Desafíos del cirujano general en la realización de la ecografía en la evaluación del trauma / Challenges of the General Surgeon in the Performance of Trauma Assessment Ultrasound

Introducción: El trauma es la pandemia que cada año cobra muchas vidas, los avances tecnológicos no han podido detenerla, sin embargo, estos han ayudado en la evaluación más efectiva de los pacientes. La ecografía realizada por médicos no radiólogos se ha convertido en una herramienta necesaria en la evaluación del paciente traumatizado. Objetivo: Describir los conocimientos que debe adquirir el cirujano general para realizar ecografía en la evaluación del trauma. Método: Se realizó una revisión bibliográfica del tema en las bases de datos PubMed, BVS-BIREME y Cochrane. Se describió los elementos que tiene que conocer el cirujano general para realizar ecografía en la evaluación del trauma. Se consideraron en la búsqueda todo tipo de estudios publicados desde enero de 1971 hasta diciembre de 2019 a los cuales se tuvo acceso y se realizó la evaluación de la validez interna de la evidencia, así como de su calidad global. Los idiomas utilizados en la búsqueda fueron el español e inglés. Desarrollo: La mayoría de los estudios aceptan a la ecografía como herramienta de evaluación en el trauma y su utilización sistemática por médicos no radiólogos. Conclusiones: Los principios básicos de la ecografía en el trauma tienen que ser parte de las herramientas de un cirujano general del siglo xxi. Los errores más frecuentes, responden a la no realización sistemática y a la falta de entrenamiento. Cada vez son menos las contraindicaciones de la ecografía en el trauma, pero sí es marcada la dependencia del operador(AU)

Introduction: Trauma is the pandemic that every year claims many lives; technological advances have not been able to stop it, but have contributed with the more effective assessment of patients. Ultrasound performed by non-radiologists physicians has become a necessary tool in the assessment of the trauma patient. Objective: To describe the knowledge that the general surgeon should acquire to perform ultrasound for assessing trauma. Methods: A bibliographic review of the subject was carried out in the PubMed, BVS-BIREME and Cochrane databases. The elements that the general surgeon must know in order to perform ultrasound in the assessment of trauma were described. The search considered all types of studies published from January 1971 to December 2019 and that could be accessed; the internal validity of the evidence was assessed, together with its overall quality. The languages used in the search were English and Spanish. Development: Most studies accept ultrasound as an assessment tool in trauma and its systematic use by non-radiologist physicians. Conclusions: The basic principles of ultrasound in trauma have to be part of the tools of a general surgeon of the twenty-first century. The most frequent errors are due to lack of systematic use and lack of training. Contraindications of ultrasound in trauma are progressively less frequent, but there is a marked dependence on the person who operates(AU)

Aspects of trauma related to violence, accidents and falls before and during the COVID-19 pandemic / Aspectos del trauma relacionados con la violencia, accidentes y caídas antes y durante la pandemia COVID-19

Abstract Introduction: Trauma is the second leading cause of mortality and the sixth leading cause of hospitalization in the country, with violence, accidents, and falls being the most prevalent. However, the country is experiencing reflexes of the COVID-19 pandemic, together with a lack of studies on trauma, as well as on clinical care. Objective: To analyze the clinical and epidemiological characteristics of trauma related to violence, accidents, and falls among the years 2019, 2020, and 2021, considered as before and during the COVID-19 pandemic. Material and Methods: Retrospective cohort study, with adults aged 25-55 years, who suffered trauma related to violence, falls, and other accidents, in the period between March and June of 2019, 2020, and 2021, in the city of São Paulo. Data surveys were carried out using the TABNET system, of the Municipal Health Department. Within this system, the search was carried out through the Information System for the Surveillance of Accidents, of the Coordination of Health Surveillance, in which situations of violence were notified and recorded by the National Information System for Notifiable Diseases. Subsequently, the Information System for Surveillance of Violence and Accidents was accessed, focusing on notifications and records of falls and other accidents. Results: Trauma remained more prevalent for males, with complete primary education, and ethnicity predominantly between white or brown. When analyzing the different types of violence: physical, torture, and sexual, there was a prevalence of higher percentages during the year 2019, the pre-pandemic period of COVID-19, except for psychological/moral violence, which was higher in 2021. It should also be noted that the different mechanisms of violence were significantly more prevalent in 2019, as well as the different causes of violence, falls, and car trauma involving pedestrians, occupants, drivers, and passengers. Outpatient care confirmed the higher trend in the pre-pandemic period; however, emergency hospital care showed a greater number of requests in 2020 and 2021. Conclusión: Trauma from violence, accidents, and falls was higher pre-pandemic compared to the period during the COVID-19 pandemic; as well as the search for health care in hospitals and outpatient clinics. These findings show a possible reduction in trauma reports and lower demand for assistance during the pandemic.

Resumen Introducción: El trauma es la segunda causa de mortalidad y la sexta de hospitalización en el país, siendo la violencia, los accidentes y las caídas las más prevalentes. Sin embargo, el país está experimentando reflejos de una pandemia de COVID-19, junto a una falta de estudios sobre el trauma, así como sobre la atención clínica. Objetivo: Analizar las características clínicas y epidemiológicas del trauma junto a la violencia, accidentes y caídas entre los años 2019, 2020 y 2021, considerados antes y durante la pandemia COVID-19. Materiales y métodos: Estudio de cohorte retrospectivo, con adultos de 25 a 55 años, que sufrieron trauma relacionado con violencia, caídas y otros accidentes, en el período comprendido entre marzo y junio de 2019, 2020 y 2021, en la ciudad de São Paulo. Las encuestas de datos fueron realizadas por el sistema TABNET, por el Departamento Municipal de Salud. Dentro de este sistema, la búsqueda se realizó a través del Sistema de Información para la Vigilancia de Accidentes, de la Coordinación de Vigilancia en Salud, en el cual las situaciones de violencia fueron notificadas y registradas por el Sistema Nacional de Información de Enfermedades Notificables. Posteriormente, se accedió al Sistema de Información de Vigilancia de Violencia y Accidentes, con enfoque en notificaciones y registro de caídas y otros accidentes. Resultados: El trauma siguió siendo más prevalente para los hombres, con educación primaria completa y raza predominantemente entre blancos y morenos. Al analizar los diferentes tipos de violencia: física, tortura y sexual, hubo mayores porcentajes de prevalencia durante el año 2019, período prepandémico de COVID-19, a excepción de la violencia psicológica / moral, que fue mayor en 2021. Nótese que los diferentes mecanismos de violencia fueron significativamente más prevalentes en 2019, así como las diferentes causas de violencia, caídas y traumatismos automovilísticos que involucran a peatones, ocupantes, conductores y pasajeros. La atención ambulatoria confirmó la tendencia de superioridad en el período prepandémico, sin embargo, la atención hospitalaria de emergencia mostró un mayor número de solicitudes en 2020 y 2021. Conclusión: Los traumas de violencia, accidentes y caídas son más prepandémico en comparación con el período durante la pandemia COVID-19; así como la búsqueda de asistencia sanitaria en hospitales y clínicas. Estos hallazgos muestran una posible reducción en los informes de trauma y una menor demanda de asistencia durante la pandemia.

