Traumatismo torácico: análisis de hospitalizaciones según grupo etario / Thoracic trauma: analysis of hospitalizations among different age-groups

Resumen Introducción: El traumatismo es la primera causa de muerte en adolescentes y la quinta en el adulto mayor. El traumatismo torácico (TT) posee características particulares en diferentes grupos de edad. Objetivos: Analizar características clínicas, índice de gravedad de traumatismo (IGT) y mortalidad en hospitalizados por TT según grupo etario. Materiales y Método: Estudio descriptivo de hospitalizaciones por TT, período enero de 1981 a diciembre de 2018. Revisión de protocolos prospectivos de TT y base de datos. Se definió grupo etario según Organización Mundial de la Salud (Adolescente: 10-19 años; Adulto Joven: 20-44 años; Adulto Maduro 45-59 años; Adulto Mayor: ≥ 60 años). Se comparó clasificación, mecanismo, agente, tratamiento, IGT, Trauma Injury Severity Score (TRISS) y mortalidad del TT según grupo etario. Se utilizó SPSS25® con pruebas chi-cuadrado y ANOVA, considerando significativo p < 0,05. Resultados: Total 4.297 TT. Grupo etario Adolescente: 608 (14,1%); Adulto Joven: 2.544 (59,2%); Adulto Maduro: 601 (14,0%); Adulto Mayor: 544 (12,7%). Se observó disminución progresiva y significativa en TT penetrante, por agresión y del TT por arma blanca desde grupo etario Adolescente hasta Adulto Mayor. En Adulto Joven predominó tratamiento invasivo: cirugía 541 (21,2%) y en Adulto Maduro el TT con lesiones asociadas 215 (35,8%), p < 0,05. Según grupo etario, se observaron diferencias significativas en TRISS y en mortalidad. La mortalidad fue 1,6%; 2,5%; 3,3%; 5,0%, según grupo etario respectivamente (p < 0,05). Conclusiones: Existen diferencias estadísticamente significativas en las características clínicas, IGT y mortalidad del TT al comparar distintos grupos etarios. La edad es uno de los factores que determina el pronóstico de pacientes hospitalizados por TT.

Background: Trauma is the leading death cause among adolescents and the fifth in the elderly. Thoracic trauma (TT) has particular characteristics in different age-groups. Aim: To analyze clinical characteristics, trauma severity indices (TSI) and mortality in patients hospitalized for TT among different age-groups. Materials and Method: Descriptive study of patients hospitalized for TT between January-1981 and December-2018. Prospective TT surgical operation notes and data base were reviewed. Age-groups were determined according to the World Health Organization (Adolescent: 10-19 years; Young Adult: 20-44 years; Mature Adult: 45-59 years; Elderly > 60 years). TT classification, mechanism, agent, treatment, TSI, Trauma Injury Severity Score (TRISS) and mortality were compared among age-groups. SPSS25® with chi-square test and ANOVA were used, considering p < 0.05 significant. Results: Total 4.297 TT. Adolescent age-group: 608 (14.1%); Young Adult: 2,544 (59.2%); Mature Adult: 601 (14.0%); Elderly: 544 (12.7%). Was observed a progressive and significant decrease of penetrating TT, aggression-caused and bladed weapon-caused TT from Adolescent to Elderly. In Young Adult the invasive treatment predominant: surgery 541 (21.2%), whereas in Mature Adult TT with associated injuries 215 (35.8%), p < 0.05. Differences in TRISS and mortality 1.6%; 2.5%; 3.4%; 5.0% (p < 0.05) were observed among age-groups, respectively. Conclusions: There are statistical significant differences in clinical characteristics, TSI and mortality when comparing TT by age group. Age is an important factor determining the outcome in TT hospitalized patients.

Assessment of trauma scoring systems in patients subjected to exploratory laparotomy / Avaliação dos escores de trauma em pacientes submetidos à laparotomia exploradora

ABSTRACT Objective: to assess the epidemiological profile of patients undergoing exploratory trauma laparotomy based on severity and prognosis criteria, and to determine the predictive accuracy of trauma scoring systems in terms of morbidity and mortality. Methods: retrospective cohort study and review of medical records of patients undergoing exploratory laparotomy for blunt or penetrating trauma at the Hospital de Pronto Socorro de Porto Alegre, from November 2015 to November 2019. Demographic data, mechanism of injury, associated injuries, physiological (RTS and Shock Index), anatomical (ISS, NISS and ATI) and combined (TRISS and NTRISS) trauma scores, intraoperative findings, postoperative complications, length of stay and outcomes. Results: 506 patients were included in the analysis. The mean age was 31 ± 13 years, with the majority being males (91.3%). Penetrating trauma was the most common mechanism of injury (86.2%), predominantly by firearms. The average RTS at hospital admission was 7.5 ± 0.7. The mean ISS and NISS was 16.5 ± 10.1 and 22.3 ± 13.6, respectively. The probability of survival estimated by TRISS was 95.5%, and by NTRISS 93%. The incidence of postoperative complications was 39.7% and the overall mortality was 12.8%. The most accurate score for predicting mortality was the NTRISS (88.5%), followed by TRISS, NISS and ISS. Conclusion: the study confirms the applicability of trauma scores in the studied population. The NTRISS seems to be the best predictor of morbidity and mortality.

