DúWDNL
WUDYPD KDVWDVÕ LQFHOHQGL .HVLWVHO YH UHWURVSHNWLI
RODUDN SODQODQDQ oDOÕúPDQÕQ YHULOHUL KDVWD GRV\DODUÕQGDQ
YH RWRPDV\RQ VLVWHPLQGHQ HOGH HGLOGL +DVWD NDUWODUÕ LOH
RWRPDV\RQ VLVWHPL DUDVÕQGD X\XPVX]OX÷X RODQODU LOH
tetkik ve tedavi\LNDEXOHWPH\HQOHUoDOÕúPDGÕúÕEÕUDNÕOGÕ
2OJXODU GHPRJUDILN |]HOOLNOHUL WUDYPD\D PDUX] NDOÕQDQ
D\ WUDYPDQÕQ ROXú úHNOL WUDYPDQÕQ ROXúWX÷X YFXW E|OJHVL YH NDSVDGÕ÷Õ E|OJHOHULQ VD\ÕVÕ ORNDO-multipl travma
J|UOPHVÕNOÕ÷ÕYH\DWWÕ÷ÕNOLQLNDoÕVÕQGDQGH÷HUOHQGLULOGL
Bulgular: 'H÷HUOHQGLULOHQ 1540 olgunun %51,3’ü (790
hasta) erkek, %48,¶VL KDVWD NDGÕQ KDVWD\GÕ YH
\DúRUWDODPDVÕLGLROJX8) lokal travma
KDVWDVÕ YH ROJX (%11,2) multipl WUDYPD KDVWDVÕ LGL.
'úPHOHUWUDYPDQÕQHQ VÕNQHGHQLLGL(%82,3) (p<0,05).
Travma sonucu en fazla etkilenen vücut bölgesi ekstremitelerdi. <XPXúDN GRNX WUDYPDVÕ ORNDO WUDYPD YDNDODUÕQGD HQ VÕN J|]OHQHQ WUDYPD\NHQ PXOWLSO WUDYPD
YDNDODUÕQGD HQ VÕN J|]OHQHQ WUDYPD HNVWUHPLWH YH EDú
boyun travmasÕELUOLNWHOL÷L\GL
Sonuç: <DúODQPDVUHFLQGHPH\GDQDJHOHQIL]\RORMLNYH
PHWDEROLN GH÷LúLNOHU ELUH\OHULQ WUDYPDGDQ NHQGLOHULQL
koruyabilme kabiliyetini azaltmakta ve geriatrik travma
VD\ÕODUÕQGD DUWÕú J|]OHQPHNWHGLU %X QHGHQOH WUDYPD
nedenlerini ortaya koyabilmek ve bunlara yönelik gerekli
|QOHPOHUL DODELOPHN LoLQ YH KHU YDND GLNNDWOL ELU úHNLOGH
LUGHOHQPHOLYHKDVWDND\ÕWODUÕoRNL\LWXWXOPDOÕGÕU
Anahtar Kelimeler: Acil Servis; geriatri; travma
ABSTRACT
Analysis of trauma in geriatric population: A crosssectional study
Aim: Geriatric people are more exposed to trauma due
to physiopathological changes caused by aging. The aim
of this study was to evaluate the demographic
characteristics of geriatric patients admitted to the
emergency clinic and their diagnosis and treatment
processes.
Material and Method: Our study was carried out at a
3th degree area hospital and evaluated 1450 geriatric
trauma cases between May 2011-April 2012. The study
data was collected and was obtained from patient charts
and automation system. Patients who had mismatch
between the patient cards and their automation
information, and who did not accept the examination
and treatment, were excluded. The patients were
evaluated in terms of the demographic characteristics,
months of exposure to trauma, body region to the
affected trauma and the number of regions covered by
trauma, type of trauma and hospitalized clinics.
Results: Of the evaluated 1540 cases, 790 were male
and 750 were female. The mean age was 73.9 in years.
1368 cases (88.8%) were local trauma patients and 172
cases were multiple trauma patients. The falls were the
most common cause of trauma (82,3%). The extremities
were the most affected body region. The soft tissue
injury was the most commonly observed trauma in cases
of local trauma, while the coexistence of the extremity
and head and neck trauma was the most frequently
observed trauma in cases of multiple trauma.
Conclusion: Physiological and metabolic changes that
occur with aging has decreased the people’s ability to
protect themselves from injury, so has increased the
number of geriatric trauma. Therefore, each case has to
be examined carefully and patient records must be kept
meticulously to reveal the causes of trauma, and to take
precautions against them.
Key Words: Emergency room; geriatrics; trauma
*ø5øù
7UDYPDWP\DúJUXSODUÕQGDNDOSKDVWDOÕ÷ÕNDQVHU
YH LQPHGHQ VRQUD G|UGQF VÕNOÕNWD görülen ölüm
QHGHQLGLU YH WUDYPD QHGHQL\OH |OHQ ROJXODUÕQ
¶LQLJHULDWULNROJXODUROXúWXUPDNWDGÕU1,2.
