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Postoperative mortality following civilian firearms injury during war: A retrospective cohort study

Year 2019, Volume: 26 Issue: 2, 131 - 140, 01.06.2019
https://doi.org/10.17343/sdutfd.417891

Abstract



Background: This study aims to identify
factors affecting mortality following surgery for civilian firearms injuries using surgical classification as a surrogate
marker of injury severity
.



Methods: This was a retrospective study of patients who underwent surgery at a
tertiary university hospital in Turkey between 2011 and 2014. All patients had
sustained firearms injury and had an American Society of Anesthesiologists
score of I-II.
A grading system
defined by the Communiqué on Health Practices in Turkey
was used based on the surgery
type and anesthetic procedure to determine the severity of injury and its
relation with patient outcome (survival or death).



Results: The median duration of hospital stay of patients who were discharged post
healing was significantly longer than those who died [12 (0–559).vs 7.5 (0–468)
days, respectively].
Overall mortality
was 11.3%; however, the mortality of patients was 8.1
%,
40.3%, and 40.3% in groups A2, C, and D, respectively. Healing in groups A2, C,
and D was 2.4%, 54.1% and 25.8%, respectively.
Independent variables affecting the coefficient
of patient discharge status
for sex, age, and
surgical groups A2, C, and D were found to be significant.



Conclusion:
There
was an association between the
surgical groups and the
firearms injuries sustained by civilians. Moreover, the coefficients associated with
surgical group in our model may help predict the mortality risk in similar
populations.

References

  • 1. Baker SP, O'Neill B, Haddon Jr W, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma Acute Care Surg 1974;14:187-96.
  • 2. Haider AH, Chang DC, Haut ER, Cornwell EE, 3rd, Efron DT. Mechanism of injury predicts patient mortality and impairment after blunt trauma. J Surg Res 2009;153:138-42.
  • 3. Brown JB, Stassen NA, Bankey PE, Sangosanya AT, Cheng JD, Gestring ML. Mechanism of injury and special consideration criteria still matter: an evaluation of the National Trauma Triage Protocol. J Trauma Acute Care Surg 2011;70:38-44.
  • 4. Newgard CD, Zive D, Holmes JF, Bulger EM, Staudenmayer K, Liao M, et al. A multisite assessment of the American College of Surgeons Committee on Trauma field triage decision scheme for identifying seriously injured children and adults. J Am Coll Surg 2011;213:709-21.
  • 5. Pannell D, Poynter J, Wales PW, Tien H, Nathens AB, Shellington D. Factors affecting mortality of pediatric trauma patients encountered in Kandahar, Afghanistan. Can J Surg 2015;58:S141-5.
  • 6. Aldrich EF, Eisenberg HM, Saydjari C, Foulkes MA, Jane JA, Marshall LF, et al. Predictors of mortality in severely head-injured patients with civilian gunshot wounds: a report from the NIH Traumatic Coma Data Bank. Surg Neurol 1992;38:418-23.
  • 7. Ambrosi PB, Valença MM, Azevedo-Filho H. Prognostic factors in civilian gunshot wounds to the head: a series of 110 surgical patients and brief literature review. Neurosurg Rev 2012;35:429-43.
  • 8. Aarabi B, Tofighi B, Kufera JA, Hadley J, Ahn ES, Cooper C, et al. Predictors of outcome in civilian gunshot wounds to the head. J Neurosurg 2014;120:1138-46.
  • 9. Willis CD, Gabbe BJ, Jolley D, Harrison JE, Cameron PA. Predicting trauma patient mortality: ICD [or ICD-10-AM] versus AIS based approaches. ANZ J Surg 2010;80:802-6.
  • 10. Clark DE, Hannan EL, Wu C. Predicting risk-adjusted mortality for trauma patients: logistic versus multilevel logistic models. J Am Coll Surg 2010;211:224-31.
  • 11. Doornik JA, Hansen H. An omnibus test for univariate and multivariate normality. Oxf Bull Econ Stat 2008;70:927-39.
  • 12. Belmont PJ Jr, McCriskin BJ, Sieg RN, Burks R, Schoenfeld AJ. Combat wounds in Iraq and Afghanistan from 2005 to 2009. J Trauma Acute Care Surg 2012;73:3-12.
  • 13. Owens BD, Kragh JF Jr, Wenke JC, Macaitis J, Wade CE, Holcomb JB. Combat wounds in operation Iraqi Freedom and operation Enduring Freedom. J Trauma Acute Care Surg 2008;64:295-99.
  • 14. Kelly JF, Ritenour AE, McLaughlin DF, Bagg KA, Apodaca AN, Mallak CT, et al. Injury severity and causes of death from Operation Iraqi Freedom and Operation Enduring Freedom: 2003–2004 versus 2006. J Trauma Acute Care Surg 2008;64:S21-7.
  • 15. Davie G, Langley J, Samaranayaka A, Wetherspoon ME. Accuracy of injury coding under ICD-10-AM for New Zealand public hospital discharges. Inj Prev 2008;14:319-23.
  • 16. Stojadinovic A, Eberhardt J, Brown TS, Hawksworth JS, Gage F, Tadaki DK, et al. Development of a Bayesian model to estimate health care outcomes in the severely wounded. J Multidiscip Healthc 2010;3:125-35.
  • 17. DeCuypere M, Muhlbauer MS, Boop FA, Klimo P. Pediatric intracranial gunshot wounds: the Memphis experience. J Neurosurg Pediatr 2016;17:595-601.
  • 18. Vertrees A, Wakefield M, Pickett C, Greer L, Wilson A, Gillern S, et al. Outcomes of primary repair and primary anastomosis in war-related colon injuries. J Trauma Acute Care Surg 2009;66:1286-91.

