Öz
Aim: As the world's elderly population has increased, so has the incidence of associated disorders. Agerelated physiological changes both predispose the elderly to trauma and exacerbate the consequences
of trauma. In our study, we aimed to determine the factors influencing the prognosis of geriatric patients
who underwent surgery or were hospitalised for head trauma.
Materials and Methods: Geriatric patients treated for head trauma in the neurosurgery department of
of the hospital between 2012 and 2023 were included in the study.
A total of 107 geriatric patients with head trauma treated by the same surgical team were
retrospectively evaluated. Factors influencing the prognosis of 70 patients who underwent surgery and
37 patients who received only hospitalization and medical treatment were investigated. Demographic
data, medical history, physical examination findings, radiological data, treatment modalities, causes of
morbidity and mortality were evaluated,
Results: The mortality rate was 20.5% in male patients and 32.4% in female patients. The final variables
that had an effect on mortality were: thickness of hemorrhage on cranial computed tomography
(CT), bleeding diathesis, haemodialysis, chronic subdural haematoma and length of stay in intensive
care unit stay.
Conclusion: Mortality risk in geriatric patients were 7.654-fold in patients with a haematoma thickness
of more than 10 mm on cranial CT, 11.825-fold in patients with bleeding diathesis, 6.847-fold in patients
receiving hemodialysis and 4.606-fold in patients without chronic subdural hematoma. As the duration
of intensive care unit stay increases by one day, the mortality risk increases 1.052 times. The results of
the study may help us to predict the prognosis in geriatric head trauma.
Anahtar Kelimeler
Kaynakça
- TC İçişleri Bakanlığı Nüfus ve Vatandaşlık İşleri Genel Müdürlüğü. Türkiye İstatistik Kurumu Haber Bülteni; 2023. Available from: https://data.tuik.gov.tr/Bulten/Index?p=Adrese-Dayalı-Nüfus-Kayıt-Sistemi-Sonuçları
- Fidan S, Çelik G, Özhasenekler A, Şener A ve ark. Geriatrik Travma Hastalarında Revize Travma Skorunun Değerlendirilmesi. Ankara Medical Journal 2020;20(3): 578-87.
- Ghodsi SM, Roudsari BS, Abdollahi M, Shadman M. Fall-related injuries in the elderly in Tehran. Injury 2003;34(11):809-14.
- Faul M, Xu L, Wald MM, Coronado VG. Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations and Deaths 2002-2006. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2010. Available from:https://stacks.cdc.gov/view/cdc/5571
- Mirzai H, Yağli N, Tekin I. Celal Bayar Universitesi Tip Fakültesi acil birimine başvuran kafa travmali olgularin epidemiyolojik ve klinik özellikleri [Epidemiologic and clinical features of cases applying to Celal Bayar University emergency unit with head trauma]. Ulus Travma Acil Cerrahi Derg 2005;11(2):146-52.
- Tieves KS, Yang H, Layde PM. The epidemiology of traumatic brain injury in Wisconsin, 2001. WMJ 2005;104(2):22-5.
- Yu WY, Hwang HF, Hu MH, Chen CY, Lin MR. Effects of fall injury type and discharge placement on mortality, hospitalization, falls, and ADL changes among older people in Taiwan. Accid Anal Prev 2013;50;887-94.
- Tanrıverdi T, Engin T. Yoğun Bakım Ünitesinde Takip Edilen Kafa Travmalı Hastaların Geriye Dönük Olarak Değerlendirilmesi ve Risk Skorlarının Prognoza Etkisi. Harran Üniversitesi Tıp Fakültesi Dergisi 2021;18(3): 417-23.
- Yousefzadeh-Chabok S, Hosseinpour M, Kouchakinejad-Eramsadati L, et al. Comparison of Revised Trauma Score, Injury Severity Score and Trauma and Injury Severity Score for mortality prediction in elderly trauma patients. Ulus Travma Acil Cerrahi Derg 2016;22(6):536-40.
- Orhon R, Eren SH, Karadayı S, et al. Comparison of trauma scores for predicting mortality and morbidity on trauma patients. Ulus Travma Acil Cerrahi Derg 2014;20(4):258-64.
