Öz
Amaç: Acil servislerde özellikle motorlu araç kazalarına bağlı sternum kırıkları görülmekte ve tüm vücut bilgisayarlı tomografisinin yaygın biçimde kullanılmasına paralel olarak saptanma oranları da artış göstermektedir. İzole sternum kırığı olan hastaların acil servisten taburculuğu konusunda net bir öneri bulunmamaktadır. Biz bu çalışma ile acil serviste saptanan sternum kırıklarında, kırık tipi ile yaralanma ciddiyeti arasındaki ilişkiyi ve erken taburculuk kararını etkileyen faktörleri incelemeyi amaçladık.
Gereç ve Yöntem: Travma nedeniyle 2014-2019 yılları arasında acil servise başvuran hastalar retrospektif olarak analiz edildi. Çalışmaya dahil edilen, toraks bilgisayarlı tomografisinde sternum kırığı tespit edilen 18 yaş üstü travma hastalarının demografik özellikleri ile travma mekanizmaları, ek yaralanmaları, travma ciddiyet skorları, sternum kırık yeri ve deplasman durumu, ekokardiyografi bulguları, troponin I değerleri, elektrokardiyografi bulguları, acil servis ve hastanede kalış süreleri, 30 günlük mortaliteleri değerlendirildi.
Bulgular: Beş yıllık süreç içinde sternum kırığı tespit edilen 184 hastanın, %75,5’i (n:139) erkek, yaş ortalaması 49.9 ± 16.6 yıldı. Travma mekanizmaları incelendiğinde en sık (%63,5; n=117) motorlu taşıt kazaları, sonucu olduğu saptandı. En sık eşlik eden yaralanmalar kaburga (%56,5; n=104) ve omurga kırıkları (%44; n=81) idi. Sternum kırıklarının, %73,9’unun (n=136) korpusta yerleşim gösterdiği ve %63’ünün (n=116) non-deplase olduğu tespit edildi. Hastaların %33'ünün (n = 61) acil servisten taburcu edildiği, ortalama acil serviste kalış süresinin 28,3 ± 24,3 saat, ortalama toplam yatış süresinin 9,8 ± 20,1 gün olduğu belirlendi. Hastaların taburculuk süresi ile travma ciddiyet skorları ve troponin I değerleri arasında anlamlı bir ilişki vardı.
Sonuç: Yüksek travma ciddiyet skoru (>15) ile başvuran ve manubrium sterni kırığı olan hastalarda hayatı tehdit eden ek yaralanmalar ile daha sık karşılaşılabileceği unutulmamalıdır. Sternum kırıklarında travma ciddiyet skoru düşük (≤15) olan hastalarda, ekokardiyografi, troponin I, elektrokardiyografi ve monitörize olarak izlemin yapıldığı takipte anormal bulgu tespit edilmeyen hastaların acil servisten erken taburculuğu düşünülebilir.
Anahtar Kelimeler
Kaynakça
- Oyetunji TA, Jackson HT, Obirieze AC, et al. Associated injuries in traumatic sternal fractures: a review of the National Trauma Data bank. Am Surg, 2013; 79: 702-5.
- Yeh DD, Hwabejire JO, DeMoya MA, et al. Sternal fracture—an analysis of the National Trauma Data Bank. Journal of Surgical Research 2014; 186 (1): 39-43.
- L Heidelberg, R Uhlich, P Bosarge, et al. The Depth of Sternal Fracture Displacement Is Not Associated With Blunt Cardiac Injury. Journal of Surgical Research 2019; 235: 322-8.
- Demetriades D, Martin M, Salim A, et al. Relationship between American College of Surgeons trauma center designation and mortality in patients with severe trauma (injury severity score > 15).Journal of the American College of Surgeons 2006; 202 (2): 212-5.
- Scheyerer MJ, Zimmermann SM, Bouaicha S, et al. Location of sternal fractures as a possible marker for associated injuries. Emergency medicine international 2013 (2013).
- Von Garrel T, Ince A, Junge A, et al. The sternal fracture: radiographic analysis of 200 fractures with special reference to concomitant injuries. Journal of Trauma and Acute Care Surgery 2004; 57 (4): 837-44.
- Uluşan A, and Karakurt Ö. Cardiac findings of sternal fractures due to thoracic trauma: A five-year retrospective study. Turkish Journal of Trauma and Emergency Surgery 2018; 24 (3): 249-54.
