Guerra civil não-declarada? Um recorte do status da violência urbana em uma capital no Brasil / Undeclared civil war? Urban violence in major city in Brazil

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.

Major interpersonal violence cases seen in a Pretoria academic hospital over a one-year period, with emphasis on community assault cases

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

Existe associação entre o uso de glicocorticoides e a presença de fraturas? estudo comparativo em um hospital de trauma / Is there an association between glucocorticoid use and fractures? a comparative study in a trauma hospital

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.

Evaluación funcional y radiológica del tratamiento quirúrgico de la luxación acromioclavicular, mediante técnica Phemister modificada vs técnica 4 suturas / Functional and radiological assessment of the surgical treatment of the acromioclavicular luxation, by means of modified technique Phemister vs technical 4 sutures

INTRODUCCIÓN: La lesión de la articulación acromio clavicular es una de las más frecuentes, quizás por su posición subcutánea y la relativa escasez de músculos que la protegen. Generalmente se producen en eventos deportivos, pero también son comunes en accidentes o traumas de alto impacto. Se producen por un mecanismo indirecto, generalmente al caer de costado sobre el hombro, aplicándose una fuerza lateral en el acromion. OBJETIVO: Determinar los resultados funcionales y radiológicos en pacientes sometidos a tratamiento quirúrgico de luxación acromio-clavicular con técnica Phemister modificada vs técnica 4 suturas. MATERIAL Y MÉTODOS: Estudio serie de casos. Se estudiaron 59 pacientes de ambos sexos de 20 a 70 años de edad, internados en el servicio de Traumatología y Ortopedia del Hospital Obrero Nº 1, durante el periodo del 1° de enero al 31 de diciembre del año 2013. Se realizó la valoración funcional (Test de Imatani) y radiológica de 55 pacientes operados con la técnica de Phemister modificada y de 4 pacientes operados con la técnica 4 suturas. RESULTADOS: Los pacientes operados con la técnica de Phemister modificada obtuvieron los resultados funcionales: 40.0% excelente, 38.2% bueno, 18.2% aceptable y 3.6% pobre; y radiológicos: 87.3% aceptable, 10.9% pobre y 1.9% recidiva. Y los pacientes operados con la técnica 4 suturas obtuvieron resultados funcionales: 75.0% excelente, 25.0% bueno, 0.0% aceptable y 0.0% pobre; y radiológicos: 100% aceptable. CONCLUSIÓN: Se observa una superioridad de la técnica 4 lazadas respecto a la técnica Phemister modificada, en lo que respecta tanto a los resultados funcionales como los radiológicos.

INTRODUCTION: The injury of the clavicular acromion joint is one of the most frequent, perhaps because of its subcutaneous position and the relative scarcity of the muscles that protect it. They usually occur at sporting events, but they are also common in accidents or high impact traumas. They are produced by an indirect mechanism, usually by falling sideways on the shoulder, applying a lateral forcé in the acromion. OBJECTIVE: Determining the functional and radiological results in patients submitted to surgical treatment of luxation clavicular acromion with engineering modified Phemister vs technical 4 sutures. MATERIAL AND METHODS: Case series study. 59 patients were studied of both sexes from 20 to 70 years of age, inpatients in the service of Traumatology and Orthopedic of the Hospital Obrero No 1, over the course of the 1 one belonging to January to December 31 the year 2013. The functional (Imatani's Test) and radiological assessment of 55 patients operated on with the modified technique of Phemister and of 4 patients operated on with the technique accomplished 4 sutures itself. RESULTS: The patients operated on with the modified technique of Phemister obtained the functional results: 40,0 % excellent, 38,2 % good, 18,2 % acceptable and 3,6 % poor; And radiological: 87,3 % acceptable, 10,9 % poor and 1,9 % relapsing. And the patients operated on with the technique 4 sutures obtained functional results: 75,0 % excellent, 25,0 % good, 0,0 % acceptable and 0,0 % poor; And radiological: 100 % acceptable. CONCLUSIONS: It is observed a superiority of the technique 4 linked in relation to the modified Phemister technique, with respect to the functional and radiological results.