Perfil dos atendimentos pré-hospitalares em serviço de atendimento móvel de urgência no nordeste do Brasil / Perfil de la atención prehospitalaria en servicio de atención móvil de urgencia en el nordeste de Brasil / Profile of pre-hospital care in a mobile emergency care service in northeast Brazil

RESUMO Objetivo: Descrever o perfil epidemiológico dos atendimentos pré-hospitalares realizados por um serviço móvel de emergência no município de Picos, Piauí, Brasil. Métodos: Trata-se de um estudo transversal, documental e retrospectivo com abordagem quantitativa, realizado nos meses de abril e maio de 2020. Foram analisados 4.220 registros com base nos atendimentos realizados pelo Serviço de Atendimento Móvel de Urgência às ocorrências que aconteceram no período de janeiro de 2019 a março de 2020. Os dados foram coletados das fichas de atendimento individuais da instituição, organizados por meio de um formulário e analisados à luz da estatística descritiva. Resultados: Foi observada frequência de ocorrências ligeiramente maior em indivíduos do sexo masculino (50,3%), predominância das faixas etárias de 20 a 30 anos (30,7%) e maior de 60 anos (34,2%), atendimentos realizados pela Unidade de Suporte Básico (65,9%). As ocorrências traumáticas provenientes de acidentes de transporte (68,5%) e as clínicas cardiológicas (18%) se apresentaram em maior percentual em relação às demais. As ocorrências traumáticas foram mais frequentes no período de outubro a dezembro e as clínicas nos meses de fevereiro e março. Conclusão: O perfil epidemiológico dos atendimentos corresponde à população do gênero masculino e faixa etária maior ou igual a 60 anos. Predominaram as ocorrências de natureza clínica, principalmente cardiológicas.

RESUMEN Objetivo: describir el perfil epidemiológico de la atención prehospitalaria realizada por un servicio de atención móvil de urgencia en el municipio de Picos, Piauí, Brasil. Métodos: se trata de un estudio transversal, documental y retrospectivo con enfoque cuantitativo, realizado en los meses de abril y mayo de 2020. Se analizaron 4.220 registros con base en las atenciones realizadas por el Servicio de Atención Móvil de Urgencia a los casos que ocurrieron en el período de enero de 2019 a marzo de 2020. Los datos fueron recolectados de las fichas de atención individuales de la institución, organizados por medio de un formulario y analizados a la luz de la estadística descriptiva. Resultados: fue observada frecuencia de casos ligeramente mayor en individuos del sexo masculino (50,3%), predominancia de las franjas etarias de 20 a 30 años (30,7%) y mayor de 60 años (34,2%), atenciones realizadas por la Unidad de Soporte Básico (65,9%). Los incidentes traumáticos provenientes de accidentes de transporte (68,5%) y las clínicas cardiológicas (18%) se presentaron en mayor porcentaje con relación a los demás. Los incidentes traumáticos fueron más frecuentes en el período de octubre a diciembre y las clínicas en los meses de febrero y marzo. Conclusión: el perfil epidemiológico de las atenciones corresponde a la población del género masculino y franja etaria mayor o igual a 60 años. Predominaron los incidentes de naturaleza clínica, principalmente cardiológicas.

ABSTRACT Objective: To describe the epidemiological profile of pre-hospital care performed by a mobile emergency service in the municipality of Picos, Piauí, Brazil. Methods: This is a cross-sectional, documentary and retrospective study with a quantitative approach, conducted in April and May 2020. We analyzed 4,220 records based on the visits performed by the Mobile Emergency Care Service to the occurrences that occurred between January 2019 and March 2020. Data were collected from the institution's individual care forms, organized through a form and analyzed in the light of descriptive statistics. Results: A slightly higher frequency of occurrences was observed in males (50.3%), predominance of the age groups from 20 to 30 years (30.7%) and higher than 60 years (34.2%), attendances performed by the Basic Support Unit (65.9%). Traumatic occurrences resulting from traffic accidents (68.5%) and cardiologic clinics (18%) were higher in percentage in relation to the other ones. Traumatic occurrences were more frequent from October to December and clinics in February and March. Conclusion: The epidemiological profile of the visits corresponds to the male population and age group greater than or equal to 60 years. Occurrences of a clinical nature, especially cardiac, predominated.

Epidemiología de los casos pediátricos en la sala de emergencias de un hospital general / Epidemiology of pediatric cases in the emergency room of a general hospital

Objetivos El objetivo de este estudio es determinar a qué tipo de patologías nos enfrentamos. Utilizamos la Clasificación Internacional de Atención Primaria para asegurar una nomenclatura objetiva y comparable. Métodos Se realizó un estudio descriptivo, observacional y retrospectivo de una muestra de 108102 consultas de atención primaria de pacientes que acudieron a Urgencias de nuestro hospital para evaluar la epidemiología de la atención pediátrica brindada entre 2011 y 2019. Utilizamos el sistema de clasificación diagnóstica ICPC-2. Resultados El número de asistencias fue mayor en enero, febrero y marzo, así como los fines de semana. Tras ser atendidos, el 6,7% de los pacientes ingresaron en nuestro hospital. Las patologías más frecuentes fueron las infecciones del tracto respiratorio superior, gastroenteritis, fiebre y traumatismos / lesiones. Las patologías que con mayor frecuencia dieron lugar a ingresos hospitalarios fueron fiebre, bronquitis, gastroenteritis y vómitos (p> 0,001). En los ingresos hospitalarios de menores de 1 año, la bronquitis fue la patología más frecuente, mientras que entre los de 1 a 6 años fue la gastroenteritis y entre los de 7 a 14 años fue la apendicitis aguda (p <0,001). Conclusiones Las patologías pediátricas suponen un porcentaje importante de las visitas a urgencias, destacando las infecciones del tracto respiratorio superior, las infecciones intestinales y la fiebre. Sería aconsejable incrementar los recursos de personal en los fines de semana. Es necesario enfatizar en la educación sanitaria de la población para ajustar la demanda de asistencia en los servicios públicos. Se requiere más investigación para adaptar mejor la terminología ICPC-2.

Objectives The aim of this study is to determine what type of pathologies we are facing. We use the International Classification of Primary Care to ensure an objective and comparable nomenclature. Methods We carried out a descriptive, observational, and retrospective study of a sample comprising 108102 primary care encounters of patients presenting at our hospital's Emergency Room to assess the epidemiology of the pediatric care provided between 2011 and 2019. We used the ICPC-2 diagnosis classification system. Results The number of attendances was higher in January, February, and March, as well as at weekends. After being seen, 6.7% of patients were admitted to our hospital. The most frequent pathologies were upper respiratory tract infections, gastroenteritis, fever and trauma/injury. Pathologies most frequently resulting in hospital admissions were fever, bronchitis, gastroenteritis and vomiting (p>0.001). In hospital admissions involving patients under 1 year of age, bronchitis was the most frequent pathology, while among those aged between 1 and 6 years, it was gastroenteritis and among those aged between 7 and 14 years it was acute appendicitis (p<0.001). Conclusions Pediatric pathologies account for a significant percentage of visits to the emergency room, highlighting infections of the upper respiratory tract, intestinal infections, and fever. It would be necessary to increase staff resources on the weekends. It is highly recommended to emphasize the health education of the population to adjust the demand for assistance in public services. More research is required to better adapt the ICPC-2 terminology.

