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1.
Article in Spanish | LILACS, BINACIS | ID: biblio-1367140

ABSTRACT

El Comité Editorial quiere brindar a sus lectores una actualización de las escalas de uso corriente. El empleo de tablas y escalas es una práctica muy extendida en la Ortopedia y Traumatología. La medición y la cuantificación de los aspectos clínicos, funcionales y radiográficos se convirtieron en una herramienta imprescindible para la toma de decisiones en diferentes aspectos de la actividad asistencial. Llevamos a cabo una revisión de las escalas más utilizadas, definiendo su uso e incluyendo bibliografía original y actualizada. Nivel de Evidencia: V


The Editorial Committee wants to provide its readers with an update on the commonly used scales. The use of tables and scales is a widespread practice in Orthopedics and Traumatology. The measurement and quantification of clinical, functional, and radiographic aspects have become an essential tool for decision-making in different aspects of healthcare activity. We carry out a review of the most used scales, defining their use and including original and updated literature. Level of Evidence: V


Subject(s)
Orthopedics , Glasgow Coma Scale , Injury Severity Score , Trauma Severity Indices , Decision Making
2.
Rev. bras. med. esporte ; 27(5): 456-459, July-Sept. 2021. tab, graf
Article in English | LILACS | ID: biblio-1288616

ABSTRACT

ABSTRACT Introduction: The integrity of articular cartilage determines the functional state of the joint. In recent years, the development of MRI sequences of various articular cartilage has become the focus of many research topics. Objective: The accuracy of diagnosis of knee cartilage injury caused by motion injury was studied retrospectively by meta-three-dimensional software. Methods: Forty-six knee joints of 45 patients with sports injuries, multi-sequence MRI was performed before surgery, including conventional knee MRI (SET1WI, FSEPD/T2WI), 3D SPGR, and 3D FIESTA sequences. Results: According to the operation results, the sensitivity, specificity, positive predictive value, and negative predictive value of 3D SPGR combined with conventional MRI sequence evaluation of cartilage damage are the highest, 73%, 98%, 95%, and 90%. Conclusions: 3D SPGR combined with conventional MRI sequences can improve accurate evaluation and diagnosis of cartilage disease over a reasonable scan time. Level of evidence II; Therapeutic studies - investigation of treatment results.


RESUMO Introdução: A integridade da cartilagem articular determina o estado funcional da articulação. Nos últimos anos, o desenvolvimento de sequências de ressonância magnética de várias cartilagens articulares se tornou o foco de muitos tópicos de pesquisa. Objetivo: A precisão do diagnóstico de lesão da cartilagem do joelho causada por lesão de movimento foi estudada retrospectivamente por software meta-tridimensional. Métodos: Quarenta e seis articulações de joelho de 45 pacientes com lesões esportivas, várias sequências de ressonância magnética foram realizadas antes da cirurgia, incluindo ressonância magnética de joelho convencional (SET1WI, FSEPD / T2WI), 3D SPGR e sequências 3D FIESTA. Resultados: De acordo com os resultados da operação, a sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo de 3D SPGR combinado com avaliação de sequência de ressonância magnética convencional de danos na cartilagem são os mais altos, 73%, 98%, 95% e 90%. Conclusões: 3D SPGR combinado com sequências convencionais de ressonância magnética pode melhorar a avaliação precisa e diagnóstico de doença da cartilagem em um tempo de varredura razoável. Nível de evidência II; Estudos terapêuticos- investigação dos resultados do tratamento.


RESUMEN Introducción: La integridad del cartílago articular determina el estado funcional de la articulación. En los últimos años, el desarrollo de secuencias de resonancia magnética de varios cartílagos articulares se ha convertido en el foco de muchos temas de investigación. Objetivo: La precisión del diagnóstico de la lesión del cartílago de la rodilla causada por una lesión por movimiento se estudió retrospectivamente mediante un software meta-tridimensional. Métodos: Cuarenta y seis articulaciones de rodilla de 45 pacientes con lesiones deportivas, se realizó una resonancia magnética de secuencia múltiple antes de la cirugía, incluida la resonancia magnética de rodilla convencional (SET1WI, FSEPD/T2WI), secuencias 3D SPGR y 3D FIESTA. Resultados: De acuerdo con los resultados de la operación, la sensibilidad, la especificidad, el valor predictivo positivo y el valor predictivo negativo de 3D SPGR combinados con la evaluación de la secuencia de resonancia magnética convencional del daño del cartílago son los más altos, 73%, 98%, 95% y 90%. Conclusiones: 3D SPGR combinado con secuencias de resonancia magnética convencionales puede mejorar la evaluación y el diagnóstico precisos de la enfermedad del cartílago en un tiempo de exploración razonable. Nivel de evidencia II; Estudios terapéuticos- investigación de los resultados del tratamiento.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Young Adult , Athletic Injuries/diagnostic imaging , Image Processing, Computer-Assisted , Trauma Severity Indices , Knee Injuries/diagnostic imaging , Predictive Value of Tests , Retrospective Studies , Sensitivity and Specificity
3.
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
4.
Rev. enferm. UFSM ; 11: e29, 2021. ilus, tab
Article in English, Portuguese | LILACS, BDENF | ID: biblio-1177835

ABSTRACT

Objetivo: identificar os fatores associados ao tempo da morte de vítimas de trauma. Método: coorte retrospectiva que analisou laudos de autópsia de vítimas de trauma admitidas em 2015 no Instituto Médico Legal Central de São Paulo, Brasil. O tempo da morte foi identificado a partir do momento da ocorrência do trauma até a confirmação do óbito. O modelo linear generalizado foi aplicado para análise dos dados. Resultados: entre as 1.500 vítimas fatais (75,7% homens; idade média 49,7 anos), prevaleceram as quedas (33,5%), seguidas das agressões (27,8%). Os fatores associados ao tempo da morte foram número de regiões corporais afetadas (p<0,001), tipo de trauma (p<0,001), sexo (p=0,009), gravidade do trauma segundo New Injury Severity Score (p<0,001), agressões (p<0,001) e lesões autoprovocadas intencionalmente (p<0,001). Conclusão: mulheres, vítimas de traumas que envolveram intencionalidade de provocar a morte e com elevada gravidade apresentaram tempo de sobrevida reduzido após a(s) lesão(ões).