- Javali RH, Krishnamoorthy, Patil A, Srinivasarangan M, Suraj, Sriharsha. Comparison of Injury Severity Score, New Injury Severity Score, Revised Trauma Score and Trauma and Injury Severity Score for Mortality Prediction in Elderly Trauma Patients. Indian J Crit Care Med 2019;23(2):73-7.
- Yee G, Jain A. Geriatric Head Injury. [Updated 2023 Jan 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553101/
- Sterling DA, O'Connor JA, Bonadies J. Geriatric falls: injury severity is high and disproportionate to mechanism. J Trauma 2001;50(1):116-9.
- Thompson HJ, McCormick WC, Kagan SH. Traumatic brain injury in older adults: epidemiology, outcomes, and future implications. J Am Geriatr Soc 2006;54(10):1590-5.
- Taylor MD, Tracy JK, Meyer W, Pasquale M, Napolitano LM. Trauma in the elderly: intensive care unit resource use and outcome. J Trauma 2002 Sep;53(3):407-14.
- Pandya S, Le T, Demissie S, Zaky A, Arjmand S, Patel N, Moko L, Garces J, Rivera P, Singer K, Fedoriv I, Garcia Z, Kennedy J, Makkapati B, Mukherjee I, Szerszen A, Gross J, Glinik G, Younan D. The Association of Gender and Mortality in Geriatric Trauma Patients. Healthcare (Basel) 2022;10(8):1472-8
- Lavoie A, Ratte S, Clas D, Demers J, Moore L, Martin M, Bergeron E. Preinjury warfarin use among elderly patients with closed head injuries in a trauma center. J Trauma 2004;56(4):802-7.
- Gannon CJ, Pasquale M, Tracy JK, McCarter RJ, Napolitano LM. Male gender is associated with increased risk for postinjury pneumonia. Shock 2004;21(5):410-4.
- Brandi G, Gambon-Mair A, Berther LS, Bögli SY, Unseld S. Sex-related differences in extracranial complications in patients with traumatic brain injury. Front Neurol 2023;6(14):1095009.
- Stiell IG, Wells GA, Vandemheen K, et al. The Canadian CT Head Rule for patients with minör head injury. Lancet 2001;357(9266):139-6.
- Yanaka K, Kamezaki T, Yamada T, Takano S, Meguro K, Nose T. Acute subdural hematoma-- prediction of outcome with a linear discriminant function. Neurol Med Chir (Tokyo) 1993;33(8):552-8.
- Servadei F. Prognostic factors in severely head injured adult patients with acute subdural haematoma's. Acta Neurochir (Wien) 1997;139(4):279-85.
- Kotwica Z, Brzeziński J. Acute subdural haematoma in adults: an analysis of outcome in comatose patients. Acta Neurochir (Wien) 1993;121(3-4):95-9.
- Macpherson BC, MacPherson P, Jennett B. CT evidence of intracranial contusion and haematoma in relation to the presence, site and type of skull fracture. Clin Radiol 1990;42(5):321-6.
- Yokobori S, Saito K, Sasaki K, et al. Treatment of Geriatric Traumatic Brain Injury: A Nationwide Cohort Study. J Nippon Med Sch 2021;88(3):194-203.
- Wasfie T, Ho T, Shapiro B. Acute Traumatic Epidural Hematoma in the Elderly: A Community Hospital Experience. Am Surg 2022;88(6):1328-9.
- Thomas KE, Stevens JA, Sarmiento K, Wald MM. Fall-related traumatic brain injury deaths and hospitalizations among older adults--United States, 2005. J Safety Res 2008;39(3):269-72.
Kafa travması nedeniyle hospitalize edilen geriatrik hastalarda prognozu etkileyen faktörlerin incelenmesi
Öz
Amaç: Dünyada yaşlı nüfusun artması ile birlikte buna bağlı hastalıklar da artmıştır. Yaşlılığa bağlı
fizyolojik değişiklikler hem yaşlıları travmaya açık hale getirmekte hem de travma sonuçlarını
ağırlaştırmaktadır. Araştırmamızda kafa travması nedeniyle opere edilen veya hospitalize edilerek takip
edilen geriatrik hastalarda, hangi faktörlerin prognoz üzerinde etkili olduğunun ortaya konulması
amaçlanmıştır.