RESUMO Objetivo: analisar o perfil epidemiológico dos pacientes submetidos a laparotomia exploradora por trauma com base em critérios de gravidade e prognóstico, e determinar a acurácia preditiva dos escores de trauma em termos de morbimortalidade. Métodos: estudo de coorte retrospectiva e revisão de prontuários dos pacientes submetidos a laparotomia exploradora por trauma contuso ou penetrante no Hospital de Pronto Socorro de Porto Alegre no período de novembro de 2015 a novembro de 2019. Foram avaliados dados demográficos, mecanismo do trauma, lesões associadas, índices fisiológicos (RTS e Shock Index), anatômicos (ISS, NISS e ATI) e mistos (TRISS e NTRISS), achados intraoperatórios, complicações pós-operatórias, tempo de internação e desfecho. Resultados: foram incluídos 506 pacientes na análise. A idade média foi de 31 ± 13 anos, com predomínio do sexo masculino (91,3%). O trauma penetrante foi o mecanismo de lesão mais comum (86,2%), sendo a maioria por arma de fogo. A média do RTS na admissão hospitalar foi 7,5 ± 0,7. A média do ISS e do NISS foi 16,5 ± 10,1 e 22,3 ± 13,6, respectivamente. A probabilidade de sobrevida estimada pelo TRISS foi de 95,5%, e pelo NTRISS de 93%. A incidência de complicações pós-operatórias foi de 39,7% e a mortalidade geral de 12,8%. O escore com melhor acurácia preditiva foi o NTRISS (88,5%), seguido pelo TRISS, NISS e ISS. Conclusões: o estudo confirma a aplicabilidade dos escores de trauma na população em questão. O NTRISS parece ser o sistema com melhor acurácia preditiva de morbimortalidade.

Epidemiological evaluation of hepatic trauma victims undergoing surgery / Avaliação epidemiológica de vítimas de trauma hepático submetidas a tratamento cirúrgico

Objective : to evaluate the epidemiological variables and diagnostic and therapeutic modalities related to hepatic trauma patients undergoing laparotomy in a public referral hospital in the metropolitan region of Vitória-ES. Methods : we conducted a retrospective study, reviewing charts of trauma patients with liver injuries, whether isolated or in association with other organs, who underwent exploratory laparotomy, from January 2011 to December 2013. Results : We studied 392 patients, 107 of these with liver injury. The male: female ratio was 6.6 : 1 and the mean age was 30.12 years. Penetrating liver trauma occurred in 78.5% of patients, mostly with firearms. Associated injuries occurred in 86% of cases and intra-abdominal injuries were more common in penetrating trauma (p <0.01). The most commonly used operative technique was hepatorrhaphy and damage control surgery was applied in 6.5% of patients. The average amounts of blood products used were 6.07 units of packed red blood cells and 3.01 units of fresh frozen plasma. The incidence of postoperative complications was 29.9%, the most frequent being infectious, including pneumonia, peritonitis and intra-abdominal abscess. The survival rate of patients suffering from blunt trauma was 60%, and penetrating trauma, 87.5% (p <0.05). Conclusion : despite technological advances in diagnosis and treatment, mortality rates in liver trauma remain high, especially in patients suffering from blunt trauma in relation to penetrating one.

Objetivo : avaliar as variáveis epidemiológicas e as modalidades diagnósticas e terapêuticas relacionadas ao trauma hepático de pacientes submetidos à laparotomia exploradora em um hospital público de referência da Região Metropolitana de Vitória-ES. Métodos: estudo retrospectivo de revisão de prontuários dos pacientes vítimas de trauma com lesão hepática isolada ou associada a outros órgãos, submetidos à laparotomia exploradora, no período de janeiro de 2011 a dezembro de 2013. Resultados: foram estudados 392 pacientes submetidos à laparotomia, dos quais 107 com lesões hepáticas. A relação masculino:feminino foi 6,6:1 e a média de idade dos pacientes foi 30,12 anos. O trauma hepático penetrante ocorreu em 78,5% dos pacientes, principalmente por arma de fogo. Lesões associadas ocorreram em 86% dos casos e as lesões intra-abdominais foram mais comuns no trauma penetrante (p<0,01). A técnica operatória mais utilizada foi a hepatorrafia, e a cirurgia para controle de danos foi feita em 6,5% dos pacientes. A quantidade média de hemoderivados utilizados foi 6,07 unidades de hemoconcentrado e 3,01 unidades de plasma fresco. A incidência de complicações pós-operatórias foi 29,9%, e as mais frequentes foram as infecciosas, incluindo pneumonia, peritonite e abscesso intra-abdominal. A taxa de sobrevida dos pacientes acometidos de trauma contuso foi 60% e de trauma penetrante, 87,5% (p<0,05). Conclusão: apesar dos avanços tecnológicos de diagnósticos e tratamentos, as taxas de morbimortalidade nos traumas hepáticos permanecem elevadas, especialmente nos pacientes acometidos de trauma hepático contuso em relação ao trauma penetrante.

Análisis comprensivo de los traumatismos torácios penetrantes atendidos en Hospital Padre Hurtado de Santiago / Penetrating chest trauma

Objectives: Penetrating chest trauma (PCT) is a life threatening condition that challenges emergency surgeons daily. The aim of this study is to make an epidemiological characterization of these patients, and secondarily analyze their treatment and outcome. Methods: A retrospective analysis of a series of consecutive patients experiencing PCT who presented at our hospital, was performed from 1st May 2009 to 30th April 2013. Results: Of 274 consecutive patients who presented to the emergency department (ED) with PCT, 257 (94 percent) were male and 17 (6 percent) were female. The median age was 26 (range 15-66) years. Stab wounds (SW) accounted for 185 (68 percent) of the injuries, and 80 (29 percent) suffered from gunshot wounds (GSW). As first treatment, chest tube drainage was performed in 229 (84 percent) patients, emergent thoracotomy in 21 (8 percent) and observation, in 13 (5 percent). 26 (9 percent) patients died: 21 (81 percent) from GSW and 4 (15 percent) with SW P<0.0001; 20 (77 percent) had heart or thoracic great vessels involvement. Thoracic complications occurred in 30 (12 percent) patients. There was no mortality associated with thoracic complications. The median hospital stay was 4 days. Conclusions: PCT is frequent in our hospital compared with historical series. The majority of the patients who died had cardiac or thoracic great vessels involvement due to GSW. Therefore, healthcare improvements are needed to reduce mortality in this group of patients.

