Ferimentos não fatais por arma de fogo entre policiais militares do Rio de Janeiro: a saúde como campo de emergência contra a naturalização da violência / Non-fatal gunshot wounds among military police in Rio de Janeiro: health as a field of emergency against the naturalization of violence

Resumo Esse artigo aborda a ocorrência de agravos à saúde decorrentes de ferimentos por arma de fogo (FAF) que atingiram policiais militares da ativa na Região Metropolitana do Rio de Janeiro (RJ). Pesquisa documental, por meio de análise de prontuários médicos de policiais militares atendidos no Hospital Central da Polícia Militar (HCPM) em decorrência de FAF, no período de junho de 2015 a dezembro de 2017 segundo variáveis relativas ao perfil profissional, às características do evento e da lesão, à distribuição espacial dos FAF e às unidades de saúde envolvidas no atendimento. No período investigado, 475 policiais militares sofreram ferimentos por armas de fogo: 98,3% do sexo masculino, 77,3% encontravam-se em serviço, 97,9% eram praças. Quanto à localização anatômica dos ferimentos, as regiões mais acometidas foram: membros inferiores (41,1%) e superiores (33,1%), região da cabeça-pescoço-face (23,5%) e tórax-abdome (17,3%). As áreas na Região Metropolitana do Rio de Janeiro onde foram encontradas as maiores ocorrências de morbidade por arma de fogo foram as áreas de planejamento 3 e 1 e a Baixada Fluminense. Constatou-se correlação entre as taxas de morbidade policial por armas de fogo dos municípios da região metropolitana e densidade demográfica (p = 0,024).

Abstract This article discusses health problems due to firearm injuries suffered on duty military police officers in the metropolitan region of Rio de Janeiro (RJ). Medical records analysis was con ducted referring to military police officers who were treated at the Military Police's Central Hos pital (MPCH) due to gunshot wounds from June 2015 to December 2017 according to professional profile, the characteristics of the event and the le sion, the spatial distribution of the incidents in volving gunshot wounds, and the healthcare units involved in their care. Firearms injured four hun dred seventy-five military police officers: 98.3% were male, 77.3% were in service, 97.9% were soldier personnel. As to the anatomical location of the wounds, the most affected regions were: lower (41.1%) and superior (33.1%) limbs, the head neck-face region (23.5%), and thorax-abdomen (3%). The areas in the metropolitan area of Rio de Janeiro with the highest occurrence of firearm morbidity are program areas 3 and 1 and the Baixada Fluminense. There is a correlation between police morbidity rates due to firearm injuries in the municipalities of the metropolitan region and demographic density (p = 0.024).

Estudo dos protocolos de traumatologia de lesão por projétil de arma de fogo: revisão de literatura / Study of the traumatology protocols for gunshot injuries: literature review

As armas de fogo são instrumentos letais que estão relacionados a uma grande quantia de homicídios no Brasil, além de traumas e violências. Assim, o atendimento pré-hospitalar e hospitalar é importante na tentativa de diminuir os índices de mortalidade por causas externas. Esta revisão de literatura teve como objetivo demonstrar as formas protocoladas de atendimento atuais a um paciente com trauma por projétil de arma de fogo (AU).

Firearms are lethal instruments that are related to a large amount of homicides in Brazil, as well as traumas and violence. Thus, pre-hospital and hospital care is important in the attempt to reduce mortality rates due to external causes. This literature review aimed to demonstrate the current protocol forms of care for a patient with gunshot wound. (AU)

Firearm-Related Fractures: Epidemiology and Infection Rate / Fraturas causadas por armas de fogo: Epidemiologia e taxa de infecção

Abstract Objective To investigate the incidence of infection in patients with gunshot-related fractures, and to correlate this finding with the occurrence of surgical debridement in the emergency room. Methods A retrospective, observational, descriptive study that included all cases of fractures caused by firearms between January 2010 and December 2014; 245 fractures in 223 patients were included. Results There was surgical-site infection in 8.5% of the fractures, and the mean number of debridements required to control the infectious process was of 1.273 ± 0.608. A correlation was identified between the surgical treatment chosen and the affected body segment (p< 0.001). The surgical treatment in the emergency room had a correlation with the occurrence of infection (p< 0.001; Chi-squared test). Conclusion Patients with gunshot injuries treated non-operatively presented less severe and stable lesions; thus, the incidence of complications in this group was found to be lower. On the other hand, those patients with complex lesions underwent debridement and external fixation. Therefore, a greater number of infectious complications in patients submitted to external fixation was found, as expected.

Resumo Objetivo Investigar a incidência de infecção em pacientes com fraturas por arma de fogo, e correlacionar esse achado com a ocorrência de desbridamento cirúrgico na sala de emergência. Métodos Estudo retrospectivo, observacional e descritivo, que incluiu todos os casos de fraturas causadas por armas de fogo entre janeiro de 2010 e dezembro de 2014; foram incluídas 245 fraturas em 223 pacientes. Resultados Houve infecção do local cirúrgico em 8,5% das fraturas, e a média de desbridamentos necessários para controlar o processo infeccioso foi de 1,273 ± 0,608. Foi identificada correlação entre o tratamento cirúrgico escolhido e o segmento corporal afetado (p< 0,001). O tratamento cirúrgico na sala de emergência teve correlação com a ocorrência de infecção (p< 0,001; teste do qui-quadrado). Conclusão Pacientes com ferimentos à bala tratados de forma não operatória apresentaram lesões menos graves e estáveis; portanto, a incidência de complicações nesse grupo foi menor. Por outro lado, os pacientes com lesões complexas foram aqueles submetidos a desbridamento e fixação externa. Portanto, como esperado, foi encontrado um maior número de complicações infecciosas em pacientes submetidos à fixação externa.

