Herramientas pronósticas de la gravedad del trauma maxilofacial en la atención de urgencia / Prognostic Tools for Maxillofacial Trauma Severity in Emergency Care

RESUMEN Introducción: La utilización de herramientas pronósticas que permitan valorar la gravedad del trauma, la supervivencia y mortalidad de los lesionados, permite la estratificación de los pacientes y la toma de decisiones acertadas para el tratamiento más efectivo en el área hospitalaria. Objetivo: Realizar una revisión bibliográfica sobre las herramientas pronósticas más utilizadas en la atención de urgencia para detectar la gravedad del trauma maxilofacial. Métodos: Se realizó una revisión bibliográfica desde octubre de 2018 hasta enero de 2019. Fueron examinados libros y artículos publicados en revistas de impacto, en idioma español, inglés y portugués, con atención prioritaria a aquellos que tuvieran cinco años o menos. Se consultaron las bases de datos MEDLINE, EBSCO, PubMed, SciELO, ClinicalKey, utilizando los descriptores: "Trauma Severity Indices", "Maxillofacial Injuries", "Traumatology", "Indexes". Se recuperaron dos libros y 50 artículos, aunque la revisión se circunscribió solamente a los 33 que mejor describían los elementos estudiados. Análisis e integración de la información: El puntaje Cooter David, el de gravedad de lesiones maxilofaciales, la escala de severidad de lesiones faciales, la de severidad de fracturas faciales y el modelo ZS, son los principales instrumentos utilizados en el pronóstico de gravedad existentes de la región facial. Conclusiones: Constan en la literatura escalas, índices y puntajes para pronosticar la gravedad del trauma maxilofacial en la urgencia, cada una exhibe ventajas que las convierte en una herramienta coadyuvante de la atención del trauma; sin embargo, poseen también desventajas que complejizan su aplicación en el medio hospitalario. Entre las herramientas más utilizadas está la escala de severidad de lesiones faciales; fácil de aplicar en los servicios de urgencia, pero con deficiencias a la hora de tratar los componentes de tejido blando y óseo. En Cuba hay escasas evidencias de la utilización de estos instrumentos en la especialidad de cirugía maxilofacial(AU)

ABSTRACT Introduction: The usage of prognostic tools that allow assessing trauma severity, as well as injury survival and mortality, allows patient stratification and making right decisions for the most effective treatment in the hospital area. Objective: To carry out a bibliographic review about the prognostic tools most widely used in emergency care to identify maxillofacial trauma severity. Methods: A bibliographic review was carried out from October 2018 to January 2019. We examined books and articles published in high-impact magazines, in Spanish, English and Portuguese, with priority attention on those five years old or less. We consulted the MEDLINE, EBSCO, PubMed, SciELO, Clinical Key databases using the descriptors Trauma Severity Indices, Maxillofacial Injuries, Traumatology, and Indexes. Two books and 50 articles were retrieved, although the review was limited to only 33 which described best the elements studied. Information analysis and integration: The Cooter-David scoring system, the maxillofacial injury severity score, the facial injury severity scale, the facial fracture severity scale, and the ZS model are the main instruments used for existing severity forecast in the facial region. Conclusions: There literature includes scales, indexes and scoring systems for predicting the maxillofacial trauma severity in the emergency department, each one showing advantages that make them an adjunct tool for trauma care; however, they also have disadvantages that complicate their application in the hospital setting. The facial injury severity scale is among the most widely used tools, as far as it is easy to apply in the emergency services, but with deficiencies for treating soft tissue and bone components. In Cuba, there is little evidence about the use of these instruments in the specialty of maxillofacial surgery(AU)

Estudio de 12 años de traumatismos maxilofaciales en niños / Twelve-year study of maxillofacial traumas in children

OBJETIVO: determinar algunos aspectos clínicos y epidemiológicos de los traumatismos maxilofaciales en una población de pacientes pediátricos. MÉTODOS: estudio descriptivo transversal con fase analítica sobre 2 450 niños de edades entre 0 y 14 años, atendidos en el Hospital Provincial "Hermanos Cordové" de Manzanillo, Cuba, durante los años 2001 al 2012. Las variables incluidas fueron: edad, sexo, procedencia geográfica, causa del trauma, tipo de lesión y tratamiento aplicado. La información fue resumida sobre la base de las frecuencias, a partir de las cuales se establecieron datos de asociación intervariables. El análisis estadístico incluyó el cálculo de intervalos de confianza y el test de chi cuadrado. RESULTADOS: predominaron el sexo masculino, el grupo de edad intermedia y la procedencia urbana. Los deportes y juegos infantiles, la caída de sus pies y los accidentes del tránsito, acumularon más del 60 % de las lesiones. Las variables demográficas mostraron diferencias estadísticamente significativas para las frecuencias de los diversos tipos de lesiones. Solo 8,3 % de los pacientes requirieron cirugía mayor.

