Incidência hospitalar de traumatismo craniencefálico no Brasil: uma análise dos últimos 10 anos / Traumatic brain injury hospital incidence in Brazil: an analysis of the past 10 years

ABSTRACT Objective: To characterize the demographic, social, and economic burden of traumatic brain injury on the public health system in Brazil during the past decade. Methods: Data from the database of the Information Technology Department of the Unified Health System (DATASUS) from January 2008 to December 2019 were analyzed. Results: There was a mean of 131,014.83 hospital admissions per year due to traumatic brain injury in Brazil from 2008 - 2019. The incidence was 65.54 per 100.000 inhabitants during the same period. The high incidence of traumatic brain injury in older adults (>70 years old) accompanied by high mortality rates should be noted. In addition, there was a high incidence of traumatic brain injury in younger adults (20 to 29 years and 30 to 39 years). The data presented here demonstrates a 3.6 male-to-female ratio of traumatic brain injury incidence. Conclusion: Although we believe that the present data underestimate the incidence and mortality related to traumatic brain injury in Brazil, this study could assist in implementation of future health promotion strategies in the Brazilian population and worldwide aiming to reduce the incidence, mortality and costs of traumatic brain injury.

Abstract Objetivo: Caracterizar os aspectos demográficos e sociais e o ônus econômico do traumatismo craniencefálico no sistema público de saúde brasileiro na última década. Métodos: Analisaram-se os dados provenientes da base de dados do Departamento de Informática do Sistema Único de Saúde referentes ao período entre janeiro de 2008 e dezembro de 2019. Resultados: Entre 2008 e 2019 ocorreram, em média, no Brasil, 131.014,83 internações por traumatismo craniencefálico ao ano, com incidência de 65,54 por 100 mil habitantes. Deve-se salientar a elevada incidência de traumatismo craniencefálico em adultos idosos (acima de 70 anos), acompanhada de altas taxas de mortalidade. Além disso, há também elevada incidência de traumatismo craniencefálico em adultos jovens (20 a 29 anos e 30 a 39 anos). Os dados aqui apresentados demonstram uma proporção de traumatismos craniencefálicos de 3,6 homens/mulheres. Conclusão: Embora se acredite que os dados apresentados subestimem a incidência e mortalidade associadas com o traumatismo craniencefálico no Brasil, este estudo pode ajudar na implantação de futuras estratégias de promoção da saúde para a população brasileira e mundial, com o objetivo de diminuir a incidência, a mortalidade e os custos do traumatismo craniencefálico.

Gender differences in adult traumatic brain injury according to the Glasgow coma scale: A multicenter descriptive study / 中华创伤杂志(英文版)

PURPOSE@#Patients' gender, which can be one of the most important determinants of traumatic brain injury (TBI) outcomes, is also likely to interact with many other outcome variables of TBI. This multicenter descriptive study investigated gender differences in epidemiological, clinical, treatment, mortality, and variable characteristics in adult TBI patients.@*METHODS@#The selection criteria were defined as patients who had been diagnosed with TBI and were admitted to the hospital between January 1, 2016 and December 31, 2018. A total of 4468 adult TBI patients were enrolled at eight University Hospitals. Based on the list of enrolled patients, the medical records of the patients were reviewed and they were registered online at each hospital. The registered patients were classified into three groups according to the Glasgow coma scale (GCS) score: mild (13-15), moderate (9-12), and severe (3-8), and the differences between men and women in each group were investigated. The risk factors of moderated and severe TBI compared to mild TBI were also investigated.@*RESULTS@#The study included 3075 men and 1393 women and the proportion of total males was 68.8%. Among all the TBI patients, there were significant differences between men and women in age, past history, and GCS score. While the mild and severe TBI groups showed significant differences in age, past history, and clinical symptoms, the moderate TBI group showed significant differences in age, past history, cause of justice, and diagnosis.@*CONCLUSION@#To the best of our knowledge, this multicenter study is the first to focus on gender differences of adult patients with TBI in Korea. This study shows significant differences between men and women in many aspects of adult TBI. Therefore, gender differences should be strongly considered in TBI studies.