Enfermedades, lesiones y accidentes en trabajadores de la construcción en Uruguay, período 2014-2018 / Illnesses, injuries and accidents among construction workers in Uruguay, 2014-2018

El presente trabajo se realizó en el marco de las actividades de investigación y extensión del Departamento de Salud Ocupacional de la Facultad de Medicina Universidad de la República, por iniciativa de los trabajadores del sindicato único de la construcción y afines. El objetivo fue conocer el perfil de salud y enfermedad de los trabajadores del sector con el propósito de generar acciones que promuevan la salud laboral del colectivo involucrado. La investigación realizada es de carácter descriptivo a partir de fuentes secundarias. De los resultados se destacaron las enfermedades del aparato osteomioarticular, lesiones por traumatismos o envenenamiento y patologías del aparato respiratorio como principales causas de ausentismo de origen médico. La patología osteomioarticular fue la primera causa de incapacidad total y también es la primera causa de incapacidad para la tarea en el periodo estudiado. La tasa de incidencia acumulada de los accidentes en el año 2014 fue de 81,8 por 1.000 trabajadores cotizantes de la construcción, presentando una caída sostenida hasta el 2018 que alcanzó el valor de 60,2 por 1.000 trabajadores cotizantes. El tipo de accidente más frecuente observado en el periodo fueron las lesiones a esfuerzo excesivo. Con respecto a los accidentes mortales existe una caída marcada entre los años 2014 al 2016 con un ascenso progresivo en 2018. De la investigación surge como necesidad mejorar el reconocimiento de la patología profesional en el sector, profundizar las acciones en seguridad y salud con énfasis en aspectos ergonómicos de la carga física(AU)

This study was carried out under the framework of the research and outreach activities of the Department of Occupational Health of the School of Medicine of the University of the Republic, as an initiative of the workers of its single union of construction and related industries. The objective was to describe the health and disease profile of workers in the sector in order to generate actions to promote their occupational health. The study was descriptive and consisted of a secondary analysis of existing data. Musculoskeletal disorders, traumatic injuries, poisonings and respiratory illnesses were the main cause of sickness absence. Musculoskeletal disorders were the main cause of both work-related and total disability. The cumulative incidence rate of injuries in 2014 was 81.8 per 1000 dues-paying construction workers, and subsequently declined until 2018, to an incidence of 62.2 per 1000 dues-paying workers. Overexertion was the most common mechanism of injury. With respect to fatal accidents, there was a arked decline between 2014 and 2016, followed by a progressive increasein 2018. This study underscores the need to improve the recognition of occupational illness and injury in the construction and related industries sector, and to add depth to safety and health interventions, with an emphasis on ergonomic aspects of physical loads(AU)

Descripción clínica de pacientes pediátricos con enfermedades neuromusculares en una muestra de población chilena / Clinical description of pediatric patients with neuromuscular diseases in a Chilean population sample

OBJETIVO: Describir clínica y diagnóstico de 152 pacientes pediátricos asistentes al policlínico del Programa de Enfermedades Neuromusculares (ENM) en un centro terciario de la Región Metropolitana, Chile. METODOLOGÍA: Revisión de fichas programa EMN (2012-2016). RESULTADOS: 49% niñas, mediana de edad: 9 años (rango, 0­18), consultan por alteraciones de la marcha, debilidad e hipotonía. Segmentos más afectados son músculo y nervio periférico (92%). Diagnósticos más frecuentes son neuropatías adquiridas (26,1%), distrofias musculares (14,8%) y trastornos miotónicos (12,7%). Comorbilidades más frecuentes son patología traumatológica (23,2%) y discapacidad intelectual (13,4%). Los pacientes con patología hereditaria tienen mayor chance de requerir ventilación mecánica (OR 15,4; IC 95% 1,9­119,2) y presentar morbilidad traumatológica (OR 4,1; IC 1,03­16,4) que los con patología adquiridas. Confirmación genético-molecular en 38,4% de los pacientes con patología hereditaria. CONCLUSIONES: El conocimiento de características clínicas y posibilidades de estudio de las ENM puede mejorar las estrategias de atención.

INTRODUCTION: Neuromuscular diseases (NMS) represent a heterogeneous group of acquired and hereditary pathologies that affect the motor unit. There are few descriptive studies of patients with NMS in Chile and Latin America. OBJECTIVES: To clinically and epidemiologically characterize the pediatric population attending a polyclinic run using the NMS program of a hospital in the Metropolitan Region in Chile. Methodology: A review was made of database and clinical records of patients diagnosed with NMS between January 2012 and December 2016. RESULTS: A total of 142 patients, 51% of whom were male, with a median age 9 years (0-18 years), were included. The most frequent reasons for consultation were altered gait, decreased strength, and hypotonia. The most frequently affected segments were muscles and peripheral nerves (92% of the sample). The most frequent diagnoses were acquired neuropathies (26.1%), muscular dystrophies (14.8%), and myotonic disorders (12.7%). The most frequent comorbidities were traumatological pathologies (23.2%) and intellectual disabilities (13.4%). When comparing NMS with hereditary vs. acquired etiologies, those with hereditary etiologies had a higher risk of requiring mechanical ventilation (OR 15.4 [95%CI 1.9-119.2]) and having a traumatological disease (OR 4.1 [CI 1.03-16.4]) compared to those with acquired etiologies. For 38.4% of patients with hereditary etiologies, confirmation was obtained through molecular genetic testing. CONCLUSIONS: This study provides information on the frequency of NMS and their main comorbidities in a Chilean pediatric sample. These results provide information regarding current possibilities for studies and could aid in planning care for these patients in our country. Keywords: Neuromuscular disease, Muscular disease, Neuropathies, Neurological Diagnostic.

Lesiones no intencionales en menores de 18 años / Unintentional Injuries in Children under Eighteen Years of Age

Introducción: Las lesiones no intencionales se consideran un problema de salud en el mundo, las tasas se elevan de forma marcada. En Cuba ocupan una de las primeras causas de morbilidad en la edad pediátrica. Objetivo: Describir las principales características epidemiológicas de las lesiones no intencionales en menores de 18 años en Matanzas. Métodos: Se realizó un estudio descriptivo en Matanzas entre el 2013 y el 2018. El universo estuvo constituido por las 4464 lesiones no intencionales ocurridas en menores de 18 años durante el periodo analizado. Para el análisis de las variables se utilizaron tasas crudas por 10 000 habitantes. Resultados: Las tasas de morbilidad en la provincia estuvieron entre 45,2 y 58,2 por 10 000 habitantes. Los municipios de mayor riesgo resultaron Matanzas y Limonar. La mayoría de las lesiones no intencionales ocurrieron en el hogar, las caídas fueron las más frecuentes y provocaron lesiones leves. Conclusiones: Las lesiones no intencionales constituyen un problema de salud. Es necesario evaluar y controlar los factores de riesgo en los distintos tipos de accidentes para prevenir o disminuir su incidencia a través de estrategias de información, educación y comunicación. Lograr que las familias estén conscientes de la vulnerabilidad de los niños es un factor esencial y básico en todos los esfuerzos que tengan como objetivo la prevención de las lesiones no intencionales en esta etapa de la vida(AU)