Objetivos: Los traumatismos torácicos penetrantes (TTP) son graves y desafían diariamente a los cirujanos de urgencia. El objetivo de este estudio es realizar una caracterización epidemiológica de los pacientes con TTP, y como objetivo secundario analizar el tratamiento efectuado y su evolución. Métodos: Se realizó un estudio retrospectivo de los pacientes atendidos en el Hospital Padre Hurtado de Santiago que presentaron un TTP desde el 1 de mayo de 2009 hasta el 30 de abril de 2013. Resultados: 274 pacientes que se consultaron al servicio de urgencia con un TTP, 257 (94 por ciento) eran hombres y 17 (6 por ciento) eran mujeres. La mediana de edad fue 26 (15-66) años. Lesiones por arma blanca 185 (68 por ciento), y 80 (29 por ciento) fueron por arma de fuego. Como primer tratamiento la pleurostomía fue realizada en 229 (84 por ciento) pacientes. La toracotomía de emergencia fue realizada en 21 (8 por ciento) pacientes. No se realizó tratamiento y solo observación en 13 (5 por ciento) de los casos. 26 (9 por ciento) de los pacientes murieron, 21 (81 por ciento) fueron consecuencia de lesiones por arma de fuego y 4 (15 por ciento) por arma blanca P<0,0001, 20 (77 por ciento) tenían lesiones cardíacas o de grandes vasos torácicos. 30 (12 por ciento) pacientes presentaron complicaciones torácicas. No hubo mortalidad asociada a complicaciones torácicas. La mediana de días de hospitalización fue 4. Conclusiones: El TTP es frecuente en nuestro hospital comparado con series históricas. La mayoría de los pacientes fallecidos presentaban TTP por arma de fuego con lesiones cardíacas o de grandes vasos torácicos. Se precisan mejoras asistenciales en este grupo para disminuir su mortalidad.

Trauma hepático: uma experiência de 21 anos / Hepatic trauma: a 21-year experience

OBJETIVO: avaliar os aspectos epidemiológicos, conduta, morbidade e resultados do tratamento trauma hepático. MÉTODOS: estudo retrospectivo de doentes com mais de 13 anos de idade admitidos em um hospital universitário de 1990 a 2010, submetidos ao tratamento cirúrgico ou não operatório (TNO). RESULTADOS: foram admitidos 748 pacientes com trauma hepático. O mecanismo de trauma mais frequente foi o trauma penetrante (461 casos; 61,6%). O trauma fechado ocorreu em 287 pacientes (38,4%). De acordo com o grau de lesão hepática (AAST-OIS), no trauma fechado foi observada uma predominância dos graus I e II e no trauma penetrante, uma predominância do grau III. O TNO foi realizado em 25,7% dos pacientes com trauma hepático contuso. Entre os procedimentos cirúrgicos, a sutura foi realizada com maior frequência (41,2%). A morbidade relacionada ao fígado foi 16,7%. A taxa de sobrevida para pacientes com trauma hepático fechado foi 73,5% e no trauma penetrante de 84,2%. A mortalidade no trauma complexo foi 45,9%. CONCLUSÃO: o trauma permanece mais incidente nas populações mais jovens e no sexo masculino. Houve uma redução dos traumas hepáticos penetrantes. O TNO se mostrou seguro e efetivo, e, frequentemente, foi empregado para tratar os pacientes com trauma hepático penetrante. A morbidade foi elevada e a mortalidade foi maior em vítimas de traumas contusos e em lesões hepáticas complexas.

OBJECTIVE: To evaluate the epidemiological aspects, behavior, morbidity and treatment outcomes for liver trauma. METHODS: We conducted a retrospective study of patients over 13 years of age admitted to a university hospital from 1990 to 2010, submitted to surgery or nonoperative management (NOM). RESULTS: 748 patients were admitted with liver trauma. The most common mechanism of injury was penetrating trauma (461 cases, 61.6%), blunt trauma occurring in 287 patients (38.4%). According to the degree of liver injury (AAST-OIS) in blunt trauma we predominantly observed Grades I and II and in penetrating trauma, Grade III. NOM was performed in 25.7% of patients with blunt injury. As for surgical procedures, suturing was performed more frequently (41.2%). The liver-related morbidity was 16.7%. The survival rate for patients with liver trauma was 73.5% for blunt and 84.2% for penetrating trauma. Mortality in complex trauma was 45.9%. CONCLUSION: trauma remains more common in younger populations and in males. There was a reduction of penetrating liver trauma. NOM proved safe and effective, and often has been used to treat patients with penetrating liver trauma. Morbidity was high and mortality was higher in victims of blunt trauma and complex liver injuries.