<D]ÕúPDDGUHVL
'U&HUHQùHQ7$15,.8/8
Erzurum Bölge E÷LWLPYH$UDúWÕUPD+DVWDQHVL$FLO7ÕS.OLQL÷L(U]XUXP
e-mail: [email protected]
<D]ÕQÕQJHOGL÷LWDULK
: 28.06.2012
<D\ÕQDNDEXOWDULKL
: 25.08.2012
100
Geriatrik dönemdeki travmalarda mortaliteyi
etkileyen eQ |QHPOL QHGHQOHU \DúOD ELUOLNWH DUWDQ
NRPRUELG KDVWDOÕNODU YH D]DOPÕú IL]\RORMLN UH]HUYdir3*HULDWULNELUH\OHU\DúODQPDQÕQQHGHQROGX÷X
DOJÕYHGLNNDWHNVLNOL÷LJ|UPHNHVNLQOL÷LQGH D]DOPD
mental ve motor aktivitedeki azalma, postural
\DSÕGDNL ER]XNOXN JLEL IL]\RSDWRORMLN GH÷LúLNOLNOHUH
ED÷OÕGDKDID]ODWUDYPDODUDPDUX]NDOPDNWDGÕUODU4,5.
%XQXQ \DQÕ VÕUD \DúODQPD VUHFLQGH PH\GDQD
JHOHQ IL]\RORMLN YH PHWDEROLN GH÷LúLNlikOHU NLúLOHULQ
&ù7DQUÕNXOXYH<7DQUÕNXOX
WUDYPDGDQNDoÕQDELOPHYHROXúDQWUDYPDVWUHVL\OH
EDú HGHELOPH NDELOLyetini azaltmakta ve D\UÕFD
KDVWDODUÕQ WHGDYL VUHoOHUL X]DPDNWD NRPSOLNDV\RQODUGDKDVÕNJ|UOPHNWHGLU6-8. Tüm bu nedenleUHED÷OÕJHULDWULNWUDYPDODUPRUWDOLWHYHPRUELGLWH
DoÕVÕQGDQ |QHPOL ELU ULVN IDNW|U ROXúWXUGX÷XQGDQ
çok iyi irdelenmeli, tedavi SODQODUÕ PXOWLGLVLSOLQHU
ELU\DNODúÕPLoHUPHOLGLU
%X oDOÕúPDQÕQ DPDFÕ EDVDPDN E|OJH H÷LWLP
hastanesi DFLO VHUYLVLQH EDúYXUDQ JHULDWULN WUDYPD
KDVWDODUÕQÕQ GHPRJUDILN YH HSLGHPL\RORMLN |]HOOLNOHULQLVDSWDPDNWÕU
MATERYAL VE METOT
dDOÕúPD3ODQÕ
Bu çaOÕúPD \ÕOOÕN RUWDODPD KDVWD VD\ÕVÕ
RODQEDVDPDNELUE|OJHH÷LWLPDUDúWÕUPDKDVWDQHVLQLQ DFLO VHUYLVLQGH JHUoHNOHúWLULOPLúWLU +DVWD
YHULOHUL JHUL\H G|QN RODUDN 0D\ÕV -30
1LVDQ WDULKOHUL DUDVÕQGD DFLO VHUYLVH JHWLULOHQ
tüm geriatrik WUDYPDOÕ KDVWDODUÕQ DFLO VHUYLVWH
G]HQOHQHQ KDVWD NDUWODUÕQGDQ YH KDVWDQH RWRPDV\RQ VLVWHPLQGHQ HOGH HGLOPLúWLU (WLN NXUXO
RQD\ÕELUORNDOHWLNNRPLWHGHQDOÕQPÕúWÕU
dDOÕúPD\D\DúVWDFLOVHUYLVHJHWLrilen tüm
KDVWDODU GDKLO HGLOGL YH EXQODUÕQ LoLQdeki travma
KDVWDODUÕ D\UÕQWÕOÕ RODUDN LQFHOHQGL Tarama esnaVÕQGDKDVWDNDUWODUÕLOHRWRPDV\RQVLVWHPLDUDVÕQGD
X\XPVX]OX÷X RODQODU NHQGL LVWH÷L LOH WHWNLN YH
WHGDYL\LNDEXOHWPH\HQOHULOHWUDYPDYDNDVÕROPDVÕ
GÕúÕQGDHNELOJL\DGDDoÕNODPDVÕROPD\DQKastalar
oDOÕúPDGÕúÕEÕUDNÕOGÕ
dDOÕúPD\D GDKLO HGLOHQ YDNDODU GHPRJUDILN
|]HOOLNOHUL WUDYPD\D PDUX] NDOGÕ÷Õ D\ WUDYPDQÕQ
ROXú úHNOL WUDYPDQÕQ ROXúWX÷X YFXW E|OJHVL YH
NDSVDGÕ÷ÕE|OJHOHULQVD\ÕVÕORNDOYHPXOWLSOWUDYPD
J|UOPHVÕNOÕ÷ÕYH\DWWÕ÷ÕNOLQLNDoÕVÕQGDQGH÷HUOHQGLULOGL /RNDO YH PXOWLSO WUDYPD D\UÕPÕ \DSÕOÕUNHQ
