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1.
Rev. Col. Bras. Cir ; 49: e20223120, 2022. tab
Article in English | LILACS | ID: biblio-1365399

ABSTRACT

ABSTRACT Objective: to describe, analyze, and trace the epidemiological profile for cardiac trauma victims on a referral trauma hospital of a major urban center. Methods: a case series study to review, describe, compile and analyze medical records of all patients sustaining traumatic cardiac injuries, from January 2015 to January 2020 admitted to the referral trauma hospital of Curitiba, Brazil. Patients sustaining traumatic heart injuries were identified using the hospitals database. Patients who died prior to reaching hospital care were excluded. Results: all 22 cases were urban victims, mostly penetrating injuries (12 stab wounds, 9 gunshot wounds); 82% were male; mean age, 37.1 years. 17 cases (77%) occurred during night hours, 15 between Friday and Sunday, and 15 were admitted hemodynamically stable. Only 27% were diagnosed with FAST, the remainder requiring other imaging exams. About incisions, 14 had thoracotomies, 6 median sternotomies and in 2 cases both. Of injuries, 8 affected the right ventricle, 3 right atrium, 9 left ventricle, 1 right coronary sulcus and 1 anterior wall. All had cardiorrhaphy repair. 3 patients died, 17 were discharged and 2 were transferred. 17 received postoperative echocardiograms, revealing ejection fractions ranging 55.1% to 75%. Patients spent a mean of 9.6 days on ICU and a mean of 15.2 days of total hospital stay. The mortality rate was 14%. Conclusions: cardiac traumas predominantly occurred in adult males, due to violent causes, during night hours on weekends. The overall mortality rate found (14%), as well as total hospital stay, accords with the literature.


RESUMO Objetivo: descrever, analisar e traçar o perfil epidemiológico das vítimas de trauma cardíaco em hospital de referência em trauma de grande centro urbano. Métodos: uma série de casos para descrever e analisar prontuários de todos os pacientes que sofreram lesões cardíacas traumáticas, entre janeiro, 2015, a janeiro, 2020, admitidos no hospital referência em trauma de Curitiba, Brasil. Pacientes que sofreram lesões cardíacas traumáticas foram identificados no banco de dados do hospital. Pacientes em óbito antes da chegada aos cuidados hospitalares foram excluídos. Resultados: todos os 22 casos foram vítimas urbanas, maioria ferimentos penetrantes (12 por arma branca, 9 por arma de fogo); 82% homens; idade média 37.1 anos. 17 casos (77%) ocorreram no período noturno, 15 entre sexta-feira e domingo. 15 foram admitidos hemodinamicamente estáveis. 27% diagnosticados com FAST; demais demandaram outros exames. Das incisões, 14 receberam toracotomias, 6 esternotomias medianas, 2 casos ambas. Das lesões, 8 afetaram ventrículo direito, 3 átrio direito, 9 ventrículo esquerdo, 1 sulco coronário direito, 1 parede anterior. Todos receberam cardiorrafias. 3 pacientes morreram, 17 tiveram alta e 2 foram transferidos. 17 receberam ecocardiograma pós-operatório, revelando frações de ejeção de 55.1% a 75%. Os pacientes passaram em média 9.6 dias em UTI e 15.2 dias de internamento hospitalar total. A taxa de mortalidade foi de 14%. Conclusões: traumas cardíacos ocorreram predominantemente em homens adultos, devido a causas violentas, durante o período noturno nos finais de semana. A taxa de mortalidade encontrada, assim como o tempo total de internamento hospitalar, esteve em acordo com a literatura.


Subject(s)
Humans , Male , Female , Adult , Wounds, Gunshot , Wounds, Penetrating/surgery , Wounds, Stab , Referral and Consultation , Trauma Centers , Retrospective Studies , Hospitals
2.
Rev. Col. Bras. Cir ; 49: e20223146, 2022. tab, graf
Article in English | LILACS | ID: biblio-1365389

ABSTRACT

ABSTRACT Objective: the study aims to analyze the performance and outcome of resuscitation thoracotomy (TR) performed in patients victims of penetrating and blunt trauma in a trauma center in southern Brazil during a 7 years period. Methods: retrospective study based on the analysis of medical records of patients undergoing TR, from 2014 to 2020, in the emergency service of the Hospital do Trabalhador, Curitiba - Paraná, Brazil. Results: a total of 46 TR were performed during the study period, of which 89.1% were male. The mean age of patients undergoing TR was 34.1±12.94 years (range 16 and 69 years). Penetrating trauma corresponded to the majority of indications with 80.4%, of these 86.5% victims of gunshot wounds and 13.5% victims of knife wounds. On the other hand, only 19.6% undergoing TR were victims of blunt trauma. Regarding the outcome variables, 84.78% of the patients had declared deaths during the procedure, considered non-responders. 15.22% of patients survived after the procedure. 4.35% of patients undergoing TR were discharged from the hospital, 50% of which were victims of blunt trauma. Conclusion: the data obtained in our study are in accordance with the world literature, reinforcing the need for a continuous effort to perform TR, respecting its indications and limitations in patients victims of severe penetrating or blunt trauma.


RESUMO Objetivo: analisar o desempenho e o desfecho das toracotomias de reanimação (TR) realizadas nos pacientes vítimas de trauma penetrante e contuso em um hospital de referência em trauma no Sul do Brasil durante um período de sete anos. Métodos: estudo retrospectivo baseado na análise de prontuários de pacientes submetidos a TR, no período de 2014 a 2020, no serviço de emergência do Hospital do Trabalhador, Curitiba - Paraná, Brasil. Resultados: um total de 46 TR foram realizadas durante o período de estudo, dos quais 89.1% eram do sexo masculino. A média de idade dos pacientes submetidos a TR foi de 34.1±12.94 anos (variação de 16 e 69 anos). O trauma penetrante correspondeu pela maioria das indicações de TR com 80.4%, destas 86.5% vítimas de ferimentos por arma de fogo e 13.5% vítimas de ferimento por arma branca. Por outro lado, apenas 19.6% submetidos a TR foram vítimas de trauma contuso. No que se refere as variáveis de desfecho, 84.78% dos pacientes tiveram óbitos declarados durante o procedimento, considerados não respondedores. 15.22% dos pacientes apresentaram sobrevida após o procedimento. 4.35% dos pacientes submetidos à TR tiveram alta hospitalar, sendo 50% pacientes vítimas de trauma contuso. Conclusão: os dados obtidos em nosso estudo estão em conformidade com a literatura mundial, reforçando a necessidade de um esforço contínuo para realização da TR respeitando suas indicações e limitações em pacientes vítimas de trauma grave penetrante ou contuso.