Objective: to identify factors associated to the time of death of trauma victims. Method: a retrospective cohort that analyzed autopsy reports of trauma victims admitted in 2015 at the Central Institute of Forensic Medicine of São Paulo, Brazil. The time of death was identified from the trauma moment to the confirmation of death. The generalized linear model was applied to analyze the data. Results: among the 1,500 fatal victims (75.7% were men; mean age of 49.7 years old), falls prevailed (33.5%), followed by aggressions (27.8%). The factors associated with the time of death were the number of body areas affected (p<0.001), type of trauma (p<0.001), gender (p=0.009), trauma severity according to the New Injury Severity Score (p<0.001), assaults (p>0.001), and intentionally self-harm injuries (p<0.001). Conclusion: women, victims of traumas with the intention of causing death and with high severity presented a reduced survival time after the injury(ies).


Objetivo: identificar los factores asociados al momento de la muerte de víctimas de traumatismos. Método: estudio de cohorte retrospectivo que analizó informes de autopsias de víctimas de traumatismos admitidas en 2015 en el Instituto Médico Legal Central de San Pablo, Brasil. El momento de la muerte se identificó a partir del momento en que sucedió el traumatismo hasta la confirmación de la muerte. Se aplicó el modelo lineal generalizado para el análisis de los datos. Resultados: entre las 1.500 víctimas fatales (75,7% de ellas hombres; media de edad de 49,7 años), prevalecieron las caídas (33,5%), seguidas por las agresiones (27,8%). Los factores asociados al momento de la muerte fueron la cantidad de áreas del cuerpo afectadas (p<0,001), el tipo de traumatismo (p<0,001), el sexo (p=0,009), la gravedad del traumatismo conforme al New Injury Severity Score (p<0,001), agresiones (p<0,001) y lesiones autoprovocadas intencionalmente (p<0,001). Conclusión: las mujeres, víctimas de traumatismos con intención de provocar la muerte y de alta gravedad presentaron un tiempo de sobrevida reducido después de la o las lesiones.


Subject(s)
Humans , Autopsy , Wounds and Injuries , Trauma Severity Indices , Risk Factors , Mortality
5.
Rev. Col. Bras. Cir ; 48: e20202769, 2021. tab, graf
Article in English | LILACS | ID: biblio-1155366

ABSTRACT

ABSTRACT Purpose: to analyze the relation between Trauma Quality Indicators (QI) and death, as well as clinical adverse events in severe trauma patients. Methods: analysis of data collected in the Trauma Register between 2014-2015, including patients with Injury Severity Score (ISS) > 16, reviewing the QI: (F1) Acute subdural hematoma drainage > 4 hours with Glasgow Coma Scale (GCS) <9; (F2) emergency room transference without definitive airway and GCS <9; (F3) Re-intubation within 48 hours; (F4) Admission-laparotomy time greater than 60 min in hemodynamically instable patients with abdominal bleeding; (F5) Unprogrammed reoperation; (F6) Laparotomy after 4 hours; (F7) Unfixed femur diaphyseal fracture; (F8) Non-operative treatment for abdominal gunshot; (F9) Admission-tibial exposure fracture treatment time > 6 hours; (F10) Surgery > 24 hours. T the chi-squared and Fisher tests were used to calculate statistical relevance, considering p<0.05 as relevant. Results: 127 patients were included, whose ISS ranged from 17 to 75 (28.8 + 11.5). There were adverse events in 80 cases (63%) and 29 died (22.8%). Twenty-six patients had some QI compromised (20.6%). From the 101 patients with no QI, 22% died, and 7 of 26 patients with compromised QI (26.9%) (p=0.595). From the patients with no compromised QI, 62% presented some adverse event. From the patients with any compromised QI, 18 (65.4%) had some adverse event on clinical evolution (p=0.751). Conclusion: the QI should not be used as death or adverse events predictors in severe trauma patients.


RESUMO Objetivo: analisar relação entre comprometimento de Filtros de Qualidade (FQ) com complicações e mortalidade entre vítimas de trauma grave. Métodos: análise dos dados coletados para o Registro de Trauma entre 2014 e 2015, sendo incluídos os traumatizados com Injury Severity Score (ISS) > 16 e analisados os FQ: (F1) drenagem de Hematoma Subdural Agudo (HSA) > 4 horas com Escala de Coma de Glasgow (ECG) <9, (F2) transferência da sala de emergência sem via aérea definitiva e com ECG<9, (F3) reintubação traqueal em até 48 horas, (F4) tempo entre admissão e laparotomia exploradora maior que 60 minutos em pacientes instáveis com foco abdominal, (F5) reoperação não programada, (F6) laparotomia > 4 horas, (F7) fratura de diáfise de fêmur não fixada, (F8) tratamento não operatório em Ferimento por Arma de Fogo (FAF) abdominal, (F9) tempo entre admissão e tratamento de fraturas expostas de tíbia > 6 horas, (F10) operação > 24 horas. Testes de Chi quadrado e Fisher para a análise estatística, considerando significativo p<0,05, foram usados. Resultado: foram incluídos 127 pacientes com ISS entre 17 a 75 (28,8 + 11,5). As complicações ocorreram em 80 casos (63%) e 29 morreram (22,8%). Vinte e seis pacientes apresentaram algum FQ comprometido (20,6%). Dos 101 doentes sem FQ comprometido, 22% faleceram, o que ocorreu em 7 dos 26 doentes com comprometimento dos FQ (26,9%) (p=0,595). Dos doentes sem FQ comprometido, 62% tiveram alguma complicação. Entre os pacientes com FQ comprometido, 18 (65,4%) tiveram complicações (p=0,751). Conclusão: os FQs não devem ser utilizados como preditor de mortes ou complicações evitáveis nas vítimas de traumas graves.