Introduction: Unintentional injuries are considered a health concern worldwide. Their rates rise drastically. In Cuba, they occupy one of the leading causes of morbidity in pediatric age. Objective: To describe the main epidemiological characteristics of unintentional injuries in children under 18 years of age in Matanzas. Methods: A descriptive study was carried out in Matanzas, between 2013 and 2018. The universe consisted of 4464 unintentional injuries experienced, during the period analyzed, by children under 18 years of age. Crude rates per 10 000 inhabitants were used for the analysis of the variables. Results: The morbidity rates in the province were between 45.2 and 58.2 per 10 000 inhabitants. The municipalities with the highest risk were Matanzas and Limonar. Most of the unintentional injuries occurred at home. Falls were the most frequent and caused minor injuries. Conclusions: Unintentional injuries constitute a health concern. It is necessary to assess and control the risk factors for the different types of accidents, in order to prevent or reduce their incidence, through information, education and communication strategies. Making families aware of the vulnerability of children is an essential and basic aspect in all efforts aimed at preventing unintentional injuries at this stage of life(AU)

Primer registro de trauma en Chile: análisis de 2 años en un hospital público / First trauma registry in Chile: 2 years analysis in a public hospital

Resumen Introducción: El trauma representa un verdadero reto para los sistemas sanitarios por ser un gran problema de salud pública. En Chile se desconoce el manejo del paciente politraumatizado. Objetivo: Describir los resultados del primer registro de trauma (RT) en línea, en los pacientes que se atienden en el Hospital Dr. Sótero del Río durante los primeros dos años de la implementación. Materiales y Método: Se recoge información prospectiva en un registro en red, sobre pacientes víctimas de trauma, ingresados al Hospital Dr. Sótero del Río durante dos años. Estas variables involucran todo el proceso de atención clínica desde el ingreso al alta o fallecimiento. Resultados: En dos años, se registran 3.515 ingresos de pacientes víctima de trauma. Entre estos, el 81,3% son hombres. El 27% sufre trauma penetrante y 59% cerrado. Destacan más lesiones por arma de fuego que por arma blanca. El 18,4% de los pacientes ingresados tiene un el Injury Severity Score (ISS) mayor a 15 puntos. 34 pacientes ingresan en paro cardiorrespiratorio y 7,3 % lo hace hipotenso. Se realizan 1.856 tomografías y el 54,4% requiere cirugía de urgencia. Ingresan 692 traumas torácicos, 654 abdominales, 1.550 de extremidades, 687 lesiones en cráneo y 190 traumas cervicales. Se activa el protocolo de transfusión masiva en el 3,1% de los ingresos. El 8,3% utiliza la unidad de paciente crítico y la mortalidad es de 2,9%, teniendo como primera causa el trauma encéfalocraneano y segunda el shock hemorrágico. Conclusiones: Nuestro hospital tiene una gran incidencia de trauma. La implementación de un RT permite conocer la dimensión y evaluar el proceso asistencial en torno al paciente víctima de trauma. Es necesario dirigir recursos e implementar capacitación en los centros de alto volumen de trauma, además, de continuar con la extensión de la herramienta como estrategia de monitorización multicéntrica.

Introduction: Trauma represents a real challenge for health systems because is a major public health problem. In Chile, the management of polytrauma patients is unknown. Aim: Describe the results of the first online trauma registry; in patients treated at the Dr. Sótero del Río Hospital during the first two years of implementation. Materials and Method: Prospective information is collected in a network registry, about trauma victims, admitted to Dr. Sótero del Río Hospital for two years. These variables involve the entire clinical care process from admission to discharge or death. Results: 3.515 admissions of trauma victims are registered in two years. Among these, 81.3% are men. 27% suffered penetrating trauma and 59% closed. They emphasize larger injuries by firearm than by bladed weapon. 18.4% of admitted patients have ISS greater than 15 points. 34 patients enter cardio-respiratory arrest and 7.3% make it hypotensive. 1,856 CT scans are performed and 54.4% require emergency surgery. They admitted 692 thoracic trauma, 654 abdominal, 1550 limb, 687 skull injuries and 190 cervical trauma. The massive transfusion protocol is activated at 3.1% of the admissions. 8.3% use the critical patient unit and mortality is 2.9%, with cranial brain trauma as the first cause and hemorrhagic shock as a second cause. Conclusions: Our hospital has a high incidence of trauma. The RT implementation allows us to know the dimension and assess the care process about the trauma patient. It is necessary to direct resources and implement training in high-volume trauma centers, as well as continuing with the extension of the tool as a multi-center monitoring strategy.

Comportamiento de las lesiones traumáticas del anillo pélvico / Behavior of the traumatic lesions of the pelvic ring

RESUMEN Introducción: las lesiones traumáticas del anillo pélvico constituyen un desafío para los cirujanos ortopedistas por su alta morbimortalidad y las consecuencias que de ellas derivan. Objetivo: describir el comportamiento de variables demográficas y clínicas en los pacientes atendidos por lesiones traumáticas del anillo pélvico en el Hospital Universitario "Comandante Faustino Pérez Hernández" de Matanzas Materiales y Métodos: se realizó un estudio longitudinal prospectivo descriptivo de los pacientes ingresados en el servicio de ortopedia y traumatología por presentar lesiones traumáticas del anillo pélvico en dicho centro en el período comprendido de enero del 2009 a enero del 2019. Se seleccionaron variables demográficas y clínicas Resultados: el estudio incluyó a 48 pacientes. Predominó el sexo masculino 29 pacientes para un 60,4%, la edad de mayor frecuencia estuvo entre 31 a 50 años. Predominaron las fracturas tipo B con 24 pacientes para 50% y el tratamiento quirúrgico con 27 pacientes para 56,2%, dentro de las complicaciones inmediatas predominó el shock hipovolémico en 14 pacientes para 29.1%, en las tardías la sepsis superficial con 6 pacientes, 12.5%. Conclusiones: las lesiones traumáticas del anillo pélvico siempre deben ser tratadas como lesiones graves, por lo que deben ser valoradas de forma multidisciplinaria y apegados a protocolos de actuación, y con especialistas de alta experiencia profesional (AU).

SUMMARY Introduction: pelvic ring traumatic lesions are a challenge for orthopedic surgeons due to their high morbi-mortality and the consequences derived from them. Objective: to describe the behavior of clinical and demographic variables in patients cared due to pelvic ring traumatic lesions in the University Hospital "Comandante Faustino Perez Hernandez" of Matanzas. Method: a descriptive, prospective, longitudinal research was carried out in patients admitted to the Orthopedics and Traumatology Service of the before-named hospital for presenting pelvic ring traumatic lesions in the period from January 2009 until January 2019. Clinical and demographic variables were chosen. Results: the study included 48 patients. Male sex predominated, 29 patients, 60.4 %; the most frequent age ranged between 31 and 50 years. Type B fractures predominated with 24 patients and 50 %; surgical treatment also predominated with 27 patients and 56.2 %; among the immediate complications, hypovolemic shock predominated in 14 patients for 29.1 %; among the late ones, surface sepsis predominated with 6 patients, 12.5 %. Conclusions: pelvic ring traumatic lesions should be always treated like serious lesions; therefore they should be evaluated in a multidiscipline way, adhered to the intervention protocols, and by highly experienced professionals (AU).