Subject(s)
Humans , Adolescent , Adult , Aged , Young Adult , Wounds, Gunshot , Thoracotomy , Trauma Centers , Brazil , Retrospective Studies , Middle Aged
3.
Rev. Assoc. Méd. Rio Gd. do Sul ; 65(2): 01022105, Abr. - Jun. 2021.
Article in Portuguese | LILACS | ID: biblio-1367429

ABSTRACT

RESUMO Introdução: O objetivo do nosso estudo foi investigar os fatores epidemiológicos envolvidos nas tentativas de suicídio atendidas em um hospital de trauma em Curitiba-PR entre janeiro de 2014 a dezembro de 2017. Métodos: Trata-se de um estudo retrospectivo realizado com base na avaliação de fichas de notificação obrigatória e banco de dados do hospital. Foram incluídos pacientes atendidos por tentativas de suicídio, maiores de 18 anos atendidos num período de 48 meses. Foram analisados dados como sexo, idade, estado civil, meio de agressão, natureza da lesão, reincidência da tentativa e desfecho. 283 pacientes foram incluídos no estudo e analisados comparativamente ao perfil característico descrito na literatura. Resultados: Observou-se no período estudado um constante crescimento no número das tentativas, significativamente maior no sexo feminino. Apesar desse aumento em mulheres, houve predomínio de pacientes do sexo masculino 1,3:1 (p < 0,005). A idade média foi de 34,6 ± 13,25 anos e não apresentou diferença significativa entre os sexos. De modo geral, o principal meio utilizado foi objeto perfurocortante (32,8%), seguido por intoxicação (31,8%), homens utilizaram mais objetos cortantes e mulheres envenenamento. Do total de pacientes, 9 (3,2%) foram a óbito obtendo-se uma relação suicídios-tentativas de suicídio de 1:31. Conclusão: O perfil do paciente que tenta suicídio mudou em comparação a estudos anteriores. Embora o número de homens permaneça superior, o número de mulheres está crescendo. O aumento nos índices sugere que há necessidade de melhora das políticas públicas. PALAVRAS-CHAVE: Tentativa de suicídio, serviços médicos de emergência, centros de traumatologia


ABSTRACT Introduction: The aim of our study was to investigate the epidemiological factors involved in suicide attempts seen at a trauma hospital in Curitiba-PR between January 2014 and December 2017. Methods: This is a retrospective study based on the evaluation of hospital mandatory notification forms and database. Patients over 18 years of age who were seen for suicide attempts along a 48-month period were included. Data such as sex, age, marital status, means of aggression, nature of injury, recurrence of attempt, and outcome were analyzed. A total of 283 patients were included in the study and analyzed against the characteristic profile described in the literature. Results: During the study period, there was a constant increase in the number of attempts, significantly higher in females. Despite this increase in women, there was a predominance (1.3:1) of male patients (p < 0.005). The mean age was 34.6 ± 13.25 years and there was no significant gender difference. In general, the main means used was sharp objects (32.8%), followed by intoxication (31.8%), men used more sharp objects, while women, poisoning. Of the total number of patients, 9 (3.2%) died, with a suicides-attempts ratio of 1:31. Conclusion: The profile of the suicide attempt patient has changed compared to previous studies. While the number of men remains higher, the number of women is growing. The increase in indices suggests that public policies should be improved. KEYWORDS: Suicide attempt, emergency medical services, trauma centers


Subject(s)
Humans , Suicide, Attempted , Trauma Centers , Emergency Medical Services
4.
Rev. colomb. cir ; 36(1): 42-50, 20210000. fig, tab
Article in Spanish | LILACS | ID: biblio-1148507

ABSTRACT

Introducción. El trauma es una de las entidades con mayor morbimortalidad en el mundo. Los equipos especializados en la atención del paciente traumatizado son llamados «equipos de trauma¼. Dichos equipos surgieron de la necesidad de brindar tratamiento oportuno multidisciplinario a individuos con heridas que condicionan gran severidad en la guerra; sin embargo, con el paso del tiempo se trasladaron al ámbito civil, generando un impacto positivo en términos de tiempos de atención, mortalidad y morbilidad. El objetivo de este estudio fue describir el proceso de desarrollo de los equipos de trauma a nivel mundial y la experiencia en nuestra institución en el suroccidente colombiano. Métodos. Se realizó una búsqueda en la base de datos PUBMED, que incluyó revisiones sistemáticas, metaanálisis, revisiones de Cochrane, ensayos clínicos y series de casos. Resultados. Se incluyeron 41 estudios para esta revisión narrativa, y se observó que el tiempo de permanencia en Emergencias, el tiempo de traslado a cirugía, la mortalidad y las complicaciones asociadas al trauma fueron menores cuando se implementan equipos de trauma. Discusión. El diseño de un sistema de atención y valoración horizontal de un paciente con traumatismos severos produce un impacto positivo en términos de tiempos de atención, mortalidad y morbilidad. Se hace necesario establecer los parámetros operativos necesarios en las instituciones de salud de alta y mediana complejidad en nuestro país para implementar dichos equipos de trabajo


Introduction. Trauma is one of the entities with the highest morbidity and mortality in the world. Teams specialized in trauma patient care are called «trauma teams¼. These teams arose from the need to provide timely multidisciplinary treatment to individuals with severe injuries in war; however, with time they moved to the civilian arena, generating a positive impact in terms of care times, mortality and morbidity. The objective of this study was to describe the process of development of trauma teams worldwide and the experience in our institution in southwestern Colombia. Methods. A search of the PUBMED database was carried out, which included systematic reviews, metaanalyses, Cochrane reviews, clinical trials, and case series.Results. Forty-one studies were included for this narrative review, and it was observed that the length of stay in the ER, the time of transfer to surgery, mortality and complications associated with trauma were lower when trauma teams are implemented. Discussion. The design of a horizontal care and assessment system for a patient with severe trauma produces a positive impact in terms of care times, mortality and morbidity. It is necessary to establish operational parameters in high and medium complexity health institutions in our country to implement such work teams


Subject(s)
Humans , Trauma Centers , Patient Care Team , Wounds and Injuries , Trauma Severity Indices , Advanced Trauma Life Support Care
5.
Esc. Anna Nery Rev. Enferm ; 25(4): e20210005, 2021. tab
Article in Portuguese | LILACS, BDENF | ID: biblio-1339868

ABSTRACT

RESUMO Objetivo identificar as principais barreiras e facilitadores do trabalho multiprofissional, com vistas à construção de um ambiente ético em um serviço de traumatologia. Método estudo exploratório-descritivo com abordagem qualitativa realizado com dez profissionais de uma equipe multiprofissional de uma unidade de traumatologia de um Hospital Universitário localizado no Sul do Brasil. Participaram três médicos, três médicos residentes, dois enfermeiros e dois técnicos em enfermagem. A coleta de dados ocorreu no período de setembro a outubro de 2019, por meio de Grupo Focal e foram submetidos à Análise Textual Discursiva. Resultados os dados permitiram a construção de duas categorias principais: as barreiras e os facilitadores encontrados para construção de um ambiente ético em um serviço de traumatologia. Conclusão e implicações para a prática como principais barreiras para a construção de um ambiente ético de trabalho foram identificadas a presença de diferentes vínculos empregatícios, a limitação de espaço físico e a burocracia e como facilitadores, foram destacados a presença de protocolos e comunicação efetiva que juntos podem resultar em uma direção para a construção de um ambiente ético de trabalho, de modo a ir ao encontro com a meta do serviço, no qual se constitui na humanização da assistência e a segurança do paciente.