Experiencia del manejo del trauma vesical en Hospital de Urgencia Asistencia Pública: revisión de cinco años, 2005- 2009 / Bladder trauma: management experience of Hospital de Urgencia Asistencia Publica: five years review, 2005- 2009

INTRODUCCIÓN: El trauma vesical es escaso, representa el 2-3 por ciento de traumatismos abdominales y es frecuente su asociación a fractura de pelvis. Con diagnóstico precoz tiene baja tasa de mortalidad. OBJETIVO: Describir el manejo de los pacientes con trauma vesical en el Hospital de Urgencia Asistencia Pública, Santiago, Chile. MATERIAL Y MÉTODO: Estudio retrospectivo, descriptivo de los registros de 16 pacientes con diagnóstico de egreso de trauma vesical, durante periodo 2005-2009. Los datos recopilados fueron sometidos a análisis estadístico simple en Microsoft Office® Excel 2010. RESULTADOS: El promedio de edad fue 29 años. Del total de pacientes, 13 son de sexo masculino. El mecanismo de lesión fue de tipo contuso en 11, siendo el accidente de tránsito el más frecuente con nueve. Los traumas penetrantes se presentaron en cinco pacientes, de los cuales cuatro fueron por arma de fuego. La hematuria es un signo frecuente, en nueve de ellos se presentó. El diagnóstico se realizó con ecotomografía abdominal en ocho y en cinco fue intraoperatorio. El manejo realizado fue quirúrgico en 15 casos, que abarca la totalidad del trauma penetrante, sólo tres pacientes presentaron complicaciones que correspondieron a sangrado activo. El trauma vesical se sospechó al ingreso en tres pacientes. DISCUSIÓN: El trauma vesical se presenta en pacientes jóvenes de sexo masculino, el mecanismo más frecuente es el contuso por accidente de tránsito. El diagnóstico se realiza principalmente con ecotomografía abdominal. El manejo es quirúrgico. La sospecha de trauma vesical es baja y se requieren exámenes de imágenes para confirmar.

INTRODUCTION: Bladder trauma is infrequent. Its incidence is estimated at 2-3 percent of all abdominal trauma and is strongly associated with pelvic fracture. If bladder trauma is suspected and identified, it has low mortality rate. OBJECTIVE: To describe the management of patients with bladder trauma in Hospital de Urgencia Asistencia Pública. MATERIAL AND METHOD: Descriptive, retrospective study of patients with discharge diagnosis of bladder trauma, between 2005 – 2009. RESULTS: Mean age was 29 years. Of all patients, 13 were male. Eleven patients presented blunt trauma, being traffic accidents the most frequent in nine. Penetrating trauma was present in five patients, of which four were by firearm. Hematuria is a frequent sign, being present in nine patients. For diagnosis, abdominal ultrasonography was used in eight cases and in five was made intraoperatively. Surgery was performed in 15 patients, which covers all cases of penetrating trauma. Three patients resented complications, all of them secondary to active bleeding. On admission, only three patients had suspicion of bladder trauma. DISCUSSION: Bladder trauma mainly occurs in young male patients and the most frequent injury mechanism are traffic accidents. Abdominal ultrasonography is the main diagnostic tool and it requires surgical resolution. Bladder trauma requires a high level of suspicion and imaging studies to make the diagnosis.

Observation of initial clinical manifestations and repercussions from the treatment of 314 human injuries caused by black sea urchins (Echinometra lucunter) on the southeastern Brazilian coast / Observação das manifestações clínicas iniciais e sua influência no tratamento de 314 acidentes causados por ouriços-do-mar pretos (Echinometra lucunter) na região sudeste do Brasil

INTRODUCTION: Injuries caused by sea urchins are the most common caused by marine animals in humans in Brazil, with the black sea urchin (Echinometra lucunter) causing the most injuries to bathers. METHODS: This study observed 314 human wounds with emphasis on the early observation of clinical signs and symptoms and their implications on the recommended treatment. RESULTS: All the injuries were caused by black sea urchins and were observed in bathers. The lesions and the pain were associated with penetration of the spines; there was no early inflammation or pain without pressure on the wounded places. Complications arising from this kind on injury, including infections and foreign body granulomas, are associated with the permanence of the spines in the wounds. CONCLUSIONS: The study confirmed that this kind of injury is the most common accident caused by aquatic animals in Brazil. The main therapeutical recommendation is early removal of the spines to prevent late complications, such as infections and the formation of foreign body granulomas.

INTRODUÇÃO: Os acidentes causados por ouriços-do-mar são as ocorrências por animais marinhos mais comuns no país. O ouriço-do-mar preto (Echinometra lucunter) é a espécie que mais causa ferimentos em banhistas. MÉTODOS: Este trabalho registrou e estudou 314 agravos com ênfase nas manifestações clínicas iniciais observadas e suas implicações na terapêutica recomendada. RESULTADOS: Todos os acidentes foram causados pelo ouriço-do-mar preto e aconteceram em banhistas. As lesões e a dor foram associadas ao trauma causado pela penetração das espículas (não ocorreu inflamação ou dor imediata sem pressão sobre os pontos comprometidos). As complicações deste tipo de acidente, incluindo infecções e granulomas de corpo estranho, estão associadas com a permanência das espículas nos ferimentos. CONCLUSÕES: Foi confirmado o fato do acidente causado por esta espécie ser o mais comum no Brasil e apresentar caráter traumático, sendo a principal recomendação a retirada precoce dos espinhos para prevenção de complicações tardias como as infecções e formação de granulomas de corpo estranho.

Resultados de la sutura primaria de colon en lesiones penetrantes de abdomen / Results of the colonic primary suture of penetrating abdominal lesions