Subject(s)
Humans , Adolescent , Adult , Aged , Young Adult , Quality Indicators, Health Care , Emergency Service, Hospital/statistics & numerical data , Hemorrhage , Glasgow Coma Scale , Injury Severity Score , Trauma Severity Indices , Retrospective Studies , Middle Aged
6.
Rev. Esc. Enferm. USP ; 55: e03747, 2021. tab, graf
Article in Portuguese | LILACS, BDENF | ID: biblio-1250732

ABSTRACT

RESUMO Objetivo: Identificar a capacidade preditiva de mortalidade dos índices Revised Trauma Score, Rapid Emergency Medicine Score, modified Rapid Emergency Medicine Score e Simplified Acute Physiology Score III em vítimas de trauma contuso internadas em unidade de terapia intensiva e comparar seu desempenho. Método: Coorte retrospectiva de pacientes com trauma contuso de uma unidade de terapia intensiva a partir do registro em prontuários. Receiver Operating Characteristic e intervalo de confiança de 95% da área sob a curva foram analisados para comparar os resultados. Resultados: Dos 165 pacientes analisados, 66,7% tiveram tratamento cirúrgico. A mortalidade na unidade de terapia intensiva e no hospital foi de 17,6% e 20,6%, respectivamente. Para mortalidade na terapia intensiva, houve variação das áreas sob a curva entre 0,672 e 0,738; porém, melhores resultados foram observados em pacientes cirúrgicos (0,747 a 0,811). Resultados similares foram observados para mortalidade hospitalar. Em todas as análises, as áreas sob a curva dos índices não diferiram significativamente. Conclusão: Houve acurácia moderada dos índices de gravidade, com melhora na performance quando aplicados em pacientes cirúrgicos. Os quatro índices apresentaram predição similar para os desfechos analisados.


RESUMEN Objetivo: Identificar la capacidad predictiva de la mortalidad de los índices Revised Trauma Score, Rapid Emergency Medicine Score, modified Rapid Emergency Medicine Score y Simplified Acute Physiology Score III en víctimas de traumas contusos hospitalizadas en una unidad de cuidados intensivos y comparar su rendimiento. Método: Cohorte retrospectiva de pacientes con trauma contuso en una unidad de cuidados intensivos a partir de los registros médicos. Se analizaron el Receiver Operating Characteristic y el intervalo de confianza del 95% del área bajo la curva para comparar los resultados. Resultados: De los 165 pacientes analizados, el 66,7% recibió tratamiento quirúrgico. La mortalidad en la unidad de cuidados intensivos y en el hospital fue del 17,6% y del 20,6%, respectivamente. Para la mortalidad en la unidad de cuidados intensivos, las áreas bajo la curva oscilaron entre 0,672 y 0,738; sin embargo, se observaron mejores resultados en los pacientes quirúrgicos (0,747 a 0,811). Se observaron resultados similares para la mortalidad hospitalaria. En todos los análisis, las áreas bajo la curva de los índices no difieren significativamente. Conclusión: La precisión de los índices de gravedad fue moderada, con un mejor rendimiento cuando se aplicaron a pacientes quirúrgicos. Los cuatro índices mostraron una predicción similar para los resultados analizados.


ABSTRACT Objective: To identify the predictive capacity for mortality of the indexes Revised Trauma Score, Rapid Emergency Medicine Score, modified Rapid Emergency Medicine Score, and Simplified Acute Physiology Score III in blunt trauma victims hospitalized in an intensive care unit and compare their performance. Method: Retrospective cohort of patients with blunt trauma in an intensive care unit from medical records. Receiver Operating Characteristic and a 95% confidence interval of the area under the curve were analyzed to compare results. Results: Out of 165 analyzed patients, 66.7% have received surgical treatment. The mortality in the intensive care unit and in the hospital was 17.6% and 20.6%, respectively. For the mortality in the intensive care unit, the area under the curve varied from 0.672 to 0.738; however, better results have been observed in surgical patients (0.747 to 0.811). Similar results have been observed for in-hospital mortality. In all analyses, the areas under the curve of the indexes presented no significant difference. Conclusion: The accuracy of the severity indexes was moderate, with an improved performance when applied to surgical patients. The four indexes presented a similar prediction for the analyzed outcomes.


Subject(s)
Wounds and Injuries , Trauma Severity Indices , Prognosis , Severity of Illness Index , ROC Curve , Mortality
8.
Rev. cir. (Impr.) ; 72(5): 434-440, oct. 2020. tab
Article in Spanish | LILACS | ID: biblio-1138735

ABSTRACT

Resumen Introducción: El hemotórax masivo (HM) se puede definir como el acúmulo súbito de ≥ 1.500 ml de sangre en la cavidad pleural o débito ≥ 200 ml/h de sangre en 3-4 h por pleurotomía; es considerada una complicación traumática grave. Objetivo: Describir las características clínicas, índices de gravedad de traumatismo (IGT), morbilidad y variables asociadas a mortalidad en pacientes con hemotórax masivo por traumatismo torácico operados (HMTT). Materiales y Método: Estudio analítico longitudinal. Período enero de 1981 a diciembre de 2018. Revisión prospectiva de base de datos, protocolos quirúrgicos y fichas clínicas. Descripción de características de HMTT. Se calcularon IGT: Injury Severity Score (ISS), Revised Trauma Score (RTS-T), Trauma Injury Severity Score (TRISS). Para mortalidad se realizó análisis univariado con cálculo de Odds Ratio. Resultados: Total 4.306 traumatismos torácicos (TT), HMTT 119 (2,8%). Hombres 112 (94,1%), edad promedio 32 ± 13,2 años, 91 (76,5%) pacientes presentaron TT aislado, 28 (23,5%) asociado a lesiones extratorácicas, de estos, 23 (19,3%) fueron politraumatismos. Fueron traumatismos penetrantes 102 (85,7%). El HMTT se atribuyó principalmente a: lesión de pared en 38 (31,9%) y lesión pulmonar en 29 (24,4%). De las cirugías torácicas: 87 (73,1%) fueron urgentes (≤ 4 h), 10 (8,4%) precoces (> 4-24 h) y 22 (18,5%) diferidas (> 24 h). Hospitalización postoperatoria promedio 7,9 ± 6,4 días. Según IGT: ISS promedio 17,4 ± 9,6, RTS-T promedio 10,2 ± 2,7, TRISS promedio 12,7. Morbilidad 46 (38,7%) y mortalidad 15 (12,6%). Discusión: Los HMTT se atribuyeron principalmente a lesiones de pared y lesión pulmonar. En la mayoría se requirió cirugía torácica de urgencia. La mortalidad observada es semejante a la esperada según IGT. Existen variables asociadas a mayor mortalidad.


