Traktör kazalarına bağlı yaralanmaların analizi
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Tarih
2023
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Kırıkkale Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş ve amaç: Traktör kazaları, tüm trafik kazalarının çok küçük bir kısmını oluşturmaktadır. Traktörler, tarımsal faaliyetlerin yanı sıra yük ve yolcu taşımacılığı içinde kullanıldığından; özellikle tarımsal faaliyetlerin yoğun olarak yürütüldüğü bölgelerde çok sayıda kazazede ile karşılaşılmaktadır. Bu çalışmada, traktör kazası nedeniyle Acil servise başvuran hastalar incelenmiş ve elde edilen verilerle traktör kazalarının genel karakteristiği hakkında bilgi edinmek amaçlanmıştır. Gereç ve yöntem: Çalışma 01. Ocak. 2012 - 01.Eylül. 2021 yılları arasında Kırıkkale Üniversitesi Tıp Fakültesi Hastanesi Acil servisine traktör kazası nedeniyle başvuran hastalar üzerinde retrospektif olarak yapıldı. Hasta kayıtlarına arşiv verilerinden ve bilgi işlem otomasyon sisteminden ulaşıldı. Hastaların demografik verileri, kazanın oluş zamanı, kazanın oluş mekanizması, kaza anında traktörde oturduğu konum, vücut yaralanma bölgeleri, travma skorları (GKS, Glasgow Koma Skoru; ISS, Injury Severity Score; RTS, Revize Travma Skoru; ve PTS, Pediatrik Travma Skoru), laboratuvar sonuçları, radyografi bulguları, bilgisayarlı tomografi sonuçları ve klinik sağkalım durumları kaydedildi. Verilerin karşılaştırılmasında Student t-testi, Mann-Whitney U-testi ve Chi-square testi kullanıldı. p<0.05 değeri istatistiksel olarak anlamlı kabul edildi. Bulgular: Çalışmaya toplam 165 hasta dahil edilmiş olup, bunların yaş ortalaması 46.48±23.24/yıl ve %82.4'ü erkekti. Traktör kazalarının, en sık 2016 yılında, temmuz ayında ve günün 16:00-20:00 saatleri arasında gerçekleştiği saptandı. Traktör kazasına en sık neden olan travma mekanizması "traktörden düşme" iken, bunu "traktör devrilmesi" takip ediyordu. Toraks, traktör kazası sonrası en fazla hasar gören bölgeydi. Tüm kazazedelerin %58.2'si yolculardan, %41.8'ini ise şoförlerden oluşuyordu. Şoförlerde kafa ve toraks bölgelerinden yaralanma oranı, yolculardan anlamlı olarak daha fazlaydı (Sırasıyla p=0.005; 0.039). Şoförler ile yolcular arasında laboratuvar sonuçları ve travma skorları bakımından farklılık saptanmadı. Kaza sonrası, toplam 6 (%3.6) kazazede eksitus kabul edilmiş olup; şoförlerin eksitus olma oranı (n=5, %7.2) yolculardan (n=1, %1.1) anlamlı olarak daha fazlaydı (p=0.036). Eksitus olan kazazedelerin solunum sayısı, sistolik kan basıncı, diastolik kan basıncı ve oksijen satürasyonu hayatta kalanlardan anlamlı olarak daha düşüktü (Sırasıyla, p=0.006; <0.001; <0.001; <0.001). Eksitus olan kazazedelerde batın ve pelvis yaralanmasının oranı, hayatta kalanlardan anlamlı olarak daha fazlaydı (Sırasıyla, p=0.018; 0.015). Hemoglobin ve trombosit düzeyi normal sınırlarda olmakla birlikte, eksitus olan kazazedelerdeki hemoglobin ve trombosit düzeyi, hayatta kalanlardan anlamlı olarak daha düşüktü (Sırasıyla, p=0.040; 0.021). Eksitus olan kazazedelerin GKS ve RTS puanı, hayatta kalan kazazedelerden anlamlı olarak daha düşük (Sırasıyla p<0.001; 0.001); ISS düzeyi ise anlamlı olarak daha yüksekti (p<0.001). Kazazedelerin %37.6'sının direk radyografisinde fraktür izlenmişken; BT'de ise sırasıyla kot fraktürü (%57.5), torakolomber fraktür (%30.7) ve pnömotoraks (%22.2) en sık saptanan patolojilerdi. Sonuç: Traktör kazaları sıklıkla orta yaş erkekleri etkilemekte ve bu tarz kazalara yaz mevsiminde daha sık rastlanmaktadır. Toraks, hem şoför hem de yolcularda en sık yaralanan anatomik bölgedir. Şoförlerdeki mortalite oranı, yolculara göre daha fazla olup, özellikle toraks ve kafa bölgesine ait yaralanmalar daha sıktır. Hayatını kaybeden kazazedelerde, batın ve pelvis yaralanması oranı daha fazla olmakla birlikte; travma şiddetinin daha fazla, hayati bulguların ise daha kötü olduğu görülmektedir. Acil servise traktör kazası nedeniyle başvuran hastalarda mortalitenin azaltılabilmesi için: yakın hemodinamik takip yapılmalı, başta toraks olmak üzere tüm organ sistemleri özenle değerlendirilmeli ve multidisipliner tedavi yaklaşımları uygulanmalıdır. Anahtar kelimeler: Acil servis, Trafik kazası, Traktör kazası