DQDWRPLN VNRU VLVWHPL RODQ NÕVDOWÕOPÕú \DUDODQPD
cetveli (Abbreviated Injury Scale-AIS)9 NXOODQÕOGÕ
øVWDWLVWLNVHO$QDOL]
Verilerin analizi SPSS for Windows 15.0 paket
SURJUDPÕQGD \DSÕOGÕ .DWHJRULN GH÷LúNHQOHU VD\Õ
(n) ve yüzde (%) olarak ifade edildi ve analizinde
Ki-NDUHWHVWLYHYH\D)LVKHU¶V NHVLQWHVWLNXOODQÕOGÕ
6D\ÕVDO GH÷LúNHQOHU RUWDODPD“standart sapma
RODUDNLIDGHHGLOGLYHLNLED÷ÕPÕ]JUXEXQRUWDODPDODUÕQÕQ NDUúÕODúWÕUÕOPDVÕ DQDOL]LQGH 6WXGHQW W WHVWL
kulODQÕOGÕ Tüm sonuçlar için p<0, GH÷HUL LVWDWLVWLNVHORODUDNDQODPOÕNDEXOHGLOGL
BULGULAR
+DVWDQHPL] DFLO VHUYLVLQH 0D\ÕV -30
1LVDQ WDULKOHUL DUDVÕQGD WRSODPGD KDVWD EDúYXUPXú ROXS EXQODUÕQ 10’unu (15813
KDVWD JHULDWULN KDVWDODU ROXúWXUPDNWD\GÕ *HULDWULN \DúWDNL EX KDVWDODUÕQ ¶VL KDVWD
WUDYPD KDVWDVÕ\GÕ $\UÕFD WUDYPD QHGHQL\OH DFLO
servise ex-duhul olarak getirilen ya da acilde ex
RODQ KDVWD LOH NHQGL LVWH÷L\OH WHWNLN YH WHGDviyi
NDEXO HWPH\HQ KDVWD YH KDVWD NDUWODUÕ YH RWRPDV\RQND\ÕWODUÕQDXODúÕODPD\DQKDVWDoDOÕúPD
GÕúÕ EÕUDNÕOGÕ dDOÕúPDPÕ]GD HOH DOÕQDQ JHULDWULN
WUDYPD KDVWDODUÕQÕQ ¶nü (790 hasta) erkek
hastalar, %48¶VLQL KDVWD NDGÕQ KDVWDODU
ROXúWXUPaNWD\GÕ S <Dú RUWDODPDVÕ HUNHNlerde 73,8, NDGÕQODUGD LGL (Q GúN \Dú
JHULDWULN \Dú VÕQÕUÕ RODQ LGL YH HQ \DúOÕ KDVWD
\DúÕQGD\GÕ $,6 VÕQÕIODPDVÕQD J|UH KDVWDODUÕQ
%88,8’i (1368 hasta) ORNDO WUDYPD KDVWDVÕ ROXS
sadece tek sistem yaraODQPDVÕ LoHUPHNWH\GL
(p<0, øNL \D da daha fazla sistem yaralanPDVÕ RODQ KDVWD VD\ÕVÕQÕQ RUDQÕ LVH hasta) idi.
$\ODUD J|UH WUDYPD YDNDODUÕ NDUúÕODúWÕUÕOGÕ÷ÕQGD
ùHNLO \D] YH VRQEDKDU D\ODUÕQGD YDND VD\ÕODUÕ
DQODPOÕGHUHFHGH\NVHNWL(Q ID]ODKDVWDVD\ÕVÕQD
KD]LUDQ WHPPX] D÷XVWRV YH
H\OO D\ODUÕQGD UDVWODQPDNWD LNHQ HQ D]
KDVWD VD\ÕVÕ úXEDW YH DUDOÕN D\ODUÕQGD
görülmekteydi.
ùHNLO+DVWDODUÕQD\ODUDJ|UHGD÷ÕOÕPÕQ
+DVWDODUÕQ PDUX] NDOGÕNODUÕ travma tipine göre
GD÷ÕOÕPODUÕ LQFHOHQGL÷LQGH 7DEOR KHU LNL FLQVL\HWWHGH GúPH YDNDODUÕ HQ ID]OD WUDYPD
WLSLQL ROXúWXUPDNWD\GÕ S, 'úPHGHQ VRQUD
HQ VÕN J|]OHQHQ WUDYPD QHGHQL LVH WUDILN ND]DODUÕ
LGL 'DUS YDNDODUÕ GDKD oRN HUNHk hastaODUGD J|UOPHNWH\GL 'L÷HU WUDYPD QHGHQOHUL KHU
iki cinsiyette benzer oranlarda idi. Travma nedenOHUL D\ODUD J|UH LQFHOHQGL÷LQGH \LQH GúPH YDNDODUÕQÕQ KHU D\ GDKD VÕN ROGX÷X WUDILN ND]DODUÕQÕQ
LVH |]HOOLNOH \D] D\ODUÕQGD GDKD ID]OD ROGX÷X
gözlendi.