Introduction: Massive hemothorax (MH) can be defined as the sudden accumulation of ≥ 1500 ml of blood in the pleural cavity or debit ≥ 200 ml/h in 3-4 hours through pleurostomy, and it is considered a serious complication. Aim: To describe features, trauma severity indexes (TSI), morbidity and variables associated with mortality in patients with traumatic MH who required surgical treatment. Materials and Method: analytical longitudinal study. Period January 1981 to December 2018. Database, surgical protocols, medical records review. Description of MH characteristics. The following TSI were calculated: Injury Severity Score (ISS), Revised Trauma Score (RTS-T), Trauma Injury Severity Score (TRISS). An Odds Ratio univariate analysis was used for mortality. Results: Total 4306 TT, operated MH 119 (2.8%). Men were 112 (94.1%), average age 32 ± 13.2 years, 91 (76.5%) had isolated TT, 28 (23.5%) were associated with extrathoracic injuries and of these 23 (19.3%) were polytraumatized patients. Penetrating TT was 102 (85.7%). MH was mainly attributed to: chest wall injury in 38 (31.9%), pulmonary lacerations 29 (24.4%). Of the thoracic surgeries: 87 (73.1%) were urgent (≤ 4 h), 10 (8.4%) early (> 4-24 h) and 22 (18.5%) deferred (> 24 h). Average post operatory stay (days): 7.9 ± 6.4 According to TSI: average ISS 17.4 ± 9.6; RTS-T average 10.2 ± 2.7; TRISS average 12.7. Morbidity 46 (38.7%). Mortality 15 (12.6%). Discussion: MH is mainly attributed to chest wall injuries and pulmonary lacerations. Most of HM required urgent thoracic surgery. The observed mortality is similar to that expected one by TSI. There are variables associated with higher mortality in MH.


Subject(s)
Humans , Thoracic Injuries , Trauma Severity Indices , Hemothorax/epidemiology , Longitudinal Studies , Morbidity
9.
Rev. cuba. estomatol ; 57(3): e2978, jul.-set. 2020. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1126524

ABSTRACT

RESUMEN Introducción: La utilización de herramientas pronósticas que permitan valorar la gravedad del trauma, la supervivencia y mortalidad de los lesionados, permite la estratificación de los pacientes y la toma de decisiones acertadas para el tratamiento más efectivo en el área hospitalaria. Objetivo: Realizar una revisión bibliográfica sobre las herramientas pronósticas más utilizadas en la atención de urgencia para detectar la gravedad del trauma maxilofacial. Métodos: Se realizó una revisión bibliográfica desde octubre de 2018 hasta enero de 2019. Fueron examinados libros y artículos publicados en revistas de impacto, en idioma español, inglés y portugués, con atención prioritaria a aquellos que tuvieran cinco años o menos. Se consultaron las bases de datos MEDLINE, EBSCO, PubMed, SciELO, ClinicalKey, utilizando los descriptores: "Trauma Severity Indices", "Maxillofacial Injuries", "Traumatology", "Indexes". Se recuperaron dos libros y 50 artículos, aunque la revisión se circunscribió solamente a los 33 que mejor describían los elementos estudiados. Análisis e integración de la información: El puntaje Cooter David, el de gravedad de lesiones maxilofaciales, la escala de severidad de lesiones faciales, la de severidad de fracturas faciales y el modelo ZS, son los principales instrumentos utilizados en el pronóstico de gravedad existentes de la región facial. Conclusiones: Constan en la literatura escalas, índices y puntajes para pronosticar la gravedad del trauma maxilofacial en la urgencia, cada una exhibe ventajas que las convierte en una herramienta coadyuvante de la atención del trauma; sin embargo, poseen también desventajas que complejizan su aplicación en el medio hospitalario. Entre las herramientas más utilizadas está la escala de severidad de lesiones faciales; fácil de aplicar en los servicios de urgencia, pero con deficiencias a la hora de tratar los componentes de tejido blando y óseo. En Cuba hay escasas evidencias de la utilización de estos instrumentos en la especialidad de cirugía maxilofacial(AU)


ABSTRACT Introduction: The usage of prognostic tools that allow assessing trauma severity, as well as injury survival and mortality, allows patient stratification and making right decisions for the most effective treatment in the hospital area. Objective: To carry out a bibliographic review about the prognostic tools most widely used in emergency care to identify maxillofacial trauma severity. Methods: A bibliographic review was carried out from October 2018 to January 2019. We examined books and articles published in high-impact magazines, in Spanish, English and Portuguese, with priority attention on those five years old or less. We consulted the MEDLINE, EBSCO, PubMed, SciELO, Clinical Key databases using the descriptors Trauma Severity Indices, Maxillofacial Injuries, Traumatology, and Indexes. Two books and 50 articles were retrieved, although the review was limited to only 33 which described best the elements studied. Information analysis and integration: The Cooter-David scoring system, the maxillofacial injury severity score, the facial injury severity scale, the facial fracture severity scale, and the ZS model are the main instruments used for existing severity forecast in the facial region. Conclusions: There literature includes scales, indexes and scoring systems for predicting the maxillofacial trauma severity in the emergency department, each one showing advantages that make them an adjunct tool for trauma care; however, they also have disadvantages that complicate their application in the hospital setting. The facial injury severity scale is among the most widely used tools, as far as it is easy to apply in the emergency services, but with deficiencies for treating soft tissue and bone components. In Cuba, there is little evidence about the use of these instruments in the specialty of maxillofacial surgery(AU)