RESUMEN Objetivo Identificar las principales barreras y facilitadores del trabajo multiprofesional, con miras a la construcción de un ambiente ético en un servicio de traumatología. Método estudio exploratorio-descriptivo con abordaje cualitativo, realizado con 10 profesionales de un equipo multidisciplinario de una unidad de traumatología en un Hospital Universitario ubicado en el sur de Brasil. Participaron tres médicos, tres médicos residentes, dos enfermeras y dos técnicos de enfermería. La recolección de datos se llevó a cabo de septiembre a octubre de 2019, a través del Focus Group, sometidos al Análisis Textual Discursivo. Resultados Los datos permitieron la construcción de dos categorías principales: barreras y facilitadores encontrados para la construcción de un ambiente ético en un servicio de traumatología. Conclusión e implicaciones para la práctica Las principales barreras para la construcción de un ambiente de trabajo ético fueron la presencia de diferentes vínculos laborales, la limitación del espacio físico y la burocracia. Como facilitadores, se destacaron la presencia de protocolos y una comunicación efectiva, que en conjunto pueden resultar en un rumbo para la construcción de un ambiente de trabajo ético, a fin de cumplir con el objetivo del servicio, que constituye la humanización del cuidado y la seguridad del paciente.


ABSTRACT Objective Identify the main barriers and facilitators to multi-professional practice to promote an ethical environment in a traumatology service. Method this exploratory-descriptive study with a qualitative approach addressed ten professionals from the multidisciplinary team of a traumatology service at a University Hospital located in southern Brazil. Three doctors, three resident doctors, two nurses, and two nursing technicians participated in the study. Data were collected from September to October 2019 through a Focus Group and analyzed through Discursive Textual Analysis. Results Two main categories emerged: barriers and facilitators to building an ethical environment in a traumatology service. Conclusion and implications for practic e: The main barriers hindering the construction of an ethical workplace environment included the presence of different employment contracts, restricted physical space, and bureaucracy, while facilitators included existing protocols and effective communication, which have the potential to promote an ethical workplace environment to fulfill the service's goals, i.e., the humanization of care and patient safety.


Subject(s)
Humans , Male , Female , Trauma Centers , Workplace/psychology , Ethics, Professional , Interprofessional Relations/ethics , Patient Care Team/ethics , Clinical Protocols , Focus Groups , Communication , Qualitative Research , Education, Continuing , Professional Training , Patient Safety
6.
Rev. Col. Bras. Cir ; 48: e20202784, 2021. tab
Article in English | LILACS | ID: biblio-1155372

ABSTRACT

ABSTRACT Objective: the aim of this study was to identify associated factors with the increased length of hospital stay for patients undergoing surgical treatment for liver trauma, and predictors of mortality as well as the epidemiology of this trauma. Methods: retrospective study of 191 patients admitted to the Cajuru University Hospital, a reference in the treatment of multiple trauma patients, between 2010 and 2017, with epidemiological, clinicopathological and therapeutic variables analyzed using the STATA version 15.0 program. Results: most of the included patients were men with a mean age of 29 years. Firearm injury represents the most common trauma mechanism. The right hepatic lobe was injured in 51.2% of the cases, and hepatorraphy was the most commonly used surgical correction. The length of hospital stay was an average of 11 (0-78) days and the length of stay in the intensive care unit was 5 (0-52) days. Predictors for longer hospital stay were the mechanisms of trauma, hemodynamic instability at admission, number of associated injuries, degree of liver damage and affected lobe, used surgical technique, presence of complications, need for reoperation and other surgical procedures. Mortality rate was 22.7%. Conclusions: the study corroborated the epidemiology reported by the literature. Greater severity of liver trauma and associated injuries characterize patients undergoing surgical treatment, who have increased hospital stay due to the penetrating trauma, hemodynamic instability, hepatic packaging, complications and reoperations.


RESUMO Objetivo: identificar fatores associados ao aumento do tempo de hospitalização de pacientes submetidos a tratamento cirúrgico por trauma hepático e descrever preditores de mortalidade, assim como a epidemiologia desse trauma. Métodos: estudo retrospectivo de 191 pacientes admitidos no Hospital Universitário Cajuru, referência no atendimento de politraumatizados, no período entre 2010 e 2017, com variáveis epidemiológicas, clinicopatológicas, terapêuticas analisadas por meio do programa STATA versão 15.0. Resultados: maioria dos pacientes incluídos eram homens com média de idade de 29 anos. Ferimento por arma de fogo representou o mecanismo de trauma mais comum. O lobo hepático direito foi lesado em 51,2% dos casos e hepatorrafia foi a correção cirúrgica mais empregada. O tempo de internamento hospitalar foi em média de 11(0-78) dias e o tempo de internação em unidade de terapia intensiva de 5 (0-52) dias. Preditores de maior tempo de hospitalização foram mecanismo de trauma, instabilidade hemodinâmica à admissão, número de lesões associadas, grau da lesão hepática e lobo acometido, técnica cirúrgica empregada, presença de complicações, necessidade de reoperação e outros procedimentos cirúrgicos. Taxa de mortalidade foi de 22,7%. Conclusões: o estudo corroborou a epidemiologia descrita na literatura. Maior gravidade do trauma hepático e das lesões associadas caracterizam os pacientes submetidos ao tratamento cirúrgico, que apresentam aumento de tempo de hospitalização devido a trauma penetrante, instabilidade hemodinâmica, tamponamento hepático, complicações e reoperações.


Subject(s)
Humans , Male , Adult , Wounds, Gunshot , Firearms , Trauma Centers , Injury Severity Score , Retrospective Studies , Hospitalization , Length of Stay , Liver/surgery , Liver/injuries
7.
Article in English | WPRIM | ID: wpr-879675

ABSTRACT

Throughout the past 2020, the pandemic COVID-19 has caused a big global shock, meanwhile it brought a great impact on the public health network. Trauma emergency system faced a giant challenge and how to manage trauma under the pandemic of COVID-19 was widely discussed. However, the trauma treatment of special population (geriatric patients and patients taking anticoagulant drugs) has received inadequate attention. Due to the high mortality following severe traumatic hemorrhage, hemostasis and trauma-induced coagulopathy are the important concerns in trauma treatment. Sepsis is another topic should not be ignored when we talking about trauma. COVID-19 itself is a special kind of sepsis, and it may even be called as serious systemic infection syndrome. Sepsis has been become a serious problem waiting to be solved urgently no matter in the fields of trauma, or in intensive care and infection, etc. This article reviewed the research progress in areas including trauma emergency care, trauma bleeding and coagulation, geriatric trauma and basic research of trauma within 2020.