Traumatismo torácico por arma de fuego / Thoracic trauma by firearms

Resumen Introducción: Los traumatismos torácicos por armas de fuego (TTAF) son cada vez más frecuentes. Objetivos: Describir características clínicas, morbilidad, mortalidad y la evolución a través del tiempo de hospitalizados por TTAF. Materiales y Método: Estudio analítico longitudinal. Período enero de 1981-diciembre de 2018. Revisión base de datos, protocolos prospectivos y fichas clínicas. Se utilizó planilla Microsoft Excel® y programa SPSS24® con chi cuadrado y de Mann-Whitney. Descripción de características de TTAF en pacientes hospitalizados y comparación por períodos. Se calcularon índices de gravedad del traumatismo (IGT): Injury Severity Score (ISS), Revised Trauma Score (RTS-T), Trauma Injury Severity Score (TRISS). Resultados: Total 4.306 pacientes hospitalizados por traumatismo torácico (TT), 205 (4,8%) hospitalizados por TTAF. Hombres: 188 (91,7%), edad promedio 28,8 ± 11,2 años, TTAF aislado 115 (56,1%), asociado a lesiones extratorácicas 90 (43,9%), de estos 55 (26,8%) se consideraron politraumatismos. Mecanismo: Agresión 193 (94,1%), autoagresión 11 (5,4%) y accidental 1 (0,5%). Lesiones y/o hallazgos torácicos más frecuentes: Hemotórax 127 (62,0%), neumotórax 96 (46,8%) y contusión pulmonar 51 (24,9%). Tratamiento definitivo: Pleurotomía 88 (42,9%), cirugía 71 (34,6%) y tratamiento médico 46 (22,4%). Mediana de hospitalización 7 días. Según IGT: ISS promedio 16,7 ± 11,7, RTS-T promedio 11,1 ± 2,1, TRISS promedio 9,6. Morbilidad: 44 (21,5%). Mortalidad: 14 (6,8%). En los diferentes períodos, se observó aumento de politraumatismos y TRISS, sin cambios en mortalidad. Discusión: La mayoría de los TTAF fueron aislados. Aproximadamente un tercio de los pacientes requirió cirugía. La mortalidad observada es menor a la esperada. Se observan cambios en los TTAF a través del tiempo.

Background: Thoracic trauma by firearms (TTF) are increasingly frequent. Aim: To describe clinical characteristics, morbidity and mortality and the evolution over time of patients hospitalized due TTF. Materials and Method: Longitudinal analytical study. Period January 1981 - December 2018. Database review, prospective protocols and clinical files. Microsoft Excel® spreadsheet and SPSS24® program with chi square and Mann-Whitney tests were used. Description of characteristics of TTF in hospitalized patients and comparison of TTF by periods. Trauma severity indexes (TSI) were calculated: Injury Severity Score (ISS), Revised Trauma Score (RTS-T), Trauma Injury Severity Score (TRISS). Results: Total: 4306 hospitalized patients due thoracic trauma (TT), 205 (4.8%) hospitalized due TTF. Men: 188 (91.7%), average age 28.8 ± 11.2 years, isolated TTF 115 (56.1%), associated with extrathoracic lesions 90 (43.9%), and of these 55 (26.8%) were considered polytraumatism. Mechanisms: aggression 193 (94.1%), self-harm 11 (5.4%) and accidental 1 (0.5%). Frequent thoracic injuries and/or findings: hemothorax 127 (62.0%), pneumothorax 96 (46.8%) and pulmonary contusion 51 (24.9%). Definitive treatment: Pleurotomy 88 (42.9%), surgery 71 (34.6%) and medical treatment 46 (22.4%). Median hospitalization 7 days. According TSI: Average ISS 16.7 ± 11.7, average RTS-T 11.1 ± 2.1, average TRISS 9.6. Morbidity: 44 (21.5%). Mortality: 14 (6.8%). There is an increase in polytraumatism and average TRISS, without changes in mortality. Discussion: The majority of TTF were isolated TT. Approximately one third of patients required surgery. The observed mortality is lower than expected. Changes in TTF were observed over time.

Adolescências feridas: retrato das violências com arma de fogo notificadas no Brasil / Wounded adolescences: a portrait of firearm violence reported in Brazil

RESUMO: Objetivos: Descrever as notificações de violências interpessoais e autoprovocadas com arma de fogo em adolescentes e identificar os fatores associados à notificação desses eventos. Metodologia: Estudo transversal com dados do Sistema de Informação de Agravos de Notificação (SINAN) de 2011 a 2017, em adolescentes de 10 a 19 anos feridos por arma de fogo. Utilizou-se o teste χ2 para verificar a diferença de proporção entre os sexos. Realizaram-se análise de correlação e regressão linear múltipla entre o logaritmo da taxa de notificação por arma de fogo e cada variável independente, em amostra de municípios de grande porte. Aplicaram-se teste de normalidade e homocedasticidade ao modelo final. Resultados: Registraram-se 30.103 notificações de violências com armas de fogo em adolescentes, sendo 74,7% no sexo masculino de 15 a 19 anos (83,8%). Entre as meninas, a violência é mais comum na residência, com agressor conhecido e violência física e sexual combinadas. A taxa de óbito por arma de fogo foi maior em Fortaleza, Maceió, João Pessoa, Salvador e Natal, variando de 105,88 a 71,73 por 100 mil. A maior taxa de notificação de violência por arma de fogo teve associação com maiores taxas de óbito por esse tipo de arma e maior cobertura das unidades de saúde. Conclusão: A violência perpetrada por arma de fogo é um importante problema de saúde pública em adolescentes. Os ataques ao estatuto do desarmamento e a flexibilização do porte e da posse de armas afrontam diretamente o presente e o futuro das crianças e adolescentes.

