Riskli Travma Nedeniyle Çocuk Acil Servisine Başvuran Hastaların Klinik, Laboratuvar ve Görüntüleme Bulgularının Değerlendirilmesi

Abstract

Trauma is an injury of human tissues and organs via energy transfer from environmental factors. The morbidity and mortality of trauma, incidence of which is greater than other major diseases, makes it an essential public health problem, especially in childhood and adolescence periods. The aim of this study is to evaluate, compare and classify clinical signs, laboratory test results and imaging modalities of risky trauma patients, who were under the risk of multisystemic trauma, during their observation in the Pediatric Emergency Department (PED). In this study, between January 2010 and September 2013, the clinical signs, laboratory test results and imaging modalities of 302 patients admitted to PED were compared and evaluated retrospectively. Pediatric risky trauma patients, to whom trauma codes of V1-99 and W1-51 were attributed according to ICD-10 International Statistical Classification of Diseases and Related Health Problems, were included for this study. It was found that the most frequent trauma mechanism was motor vehicle collision (32.5% of the study population) when the patients were pedesterians, bicycle riders or motorbike riders, and males (60%) were affected more than females. Whereas motor vehicle collisions were detected as the most frequent mechanism amongst all pediatric age groups, falls were seen more frequently amongst children aged one year or fewer and those aged between one and five, and assaults were found to be more common amongst children aged more than 12 (p<0.05). The most affected anatomical regions, whose physical signs were determined during detailed examinations were found as extremities (%49.7) and scalp (%42.1). After laboratory tests and imaging modalities resulted, definite diagnosis of trauma patterns was made. The ratios of the definite patterns of injury were as follows: 16.6% (50/302) had no injury pattern, 7% (21/302) had multiple trauma, 50.7% (153/302) had soft tissue trauma, 11.9% (36/302) end up with isolated extremity trauma, 7.6% (23/302) had isolated cranial trauma, 4% (12/302) had isolated face (maksillofacial, ocular, oral) trauma, 1.7% (5/302) was found as isolated vertebral trauma, 0.7% (2/302) had isolated abdominal trauma. The most frequent components of multiple trauma were cranial trauma and extremity injury. When patterns of injury were compared, it was understood that GCS was calculated lower in the patterns of multiple trauma and cranial injury compared to other trauma patterns (p<0.05). In addition, PTS was detected as lower in the patterns of multiple trauma and extremity injury compared to other patterns (p<0.05). 98.7% of the patients underwent any of the radiological imaging modalities. It was determined that the most frequent type of computed tomography (CT) was cranial CT (39.4%), 17.6% (21/119) of these cranial CTs resulted in traumatic brain injury, yet 66.6% of these brain injury cases (14/21) recovered without a definite neurological sequela. Five patients whose Abdominal CTs showed liver and spleen lacerations, did not need any abdominal operation during their clinical recovery. However, diaphragmatic laceration of one patient was repaired under general anesthesia. When we examined thoracic injury cases detected by thoracic CT, ten patients recovered without needing any thoracic operation, but pediatric surgeons performed chest tube insertions on three patients depending on pneumothorax or pleural effusion. 93% of cases needed one of the laboratory tests. The ratio of leukocytosis was found higher in the patients who had definite diagnosis of a trauma pattern, compared to the patients having no injury pattern (p<0.05). The frequencies of hematuria and elevated liver enzyme tests in isolated abdominal injury and multiple trauma patterns were higher compared to no injury pattern (p<0.05). Only three patients died at the end of their observation in the hospital, 14 patients (4.6%) were discharged from hospital with a sequela and their sequelae became permanent during their follow-up. Eight of the sequelae were due to Central Nervous System injury. It as also found that motor vehicle collision mechanism (when the patients were passengers or bike riders) caused sequelae more frequently than other trauma mechanisms (p>0.05). In conclusion, risky trauma mechanism is one of the important factors which determines pattern of injury in children and while evaluating pediatric trauma patients in PED, it is essential to consider the risk of trauma mechanism in combination with examination findings, laboratory tests and imaging modalities.