Subject(s)
COVID-19 , Community Networks , Disseminated Intravascular Coagulation/therapy , Emergency Medical Services , Female , Health Services for the Aged , Hemorrhage/therapy , Hemostasis , Humans , Male , Pandemics , Public Health , Sepsis/therapy , Time Factors , Trauma Centers , Wounds and Injuries/therapy
8.
Rev. Col. Bras. Cir ; 47: e20202533, 2020. tab, graf
Article in English | LILACS | ID: biblio-1136597

ABSTRACT

ABSTRACT Purpose: to trauma quality indicators as a tool to identify opportunities of improvement in elderly trauma patient's' treatment. Methods: prospective analysis of data collected between 2014-2015, and stored in the iTreg software (by Ecossistemas). Trauma victims, aged older than 60 years and trauma quality indicators were assessed, based on those supported by SBAIT in 2013: (F1) Acute subdural hematoma drainage after 4 hours from admission, in patients with GCS<9; (F2) emergency room transference without definitive airway and GCS <9; (F3) Re-intubation within 48 hours from extubation; (F4) Admission-laparotomy time greater than 60 min. in hemodynamically uinstable patients with abdominal bleeding; (F5) Unprogrammed reoperation; (F6) Laparotomy after 4 hours from admission; (F7) Unfixed femur diaphyseal fracture; (F8) Non-operative treatment for abdominal gunshot; (F9) Admission-tibial exposure fracture treatment time greater than 6 hours; (F10) Surgery after 24 from admission. The indicators, treatments, adverse effects and deaths were analyzed, using the SPSS software, and the chi-squared and Fisher tests were used to calculate the statistical relevance. Results: from the 92 cases, 36 (39,1%) had complications and 15 (16,3%) died. The adequate use of quality indicator's were substantially different among those who survived (was of 12%) compared to those who died (55,6%). The incidence of complications was of 77,8% (7/9) in patients with compromised indicators and 34,9% (28/83) in those without (p=0.017). Conclusions: trauma quality indicators are directly related with the occurrence of complications and deaths, in elderly trauma patients.


RESUMO Objetivo: analisar a utilidade de "filtros de qualidade" pré-estabelecidos para a identificação de oportunidades de melhora no atendimento ao idoso traumatizado. Método: análise prospectiva dos dados coletados entre 2014-2015 e armazenados em software iTreg (Ecossistemas). Foram revisados vítimas de trauma maiores de 60 anos e filtros de qualidade propostos, baseados naqueles idealizados pela SBAIT em 2013: (F1) Drenagem de hematoma subdural agudo após 4 horas da admissão em pacientes com ECG<9; (F2) transferência da sala de emergência sem via aérea definitiva e ECG<9; (F3) Reintubação em até 48 horas da extubação; (F4) Tempo admissão-laparotomia exploradora maior que 60 min. em pacientes instáveis com foco abdominal; (F5) Reoperação não programada; (F6) Laparotomia após 4 horas da admissão; (F7) Fratura de diáfise de fémur não fixada; (F8) Tratamento não operatório de ferimento abdominal por PAF; (F9) Tempo admissão-tratamento de fraturas expostas de tíbia superior a 6 horas; (F10) Operação após 24 horas da admissão. Foi analisada relação dos filtros com tratamentos, complicações e óbitos, pelo software SPSS, utilizando-se o teste qui-quadrado e Fisher para calcular a relevância estatística. Resultados: dos 92 casos, 36 (39,1%) tiveram complicações e 15 (16,3%) morreram. A frequência da quebra dos filtros foi de 12% em pacientes que sobreviveram e 55,6% nos entre os que faleceram (p=0,005). A incidência de complicações foi de 77,8% (7/9) nos doentes com FQ comprometido, contra 34,9% (28/83) nos não comprometidos (p=0,017). Conclusões: o comprometimento dos filtros de qualidade se relaciona diretamente com a ocorrência de complicações e óbitos em idosos traumatizados.


Subject(s)
Humans , Male , Female , Aged , Trauma Centers/standards , Wounds and Injuries/surgery , Hematoma, Subdural, Acute/surgery , Airway Extubation , Laparotomy , Attention , General Surgery , Prospective Studies , Retrospective Studies , Treatment Outcome , Hemorrhage , Middle Aged
9.
Rev. Col. Bras. Cir ; 47: e20202438, 2020. tab
Article in English | LILACS | ID: biblio-1136596

ABSTRACT

ABSTRACT Objective: to compare hospital costs and clinical outcomes in inguinal and incisional hernioplasty before and after implementation of the ACERTO project in a university hospital. Methods: retrospective study of 492 patients undergoing either inguinal hernioplasty (n=315) or incisional hernioplasty (n=177). The investigation involved two phases: between January 2002 and December 2005, encompassing cases admitted before the implementation of the ACERTO protocol (PRE-ACERTO period), and the other phase, with cases operated between January 2006 and December 2011, after the implementation of the protocol (ACERTO period). The main outcome variable was the comparison of the mean hospital costs between the two periods. As secondary endpoints, we analyzed the length of stay, the surgical site infection rate and mortality. We used the cost method suggested by Public Sector Cost Information System. Results: surgical site infection was higher (p = 0.039) in the first phase of the study for both inguinal hernia operations (2 (1.6%) versus 0 (0%) cases) and incisional hernioplasty (5 (7.6%) versus 3 (2.7%) cases). The length of stay decreased one day after the implementation of the ACERTO protocol (p=0.005). There was a reduction in costs per patient from R$ 4,328.58 per patient in the first phase to R$ 2,885.72 in the second phase (66.7% reduction). Conclusion: there was a reduction in infectious morbidity, length of stay and hospital costs in hernioplasty after the implementation of the ACERTO protocol.


RESUMO Objetivo: comparar custos hospitalares e desfechos clínicos em hernioplastias inguinal e incisional antes e após a implementação do projeto ACERTO, em hospital universitário. Métodos: estudo retrospectivo com 492 pacientes submetidos à hernioplastias inguinais (n=315) ou incisionais (n=177). A investigação envolveu duas fases: entre janeiro de 2002 e dezembro de 2005, englobando casos internados antes da implantação do protocolo ACERTO (período PRÉ-ACERTO), e outra, com casos operados entre janeiro de 2006 e dezembro de 2011, após a implantação (período ACERTO). A variável de desfecho principal foi o custo médio de internação comparando-se os dois períodos estudados. Como desfecho secundário, analisou-se tempo de internação, infecção de sítio cirúrgico e mortalidade. Foi utilizado o método de custeio do Sistema de Informação de Custos do Setor Público. Resultados: a ocorrência de infecção de sítio cirúrgico foi maior (p=0,039) na primeira fase do estudo tanto para hernioplastias inguinais (2 (1,6%) versus 0 (0%) casos) quanto para incisionais (5 (7,6%) versus 3 (2,7%) casos). O tempo de internação diminuiu em um dia após a implementação do protocolo ACERTO (p=0,005). Houve redução no custo por paciente indo de R$ 4.328,58 por paciente na 1ª fase para R$ 2.885,72 na 2ª fase (redução de 66,7%). Conclusão: o conjunto de dados mostrou que houve redução da morbidade infecciosa, tempo de internação e custos hospitalares em hernioplastias após a implementação do protocolo ACERTO.