Introduction and Aim: Tractor accidents represent only a very small part of all traffic accidents. Since tractors are used to carry cargo and passengers in addition to agricultural activities, numerous casualties are encountered in regions in which intensive agricultural activities are carried out in particular. Patients presenting to the emergency department due to tractor accidents were examined in this study, the purpose of which was to elicit information concerning the general characteristics of such accidents from the data obtained. Material and Method: This retrospective study involved patients presenting to the Kırıkkale University Medical Faculty Emergency Department due to tractor accidents between 01 January, 2012, and 01 September, 2021. Patient records were accessed from archive data and the data processing automation system. Patients' demographic data, the time of the accident, the mechanism involved, the position in which they were seated on the tractor at the time of the accident, body region injuries, trauma scores (Glasgow Coma Score (GCS), Injury Severity Score (ISS), Revised Trauma Score (RTS), and Pediatric Trauma Score (PTS)), laboratory results, radiography findings, computed tomography (CT) results, and clinical survival status were recorded. Student's t-test, the Mann-Whitney U-test, and the Chi-square test were employed for data comparison. P values <0.05 were regarded as statistically significant. Results: One hundred sixty-five patients, with a mean age of 46.48±23.24 years, 82.4% of whom were men, were included in the study. Tractor accidents were most frequent in 2016, in the month of July, and between 16:00 and 20:00 h. The most common trauma mechanism resulting in tractor accidents was 'falling from the tractor,' followed by 'the tractor overturning.' The thorax was the region exhibiting the most damage after tractor accidents. Passengers represented 58.2% of all accidents, and drivers 41.8%. The rates of head and thorax injury were significantly higher in drivers compared to passengers (p=0.005 and 0.039, respectively). No difference was determined between drivers and passengers in terms of laboratory results or trauma scores. Six (3.6%) casualties were identified as exitus after accidents, the exitus rate being significantly higher among drivers (n=5, 7.2%) than passengers (n=1, 1.1%) (p=0.036). The exitus casualties exhibited significantly lower respiration rates, systolic blood pressure, diastolic blood pressure, and oxygen saturation than the survivors (p=0.006, <0.001, <0.001, and <0.001, respectively). The rate of abdominal and pelvic injuries was also significantly higher in the exitus casualties than in the survivors (p=0.018 and 0.015, respectively). Hemoglobin and platelet values were within normal limits, but were also significantly lower in the exitus casualties compared to the survivors (p=0.040 and 0.021, respectively). The GCS and RTS values of the exitus casualties were significantly lower than those of the survivors (p<0.001 for both), while ISS values were significantly higher (p<0.001). Fractures were observed in 37.6% of the casualties at direct radiography. The most frequently detected pathologies at CT, in descending order, were rib fractures (57.5%), thoracolumbar fracture (30.7%), and pneumothorax (22.2%). Conclusion: Tractor accidents frequently affect middle-aged men, and are more frequent in the summer. The thorax is the most frequently injured anatomical region, in both drivers and passengers. The mortality rate is higher and injuries to the thorax and head in particular are more common among drivers than passengers. Rates of injury to the abdomen and pelvis are higher, severity of trauma is greater, and vital findings are poorer among non-surviving casualties. Close hemodynamic follow-up should be performed, all organs, particularly the thorax, should be carefully evaluated, and multidisciplinary approaches should be adopted in order to be able to reduce mortality rates in patients presenting to the emergency department due to tractor accidents. Keywords: Emergency department, Traffic accident, Tractor accident