The Applicability of Trauma and Injury Severity Score for a Blunt Trauma Population in Korea and a Proposal of New Models Using Score Predictors

PURPOSE: The purpose of this study was to verify the utility of existing Trauma and Injury Severity Score (TRISS) coefficients and to propose a new prediction model with a new set of TRISS coefficients or predictors. MATERIALS AND METHODS: Of the blunt adult trauma patients who were admitted to our hospital in 2014, those eligible for Korea Trauma Data Bank entry were selected to collect the TRISS predictors. The study data were input into the TRISS formula to obtain "probability of survival" values, which were examined for consistency with actual patient survival status. For TRISS coefficients, Major Trauma Outcome Study-derived values revised in 1995 and National Trauma Data Bank-derived and National Sample Project-derived coefficients revised in 2009 were used. Additionally, using a logistic regression method, a new set of coefficients was derived from our medical center's database. Areas under the receiver operating characteristic (ROC) curve (AUC) for each prediction ability were obtained, and a pairwise comparison of ROC curves was performed. RESULTS: In the statistical analysis, the AUCs (0.879-0.899) for predicting outcomes were lower than those of other countries. However, by adjusting the TRISS score using a continuous variable rather than a code for age, we were able to achieve higher AUCs [0.913 (95% confidence interval, 0.899 to 0.926)]. CONCLUSION: These results support further studies that will allow a more accurate prediction of prognosis for trauma patients. Furthermore, Korean TRISS coefficients or a new prediction model suited for Korea needs to be developed using a sufficiently sized sample.

Fractura de cadera: caracterización epidemiológica de egresos quirúrgicos, Hospital de Victoria, Chile 2009-2013 / Hip francture: epidemiological characterization of surgical discharges: Hospital of Victoria, Chile 2009-2013

INTRODUCCIÓN: La fractura de cadera (FC) es la causa más frecuente de hospitalización en servicios de urgencia ortopédicos. La mayoría ocurre en pacientes ancianos con mala calidad ósea y trauma menor. La pérdida de los reflejos protectores y reducción de la fortaleza ósea son factores de riesgo. OBJETIVO: Caracterizar epidemiológicamente los egresos quirúrgicos por FC en Hospital de Victoria 2009-2013, respecto a antecedentes nacionales, no existen registros previos, así generar información cuantitativa para decisiones administrativas. MATERIALES Y MÉTODO: Estudio cuantitativo, descriptivo y retrospectivo de corte transversal, realizado en Hospital de Victoria, Chile, durante enero-febrero 2014. Se utiliza la tabla digitalizada de Diagnósticos de Egresos Quirúrgicos entre 2009-2013. Para los criterios de inclusión, se usa la Clasificación Internacional de EnfermedadesCIE-10, seleccionando Coxartrosis, Fractura del cuello femoral, pertrocanteriana, subtrocanteriana;de los cuales los intervenidos quirúrgicamente, excluyendo los no quirúrgicos. El análisis se realizacon Microsoft Office Excel© 2007 y EPIDAT© 3,1. El estudio es aprobado por el Comité de Ética de la Universidad Mayor, Temuco, Chile. RESULTADOS: Se obtiene N= 204 con promedio de 75años, la mayoría mujeres. Del total, el 75 por ciento son fracturas del cuello femoral, y en la mayoría se usa osteosíntesis. Por otro lado, el 22 por ciento se diagnostica de coxartrosis, y todas reciben endoprótesis. DISCUSIÓN: Existe un incremento del grupo de adultos mayores como de incidencia de FC. La incidencia total a nivel países de riesgo bajo, y a nivel provinciales moderado. Determina que la patología es de mayor riesgo en Malleco respecto al nacional

INTRODUCTION: Hip fracture (HF) is the most frequent cause of hospitalization in emergency orthopedic services. They usually occur in elderly patients with poor bone quality and lower trauma. The loss of protective and reduced bone strength reflexes are risk factors. OBJECTIVE: To characterize the epidemiological profile of surgical discharges with diagnosis of HF, Hospital of Victoria, 2009-2013, regarding national background, of which there are no previous records, thus generate quantitative information for making management decisions. MATERIALS AND METHODS: a quantitative, descriptive and retrospective cross-sectional study, carried out in Hospital of Victoria, Chile, during January February 2014. It is used the digitalized Table of Diagnostics of Surgical Expenses of 2009-2013. The International Classification of Diseases ICD-10 is used for the inclusion criteria, and are selected: Coxarthrosis, Fracture of the femoral neck, pertrochanteric, and subtrochanteric; of which only surgically. Excluding non-surgical. The analysis is performed with Microsoft Office Excel 2007 and EPIDAT © © 3.1. The study is approved by the Ethics Committee of the Universidad Mayor, Temuco, Chile. RESULTS: N= 204 is obtained, mostly women, mean 75.5 years. Of the total, 75.5 percent are femoral neck fractures, of which67.5 percent is used osteosynthesis. Furthermore, 22.1 percent were diagnosed with coxarthrosis, and all of them receiving endoprosthesis. DISCUSSION: There is a constant increase in the elderly group and incidence of HF. The national overall incidence was set as low risk, but atlocal level, it is moderate. It determines that the condition is riskier in the Province of Malleco rather than the national level

Trauma care audit using Srinagarind hospital's audit filter.

