Travmada Bedel-Etkinlik: Laboratuvar Kullanım İlkeleri
Özet
Travma hastalarının yönetiminde, hastanın kliniğine göre ve sağlık maliyetlerinde israfa yol açmayacak şekilde, en kısa zamanda doğru tanıya ulaşmada yardımcı olacak testlerin seçilmesi, laboratuvar kullanım ilkelerinde bedel-etkinlik olarak nitelendirilmektedir. Laboratuvar testlerinin gereksiz kullanımı, hastane kaynaklarının israfına, acil servisin verimliliğinde azalmaya, hastaların acil serviste kalış sürelerinde uzamaya, mortalitede artışa ve kaosa neden olmaktadır. Travma hastasının yönetimindeki bu ekonomik giderin kontrolünün acil hekiminde olması, testlerin seçiminde akılcı davranma zorunluluğuna sebebiyet vermektedir.
Referanslar
World Health Organization. Decade of Action for Road Safety 2011-2020. (13/10/2024 tarihinde https://www.who.int/publications/i/item/decade-of-action-for-road-safety-2011-2020 adresinden ulaşılmıştır).
Van Breugel JMM, Niemeyer MJS, Houwert RM, et al. Global changes in mortality rates in polytrauma patients admitted to the ICU-a systematic review. World J Emerg Surg. 2020; 30;15(1):55.
Köksal Ö., Eren Çevik Ş., Akköse Aydin Ş., et al. Analysis of the necessity of routine tests in trauma patients in the emergency department. Ulusal Travma ve Acil Cerrahi Dergisi. 2012;18(1):23–30.
Gül M., Cander B., Sadık Girişgin S., et al. Acil serviste uygun tanısal tetkiklerin seçimi. Akademik Acil Tıp Dergisi. 2006; 4(6): 4-8.
Ulusal Travma ve Acil Cerrahi Derneği. TÜRKİYE’DE TRAVMA VE ACİL CERRAHİNİN GÜNCEL DURUMU. 2008. (13/10/2024 tarihinde https://www.travma.org/TravmaData/Uploads/files/UUppVK6ZxIWN.pdf adresinden ulaşılmıştır.)
The Royal College of Surgeons of England and the British Orthopaedic Association. Better care for the severely injured. Royal College of Surgeons of England; 2000. 61 p.
Student Course Manual ATLS ® Advanced Trauma Life Support ®. 2018.
Duggan S, Tillotson L, McCann P. Routine Laboratory Tests in Adult Trauma: Are they Necessary? The Bulletin of the Royal College of Surgeons of England. 2011 ;1;93(7):266–72.
Frankel HL, Rozycki GS, Ochsner MG, et al. Minimizing admission laboratory testing in trauma patients: use of a microanalyzer. J Trauma. 1994 ;37(5):728–36.
Jacobs IA, Kelly K, Valenziano C, et al. Cost Savings Associated with Changes in Routine Laboratory Tests Ordered for Victims of Trauma. Am Surg. 2000 ;28;66(6):579–84.
Namias N, McKenney MG, Martin LC. Utility of admission chemistry and coagulation profiles in trauma patients: a reappraisal of traditional practice. J Trauma. 1996 ;41(1):21–5.
Asimos AW, Gibbs MA, Marx JA, et al. Value of point-of-care blood testing in emergent trauma management. J Trauma. 2000 ;48(6):1101–8.
Tintinalli JE. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, Ninth Edition.
Sarandöl E. Klinisyen Hekimler için Tıbbi Biyokimya Laboratuvarı Hakkında Gerekli Bilgiler. Ersoy A (ed.), Uludağ İç Hastalıkları Kitabı Cilt 1 -Tanıda Temel Bilgi içinde. Bursa: Bursa Uludağ Üniversitesi Tıp Fakültesi Yayınları; 2022. p. 133-146.
Baydın A., Yardan T., Guven H. The relation of the lactate, base excess and Injury Severity Scores (ISS) with mortality in trauma. Turk J Emerg Med 2007;7(3):97-10.
Vohra T, Paxton J. Abnormal arterial blood gas and serum lactate levels do not alter disposition in adult blunt trauma patients after early computed tomography. West J Emerg Med. 2013 ;14(3):212–7.
Yanar H, Ertekin C, Taviloglu K, et al. Nonoperative treatment of multiple intra-abdominal solid organ injury after blunt abdominal trauma. Journal of Trauma- Injury, Infection and Critical Care. 2008 ;64(4):943–8.
Snyder HS. Significance of the initial spun hematocrit in trauma patients. Am J Emerg Med. 1998 ;16(2):150–3.
Popal Z, Schepers T, Schie P Van,et al. The use of routine laboratory testing in acute trauma care: A retrospective analysis. Ulusal Travma ve Acil Cerrahi Dergisi. 2022; 1;28(7):954–9.