Subject(s)
Humans , Male , Female , Aged , Trauma Centers/standards , Wounds and Injuries/surgery , Hematoma, Subdural, Acute/surgery , Airway Extubation , Laparotomy , Attention , General Surgery , Prospective Studies , Retrospective Studies , Treatment Outcome , Hemorrhage , Middle Aged
10.
Rev. Col. Bras. Cir ; 47: e20202648, 2020. tab
Article in English | LILACS | ID: biblio-1136534

ABSTRACT

ABSTRACT Objective: to perform an external validation of two clinical decision instruments (DIs) - Chest CT-All and Chest CT-Major - in a cohort of patients with blunt chest trauma undergoing chest CT scanning at a trauma referral center, and determine if these DIs are safe options for selective ordering of chest CT scans in patients with blunt chest trauma admitted to emergency units. Methods: cross-sectional study of patients with blunt chest trauma undergoing chest CT scanning over a period of 11 months. Chest CT reports were cross-checked with the patients' electronic medical record data. The sensitivity and specificity of both instruments were calculated. Results: the study included 764 patients. The Chest CT-All DI showed 100% sensitivity for all injuries and specificity values of 33.6% for injuries of major clinical significance and 40.4% for any lesion. The Chest CT-Major DI had sensitivity of 100% for injuries of major clinical significance, which decreased to 98.6% for any lesions, and specificity values of 37.4% for injuries of major clinical significance and 44.6% for all lesions. Conclusion: both clinical DIs validated in this study showed adequate sensitivity to detect chest injuries on CT and can be safely used to forego chest CT evaluation in patients without any of the criteria that define each DI. Had the Chest CT-All and Chest CT-Major DIs been applied in this cohort, the number of CT scans performed would have decreased by 23.1% and 24.6%, respectively, resulting in cost reduction and avoiding unnecessary radiation exposure.


RESUMO Objetivo: realizar validação externa de dois instrumentos de decisão clínica (IDCs) - TC de tórax-All e TC de tórax-Major - em uma coorte de pacientes com trauma torácico fechado submetidos a tomografia computadorizada de tórax em centro de referência para trauma, e determinar se esses IDCs são opções seguras para solicitação seletiva de tomografias computadorizadas de tórax em pacientes com trauma torácico fechado admitidos em unidades de emergência. Métodos: estudo retrospectivo transversal de pacientes com trauma torácico fechado submetidos a tomografia computadorizada de tórax, por período de 11 meses. Os laudos da TC de tórax foram cruzados com os dados do prontuário eletrônico dos pacientes. A sensibilidade e especificidade de ambos os instrumentos foram calculadas. Resultados: o estudo incluiu 764 pacientes. O IDC TC de tórax-All apresentou sensibilidade de 100% para todas as lesões e especificidades de 33,6% para lesões de maior significado clínico e 40,4% para qualquer lesão. O IDC TC de tórax Major teve sensibilidade de 100% para lesões de maior significado clínico, que diminuiu para 98,6% para quaisquer lesões, e especificidades de 37,4% para lesões de maior significado clínico e 44,6% para todas as lesões. Conclusão: ambos os instrumentos de decisão clínica validados neste estudo mostraram sensibilidade adequada para detectar lesões torácicas na TC e podem ser usados com segurança para dispensar a avaliação da TC de tórax em pacientes sem nenhum dos critérios que definem o IDC. Se os IDCs TC de tórax-All e TC de tórax Major de tórax tivessem sido aplicados nesta coorte, o número de tomografias realizadas teria diminuído em 23,1% e 24,6%, respectivamente, resultando em redução de custos e evitando exposição desnecessária à radiação.


Subject(s)
Humans , Male , Female , Adult , Thoracic Injuries/diagnostic imaging , Wounds, Nonpenetrating/diagnostic imaging , Radiography, Thoracic/instrumentation , Tomography, X-Ray Computed/methods , Decision Support Techniques , Trauma Centers , Brazil , Cross-Sectional Studies , Predictive Value of Tests , Reproducibility of Results , Sensitivity and Specificity , Middle Aged
11.
Einstein (Säo Paulo) ; 18: eAO5448, 2020. tab, graf
Article in English | LILACS | ID: biblio-1133724

ABSTRACT

ABSTRACT Objective To characterize the processes of brain death diagnosis and organ donation in a reference trauma center. Methods Observational and cross-sectional study with patients notified with brain death at a reference trauma center. Data were obtained through the collection of medical records and brain death declaration forms. Results One hundred fity-nine patients were notified with brain death, mostly male (82.6%), young adults (97.61%) and victims of brain traumatic injury (93.7%). Median of the total time interval for the diagnosis of brain death was 20.75 hours, with no difference between organ donors and non-donors. We had excessive time intervals on brain death declaration, but without statistical effect on organ donation numbers. Conclusion We had low efficacy in brain death declaration based on longer time intervals, with no impact on organ donation.


RESUMO Objetivo Caracterizar os processos de diagnóstico de morte encefálica e doação de órgãos em um centro de referência de trauma. Métodos Estudo observacional e transversal com pacientes notificados com morte encefálica em um centro de referência de trauma. Os dados foram obtidos por meio da coleta de prontuários e formulários de declaração de morte encefálica. Resultados Foram notificados com morte encefálica 159 pacientes, com prevalência do sexo masculino (82,6%), adultos jovens (97,61%) e vítimas de traumatismo craniencefálico (93,7%). A mediana do intervalo total de tempo para o diagnóstico de morte encefálica foi de 20,75 horas, sem diferença entre doadores de órgãos e não doadores. Tivemos intervalos de tempo excessivos na declaração de morte encefálica, mas sem efeito estatístico no número de doações de órgãos. Conclusão Foi baixa a eficácia na declaração de morte encefálica com base em intervalos de tempo mais longos, sem impacto na doação de órgãos.


Subject(s)
Humans , Male , Young Adult , Tissue and Organ Procurement , Brain Death , Organ Transplantation , Tissue Donors , Trauma Centers , Cross-Sectional Studies , Retrospective Studies
12.
Rev. Col. Bras. Cir ; 47: e20202506, 2020. tab, graf
Article in Portuguese | LILACS | ID: biblio-1136541

ABSTRACT

RESUMO Objetivo: a violência civil é responsável por 2,5% da mortalidade mundial, matou mais pessoas no século XXI do que o somatório de todas as guerras deste período. Este estudo descreve as vítimas de violência admitidas em um hospital de referência em trauma em Salvador - Bahia, Brasil e analisa o impacto dos diferentes tipos de violência interpessoal. Métodos: foram incluídos vítimas de violência interpessoal admitidas entre julho de 2015 e julho de 2017. 1296 pacientes (média de idade foi 30,3 anos, 90% do sexo masculino) foram divididos em três grupos de acordo com o mecanismo de violência interpessoal: espancamento, ferimentos por projétil de arma de fogo (FPAF), ferimentos por arma branca (FAB). Os grupos foram comparados de acordo com as seguintes variáveis: idade, sexo, mecanismo de trauma, Revised Trauma Score (RTS) na admissão, necessidade de internamento em unidade de tratamento intensivo (UTI), tempo de internamento, necessidade de transfusão de hemocomponentes e morte. Resultados: FPAF foram o principal mecanismo de injúria (59%), seguido por agressão (24%) e FAB (17%). As vítimas de FPAF apresentaram a menor média de RTS na admissão, maior necessidade de uso de hemocomponentes e de internamento em UTI. Vítimas de espancamento tiveram a maior média de duração de internação hospitalar (11,6±19,6 dias). Os FPAF causaram 77,4% das mortes. Conclusão: vítimas de FPAF são mais críticas, requerendo maior tempo de tratamento em UTI, mais hemocomponentes e maior mortalidade comparativamente às vítimas de FAB e espancamento.