Gereç ve Yöntem: Hastanemiz beyin cerrahi kliniğinde 2012-2023 yılları arasında kafa travması
nedeniyle tedavi edilen geriatrik hastalar çalışmaya dahil edildi. Aynı cerrahi ekip tarafından tedavi edilen
107 kafa travmalı geriatrik hasta retrospektif olarak değerlendirildi. Opere edilerek tedavi gören 70
hasta ve sadece hospitalize edilerek tıbbi tedavi alan 37 hastanın prognozlarını etkileyen faktörler
araştırıldı. Hastaların demografik verileri, anamnezleri, fizik muayene bulguları, radyolojik verileri,
tedavi şekilleri morbidite ve mortalite nedenleri, değerlendirildi.
Bulgular: Erkek hastaların %20,5’i ve kadın hastaların %32,4’ü kaybedilmiştir. Mortalite üzerine etkili
olan nihai değişkenler kraniyal bilgisayarlı tomografide (BT) hematom kalınlığı, kanama diyatezi,
hemodiyaliz, kronik subdural hematom ve yoğun bakım yatış süresi olarak elde edildi.
Sonuç: Geriatrik hastalarda mortalite riski: kraniyal BT’de hematom kalınlığı 10 mm’den fazla olan
hastalarda 7,654 kat, kanama diyatezi olan hastalarda 11,825 kat, hemodiyaliz alan hastalarda 6,847
kat ve kronik subdural hematom olmayan hastalarda 4,606 kat artmaktadır. Yoğun bakım yatış süresi
bir gün arttıkça mortalite riski 1,052 kat artmaktadır. Araştırmanın sonuçları geriatrik kafa travmalarında
prognozu tahmin etmemizde yardımcı olabilir.
Anahtar Kelimeler
Kaynakça
- TC İçişleri Bakanlığı Nüfus ve Vatandaşlık İşleri Genel Müdürlüğü. Türkiye İstatistik Kurumu Haber Bülteni; 2023. Available from: https://data.tuik.gov.tr/Bulten/Index?p=Adrese-Dayalı-Nüfus-Kayıt-Sistemi-Sonuçları
- Fidan S, Çelik G, Özhasenekler A, Şener A ve ark. Geriatrik Travma Hastalarında Revize Travma Skorunun Değerlendirilmesi. Ankara Medical Journal 2020;20(3): 578-87.
- Ghodsi SM, Roudsari BS, Abdollahi M, Shadman M. Fall-related injuries in the elderly in Tehran. Injury 2003;34(11):809-14.
- Faul M, Xu L, Wald MM, Coronado VG. Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations and Deaths 2002-2006. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2010. Available from:https://stacks.cdc.gov/view/cdc/5571
- Mirzai H, Yağli N, Tekin I. Celal Bayar Universitesi Tip Fakültesi acil birimine başvuran kafa travmali olgularin epidemiyolojik ve klinik özellikleri [Epidemiologic and clinical features of cases applying to Celal Bayar University emergency unit with head trauma]. Ulus Travma Acil Cerrahi Derg 2005;11(2):146-52.
- Tieves KS, Yang H, Layde PM. The epidemiology of traumatic brain injury in Wisconsin, 2001. WMJ 2005;104(2):22-5.
- Yu WY, Hwang HF, Hu MH, Chen CY, Lin MR. Effects of fall injury type and discharge placement on mortality, hospitalization, falls, and ADL changes among older people in Taiwan. Accid Anal Prev 2013;50;887-94.
- Tanrıverdi T, Engin T. Yoğun Bakım Ünitesinde Takip Edilen Kafa Travmalı Hastaların Geriye Dönük Olarak Değerlendirilmesi ve Risk Skorlarının Prognoza Etkisi. Harran Üniversitesi Tıp Fakültesi Dergisi 2021;18(3): 417-23.
- Yousefzadeh-Chabok S, Hosseinpour M, Kouchakinejad-Eramsadati L, et al. Comparison of Revised Trauma Score, Injury Severity Score and Trauma and Injury Severity Score for mortality prediction in elderly trauma patients. Ulus Travma Acil Cerrahi Derg 2016;22(6):536-40.
