Prognosis Factors in Patients with Spinal Cord Trauma / Fatores de prognóstico em pacientes com trauma raquimedular

Objective Analyze the predictors of prognosis in patients with spinal cord trauma (SCT) in a tertiary hospital. Method Study prospective with 321 patients. The analysis focused on patient-related data, cause of accident, anatomical distribution, neurologic status, associated injuries, length of hospital stay, and in-hospital complications/mortality. Results The SCT was more common in men, but women older than 50 years presented a higher risk than men of the same age. Automobile accidents, motorcycle accidents, and gunshots resulted in more injuries associated. The cervical spine involvement was directly related to an increase in the number of associated injuries, complications, and mortality. Already, the neurologic status ASIA-A was associated with an increase in the number of complications, length of stay, and mortality. Conclusion The predictive factors of prognosis in these patients included age, sex, cause of injury, anatomic distribution, and neurologic status.

Objetivo Analisar os preditores de prognóstico em pacientes vítimas de trauma raquimedular (TRM) em um hospital terciário. Método Estudo prospectivo com 321 pacientes. A análise foi direcionada aos dados relacionados aos pacientes, causa do acidente, distribuição anatômica, status neurológico, lesões associadas, tempo de permanência hospitalar e complicações e mortalidade no hospital. Resultados O TRM foi mais comum em homens, mas mulheres com idade superior a 50 anos apresentaram mais risco que homens da mesma faixa etária. Ferimento por arma de fogo, acidentes automobilísticos e de motocicleta resultaram em maior número de lesões associadas. O trauma na coluna cervical foi diretamente relacionado

Características epidemiológicas del trauma raquimedular: una comparación entre Valparaiso-Chile y Cochabamba-Bolivia / Epidemiological characteristics of spinal cord trauma: a comparison of Valparaiso-Chile-Bolivia and Cochabamba

El estudio de los traumatismos raquimedulares, tiene vital importancia por afectar una población económicamente activa, perjudicando entre otras, el crecimiento económico de las familias comprometidas, por ello; el presente estudio pretende conocer cuáles son las características epidemiológicas del trauma raquimedular; analizando la prevalencia según el sexo, grupo etareo, etiología, secuelas, manejo hospitalario, complicaciones y morbi-mortalidad entre otras variables; mediante un estudio multicéntrico comparativo, descriptivo retrospectivo, entre los centros neuro-quirúrgicos de referencia de Valparaíso-Chile y Cochabamba-Bolivia. Se revisaron 372 historias clínicas de pacientes con diagnóstico final de trauma raquimedular; correspondientes al periodo comprendido entre enero-2002 hasta junio-2010, obteniéndose los siguientes resultados: Se obtuvo una media de 3.72 + 0.12 casos por mes: el grupo etareo más afectado fue el de 15-29 años en Valparaíso y los 30-39 años en Cochabamba (28.8 por ciento; DE + 2.2), el sexo masculino es el más afectado (72.84 por ciento; DE + 3.7) siendo la causa más frecuente la caída de grandes alturas en Cochabamba y la actividad de los piqueros en el mar, en Valparaíso (28.83 por ciento; DE + 4.3), la media de estancia hospitalaria fue de 20.29 + 19.4 días en Valparaíso vs 22.16 + 11.5 días en Cochabamba, el tratamiento conservador fue el más usado en Cochabamba; sin embargo el 77.48 + 0.19 por ciento fue intervenido quirúrgicamente en Valparaíso, el 78.19 + 0.19 por ciento tuvieron una evolución favorable, la secuela más común fue la paraplejia en el 6.44 + 0.13 por ciento y la mortalidad fue del 4.5 por ciento en Valparaíso y 2.73 por ciento en Cochabamba. Llegándose a concluir que el paciente con trauma raquimedular es un varón joven económicamente activo, con estancia hospitalaria prolongada, de evolución favorable pues responde al tratamiento conservador; con riesgo de incapacidad por paraplejia.

