SUDA BOÐULMA NEDENÝYLE HASTANEDE YATAN OLGULARIN ÖZELLÝKLERÝ VE PROGNOSTÝK BULGULAR

Amaç: Ýstanbul'da bir eðitim hastanesinde tedavi edilen suda boðulma olgularýnýn demografik verileri, klinik, laboratuvar ve radyolojik bulgularýný retrospektif olarak gözden geçirmeyi ve bunlarýn prognoz ile iliþkisini ortaya koymayý amaçladýk. Gereç ve yöntem: 2007-2012 tarihleri arasýnda hastanemiz acil servisine getirilen ve hastaneye yatýrýlan suda boðulma olgularýnýn dosyalarý retrospektif olarak incelendi. Hastalarýn demografik özellikleri, boðulma karakteristikleri (yer, su ýsýsý, suda kalma süresi vb), fizik muayene ve akciðer grafisi bulgularý, kan gazý deðerleri, Glaskow koma skorlarý (GKS), Rapid Acute Physiology Score (RAPS), Rapid Emergency Medicine Score (REMS) ve taburculuk anýnda hesaplanan Glaskow Outcome Score (GOS)'larý kayýt edildi. Ayrýca hastalarýn yoðun bakýma yatýþ, entübasyon ve CPR öyküleri dikkate alýndý. Hastalarýn prognozu ile su altýnda kalma süresi, kan pH'sý, GKS, RAPS, REMS, CPR uygulanmasý ve hastanýn entübe edilmesi arasýndaki iliþki istatistiksel olarak araþtýrýldý. Bulgular: Çalýþmaya yaþ ortalamasý 25.1±20.1 (min:2; max:77) olan, 32(%76.2)'si erkek, 10 (23.8%)'u kadýn, 42 olgu dahil edildi. Olgularýn su altýnda kalma süresi, ortalama 2.46±1.59 (min:0.5;max:7) dakika idi. Entübe edilen ve edilmeyen hastalarýn GKS, RAPS, REMS ve GOS skorlarý arasýnda, CPR yapýlan ve yapýlmayan olgularýn ise RAPS ve GOS deðerleri arasýnda anlamlý fark olduðu (p<0.05) saptandý. Ayrýca GOS 1-3 hastalar ile GOS 4-5 hastalarýn baþvuru anýndaki kan pH'larý arasýndaki fark da anlamlý bulundu (p=0.003). Olgularýn GKS, RAPS ve REMS skorlarý ile GOS skoru arasýndaki iliþki anlamlý idi (r=0.615,p<0.001;r=- 0.459,p=0.002;r=-0.347,p=0.003). Sonuç: Acile getirilen hastalarda prognozun erkenden belirlenebilmesi için objektif verilere gereksinim vardýr. GKS, RAPS ve REMS gibi skorlama sistemleri bu alanda kullanýlabilir.

THE CHARACTERISTICS OF PATIENTS HOSPITALIZED FOR DROWNING AND PROGNOSTIC FEATURES AT DROWNING

Aim: To review the demographic data, clinical, laboratory and radiological findings of drowning patients treated at a training hospital in Ä°stanbul and evaluate their relationship with the prognosis, retrospectively. Material-method: The files of drowning patients admitted to our emergency service and hospitalized between 2007-2012 were evaluated, retrospectively. The demographic features, characteristics of drowning, (drowning site, water, the time past under water etc.), physical examination and chest X-ray findings, arterial blood gas values, Glasgow Coma Score (GCS), Rapid Acute Physiology Score (RAPS), Rapid Emergency Medicine Score (REMS) and Glaskow Outcome Score (GOS) which is calculated at the discharge period were registered. Length of stay in intensive care and service, if intubation and cardiopulmonary resuscitation (CPR) were applied were also evaluated. The relationship between prognosis of patients and the time past under water, arterial blood pH, GCS, RAPS, REMS, the application of CPR and intubation were analaysed statistically. Results: Thirty two (76.2%) male, 10(23.8%) female totally 42 patients with a mean age of 25.1±20.1 (min:2;max:77) were included. The mean time of cases past under the water was 2.46±1.59 (min: 0.5;max:7) minutes. Statistically significant difference was observed between GCS, RAPS, REMS, GOS scores of intubated and nonintubated patients and RAPS, GOS scores of patients CPR performed and not performed (p<0.05). There is significant difference between blood pH value of GOS score of 1-3 and GOS 4-5 patients at admission (p=0.003). There is a significant relation between the GCS, RAPS, REMS scores and GOS score of patients (r=0.615, p<0.001;r=-0.459,p=0.002;r=-0.347,p=0.003). Conclusion: Objective data is necessary in order to determine the prognosis of drowning patients at emergency room. Scoring systems such as GCS, RAPS and REMS are available in this area.