ABSTRACT: Objective: To describe the notifications of interpersonal and self-inflicted firearm violence in adolescents and to identify the factors associated with the notification of this event. Methodology: Cross-sectional study analyzing data from Sinan from 2011 to 2017, in adolescents aged 10-19 years, injured by firearms. The χ2 test was used to verify the gender ratio difference. Correlation analysis and multiple linear regression were performed between the logarithm of the firearm notification rate and each independent variable, in a sample of large municipalities. Results: There were 30,103 reports of firearm violence in adolescents, of which (74.7%) were males aged 15-19 years (83.8%). Among girls, violence is more common at home, with a known perpetrator, and with physical and sexual violence combined. The death rate by firearms was higher in Fortaleza, Maceió, João Pessoa, Salvador and Natal, ranging from 105.88 to 71.73 per 100 thousand. Higher notification rates of firearm violence were associated with higher firearm death rates and greater coverage of health facilities. Conclusion: Firearm violence is a major public health problem in adolescents. Attacks on the disarmament statute and the loosening of gun possession and ownership directly confront the present and future of children and adolescents.

Analysis of combat casualties admitted to the emergency department during the negotiation of the comprehensive Colombian process of peace / Análisis de los soldados heridos en combate admitidos al departamento de emergencias durante la negociación del proceso de paz en Colombia

Abstract Aim: Our objective was to describe the variations in casualties admitted to the emergency department during the period of the negotiation of the comprehensive peace agreement in Colombia between 2011 and 2016. Methods: A retrospective study of all hostile military casualties managed at a regional Level I trauma center from January 2011 to December 2016. Patients were subsequently divided into two groups: those seen before the declaration of the process of peace truce (November 2012) and those after (negotiation period). Variables were compared with respect to periods Results: A total of 448 hostile casualties were registered. There was a gradual decline in the number of admissions to the emergency department during the negotiation period. The number of soldiers suffering blast and rifle injuries also decreased over this period. In 2012 there were nearly 150 hostile casualties' admissions to the ER. This number decreased to 84, 63, 32 and 6 in 2013, 2014, 2015 and 2016 respectively. Both, the proportion of patients with an ISS ≥9 and admitted to the intensive care unit were significantly higher in the period before peace negotiation. From August to December/2016 no admissions of war casualties were registered. Conclusion: We describe a series of soldiers wounded in combat that were admitted to the emergency department before and during the negotiation of the Colombian process of peace. Overall, we found a trend toward a decrease in the number of casualties admitted to the emergency department possibly in part, as a result of the period of peace negotiation.

Resumen Objetivo: Describir las variaciones en los soldados heridos en combate admitidos al departamento de emergencias durante el periodo de negociación del proceso de paz colombiano entre el 2011 y el 2016. Métodos: Estudio retrospectivo de todos los soldados heridos en combate que fueron manejados en un centro de trauma desde Enero del 2011 a Diciembre del 2016. Los pacientes se dividieron en dos grupos: aquellos que ingresaron al departamento de emergencias antes de la tregua del proceso de paz (Noviembre 2012) y aquellos que ingresaron durante la negociación. Los grupos se compararon con respecto a los periodos de tiempo. Resultados: Un total de 448 soldados heridos en combate fueron incluidos. Hubo una disminución gradual en el número de admisiones durante el periodo de negociación. Además, el número de soldados que sufrieron heridas por explosiones y fusiles disminuyó durante este periodo. En el 2012 se registraron 150 soldados heridos en combate. Este número disminuyó a 84, 63, 32 y 6 en los años 2013, 2014, 2015 y 2016 respectivamente. La proporción de pacientes con un ISS ≥9 y la proporción de admitidos a la unidad de cuidado intensivo fueron significativamente mayores en el periodo antes de la negociación. Desde Agosto a Diciembre/2016 no se registraron admisiones. Conclusión: Este estudio describe una disminución gradual en el número de soldados heridos en combate admitidos al departamento de emergencia en un periodo de 6 años. Este fenómeno pudo deberse al periodo de negociación del proceso de paz.

Trauma Registry of the Pan-American Trauma Society: One year of experience in two hospitals in southwest Colombia / Registro de Trauma de la Sociedad Panamericana de Trauma: Un año de experiencia en dos hospitales en el suroccidente colombiano

Abstract Background: Trauma information systems are needed to improve decision making and to identify potential areas of intervention. Objective: To describe the first year of experience with a trauma registry in two referral centers in southwest Colombia. Methods: The study was performed in two referral centers in Cali. Patients with traumatic injuries seen between January 1 and December 31, 2012, were included. The collected information included demographics, mechanism of trauma, injury severity score (ISS), and mortality. A descriptive analysis was carried out. Results: A total of 17,431 patients were registered, of which 67.8% were male with an average age of 30 (±20) years. Workplace injuries were the cause of emergency consultations in 28.2% of cases, and falls were the most common mechanism of trauma (37.3%). Patients with an ISS ≥15 were mostly found in the 18-35-year age range (6.4%). Most patients who suffered a gunshot wound presented an ISS ≥15. A total of 2.5% of all patients died, whereas the mortality rate was 54% among patients with an ISS ≥15 and a gunshot wound. Conclusion: Once the trauma registry was successfully implemented in two institutions in Cali, the primary causes of admission were identified as falls and workplace injuries. The most severely compromised patients were in the population range between 18 and 35 years of age. The highest mortality was caused by gunshot wounds.