Introduction and Aim: Tractor accidents represent only a very small part of all traffic accidents. Since tractors are used to carry cargo and passengers in addition to agricultural activities, numerous casualties are encountered in regions in which intensive agricultural activities are carried out in particular. Patients presenting to the emergency department due to tractor accidents were examined in this study, the purpose of which was to elicit information concerning the general characteristics of such accidents from the data obtained. Material and Method: This retrospective study involved patients presenting to the Kırıkkale University Medical Faculty Emergency Department due to tractor accidents between 01 January, 2012, and 01 September, 2021. Patient records were accessed from archive data and the data processing automation system. Patients' demographic data, the time of the accident, the mechanism involved, the position in which they were seated on the tractor at the time of the accident, body region injuries, trauma scores (Glasgow Coma Score (GCS), Injury Severity Score (ISS), Revised Trauma Score (RTS), and Pediatric Trauma Score (PTS)), laboratory results, radiography findings, computed tomography (CT) results, and clinical survival status were recorded. Student's t-test, the Mann-Whitney U-test, and the Chi-square test were employed for data comparison. P values <0.05 were regarded as statistically significant. Results: One hundred sixty-five patients, with a mean age of 46.48±23.24 years, 82.4% of whom were men, were included in the study. Tractor accidents were most frequent in 2016, in the month of July, and between 16:00 and 20:00 h. The most common trauma mechanism resulting in tractor accidents was 'falling from the tractor,' followed by 'the tractor overturning.' The thorax was the region exhibiting the most damage after tractor accidents. Passengers represented 58.2% of all accidents, and drivers 41.8%. The rates of head and thorax injury were significantly higher in drivers compared to passengers (p=0.005 and 0.039, respectively). No difference was determined between drivers and passengers in terms of laboratory results or trauma scores. Six (3.6%) casualties were identified as exitus after accidents, the exitus rate being significantly higher among drivers (n=5, 7.2%) than passengers (n=1, 1.1%) (p=0.036). The exitus casualties exhibited significantly lower respiration rates, systolic blood pressure, diastolic blood pressure, and oxygen saturation than the survivors (p=0.006, <0.001, <0.001, and <0.001, respectively). The rate of abdominal and pelvic injuries was also significantly higher in the exitus casualties than in the survivors (p=0.018 and 0.015, respectively). Hemoglobin and platelet values were within normal limits, but were also significantly lower in the exitus casualties compared to the survivors (p=0.040 and 0.021, respectively). The GCS and RTS values of the exitus casualties were significantly lower than those of the survivors (p<0.001 for both), while ISS values were significantly higher (p<0.001). Fractures were observed in 37.6% of the casualties at direct radiography. The most frequently detected pathologies at CT, in descending order, were rib fractures (57.5%), thoracolumbar fracture (30.7%), and pneumothorax (22.2%). Conclusion: Tractor accidents frequently affect middle-aged men, and are more frequent in the summer. The thorax is the most frequently injured anatomical region, in both drivers and passengers. The mortality rate is higher and injuries to the thorax and head in particular are more common among drivers than passengers. Rates of injury to the abdomen and pelvis are higher, severity of trauma is greater, and vital findings are poorer among non-surviving casualties. Close hemodynamic follow-up should be performed, all organs, particularly the thorax, should be carefully evaluated, and multidisciplinary approaches should be adopted in order to be able to reduce mortality rates in patients presenting to the emergency department due to tractor accidents. Keywords: Emergency department, Traffic accident, Tractor accident
Açıklama
Tıp Fakültesi, Acil Tıp Ana Bilim Dalı
Anahtar Kelimeler
Acil Tıp, Emergency Medicine