Subject(s)
Humans , Trauma Severity Indices , Emergency Medical Services/methods , Facial Injuries/therapy , Maxillofacial Injuries/etiology , Periodicals as Topic , Databases, Bibliographic , Survivorship
10.
Rev. cir. (Impr.) ; 72(3): 224-230, jun. 2020. tab
Article in Spanish | LILACS | ID: biblio-1115546

ABSTRACT

Resumen Introducción: Los traumatismos constituyen la quinta causa de muerte en el adulto mayor (60 años o más), siendo los traumatismos contusos los más frecuentes. Objetivo: Describir características, índices de gravedad de traumatismo (IGT), morbilidad y mortalidad en adultos mayores (AM) hospitalizados con traumatismo torácico (TT). Materiales y Método: Estudio descriptivo transversal. Período desde enero de 1981 a diciembre de 2017. Revisión de base de datos, protocolos quirúrgicos y fichas clínicas. Descripción de características de TT en AM hospitalizados. Se calculó IGT: Injury Severity Score (ISS), Revised Trauma Score (RTS-T), Trauma Injury Severity Score (TRISS). Resultados: Total 4.163 TT, AM 513 (12,3%). Hombres: 350 (68,2%), edad promedio 71,2 ± 8,4 años, mediana 70 (rango: 60-103), TT aislado 350 (68,2%), asociado a lesiones extratorácicas 163 (31,8%) y de estos 96 (18,7%) se consideraron politraumatismos. Traumatismo contuso 456 (88,9%) y penetrante 57 (11,1%). La causa más frecuente fueron las caídas en 252 (49,1%). Lesiones y/o hallazgos torácicos más frecuentes: fracturas costales 409 (79,7%), hemotórax 186 (36,3%) y neumotórax 185 (36,1%). Tratamiento definitivo: médico 287 (55,9%), pleurotomía 193 (37,6%) y cirugía 40 (7,8%). Cirugía extratorácica 33 (6,4%). Hospitalización promedio 9,0 ± 8,8 días. Según IGT: ISS promedio 12,1 ± 9,6, RTS-T promedio 11,6 ± 1,3, TRISS promedio 8,1. Morbilidad 76 (14,8%) y mortalidad 26 (5,1%). Discusión: La mayoría de los TT en AM son contusos, causados por accidentes domésticos. Las lesiones y hallazgos más frecuentes fueron fracturas costales y hemotórax. La mortalidad fue menor a la esperada según IGT.


Introduction: Trauma is the fifth leading cause of death in the elderly (60 or older), with blunt trauma being the most frequent. Objective: To describe characteristics, Trauma Severity Indices (TSI) and morbidity and mortality in hospitalized elderly for Thoracic Trauma (TT). Materials and Method: Crosssectional descriptive study was carried out. Term: from January 1981 to December 2017. Database review, surgical protocols and medical records were performed. TT description of characteristics was conducted in hospitalized elderly. TSI was calculated: Injury Severity Score (ISS), Revised Trauma Score (RTS-T), Trauma Injury Severity Score (TRISS). Results: Total 4.163 TT, 513 elderly (12.3%). Men: 350 (68.2%), average age 71.2 ± 8.4 years, 70 median (range 60-103). Isolated TT: 350 (68.2%), 163 associated with extrathoracic trauma (31.8%) and of these 96 (18.7%) were considered polytraumatism. Blunt trauma 456 (88.9%) and penetrating 57 (11.1%). Most frequent domestic accident mechanism was 196 (38.2%) and 158 traffic accidents (30.8%). Frequently thoracic injuries or findings: 409 rib fractures (79.7%), 186 hemothorax (36.3%), and 185 pneumothorax (36.1%). Final treatment: 287 Medical treatment (55.9%), 193 pleurotomy (37.6%), and 40 thoracic surgery (7.8%). Extrathoracic surgery 33 (6.4%). Average hospitalization: 9.0 ± 8.8 days. According IGT: ISS 12.1 ± 9.6, RTS-T 11.6 ± 1.3, TRISS 8.1. Morbidity: 76 (14.8%) and mortality: 26 (5.1%). Discussion: Most TT in elderly are blunt, caused by domestic accidents. Injuries and most frequent findings were rib fractures and hemothorax. Mortality was lower than expected according to TSI.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Thoracic Injuries/etiology , Thoracic Injuries/mortality , Thoracic Injuries/epidemiology , Thoracic Injuries/physiopathology , Wounds, Penetrating/complications , Accidents, Traffic , Trauma Severity Indices , Epidemiology, Descriptive
11.
Int. braz. j. urol ; 46(2): 194-202, Mar.-Apr. 2020. tab, graf
Article in English | LILACS | ID: biblio-1090584