Savaş sırasında sivil ateşli silah yaralanmalarını takiben ortaya çıkan mortalite: Retrospektif bir kohort araştırması

Year 2019, Volume: 26 Issue: 2, 131 - 140, 01.06.2019
https://doi.org/10.17343/sdutfd.417891

Abstract



Amaç: Bu çalışma savaş yaralanması nedeni ile ameliyat edilen hastalar
arasında, cerrahi grupların sınıflandırmasını yaralanma şiddetinin yerine
kullanarak, mortaliteyi etkileyen faktörleri tanımlamayı amaçlamaktadır.



Yöntem: Bu Türkiye’de bir üçüncü basamak üniversite hastanesinde 2011 ve
2014 yılları arasında ameliyata alınan hastalarda yapılan retrospektif bir
çalışmadır. Tüm hastalar ateşli silah yaralanması nedeni ile ameliyata alınmış
ve ASA skorları I–II idi. Yaralanmanın şiddetini ve hastanın son durumunu (sağ
kalım veya ölüm) saptamak için cerrahinin tipi ve bununla ilişkili anestezi
işlemine dayalı bir derecelendirme sistemi-Türkiye’de Sağlık Uygulamaları
Tebliğinde tanımlandığı şekli ile- kullanıldı.



İstatistiksel analiz sonuçları: Şifa ile taburcu
olanların hastane süreleri ölenlerden anlamlı dercede daha uzundu
[medyan
(min-maks.) olarak sırası ile 12 (0-559).ve 7.5(0-468) gün]. Hastalar altı kategorik cerrahi gruba (A2, A3, B,
C, D, ve E) dağılmıştı. Tüm mortalite %11.3 idi ancak A2, C, ve D gruplarında
hastaların sırası ile %8.1, %40.3 ve %40.3’ü, ve şifa-sağ kalım yine A2, C, D
grup hastalarda sırası ile %2.4, %54.1, %25.8 oranında idi. Hastanın son
durumunu etkileyen bağımsız değişkenlerin cinsiyet, yaş ve cerrahi gruplardan
A2, C ve D için katsayıları anlamlı idi.



Sonuç: Cerrahi
operasyon kategorileri ve sivil ateşli silah yaralanmaları arasında bir ilişki
olduğu gözükmektedir, Dahası, modelimizdeki cerrahi grupları ile ilişkili
katsayılar benzer populasyonlarda mortalite riskini tahmin etmeye yardımcı
olabilir.