ABSTRACT Purpose: Civil violence is responsible for 2.5% of deaths worldwide; it killed more people in the 21st century than the sum of all wars. This study describes violence victims treated at a trauma reference hospital in Salvador, Brazil and analyzes the impact of different types of interpersonal violence. Methods: Interpersonal violence victims admitted between July 2015 and July 2017 were included. The 1,296 patients (mean age: 30.3 years; 90% male) were divided into three groups according to the mechanism of interpersonal violence: 1) beating, 2) firearm injury and 3) stab wound (STW) injury. The groups were compared for the following variables: age, gender, trauma mechanism, Revised Trauma Score (RTS) at admission, need for intensive care unit (ICU) attention, length of hospital stay, need for transfusion of blood products and death. Results: Gunshot wounds (GSW) were the primary mechanism of injury (59%), followed by beating (24%) and STW (17%). Gunshot wound victims had a lower mean RTS upon admission, increased need for blood products and more Intensive Care Unit (ICU) admissions. Beating victims had the longest mean hospital stay (11.6 ± 19.6 days). The GSW group accounted for 77.4% of all deaths. The in-hospital mortality rate was significantly higher in the GSW group (12.7%) than in the beating group (5.4%) and in the STW group (4.9%). Conclusions: Gunshot wound victims are more critical: they require longer ICU stays, more transfusions of blood products and exhibit increased mortality compared with STW and beating victims.


Subject(s)
Humans , Male , Female , Adult , Young Adult , Trauma Centers/statistics & numerical data , Violence/statistics & numerical data , Crime Victims/statistics & numerical data , Wounds, Gunshot/mortality , Brazil/epidemiology , Injury Severity Score , Retrospective Studies , Hospital Mortality , Length of Stay , Middle Aged
13.
Article in English | AIM, AIM | ID: biblio-1258615

ABSTRACT

Introduction: Interpersonal violence cases make up a significant portion of the trauma cases seen in emergency centres in South Africa. Community assaults are extremely violent attacks on suspected perpetrators by members of the community aimed at inflicting serious injury. The aim of this study was to profile the major interpersonal violence cases at Kalafong Hospital with emphasis on the community assaults and how this group compares with non- community assaults regarding demographics, surgical intervention and mortality. Methods: A retrospective analysis was conducted of the major interpersonal violence cases seen over a one-year period (1 January 2016 to 31 December 2016) at Kalafong Hospital, Pretoria, South Africa. Data was manually collected and entered into a Microsoft Excel spreadsheet. The Stata 13 statistical program was used for data analysis. Results: During the study period, a total of 578 cases were analysed. Penetrating trauma accounted for 446 (77.2%) cases and blunt trauma for 132 (22.8%) cases. The number of community assault cases was 75 (12.9%). A total of 28 deaths were recorded during this period. Community assaults accounted for 13 (46.4%) of these deaths. Community assault cases had a significantly higher mortality compared to non-community assault cases with 17.3% versus 3%; Odds ratio 6.82 (95% CI 3.04­15.33, p < 0.001). The community assault group also showed a statistically significant difference in the intensive care admission rate with 15.3% compared to 6.9% in the interpersonal violence cases; Odds ratio 2.41 (CI 1.07­5.43, p = 0.028). Conclusion: Community assault cases may present with similar demographics when compared to non-community assault cases, but the difference in disposition and outcome was highlighted in this study with a higher intensive care unit admission rate and a higher mortality rate. A multi-centre follow-up study is recommended to compare demographics across Pretoria and to monitor trends in this subgroup of interpersonal violence cases


Subject(s)
Aggression , South Africa , Tertiary Care Centers , Trauma Centers/statistics & numerical data , Violence
14.
Article in English | AIM, AIM | ID: biblio-1258617

ABSTRACT

Introduction: Time is critical in the trauma setting. Emergency computed tomography (CT) scans are usually interpreted by the attending doctor and plans to manage the patient are implemented before the formal radiological report is available. This study aims to investigate the discrepancy in interpretation of emergency whole body CT scans in trauma patients by the trauma surgeon and radiologist and to determine if the difference in trauma surgeon and radiologist interpretation of emergency trauma CT scans has an impact on patient management. Method: This prospective observational comparative study was conducted over a 6 month period (01 April­30 September 2016) at the Inkosi Albert Luthuli Central Hospital which has a level 1 trauma department. The study population comprised 62 polytrauma patients who underwent a multiphase whole body CT scans as per the trauma imaging protocol. The trauma surgeons' initial interpretation of the CT scan and radiological report were compared. All CT scans reported by the radiology registrar were reviewed by a consultant radiologist. The time from completion of the CT scan and completion of the radiological report was analysed. Results: Since the trauma surgeon accompanied the patient to radiology and reviewed the images as soon as the scan was complete, the initial interpretation of the CT was performed within 15­30 min. The median time between the CT scan completion and reporting turnaround time was 75 (16­218) min. Critical findings were missed by the trauma surgeon in 4.8% of patients (bronchial transection, abdominal aortic intimal tear and cervical spine fracture) and non-critical/incidental findings in 41.94%. The trauma surgeon correctly detected and graded visceral injury in all cases. Conclusion: There was no significant discrepancy in the critical findings on interpretation of whole body CT scans in polytrauma patients by the trauma surgeon and radiologist and therefore no negative impact on patient management from missed injury or misdiagnosis. The turnaround time for the radiology report does not allow for timeous management of the trauma patient


Subject(s)
Multidetector Computed Tomography , Multiple Trauma , Radiologists , South Africa , Trauma Centers
16.
Chinese Journal of Traumatology ; (6): 243-248, 2020.
Article in English | WPRIM | ID: wpr-827836

ABSTRACT

PURPOSE@#To explore the epidemiological and clinical profile of patients admitted to the trauma and emergency department (TED) of a tertiary care hospital due to tropical cyclone Fani and highlight the challenges faced by the hospital in this natural disaster.@*METHODS@#A retrospective study was conducted in the TED in the affected zone. Data of all victims affected by the cyclone Fani on May 3, 2019 were obtained from disaster records and medical case sheets. All patients except death on admission were included. Clinical variables included anatomical sites and severity of injuries which was assessed by revised trauma score (RTS) and injury severity score (ISS). Trauma injury severity score (TRISS) was also calculated.@*RESULTS@#Of 75 patients, 74 were included and the other one was brought dead and thus excluded. The age, median ± interquartile range (IQ), was 41.0 (27.7-53.0) years. The male to female ratio was 2:1. Most of the wounded were transported by the police control room vans on day 1: first 10 h, 50.0%; 10-24 h, 20.3%. The median ± IQ range of RTS, ISS and TRISS were 20 (14-28), 7.84 (7.841-7.841), and 97.4 (91.6-98.9), respectively. Simple external injury was the dominant injury type. Polytrauma (ISS >15) was seen in 67% cases and spine injury in 14% cases (7% cervical and 7% thoracolumbar). Injury causes included sharp flying objects (broken pieces of glasses and asbestos) in 31% cases, followed by fall of trees in 20.3%. Twenty-four patients were discharged after primary treatment, 30 admitted to the indoor-trauma ward or intensive care unit and 20 deferred or transferred to another center. There was no in-house mortality. Challenges were related to electricity failure, mobile network breakdown, infrastructure collapse, and delay in expertise repair from outside due to airport/railway closure.@*CONCLUSION@#In cyclonic storm like Fani, sharp flying objects, fall of trees/poles and collapsing walls constitute the common mode of injuries causing harm to more than one body regions. Polytrauma was seen in the majority of patients though external injury was the commonest. The affected hospital had the uphill task of treating hospitalized patients as well as disaster victims.