ABSTRACT

ABSTRACT Objective To evaluate usage of renal artery embolization (RAE) for renal injuries and discuss the indications for this treatment. Materials and Methods A retrospective study was performed evaluating the electronic medical records of all patients with renal trauma admitted to two major comprehensive hospitals in Shantou city from January 2006 to December 2015. Results There were 264 and 304 renal traumatic patients admitted to hospital A and B, respectively. LGRT was the reason for presentation in the majority of patients (522, 91.9%). A total of 534 (94.0%) patients were treated conservatively. RAE was performed in 9 patients from 2012 to 2015 at hospital A, including in 6 patients (6/9, 66.7%) with LGRT, and 3 patients (3/9, 33.3%) with HGRT. No patient underwent interventional therapy (RAE) at hospital B during the same period. No significant differences in the operative rate of hospital A were observed between the two time periods (2006-2011 and 2012-2015). The operative rate for LGRT between the two hospitals from 2006 to 2011 and 2012 to 2015 was not significantly different. Hospital A showed a significant decrease in the rate of conservative treatment for patients with LGRT. In the univariate and multivariate analyses, the AAST renal grade both were significantly associated with undergoing RAE. Conclusions LGRT was present in the majority of patients, and most cases of renal trauma could be treated with conservative treatment. RAE was well utilized for the treatment of renal trauma. However, some patients with LGRT were treated with unnecessary interventional therapy.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Aged , Young Adult , Renal Artery/injuries , Embolization, Therapeutic/methods , Kidney/blood supply , Kidney Diseases/therapy , Trauma Severity Indices , Retrospective Studies , Treatment Outcome , Kidney Diseases/etiology , Kidney Diseases/diagnostic imaging , Middle Aged
12.
J. health med. sci. (Print) ; 6(1): 57-63, ene.-mar. 2020. tab, ilus
Article in Spanish | LILACS | ID: biblio-1096722

ABSTRACT

El objetivo de este trabajo fue determinar la relación entre el pronóstico visual según el Ocular Trauma Score (OTS) y la agudeza visual (AV) a los 6 meses de ocurrido el trauma ocular, en pacientes atendidos en la Unidad de Trauma Ocular del Hospital del Salvador, Santiago de Chile. Se hizo uso de un estudio descriptivo, longitudinal, retrospectivo. Se accedió a los registros clínicos de pacientes atendidos por trauma ocular grave entre el 1 de enero de 2014 al 15 de marzo 2015. 145 pacientes conformaron una muestra de 153 ojos. Se estableció la relación entre OTS obtenido y la AV a 6 meses del trauma mediante el coeficiente de correlación de Spearman. De los ojos estudiados, el grupo mayor N=68 (44,4%) calificó para OTS 3 y el menor N=16 (10,5%) para OTS 1. Se presentaron cinco categorías de visión, en un tiempo inicial la mayoría de los casos presentaron AV de luz, mala proyección-cuenta dedos (n=89). Tras seis meses dicha distribución se desplazó hacia la categoría 20/40 - 20/20 (n=68). Se encontró una fuerte asociación (r=0,711 p=0,000) entre el OTS calculado y la AV luego de seis meses de seguimiento. El OTS demostró poseer un gran valor predictivo y es una herramienta aplicable en nuestro medio, los datos obtenidos indican que existe un mejor pronóstico visual que los obtenidos en otro estudio. Cabe destacar que es la primera instancia en que se evalúa la aplicación del OTS en Chile.


This work aimed to determine the relationship between the visual prognosis according to the Ocular Trauma Score (OTS) and visual acuity (AV) 6 months after the ocular trauma in patients treated at the Eye Trauma Unit from the Hospital del Salvador, in Santiago, Chile. A descriptive, longitudinal and retrospective study was performed. We accessed registers of clinical patients attended for severe eye trauma from 1 January 2014 to 15 March 2015. 145 patients constitute a sample of 153 eyes. A connection was established between the OTS obtained and the AV 6 months after the trauma via the Spearman correlation coefficient. From the eyes studied, the greatest group N=68 (44.4%) qualified for OTS 3 and the smallest N=16 (10.5%) for OTS 1. Five eye categories were presented, in the beginning, most of the cases presented visual acuity with bad projection ­ hand motion (n=89). After six months of distribution, it moved to the category 20/40 ­ 20/20 (n=68). A strong relation (r=0,711 p=0,000) was found between the estimated OTS and the AV after six months of tracking. The OTS proved to have great predictive valor and is an applicable tool in our area, the data obtained showed that there is a better visual prognosis than the obtained in other studies. It is worth noting that this is the first stage where the application of OTS is assessed in Chile.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Visual Acuity/physiology , Trauma Severity Indices , Eye Injuries/diagnosis , Eye Injuries/physiopathology , Prognosis , Chile , Eye Injuries/therapy , Predictive Value of Tests , Retrospective Studies , Follow-Up Studies , Longitudinal Studies , Emergencies , Eye Health Services
13.
Ciênc. Saúde Colet ; 25(2): 483-494, Feb. 2020. tab
Article in Portuguese | LILACS | ID: biblio-1055812

ABSTRACT

Resumo Este estudo analisa as diferenças entre os casos de violência contra a mulher, formalizados em boletins de ocorrência (BO) na Delegacia de Defesa da Mulher (DDM), durante a rotina dos formalizados nas Delegacias Civis durante os plantões policiais, em um município de médio porte do interior paulista. Trata-se de um estudo transversal, com base nos BOs realizados no período de um ano (2013/2014). As ocorrências foram diferenciadas conforme o período em que foram lavrados os BOs, na rotina ou nos plantões, sendo este último tomado como variável dependente. As comparações entre os grupos foram realizadas pelo teste χ2. Foram registrados 440 boletins, sendo 373 na rotina e 67 no plantão. As ocorrências realizadas nos plantões apresentaram maior ameaça à integridade da mulher com um maior número de flagrantes do agressor, solicitação de medidas protetivas e gravidade das agressões, como hematomas, hospitalização e encaminhamento ao IML; caracterizando maior gravidade das ocorrências no período em que a DDM está fechada. Deste modo, falta às mulheres um serviço especializado de acolhimento e ampla garantia de direitos nos períodos de maior risco e vulnerabilidade.


