Analysis of the necessity of routine tests in trauma patients in the emergency department.

BACKGROUND: The necessity of routine tests as regarded in the Advanced Trauma Life Support protocols has become controversial in recent years. The aim of this study was to analyze the necessity of routine tests in trauma patients. METHODS: This was a prospective study. A total of 103 blunt trauma patients aged between 15 and 65 years who presented to the emergency department with major trauma, Glasgow Coma Scale of 15 and Revised Trauma Score of 12 were admitted to the study. RESULTS: The average age of the patients (30.1% female, 69.9% male) was 35±12.97 years. A total of 72.8% of the patients presented for motor vehicle crashes, 12.6% for pedestrian injury and 14.6% for fall from a height. All of the routine tests were evaluated separately. With the exception of cervical examination-lateral cervical X-ray results and pelvic examination-complete blood count and urinalysis test results, significant relations were determined between the reason for requiring a test and the results of the other tests (complete blood count, lateral cervical X-ray and abdominal ultrasonography). CONCLUSION: According to our study, biochemical tests, anterior-posterior chest X-ray and anterior-posterior pelvic X-ray can be ordered as targeted tests. Conducting targeted tests will reduce costs and workload.

Factors affecting mortality in patients with thorax trauma.

BACKGROUND: The purpose of this study was to define the epidemiologic properties and correlation of physiological and anatomical risk factors with the mortality rate among patients with thorax trauma and to ensure early prediction of severe trauma. METHODS: Files of 371 cases were retrospectively examined. Their initial state in the emergency department was analyzed in terms of mortality development. Age, gender, trauma mechanism, systolic blood pressure and respiration type on admission, accompanying injuries, thorax pathology, trauma scores, and treatment approaches in exitus and surviving cases were compared. Survival probabilities and unexpected mortality rates were computed using the Trauma Revised Score-Injury Severity Score (TRISS). RESULTS: Age, hypotension, pathologic respiration, blunt injury, accompanying injury, abdominal trauma, high Injury Severity Score (ISS), and low Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), and TRISS were the factors affecting mortality, and presence of blunt injuries, TRISS <85, ISS >22 and GCS <13 were found to be independent prognostic factors. The strongest factor indicating mortality was TRISS. Thirty-four of 307 cases with survival probability of over 50% died. CONCLUSION: In the presence of factors affecting mortality, patients with thorax trauma should be evaluated as being in a high-risk group and treatment strategies must be aggressive. Case analysis based on the TRISS model would further reveal the mistakes and may improve patient care.

Trauma in the elderly patients in Bursa.

BACKGROUND: The aim of this study was to determine the epidemiology and clinical features of the trauma in elderly patients, to investigate the factors influencing mortality and morbidity and to make a contribution to the national trauma data. METHODS: We retrospectively investigated the medical records of three hundred seventy-one trauma patients (231 males (62,3%); 140 females (37,7%); mean age 71,9), aged 65 and older presenting to our hospital. Patients' census data, diagnosis, dispositions, prognosis, trauma scores (GCS (Glasgow Coma Score), RTS (Adult Trauma Score), ISS (Injury Severity Score)), sites of injury were analyzed. RESULTS: During the study period 187.326 patients were admitted to our emergency department (ED). A total of 9.520 patients were trauma patients. There were 371 patients 65 years and older. Mean GCS, mean RTS and mean ISS were 13,6, 11,3, and 9,3 respectively. A total of 213 patients were hospitalized. Mean length of stay was 7,9 days. Sixty-six patients were discharged from the ED. Mortality rate was 10,2% (38/371). The mechanism of injury, injury severity, increasing age were predictors of mortality (p<0.001). Major injuries included head trauma (36,4%), extremity trauma (36,4%), and thoracic trauma (18%). Head trauma and abdominal trauma were significantly more frequent in the nonsurvivors (p<0.001 and p=0.02 respectively). CONCLUSION: Injury severity and increasing age were the predictors of mortality. Also pedestrian- vehicle collision patients were high mortality rate than the other trauma mechanisms. The most common injured organs were head and extremities.