Algoritmos para prevenção e tratamento de lesão por fricção / Algoritmos para prevención y tratamiento de lesión por fricción / Algorithms for the prevention and treatment of friction injury

Resumo Objetivo: Elaborar e validar o conteúdo de algoritmos para prevenção e tratamento de lesão por fricção. Métodos: Para a construção dos algoritmos, foi realizada uma revisão integrativa da literatura após busca nas bases de dados: SciELO, LILACS e MEDLINE. A avaliação dos algoritmos foi realizada por 26 juízes, sendo 10 médicos e 16 enfermeiros, utilizando-se a técnica Delphi. Os resultados foram analisados por meio do Índice de Validade de Conteúdo. Resultados: No primeiro ciclo de avaliação, os itens dos algoritmos foram considerados pelos juízes de "inadequados" a "totalmente adequados". Após as correções sugeridas pelos juízes, os algoritmos foram reenviados para o segundo ciclo de avaliação, no qual todos os itens foram julgados "adequados" ou "totalmente adequados", resultando em um Índice de Validade do Conteúdo de 1,0. Conclusão: Os algoritmos desenvolvidos possuem validade de conteúdo e podem auxiliar profissionais de saúde na avaliação, prevenção e tratamento da lesão por fricção.

Resumen Objetivo: Elaborar y validar el contenido de algoritmos para prevención y tratamiento de lesión por fricción. Métodos: Para la construcción de los algoritmos, se realizó una revisión integradora de la literatura luego de una búsqueda en las bases de datos: SciELO, LILACS y MEDLINE. La evaluación de los algoritmos fue realizada por 26 jueces, de los cuales 10 eran médicos y 16 enfermeros, con la utilización del método Delphi. Los resultados fueron analizados mediante el Índice de Validez de Contenido. Resultados: En el primer ciclo de evaluación, los ítems de los algoritmos fueron considerados desde "inadecuados" a "totalmente adecuados" por los jueces. Luego de las correcciones sugeridas por los jueces, se enviaron los algoritmos para el segundo ciclo de evaluación, en el que todos los ítems fueron considerados "adecuados" o "totalmente adecuados", lo que tuvo como resultado un Índice de Validez de Contenido de 1,0. Conclusión: Los algoritmos elaborados tienen validez de contenido y pueden ayudar a profesionales de la salud en la evaluación, prevención y tratamiento de la lesión por fricción.

Abstract Objective: Develop and validate the content of algorithms for the prevention and treatment of friction injury. Methods: For the construction of algorithms, an integrative literature review was conducted after searching SciELO, LILACS and MEDLINE databases. The algorithms were evaluated by 26 raters - 10 physicians and 16 nurses - using the Delphi technique. The results were analyzed by the Content Validity Index (CVI). Results: In the first evaluation cycle, the items of the algorithms were considered "inadequate" to "totally adequate" by the raters. After adjustments suggested by the raters, the algorithms were submitted to a second evaluation cycle, when all items were considered "adequate" or "totally adequate," resulting in a content validity index of 1.0. Conclusion: The algorithms have valid content and can help health professionals in the evaluation, prevention and treatment of friction injuries.

Current state of trauma and violence in São Paulo - Brazil during the COVID-19 pandemic / Estado atual do trauma e violência em São Paulo - Brasil durante a pandemia de COVID-19

ABSTRACT The coronavirus pandemic led society to adopt measures to contain its spread that generate impacts in the social, economic and psychological spheres, mainly due to social isolation. Some authors point out that social changes have generated changes in the various forms of trauma and violence. For this study, data collection for the years 2019 and 2020 was carried out on DATASUS - TABNET and on the website of the Secretariat of Public Security - SSP, considering various types of trauma and violence, with subsequent correlation analysis using the Kendall coefficient and correlation test. There was statistical significance, allowing a correlation with the negative pandemic for the rates of body injury due to traffic accidents, gunshot injuries, stab wounds, sexual violence, bodily injuries and interpersonal violence. As factors possibly associated with a reduction in the incidence of these variables, the literature presents some changes resulting from the pandemic, such as adherence to isolation, with a reduction in the flow of people on the street, and a decrease in reports of violence. The present study indicates that the findings may serve as a warning for future changes and for the adoption of preventive measures, however they represent the initial situation of the pandemic in São Paulo and, therefore, further investigations must be carried out with the course of the pandemic, which still remains.

RESUMO A pandemia do coronavírus levou a sociedade a adotar medidas de contenção de sua disseminação que geram impactos em âmbito social, econômico e psicológico, principalmente pelo isolamento social. Alguns autores apontam que as mudanças sociais geraram mudanças sobre as variadas formas de trauma e violência. Para este estudo, foi realizada coleta de dados referente aos anos de 2019 e 2020 no DATASUS - TABNET e no site da Secretaria de Segurança Pública- SSP, considerando diversos tipos de trauma e violência, com posterior análise de correlação pelo teste de coeficiente e correlação de Kendall. Houve significância estatística, permitindo realizar correlação com a pandemia de caráter negativo para as taxas de lesão corporal por acidente de trânsito, ferimento por arma de fogo, ferimento por arma branca, violência sexual, lesão corporal e violência interpessoal. Como fatores possivelmente associados a redução na incidência destas variáveis, a literatura apresenta algumas mudanças provenientes da pandemia, como adesão ao isolamento, com redução do fluxo de pessoas na rua, e diminuição de denúncias de violência. O presente estudo indica que os achados podem servir de alerta para mudanças futuras e para adoção de medidas preventivas, porém representam o quadro inicial da pandemia em São Paulo e, portanto, mais investigações devem ser elaboradas com o decorrer da pandemia, que ainda se mantém.

Lesões por fricção em idosos internados: estudo transversal / Lesiones por fricción en ancianos hospitalizados: un estudio transversal / Friction injuries in hospitalized elderly: a cross-sectional study

OBJETIVO: identificar a prevalência e os fatores associados à lesão por fricção em idosos internados em uma unidade de terapia intensiva. MÉTODO: estudo transversal, com amostra de 133 idosos internados em um hospital de ensino, entre julho de 2017 a julho de 2018. A coleta de dados contemplou consulta ao prontuário para levantamento sociodemográfico e clínico, exame físico de pele para avaliação de Skin tears. Os dados foram analisados pelo software Stata® versão12. RESULTADO: constatou-se prevalência de lesão por fricção em 10,5% dos idosos, com associação significativa ao índice de massa corpórea (p=0,003). CONCLUSÃO: Acredita-se que os resultados do presente estudo possam contribuir para sensibilizar o enfermeiro e sua equipe, quanto à realização de ações efetivas de prevenção e de cuidado às lesões por fricção, com o objetivo de melhorar a qualidade de assistência prestada aos idosos.