Resumen Introducción: Los sistemas de información en trauma son requeridos para mejorar la toma de decisiones e identificar potenciales áreas de intervención. Objetivo: Describir el primer año de experiencia del registro de trauma en dos centros de referencia de trauma del suroccidente Colombiano. Métodos: Estudio realizado en dos centros de referencia de Cali. Se incluyeron pacientes con trauma o lesiones externas entre el 1-Ene y el 31-Dic-2012. Se recolectó información demográfica, relacionada con mecanismos de trauma, severidad (ISS) y mortalidad. Se presenta un análisis descriptivo. Resultados: Se registraron 17,431 pacientes. El 67.8% de los pacientes eran de género masculino con edad promedio de 30 (±20) años. Las lesiones laborales fueron causa de consulta a urgencias en un 28.2%, y las caídas el mecanismo de trauma más frecuente (37.3%). Los pacientes con ISS ≥15 en su mayoría se encontraban en el rango de edad de 18-35 años (6.4%). El 28% de los pacientes que sufrieron lesión por arma de fuego presentaron un ISS ≥15. El 2.5% de los pacientes murieron y aquellos pacientes con ISS ≥15 y lesión por arma de fuego presentaron mortalidad del 54%. Conclusión: una vez se logró implementar el registro de trauma en dos instituciones en Cali, se identificó que la principal causa de ingreso fue secundaria a caídas y las lesiones laborales. Los pacientes más severamente comprometidos están en el rango de población entre 18 a 35 años. La mayor mortalidad se presentó secundario a lesiones de causa externa por arma de fuego.

Traumatismo cranioencefálico por projétil de arma de fogo: experiência de 16 anos do serviço de neurocirurgia da Santa Casa de São Paulo / Traumatic brain injury by a firearm projectile: a 16 years experience of the neurosurgery service of Santa Casa de São Paulo

OBJETIVO: avaliar os aspectos epidemiológicos e fatores prognósticos associados a uma série de pacientes vítimas de traumatismo cranioencefálico por projétil de arma de fogo (PAF). MÉTODOS: Foram revisados os prontuários de 181 pacientes da Disciplina de Neurocirurgia da Santa Casa de São Paulo com diagnóstico de traumatismo cranioencefálico (TCE) decorrente de agressão por PAF no período de janeiro de 1991 a dezembro de 2005. Foram avaliados: idade, sexo, pontuação na escala de coma de Glasgow (ECG) à admissão, região encefálica acometida pelo PAF, tipo de lesão (penetrante ou tangencial), tipo de tratamento realizado e resultado ou desfecho, baseado na Escala de coma de Glasgow. A relação entre estratégia terapêutica e o resultado final foi analisada pelo teste Chi-quadrado de Pearson com correção de Yate. O teste de Fisher foi utilizado para verificar a mesma correlação individualmente para cada grupo estratificado pela ECG à admissão. RESULTADOS: Na nossa série de 181 pacientes, 85% eram do sexo masculino (n=154) e 15%, do sexo feminino (n=27). A média de idade foi 31,04 anos (+/- 10,98). A principal região encefálica acometida foi o lobo frontal (27,6%), seguido pelo temporal (24,86%) e occipital (16,57%). Dos TCE avaliados, 16% eram tangenciais e 84% penetrantes. CONCLUSÃO: Os pacientes submetidos ao tratamento cirúrgico evoluíram melhor do que os submetidos ao tratamento conservador, e os pacientes que se apresentam mais graves à admissão (com ECG entre 3-8) apresentam melhores resultados com o procedimento neurocirúrgico.

OBJECTIVE: To evaluate the epidemiology and prognostic factors associated with traumatic brain injury by a firearm projectile (FAP). METHODS: We reviewed the medical records of 181 patients in the Department of Neurosurgery of Santa Casa de São Paulo (São Paulo Holy House) diagnosed with traumatic brain injury (TBI) resulting from FAP from January 1991 to December 2005. Were evaluated: age, sex, Glasgow Coma Scale (GCS) on admission, brain region affected by the FAP, type of injury (penetrating or tangential), type of treatment and outcome, based on GCS. The relationship between therapeutic strategy and outcome was analyzed using the Chi-square test with Yates correction. The Fisher test was used to verify the same correlation individually for each group stratified by GCS on admission. RESULTS: Of the181 patients, 85% were male (n = 154) and 15% female (n = 27). Mean age was 31.04 years (± 10.98). The mostly affected brain region was the frontal lobe (27.6%), followed by temporal (24.86%) and occipital (16.57%) ones. Of the TBIs evaluated, 16% were tangential and 84%, penetrating. CONCLUSION: Patients undergoing surgical treatment had better outcome than those submitted to conservative treatment, and patients who were more severe at admission (GCS 3-8) have better results with the neurosurgical procedure.

Caracterización de las lesiones vasculares por tomografía computada (TC) en heridas de arma de fuego: experiencia de tres años en hospital público del sector suroriente de Santiago de Chile / Characterization of vascular lesions in firearm wounds, using computed tomography (CT): three years experience in a public hospital in the southeastern area of Santiago, Chile

