Pediatric vascular trauma in Manaus, Amazon - Brazil / Traumatismos vasculares pediátricos na cidade de Manaus, Amazonas - Brasil

ABSTRACT Objective: to assess the incidence of pediatric vascular injuries in patients treated at the Emergency Room of the Eastern Children's Hospital, in Manaus. Methods: we conducted a retrospective study of pediatric patients who suffered vascular injuries treated between February 2001 to February 2012. Results: we studied 71 patients, predominantly male (78.87%), with a mean age of 7.63 years. The predominant mechanism of injury was stab wound in 27 patients (38.03%). The average hospital stay was 10.18 days; 16 patients required care in intensive care unit, with average stay of 8.81 days. The main injuries occurred in the extremities, the upper limb being the most affected, with lesions of the ulnar artery in 13 (15.66%) and radial in 10 (12.04%). The mostly applied procedure was vascular exploration 35 (32.4%). Complications occurred in nine patients (12.68%). Mortality was 1.4%, in one patient with a lesion of the common iliac vein and the inferior vena cava due fall from height. Conclusion: pediatric vascular injury occurred predominantly in the extremities. The dimensions of the injured vessels made surgical correction more complex and increased complication rates, particularly amputations.

RESUMO Objetivo: avaliar a incidência de traumatismos vasculares pediátricos em doentes atendidos no Hospital Pronto Socorro da Criança Zona Leste, na cidade de Manaus. Métodos: estudo retrospectivo de doentes pediátricos vítimas de traumatismos vasculares atendidos no período de fevereiro de 2001 a fevereiro de 2012. Resultados: foram estudados 71 doentes com predominância do sexo masculino (78,87%) com média de idade de 7,63 anos. O mecanismo de trauma predominante foi o ferimento por arma branca em 27 pacientes (38,03%). A média de internação foi 10,18 dias, com 16 doentes necessitando de cuidados em unidade de tratamento intensivo com permanência média de 8,81 dias. As principais lesões ocorreram em extremidades, com predomínio do membro superior, com lesões das artérias ulnar em 13 (15,66%) e radial em dez (12,04%). O procedimento mais utilizado foi a exploração vascular 35 (32,4%). Em nove doentes (12,68%) ocorreram complicações. A mortalidade foi 1,4%, em um paciente com lesão da veia ilíaca comum e da veia cava inferior, devido à queda de altura. Conclusão: o traumatismo vascular pediátrico ocorreu predominantemente em extremidades. As dimensões dos vasos lesionados tornaram a correção cirúrgica mais complexa e aumentaram os índices de complicações, particularmente, de amputações.

Vascular injuries in the state of Pará, Brazil, 2011-2013 and their relation with demographic and clinical variables / Traumatismo vasculares no estado do Pará, Brasil, período de 2011 a 2013, e sua relação com variáveis clínicas e demográficas

BACKGROUND:Vascular traumas are associated with high morbidity rates.OBJECTIVE: To report the characteristics of vascular traumas in the Brazilian state of Pará, in trauma victims treated at the Hospital Metropolitano de Urgência e Emergência (HMUE), from 2011 to 2013.METHOD: This was a descriptive, cross-sectional, retrospective and quantitative study that analyzed data on sex, age group, geographical origin, time waiting for care, mechanism of trauma, clinical status, anatomic site of injury, prevalence of associated fractures, vascular structures injured, types of vascular injury, principal types of surgery, early postoperative outcomes, level of amputation, number of deaths, length of hospital stay and multidisciplinary care for 264 medical records.RESULTS: The majority of victims were male and the most common age group was from 16 to 30 years. The majority of cases were from towns other than the state capital, accounting for 169 cases (64.02%). The principal mechanism of injury was firearm wounding - 110 (41.67%) followed by cold weapon wounds - 65 (24.62%) and traffic accidents - 42 (15.91%). The segments of the body and the vascular structures most often injured were lower limbs - 120 (45.45%) and injuries to the popliteal and femoral arteries and veins. The most common clinical presentation at admission was hemorrhage - 154 (58.33%). The most common surgeries were ligatures of veins and arteries. There were 163 (61.74%) hospital discharges and 33 (12.5%) deaths.CONCLUSIONS: The greatest prevalence observed was related to traumas caused by urban violence. Victims were most frequently male, of working age and from towns other than the capital of the state of Pará.