OBJETIVO: identificar la prevalencia y los factores asociados con la lesión por fricción en pacientes de edad avanzada internados en una unidad de cuidados intensivos. MÉTODO: estudio transversal, con una muestra de 133 personas mayores internadas en un hospital universitario, entre julio de 2017 y julio de 2018. La recopilación de datos incluyó la consulta de registros médicos para encuestas sociodemográficas y clínicas, un examen físico de la piel para evaluar Skin tears. Los datos se analizaron utilizando el software Stata® versión 12. RESULTADO: Se encontró una prevalencia de lesión por fricción en el 10,5% de los ancianos, con una asociación significativa con el índice de masa corporal (p = 0,003). CONCLUSIÓN: Se cree que los resultados del presente estudio pueden colaborar hacia sensibilizar al enfermero y su equipo, con respecto a la realización de acciones efectivas de prevención y atención para lesiones por fricción, con el objetivo de mejorar la calidad de la atención brindada a los ancianos.

OBJECTIVE: to identify the prevalence and factors associated with friction injury in elderly patients admitted to an intensive care unit. METHOD: cross-sectional study, with a sample of 133 elderly people admitted to a teaching hospital, between July 2017 and July 2018. Data collection included consulting medical records for sociodemographic and clinical surveys, physical examination of the skin to assess Skin tears. The data were analyzed using the Stata® version 12 software. RESULT: a prevalence of friction injuries was found in 10.5% of the elderly, with a significant association with the body mass index (p = 0.003). CONCLUSION: It is believed that the results of the present study may contribute to sensitize the nurse and his team, regarding the realization of effective prevention and care actions for friction injuries, with the aim of improving the quality of care provided to the elderly.

Violência, saúde e adoecimento dos corpos na comarca de Vila Rica, século XVIII / Violence, health and ailment of bodies in the parish of Vila Rica, eighteenth century

Resumo Estudos sobre violência no século XVIII abrangem especialmente questões relacionadas à justiça e à criminalidade, mas não à saúde. A pesquisa objetivou compreender como os corpos nas Minas Gerais setecentistas eram afetados por atos violentos. Foram investigados autos de devassas do termo de Vila Rica pertencentes ao acervo do Arquivo Histórico do Museu da Inconfidência. Os resultados mostraram crimes causados por motivos distintos e de tipologias diferentes, predominando os crimes contra o corpo, com consequentes lesões corporais provocadas predominantemente por objetos/instrumentos perfurocortantes. Os homens foram os mais acometidos, sendo a cabeça a principal região atingida. Atos criminosos e violentos, muito comuns nessa sociedade, interferiam na saúde e no adoecimento dos corpos.

Abstract Studies into violence in the eighteenth century tend to address questions related to justice and criminality, but not health. The aim of this study is to understand how, in eighteenth century Minas Gerais, Brazil, bodies were affected by violent acts. The investigation records from the parish of Vila Rica held at the historical archive of the Museu da Inconfidência were investigated. The results showed crimes of different kinds associated with a variety of motives, primarily crimes against the body, with the resulting bodily injuries being caused by sharp or pointed objects/instruments. There were more male victims than female, the head being the principal part of the body affected. Criminal and violent acts, very commonplace in this society, interfered in the health and disease processes of the bodies.

Mortalidade de motociclistas com lesões traumáticas resultantes de acidentes de trânsito na cidade de São José dos Campos, em 2015: estudo de coorte / Mortalidad de motociclistas con lesiones traumáticas resultantes de accidente de tránsito en la ciudad de São José dos Campos, Brasil, en 2015: estudio de cohorte / Mortality of motorcyclists with traumatic injuries resulting from traffic accidents in São José dos Campos city, Brazil, in 2015: a cohort study

Objetivo: Analisar fatores associados à mortalidade por lesões traumáticas entre motociclistas. Métodos: Coorte prospectiva, conduzida no Hospital Municipal de São José dos Campos, Brasil, 2015. Foram incluídos motociclistas com lesões traumáticas, ≥14 anos de idade, hospitalizados. Analisaram-se as variáveis sociodemográficas do acidente e da hospitalização, por modelo de regressão de Poisson, apresentando-se risco relativo (RR) e intervalos de confiança de 95% (IC95%). Resultados: Entre 190 motociclistas, 161 (84,7%), jovens do sexo masculino, revelaram 422 (41,8%) lesões em extremidades inferiores e superiores. A incidência de óbito foi maior na medida do aumento da gravidade do trauma, fisiológica (RR=9,67 [IC95% 1,46;64,26]; e RR=4,71 [IC95% 1,36;16,26]) e anatômica (RR=31,49 [IC95% 3,72;266,38]); e mostrou-se menor em até uma semana de internação (RR=0,39 [IC95% 0,15;0,98]). Conclusão: A gravidade do trauma e o tempo de internação associaram-se ao óbito de motociclistas, mas novos estudos devem ser conduzidos para confirmar esses achados e analisar essas relações mais detalhadamente.

Objetivo: Analizar los factores asociados con la mortalidad por lesiones traumáticas entre motociclistas. Métodos: Cohorte prospectiva realizada en el Hospital Municipal de São José dos Campos en 2015. Se incluyó a motociclistas con lesiones traumáticas, ≥14 años, hospitalizados. Se analizaron vVariables sociodemográficas, del accidente y de la hospitalización se analizaron utilizando la regresión de Poisson y y fueran presentarondos en riesgco relativo (RR) ey intervalos de confianza de 95% (IC95%). Resultados: Entre 190 motociclistas, 161 (84,7%) hombres jóvenes de sexo masculino revelaron 422 (41,8%) lesiones en extremidades inferiores y superiores. La incidencia de muerte fue mayor aumentando según lacon aumento en severidad del trauma fisiológico (RR=9,67 [IC95% 1,46; 64,26]; y RR=4,71 [IC95% 1,36; 16,26]) y anatómico (RR=31,49 [IC95% 3,72; 266,38]), pero fue menor con hasta hasta una semana de hospitalización (RR=0,39 [IC95% 0,15; 0,98]). Conclusión: La Ggravedad del trauma y la estadía hospitalaria se asociaron con la muerte de motociclistas. Otros estudios deben efectuarse para confirmar estos hallazgos y analizar las relaciones con mayor detalle.

Objective: To analyze factors associated with mortality from traumatic injuries among motorcyclists. Methods: This was a prospective cohort conducted at the Municipal Hospital of São José dos Campos, Brazil, in 2015. Motorcyclists with traumatic injuries, ≥14 years old and hospitalized were included. Sociodemographic, accident and hospitalization variables were analyzed by applying a Poisson regression model showing relative risk (RR) and 95% confidence intervals (95%CI). Results: Among 190 motorcyclists, 161 (84.7%) young men were found to have 422 (41.8%) injuries to the lower and upper extremities. Incidence of death increased as physiological injury severity (RR=9.67 [95%CI 1.46;64.26] and RR=4.71 [95%CI 1.36;16.26]), and anatomical injury severity (RR=31.49 [95%CI 3.72;266.38]) increased, but was lower within up to one week of hospitalization (RR=0.39 [95%CI 0.15;0.98]). Conclusion: Injury severity and length of hospital stay were associated with motorcyclist deaths. Further studies should be conducted to confirm these findings and to analyze the relationships in greater detail.