Resumen: Objetivos. Conocer las características epidemiológicas y radiológicas en TC, de las lesiones vasculares en pacientes que han sufrido heridas por arma de fuego (HAF), en el servicio de urgencia de un hospital público de Santiago-Chile, en un período de tres anos. Material y método. Revisión retrospectiva de 211 TC realizadas a pacientes ingresados al servicio de urgencia con diagnóstico de HAF entre 31/05/2009 y el 31/05/2012. Se incluyeron pacientes con TC dentro de las primeras 48 horas de ocurrido el evento, excluyendo los pacientes que por su condición clínica, fueron a intervención quirúrgica previa a la TC, obteniendo un N° final de 178. Se analizó la distribución según sexo, edad, tipo de lesión vascular, segmento topográfico afectado, tipo de proyectil y outcome de los pacientes. Resultados. El 96,8 por ciento (n°= 31) de los afectados fueron hombres, 71,8 por ciento menores de 36 años. El segmento más afectado correspondió a las EEII, con un 55,8 por ciento. El tipo de lesión que más frecuente fue el pseudoaneurisma y la hemorragia activa, con un 20,5 por ciento en cada caso. El tipo de proyectil que más frecuentemente se encontró, fueron las balas (65 por ciento) y en la gran mayoría de las veces, sin salida del proyectil. En nuestro grupo hubo un fallecido. Conclusión. Si bien el trauma vascular representa un bajo porcentaje dentro del total de las lesiones por trauma, su extrema gravedad, y por ende necesidad de diagnóstico certero y precoz, explica la importancia del conocimiento y familiarización que los radiólogos deberíamos tener con ese tipo de lesiones. Las extremidades son el principal sitio de lesiones vasculares por herida penetrante, alcanzando hasta el 70 por ciento en nuestro trabajo. En estos casos los exámenes imaginológicos muchas veces son sólo complementarios, porque clínicamente el diagnóstico está hecho, no así en las lesiones de vasos intratorácicos e intra-abdominales, donde las imágenes son indispensables para su...

Objectives. To determine the epidemiological and CT characteristics of vascular lesions in patients who have suffered gunshot wounds, in the emergency department of a public hospital in Santiago, Chile, over a period of three years. Material and Methods. Retrospective review of 211 CT performed on patients admitted to the emergency department with gunshot wounds, between 31/05/2009 and 31/05/2012. Patients with a CT within the first 48 hours after the event occurred were included, excluding patients who for their clinical condition, underwent surgery prior to the CT, obtaining a final number of 178. Distribution was analyzed by sex, age, type of vascular injury, topographic segment affected, projectile type and outcome of patients. Results. 96.8 percent (n° = 31) of those affected were men, 71.8 percent under 36 years. The most affected segment were to the lower extremities, with 55.8 percent. The most frequent type of injury was pseudoaneurysm and active hemorrhage, with 20.5 percent in each case. The type of projectile most frequently found were bullets (65 percent) and the majority, without projectile exit. In our group there was 1 death. Conclusion. Although vascular trauma represents a low percentage of total trauma injuries, their seriousness, and therefore the need for early and accurate diagnosis, explains the importance of the knowledge and familiarity that radiologists should have, with that kind of injury. Extremities are the main site of vascular injury caused by penetrating wounds, affecting up to 70 percent in our sample. In these cases CT examinations are often only complementary because the diagnosis is made clinically; this is not the case in intrathoracic and intraabdominal vessel injuries, where images are essential for diagnosis.

Egresos por lesiones externas en un hospital de Ciudad Juárez, México / Discharges for external injuries from a hospital in Ciudad Juarez, Mexico

In Ciudad Juarez, Chihuahua, Mexico, morbidity and mortality from injuries have increasedalarmingly since 2008. This paper aims to examine the changes in the numberof hospital discharges for external injuries recorded during the 2008–2010 period in ahospital in Ciudad Juarez. A descriptive retrospective study conducted at the CiudadJuarez General Hospital looked at the incidence of external injuries as the reason forhospital discharges during the period under analysis. The average proportion of hospitaldischarges attributed to external injuries was 27%, with the 25–44-year-old agegroup being the most affected. More than half of the discharges were for fractures.The incidence rate of hospital discharges attributed to injuries in Ciudad Juarez wasalmost four times greater than that reported at the national level.

En Ciudad Juárez (Chihuahua), México, la morbilidad y la mortalidad por lesiones aumentaronen forma alarmante a partir de 2008. El presente trabajo se propone determinar los cambiosen el número de egresos hospitalarios por causas externas registrados durante el período 2008–2010 en un hospital de dicha ciudad. Se realizó un estudio retrospectivo descriptivo sobre laincidencia de causas externas como causa de egreso hospitalario en los años antes mencionadosen el Hospital General Ciudad Juárez. La media de egresos hospitalarios por causas externasfue de 27%, con el grupo etario de 25 a 44 años como el más afectado. Las fracturas fueron lacausa de más de la mitad de los egresos. Los egresos hospitalarios por lesiones en Ciudad Juárezpresentan una incidencia casi cuatro veces mayor que la reportada a nivel nacional.

Ferimento por projétil de arma de fogo: um problema de saúde pública / Firearm injury: a public health problem / Herida por proyectil de arma de fuego: un problema de salud publica

Objetivou-se com esta pesquisa traçar o perfil epidemiológico das vítimas de ferimento por projétil de arma de fogo (FPAF) atendidas no pronto-socorro de um hospital universitário em 2007, bem como caracterizar o atendimento no ambiente pré- e intra-hospitalar. Utilizou-se a abordagem quantitativa e de natureza transversal. A amostra constituiu-se de 98 pacientes. A maioria das vítimas tinha ferimento único por projétil de arma de fogo, eram jovens, do sexo masculino, solteiros, provenientes de Londrina. A principal causa foi o assalto. O SIATE foi o transporte mais utilizado e o principal responsável pelo atendimento pré-hospitalat (APH). Os procedimentos mais realizados no APH e no atendimento intra-hospitalar, respectivamente, foram o curativo, a imobilização e a reposição volêmica. Ocorreram internações prolongadas, necessidade de UTI e cirurgias, além de óbitos e incapacidades. Portanto, as armas de fogo têm grande importância epidemiológica, havendo a necessidade de intervenções que vão além da esfera da saúde.