101
&ù7DQUÕNXOXYH<7DQUÕNXOX
Tablo 1. +DVWDODUÕQ0DUX].DOÕQDQ7UDYPD7LSLQH*|UH'D÷ÕOÕPÕ
Travma nedeni
7UDILNND]DVÕ
'úPH
Darp
Delici kesiciyle yaralanma
Yanma
dDUSPDdDUSÕúPD
$WHúOLVLODKOD\DUDODQPD
+DY\DQWDUDIÕQGDQÕVÕUÕOPD
Toplam
Erkek (n%)
96 (57,4)
637 (50,2)
14 (93,3)
12 (60)
8 (40)
20 (43,4)
1 (100)
2 (66,7)
790
.DGÕQQ
71 (52,6)
631 (49,8)
1 (6,7)
8 (40)
12 (60)
26 (56,6)
0 (0)
1 (33,3)
750
Toplam (n%)
167 (10,8)
1268 (82,3)
15 (1)
20 (1,3)
20 (1,3)
46 (2,9)
1 (0,1)
3 (0,3)
1540
P
<0,05
<0,05
>0,05
>0,05
>0,05
>0,05
>0,05
>0,05
Tablo 2. +DVWDODUÕQ7UDYPD6RQXFX(WNLOHQHQ9FXW%|OJHOHULQH*|UH'D÷ÕOÕPÕ
7UDYPDVRQXFXROXúDQSDWRORMLOHU
%Dú-boyun–\]WUDYPDVÕ
(NVWUHPLWHWUDYPDVÕ
7RUDNVWUDYPDVÕ
%DWÕQWUDYPDVÕ
0XOWLRUJDQWUDYPDVÕ
<DQÕN
Toplam
Erkek (n%)
78 (59,1)
579 (48,8)
19 (79,2)
4 (57,1)
102 (59,3)
8 (42,1)
790
.DGÕQQ
54 (40,9)
607 (51,2)
5 (21,8)
3 (42,9)
70 (40,7)
11 (57,9)
750
Toplam (n%)
132 (8,8)
1186 (77)
24 (1,6)
7 (0,5)
172 (11,1)
19 (1,2)
1540
Tablo 3. +DVWDODUÕQ<DWWÕ÷Õ.OLQLNOHUH*|UH'D÷ÕOÕPÕ
<DWWÕ÷Õ.OLQLN
Ortopedi ve Travmatoloji
Beyin Cerrahisi
Genel Cerrahi
Plastik ve Rek. Cerrahi
*|÷V&HUUDKLVL
Kalp-Damar Cerrahisi
<DQÕN7HGDYL0HUNH]L
<R÷XQ%DNÕPhQLWHVL
Toplam
Lokal travma (n)
115
16
1
3
12
2
4
4
157
+DVWDODUÕQ PDUX] NDOGÕNODUÕ WUDYPD VRQXFX
HWNLOHQGLNOHUL WUDYPD E|OJHOHULQH J|UH GD÷ÕOÕPODUÕ
LQFHOHQGL÷LQGH 7DEOR ) en fazla etkilenen sistePLQ HNVWUHPLWHOHU ROGX÷X J|UOG KDVWD øNL \D GD GDKD ID]OD VLVWHPLQ HWNLOHQGL÷L
PXOWLSOWUDYPDROJXODUÕQÕQVD\ÕVÕRODrak tespit edildi. En az etkilenen travma bölgesinin
LVH EDWÕQ ROGX÷X WHVSLW Hdildi. Tek vücut
E|OJHVLQLQ HWNLOHQGL÷L ORNDO WUDYPD YDNDODUÕQÕQ
|]HWLùHNLO¶GHJ|UOPHNWHGLU
ùHNLO Lokal travma vDNDODUÕQÕQetkilenen vücut bölgelerine göre dD÷ÕOÕPÕQ
102
Multipl travma (n)
2
8
0
2
11
0
0
11
34
Total (n/%)
117 (%61,2)
24 (%11,5)
1 (%0,5)
5 (%2,6)
23 (%12,0)
2 (%1)
4 (%2,4)
15 (%7,8)
191 (%100)
'H÷HUOHQGLULOHQ ORNDO WUDYPDOÕ ROJXODUÕQ
VRQXoODUÕQDgöre en fazlDKDVWDVD\ÕVÕQÕQ]HGHOHQPH
burkulma, çarpma-oDUSÕúPD VRQXFX GHUPDEUD]\RQVÕ\UÕNJLELEXOJXODUÕQWRSODQGÕ÷Õ ³\XPXúDNGRNX
WUDYPDVÕ´ (773 hasta- JUXEXQGD ROGX÷X
görüldü. +DVWD ND\ÕWODUÕ ve bilgisayar sistemleri
taramasÕQGD EX JUXSWDNL KDVWDODUÕQÕQ %75’lik bir
NÕVPÕQÕQ EXUNXOPD H]LOPH JLEL HNVWUHPLWH WUDYPDVÕ ROGX÷X WHVSLW HGLOGL (Q D] HWNLOHQHQ WUDYPD
E|OJHVLQLQLVHEDWÕQROGX÷XJ|UOG
0XOWLSO WUDYPD YDNDODUÕQD DLW YHULOHU ùHNLO ¶WH
YHULOPLúWLU %XQD J|UH HNVWUHPLWH WUDYPDODUÕQÕQ
multipl travmalar içerisinde en fazla birliktelik
J|VWHUHQ VLVWHP ROGX÷X YH HQ VÕN J|UOHQ multipl
WUDYPDQÕQ ³HNVWUHPLWHEDú ER\XQ´ WUDYPDVÕ
ELUOLNWHOL÷L ROGX÷X WHVSLW HGLOGL KDVWD-%44,2).
