Ağaçtan Düşmelerin Torakolomber Yaralanma Sınıflandırma Sistemi Skorları ve Hasta Sonuçları Açısından Analizi

Year 2023, , 368 - 372, 21.09.2023

Gürkan Berikol , Göksu Bozdereli Berikol , İbrahim Sarbay , Mehmet Ali Karataş

https://doi.org/10.33631/sabd.1309087

Abstract

Amaç: Ağaçtan düşmeler, iş sağlığı hizmetlerinin temel sorunlarından biridir. Ağaçtan düşen hastalar, yüksek enerjili travmalar nedeniyle omurga ve ekstremite yaralanmalarına maruz kalmaktadır. Bu çalışma ile amacımız, farklı plantasyonlardaki farklı ağaç türlerinden düşme ile gelen hastalara ait torakolomber yaralanma sınıflandırma sistemi (TLICS) skorları, spinal hasar dereceleri ve travma tedavilerindeki farklılıkları ortaya koymaktır.
Gereç ve Yöntemler: Bu retrospektif gözlemsel bir çalışmadır. 2015-2020 yılları arasında ağaçtan düşme nedeniyle acil servise getirilen hastalar dahil edildi. Ağaçtan düşmelere bağlı yaralanmaların özellikleri, TLICS skorları, tedavi türleri ve 3 aylık takip sonuçları hastane bilgi sisteminden alınarak karşılaştırmalı analizler yapılmıştır.
Bulgular: Hastaların ortalama yaşı 53,25±17,9 olup, %54,9’u erkekti. Düşmelerin en çok zeytin ağacından olduğu görüldü(n=23, %45,1) Hastaların 33'üne (%64,7) vertebroplasti veya stabilizasyon uygulandı. Boy kategorilerine göre TLICS puanları(p=0.003) ve stabilizasyon düzeyleri(p=0.003) istatistiksel olarak yüksek ağaç kategorilerinde daha yüksek bulundu (p=0.003). Dört metreden yüksek ağaç düşmelerinde cerrahi müdahaleler istatistiksel olarak daha yüksek olmakla birlikte (p=0,026), tedavi şekli (p=0,315), VAS skoru(p=0,219) ve 30 gün VAS skoru açısından ağaçlar arasında istatistiksel olarak anlamlı fark yoktu(p=0.329)Ayrıca Görsel Analog Ölçeği (VAS) skorundaki değişim opere olan hastalarda (median VAS=7) opere olmayan hastalara göre (median VAS=5,5) istatistiksel olarak daha yüksekti (p=0,012).
Sonuç: Bulgularımız, TLICS puanlarının ağaç boyları ile anlamlı bir şekilde ilişkili olduğunu ve VAS puanlarında iyi sonuçlarla çalıştığını ortaya koymaktadır.

Keywords

ağaçtan düşme, spinal yaralanma, travma

Analysis of Tree-related Falls in Terms of Thoracolumbar Injury Classification System Scores and Patient Outcomes

Abstract

Aim: Falling from trees are main problems of occupational healthcare. Patients falling from trees are suffered from spinal and extremity injuries due to high energy traumas. Our aim with this study was to reveal the differences in thoracolumbar injury classification system (TLICS) scores, degrees of spinal damage and treatments of traumas belonging to patients who presented with falls from different tree species in different plantations.
Material and Methods: This is a retrospective observational study. Patients who were brought to the emergency department due to falling from a tree between 2015-2020 were included. Characteristics of injuries due to falls from trees, TLICS scores, treatment types and 3 month follow up results were obtained from the hospital information system and comparative analysis was done.
Results: The mean age of the patients was 53.25±17.9 years and 54.9% were male. 33(64.7%) patients had undergone vertebroplasty or stabilization. According to height categories, TLICS scores(p=0.003) and stabilization levels(p=0.003) were statistically higher in taller tree categories (p=0.003). Although surgical interventions were statistically higher in tree falls higher than four meters (p=0.026), there was no statistically significant difference between trees in terms of treatment type (p=0.315), VAS score (p=0.219) and 30-day VAS score (p=. 0.329) In addition, the change in Visual Analogue Scale (VAS) score was statistically higher in operated patients (median VAS=7) than in non-operated patients (median VAS=5.5) (p=0.012).
Conclusion: Our findings reveal that TLICS scores are significantly associated with tree heights and operate with good results in VAS scores.