Atención de los pacientes con trauma grave durante los primeros días: evolución entre la urgencia, el pabellón y la unidad de cuidados intensivos / Features of patients with trauma admitted to an emergency room of a general hospital

Background: Trauma is the main cause of death among people aged 5 to 44 years. Aim: To describe features, treatment and evolution of trauma patients admitted to an emergency room. Material and Methods: Adult patients admitted in the emergency department of a public hospital due to severe trauma were studied and followed during their hospital stay. Results: We included 114 patients aged 40 ± 17 years (78%men) with an injury severity score of 21 ± 11. Trauma was penetrating in 43%. Traumatic brain injury (TBI) was the most common diagnosis in 46%. In the emergency room, 8% had hypotension, 5% required vasopressors and 23% required mechanical ventilation. The initial lactate was 3.6 ± 2.9 mmol/L. Sixty-five patients (57%) required emergency surgery. The intraoperative lactate was 3 ± 1.7 mmol/L and 20% required vasopressors. Sixty-four patients (56%) were admitted to the ICU, with APACHEII and SOFA scores of 16 ± 8 and 5 ± 3, respectively. ICU lactate was 3.2±1.5 mmol/L. In the ICU 40% required vasopressors and 63% mechanical ventilation. Thirty two percent had coagulopathy, 43% received transfusions and 10% required massive transfusions. The hospital stay was 13 (6-32) days, being significantly longer in patients with TBI. ICU and hospital mortalities were 12.5 and 18.4% respectively. The only predictor for mortality was the APACHEII score (Hazard Ratio 1.18, 95% confidence intervals 1.03-1.36). Conclusions: APACHE score was a predictor of mortality in this group of patients.

Prevalência de sequelas neurológicas associadas a trauma em face / Prevalence of neurological sequelae associated with facial trauma

Introdução: pacientes acometidos por traumatismo craniofacial podem evoluir com sequelas variadas. Objetivo: identificar a prevalência de sequelas neurológicas ocorridas entre os pacientes com traumatismo craniofacial em um serviço de referência para o trauma no sul do Brasil. Sujeitos e método: foram analisados 1.385 prontuários, em que 169 (12%) pacientes foram selecionados com trauma em crânio e face simultaneamente, levando em consideração o agente etiológico, a procedência, a idade, o sexo do paciente e a localização das fraturas. Resultados: uma taxa de 85% dos indivíduos era do sexo masculino, com faixa etária entre 31-40 anos. Os fatores etiológicos mais prevalentes foram acidentes de trânsito (36%), quedas (22%) e violência interpessoal (21%). No grupo selecionado, o traumatismo cranioencefálico esteve presente em 89% dos casos; em 64% da população, não houve sequela neurológica; 28% apresentaram algum tipo de sequela; e em 8% dos prontuários não havia informações completas. Conclusão: na população estudada, mesmo com um subgrupo específico de traumatizados, houve prevalência de gênero masculino, terceira década de vida e acidente automobilístico. Além disso, a região anatômica mais acometida foi o conjunto de ossos do terço médio da face, e, ainda nesta condição de associação, o traumatismo cranioencefálico esteve presente na maioria dos casos, porém, somente 28% dos casos evoluíram com alguma sequela neurológica. (AU)