(Q D] J|UOHQ PXOWLSO WUDYPD ELUOLNWHOL÷LQLQ LVH
³EDú ER\XQ EDWÕQ´ WUDYPDVÕ ROGX÷X J|UOG 3
\D GDKD ID]OD VLVWHPLQ HWNLOHQGL÷L PXOWLSO WUDYPD
VD\ÕVÕLVHRODUDNEXOXQGX
øOJLOL NOLQLNOHUH \DWÕUÕODQ KDVWDODUD DLW GD÷ÕOÕPODU
7DEOR ¶WH YHULOPLúWLU %X VRQXoODUD J|UH WRSODP
\DWÕú RUDQÕ ¶W KDVWD YH \DWÕUÕODQ
&ù7DQUÕNXOXYH<7DQUÕNXOX
NOLQLNOHU LoHULVLQGH HQ ID]OD \DWÕúÕQ ROGX÷X NOLQL÷LQ
³RUWRSHGLYHWUDYPDWRORML´ROGX÷XJ|]OHQGL
*HQHOFHUUDKLNOLQL÷LQHVDGHFHKDVWD\DWÕúÕQÕQ
ROGX÷X ³\R÷XQ EDNÕP QLWHVLQH´ KDVWD \DWÕúÕQÕQROGX÷XWHVSLWHGLOGL/RNDOWUDYPDKDVWDODUÕQda
HQID]OD\DWÕú\DSÕODQNOLQL÷LQ³RUWRSHGLYHWUDYPDWRORML´ PXOWLSO WUDYPD KDVWDODUÕQGD LVH ³J|÷V
FHUUDKLVL´ROGX÷XJ|]OHQGL2UWRSHGLNOLQL÷LQH\DWÕUÕODQ KDVWDODUÕQ ¶ini femur ve pelvik fraktürler
ROXúWXUPDNWD\GÕ 3ODVWLN YH UHNRQVWUNWLI FHUUDKL
NOLQL÷LQH \DWÕUÕODQ KDVWDODUÕQ KHSVL PDNVLOORIDVLDO
WUDYPDKDVWDVÕ\GÕ
ùHNLO 0XOWLSO WUDYPD YDNDODUÕQÕQ HWNLOHQHQ YFXW E|OJHOHULQHJ|UHGD÷ÕOÕPÕQ
7$57,ù0$
<DSÕODQ EX oDOÕúPD VRQXQGD JHULDWULN WUDYPD
RUDQÕQÕQELUKD\OL\NVHNROGX÷XYHHQVÕNJ|UOHQ
yaralanmDWLSLQLQ\DúODQPDQÕQGDJHWLUPLúROGX÷X
IL]\RORMLN GH÷LúLNOLNOHU VRQXFX GúPHOHU ROGX÷X
WHVSLW HGLOGL $\UÕFD KDVWD ND\ÕWODUÕQÕQ \HWHUVL]
WXWXOGX÷X RWRPDV\RQ VLVWHPLQLQ \HWHULQFH NDWNÕ
VD÷OD\DPDGÕ÷ÕJ|]OHQGL
7UDYPD WP \Dú JUXSODUÕQGD NDOS KDVWDOÕ÷Õ
NDQVHU YH LQPHGHQ VRQUD G|UGQF VÕNOÕNWD UDVWlanan ölüm nedenidir ve travma nedeniyle ölen
ROJXODUÕQ ¶LQL JHULDWULN ROJXODU ROXúWXUPDNWDGÕU1,2. Geriatrik dönemdeki travmalarda mortaliteyi
HWNLOH\HQ HQ |QHPOL QHGHQOHU \DúOD ELUOLNWH DUWDQ
NRPRUELG KDVWDOÕNODU YH D]DOPÕú IL]\RORMLN UH]HUYdir3*HULDWULN\DúWDNLELUH\OHU\DúODQPDQÕQQHGHQ
ROGX÷XDOJÕYHGLNNDWHNVLNOL÷LJ|UPHNHVNLQOL÷LQGH
azalma, mental ve motor aktivitedeki azalma,
SRVWXUDO\DSÕGDNLER]XNOXNJLELIL]\RSDWRORMLNGH÷LúLNOLNOHUH ED÷OÕ GDKD ID]OD WUDYPDya maruz kalPDNWDGÕUODU4,5.
+DVWDQHPL] E|OJH KDVWDQHVL QLWHOL÷LQGH ROGX÷XQGDQ DFLO servise EDúYXUDQ KDVWD VD\ÕVÕQÕQ
\DNODúÕN-40µÕoHYUe il ve ilçelerden gelen hastalardan oOXúPDNWDGÕU $FLOH VHUYLVWH GH÷HUOHQGLULOHQ JHULDWULN KDVWDODU EDúYXUDQ KDVWD VD\ÕVÕQÕQ
¶XQXROXúWXUPDNWD\GÕ
*HULDWULN \Dú JUXEXQGDNL WUDYPD KDVWDODUÕQÕQ
VD\ÕVÕROXSJHULDWULNSRSODV\RQXQ¶VLQH
tekabül etmekteydi. Hastanemizdeki bu oranlar
OLWHUDWUGHNL JHQLú VHULOHUGH EHOLUWLOHQ -23’lük
oranlarla benzer nitelikteydi8-11. Mersin ÜniversiteVLQGH \DSÕODQ ELU oDOÕúPDGD12 ise geriatrik travma
RUDQÕ EXOXQPXú ROXS KDVWDQHPL] 6D÷OÕN
%DNDQOÕ÷Õ YH E|OJH KDVWDQHVL ROGX÷XQGDQ EL]LP
oDOÕúPDPÕ]GDEXRUDQGDKD\NVHNWHVSLWHGLOPLúWir.
*HULDWULN \Dú JUXEXQGD NDGÕQ VD\ÕVÕQÕQ HUNHNOHUGHQ GDKD ID]OD ROGX÷X YH EX QHGHQOH ROXúDELOHFHNWUDYPDROJXODUÕQÕQNDGÕQODUGDGDKDVÕNJ|UOPHVL EHNOHQPHNWH\VH GH \DSÕODQ oDOÕúPDODUGD
IDUNOÕVRQXoODUHOGHHGLOPLúWLU7,12.