OBJECTIVE: to determine some clinical and epidemiological aspects of maxillofacial traumatism in a pediatric patient population. METHODS: cross-sectional and descriptive study at analytical phase of 2 450 children aged 0-14 years, who were assisted in "Hermanos Cordové" provincial hospital located in Manzanillo, Granma province, from 2001 through 2012. The variables were age, sex, geographic origin, cause of trauma, type of injure and applied treatment. Information was summarized on the basis of frequencies from which inter-variable association data were drawn. The statistical analysis included estimation of confidence intervals and chi-square test. RESULTS: males, intermediate age group and urban origin predominated. Sports and child games, falls and traffic accidents accounted for 60 % of injures. The demographic variables showed statistically significant differences in frequencies of several types of lesions. Just 8.3 % of patients required major surgery.

A violência urbana contra crianças e adolescentes em Belo Horizonte: uma história contada através dos traumas maxilofaciais / The urban violence against children and adolescents in Belo Horizonte: a story told through the maxillofacial traumas

Os traumas maxilofaciais decorrentes da violência contra crianças e adolescentes impactam suas vidas, física e psiquicamente, pelas deformidades que podem provocar e pela exposição da lesão na face das vítimas. O objetivo deste trabalho é identificar a prevalência dos traumas maxilofaciais em crianças e adolescentes decorrentes da violência urbana em Belo Horizonte- Brasil. O estudo foi conduzido no Hospital Municipal Odilon Behrens, único hospital municipal de referência nesse tipo de atendimento em Belo Horizonte. Coletaram-se os registros de vítimas atendidas de janeiro a dezembro de 2007. O principal evento de violência sofrido entre crianças e adolescentes foi agressão física, 44,2 por cento e 64,7 por cento, respectivamente. Entre as crianças, o tipo de trauma mais comum foi o trauma dentoalveolar (53,8 por cento), e entre os adolescentes, trauma de tecidos moles (47,5 por cento). O maior número de ocorrências se deu no período noturno: crianças (84,6 por cento) e adolescentes (74,8 por cento). O gênero mais vitimado foi o masculino, crianças (63,5 por cento) e adolescentes (68,3 por cento). Estratégias apropriadas para identificação do evento de violência e do agressor são necessários para que melhor sejam planejados mecanismos de proteção da criança e do adolescente, uma vez que a violência sofrida por crianças e adolescentes no Brasil, considerando a complexidade dessa fase da vida, assume um quadro sombrio, desconstruindo o desenvolvimento, a sociabilidade e comprometendo a visão das vítimas sobre si mesmas e sobre o mundo que as cercam.

The maxillofacial traumas resulting from violence against children and adolescents have physical and psychical impact on their lives, because of the deformities and the injuries on their faces. This study aims to identify the prevalence of maxillofacial traumas in children and adolescents caused by urban violence in Belo Horizonte, Brazil. The study was conducted at Hospital Municipal Odilon Behrens, the primary reference hospital in this type of care in Belo Horizonte. We collected records of victims attended between January and December 2007. Among children and adolescents, the most recurring violence event was physical aggression, 44,2 percent and 64.7 percent respectively. Among children, the most common type was the dental-alveolar trauma (53.8 percent), while among adolescents, soft tissues trauma (47.5 percent). The highest number of occurrences was at night, for both children (84.6 percent) and adolescents (74.8 percent). The most victimized gender was masculine, children (63.5 percent), and adolescents (68.3 percent). Appropriate strategies to indentify violent events, as well as the aggressor himself, are necessary for planning better protection mechanisms for children and adolescents, since the violence suffered by this group in Brazil, considering the complexity of this stage of life, takes a gloomy picture, deconstructing their development, sociability, and undermining the victims' perspective about themselves and the world around them.