Accidentes no fatales en población mexicana, prevalencia y factores asociados. Ensanut 2018-19 / Non-fatal unintentional injuries in Mexican population: prevalence and associated factors. Ensanut 2018-19

Resumen Objetivo: Estimar la prevalencia de lesiones accidentales no fatales en población mexicana y analizar los factores individuales, ambientales y del hogar asociados con su ocurrencia. Material y métodos: Se analizó la prevalencia de lesiones accidentales a partir de la Encuesta Nacional de Salud y Nutrición (Ensanut) 2018-19, diseñada con un muestreo probabilístico, estratificado y por conglomerados, en tres etapas. Se evaluó mediante regresión logística su asociación con distintas variables independientes. Resultados: La prevalencia de lesiones accidentales fue de 4.5% (IC95%: 4.2-4.7), equivalente a 5.6 millones de personas. De ellas, 22.3% o 1.2 millones sufrieron consecuencias permanentes en su estado de salud. La posibilidad de tener una lesión accidental fue mayor en región Norte, Centro y Ciudad de México-Estado de México, en hombres de 0 a 59 años, mujeres de 60 o más años, en personas con alguna discapacidad y en quienes reportaron sentir depresión. Conclusión: Es necesario y urgente reforzar la prevención de lesiones accidentales, especialmente en grupos vulnerables.

Abstract Objective: To estimate the prevalence of non-fatal unintentional injuries in Mexican population and to analyze individual, environmental and household factors associated with its occurrence. Materials and methods: A cross-sectional study, analyzed the prevalence of unintentional injuries from Encuesta Nacional de Salud y Nutrición (Ensanut 2018-19), which is a nationally representative health survey designed with a probability, stratified and cluster sampling, in three stages. Association with variables of interest was explored using logistic regression analysis. Results: Prevalence of non-fatal unintentional injuries was 4.5% (IC95%: 4.2-4.7), equivalent to 5.6 million people per year. Of them, 22.3% or 1.2 million suffered permanent consequences. Probability of having unintentional injuries was higher in the North and Center regions, as in Mexico City-State of Mexico; in males from 0 to 59 and females of 60 or more years of age, in people living with disabilities and those who self-reported depression symptoms. Conclusions: Strengthening unintentional injury prevention is necessary and urgent, especially within vulnerable groups of population.

Patterns of injury at an Ethiopian referral hospital: Using an institutional trauma registry to inform injury prevention and systems strengthening

Background: Data about injury patterns and clinical outcomes are essential to address the burden of injury in low- and middle-income countries. Institutional trauma registries (ITRs) are a key tool for collecting epidemiologic data about injury. This study uses ITR data to describe the demographics and patterns of injury of trauma patients in Addis Ababa, Ethiopia in order to identify opportunities for injury prevention, systems strengthening and further research. Methods: This is an analysis of prospectively collected data from a sustainable ITR at Menelik II Specialized Hospital, a public teaching hospital with trauma expertise. All patients presenting to the hospital with serious injuries requiring intervention or admission over a 13 month period were included. Univariable and bivariable analyses were performed for patient demographics and injury characteristics. Results: A total of 854 patients with serious injuries were treated during the study period. Median age was 33 years and 74% were male. The most common mechanisms of injury were road traffic injuries (RTI) (37%), falls (30%) and blunt assault (17%). Over half of RTI victims were pedestrians. Median delay in presentation was 2 h; 17% of patients presented over 6 h after injury. 58% of patients were referred from another hospital or a clinic, and referrals accounted for 84% of patients arriving by ambulance. Median emergency center length of stay was 2 h and 62% of patients were discharged from the emergency center. Conclusion: This study highlights the utility of institutional trauma registries in collecting crucial injury surveillance data. In Addis Ababa, road safety is an important target for injury prevention. Our findings suggest that the most severely injured patients may not be making it to the referral centers with the capacity to treat their injuries, thus efforts to improve prehospital care and triage are needed. African relevance: Injury is a public health priority in Africa. Institutional trauma registries play a crucial role in efforts to improve trauma care by describing injury epidemiology to identify targets for injury prevention and systems strengthening efforts. In our context, pedestrian safety is a key target for injury prevention. Improving prehospital care and developing referral networks are goals for systems strengthening

Injury patterns of patients presenting to a non-governmental hospital in Western Uganda

Introduction: Injury is a leading cause of morbidity and mortality globally and disproportionately affects low-income countries. While most injury data comes from tertiary care centers in urban settings, the purpose of this study was to describe the characteristics and severity of injury in rural Uganda and the associated treatment patterns and delays in care. Methods: This is a retrospective cohort study of a trauma registry that was implemented at Masindi-Kitara Medical Center (MKMC), a rural hospital in Western Uganda. Demographic information, injury characteristics, modified Kampala Trauma Scores (M-KTS), and treatment modalities over a 12 month period were retrospectively collected from paper-based registry forms completed for all injury patients presenting to MKMC. Results: A total of 350 patients were entered into the trauma registry. Most patients were male (71.2%) with a median age of 26.5 years. Motorcycle crashes were the most prevalent mechanism of injury (42.3%) with the majority being unhelmeted (83.3%). Soft tissue injury was the most common diagnosis (44.9%). Patients were frequently treated in the outpatient department and then discharged (54.8%). Patients requiring admission or transfer (M-KTS = 11.57 or 11.67) tended to have a lower M-KTS than discharged patients (M-KTS = 12.75). Analgesics (74.6%) and antibiotics (52.9%) were the most common treatments administered. For those patients requiring admission (29.4%), only one in-hospital death was documented. Thirty-nine percent of patients reported a delay in seeking care, most frequently due to lack of transportation (31.5%) with a median time of delay of 11 h. Conclusion: Road traffic injuries were the leading cause of injury in Masindi, with a high proportion of injuries associated with unhelmeted motorcycle crashes. Future opportunities to prevent injury and improve care may be seen through improved prehospital care, enforcement of helmet laws, increased access to neurosurgical services, and enactment of hospital quality improvement measures

Uso de capacete e gravidade de lesões em motociclistas vítimas de acidentes de trânsito nas capitais brasileiras: uma análise do Viva Inquérito 2017 / Helmet use and injury severity among crashed motorcyclists in Brazilian state capitals: an analysis of the violence an accidents survey 2017

RESUMO: Objetivo: Analisar o efeito do uso de capacete na gravidade de lesões em condutores e passageiros de motocicletas envolvidos em acidentes de trânsito. Métodos: Estudo de corte seccional sobre vítimas de acidentes de transporte terrestre envolvendo motociclistas, atendidos nos serviços de urgência e emergência e participantes do Inquérito de Vigilância de Violências e Acidentes (Viva Inquérito) 2017. Resultados: Verificou-se predomínio de indivíduos na faixa de 18 a 29 anos (46,6%), negros (75,2%) e com ensino médio (50,6%). Em 14,1% dos acidentes houve relato de uso de álcool. O uso do capacete reduziu em 76% a ocorrência de trauma cranioencefálico e em 28% a ocorrência de encaminhamento para outro hospital, internação ou óbito. Conclusão: Motociclistas jovens, negros, de baixa escolaridade e do sexo masculino apresentaram-se mais vulneráveis aos acidentes. O uso do capacete mostrou-se protetor para lesões graves.

