Investigation of clinical and laboratory features that determine mortality in multi-trauma patients admitted to the emergency department

Investigation of Clinical and Laboratory Features that Determine Mortality in Multi-trauma Patients Admitted to the Emergency Department. Multitrauma is an important cause of morbidity and mortality all over the world. In this study, the effects of some laboratory values and trauma scores on mortality in patients with multitrauma were investigated. This study was conducted on patients who applied to the emergency department of Adıyaman Training and Research Hospital with multitrauma between 2021 and 2022, prospectively. Patient's gender, age, presentation, duration of admission to the emergency department, season of admission, mean arterial pressure, trauma mechanism, type of injury, injured area, CRP and albumin values at the time of admission and Glasgow coma scale (GCS), Revised trauma score (RTS), Abbreviated Injury Scale, Inujury severity score and Trauma and Injury Severity Score (TRISS) scores of all patients were recorded on the prepared standard forms and their relationship with mortality was examined. While 79% of the 419 cases included in the study were male, 21% were female. While 371 of the cases resulted in survival, 48 resulted in death. While the median age value of all cases was 30 (0-87), the median age of those who died was 38 (1-87). It was seen that the majority of the cases were in the group between the ages of 18-44 with a rate of 45.6%. Similarly, it was determined that 33% of the cases that resulted in death were in the 18-44 age group. While 395 of the patients applied to the emergency service by ambulance, 24 of them applied as an outpatient. It was observed that 66% of those who applied to the emergency department applied within the first 30 minutes after the trauma, while 62.5% of the cases that resulted in death were found to apply in the first 30 minutes. In order of frequency, patients' admission mechanisms to the emergency department; non-vehicle traffic accident (37%), in-vehicle traffic accident (27%) and fall (25%), respectively. When the distribution of the cases according to the seasons was examined, it was determined that the most applications were in the summer season (60.4%). In parallel, deaths were mostly seen in summer and autumn seasons (80%). Considering the injury sites in the patients, it was seen that the most injuries were in the pelvis-extremities (76%) and head-neck (64%) regions. Head-neck (87.5%) and thorax (77.1%) injuries were the most common in the patients who died. The most common clinical finding in these patients was found to be cranial fracture (21.5%). Head-neck and thorax injuries were found to be statistically significantly higher in patients who died (p<0.001). In addition, cranial fracture, subarachnoid hemorrhage, intracerebral contusion, subdural hemorrhage, hemothorax, pneumothorax, lung contusion, sternum-rib fracture, intra-abdominal hemorrhage, spleen and other intra-abdominal organ injuries were found to be statistically significantly higher in deceased patients (p <0.001). In addition, the presence of maxillofacial fracture (p=0.002), liver injuries (p=0.001) and pelvis fracture (p=0.002) was also found to be statistically significantly higher in patients who died. In the study, increased CRP/albumin ratio, high AIS and ISS scores and low GCS, RTS and TRISS scores were found to be statistically significant in died patients (p<0.001). In our study, it was found that trauma scores (GCS, RTS, AIS, ISS, TRISS), CRP/albumin ratio, presence of head-neck and thoracic region injuries were significantly different between died and surviving patients. The guidance of these results in the necessary examination and treatment stages in the management of trauma patients will reduce mortality rates. In addition, these injuries can be reduced by increasing social education and traffic inspections in these months, since the incidents are most common in summer and autumn and traffic accidents are the most responsible mechanisms in these months. Keywords: Multitrauma, CRP/albumin ratio, trauma scores, emergency department