BACKGROUND: To audit trauma care (including the mortality rate and obstacles faced by the authors) at Srinagarind (University) Hospital using the trauma audit filter. MATERIAL AND METHOD: Conduct a prospective, descriptive, study of trauma patients who received trauma medical care at Srinagarind Hospital, Khon Kaen University, Thailand, between January and May 2006. Srinagarind Hospitals trauma audit filter was used to audit trauma care. The audit filter comprised 14 criteria (i.e., 1) emergency medical service; 2) accident and emergency out-patient service; 3) in-patient service). Any filter that generated a "Yes" response was investigated to find the reason(s). The obstacles and mortality were also recorded. RESULTS: The authors enrolled 3209 patients. The mortality rate was 0.5% (95% CI 0.3-0.8). Emergency medical service, accident and emergency out- and in-patient service were rated satisfactorily. The reported obstacles were lack of hospital beds, inappropriate locale for trauma care, financial process, admission process, and lack of equipment. CONCLUSIONS: Srinagarind Hospital's audit filter had the capability to audit trauma care. Overall trauma care at Srinagarind Hospital was satisfactory albeit improvements are needed.

Perfil das vítimas de trauma por acidente de moto atendidas em um serviço público de emergência / Profile of motorcycle accident victims treated at a public hospital emergency department

No Brasil, observa-se um aumento dos acidentes envolvendo motocicletas. Este estudo objetivou caracterizar as vítimas desse tipo de acidente atendidas em um serviço de emergência no Piauí. Pesquisa quantitativa com amostra de 430 vítimas. A análise mostrou predominância do sexo masculino, na faixa etária de 15 a 24 anos e procedentes do próprio estado. Observou-se que 301 dessas vítimas eram condutores da motocicleta, 81 passageiros e 48 foram atropelados por moto. Verificou-se que 76,05 por cento das vítimas sofreram acidente de quinta-feira a domingo, 80,75 por cento apresentaram seqüelas temporárias e 52,33 por cento dos acidentes ocorreram no período noturno. Os tipos de lesão corresponderam em 69,3 por cento dos casos a ferimentos; 51,4 por cento a fraturas; 27,44 por cento a hematomas; e 20,7 por cento a traumatismos cranioencefálicos. Entre as vítimas de acidente, condutores da moto e suspeitos de ingestão de álcool, 52,07 por cento não utilizavam capacete no momento do acidente. A maioria das vítimas recebeu alta hospitalar e 14 foram a óbito. Conclui-se que o trauma provocado pelos acidentes envolvendo motocicletas merece atenção, especialmente em relação ao planejamento de ações preventivas, assim como controle de sua ocorrência no estado.

The number of accidents involving motorcycles has increased in Brazil. The objective of this study was to identify the type of victims of these accidents who were treated at an emergency department in Piauí State, Brazil. The sample included 430 such victims in this quantitative study. Most were male, 15-24 years of age, and from the State of Piauí itself. 301 of the victims were drivers of the motorcycles, 81 were passengers, and 48 were struck or run over by the motorcycles. 76.05 percent of the accidents occurred from Thursday to Sunday. 80.75 percent had temporary sequelae, and 53.33 percent of the accidents occurred at night. In 69.3 percent of the cases, victims suffered lacerations; 51.4 percent fractures; 27.44 percent hematomas; and 20.7 percent head trauma. Among the accident victims, motorcycle drivers, and those suspected of alcohol consumption, 52.07 percent were not wearing a helmet at the time of the accident. Most of the victims were discharged from hospital, while 14 died. In conclusion, injuries from motorcycle accidents deserve attention, especially to plan preventive measures to help control their occurrence in the State.

Epidemiología de la consulta traumatológica infantil en un centro deatención primaria / Epidemiology of childhood trauma consultation in a primary care

Traumatology is a frecuent topic in primary care in urgency and in the ambulatorie setting. In this days, a less of assitents hours are disponible in the formation of generals doctors, and in the residence of Primary care doctors, about management of traumalologic disease. In this study, we present the traumatologic consult reason of the health family center Madre Teresa de Calcuta, Puente Alto, during the year 2007. Pain and functional impotence were the most frecuent consult reason. In thirth place were fractures, with a predominant place of upper limb. Actually, we disposed a few national and international epidemiology information, about this matter.