The study of traumatic spinal cord injuries, is vitally important because it affects the economically active population, harming among others, the economic growth of the families involved, therefore, the study seeks to examine what are the epidemiological characteristics of spinal cord injuries, evaluating the prevalence according sex, age group, etiology, sequelae, hospital management, complications and morbidity and mortality among other variables, through a multicenter comparative descriptive retrospective, including neurosurgical centers for reference of Valparaiso-Chile and Bolivia-Cochabamba. We reviewed medical records of 372 patients with final diagnosis of spinal cord injury, of the period January to June 2002-2010, and the results were as follows: We obtained an average of 3.72 + 0.12 cases per month: the age group most affected was 20-29 years in Valparaiso and 30-39 years in Cochabamba (28.8 percent, SD + 2.2). The male is most affected (66.9 percent, SD + 3.7) being the most common cause from great heights in Cochabamba and the activity of the boobies in the sea in Valparaiso (36.9 percent, SD + 4.3), the average hospital stay was 20.29 + 19.4 days in Valparaiso and 22.16 +11.5 days in Cochabamba. The conservative treatment was the most used and only 12 + 2.16 percent underwent surgery, 97 + 3.3 percent had a favorable outcome, the most common sequel was the paraplegia in 6.7 + 3.2 percent of the cases, and mortality was 6.3 percent in Valparaiso and 3 percent in Cochabamba. The authors conclude that patients with spinal cord injury are most frequent in the young male economically active, with prolonged hospital stay, because of favorable response to conservative treatment, with risk of disability due to paraplegia.

Spinal cord injury: epidemiologycal study of 386 cases with emphasis on those patients admitted more than four hours after the trauma / Trauma raquimedular: estudo epidemiológico de 386 casos com ênfase para aqueles pacientes admitidos após quatro horas do trauma

We studied 386 cases of spinal cord injury to analyze the follow up of the patients admitted most of the time more than four hours, the majority of the injuries happening far from the attending health service and first specialized care received long after the accident. This is a clinical study based on data collected during hospitalization of the patients, operated or not, in a Brazilian public health service. The lesion mainly seen was fracture and dislocation, isolated or on multiple levels, and the most important clinical complications were due to respiratory failure and hypotension, especially because 73.8 percent were from outside and they were admitted more then four hours after the trauma. The mortality rate was 11.9 percent, but just 2.1 percent had undergone a surgery. The complications resulted in major risk of death when the trauma was at the cervical level and the patients were over 50 years old, especially when admitted more than four hours after the trauma. We emphasize the importance of the first health care concerning the clinical treatment, aiming to reduce the mortality rate.

Estudamos 386 casos de trauma raquimedular, observando a evolução dos pacientes admitidos na maioria das vezes após quatro horas do trauma, a maioria procedente de lugar distante do serviço de saúde. Trata-se de um estudo clínico baseado em dados coletados durante a hospitalização, de pacientes operados ou não, em serviço de saúde pública no Brasil. Na maioria das vezes a lesão principal foi fratura-luxação, isolada ou em múltiplos níveis, e as complicações clínicas mais importantes foram devido à insuficiência respiratória e hipotensão, especialmente porque 73.8 por cento dos casos eram de lugares distantes, tendo sido admitidos mais de quatro horas após o trauma. A taxa de mortalidade foi 11,9 por cento, sendo 2,1 por cento em pós-operatório. As complicações resultaram em maior risco de morte quando o trauma foi ao nível cervical, idade acima de 50 anos, especialmente aqueles admitidos com mais de quatro horas. Enfatizamos a importância do primeiro atendimento na admissão, sobretudo para as alterações respiratórias e hemodinâmicas, objetivando reduzir a mortalidade.

Traumatismo encefalocraneano y raquimedular: experiencia inicial: Unidad de Cuidados Intensivos - Hospital Regional Copiapó / Encephalocranial and spine trauma: initial experience: intensive care unit - Regional Hospital Copiapó

Neurotrauma is one of the three causes of mortality. We are showing our initial experience, with neurosurgical support and specifically all of the patients were admited to the Critical Care Unit of the Hospital Regional of Copiapó; at the 3rd region of the country. We described the head trauma and spine trauma cases, and the neurointensive management; now with neurotrauma surgery at all. The goal of this article is to show our initial experience and our capabilities and the proyection in the development of neurointensivism in our center.

Consideraciones anestésicas en el paciente con traumatismo raquimedular / Anesthetic considerations in the patient with traumatic spinal injury