This research's objective was to outline the epidemiological profile of firearm injury victims attended in the emergency unit of a university hospital in 2007. It aimed as well to characterize pre and intra hospital care. It is a cross-sectional study with a quantitative approach. The sample consisted of 98 patients. The majority of victims presented a single firearm injury, were young, male, single, from the city of Londrina, Paraná. The injury main cause was robbery. The ambulances of the Trauma and Emergency Care Integrated System (in Portuguese, SIATE) were the most employed means of transportation and the main provider of pre-hospital care. The most common pre and intra-hospital care procedures were dressing, immobilization and fluid replacement, respectively. Prolonged hospitalization, need for intensive care and surgery as well as injury related disabilities and deaths occurred. The epidemiology of firearms injuries must be better understood although its control depends on interventions that are outside the healthcare scope.

Con este estudio se buscó trazar el perfil epidemiológico de las víctimas de proyectil de arma de fuego (HPAF) atendidas en la guardia de un hospital escuela durante 2007 y, asimismo, determinar la atención previa e intra hospitalaria. Se trata de un estudio transversal con enfoque cuantitativo. La muestra consistió en 89 pacientes. La mayoría de las víctimas tenían una sola herida por proyectil de arma de fuego, eran jóvenes, varones, solteros, de la ciudad de Londrina. La causa principal era asalto. Las ambulancias de Traumas y Emergencias del Sistema Integrado de Salud fueron los vehículos más utilizados y los más responsables de la atención pre- hospitalaria (APH). Los procedimientos más realizados en la APH y en la atención intrahospitalaria, respectivamente, fueron curativo, inmovilización y reposición volémica. Hubo internaciones prolongadas, necesidad de UTI y cirugías, además de óbitos e incapacidad. Las armas de fuego tienen gran importancia epidemiológica y por ello es necesario que su control implique otras esferas más allá del alcance del área de salud.

Gunshot wound injuries to the male external genitalia

To identify the patterns of civilian gunshot wound [GSW] injuries to the male external genitalia, and to present our experience in the management of such injuries. This descriptive study was carried out in the Urology and Nephrology Center, Al-Thawra Modern General and Teaching Hospital, Sanaa, Yemen from June 2005 to April 2008, and included 20 men that presented with GSW injuries to the external genitalia. After clinical and radiological evaluation with retrograde urethrography when indicated, early surgical repair was undertaken for all patients with evident, or suspected deep genito-urinary wounds. The mean age of the patients was 33.2 years. In 15 [75%] patients, injuries were inflicted by high-velocity weapons, and in 5 by low-velocity pistols, and 18 [90%] patients had other associated injuries. The penis was involved alone in 10 [50%], scrotum in 4 [20%], and the penis and scrotum in combination in 6 [30%] patients. In 5 patients, the lesions were superficial. Corporeal injuries were detected in 13 patients, and urethral injuries were detected in 6 patients. In post-repair, mild curvature during erection was experienced by 5 patients, severe angulation by one, and sexual dysfunction by 2 patients. We encountered 9 testicular ruptures, and our testicular salvage rate was 45.5%. Although the dominant inflicting weapons were high-velocity automatic rifles, the severity of injuries and their related outcomes were almost comparable to other low-velocity series. This is possibly due to the primary involvement of nearby bulky muscles in 90% of cases, which may absorb the blasts' effect of the projectiles on the genitalia

Reparación primaria versus colostomía en lesiones del colon / Primary repair vs. colostomy in colon injuries

Introducción: El colon es el segundo órgano más frecuentemente lesionado en las heridas por trauma penetrante de abdomen. En México, las lesiones por arma blanca o de fuego van en aumento. Nuestro objetivo fue evaluar el principal manejo para las lesiones traumáticas de colon. Material y métodos: Estudio retrospectivo y aleatorizado de 178 pacientes con trauma abdominal y lesiones de colon, en un lapso de cinco años (enero de 2003 a junio de 2008) en el Hospital General de Balbuena. Se comparó el uso del cierre primario y cirugía derivativa con colostomía. Se analizó sexo, grupo de edad, tipo de herida, grado de lesión y mortalidad. Resultados: De 178 pacientes, 156 fueron hombres (87.6 %) y 22 mujeres (12.4 %). El grupo de edad con mayor afección fue el de 21 a 30 años; 74 pacientes (41.6 %) presentaron heridas por instrumento punzocortante y 104 pacientes (58.4 %) heridas por arma de fuego. El principal manejo fue mediante cierre primario: 92 casos (51.7 %) versus 86 (48.3 %) para cirugía derivativa; sin embargo, en las heridas por arma de fuego el principal manejo fue la colostomía (67 casos). La mortalidad fue de 17 casos (9.55 %) debido a causas diversas como lesiones a múltiples órganos de manera asociada. Conclusiones: En las lesiones colónicas debe individualizarse el tratamiento, según la etiopatogenia, grado de lesión y lesiones asociadas.

BACKGROUND: Colon trauma is frequent and its prevalence is difficult to establish because of the different factors that intervene in its origin. In Mexico, traumatic colon injuries, albeit stab wounds or gunshot wounds, are on the rise. Our objective was to evaluate the most appropriate management for traumatic colon injuries. METHODS: We conducted a retrospective study of 178 case files of patients with abdominal trauma and colon lesions during a 5-year period from January 2003 to June 2008 from the General Hospital of Balbuena, Mexico City. The study compared the use of primary closure vs. colostomy, analyzing variables such as sex, age, type of wound, severity of lesion and mortality. RESULTS: There were a total of 178 patients; 156 were male (87.6%) and 22 were female (12.4%). The most affected age group was between 21 and 30 years; 74 patients (41.6%) had stab wounds and 104 patients (58.4%) had gunshot wounds. Management consisted mainly of primary closure in 92 cases (51.7%) vs. colostomy in 86 patients (48.3%). However, 64% of gunshot wounds were treated with colostomy. Reported mortality was 9.55% and this was due to different factors such as multiple organ injury. CONCLUSIONS: Treatment of traumatic colon injury should be case specific, taking into account the mechanism of the lesion, its severity and associated injuries.