Tasse JL, Janzen ML, Ahmed NA, et al. Screening laboratory and radiology panels for trauma patients have low utility and are not cost effective. J Trauma. 2008 ;65(5):1114–6.
Cantürk N., Utkan NZ., Analay H., et al. Künt travmaları takiben oluşan major gastroenterik yaralanmalarda prognozu belirleyen faktörler. Turkish Journal of Trauma & Emergency Surgery. Vol.4, 1998.
Avcı A., Eren TŞ,. Toraks travmalarında mortalite ve morbiditeyi etkileyen faktörler. EJONS International Journal on Mathematic, Engineering and Natural Sciences. Vol. 5, 2018. [Online]. Available from: www.ejons.co.uk
Turtay M, Kirimlioğlu V, Ceylan C. Coagulopathy in multiple traumas. Turkish Journal of Trauma & Emergency Surgery. Vol. 16, 2010.
Bhandarkar P, Pal R, Munivenkatappa A, et al. Distribution of Laboratory Parameters in Trauma Population. J Emerg Trauma Shock. 2018;11(1):10–4.
Kasap Demir B, Başaran C. Deprem sonrası çocuk hasta, ezilme (crush) sendromu. TOTBİD Dergisi. 2022; 1;21(3):304–11.
Harrois A, Anstey JR, van der Jagt M, et al. Variability in Serum Sodium Concentration and Prognostic Significance in Severe Traumatic Brain Injury: A Multicenter Observational Study. Neurocrit Care. 2021; 2;34(3):899–907.
Sen S, Tran N, Chan B,et al. Sodium variability is associated with increased mortality in severe burn injury. Burns Trauma. 2017.1;5.
Newton MV, Subramanyam SG. Predicting and grading liver injury in the absence of computed tomographic imaging. J Family Med Prim Care. 2023 ;12(2):326–31.
Vela JH, Wertz CI, Onstott KL, et al. Trauma Imaging: A Literature Review. Radiol Technol. 2017 ;88(3):263–76.
İskit SH, Alpay H, Tuğtepe H, et al. Analysis of 33 pediatric trauma victims in the 1999 Marmara, Turkey earthquake. J Pediatr Surg. 2001 ;36(2):368–72.
Akay S. Acil Servise Travma ile Başvuran Olgularda Kan Alkol Düzeyi ile Travma Skorları Arasındaki İlişkinin Araştırılması. Uzmanlık Tezi. İzmir; 2006.
Weber B, Lackner I, Braun CK, et al. Laboratory Markers in the Management of Pediatric Polytrauma: Current Role and Areas of Future Research. Front Pediatr. 2021; 9:622753.
Lee JY, Coombs C, Clarke J, et al. AST and ALT Elevation in Suspected Physical Abuse: Can the Threshold to Obtain an Abdominal CT be Raised? Journal of Trauma and Acute Care Surgery. 2024; 11.
Mai G, Lee JH, Caporal P, et al. Initial dysnatremia and clinical outcomes in pediatric traumatic brain injury: a multicenter observational study. Acta Neurochir (Wien). 2024; 14;166(1):82.
Keller MS, Coln CE, Trimble JA, et al. The utility of routine trauma laboratories in pediatric trauma resuscitations. The American Journal of Surgery. 2004 ;188(6):671–8.
Jain V, Chari R, Maslovitz S, et al. Guidelines for the Management of a Pregnant Trauma Patient. Journal of Obstetrics and Gynaecology Canada. 2015 ;37(6):553–71.
Yılmaz E, Bor C, Uyar M,et al. The Effect of Lactate, Albumin, C-reactive Protein, PaO2/FiO2 and Glucose Levels of Trauma Patients at the Time of Administration to Intensive Care. Türk Yoğun Bakım Derneği Dergisi. 2014; 5;12(3):82–5.
Çevik Ş.E. Acil Servise Başvuran Travma Hastalarında Rutin Tetkiklerin Gerekliliğinin Analizi. Uzmanlık Tezi. Bursa; 2009.
Ergene Ü, Ergene O, Fowler J. Acil tıptaki tanı testlerinde bedel–etkinlik. 1. baskı. Isparta: Süleyman Demirel Üniversitesi Yayınları; 1999.
Winkens R, Dinant GJ. Evidence base of clinical diagnosis: Rational, cost effective use of investigations in clinical practice. BMJ. 2002; 30;324(7340):783.
Çebiçci H., Bulut M., Aydın A.Ş., et al. Emergency Management of Multiple Trauma Patients in a Level I Trauma Center: “Time” as a Quality Assurance. Akademik Acil Tıp Dergisi. 2008; 4(1): 18-22.