dDOÕúPDPÕ]GD HUNHN travma KDVWDODUÕQ VD\ÕVÕ
daha yüksek tespit edildi ve bu oran ülkemizde
\DSÕOPÕú GL÷HU oDOÕúPDODU LOH X\XPOX\GX13,14. Bu
durumun ülkemizde erkek popülâsyonun özellikle
Lú JF JHUHNWLUHQ mesleklerde daha aktif olarak
oDOÕúPDODUÕ YHVRV\DO\DúDPDNDWÕOPDODUÕQGDQGROD\Õ
ROXúWX÷XQX GúQPHNWH\L] (OH DOÕQDQ ROJXODUGD
\DúRUWDODPDVÕHUNHNOHUGHYHNDGÕQODUGD
LGL(QGúN\DúJHULDWULN\DúVÕQÕUÕRODQLGLYH
HQ\DúOÕKDVWD\DúÕQGD\GÕ
/RNDOYHPXOWLSOWUDYPDD\UÕPÕQÕQ\DSÕOPDVÕQGD
AIS9, Injury Severity Score (ISS)15, Comprehensive
Research Injury Scale (CRIS)16, “Trauma Injury
Severity Score (TRISS)17 ve A Severity Characterisation Of Trauma (ASCOT)18 gibi birçok skorlama
sisWHPL NXOODQÕOPDNWDGÕU %L] oDOÕúPDPÕ]GD UHWURVSHNWLIYHULOHUGHQHOGHHGHELOGL÷LPL]ELOJLOHUGR÷UXOWXVXQGD $,6 VNRU VLVWHPLQL NXOODQGÕN %X VNRU
VLVWHPL VRQXoODUÕQD J|UH ORNDO WUDYPD KDVWDODUÕQÕQ
VD\ÕVÕROGXNoD\NVHNVDSWDQGÕ0DUPDUD
Üniversitesi’QGH WP \Dú JUXSODUÕQGDNL WUDYPD
]HULQH \DSÕODQ ELU oDOÕúPDGD19 lokal ve multiple
WUDYPD KDVWDODUÕQÕQ VD\ÕVÕ ELUELULQH \DNÕQ EXOXQPXúWXU $,6 VLVWHPLQH J|UH \DSWÕ÷ÕPÕ] WUDYPD
KDVWDVÕ VÕQÕIODPDVÕ GDKD NDSVDPOÕ GL÷HU VNRUODPD
VLVWHPOHUL LOH \DSÕOPÕú ROVD\GÕ GDKD IDUNOÕ VRQXoODU
elde edilebilirdi.
$\ODUD J|UH WUDYPD KDVWDODUÕQÕQ GD÷ÕOÕPÕ LQFHOHQGL÷LQGH KDVWD VD\ÕVÕQÕQ HQ \R÷XQ ROGX÷X D\ODU
KD]LUDQWHPPX]YHH\OOLGL+DVWDVD\ÕVÕQÕQ\D]D
GR÷UX JLGHUHN DUWWÕ÷Õ YH NÕú D\ODUÕQGD D]DOÕú
J|VWHUGL÷LWHVSLWHGLOGLdDOÕúPDQÕQ\DSÕOGÕ÷ÕE|OJHGHNÕúG|QHPLoRNúLGGHWOLJHoWL÷LQGHQ\DúOÕKDVWDODUÕQ VRV\DO \DúDQWÕODUÕQÕQE\N ELU NÕVPÕQÕ NDSDOÕ
PHNDQODUGD JHoLUPHVL YH DNWLI LKWL\DoODUÕQÕ JHoLFL
ELU VUH DVNÕ\D DOPDVÕQÕQ EX DUWÕú YH D]DOÕúODUGD
HWNLOL ROGX÷XQX GúQPHNWH\L] .DQGLú YH DUN.14
NDUDVDO YH VR÷XN KDYD úDUWODUÕQÕQ HJHPHQ ROGXNODUÕ ELU PHUNH]GH \DSWÕNODUÕ oDOÕúPDGD EHQ]HU
VRQXoODUÕHOGHHWPLúOHUGLU
+DVWDODUÕQ PDUX] NDOGÕNODUÕ WUDYPD WLSOHUL GH÷LúLNOLN J|VWHUPHNWH ROXS ONHPL]GH JHULDWULN \Dú
gruplarÕQGD WUDYPD QHGHQOHULQH \|QHOLN \DSÕODQ
oDOÕúPDODUGDHQVÕNWUDILNND]DODUÕYHGúPHROJXODUÕQD UDVWODQÕOPÕúWÕU7,11 \Dú YH ]HUL WUDYPD
KDVWDODUÕQGD \DSÕODQ ELU oDOÕúPDGD HQ VÕN J|UOHQ
103
&ù7DQUÕNXOXYH<7DQUÕNXOX
WUDYPD WLSOHUL VÕNOÕN VÕUDVÕQD J|UH WUDILN ND]DVÕ
GúPHOHU\D\DND]DODUÕDWHúOL
VLODKOD\DUDODQPDODURODUDNEHOLUOHQPLúWLU20.