La consulta traumatológica es altamente frecuente en el ámbito de la atención primaria tanto a nivel ambulatorio como de urgencias. Actualmente, se disponen de pocas horas asistenciales en la formación del clínico general así como en el de atención primaria, en el manejo de patologías traumatológicas. En el presente trabajo, se presentan los diagnósticos y motivos de consulta traumatológicos del año 2007, ocurridos en el centro de salud familiar Madre Teresa de Calcuta de Puente Alto. Destacan como principales motivos de consulta el dolor y la impotencia funcional. Las fracturas se situaron en tercer lugar, con clara predominancia de estas, en la región correspondiente a la extremidad superior del aparato locomotor. En la actualidad, se dispone de poca información epidemiológica nacional y extranjera al respecto.

Trauma craniofacial: perfil epidemiológico de 1223 fraturas atendidas entre 1999 e 2005 no Hospital São Paulo - UNIFESP - EPM / Craniofacial trauma: epidemiologic profile of 1223 fractures treated between 1999 and 2005 at São paulo Hospital - UNIFESP - EPM

As características do trauma craniofacial dependem do centro médico e do período considerado. O objetivo do estudo foi determinar o perfil das fraturas craniofaciais atendidas em um hospital universitário urbano em seis anos. Realizada a análise retrospectiva dos registros epidemiológicos de 912 pacientes atendidos no Hospital São Paulo, além da coleta de dados sobre o mecanismo do trauma, tipo e localização das fraturas. O sexo masculino predominou em todas as faixas etárias, com 692 (76%) casos, exceto pela faixa etária superior aos 60 anos. Com relação à raça, 574 (62%) pacientes eram Caucasianos e o grupo etário dos 20 ao 29 anos foi o mais acometido, com 305 (33%) casos. Foram diagnosticadas 1223 fraturas craniofaciais, sendo que em 821 (90%) pacientes elas ocorreram de modo isolado e, em 91 (10%) casos, houve a associação de fraturas em duas ou mais regiões na face. A agressão física foi reponsável por 265 (29%) casos, seguida pelos acidentes de trânsito em 23 7 (26%) e pelas quedas em 221 (24%). As fraturas da órbita foram encontradas em 438 (48%) pacientes, seguidas pela fratura nasal em 300 (33%) e mandíbula em 217 (24%). Variações na etiologia e na distribuição por faixa etária ocorreram de acordo com a fratura considerada. O trauma craniofacial acomete uma parcela importante da população economicamente produtiva. A documentação sistemática e permanente nos centros especializados no seu tratamento que sejam elaborados medidas preventivas específicas, reduzindo suas seqüelas e custos financeiros.

Estudo epidemiológico das fraturas de face em pacientes com até 18 anos, de 1998 a 2002, no Hospital Cristo Redentor, de Porto Alegre/RS / Epidemiologic study about facial fractures in patients between 0 to 18 years old, from 1998 to 2002, in the Hospital Cristo Redentor, in Porto Alegre/ Brazil

Um estudo epidemiológico das fraturas de face em pacientes de zero a 18 anos de idade foi realizado, a partir dos prontuários de internação no HCR, em Porto Alegre/RS, no período entre 1998-2002. Nesta investigação analisaram-se as seguintes variáveis, encontrando-se os seguintes resultados: a prevalência, em relação ao total de pacientes, excluídas as fraturas nasais e dentoalveolares, foi de 3,17 por cento; quedas foram o principal agente etiológico (24,2 por cento) ; pacientes com idades entre 6 e 18 anos sofreram mais fraturas de face do que os com até 5 anos de idade; pacientes do gênero masculino foram os mais acometidos (68,2 por cento); o mês de maior ocorrência foi outubro (16,7 por cento); a mandíbula foi o principal sítio de instalação de fraturas (71,21 por cento); o tratamento cruento foi a modalidade terapêutica mais utilizada (62,0 por cento); grande parte dos pacientes foi proveniente do interior do estado do Rio Grande do Sul (72,2 por cento)