References

  • 1. Baker SP, O'Neill B, Haddon Jr W, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma Acute Care Surg 1974;14:187-96.
  • 2. Haider AH, Chang DC, Haut ER, Cornwell EE, 3rd, Efron DT. Mechanism of injury predicts patient mortality and impairment after blunt trauma. J Surg Res 2009;153:138-42.
  • 3. Brown JB, Stassen NA, Bankey PE, Sangosanya AT, Cheng JD, Gestring ML. Mechanism of injury and special consideration criteria still matter: an evaluation of the National Trauma Triage Protocol. J Trauma Acute Care Surg 2011;70:38-44.
  • 4. Newgard CD, Zive D, Holmes JF, Bulger EM, Staudenmayer K, Liao M, et al. A multisite assessment of the American College of Surgeons Committee on Trauma field triage decision scheme for identifying seriously injured children and adults. J Am Coll Surg 2011;213:709-21.
  • 5. Pannell D, Poynter J, Wales PW, Tien H, Nathens AB, Shellington D. Factors affecting mortality of pediatric trauma patients encountered in Kandahar, Afghanistan. Can J Surg 2015;58:S141-5.
  • 6. Aldrich EF, Eisenberg HM, Saydjari C, Foulkes MA, Jane JA, Marshall LF, et al. Predictors of mortality in severely head-injured patients with civilian gunshot wounds: a report from the NIH Traumatic Coma Data Bank. Surg Neurol 1992;38:418-23.
  • 7. Ambrosi PB, Valença MM, Azevedo-Filho H. Prognostic factors in civilian gunshot wounds to the head: a series of 110 surgical patients and brief literature review. Neurosurg Rev 2012;35:429-43.
  • 8. Aarabi B, Tofighi B, Kufera JA, Hadley J, Ahn ES, Cooper C, et al. Predictors of outcome in civilian gunshot wounds to the head. J Neurosurg 2014;120:1138-46.
  • 9. Willis CD, Gabbe BJ, Jolley D, Harrison JE, Cameron PA. Predicting trauma patient mortality: ICD [or ICD-10-AM] versus AIS based approaches. ANZ J Surg 2010;80:802-6.
  • 10. Clark DE, Hannan EL, Wu C. Predicting risk-adjusted mortality for trauma patients: logistic versus multilevel logistic models. J Am Coll Surg 2010;211:224-31.
  • 11. Doornik JA, Hansen H. An omnibus test for univariate and multivariate normality. Oxf Bull Econ Stat 2008;70:927-39.
  • 12. Belmont PJ Jr, McCriskin BJ, Sieg RN, Burks R, Schoenfeld AJ. Combat wounds in Iraq and Afghanistan from 2005 to 2009. J Trauma Acute Care Surg 2012;73:3-12.
  • 13. Owens BD, Kragh JF Jr, Wenke JC, Macaitis J, Wade CE, Holcomb JB. Combat wounds in operation Iraqi Freedom and operation Enduring Freedom. J Trauma Acute Care Surg 2008;64:295-99.
  • 14. Kelly JF, Ritenour AE, McLaughlin DF, Bagg KA, Apodaca AN, Mallak CT, et al. Injury severity and causes of death from Operation Iraqi Freedom and Operation Enduring Freedom: 2003–2004 versus 2006. J Trauma Acute Care Surg 2008;64:S21-7.
  • 15. Davie G, Langley J, Samaranayaka A, Wetherspoon ME. Accuracy of injury coding under ICD-10-AM for New Zealand public hospital discharges. Inj Prev 2008;14:319-23.
  • 16. Stojadinovic A, Eberhardt J, Brown TS, Hawksworth JS, Gage F, Tadaki DK, et al. Development of a Bayesian model to estimate health care outcomes in the severely wounded. J Multidiscip Healthc 2010;3:125-35.
  • 17. DeCuypere M, Muhlbauer MS, Boop FA, Klimo P. Pediatric intracranial gunshot wounds: the Memphis experience. J Neurosurg Pediatr 2016;17:595-601.
  • 18. Vertrees A, Wakefield M, Pickett C, Greer L, Wilson A, Gillern S, et al. Outcomes of primary repair and primary anastomosis in war-related colon injuries. J Trauma Acute Care Surg 2009;66:1286-91.
There are 18 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Research Articles
Authors

Menekşe Okşar

Cagla Akkurt This is me

Selim Turhanoglu

Publication Date June 1, 2019
Submission Date April 23, 2018
Acceptance Date April 25, 2018
Published in Issue Year 2019 Volume: 26 Issue: 2

Cite

Vancouver Okşar M, Akkurt C, Turhanoglu S. Postoperative mortality following civilian firearms injury during war: A retrospective cohort study. Med J SDU. 2019;26(2):131-40.

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