Abstract The study analyzes the differences among cases of violence against women registered in police reports (PR) at the Women's Protection Police Station (WPPS) during regular working hours, and those registered during after-hours, in a medium-sized city in the inland state of São Paulo, Brazil. This is a cross-sectional study based on data from PRs registered for one year (2013/2014). PRs were differentiated by period of registration, at regular working hours and after-hours (dependent variable). A chi-square test was used to compare groups. In total, 440 PRs were registered, 373 during regular working hours, and 67 during after-hours. Cases of violence registered during after-hours evidenced more significant threats to women's integrity, as shown by the higher number of cases of perpetrators' flagrante delicto, requests for protective measures and greater severity of assaults, such as bruises, need for hospitalization and referral to forensic medicine (IML), which characterize the greater severity of occurrences when WPPS are closed. Thus, women lack a specialized reception service and a full guarantee of rights in periods of highest risk and vulnerability.


Subject(s)
Humans , Female , Adult , Young Adult , Police/statistics & numerical data , Crime Victims/statistics & numerical data , Gender-Based Violence/statistics & numerical data , Time Factors , Wounds and Injuries , Brazil/epidemiology , Trauma Severity Indices , Cross-Sectional Studies , Hospitalization/statistics & numerical data
14.
Chinese Journal of Traumatology ; (6): 363-366, 2020.
Article in English | WPRIM | ID: wpr-879653

ABSTRACT

The treatment of severe trauma, especially multiple injuries, requires multidisciplinary collaboration. The current study aims to highlight the challenges of consultation mode for severe trauma in general hospitals and emphasizes the need to create a new temporary-sustainable team. It suggests developing an information consultation mode and enforcing the fine management to improve the quality and safety of the medical treatment. The management mode of a temporary-sustainable team will reduce the cost and improve the treatment efficiency. Overall, a temporary-sustainable team has significant advantages over a traditional multidisciplinary team for severe trauma treatment.


Subject(s)
Female , Humans , Injury Severity Score , Intersectoral Collaboration , Male , Multiple Trauma/therapy , Patient Care Team/organization & administration , Quality of Health Care , Referral and Consultation , Safety , Trauma Severity Indices , Traumatology/organization & administration , Treatment Outcome
15.
Chinese Journal of Traumatology ; (6): 145-148, 2020.
Article in English | WPRIM | ID: wpr-827840

ABSTRACT

PURPOSE@#The blunt abdominal trauma (BAT) is a common emergency and is significantly associated with morbidity and mortality. Our study was conducted to achieve the goal that a new scoring system could be used for the BAT patients.@*METHODS@#The statistical population of this study was 1000 patients with BAT referred to emergency department of Imam Hossein Hospital, Tehran, Iran. Sampling was carried out in a convenience non-random manner and continued to reach the required sample size. All the patients with BAT due to road traffic accidents, falls, and other direct blunt traumas such as punctures and kickbacks were included in the study. Exclusion criteria were after 3 months of pregnancy, under the age of 18, warfarin taking, no reliable medical history providing and penetrating trauma. The study questionnaire was based on BAT scoring system. The data were analyzed by SPSS V20 software. The receiver operating characteristic curve was used to analyze the effectiveness of the new scoring system in predicting the BAT patients' outcome.@*RESULTS@#The mean age of the patients (n = 1000) was (35.79 ± 13.09) years. The mean score of patients was (6.29 ± 5.80). Based on this scoring system, the patients were divided into three categories. The first group was patients at low risk with score of less than 8, the second group was patients at moderate risk with score of 8-12 and the third group was patients at high risk with score of 12-24. The score of 661 (66.1%) patients were low, 109 (10.9%) were moderate and 230 (23%) had a high score. The association between hip fracture and abdominal tenderness with abdominal injury was significant (p < 0.001). Cronbach's alpha was 0.76 showing the reliability of this questionnaire to predict the future of patients.@*CONCLUSIONS@#The study tool has a sensitivity to predict the BAT patients' outcome, and has a proper specificity that can be used to reduce the use of harmful modalities such as computed tomography scan.


Subject(s)
Abdominal Injuries , Diagnosis , Adult , Diagnosis , Diagnostic Techniques and Procedures , Emergency Service, Hospital , Female , Humans , Iran , Male , Middle Aged , Predictive Value of Tests , Prognosis , ROC Curve , Risk , Sensitivity and Specificity , Surveys and Questionnaires , Trauma Severity Indices , Wounds, Nonpenetrating , Diagnosis , Young Adult
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.
Chinese Journal of Traumatology ; (6): 224-232, 2020.
Article in English | WPRIM | ID: wpr-827831

ABSTRACT

PURPOSE@#The mortality rate for severely injured patients with the injury severity score (ISS) ≥16 has decreased in Germany. There is robust evidence that mortality is influenced not only by the acute trauma itself but also by physical health, age and sex. The aim of this study was to identify other possible influences on the mortality of severely injured patients.@*METHODS@#In a matched-pair analysis of data from Trauma Register DGU®, non-surviving patients from Germany between 2009 and 2014 with an ISS≥16 were compared with surviving matching partners. Matching was performed on the basis of age, sex, physical health, injury pattern, trauma mechanism, conscious state at the scene of the accident based on the Glasgow coma scale, and the presence of shock on arrival at the emergency room.@*RESULTS@#We matched two homogeneous groups, each of which consisted of 657 patients (535 male, average age 37 years). There was no significant difference in the vital parameters at the scene of the accident, the length of the pre-hospital phase, the type of transport (ground or air), pre-hospital fluid management and amounts, ISS, initial care level, the length of the emergency room stay, the care received at night or from on-call personnel during the weekend, the use of abdominal sonographic imaging, the type of X-ray imaging used, and the percentage of patients who developed sepsis. We found a significant difference in the new injury severity score, the frequency of multi-organ failure, hemoglobine at admission, base excess and international normalized ratio in the emergency room, the type of accident (fall or road traffic accident), the pre-hospital intubation rate, reanimation, in-hospital fluid management, the frequency of transfusion, tomography (whole-body computed tomography), and the necessity of emergency intervention.@*CONCLUSION@#Previously postulated factors such as the level of care and the length of the emergency room stay did not appear to have a significant influence in this study. Further studies should be conducted to analyse the identified factors with a view to optimising the treatment of severely injured patients. Our study shows that there are significant factors that can predict or influence the mortality of severely injured patients.


