Toplam yanık yüzey alanı yüzde otuz ve üzeri olan majör yanıklı hastalarda mortaliteye etkı eden faktörlerin retrospektif analizi
Retrospective analysis of factors which affecting mortality in major burn patients with total body burn surface area over %30
Yazar: CEM EMİR GÜLDOĞAN
Danışman: PROF. DR. AHMET ÇINAR YASTI
Sağlık Bakanlığı / Ankara Numune Eğitim ve Araştırma Hastanesi / Genel Cerrahi Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2014
Konu: Genel Cerrahi = General Surgery
Dizin: Yanıklar = Burns

Özet:
Majör yanıklar yüksek morbidite ve mortalite ile seyreden, tüm yaş gruplarının risk altında olduğu bir travma türüdür. Bu çalışmadaki amacımız yanıklara bağlı gelişen yaralanmaları analiz etmek, mortalite oranlarını belirlemek, mortaliteyi etkileyen risk faktörlerini belirlemek ve yanık tedavisinde yol göstermektir. Bu çalışmada, üçüncü basamak bir sağlık kurumunun yanık tedavi merkezinde,  yanık yüzey alanı %30 ve üzeri olan majör yanıklı hastalarda, mortaliteye etki eden faktörlerin araştırılması amaçlanmıştır.

Abstract:
Aim: Major burn injury is a type of trauma that comes along with high morbidity and mortality rates and it could effect all age groups. The aim of this study is to analyze the injuries due to burn, determine the mortality rates, sort out the factors that has an effect on mortality and be a guide to burn treatment. In this thesis study, factors that effect mortality in major burns patients with over 30% burn of total body surface area (TBSA) who were treated in a burn treatment center of a third step hospital. 

Material Method:
Medical records and follow-up notes of patients who were hospitalized in Ankara Numune Training and Research Hospital Burns Clinic between January 2008- December 2012 were evaluated retrospectively. Age, gender, co-morbidities, burn percentage, locality, type of burn, process of the burn, presence of inhalation injury, results of blood hemogram and biochemical tests, duration of hospital stay, type of surgical performed surgical procedures, presence of multi-trauma, need of ventilation support were selected for assessment to determine the factors that effect mortality. White blood cell count, hemoglobin count, platelet count, lactate dehydrogenase levels were examined thoroughly. In addition to this, calculated LDH levels at administration, at the middle time of the hospital stay and at the end of the hospital stay were studied. 

Findings: 
A total of 224 patients who have burn injury ≥30% TBSA were selected for evaluation within hospitalized burns patients in Ankara Numune Training and Research Hospital Burns Clinic between January 2008- December 2012. Demographic specialities of 224 patients were evaluated retrospectively. Of 224 patient, 81.7% were male and 18.4% were female. In mortality group 41.5% were male and 58.5% were female. Variables that were found to be significant after univariate analyzes (gender, age, age group, TBSA effected from burn, type of burn,  presence of inhalation injury, process of the burn, time spent before administration to hospital,  duration of hospital stay, presence of co-morbidity, diabetes mellitus, need of ventilation support, LDH values, leukocyte count, platelet count) were evaluated with multivariate analyzes end LDH value, age, duration of hospital stay, presence of inhalation injury, TBSA effected from burn and leukocytosis were found to be significantly associated with mortality.  

Result: 
Early realization of the factors effecting morbidity and mortility in patients and taking preventive measures, besides earlier detection and prevention of complications in long time ICU patients could reduce complication and mortality rates in major burn trauma patients.  
Another point of view to reduce the mortality due to major burn trauma is protection from burns. Intermediate and major burn patients should be treated in specialized centers. 

Key words: Major burns, prognostic factors, mortality