INTRODUCCIÓN. La mortalidad por heridas de colon debidas a traumatismos penetrantes del abdomen ha disminuido, pero en algunos centros sanitarios se mantiene una controversia en relación con efectuar o no la sutura primaria de dichas heridas. En este trabajo se buscó presentar los resultados del uso de la sutura primaria de colon en heridas penetrantes de abdomen en pacientes atendidos por un grupo básico de trabajo de cirugía del Hospital Clinicoquirúrgico Joaquín Albarrán Domínguez (La Habana). METODOS. Se realizó un estudio prospectivo de todos los pacientes con heridas penetrantes de abdomen y lesión de colon a los cuales se les realizó sutura primaria de colon, que fueron atendidos por nuestro grupo básico de trabajo entre enero de 2005 y mayo de 2008. Los criterios de exclusión comprendieron solamente el estado de choque hipovolémico, la demora de más de 6 h entre el momento de la lesión y la cirugía y la contaminación fecal grave. RESULTADOS. En el período citado fueron intervenidos quirúrgicamente de urgencia 17 pacientes: 94 por ciento de ellos del sexo masculino, rango de edad de entre 16 y 43 años, el 76,4 por ciento de ellos con lesiones intraabdominales asociadas. El agente causal de la herida fue un arma blanca en el 100 por ciento de los casos. El colon izquierdo fue el sitio más afectado (53 por ciento). El 100 por ciento de los pacientes recibieron antibióticos, y los más empleados fueron las cefalosporinas de tercera generación asociadas siempre con metronidazol. Hubo 3 reintervenciones, ninguna por dehiscencia de suturas. No hubo muertes y la estadía promedio fue de 6,9 días. CONCLUSIONES. La sutura primaria de las heridas de colon producidas por arma blanca es segura, aun cuando éstas se localicen en el colon izquierdo y existan lesiones asociadas en otros órganos(AU)

INTRODUCTION. Mortality due to colon due to penetrating abdominal traumata has decreased but in some health centers there is a controversy related to primary stitch or not such wounds. In present paper authors showed the results of colonic primary suture in penetrating abdominal wounds in patients seen by a surgery working basic team from the Joaquín Albarrán Domínguez Clinical Surgical Hospital (La Habana). METHODS. A prospective study was performed in all patients presenting with abdominal penetrating wounds and colonic lesions who underwent colon primary suture seen by our working basic team between January, 2005 and May, 2008. The exclusion criteria included only the hypovolemic shock status, delay for more than 6 hours from the moment of lesion and surgery as well as the severe fecal contamination. RESULTS. During the above period 17 male patients aged 16 and 43 were operated on the 76,4 percent with associated intra-abdominal lesions. The causal agent of wound was a steel in the 100 percent of cases. Left colon was the more involved site (53 percent). The 100 percent of patients received antibiotics and the more used were third-generation cephalosporins associated always with the Metrodinazole. There were re-surgical interventions without dehiscence suture. No death occurred and man stay was of 6,9 days. CONCLUSIONS.The suture of colonic wounds produced by steel safe even though these be located in the left colon and there are lesions associated with other organs(AU)

Trauma ocular: experiencia de 16 Años de la UTO / Ocular trauma: UTO 16 years of experience

Se presenta una visión personal del jefe de la unidad de trauma ocular, en la cual se describen los hechos históricos más importantes, y los pasos que se dieron para la creación del primer centro nacional de referencia en Chile de trauma ocular severo. También en estudios previos se han mencionado las características principales de los pacientes que se atienden en este centro. El objetivo del artículo es revisar los hitos históricos más importantes que participaron en la creación de la Unidad de Trauma Ocular del hospital el Salvador hasta ahora, haciendo énfasis en los resultados epidemiológicos en estudios previos. Desde 1971, el primer esfuerzo por dar atención de urgencia oftalmológica, se concentró en el de la Urgencia de la asistencia pública Dr. Alejandro del Río. Con solo 12 oftalmólogos, y muchas dificultades para operar como un departamento de urgencia independiente. El servicio tuvo una lento deterioro, hasta mediados de los 80, en que comenzaron a colapsar otros servicios oftalmológicos. Sin embargo, diversos personajes de la esfera oftalmológica presionaron a las autoridades para la creación de una unidad de trauma ocular. De este modo en 1994 se creó la primera unidad de trauma ocular con dos oftalmólogos con turno de medio día, una pequeña sala de emergencia, que fue gradualmente creciendo y prosperando hasta como se conoce hoy día. Desde el 2007, fue declarada por ley, el centro de referencia del trauma ocular severo, en el nuevo régimen de garantías explícitas de salud. Actualmente, desde el 2010, nuestra unidad se convertido el Centro Nacional de trauma ocular severo y accidentes del trabajo, con más de 33.000 atenciones y 1.500 cirugías al año. La creación del Centro Nacional de Trauma Ocular severo es el resultado de largos años de trabajo y representa el esfuerzo conjunto para prevenir la ceguera por trauma en Chile.

Purpose: To review the main historical landmarks of the creation of the Ocular Trauma Unit of Hospital del Salvador until nowadays, making emphasis in epidemiological findings of previous studies. Methods: A personal point of view, made by the Ocular Trauma Unit head chief is presented here describing the most important historical facts that they took step to the creation of the First Center of National Reference for Severe Ocular in Chile. Also, a previous epidemiological study is mentioned in order to reference main characteristics of patients attended here. Results: Since 1971, the first effort to provide ophthalmological emergency attention was concentrated in its beginnings in the Emergency Department of The Public Assistance Dr. Alejandro del Río. With only 12 ophthalmologists and many difficulties to operate as an independent emergency department, the service had a slow deterioration until middle eighties, starting to collapse other Ophthalmology Services. Nevertheless, diverse personages of the ophthalmological sphere, pressed to the authorities for the creation of a unit of ocular trauma. Thus, in 1994 it was created the first ocular trauma unit with only two ophthalmologists with half-day shifts in a small emergency room that gradually prospered to which we know now. Since 2007, it was declared by law as The Referral Center for Severe Ocular Trauma in the new regimen of Explicit Guaranties in Health, and currently (since 2010) our unit has become the National Center for Severe Ocular Trauma and Work-Related accidents, with more than 33,000 attentions and 1,500 surgeries per year. Conclusion: The creation of The National Center for Severe Ocular Trauma has been the result of long years of work and represents a joint effort in preventing the blindness by ocular trauma in Chile.