Introduction: patients affected by craniofacial trauma may evolve into various sequelae. Objective: to identify the prevalence of neurological sequelae among patients with craniofacial trauma in a reference trauma service in southern Brazil. Subjects and method: a total of 1.385 medical records were analyzed, from which 169 (12%) patients were selected with simultaneous skull and face trauma, considering the etiologic agent, origin, age and sex of the patient, and fracture location. Results: a rate of 85% of the individuals were men aged 31 through 40 years. The most prevalent etiological factors were car accidents (36%), falls (22%), and interpersonal violence (21%). In this selected group, traumatic brain injury was present in 89% of the cases. In 64% of the population, there were no neurological sequelae, 28% presented some type of sequelae, and 8% of the medical records did not contain complete information. Conclusion: for this population studied, even with a specific subgroup of traumatized subjects, the male sex, the third decade of life, and car accidents are the most prevalent factors. In addition, the most affected anatomic region is the set of bones in the middle third of the face and, in this condition of association, traumatic brain injury was present in the great majority of cases, but only 28% of them evolved into some type of neurological sequelae. (A)

Cesárea electiva en gestante con fractura-hundimiento antigua en región frontal del cráneo / Pregnant With an Old Fracture-Sink in Skull Frontal Region Determines Elective Caesarean Section

Los traumatismos craneoencefálicos constituyen una epidemia silenciosa para la Organización Mundial de la Salud; y en específico, las fracturas de cráneo tienen una incidencia elevada en la sociedad moderna. El objetivo es presentar el caso de una embarazada con una fractura craneal antigua (fractura-hundimiento frontal) que condiciona la indicación de una cesárea electiva. Además, resulta una afectación anatómica poco habitual en la práctica de la Obstetricia. Se presenta una gestante de 22 años que a la edad de 4 años sufrió trauma craneoencefálico al caer accidentalmente desde un cuarto piso. Se impactó en la región frontal del cráneo con un recipiente de cerámica pesado. Quedó inconsciente y con sangrado profuso, se operó de urgencia y la paciente quedó sin secuela clínica de daño cerebral, pero con deformidad craneal por hundimiento de forma ovalada bien delimitada. Se determinó cesárea electiva por orientación del Programa Materno Infantil Nacional a las 40,5 semanas, peso del recién nacido 3 802 g y Apgar 9-9. Tuvo una evolución satisfactoria durante su atención prenatal y puerperio. La valoración y el manejo de una gestante con antecedentes de un traumatismo craneoencefálico antiguo requieren de un seguimiento multidisciplinario que involucre a obstetras, neurocirujanos, neurólogos y otros especialistas, con vistas a evitar las complicaciones que una afección como esta, pueden resultar letales para la madre o el feto(AU)

Cranium cerebral trauma constitutes a silent epidemic for the World Organization of the Health; and specifically skull fractures have risen incidence in the modern society. To present the case of a pregnant woman with an old cranial fracture (front fracture-sinking) that conditions the indication of elective caesarean operation. In addition, it is an unusual anatomical involvement in Obstetrics practice. We present the case of a 22 year-old pregnant that suffered encephalic skull trauma at the age of 4. This trauma is the result of her falling accidentally from a fourth floor to a heavy ceramic recipient and she impacted the front region of her skull. She was unconscious and bled profusely. She underwent urgent surgery. She survived without clinical sequel of cerebral damage but she has cranial sinking deformity in a well-defined oval way. Elective caesarean operation is determined by orientation from the national infantile maternal program to the 40,5 weeks, weight of the newly born 3 802 grams, Apgar 9-9. Satisfactory evolution during their prenatal attention and puerperium. Elective cesarean section is determined at 40.5 weeks, the newborn weight 3 802 g, Apgar 9-9, in alignment with the Cuban national program for the mother and the child. She had a satisfactory evolution during her prenatal and puerperal care. The assessment and management of a pregnant woman with a history of an old cranioencephalic trauma requires multidisciplinary monitoring involving obstetricians, neurosurgeons, neurologists and other specialists, for avoiding complications which can be lethal to the mother or the fetus(AU)