- Skinner DL, Laing GL, Rodseth RN, et al. Blunt cardiac injury in critically ill trauma patients: a single centre experience. Injury 2015; 46: 66-70.
- Clancy K, Velopulos C, Bilaniuk JW, et al. Screening for blunt cardiac injury: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg 2012; 73: 301-6.
Öz
Aim: Sternal fractures, especially those due to motor vehicle accidents, are encountered in emergency department. There are no clear recommendations on discharge of patients with isolated sternal fractures from the emergency department. In this study, we aimed to examine the relationship between fracture type and severity of injury as well as factors affecting the decision of early discharge in case of sternal fractures detected in the emergency department.
Materials and Methods: Patients who presented to the emergency department with trauma between 2014 and 2019 were retrospectively analyzed. Demographic characteristics, trauma mechanisms, additional injuries, injury severity scores, location of sternal fracture and displacement status, echocardiography findings, troponin I values, electrocardiography findings, duration of emergency department and hospital stay, and 30- day mortality of trauma patients aged above over 18 years with sternal fractures on thorax computed tomography included in the study were evaluated.
Results: The mean age of 184 patients who were diagnosed with sternal fractures during the 5-year period was 49.9 ± 16.6 years, and 75.5% (n=139) of them were males. On examining the mechanisms of trauma, we found that the most common cause (63.5%; n=117) was motor vehicle accidents. The most common concomitant injuries were rib fractures (56.5%; n=104) and spinal fractures (44%; n=81). It was found that 73.9% (n=136) of sternal fractures were localized in the corpus and 63% (n=116) were non-displaced. It was determined that 33% (n = 61) of the patients were discharged from the emergency department, the mean duration of emergency department stay was 28.3 ± 24.3 hours, and the mean total hospitalization time was 9.8 ± 20.1 days. There was a significant relationship between the time to discharge with injury severity scores (ISS) and troponin I values of the patients.
Conclusion: It should be noted that additional life-threatening injuries may be encountered more often in patients presenting with a high injury severity score (>15) and with a manubrium sterni fracture. In sternal fractures, early discharge from the emergency department can be considered in patients with a low injury severity scores (≤15) in whom no abnormal findings are detected in a follow-up performed with echocardiography, troponin I, electrocardiography, and constant monitoring.
Anahtar Kelimeler
Teşekkür
We thank, Turgay Yılmaz Kılıç (Izmir University of Health Sciences Tepecik Training And Research Hospital Ministry of Health) and Gülden Hakverdi (Faculty of Medicine Department of Biostatistics and Medical Informatics).
Kaynakça
- Oyetunji TA, Jackson HT, Obirieze AC, et al. Associated injuries in traumatic sternal fractures: a review of the National Trauma Data bank. Am Surg, 2013; 79: 702-5.
- Yeh DD, Hwabejire JO, DeMoya MA, et al. Sternal fracture—an analysis of the National Trauma Data Bank. Journal of Surgical Research 2014; 186 (1): 39-43.
- L Heidelberg, R Uhlich, P Bosarge, et al. The Depth of Sternal Fracture Displacement Is Not Associated With Blunt Cardiac Injury. Journal of Surgical Research 2019; 235: 322-8.
- Demetriades D, Martin M, Salim A, et al. Relationship between American College of Surgeons trauma center designation and mortality in patients with severe trauma (injury severity score > 15).Journal of the American College of Surgeons 2006; 202 (2): 212-5.
- Scheyerer MJ, Zimmermann SM, Bouaicha S, et al. Location of sternal fractures as a possible marker for associated injuries. Emergency medicine international 2013 (2013).
- Von Garrel T, Ince A, Junge A, et al. The sternal fracture: radiographic analysis of 200 fractures with special reference to concomitant injuries. Journal of Trauma and Acute Care Surgery 2004; 57 (4): 837-44.
- Uluşan A, and Karakurt Ö. Cardiac findings of sternal fractures due to thoracic trauma: A five-year retrospective study. Turkish Journal of Trauma and Emergency Surgery 2018; 24 (3): 249-54.
- Skinner DL, Laing GL, Rodseth RN, et al. Blunt cardiac injury in critically ill trauma patients: a single centre experience. Injury 2015; 46: 66-70.
- Clancy K, Velopulos C, Bilaniuk JW, et al. Screening for blunt cardiac injury: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg 2012; 73: 301-6.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 31 Mart 2021 |
| Gönderilme Tarihi | 23 Ekim 2020 |
| Yayımlandığı Sayı | Yıl 2021 |