Pre-adolescent gunshot injuries: anatomy of a Jamaican problem

This retrospective analysis explores the apparent increase in gunshot injuries among pre-adolescent Jamaican children. During the five-year study period (2001-2005), 74 children less than 12 years old were treated for gunshot injuries at the Bustamante Hospital for Children. In the last four years of the study, the hospital incidence of such child shootings rose by 155%. Children between six and eleven years of age were seen to be at particular risk. Shootings were likely to occur between 4:00 pm and 10:00 pm in the evening, at or near home, in inner city communities. Affected children were unlikely to have been under direct adult supervision at the time of injury and were reported to be intended targets of the shooting in 49% of cases. Injuries to the limbs occurred most frequently, resulting chiefly in soft tissue injuries and open fractures. Half required operative intervention, most avoiding blood transfusion. Hospital stay was usually less than a week. Though clearly needed, social support services were underutilized A mortality rate of 4% was seen but long-term morbidity was uncommon. Routine social and psychiatric evaluation of victims, organized after school-care, establishment of paediatric paramedical services, establishment of a dedicated paediatric interhospital transfer team and more widespread training in paediatric trauma management are recommended to improve the quality of care given to paediatric victims of firearm injuries.

Este análisis retrospectivo explora el aumento evidente de las heridas de bala entre los niños jamaicanos pre-adolescentes. Durante un período de cinco años de estudio (2001–2005), 74 niños menores de 12 años fueron atendidos debido a heridas de bala en el Hospital Pediátrico Bustamante. En los últimos cuatro años de este estudio, la incidencia en el hospital de heridas producidas con armas de fuego a niños aumentó en un 155%. Niños entre seis y once años de edad se considerabanparticularmente en riesgo. Los tiroteos ocurrían probablemente entre 4 pm de la tarde y 10 pm de la noche, en la casa o en el vecindario, en las comunidades de los suburbios citadinos internos (conocidos como inner cities). Es poco probable que los niños afectados hayan estado bajo supervisión directa dealgún adulto en el momento de recibir la herida, y se reportó que fueron objetivo expreso de los disparos en el 49% de los casos. Las heridas en las extremidades ocurrieron con mayor frecuencia, trayendo como consecuencia principalmente heridas en tejidos blandos y fracturas abiertas. La mitadde ellos requirió intervención quirúrgica, evitándose la transfusión sanguínea en la mayoría de los casos. La estadía en el hospital por lo general duró menos de una semana. Aunque evidentemente senecesitaban servicios de apoyo social, hubo una marcada subutilización de los mismos. Se observó una tasa de mortalidad del 4% pero la morbilidad a largo plazo resultó poco común. La evaluación psiquiátrica y social de rutina de las víctimas, organizada después de la atención en la escuela, el establecimiento de servicios paramédicos pediátricos, el establecimiento de un equipo dedicado de transferencia interhospitalaria pediátrica, y un entrenamiento más amplio en el tratamiento de traumaspediátricos, se recomiendan a fin de mejorar la calidad de la atención brindada a las víctimas pediátricas de heridas por arma de fuego.

Heridas por armas de fuego y traumas vasculares: una ventana a la violencia civil en Caracas

Las muertes por violencias en Venezuela han aumentado gradualmente hasta convertirse en un problema de salud pública, de acuerdo a los datos de epidemiología y estadística vital del Ministerio de Salud y Desarrollo Social, entre 1850 y 2005, el reporte de un mayor número de traumas por armas de fuego atendidos en centros hospitalarios nacionales y el aumento de biopsias vasculares traumáticas, en población masculina joven. Las tasas de mortalidad por agresiones aumentaron un 93,7 por ciento entre 1995 y 2005. De acuerdo a la forma de ataque en las agresiones, el ataque por arma de fuego aumentó de un 53,4 por ciento en 1980 a 87,2 por ciento en 2005. Entre 1990 y 2002, en 1307 biopsias analizadas en el Instituto Anatomopatológico "Dr. José Antonio O'Daly", de la Universidad Central de Venezuela, 300 fueron vasculares y 70 de ellas traumáticas. El 90 por ciento ocurrió en varones, el 74,3 por ciento fueron producidas por armas de fuego y el 57 por ciento era menor de 30 años. El 78,6 por ciento de las lesiones vasculares traumáticas estuvieron localizadas en arterias de las extremidades

Deaths by violence in Venezuela had increased gradually becoming a public health problem, according to epidemiological and vital statistics data from the National Public Health Service, between 1950 and 2005, reports on more number of gun fire arms lesions attendedin national care centres and an increase of traumatic vascular biopsies in the young male population. Aggression death rates increased 93,7% between 1995 and 2005. According to the aggression type of attack, gun fire arms attack increased from 53,4% in 1980 to 87,2% in 2005. From 1990 to 2002, out of 1307 biopsies analyzed at the “Dr. José Antonio O’Daly”, Anatomopathological Institute in the Central University, 300 were vascular and 70 of them traumatic. The 90% occurred in males, 74,3% were produced by gun fire arms and 57% were younger than 30 years old. The 78,6% of the traumatic vascular lesions were located in the extremities

Estudo retrospectivo de janeiro de 1998 a maio de 2005, no Hospital Universitário de Maringá, sobre ferimentos por arma branca e arma de fogo / Retrospective study (january 1998 / may 2005) at the University Hospital of Maringá, on wounds caused by edged weapons and firearms

