title: High velocity missile-related colorectal injuries: In-theatre application of injury scores and their effects on ostomy rates.
abstract: BACKGROUND
  Treatment of colorectal injuries (CRIs) remains a significant cause of morbidity and mortality. The aim of the present study was to analyze treatment trends of Turkish surgeons and effects of the American Association for the Surgery of Trauma (AAST), Injury Severity (ISS), and Penetrating Abdominal Trauma Index (PATI) scoring systems on decision-making processes and clinical outcomes.
  
  
  METHODS
  Data regarding high velocity missile (HVM)-related CRIs were retrospectively gathered. Four patient groups were included: Group 1 (stoma), Group 2 (no stoma in primary surgery), Group 2a (conversion to stoma in secondary surgery), and Group 2b (remaining Group 2 patients).
  
  
  RESULTS
  Groups 1, 2, 2a, and 2b included 39 (66%), 20 (34%), 6 (30%), and 14 (70%) casualties, respectively. Ostomies were performed in casualties with significantly higher AAST scores (p<0.001). However, PATI and ISS scores were not decisive factors in the performance of ostomy (p=0.61; p=0.28, respectively). Ostomy rates of civilian and military surgeons were 62% and 68%, respectively (p=0.47). Receiver operating characteristic (ROC) analysis showed that AAST score was a more accurate guide for performing ostomy, with sensitivity and specificity rates of 80% and 92.9%, respectively.
  
  
  CONCLUSIONS
  Clinical significance of diversion in HVM-related CRIs remains. Stomas were associated with lower complication rates and significantly higher AAST colon/rectum injury scores.
authors.affiliation: Department of General Surgery, Gülhane Military Medical Academy, Ankara-Turkey. skaymak@gata.edu.tr.
authors.forename: Şahin
authors.initials: Ş
authors.lastname: Kaymak
authors.affiliation: Department of General Surgery, Gülhane Military Medical Academy, Ankara-Turkey.
authors.forename: Aytekin
authors.initials: A
authors.lastname: Ünlü
authors.affiliation: Department of General Surgery, Gülhane Military Medical Academy, Ankara-Turkey.
authors.forename: Ali
authors.initials: A
authors.lastname: Harlak
authors.affiliation: Department of General Surgery, Gülhane Military Medical Academy, Ankara-Turkey.
authors.forename: Nail
authors.initials: N
authors.lastname: Ersöz
authors.affiliation: Department of General Surgery, Gülhane Military Medical Academy, Ankara-Turkey.
authors.forename: Rahman
authors.initials: R
authors.lastname: Şenocak
authors.affiliation: Department of General Surgery, Gülhane Military Medical Academy, Ankara-Turkey.
authors.forename: Ali Kağan
authors.initials: AK
authors.lastname: Coşkun
authors.affiliation: Department of General Surgery, Gülhane Military Medical Academy, Ankara-Turkey.
authors.forename: Nazif
authors.initials: N
authors.lastname: Zeybek
authors.affiliation: Department of General Surgery, Gülhane Military Medical Academy, Ankara-Turkey.
authors.forename: Emin
authors.initials: E
authors.lastname: Lapsekili
authors.affiliation: Department of General Surgery, Gülhane Military Medical Academy, Ankara-Turkey.
authors.forename: Orhan
authors.initials: O
authors.lastname: Kozak
mesh_terms: D000007:Abdominal Injuries / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D003125:Colostomy / Q000706:statistics & numerical data; D005260:Female; D044709:Forensic Ballistics; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008887:Military Medicine; D011183:Postoperative Complications; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014421:Turkey / Q000453:epidemiology; D014950:Wounds, Penetrating / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D055815:Young Adult