- Orhon R, Eren SH, Karadayı S, et al. Comparison of trauma scores for predicting mortality and morbidity on trauma patients. Ulus Travma Acil Cerrahi Derg 2014;20(4):258-64.
- Javali RH, Krishnamoorthy, Patil A, Srinivasarangan M, Suraj, Sriharsha. Comparison of Injury Severity Score, New Injury Severity Score, Revised Trauma Score and Trauma and Injury Severity Score for Mortality Prediction in Elderly Trauma Patients. Indian J Crit Care Med 2019;23(2):73-7.
- Yee G, Jain A. Geriatric Head Injury. [Updated 2023 Jan 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553101/
- Sterling DA, O'Connor JA, Bonadies J. Geriatric falls: injury severity is high and disproportionate to mechanism. J Trauma 2001;50(1):116-9.
- Thompson HJ, McCormick WC, Kagan SH. Traumatic brain injury in older adults: epidemiology, outcomes, and future implications. J Am Geriatr Soc 2006;54(10):1590-5.
- Taylor MD, Tracy JK, Meyer W, Pasquale M, Napolitano LM. Trauma in the elderly: intensive care unit resource use and outcome. J Trauma 2002 Sep;53(3):407-14.
- Pandya S, Le T, Demissie S, Zaky A, Arjmand S, Patel N, Moko L, Garces J, Rivera P, Singer K, Fedoriv I, Garcia Z, Kennedy J, Makkapati B, Mukherjee I, Szerszen A, Gross J, Glinik G, Younan D. The Association of Gender and Mortality in Geriatric Trauma Patients. Healthcare (Basel) 2022;10(8):1472-8
- Lavoie A, Ratte S, Clas D, Demers J, Moore L, Martin M, Bergeron E. Preinjury warfarin use among elderly patients with closed head injuries in a trauma center. J Trauma 2004;56(4):802-7.
- Gannon CJ, Pasquale M, Tracy JK, McCarter RJ, Napolitano LM. Male gender is associated with increased risk for postinjury pneumonia. Shock 2004;21(5):410-4.
- Brandi G, Gambon-Mair A, Berther LS, Bögli SY, Unseld S. Sex-related differences in extracranial complications in patients with traumatic brain injury. Front Neurol 2023;6(14):1095009.
- Stiell IG, Wells GA, Vandemheen K, et al. The Canadian CT Head Rule for patients with minör head injury. Lancet 2001;357(9266):139-6.
- Yanaka K, Kamezaki T, Yamada T, Takano S, Meguro K, Nose T. Acute subdural hematoma-- prediction of outcome with a linear discriminant function. Neurol Med Chir (Tokyo) 1993;33(8):552-8.
- Servadei F. Prognostic factors in severely head injured adult patients with acute subdural haematoma's. Acta Neurochir (Wien) 1997;139(4):279-85.
- Kotwica Z, Brzeziński J. Acute subdural haematoma in adults: an analysis of outcome in comatose patients. Acta Neurochir (Wien) 1993;121(3-4):95-9.
- Macpherson BC, MacPherson P, Jennett B. CT evidence of intracranial contusion and haematoma in relation to the presence, site and type of skull fracture. Clin Radiol 1990;42(5):321-6.
- Yokobori S, Saito K, Sasaki K, et al. Treatment of Geriatric Traumatic Brain Injury: A Nationwide Cohort Study. J Nippon Med Sch 2021;88(3):194-203.
- Wasfie T, Ho T, Shapiro B. Acute Traumatic Epidural Hematoma in the Elderly: A Community Hospital Experience. Am Surg 2022;88(6):1328-9.
- Thomas KE, Stevens JA, Sarmiento K, Wald MM. Fall-related traumatic brain injury deaths and hospitalizations among older adults--United States, 2005. J Safety Res 2008;39(3):269-72.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Beyin ve Sinir Cerrahisi (Nöroşirurji) |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 18 Eylül 2023 |
| Gönderilme Tarihi | 18 Haziran 2023 |
| Yayımlandığı Sayı | Yıl 2023Cilt: 62 Sayı: 3 |