O objetivo deste trabalho é determinar as características dos pacientes atendidos no Hospital Universitário de Maringá (HUM), com ferimento por arma branca (FAB) e por arma de fogo (FAF), quanto ao sexo, idade, às regiões corporais, órgãos mais atingidos, tempo de internamento, complicações e mortalidade. Após análise de uma planilha elaborada para a pesquisa, observou-se que 68% dos atendimentos foram por FAB e 32%, por FAF, sendo a maioria homens (mais de 90%), adultos jovens (2ª e 3ª década, por FAF e FAB, respectivamente). As regiões mais acometidas foram abdome e tórax. e os órgãos mais atingidos foram intestino delgado e fígado, na lesão por arma branca, e fígado e intestino delgado, no FAF. A complicação mais comum foi o choque hipovolêmico. Concluiu-se que os FAB ocorreram em maior número no sexo masculino, na terceira década de vida

The objective of this study is to determine the characteristics of patients assisted at the University Hospital of Maringá (HUM) with wounds from edged weapons (EWW) or firearms (FW), in regards to gender, age, wounded body areas, most affected body organs, length of hospitalization, complications and mortality rates. After the analysis of a worksheet elaborated for the study, it was observed that 68% of admissions had been for EWW and 32% for FW. The majority were men (90%) and young adults (20s and 30s, for FW and EWW, respectively). The most affected body areas were the abdomen and thorax, and the most wounded organs were, in order: the small intestine and liver for EWW, and the liver and small intestine for FW. The most common complication was hypovolemic shock. It was concluded that EWW had occurred in larger numbers than FW, with predominance in males in their 30s

The incidence of drug abuse in unnatural deaths in northern Thailand.

OBJECTIVE: Study the incidence of drug abuse in persons with unnatural deaths such as traffic accidents, homicide with gunshot wounds, etc. MATERIAL AND METHOD: One hundred and fifty three cases with a mean age of 34 years (range 10 to 76) were studied. The decedents were mostly male (92%), with a variety of occupations including laborers (76.9%), traders (15.4%), and student (7.7%). The causes of death were mainly traffic injuries (33%), gunshot wounds (26%) and others (stab wound, poisoning, asphyxia etc 41%). The manner of death was accidents in 40% and homicides in 28%. RESULTS: Nine percent were positive for methamphetamine or amphetamine derivatives. Tests for Heroin, 6-MAM, morphine, or cocaine were also performed but not detected. The drug positive cases were mostly males (85%) with the most common age range of 21-30 years (35.4%) and 61% with only primary education. Homicide by gunshot wounds was the most common cause of death at 69.2%, followed by hanging (15.4%), electrocution (7.7%), and poisoning (7.7%). The concentration of methamphetamine in urine was between 501-61,147 ng/ml, which cannot be correlated with intoxication. There were no deaths from overdose. Three Benzodiazepine, one toluene, and one meperidine cases were also found in cases of methamphetamine abuse. Alcohol was found mostly in the persons with unnatural deaths (53.6%) from traffic accidents. CONCLUSION: This information helps us understand the marketing strategies, and the trading routes. All data will be used for planning to eradicate these drugs from Thailand in line with government strategies.

Heridas de bala en colon y recto. Experiencia en el Servicio de Emergencia de un Hospital General de Agudos en el Gran Buenos Aires / Gunshot wounds in colon and rectum. Experience in the Emergency Service of an Acute General Hospital in Gran Buenos Aires

Introducción: La incidencia y la gravedad de las lesiones por proyectiles de armas de fuego (PAF) aumentaron considerablemente en los últimos años, con mayor impacto en las edades tempranas, siendo esta tendencia mundial. Pacientes y métodos: Estudiar los pacientes ingresados en nuestro hospital por PAF y compararlo con otras series. Diseño: retrospectivo. Población: 598 pacientes entre junio 1997 y junio 2004. Se considera: incidencia, sexo, edad, áreas de impacto, con un análisis especial en las lesiones de colón y recto, estudiando: topografía de las lesiones, asociación con otros órganos, estrategia terapéutica y morbimortalidad. Resultados: Total de pacientes 598, masculino: 513 (85,7 por ciento), femenino: 85 (14,3 por ciento). Edad promedio: 32,56 años, rango de 10 a 85. Areas de impacto: tronco 168 (28,08 por ciento), miembros: superiores 8 (14,04 por ciento), inferiores 334 (55,85 por ciento), compromiso colorrectal 29 (20 por ciento de las abdominales). Topografia: ciego 2 pacientes (6,8 por ciento), colon ascendente 1 (3,4 por ciento), ángulo hepático 2 (6,8 por ciento), transverso 4 (13,7 por ciento), ángulo esplénico 1 (3,4 por ciento), descendente 6 (20,6 por ciento), sigmoides 6 (20,6 por ciento) y recto 7 (24 por ciento). Órganos asociados: mesenterio e intestino delgado 8 pacientes, epiplón mayor 6, estómago 4, hígado 3, bazo 2, páncreas 2, vena ilíaca 3; arteria ilíaca 2, arteria aorta 1. Tratamientos realizados: cecostomía 2 pacientes, colostomía sobre varilla 9, exteriorización y cierre primario 4, operación tipo Lahey 4, operación tipo Hartmann 7, resección y anastomosis 3 y drenaje presacro 4 pacientes. Complicaciones: absceso de pared 8 pacientes (27,5 por ciento), peritonitis 4 (13,7 por ciento), evisceración 2 (6,8 por ciento), hemorragia 2 (6,8 por ciento), metabólicos 4 (13,7 por ciento). Mortalidad 2 pacientes. Discusión: en nuestra serie, 1 de cada 1200 admisiones en el servicio de emergencia correspondió a PAF, la mayoría, 69,89