El traumatismo raquimedular involucra frecuentemente a individuos jóvenes; causado por accidentes de tránsito, actos de violencia o durante la práctica deportiva, produce significativa morbimortalidad y elevados costos durante la recuperación. Las medidas de transporte y soporte se basan en la inmovilización, el mantenimiento de la vía aérea y el control hemodinámico. La cirugía puede ser necesaria para remoción de fragmentos óseos, descompresión y estabilización o evacuación de hematomas. El cuadro clínico depende del nivel de lesión, por debajo del cual estará comprometido el funcionamiento de todos los órganos y la termorregulación, pudiendo existir falla respiratoria, secundaria a parálisis de los músculos de la respiración. Durante la anestesia debe asegurarse el flujo sanguíneo medular manteniéndose la presión de perfusión dentro de los límites de autorregulación (entre 60 y 120 mmHg de tensión arterial media); la hipotensión y la bradicardia deben corregirse mediante la expansión, seguida de la utilización de drogas inotrópicas, pudiendo ser necesario monitoreo hemodinámico invasivo (catéter en la arteria pulmonar). Se deben tomar medidas para evitar la aspiración del contenido gástrico y tratar el edema y el embolismo pulmonar. El tratamiento médico agresivo (resucitación y aumento de la presión de perfusión) y la cirugía de descompresión en las lesiones por dislocación, mejoran el pronóstico clínico neurológico.

Urologic and sexual complications in chronic spinal cord injury patients with its management overview: a review of 500 patients

A total of 500 patients with chronic SCI were studied clinically, radiologically, bacteriologically, urodynamically in a specialized SCI Center, over one year. Medical treatment, different endoscopic procedures [182 patients] and surgical procedures [77 patients] have been performed. The results revealed that hydronephrosis was reported in 100 patients [V-U reflux 65, stricture ureter 20, renal calculi 9, and infravesical obstruction 6]. Renal stones were occurred in 45, bladder stones in 65 and RF in 16 patients. Also, stricture urethera was occurred in 16, uretheral diverticulum in 3, dyssenergia in 60 in UMNL and 15 in LMNL. Urinary scrotal fistula was represented in 19, traumatic hypospadius in one, penile amputation and edema in 4 patients. Erection was preserved in 70% and antegrade ejaculation in 10% of patients. It was concluded that urologic manifestations of SCI are protean. Their management are controversial with wide range of treatments. The main goal in treatment is to control urosepsis and to provide adequate bladder drainage

Traumatismos raquemedulares agudos: estudo epidemiológico de cem casos consecutivos / Acute spinal cord injuries: epidemiological study of 100 consecutive cases

Os traumatismos raquemedulares (TRM) representam importante causa de mortalidade e morbidade. Neste trabalho é apresentado um estudo epidemiológico de 100 casos consecutivos de TRM agudos, hospitalizados no Hospital Municipal de Pronto-Socorro de Porto Alegre. Nesta série, observa-se nítida prevalência de pacientes do sexo masculino, com pico de incidência entre 16 e 30 anos de idade. As causas mais comuns de TRM foram as quedas (54), destacando-se os acidentes por mergulho (37), seguidos pelos acidentes de trânsito (26) e as agressöes (20). A regiäo vertebral mais comumente acometida foi a coluna cervical (63), especialmente entre C5 e C6, com maior incidência de fraturas com deslocamento vertebral (49). A grande maioria dos casos apresentava-se com deficiência motora acentuada no momento da hospitalizaçäo (86), com alta percentagem de pacientes com distúrbios sensitivos e esfincterianos associados. Considerável quantidade de pacientes apresentava lesöes associadas de outros órgäos ou sitemas, sendo que a mortalidade global observada foi de 24%

Lesión cervical de un neonato por trauma obstétrico / Cervical lesion of the neonate caused by obstetric trauma

La presentación de un caso clínico de lesión de columna vertebral permite la revisión de una patología no frecuente en la actualidad. Se trata de daños de distinto grado en la columna y médula cervical producidos en el neonato, como consecuencia de partos distócicos. Sus consecuencias son de carácter neurológico y/o traumatológico en la mayoría de las veces. Sin duda su baja incidencia actual corresponde a los adelantos logrados en la obstetricia. Las consecuencias de este traumatismo pueden ocasionar la muerte del neonato en minutos, horas o días, como también dejar secuelas invalidantes. La incidencia mayor que relata la bibliografía se manifiesta en partos de podálica.

Traumatismos craneoencefalicos en accidentes de transito / Head injuries in traffic accidents

Los accidentes de transito unidos a las lesiones por arma de fuego y cortopunzantes ocupan los primeros lugares como causas de muerte y de necropsia Medico-Legal en la ciudad de Bogota en el ano de 1979. El trauma craneo-encefalico constituye la primera causa de muerte como consecuencia de un accidente de vehiculo a motor y por lo tanto la lesion medico-legal mas frecuentemente observada. Se encontro un franco predominio del sexo masculino, siendo el peaton la victima mas comprometida y el grupo de poblacion entre los 0 y 44 anos, la mas afectada. El alcohol se encontro en un 18% con grados de embriaguez de I a III.