ABSTRACT: Objective: To analyze the effect of helmet use on injury severity among motorcyclists and passengers involved in traffic accidents. Methods: Cross-sectional study of traffic accidents involving motorcyclists attended at the emergency healthcare units participating in the Violence and Accidents Survey Conducted in Sentinel Emergency Departments (Viva Survey) 2017. Results: There was a predominance of individuals aged 18 to 29 years old (46.6%), black (75.2%), with high school education (50.6%). Alcohol use was observed in 14.1% of cases. Helmet use was associated with a 76% reduction in the occurrence of head trauma and a 28% reduction in the referral, hospitalization or death. Conclusion: Young, male, black individuals and those with low education were the most frequent victims of accidents. Helmet use was protective for severe injuries.

Violências contra adolescentes: análise das notificações realizadas no setor saúde, Brasil, 2011-2017 / Violence against adolescents: analysis of health sector notifications, Brazil, 2011-2017

RESUMO: Introdução: A violência sofrida na adolescência resulta em sérios prejuízos e sofrimento para a sociedade. Este estudo objetivou caracterizar o perfil das violências, das vítimas e dos prováveis autores das violências perpetradas contra adolescentes, bem como descrever o percentual de municípios notificantes por unidade da Federação. Métodos: Estudo transversal, realizado com dados de notificação de violência contra adolescentes do Sistema de Informação de Agravos de Notificação referentes ao período de 2011 a 2017. A significância estatística das diferenças entre as proporções na comparação entre sexos foi testada com o qui-quadrado. Estimaram-se razões de proporção para os tipos de violência mais frequentes segundo variáveis selecionadas. Resultados: As notificações foram procedentes de 75,4% dos municípios brasileiros. A violência física predominou no sexo masculino, na idade de 15 a 19 anos. A violência psicológica predominou no sexo feminino, entre 10 e 14 anos, quando praticada de forma repetitiva, no domicílio, por agressores familiares. A violência sexual prevaleceu no sexo feminino, entre 10 e 14 anos, nas raças/cores indígena, negra e amarela, quando perpetrada de forma repetitiva, no domicílio. A negligência predominou no sexo masculino, entre 10 e 14 anos, quando praticada de forma repetitiva, por agressores familiares. Conclusões: Violências sexuais ocorreram preponderantemente no sexo feminino e geram consideráveis impactos negativos à saúde mental, física, sexual e reprodutiva. Violências comunitárias perpetradas com objetos perfurocortantes e arma de fogo tiveram destaque no sexo masculino e são fatores de risco significativos para a sobremortalidade masculina. Como os problemas são complexos, demandam atuação intersetorial para seu enfrentamento.

ABSTRACT: Introduction: Violence experienced in adolescence results in serious damage and suffering to society. This study aims to characterize the profile of violence victims and likely perpetrators of violence against adolescents, as well as to describe the percentage of notifying municipalities according to the federation unit. Methods: Cross-sectional study conducted with data on notification of violence against adolescents from the Information System for Notifiable Diseases, from 2011 to 2017. The chi-square test was used to assess the statistical significance of the differences between the proportions in the comparison between genders. Proportion ratios for the most frequent types of violence were estimated according to selected variables. Results: The notifications came from 75.4% of all the Brazilian municipalities. Physical violence predominated among males, aged 15-19 years. Psychological violence was predominant among females, between 10 and 14 years old, when perpetrated repeatedly at home by family aggressors. Sexual violence prevailed among females, aged 10 to 14 years old, in the indigenous, black and yellow races/colors, when perpetrated repeatedly at home. Negligence was more common among males, between 10 and 14 years old, when perpetrated repeatedly by family aggressors. Conclusions: Sexual violence occurred predominantly against females and generated significant negative impacts on mental, physical, sexual and reproductive health. Community violence, perpetrated with sharp objects and firearms, were prominent among males and are important risk factors for male over-mortality. Because the problems are complex, addressing them requires intersectoral actions.

Trauma em Curitiba: avaliação multifatorial de vítimas admitidas em um hospital universitário / Trauma in Curitiba: multifactorial assessment of victims admitted to a university hospital

RESUMO Objetivo: descrever o perfil epidemiológico das vítimas de trauma atendidas em um hospital de referência no município de Curitiba (PR), bem como investigar os mecanismos do trauma, além de avaliar os escores de gravidade. Métodos: estudo descritivo observacional transversal, cujos dados foram obtidos através da aplicação de questionário em vítimas atendidas na sala de emergência, entre dezembro de 2016 e fevereiro de 2018. Resultados: foram incluídos no estudo 1354 vítimas de trauma, das quais 60% tiveram como transporte pré-hospitalar o Serviço Integrado de Atendimento ao Trauma em Emergência (SIATE), e 40%, o Serviço de Atendimento Móvel de Urgência (SAMU). Quanto ao sexo, 70% dos pacientes eram do sexo masculino. A média de idade foi de 39,48 anos. Sobre o horário e dia dos atendimentos, a maior proporção se concentrou no período noturno na sexta-feira. Quanto ao mecanismo do trauma, nos pacientes atendidos pelo SIATE, o mais frequente em homens foi a colisão de motocicleta (34,3%), enquanto que em mulheres foi a queda de mesmo nível (21,42%). Já no SAMU, o mecanismo mais frequente independentemente do sexo foi queda de mesmo nível (20,06% e 40,66%, respectivamente). Analisando-se os escores de gravidade, observou-se que 95,5% dos pacientes eram classificados como leves pela escala de coma de Glasgow. Conclusões: o perfil das vítimas analisadas neste grande estudo muito se assemelha a outros estudos nacionais menores: homens, jovens, vítimas de acidentes de trânsito. A população economicamente ativa, portanto, é a mais afetada, refletindo em alto custo para a sociedade.

ABSTRACT Objective: to describe the epidemiological profile of trauma patients admitted to a referral hospital in Curitiba (PR). Also, to investigate trauma mechanisms and to evaluate trauma severity scores. Methods: descriptive observational cross-sectional study. Data were collected by applying a questionnaire to victims admitted in the emergency room from December 2016 to February 2018. Results: a total of 1354 trauma victims were included in the study, of which 60% were transported by SIATE and 40% by SAMU. Regarding gender, 70% of the patients were male. The mean age was 39.48 years. About the time and day of the calls, the largest proportion was concentrated on Friday night. In relation to the mechanism of trauma, in patients transported by SIATE, the most frequent in men was motorcycle collision (34.3%), while in women was same-level fall (21.42%). In SAMU, the most frequent mechanism regardless of gender was same-level fall (20.06% and 40.66%, respectively). Analyzing the severity scores, it was observed that 95.5% of the patients were classified as mild by the Glasgow Coma Scale. Conclusion: the profile of trauma victims analyzed in this large study is quite similar to what other national smaller studies have already described: young men victims of traffic accidents. Therefore, the economically active population is the most affected, reflecting in high cost to society.