%HQ]HUúHNLOGH%LOJLQYHDUN.12 LOH$NWDúYHDUN.13
JHULDWULN WUDYPDODU ]HULQH \DSWÕNODUÕ oDOÕúPDODUGD
HQVÕNWUDYPDROXúPHNDQL]PDVÕQÕGúPHYHWUDILN
ND]DODUÕ ROGX÷XQX WHVSLW HWPLúOHUGLU hONHPL]GH
\DSÕODQ GL÷HU ELU oDOÕúPDGD .DQGLú YH DUN.14 trafik
ND]DODUÕQGDQ VRQUD HQ VÕN J|UOHQ WUDYPD ROXú
WLSLQL GDUS RODUDN EXOPXúODUGÕU %L]GH oDOÕúPDPÕ]GDHQVÕNPDUX]NDOÕQDQWUDYPDWLSOHULQLOLWHUDWUOH
X\XPOX RODUDN GúPH YH WUDILN ND]DVÕ
RODUDN WHVSLW HWWLN 'DUS YDNDODUÕQÕQ RUDQÕQÕLVHRODUDNEXOGXN*HULDWULN\DúODUGDVHQNRSJ|UPHGX\XYHDOJÕIRQNVL\RQODUÕQGDD]DOPD
GHQJH SUREOHPOHUL NDV JoV]O÷ YH RVWHRDUWULWRVWHRSRUR] JLEL QHGHQOHU GúPHOHUde en önemli
risk faktörleridir12 $\ODUD J|UH GD÷ÕOÕPda GúPH
YDNDODUÕQGD IDUNOÕOÕN WHVSLW HGLOPH]NHQ WUDILN ND]DODUÕQÕQ\D]D\ODUÕQGDGDKDID]ODROGX÷XJ|]OHQGL
*HULDWULN SRSODV\RQGD WUDYPD VRQUDVÕ VÕNOÕNOD
WUDYPD\DPDUX]NDODQE|OJHOHUEDú-boyun ve eksWUHPLWHOHUGLU 0DUX] NDOÕQDQ HQ VÕN WUDYPD WLSL
GúPH ROGX÷XQGDQ YH GúPH VRQXFX HNVWUHPLWHOHULQWUDYPDGDQGDKDID]ODHWNLOHQPHOHULEXRUDQÕQ
ROXúPDVÕQGD HQ E\N HWNHQGLU21,22 .DQGLú YH
ark.14 \DSWÕNODUÕoDOÕúPDGD\XPXúDNGRNXWUDYPDVÕ
RUDQÕQÕHNVWUHPLWHWUDYPDVÕRUDQÕQÕ
RODUDNEXOPXúODUGÕU%HQ]HUúHNLOGH%LOJLQYHDUN.12
\DSWÕNODUÕ oDOÕúPDODUGD HNVWUHPLWH WUDYPDVÕQÕ \XPXúDN GRNX WUDYPDVÕQÕ RODUDN WHVSLW
HWPLúOHUGLU $NR÷OX YH DUN.19 WP \Dú JUXSODUÕQGD
\DSWÕNODUÕ oDOÕúPDGD KHP lokal hem de multipl
WUDYPDOÕ KDVWDODUGD HQ ID]OD \DUDODQDQ RUJDQÕQ
HNVWUHPLWHOHU ROGX÷XQX WHVSLW HWPLúOHUGLU %L]LP
oDOÕúPDPÕ]GD OLWHUDWUOH X\XPOX RODUDN HNVWUHPLWH
WUDYPDVÕEDú-ER\XQWUDYPDVÕYHPXOWLSO RUJDQ WUDYPDVÕ RUDQÕQGD WHVSLW HdilPLúWLU /RNDO WUDYPD YDNDODUÕ LQFHOHQGL÷LQGH HQ
ID]OD KDVWD VD\ÕVÕQÕQ ]HGHOHQPH EXUNXOPD oDUSma-oDUSÕúPD VRQXFX GHUPDEUD]\RQ VÕ\UÕN JLEL
EXOJXODUÕQ WRSODQGÕ÷Õ \XPXúDN GRNX WUDYPDVÕ
(%56,5) olGX÷X J|UOG %X WUDYPD\Õ ‘lik
oranla ekstremite traYPDODUÕ L]OHPHNWH\GL 0XOWLSO
travmalar içerisinde en fazla birliktelik gösteren
VLVWHP \LQH HNVWUHPLWH WUDYPDODUÕ ROXS HQ VÕN
HNVWUHPLWHEDú ER\XQ WUDYPDVÕ ELUOLNWHOL÷LúHNOLQGe
görülmekteydi (%44,2). dDOÕúPDPÕ]GDWUDYPDWLSL
ve etkilenen vücut bölgesiyle paralel olarak en
ID]OD\DWÕú\DSÕODQNOLQLNRUWRSHGLYHWUDYPDWRORML\di
%XQX VÕUDVÕ\OD EH\QL FHUUDKLVL NOLQL÷L
YH \R÷XQ EDNÕP QLWHVL WDNLS HWmekteydi.
6RQXo RODUDN \DúODQPD VUHFLQGH PH\GDQD
JHOHQ IL]\RORMLN YH PHWDEROLN GH÷LúLkler bireylerin
WUDYPDGDQ NHQGLOHULQL NRUX\DELOPH \HWHQH÷LQL
D]DOWPDNWDYHEXQHGHQOHJHULDWULNWUDYPDVD\ÕODUÕQGD DUWÕú J|]OHQPHNWHGLU dR÷X DGOL ROD\ÕQ ND]D
RODUDNELOGLULOPHVLQHUD÷PHQGúPHYDNDODUÕHQVÕN
J|UOHQWUDYPDWLSLROGX÷XQGDQIL]LNVHOLVWLVmar ve
LKPDOOHULQ RODELOHFH÷L J|] |QQGH EXOXQGXUXOPDOÕGÕU%XQHGHQOHWUDYPDQHGHQOHULQLRUWD\DNR\Dbilmek ve bunlara yönelik gerekli önlemleri alabilPHN LoLQ KHU YDND GLNNDWOL ELU úHNLOGH LUGHOHQPHOL
YHKDVWDND\ÕWODUÕoRNL\LWXWXOPDOÕGÕU
REFERANSLAR
1. Schwab CW, Kauder DR. Trauma in the geriatric patient. Arch Surg
1992;127(6):701-6.
2. Ma OJ, DeBehnke DJ. Geriatric trauma. in: Tintinalli J, Kelen GD,
Stapcznski JS, editors. 5th ed. Emergency Medicine, A comprehensive
Study Guide, New York: McGraw-Hill; 1999. p.1623-7.
3. Perdue PW, Watts DD, Kaufmann CR, Trask AL. Differences in
mortality between elderly and younger adult trauma patients: geriatric
status increases risk of delayed death. J Trauma 1998;45(4):805-10.
4. Levy DB, Hanlon DP, Townsend RN. Geriatric trauma. Clin Geriatr
Med 1993;9(3):601-20.