Accidentalidad por fluidos biológicos en profesionales de laboratorios clínicos de Maracaibo, Venezuela / Biological fluid-related accidents amongst professionals working in clinical laboratories in Maracaibo, Venezuela

Objetivo Determinar la exposición laboral accidental a fluidos biológicos por contacto percutáneo en el personal Bioanalista de Laboratorios Clínicos públicos, sus factores asociados y el cumplimiento de medidas post exposición biológica. Métodos Se realizó un estudio descriptivo transversal, la muestra fue de 156 bioanalistas adscritos a laboratorios clínicos del área metropolitana del estado Zulia. Para la recolección de datos se aplicó un instrumento de escalas que exploró la exposición percutánea, los factores vinculados y el cumplimiento de medidas post exposición biológica. Resultados Se evidenció exposición por accidentes percutáneos, representados principalmente por pinchazos y cortaduras, detectados en razón de su ocurrencia en un nivel moderado (media entre 2-3,99). Como factores vinculados a la accidentabilidad percutánea, se registra la ocurrencia en nivel moderado con diversas agujas huecas, con sangre y hemoderivados, en manos y dedos, con una severidad superficial, en áreas de toma y procesamiento de muestras durante el re-encapuchado de objetos punzo cortantes. Un nivel de mediano cumplimiento se obtuvo para el manejo post exposición. Existe relación entre la exposición percutánea con el nivel de cumplimiento detectado para el manejo post exposición p <0,001. Conclusión La magnitud y características de la exposición a fluidos biológicos detectada en este colectivo laboral reviste una problemática que puede impactar en la salud del personal y debe ser abordada institucionalmente para una efectiva gestión de prevención y control de riesgo.

Objective Determining the occupational exposure to biological fluids of medical technicians working in public clinical laboratories caused by accidental percutaneous contact, associated factors and compliance with post-exposure biological measures. Methods This was a descriptive cross-sectional study. The sample consisted of 156 medical technicians assigned to clinical laboratories in the metropolitan area of Zulia state in Venezuela. Data was collected by applying an instrument for exploring exposure and related factors, as well as compliance with established post-biological exposure measures. Results There was evidence of exposure caused by percutaneous accidents, mainly represented by a moderate level of needle-pricks and cuts (2-3.99 mean). There was a moderate level of factors regarding percutaneous injury in the hands and fingers associated with hollow needles, blood and blood products and superficial severity in sample taking and processing areas when recapping needles or handling sharp or cutting objects. A medium level (2-3.99 mean) of compliance was obtained for post-exposure handling. A significant correlation was found (p<001) between percutaneous exposure and level of compliance with post-exposure management. Conclusion The magnitude and characteristics of exposure to biological fluids detected in this work represents a problematic situation which can affect staff health and must be approached by institutions to ensure effective prevention management and risk control.

Cierre primario en trauma de colon / Primary closure in colon trauma

Objetivo: Informar si la evolución > 6 horas, grado de contaminación y lesión, sitio anatómico lesionado, PATI (penetrating abdominal trauma index) > 25 y presencia de otras lesiones en trauma de colon, se asocian a mayor morbimortalidad en pacientes con lesión colónica a quienes se les realizó cierre primario. Material y métodos: Estudio prospectivo, observacional, longitudinal, descriptivo, en el Hospital Central “Dr. Ignacio Morones Prieto”, San Luis Potosí. Se incluyeron pacientes con trauma abdominal sometidos a cirugía que presentaron lesión colónica. Análisis estadístico básico con χ2. Resultados: 481 pacientes fueron intervenidos por trauma abdominal; 77 (16.1 %) tuvieron lesión colónica, de los cuales 90 % (n = 69) se intervino en las primeras seis horas; 91 % fue lesión penetrante. El colon transverso fue el más lesionado (38 %, n = 29); las lesiones grado I y II representaron 75.3 % (n = 58). Se efectuó cierre primario en 76.66 % (n = 46), resección con anastomosis en 8.3 % (n = 5) y colostomía en 15 % (n = 9). Hubo lesiones asociadas en 76.6 % (n = 59) y contaminación en 85.7 % (n = 66); 82.8 % (58) tuvo PATI < 25; complicaciones asociadas al procedimiento operatorio, 28.57 % (n = 22); reintervenciones, 10 % (n = 8); estancia hospitalaria promedio, 11.4 días; mortalidad no relacionada a lesión de colon, 3.8 % (n = 3). Conclusiones: El cierre primario es un procedimiento seguro para el tratamiento de lesiones colónicas. Los pacientes con cierre primario presentaron menor morbilidad (p < 0.009). Los pacientes con cirugía en las primeras seis horas (p < 0.006) y estabilidad hemodinámica (p < 0.014) tuvieron menor riesgo de complicación.

BACKGROUND: Primary repair of colon injuries is an accepted therapeutic option; however, controversy persists regarding its safety. Our objective was to report the evolution and presence of complications in patients with colon injury who underwent primary closure and to determine if the time interval (>6 h), degree of injury, contamination, anatomic site injured, PATI (Penetrating Abdominal Trauma Index) >25, and the presence of other injuries in colon trauma are associated with increased morbidity and mortality. METHODS: This was a prospective, observational, longitudinal and descriptive study conducted at the Central Hospital "Dr. Ignacio Morones Prieto," San Luis Potosí, Mexico, from January 1, 2003 to December 31, 2007. We included patients with abdominal trauma with colon injury subjected to surgical treatment. chi(2) was used for basic statistical analysis. RESULTS: There were 481 patients with abdominal trauma who underwent surgery; 77(16.1%) had colon injury. Ninety percent (n = 69) were treated in the first 6 h; 91% (n = 70) were due to penetrating injuries, and gunshot wound accounted for 48% (n = 37). Transverse colon was the most frequently injured (38%) (n = 29). Grade I and II injuries accounted for 75.3% (n = 58). Procedures included primary repair (76.66 %) (n = 46); resection with anastomosis (8.3%) (n = 5); and colostomy (15%) (n = 9). Associated injuries were present in 76.6% (n = 59). There was some degree of contamination in 85.7% (n = 66); 82.8% (58) had PATI <25. Complications associated with the surgical procedure were observed in 28.57% (n = 22). Reoperation was necessary in 10% (n = 8). Average hospital stay was 11.4 days. Mortality was 3.8% (n = 3); none of these were related to colon injury. CONCLUSIONS: Primary repair is a safe procedure for treatment of colon injuries. Patients with primary repair had lower morbidity (p <0.009). Surgery during the first 6 h (p <0.006) and in hemodynamically stable patients (p <0.014) had a lower risk of complications.

