• Şahin Kaymak, Aytekin Ünlü, Ali Harlak, Nail Ersöz, Rahman Şenocak, Ali Kağan Coşkun, Nazif Zeybek, Emin Lapsekili, and Orhan Kozak.
• Department of General Surgery, Gülhane Military Medical Academy, Ankara-Turkey. skaymak@gata.edu.tr.
• Ulus Travma Acil Cer. 2016 Mar 1; 22 (2): 169-74.

BackgroundTreatment 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.MethodsData 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).ResultsGroups 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.ConclusionClinical significance of diversion in HVM-related CRIs remains. Stomas were associated with lower complication rates and significantly higher AAST colon/rectum injury scores.

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