Subject(s)
Adolescent , Adult , Child , Cyclonic Storms , Disaster Planning , Disaster Victims , Emergency Service, Hospital , Female , Humans , Male , Middle Aged , Multiple Trauma , Epidemiology , Retrospective Studies , Tertiary Care Centers , Trauma Centers , Trauma Severity Indices , Young Adult
17.
Rev. Pesqui. Fisioter ; 9(4): 524-531, Nov. 2019. ilus
Article in English, Portuguese | LILACS | ID: biblio-1151926

ABSTRACT

INTRODUÇÃO: A intervenção em realidade virtual (RV) foi viável em amputados de membros inferiores (AMI). Até onde sabemos, não existe um estudo controlado randomizado disponível sobre a reabilitação do AMI usando RV. As evidências sugerem que são necessárias mais pesquisas para reabilitação de amputados usando VR. OBJETIVO: Comparar a eficácia da terapia de RV como um complemento terapêutico adicional com o protocolo de fisioterapia nos limites de estabilidade e estabilidade postural, dor e qualidade de vida entre os AMI. MÉTODOS: Um total de 100 AMI foi recrutado por amostragem aleatória simples (gerador de número aleatório) do JPN Apex Trauma Center, AIIMS, para participar de um ensaio clínico randomizado. O AMI recrutado foi dividido aleatoriamente em dois grupos: terapia de realidade virtual juntamente com o grupo protocolo de fisioterapia (VRT-PTP) e o grupo protocolo de fisioterapia (PTP). A duração do tratamento será de 30 minutos em uma sessão / dia, durante 4 dias / semana, durante 3 semanas. Assim, cada AMI receberá 12 sessões no total. O Sistema de Equilíbrio Biodex para medir o equilíbrio dinâmico, NPRS para dor e qualidade de vida pelo WHOQOL-BREF da OMS (WHOQOL-BREF) são as medidas de resultado que serão registradas na linha de base, no final do período pós-intervenção de três semanas. O acompanhamento será realizado na 6ª e 9ª semana após a inscrição. RESULTADOS: A normalidade dos dados coletados será confirmada pelo teste de Kolmogorov-Smirnov. A significância estatística intra e inter grupos será determinada por testes apropriados. O tamanho do efeito e a análise de potência serão realizados. CONCLUSÃO: Este estudo apresentará dados para a eficácia do VRT na melhora do equilíbrio e da marcha, além do PTP.


INTRODUCTION: Virtual reality (VR) intervention was found to be feasible in lower limb amputees (LLA). To best of our knowledge, only there is no randomized controlled trial available regarding the rehabilitation of LLA using VR. Evidence suggest that more researches for amputee rehabilitation using VR is warranted. OBJECTIVE: To compare the effectiveness of VR therapy as an additional therapeutic adjunct with physical therapy protocol on limits of stability and postural stability, pain and quality of life among LLA. METHODS: A total of 100 LLA will be recruited by the simple random sampling (random number generator) from JPN Apex Trauma Centre, AIIMS to participate in randomized controlled trial. Recruited LLA will be randomly divided into two groups, virtual reality therapy along with physical therapy protocol (VRT-PTP) group and physical therapy protocol (PTP) group. Duration of the treatment will be 30 minutes in one session/day for 4 days/week for 3 weeks. Thus, each LLA will receive 12 sessions in total. The Biodex Balance System for measuring dynamic balance, NPRS for pain and quality of life by WHO Quality of Life-BREF (WHOQOL-BREF) are the outcome measures will be recorded at baseline, end of 3-week post-intervention period. The follow-up will be taken at 6th and 9th week after enrollment. RESULTS: Normality of the collected data will be confirmed by Kolmogorov-Smirnov test. Statistical significance within and between the groups will be determined. Effect size and power analysis will be performed. CONCLUSION: This study will present data for the efficacy of the VRT in improving balance and gait in addition to PTP.


Subject(s)
Amputees , Trauma Centers , Physical Therapy Specialty
18.
Rev. chil. endocrinol. diabetes ; 12(3): 165-169, jul. 2019. graf
Article in Spanish | LILACS | ID: biblio-1006502

ABSTRACT

Existe escasa información respecto al estudio y manejo de la osteoporosis en los pacientes que han sufrido fractura por fragilidad en Chile. Objetivo: Describir la epidemiologia, aproximación diagnóstica y manejo realizado a pacientes hospitalizados por fractura por fragilidad (muñeca, cadera, columna) que ingresaron al Servicio de Traumatología (ST) del Hospital de Antofagasta (HRA). Método: Estudio retrospectivo, se revisó registros de pacientes hospitalizados en ST y se identificó a pacientes que presentaron fractura por fragilidad. Se revisó sus fichas clínicas (período enero 2015-diciembre 2016). Se analizaron factores de riesgos, exámenes realizados, terapias y controles médicos al alta. Resultados: Fueron 971 ingresos y 100 pacientes con fractura por fragilidad. 88% fueron mujeres cuya edad promedio fue 73,1 años. El factor de riesgo más común fue la postmenopausia y antecedente de fractura previa. Las fracturas se distribuyeron en cadera 64%, muñeca 35% y columna 1%. A solo 3 pacientes se le pidió densitometría ósea. En ninguno fue evaluada vitamina D ni PTH. Al 7% se indicó calcio y vitamina D post fractura, a 4% se indicó antiresortivos. En ningún paciente se promovió el consumo de lácteos. Discusión: Las fracturas osteoporóticas en el HRA son inadecuadamente estudiadas para descarte de factores modificables y son farmacológicamente subtratadas, con el riesgo de nueva aparición de fracturas por fragilidad y morbimortalidad asociada. Es importante reforzar en los servicios de traumatología la importancia del manejo médico postfracturas y eventualmente incorporar la participación de otros especialistas en el manejo de estos pacientes durante la hospitalización y al alta.


We have poor information regarding study and management of osteoporosis in patient who have a fragility fracture in Chile. Objetive: Describe epidemiology, diagnostic approach and management performed on patients hospitalized for fragility fracture in Traumatology Service(ST) of the Antofagasta Hospital(HRA). Method: Retrospective study, we reviewed your clinical record (period January 2015-December 2016). Risk factor, laboratory test performed, therapies and medical controls at discharge were analyzed. Resuls: 971 patient admited to ST, 100 were fragility fracture. 88% were women with average age 73,1 years old. The mosts commons risk factors were chronic kidney failure and anticonvulsants treatment. The fractures were 64% of hip, 35% wrist, and 1% column. Only 3 patients have bone densitometry. None had vitamin D or PTH evaluated. Calcium and vitamin D after fracture were indicated at 7%, antiresorptives were indicated at 4%. In none diary consumption were promoted. Discussion: Osteoporotic fractures in HRA are inadequately studied to rule out modifiable factors and they are pharmacologically subtracted, with risk of new fractures an mobility and mortality. Is important remember in the ST importance of the medical management postfracture and the multidisciplinary work.