Trauma penetrante cardíaco en la Unidad de Emergencia del Hospital Carlos Van Buren / Penetrating cardiac trauma: review of 36 operated patients

Background: The most common cause of cardiac penetrating trauma is wounds caused by knives or firearms. Aim: To review the operated cases of penetrating cardiac trauma in a public hospital emergency room. Material and Methods: Review of medical records of patients operated for penetrating cardiac trauma between 1986 and 2009. Results: We retrieved the records of 36 patients (33 males) with a median age of 30 years. Ninety four percent of lesions were cause by knife wounds. In 24 patients, the right ventncle was injured. Immediate surgical mortality was 17 percent and 22 percent of patients had complications. Conclusions: Surgical mortality in penetrating cardiac trauma is related to the delay of surgical correction, injury by firearms or the presence of complex lesions.

El trauma penetrante cardíaco representa una de las mayores causas de muerte por motivo de violencia urbana y se clasifica en penetrante o contuso. La causa más común de trauma cardíaco penetrante es la herida por arma blanca o de fuego. La principal causa de trauma penetrante cardíaco en nuestra serie fue la lesión por arma blanca, siendo el ventrículo derecho la principal cámara cardíaca afectada. Los resultados quirúrgicos son comparables con otras series, con una mortalidad del 16,6 por ciento y una morbilidad de 22 por ciento. La mortalidad quirúrgica está relacionada con el retraso de la cirugía, o la lesión por arma de fuego, o la presencia de lesiones complejas. Aún sigue siendo fundamental el diagnóstico clínico y el manejo precoz.

[Trauma: an epidemiological study from a single institute in Ahvaz, Iran]

This prospective study was conducted to evaluate the characteristics and outcomes of trauma patients attending the emergency department of a university hospital in Ahvaz- Iran [2000]. We identified all trauma admissions due to blunt and penetrating injuries. Data were collected from emergency departments and intensive care log books at Golestan hospital by on-site data collectors. The total number of patients included in the study was 1141; of these, 952 [83.4%] were males. The mean age of the study sample was 26.7 +/- 17 years [range, 1- 84 years]. Injuries were predominantly of the blunt type [91.8%], with only a small percentage of penetrating injuries [8.2%]. The most common cause of injury was traffic accidents [59%]. There were a total of 96 deaths [8.4%], and only a small number had an ISS of

Homicides by sharp weapons.

In the present society, which is gradually becoming over democratic it is natural that old values of sanctity of life changes and personality problems develop due to consequent stress of life. This ultimately results in violence. Killing of a human being is one of the most serious or major crimes. Since very long time, different judicial authority to prevent crime and its further occurrence framed laws. The laws were made according to the religious make up of the society but later the laws were according to the emperor’s own convenience. In spite of all these, there has been a phenomenal rise in the incidence of homicide all over the world and also in India. The study was conducted on 200 alleged cases of homicides. The incidence of homicidal deaths was observed as 13.03% with male preponderance and the commonest age affected was 21 to 40 yrs. Out of different weapons used to inflict the injuries on dead bodies of homicides, 31(10.88%) sharp cutting weapons were used. Incised wounds were present maximum 38(29.69%) on head and face. Defence wounds were present in 72(36%) of homicide deaths.

Trauma abdominal penetrante / Penetrating abdominal trauma

Introducción: el abdomen ocupa el tercer lugar corporal dañado por trauma. La evaluación y la estabilización de los individuos con lesiones en esa región son la piedra angular en los momentos de urgencias. El abordaje diagnóstico y el resultado del tratamiento están influidos por múltiples factores. El mecanismo y los patrones de las lesiones varían. La exploración física es el indicador más confiable para determinar la necesidad de cirugía. El objetivo de esta investigación fue conocer frecuencia, incidencia, factores demográficos, tasa de laparotomías inmediatas y diferidas, y complicaciones asociadas con el trauma abdominal penetrante; así como definir la utilidad del índice de trauma abdominal penetrante (PATI). Material y métodos: estudio observacional, prospectivo, longitudinal, descriptivo, realizado en el Hospital Central “Ignacio Morones Prieto”, San Luis Potosí, México, del 1 de enero al 31 de diciembre de 2005; incluyó pacientes con trauma abdominal penetrante sometidos a laparotomía exploradora. Fueron estudiadas 21 variables y se llevó a cabo análisis estadístico básico, con t de Student, χ2 y ANOVA. Resultados: se operaron 79 pacientes, 93.67 % del sexo masculino; predominaron los pacientes en la tercera década de la vida; numerosas lesiones fueron producidas durante la noche y por violencia interpersonal; 50.6 % estuvo asociado con el consumo de drogas y 63.3 % se debió a instrumento punzocortante. Con más frecuencia las lesiones se localizaron en cuadrante superior izquierdo, inferior derecho y epigastrio, prevaleciendo las heridas únicas; en las asociadas estuvieron involucrados el tórax y las extremidades; de las laparotomías, 92.4 % se realizó en forma inmediata y en 60.53 %, terapéutica. Existieron complicaciones en 39.24 %; 15.19 % fue reintervenido y la mortalidad representó 3.9 %. Conclusión: debido al elevado índice de laparotomías no terapéuticas y negativas, se requiere abordaje más selectivo que incluya la exploración física...