Subject(s)
Accidents , Classification , Adult , Age Factors , Blood Transfusion , Data Analysis , Emergency Medical Services , Female , Fluid Therapy , Germany , Epidemiology , Hemoglobins , Humans , International Normalized Ratio , Intubation , Male , Matched-Pair Analysis , Multiple Organ Failure , Registries , Sex Factors , Survival Rate , Trauma Severity Indices , Wounds and Injuries , Mortality
18.
Rev. Col. Bras. Cir ; 47: e20202529, 2020. tab, graf
Article in English | LILACS | ID: biblio-1136588

ABSTRACT

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.


Subject(s)
Humans , Male , Adolescent , Adult , Young Adult , Wounds, Nonpenetrating/epidemiology , Wounds, Penetrating/epidemiology , Retrospective Studies , Laparotomy/methods , Abdominal Injuries/surgery , Wounds, Nonpenetrating/surgery , Wounds, Penetrating/surgery , Injury Severity Score , Trauma Severity Indices , Predictive Value of Tests , Abdominal Injuries/epidemiology , Middle Aged
19.
Rev. bras. cir. cardiovasc ; 35(2): 198-205, 2020. tab, graf
Article in English | LILACS | ID: biblio-1101485

ABSTRACT

Abstract Objective: To compare the anatomical and physiological scoring systems and the outcomes of surgical management of penetrating cardiovascular trauma at a rural center. Methods: Seventy-seven patients underwent emergency surgery at our center between January/2012 and October/2018 due to penetrating cardiovascular trauma. Injury Severity Score (ISS), Revised Trauma Score (RTS), New Injury Severity Score (NISS), and Trauma and Injury Severity Score (TRISS) were calculated. The validation of these risk scores to predict mortality was assessed by the area under the receiver operating characteristic curve analysis. Results: All trauma scores were correlated with mortality. As ISS, NISS, and TRISS values increased and RTS values decreased, the mortality rate increased. The area under the curve (AUC) in the receiver operating characteristic curve analysis was 0.943 for TRISS, 0.915 for RTS, 0.890 for ISS, and 0.896 for NISS (P<0.001 for each). Logistic regression analysis revealed that scores were correlated with mortality (P<0.001 for each). By investigating cardiac injuries alone, only TRISS and RTS results correlated with mortality for cardiac injuries (Mann-Whitney U test, P=0.003 and P=0.01, respectively). The AUC was only statistically significant for TRISS and RTS (AUC=0.929, P<0.05 for both). For vascular injuries, all the scores were significantly correlated with in-hospital mortality (Mann-Whitney U test, P<0.001 for each). TRISS had the highest AUC (AUC=0.946, P<0.001). Conclusion: TRISS has the highest predictivity for in-hospital mortality in patients with penetrating cardiovascular trauma.


Subject(s)
Humans , Wounds, Penetrating , Trauma Severity Indices , Predictive Value of Tests , Retrospective Studies , ROC Curve , Hospital Mortality
20.
Rev. bras. epidemiol ; 23: e200015, 2020. tab
Article in Portuguese | LILACS | ID: biblio-1092604

ABSTRACT

RESUMO: Objetivo: Estudar fatores associados à perda de produtividade em pessoas envolvidas em acidentes de trânsito (AT). Métodos: Realizou-se uma coorte prospectiva de base comunitária no município de Jequié, Bahia, Brasil, entre 2013 e 2015. Foi aplicado instrumento de coleta em forma de formulário em participantes que se envolviam em AT, seguido de entrevistas a cada quatro meses. Investigou-se, por meio da análise bivariada e multivariável, a associação entre perda de produtividade e variáveis sociodemográficas e ocupacionais, condições de saúde e gravidade das lesões. Resultados: Observaram-se incidência cumulativa de perda de produtividade de 61,1% e densidade de incidência geral de 7,45 casos/100 pessoas/mês. A análise multivariável demonstrou associação com perda de produtividade para quem utilizava o veículo como instrumento de trabalho (razão de densidade de incidência - RDI = 4,23; intervalo de confiança de 95% (IC95%) = 2,90 - 6,17) e aqueles que apresentaram lesão corporal (RDI = 2,80; IC95% = 1,62 - 4,85). Conclusão: São necessárias políticas públicas que assegurem a segurança no trânsito a fim de minimizar os efeitos dos AT sobre a produtividade, além da realização de novos estudos na área para ampliar o conhecimento sobre o tema.


ABSTRACT: Objective: To study associated factors with loss productivity in people involved road traffic accidents (RTA). Methods: The population based cohort study was conducted in Jequié, Brazil between 2013 to 2015. The instrument for interview was used in people involved in RTA and interview in four months. Individuals, occupational, health conditions, injury and support variables were used for bivariate and multivariate analysis. Results: The cumulative incidence was loss productivity was 61.1% and density incidence of 7.45 cases/100 person-month. Multivariate analysis showed association for injury (IDR = 4.23; 95%CI = 2.90 - 6.17) and vehicle used with work instrument (IDR = 2.80; 95%CI = 1.62 - 4.85). Conclusion: Public policies are needed to ensure traffic safety in order to minimize the effects of RTA about productivity and to carry news studies to expand knowledge about loss productivity.


Subject(s)
Humans , Male , Female , Adult , Automobile Driving/statistics & numerical data , Wounds and Injuries/economics , Accidents, Traffic/statistics & numerical data , Cost of Illness , Sick Leave/statistics & numerical data , Efficiency , Wounds and Injuries/etiology , Brazil , Trauma Severity Indices , Incidence , Prospective Studies , Risk Factors , Cohort Studies , Sick Leave/economics , Middle Aged
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