Subject(s)
Humans , Male , Female , Aged , Frail Elderly , Osteoporotic Fractures/therapy , Osteoporotic Fractures/epidemiology , Osteoporosis/complications , Trauma Centers , Chile/epidemiology , Retrospective Studies , Risk Factors , Osteoporotic Fractures/diagnosis , Hospitalization
19.
Rev. colomb. anestesiol ; 47(1): 41-48, Jan.-Mar. 2019. tab, graf
Article in English | LILACS, COLNAL | ID: biblio-990920

ABSTRACT

Abstract Introduction: High lactate values are associated with adverse outcomes in almost all clinical situations, lactate levels above 2 mmol/L are proposed as an early and reliable marker of tissue hypoperfusion, and lactate clearance during treatment has also been proposed during resuscitation as a prognostic factor. Objective: To determine the association between the initial value of lactate and its clearance after 6 and 24 hours in trauma patients with mortality. Materials and methods: A subanalysis of a prospective cohort collected between March 2014 and October 2016 was carried out at the San Vicente Fundación University Hospital (Medellin, Colombia), with trauma patients over 18 years of age. Lactate and clinical variables were measured at admission, at 6 and at 24hours. The association of lactate levels at admission and clearance with in hospital mortality was estimated, using logistic regression models. Results: A total of 251 patients met the inclusion criteria, 15.5% died, 45.4% required admission to intensive care, in patients who died the lactate at admission was 4.6mmol/L (Interquartile range = 2.9-6.9). The adjusted logistic regression model showed that lactate on admission, lactate clearance of 50% (0-24hours), trauma mechanism, and Sequential Organ Failure Assessment score were independent factors associated with mortality. Conclusion: High values of lactate at admission are associated with greater probability of dying and its clearance is an independent factor of mortality in those who enter with high lactate values.


Resumen Introducción: Valores elevados de lactato se relacionan con desenlaces adversos en casi todas las situaciones clínicas, los niveles de lactato por encima de 2mmol/L se proponen como marcador temprano y confiable de hipoperfusión tisular, igualmente se ha propuesto la depuración de lactato durante la reanimación como factor pronóstico. Objetivo: Determinar en pacientes traumatizados la asociación del valor inicial de lactato y su depuración después de 6 y 24 horas con mortalidad. Materiales y métodos: Se realizó un sub-análisis de una cohorte prospectiva recolectada entre marzo de 2.014 y octubre de 2.016 en el Hospital Universitario San Vicente Fundación (Medellín, Colombia), con pacientes mayores de 18 años poli traumatizados. Se midió el lactato y las variables clínicas al ingreso, a la hora 6 y a las 24. Se estimó la asociación con mortalidad hospitalaria, los niveles de lactato al ingreso y su depuración, mediante modelos de regresión logística. Resultados: 251 pacientes cumplieron criterios de inclusión, el 15.5% fallecieron, el 45.4% requirieron ingreso a cuidados intensivos, en pacientes que murieron el lactato al ingreso fue de 4,6 mmol/L (IQR=2,9-6,9), en el modelo de regresión logística ajustado se encontró que el lactato al ingreso, la depuración de lactato del 50% (0-24 horas), el mecanismo de trauma y el puntaje de SOFA fueron factores independientes asociados con mortalidad. Conclusión: Valores altos de lactato al ingreso se asocian con mayor probabilidad de morir y en quienes ingresan con valores de lactato elevados, su depuración es un factor independiente de mortalidad.


Subject(s)
Humans , Male , Adult , Middle Aged , Mortality , Lactic Acid , Trauma Centers , Hospital Mortality , Critical Care , Inpatients
20.
Rev. Paul. Pediatr. (Ed. Port., Online) ; 37(1): 4-10, Jan.-Mar. 2019. tab, graf
Article in Portuguese | LILACS | ID: biblio-985133

ABSTRACT

RESUMO Objetivo: Avaliar se houve associação entre a ocorrência de fratura após trauma físico e o uso de glicocorticoides nos 12 meses precedentes ao trauma, em crianças e adolescentes atendidos em uma emergência. Métodos: No período de abril a outubro de 2015 foi conduzido em uma emergência pediátrica um estudo tipo caso controle, em pacientes de 3 a 14 anos incompletos, vitimados por trauma físico, com e sem fratura. Os dados analisados foram obtidos pela consulta dos prontuários, pelo exame físico dos pacientes e por entrevista dos responsáveis, comparando-se uso de glicocorticoides nos últimos 12 meses, características demográficas, índice de massa corpórea, ingesta de leite, intensidade do trauma, prática de exercício físico e tabagismo passivo domiciliar nos dois grupos de pacientes. Resultados: Estudaram-se 104 pacientes com trauma físico, 50 com fratura e 54 sem fratura. O uso de glicocorticoides ocorreu em 15,4% dos pacientes estudados, sem diferença estatisticamente significante entre os dois grupos. A faixa etária de 10 a 14 anos incompletos, o trauma grave e a prática de exercício físico predominaram entre os pacientes com fratura. Conclusões: Este estudo não mostrou associação entre o uso prévio de glicocorticoides e a ocorrência de fraturas em crianças e adolescentes. A faixa etária de 10 a 14 anos incompletos, o trauma grave e a prática de exercício físico associaram-se com maior risco para fraturas.


ABSTRACT Objective: To assess the association between traumatic fractures and glucocorticoids taken 12 months prior to a trauma, in children and adolescents seen at an emergency room. Methods: A case-control study was conducted from April to October 2015, at a pediatric emergency hospital with patients aged 3- to 14 years-old, who had suffered physical trauma. Some of the patients had a fracture and some did not. The data analyzed were obtained from medical records, physical examination of the patients, and interview with the patients' caregivers. Glucocorticoid use in the past 12 months, demographic variables, body mass index, milk intake, trauma intensity, physical activity and smoking in the household were compared between the two patient groups. Results: A total of 104 patients with physical trauma were studied - 50 had a fracture and 54 did not. Of all the patients, 15.4% had previously used glucocorticoids, and there were no statistically significant differences between the groups. The age range of 10- to 14 years-old, severe trauma and physical activity were more prevalent among patients with a bone fracture. Conclusions: This study did not find an association between previous glucocorticoid use and the occurrence of fractures in children and adolescents. The age range of 10- to 14 years-old, severe trauma, and physical activity were associated with an increased risk for fractures.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Exercise/physiology , Trauma Centers/statistics & numerical data , Brazil/epidemiology , Case-Control Studies , Trauma Severity Indices , Risk Factors , Fractures, Bone/diagnosis , Fractures, Bone/etiology , Fractures, Bone/epidemiology , Glucocorticoids/adverse effects , Glucocorticoids/therapeutic use
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