BACKGROUND: The abdomen ranks in third place of body areas injured by trauma. Evaluation and stabilization of these patients form the cornerstone in emergency medicine. Diagnostic approach and treatment outcome are influenced by several factors. Injury mechanism and pattern vary according to geography and there is an association with drugs and alcohol. Physical examination remains the most reliable indicator for surgery. Associated injuries are present in up to 26% of cases. We undertook this study to determine penetrating abdominal trauma incidence and frequency, demographic factors, rate of immediate and delayed laparotomies, and associated complications as well as to define the usefulness of penetrating abdominal trauma index (PATI). METHODS: An observational, prospective, longitudinal descriptive study was carried out at the Hospital Central [quot ]Ignacio Morones Prieto,[quot ] San Luis Potosi, Mexico from January 1, 2005 to December 31, 2005 on patients who underwent exploratory laparotomy for penetrating abdominal trauma. Twenty one variables were studied. Basic statistical analysis, ANOVA, chi(2) and Student's t-test were used. RESULTS: Of the 79 patients who were included, 93.67% were males. The third decade of life was the most affected, with a night presentation being predominant as a result of personal violence. Drug use was observed in 50.6%; stab wounds in 63.3%. The most frequent locations were the left upper and right lower quadrants and epigastrium; solitary wounds were predominant. Associated injuries were most common in the thorax and limbs. Of the laparotomies performed, 92.4% were urgent and 60.53% were therapeutic; 15.19% required reoperations; complications were observed in 39.24%; and mortality rate was 3.9%. CONCLUSIONS: Due to high non-therapeutic and negative laparotomies rates, a more selective approach is needed, including repetitive physical examination and the appropriate use of auxiliary diagnostic studies.

Ocorrência de acidente de trabalho por materiais perfurocortantes e fluidos biológicos em estudantes e trabalhadores da saúde de um hospital escola de Brasília / Frecuencia de accidentes del trabajo causados por instrumentos puntiagudo-cortantes y fluidos biológicos entre estudiantes y personal de un hospital escuela de la ciudad de Brasilia / Occurrence of work accidents caused by sharp-edged hollow-pointed equipment and biological fluids among medical students and health personnel in a Brasília university hospital

Estudo teve por objetivo verificar e analisar a ocorrência de acidentes de trabalho causados por materiais perfurocortantes e fluidos biológicos em estudantes e trabalhadores da área da saúde. Foi realizado em um hospital-escola de Brasilia. A coleta de dados foi feita a partir dos registros de acidentes de trabalho mantidos pela Comissão de Controle de Infecção Hospitalar e referentes ao período de agosto de 1998 a junho de 2000. Verificou-se que 117 pessoas sofreram acidentes de trabalho, em sua grande maioria causados por agulhas. Concluiu-se que existe a necessidade de melhoria nos sistemas de prevenção de acidentes na instituição.

The objective of the study was to check and analyze the occurrence of work accidents caused by sharp-edged hollow-pointed equipment and biological fluids among medical students and health personnel. It was carried out in a Brasilia university hospital. The data were collected from records of work accidents kept by the Hospital Infection Control Committee, from August 1998 to June 2000. It has turned out that 117 persons were victims of work accidents, the vast majority of them caused by needles. The study has reached the conclusion that the accident prevention system must be improved at the above mentioned hospital.

El objetivo del estudio fue el de verificar y analizar la frecuencia de accidentes del trabajo causados por instrumentos puntiagudo-cortantes entre estudiantes y personal de un hospital escuela de la ciudad de Brasilia. Los datos, recogidos de los registros de accidentes del trabajo de la Comisión de Control de Infección Hospitalaria, corresponden al periodo entre agosto de 1998 y junio de 2000. Se verifico que 117 personas sufrieron accidentes del trabajo, en su gran mayoría causados por agujas. Se llegó a la conclusión de que es necesario mejorar el sistema de prevención de accidentes en dicha institución.

Gastrointestinal injuries

Gastrointestinal injuries are the most important among abdominal injuries. These injuries could be the result of blunt trauma, penetrating wound, or iatrogenic 292 gastrointestinal injuries were recorded in our work 13 were iatrogenic, 55 due to blunt trauma and 224 were due to penetrating injuries. These injuries were dealt with according to general surgical rules, any part of the gastrointestinal tract could be injured, no part was immune except the thoracic esophagus which was well protected by the thoracic cage. All patients were subjected to history. clinical examination, diagnostic peritoneal lavage. X-ray and sonogram when possible. Wound infection was 32. burst abdomen 8 D.V.T 12. chest infection 18 minor leak 13. severe leak 8. septicaemia 4 bleeding 3. trauma high risk area 3. pulmonary embolism 3 and mvocardial infarction 2. All gastrointestinal injuries could be treated with favorable outcome except duodenal injuries which were in deep need for meticulous handling and perfect drainage

Cut throat injury: a retrospective study of 26 cases.

Cut throat injuries and associated deaths are common in our society. Majority succumb to their injuries. In this study, the hospital records of twenty six such cases (13 M & 13 F) were reviewed. Eleven victims were in their third decade. Eighteen cases came from poor socio-economic class. Eleven had suicidal, eleven homicidal and four accidental injuries. Familial troubles, psychiatric illness and poverty were the triggering factors in suicidal attempts. The motives of homicide included political conflict, sex related crimes, dacoity, familial, land related disputes, etc. All had their hypopharynx and/or larynx exposed. Tracheostomy was done in fifteen cases. All but two had uneventful recovery. One died in the hospital due to hemorrhage, shock and asphyxia from aspirated blood. It was observed that appropriate measures could save lives in vast majority.