Luxación traumática de cadera en niños / Traumatic hip dislocation in children

Patología de muy baja frecuencia, pero de extrema importancia, dada la eventual aparición de complicaciones futuras dependientes no sólo del cuadro en sí, sino además del paciente y de su tratamiento. desde 1989 a 1999, diez pacientes fueron tratados por miembros del Servicio de Ortopedia y Traumatología Infantil del Hospital Carlos Van Buren de Valparaiso. Se estudiaron retrospectivamente sus características epidemiológicas; edad, sexo, lateralidad, mecanismo lesional, lesiones asociadas, tiempo entre la luxación y su reducción, tipo de reducción y complicaciones. A diciembre de 1999, ocho pacientes pudieron ser evaluados tanto clínica como radiológicamente. Normalidad clínica y radiológica concomitante se observó en cinco casos. Se concluye que las características epidemiológicas se asemejan a la literatura y que un buen resultado se relaciona con la corta edad del paciente, escaso tiempo entre la lesión y su reducción y la ausencia de necrosis avascular de la cabeza femoral durante la evolución

Resultados del tratamiento de 588 pacientes con trauma múltiple / Treatment results in 588 patients with multiple trauma

Background: Ten to fifteen million wounded and 700,000 deaths each year, around the world, are the consequences of accidents, according to the World Health Organization. In Chile 2,269 deaths occur each year due to accidents. The successful treatment of these patients requires a schematized initial management, that is taught in the Advanced Trauma Life Support Courses. Aim: To review the results of trauma treatment using this model at Hospital del Trabajador in Santiago. Patients and methods: A retrospective review of patients with trauma treated between 1984 and 1994. The severity of trauma was classified according to the Injury Severity Score. Results: Five hundred eighty eight patients (60 female) aged 35.4ñ14 years old were treated in the period. Vehicular accidents accounted for 62 percent of trauma. The most frequently injured corporal segments were limbs and pelvis in 79 percent, head and neck in 66 percent and thorax in 44 percent. There were 2.45 lesions per patient. Mortality was 8 percent and, among survivors, 79 percent had a complete recovery and were reintegrated to their usual activities. Fifteen percent of patients were severely injured. Among these, mortality was 28 percent and 43 percent of survivors had some sequel. Head injuries had a predominant role in mortality and post traumatic disabilities. Conclusions: These results confirm the efficacy of Advanced Trauma Life Support system in the treatment of patients with multiple trauma

La atención ortopédica y traumatológica infantil en el SNSS: ¿quiénes la otorgan? ¿cómo se otorga? / Pediatric orthopaedics in the public health system in Chile: who grant it? how it is granted?

Se analiza el resultado de una encuesta nacional realizada en septiembre-octubre de 1997 a los distintos establecimientos que otorgan atención ortopédica traumatológica infantil. En relación a los servicios de ortopedia y traumatología infantil se encontró una gran disparidad en: a) su dependencia administrativa; b) la formación de post-grado de los médicos que lo componen (47 por ciento post beca C.I. y Ort. 23 por ciento post beca traumatológica, 26 por ciento autoformado y 4 por ciento otro); c) cantidad de tiempo que le dedican a la especialidad; d) en la distribución de los médicos en las distintas regiones de Chile. En relación a la atención de urgencia se encontró que en la mayoría de los hospitales, la primera atención al niño con trauma la da el cirujano de adulto y sólo en Santiago, Valparaiso, Viña del Mar, Coquimbo y Puerto Montt la otorga el especialista adecuado, solucionado en forma oportuna y adecuada todas las lesiones. Finalmente sugieren medidas para mejorar la atención ortopédica y traumatológica infantil en Chile

Registro de trauma pediátrico / Pediatric trauma registry

El Registro de Trauma Pediátrico es una base de datos computadorizada que permite incorporar casos de víctimas pediátricas traumatizadas, con una serie de campos de datos epidemiológicos, relacionados con las características de la víctima, del hecho traumático y de la modalidad de atención prehospitalaria y hospitalaria. Los autores implementaron un programa de trabajo para desarrollar en forma prospectiva este proyecto, a partir de 1990. se incorporaron al mismo 22 grupos de trabajo y, en mayo de 1992, se hallaban registrados en la base 1810 casos. Los informes epidemiológicos del análisis de los datos, que son de dos tipos, general y particular, se emiten una vez por año, en el mes de mayo. Hasta el momento el Registro de Trauma Pediátrico demuestra ser una herramienta efectiva para un mejor análisis estadístico de todo lo relacionado con la "enfermedad accidente" en los niños, que seguramente permitirá mejorar la calidad de atención de estos pacientes