CONTEXTO: Os traumatismos vasculares estão relacionados a altas taxas de morbidade. OBJETIVO: Caracterizar o traumatismo vascular no Estado do Pará, em vítimas atendidas no Hospital Metropolitano de Urgência e Emergência (HMUE), no período de 2011 a 2013. MÉTODO: Trata-se de um estudo descritivo, transversal, retrospectivo, quantitativo, que analisou: sexo, faixa etária, procedência, tempo de espera pelo atendimento, mecanismo de trauma, quadro clínico, região anatômica acometida, prevalência de fraturas associadas, estrutura vascular, tipos de lesão vascular, principais tipos de cirurgias, evolução do pós-operatório, nível de amputação, número de óbitos, tempo de internação e atendimento multiprofissional, dentre 264 prontuários.RESULTADOS: A maioria das vítimas foi do sexo masculino e a faixa etária mais acometida foi entre 16 a 30 anos. A maioria dos casos foi procedente de fora da capital, perfazendo 169 casos (64,02%). O principal mecanismo de lesão foi por arma de fogo - 110 (41,67%), seguido por arma branca - 65 (24,62%) e acidente de trânsito - 42 (15,91%). O segmento corporal e as estruturas vasculares mais acometidas foram os membros inferiores - 120 (45,45%), com lesões de artéria e veia poplítea e femoral. Durante a admissão, o quadro clínico mais frequente foi a hemorragia - 154 (58,33%). As ligaduras de veias e artérias foram as cirurgias mais frequentes. Houve 163 (61,74%) altas e 33 (12,5%) óbitos.CONCLUSÃO: A maior prevalência encontrada foi referente a traumas decorrentes da violência urbana, sendo também frequente o acometimento de indivíduos do sexo masculino, em idade produtiva e não procedentes da capital do Estado do Pará.

Caracterización de las lesiones vasculares por tomografía computada (TC) en heridas de arma de fuego: experiencia de tres años en hospital público del sector suroriente de Santiago de Chile / Characterization of vascular lesions in firearm wounds, using computed tomography (CT): three years experience in a public hospital in the southeastern area of Santiago, Chile

Resumen: Objetivos. Conocer las características epidemiológicas y radiológicas en TC, de las lesiones vasculares en pacientes que han sufrido heridas por arma de fuego (HAF), en el servicio de urgencia de un hospital público de Santiago-Chile, en un período de tres anos. Material y método. Revisión retrospectiva de 211 TC realizadas a pacientes ingresados al servicio de urgencia con diagnóstico de HAF entre 31/05/2009 y el 31/05/2012. Se incluyeron pacientes con TC dentro de las primeras 48 horas de ocurrido el evento, excluyendo los pacientes que por su condición clínica, fueron a intervención quirúrgica previa a la TC, obteniendo un N° final de 178. Se analizó la distribución según sexo, edad, tipo de lesión vascular, segmento topográfico afectado, tipo de proyectil y outcome de los pacientes. Resultados. El 96,8 por ciento (n°= 31) de los afectados fueron hombres, 71,8 por ciento menores de 36 años. El segmento más afectado correspondió a las EEII, con un 55,8 por ciento. El tipo de lesión que más frecuente fue el pseudoaneurisma y la hemorragia activa, con un 20,5 por ciento en cada caso. El tipo de proyectil que más frecuentemente se encontró, fueron las balas (65 por ciento) y en la gran mayoría de las veces, sin salida del proyectil. En nuestro grupo hubo un fallecido. Conclusión. Si bien el trauma vascular representa un bajo porcentaje dentro del total de las lesiones por trauma, su extrema gravedad, y por ende necesidad de diagnóstico certero y precoz, explica la importancia del conocimiento y familiarización que los radiólogos deberíamos tener con ese tipo de lesiones. Las extremidades son el principal sitio de lesiones vasculares por herida penetrante, alcanzando hasta el 70 por ciento en nuestro trabajo. En estos casos los exámenes imaginológicos muchas veces son sólo complementarios, porque clínicamente el diagnóstico está hecho, no así en las lesiones de vasos intratorácicos e intra-abdominales, donde las imágenes son indispensables para su...

Objectives. To determine the epidemiological and CT characteristics of vascular lesions in patients who have suffered gunshot wounds, in the emergency department of a public hospital in Santiago, Chile, over a period of three years. Material and Methods. Retrospective review of 211 CT performed on patients admitted to the emergency department with gunshot wounds, between 31/05/2009 and 31/05/2012. Patients with a CT within the first 48 hours after the event occurred were included, excluding patients who for their clinical condition, underwent surgery prior to the CT, obtaining a final number of 178. Distribution was analyzed by sex, age, type of vascular injury, topographic segment affected, projectile type and outcome of patients. Results. 96.8 percent (n° = 31) of those affected were men, 71.8 percent under 36 years. The most affected segment were to the lower extremities, with 55.8 percent. The most frequent type of injury was pseudoaneurysm and active hemorrhage, with 20.5 percent in each case. The type of projectile most frequently found were bullets (65 percent) and the majority, without projectile exit. In our group there was 1 death. Conclusion. Although vascular trauma represents a low percentage of total trauma injuries, their seriousness, and therefore the need for early and accurate diagnosis, explains the importance of the knowledge and familiarity that radiologists should have, with that kind of injury. Extremities are the main site of vascular injury caused by penetrating wounds, affecting up to 70 percent in our sample. In these cases CT examinations are often only complementary because the diagnosis is made clinically; this is not the case in intrathoracic and intraabdominal vessel injuries, where images are essential for diagnosis.