Traumatic Brain Injury Caused by Motor Vehicle Collision and Alcoholism in Piauí

Objectives To determine the relationship between alcohol consumption and the incidence of traumatic brain injury (TBI) with diffuse axonal injury (DAI), determining these indices, checking acquired comorbidities and characterizing the patients by gender, age and race/color, as well as describing the characteristics of the motor vehicle collision (vehicle, period of the day, day of the week and site) in people admitted to an emergency hospital in the city of Teresina, in the state of Piauí, Brazil. Methods We have analyzed the data contained in the medical records of patients admitted with a history of motor vehicle collision and severe TBI in intensive care units, based on the forms provided by the Mobile Emergency Care Service (SAMU, in the Portuguese acronym) in the period between February 28 and November 28, 2013. Results In the period covered by the present study, 200 individuals were analyzed, and 54 (27%) had consumed alcohol; of these 11 had DAI. Of the total sample, 17% (34) presented DAI, however, with unknown data regarding the consumption of alcoholic beverages. Conclusion Considering the data, we observed that the profile of the head trauma patients are brown men, mostly (53.5%) aged between 15 and 30 years. The collisions occurred mostly on weekends and at night (55%), and 89.5% of the crashes involved motorcycles.

Predictors of quality of life after moderate to severe traumatic brain injury / Preditores de qualidade de vida após trauma crânio-encefálico moderado a grave

ABSTRACT Objective To verify correlations between age, injury severity, length of stay (LOS), cognition, functional capacity and quality of life (QOL) six months after hospital discharge (HD) of victims of traumatic brain injury (TBI). Method 50 patients consecutively treated in a Brazilian emergency hospital were assessed at admission, HD and six months after HD. The assessment protocol consisted in Abbreviated Injury Scale, Injury Severity Score, Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), Mini Mental Test, Barthel Index and World Health Organization QOL - Brief. Results Strong negative correlation was observed between LOS and GCS and LOS and RTS. An almost maximal correlation was found between RTS and GCS and functional capacity and GCS at HD. Age and LOS were considered independent predictors of QOL. Conclusion Age and LOS are independent predictors of QOL after moderate to severe TBI.

RESUMO Objetivo Verificar correlações entre idade, gravidade do trauma, tempo de hospitalização (TH), cognição, capacidade funcional e qualidade de vida (QV) seis meses após alta hospitalar (AH) de vítimas de trauma crânio-encefálico (TCE). Método 50 pacientes tratados em um hospital de emergência brasileiro foram avaliados na admissão, AH e seis meses após AH. O protocolo de avaliação consistia em Escala Abreviada de Lesões, Índice de Gravidade de Lesão, Escala de Coma de Glasgow (ECG), Escore de Trauma Revisado (RTS), teste Mini-Mental, Índice de Barthel e Questionário Breve de QV da Organização Mundial de Saúde. Resultados Forte correlação negativa foi observada entre TH e ECG e TH e RTS. Correlação quase máxima foi observada entre RTS e ECG e capacidade funcional e ECG na AH. Idade e TH foram considerados preditores independentes de QV. Conclusão Idade e TH são preditores independentes de QV após TCE moderado e grave.

Perfil clínico e sociodemográfico de vítimas de traumatismo cranioencefálico atendidas na área vermelha da emergência de um hospital de referência em trauma em Sergipe / Clinical and Sociodemographic Profile of Traumatic Brain Injury Victims Attended on Emergency Red Area from a Hospital Reference in Trauma of Sergipe