Keywords

spinal injury, trauma, tree falls

References

• The ATLS Subcommittee, American College of Surgeons’, Committee on Trauma, and the International ATLS working group. Advanced trauma life support (ATLS®): The ninth edition: Journal of Trauma and Acute Care Surgery. 2013; 74: 1363-6. https://doi.org/10.1097/01586154-201305000-00026.
• American College of Surgeons, Committee on Trauma. Advanced trauma life support: student course manual. 2018.
• Ersoy S, Sonmez BM, Yilmaz F, Kavalci C, Ozturk D, Altinbilek E, et al. Analysis and injury paterns of walnut tree falls in central anatolia of Turkey. World J Emerg Surg 2014; 9: 42. https://doi.org/10.1186/1749-7922-9-42.
• Avşar A, Okdemir E, Keten A, Karanfil R. Ağaçtan düşmelere bağlı ölümler. Dicle Med J. 2015; 42(3): 331-4. https://doi.org/10.5798/diclemedj.0921.2015.03.0584.
• Marshall EG, Lu S-E, Williams AO, Lefkowitz D, Borjan M. Tree-related injuries associated with response and recovery from hurricane sandy, New Jersey, 2011-2014. Public Health Rep. 2018; 133(3): 266-73. https://doi.org/10.1177/0033354918766871.
• Barss P, Dakulala P, Doolan M. Falls from trees and tree associated injuries in rural Melanesians. Br Med J (Clin Res Ed) 1984; 289: 1717-20.
• Crites BM, Moorman CT, Hardaker WT. Spine injuries associated with falls from hunting tree stands. J South Orthop Assoc. 1998; 7: 241-5.
• Fayssoux RS, Tally W, Sanfilippo JA, Stock G, Ratliff JK, Anderson G, et al. Spinal injuries after falls from hunting tree stands. The Spine Journal. 2008; 8: 522-8. https://doi.org/10.1016/j.spinee.2006.11.005.
• Özkan S, Duman A, Durukan P, Avşaroğullari L, İpekci̇ A, Mutlu A. Features of injuries due to falls from walnut trees. 2010: 10(2): 51-4.
• Nabi DG, Rashid TS, Kangoo KA, Ahmed DF. Fracture patterns resulting from falls from walnut trees in Kashmir. Injury. 2009; 40(6): 591-4.
• Javadi SA, Naderi F. Pattern of spine fractures after falling from walnut trees. World Neurosurgery. 2013; 80(5):e41-3. https://doi.org/10.1016/j.wneu.2012.12.014.
• Lee JY, Vaccaro AR, Lim MR, Öner FC, John Hulbert R, Hedlund R, et al. Thoracolumbar injury classification and severity score: a new paradigm for the treatment of thoracolumbar spine trauma. Journal of Orthopaedic Science. 2005; 10(6): 671-5.
• van Laarhoven JJ, Lansink KW, van Heijl M, Lichtveld RA, Leenen LP. Accuracy of the field triage protocol in selecting severely injured patients after high energy trauma. Injury. 2014; 45(5): 869-73.
• Mekkodathil A, El-Menyar A, Kanbar A, Hakim S, Ahmed K, Siddiqui T, et al. Epidemiological and clinical characteristics of fall-related injuries: a retrospective study. BMC public health. 2020; 20(1): 1-9.
• Oguzturk H, Turgut K, Turtay M.G, Sarıhan ME, Gur A, Beydilli İ, et al. Apricot tree falls: a study from Malatya, Turkey. Biomedical Research-India. 2016; 27: 210-3.
• Joaquim AF, de Almeida Bastos DC, Jorge Torres HH, Patel AA. Thoracolumbar injury classification and injury severity score system: a literature review of its safety. Global spine journal. 2016; 6(1): 80-5.
• Do Koh Y, Dong JK, Won Koh Y. Reliability and validity of thoracolumbar injury classification and severity score (TLICS). Asian spine journal. 2010; 4(2): 109-17.
• Rahman A, Asif DS, Bhandari PB, Sader Hossain SK. A Demographic study of thoracolumbar junction fracture in a developing country and its social impact. Journal of Spine, 2013;2(2).
• Butt MF, Farooq M, Mir B, Dhar AS, Hussain A, & Mumtaz M. Management of unstable thoracolumbar spinal injuries by posterior short segment spinal fixation. International orthopaedics, 2007; 31: 259-64.
• Khurshid N, Singh V, Chhiber SS. Clinico-radiological profile of thoraco-lumbar fractures-an institutional experience. JMS SKIMS. 2021; 24(3): 25-30.
• Karaali E, Çiloğlu O, Duramaz A, Özkan AK, Ekiz T. Management of thoracolumbar injury classification and severity score of 4 (TLICS= 4) thoracolumbar vertebra fractures: Surgery versus conservative treatment. Turkish Journal of Trauma & Emergency Surgery. 2020; 26(5): 805-10.