5. Miller KE, Zylstra RG, Standridge JB. The geriatric patient: a
systematic approach to maintaining health. Am Fam Physician 2002;61(4):
1089-104.
6. Baum SA, Rubenstein LZ. Old people in the emergency room: agerelated differences in emergency department use and care. J A Geriatr Soc
1987;35(5):398-404.
7. øNL]FHOL ø 6|]HU (0 %HGLUOL $ <ÕOGÕUÕP & *QD\ 1 <UPH] <
0XOWLWUDYPDOÕ KDVWDODUÕQ SURJQR]XQX EHOLUOHPHGH \Dú IDNW|U 8OXV 7UDYPD
Acil Cerrahi Derg 1999;5(1):40-2.
8. hQVDO $ dHYLN $$ 0HWLQWDúÕ 6 $UVODQWDúÕ ' øQDQ 2d <DúOÕ
KDVWDODUÕQDFLOVHUYLVHEDúYXUXODUÕ*HULDWUL-8.
9. Committee on Medical Aspects of Automotive Safety: rating the
severity of tissue damage. 1. The Abbreviated scale. J Am Med Assoc 1971;
215(1):277-80.
10. Eachempati SR, Reed RL 2nd, St Louis JE, Fischer RP. "The
Demographics of Trauma in 1995" Revisited: An Assessment of the
Accuracy and Utility of Trauma Predictions. J Trauma 1998;45(2):208-14.
11. Strange GR, Chen EH. Use of emergency departments by elder
patients: a five-year follow-up study. Acad Emerg Med 1998;5(12):115762.
104
12. Bilgin NG, 0HUW(*HULDWULN\DúJUXEXDGOÕ ROJXODUÕQ|]HOOLNOHUL7UN
Geriatri Dergisi 2005;8(1):13-6.
13. $NWDú & (UHQ 6+ (U\LOPD] 0 (IIHFWV RI FR-morbid disease and
drug consumption on trauma patients 65 years of age and older: a
university emergency department experience. Ulus Travma Acil Cerrahi
Derg 2008;14(4):313-7.
14. .DQGLú+.DUDNXú$.DWÕUFÕ<.DUDSRODW6.DUDø+*HULDWULN\Dú
grubu ve adli travmalar. Turkish Journal of Geriatrics 2011;14(3):93-8.
15. Goris RJA. The injury severity score. World J Surg 1983;7(1):12-8.
16. Committee on Medical Aspects of Automotive Safety: rating the
severity of tissue damage. 2. The Comprehensive scale. J Am Med Assoc
1972;220(1):717-20.
17. Boyd CR, Tolson MA, Copes WS. Evaluating trauma care: the
TRISS method. Truma Score and the Injury Severity Score. J Trauma
1987;27(4):370-8.
18. Champion HR, Copes WS, Sacco WJ, Frey CF, Holcroft JW, Hoyt
DB, et al. Improved predictions from a severity characterisation of trauma
(ASCOT) over Trauma and Injury Severity Score (TRISS):results of an
independent evaluation. J Trauma 1996;40(1):42-8.
19. $NR÷OX + 'HQL]EDúÕ $ hQOHU ( *QH\VHO g 2QXU g Marmara
üniversitesi hastanesi acil servisine EDúYXUDQ WUDYPD KDVWDODUÕQÕQ
demografik özellikleri. Marmara Medical Journal 2005;18(3);113-22.
20. Binder S. Injuries among older adults: the challenge of optimizing
safety and minimizing unintended consequences. Inj Prev 2002;8(4):2-4.
21. Ghodsi SM, Roudsari BS, Abdollahi M, Shadman M. Fall-related
injuries in the elderly in Tehran. Injury 2003;34(11):809-14.
22. Liberman M, Mulder DS, Sampalis JS. Increasing volume of
patients at level I trauma centers: Is there a need for triage modification in
elderly patients with injuries of low severity? Can J Surg 2003;46(6):44652.

Benzer belgeler

Detaylı Bilgi için tıklayınız.

Detaylı Bilgi için tıklayınız. NHQGLQL \HQLOHPHNWHGLU  %DNDQOÕ÷ÕPÕ] WDUDIÕQGDQ  \UWOHQ ³6D÷OÕNWD '|QúP 3URJUDPÕ´NDSVDPÕQGDGDKDYHULPOLYHQLWHOLNOLVD÷OÕNKL]PHWLQLVD÷ODPD\D\|QHOLN oDOÕúPDODU KÕ]OD LOHUOHUN...

Detaylı

Hastane Öncesi ACİL HASTA BAKIMI Cilt I

Hastane Öncesi ACİL HASTA BAKIMI Cilt I %XJQ\DúDGÕ÷ÕPÕ]ELOJLoD÷ÕQGDONHOHULGL÷HUOHULQGHQ|QSODQDoÕNDUDQ HQ|QHPOL|]HOOLNELOLPVHOELOJLUHWHELOPHNWLUhONHPL]GHELUoRNDODQGDROGX÷X JLEL  H÷LWLPLQH EDúODQDQ øON YH...

Detaylı

1. RİTİM ANALİZİ II. Ritim Hızı

1. RİTİM ANALİZİ II. Ritim Hızı øNL5-5GDOJDVÕ\DQLLNLYHQWULNOHU GHSRODUL]DV\RQ DUDVÕQGDNLE\NNDUH VD\ÕVÕEXOXQXUEXOXQDQUDNDPD E|OQHUHNNDOSDWÕPKÕ]ÕKHVDSODQÕU +HVDSODPDLoLQLNL5GDOJDVÕQÕQGDE\N oL]JL...

Detaylı