The effect of the use of trauma scoring systems on prognosis in patients with multiple traumas

The objective of this formative study is to examine the effects of the use of trauma scoring systems on prognosis in patients with multiple traumas. A total of 70 male and female patients over the age of 18 who have applied to the emergency service of the Muğla Sıtkı Koçman University Education and Research Hospital with multiple trauma during the dates of 08.03.2013-11.05.2014 and who have been taken under follow up and treatment have been included in this study with their own consent. Study data was acquired via patient introduction form and patient follow up form whih which have been prepared by the researcher in accordance with the relevant literature. The data for the first and fourth days were chosen for comparisons of analyses. The numerical data was expressed as average ± standard deviation. The differences in numerical data were compared with the t-test of the Student. Whereas the relationship between the variables was determined via correlation analysis. The levels of prediction of the deaths in trauma scoring systems has been analyzed via ROC curves. Sensitivity and specificity values were calculated for the predictive values where the areas under the curves reached statistically significant levels. The statistically significance level was accepted as p<0.05 for all tests. It has been determined as a result of the study that 78.6 % of the patients are male and 21.4 % are female. Age average ± Standard deviation is 40.97 ± 1.94. Reasons for trauma are %32.9 car accident while inside the vehicle, % 31.4 motorcycle accident, %12.9 car accident while outside the vehicle, %10.0 occupational hazards, %5.7 falling from heights and sharp object injuries and %1.4 firearm injuries. %91.4 of the trauma mechanisms are blunt trauma whereas %8.6 are penetrating trauma. Whereas % 91.4 of the patients stayed alive, it was determined that % 8.6 died. It was determined from the first and fourth day prognosis indicators that there was a statistically significant correlation between intubation, erythrocyte, fresh frozen plasma transfusion and death with all scoring systems. A statistically significant difference was determined on the fourth day between time spent under intensive care unit intubation, haemogram result, erythrocyte, fresh frozen plasma transfusion and death with all scoring systems (p<0.05). Whereas a statistically significant correlation was determined between systolic and diastolic blood pressure, respiration and oxygen saturation from among vital signs; no statistically significant correolation was determined between body temperature with all scoring systems. A statistically significant difference was determined between the first and fourth day all scoring systems for patients who died and who stayed alive (p<0.05). It was determined that all scoring systems were determinant for the estimation of survival and death ratios of patients. It was determined that AIS, ISS and TRISS were much more selective and sensitive in the evaluation via ROC curve of the specificity and sensitivity of the trauma scoring systems in predicting the deaths of patients. Our study results support the hypothesis that "GKS, RTS, AIS, ISS, TS and TRISS trauma scoring systems are effective in estimating prognosis in multiple trauma patients". It can be stated that the trauma scoring systems used for multiple trauma patients is important for the determination of the physiological status and mortality of the patient and that the trauma scoring system can be used effectively in patient follow up and nursing management. It is thought that similar studies as well as this study will contribute to taking the necessary precautions, increasing the awareness of risk groups, developing the protective health policies in our country and thus the decrease of morbidity and mortality. Key Words: Multiple trauma, prognosis, trauma scoring systems