Objetivo Traçar o perfil clínico e sociodemográfico das vítimas de TCE atendidas na área vermelha da emergência de um hospital de referência em trauma em Sergipe. Método A amostra foi composta por 96 vítimas de TCE, para coleta de dados foram usados instrumento estruturado, prontuário e ficha de atendimento. Resultados A faixa etária mais acometida foi de 18 a 30 anos; a grande maioria do sexo masculino, natural de Sergipe. Quanto ao estado civil, escolaridade e profissão, foi notado o não preenchimento destes campos na totalidade das fichas de atendimento. A grande maioria dos acidentes ocorreu em via pública com motocicletas procedentes de outros municípios de Sergipe, domingo; amaioriados TCEs foi classificada emgrave. Para a grande maioria foi adotado o tratamento conservador. A maioria das vítimas utilizou analgesia. O suporte ventilatório que prevaleceu foi o TOT. A totalidade usava monitorização não invasiva; 81,3% fizeram uso de nutrição enteral, sendo 51,0% por via nasal; 60,4% com balanço hídrico e 77,1% com sonda vesical de demora; 64,6% das vítimas foram transferidos para outras áreas do hospital e 21,9% evoluíram para óbito. Conclusão O TCE grave prevaleceu no adulto jovem do sexo masculino; o trauma por moto foi representativo com número de óbitos significativo. Estima-se que o tratamento conservador e as terapias de suporte sejam padrão na condução clínica das vítimas de TCE, o que exige dos profissionais de saúde intervenções a fim de minimizar danos físicos e psicológicos.

Objective Draw a clinical, social and demographic profile of TBI victims attended on emergency red area from a hospital reference in trauma of Sergipe. Methods The sample was composed for 96 TBI victims; for the search of data was used structured instrument and clinical and service records. Results The age group more affected was from 18 to 30 years old; the great majority male, born in Sergipe. It was noted that the fields of marital status, education and profession were not filled in the total of the service records. The great majority of accidents occurred in public way originated in others cities of Sergipe; the trauma mechanism was motorcycle accident on Sunday; the majority of the TBI was classified as serious. For the most of victims it was chosen the conservatory treatment. The majority of them used analgesics. The ventilatory support most used was the endotracheal tube. The totality used non-invasivemotorization; (81.3%) were in enteral nutrition, being (51.0%) nasally; (60.4%) with hydric balance and (77.1%) with urinary catheter; (64.6%) of the victims were transferred to other hospital areas and (21.9%) evolved to death. Conclusion The serious TBI, in the male young adult was prevalent; the motorcycle trauma was representative with significant number of deaths. It is estimated that the conservatory treatment and the support therapies be a pattern on the clinical management of TBI victims, what requires interventions from the health professionals to minimize the physical and physiologic damages.

Fatores relacionados ao prognóstico de vítimas de traumatismo cranioencefálico: uma revisão bibliográfica / Factors associated with prognosis of traumatic brain injury: a literature review

O traumatismo cranioencefálico (TCE) é uma agressão traumática ao cérebro, em consequência de um trauma externo, resultando em alterações cerebrais momentâneas ou permanentes e comprometimento das habilidades cognitivas ou físicas. O presente artigo tem como objetivo apresentar uma revisão bibliográfica sobre os fatores relacionados ao prognóstico de vítimas de TCE. O estudo compreende um levantamento bibliográfico para o conhecimento e melhor abordagem sobre o tema, possibilitando uma reflexão sobre esses fatores. Com base na literatura e análise dos estudos, evidenciou-se que a baixa pontuação na Escala de Coma de Glasgow tem sido um forte indicador de mau prognóstico das vítimas de TCE. Além disso, a influência de fatores como gravidade das lesões, tipo de lesão intracraniana, idade, hipóxia e hipotensão arterial também se apresentou como determinante sobre a evolução dos pacientes e esteve relacionada ao prognóstico de vítimas de TCE. Podemos observar que nos últimos anos se têm aprofundado os estudos no intuito de se buscar os fatores prognósticos para o TCE, e a identificação desses indicadores tem representado um grande avanço na busca de alternativas para orientar o tratamento do paciente e se estimar o resultado final.

Traumatic brain injury is an injury to the brain trauma as a result of external trauma, resulting in momentary or permanent brain changes and impairment of cognitive abilities or physical functioning. This article aims at reviewing the literature on the factors related to the prognosis of traumatic brain injury. The study comprises a literature to the best knowledge and approach to the subject, providing a reflection on these factors. Based on the literature and analysis of the studies showed that the low score on the Glasgow Coma Scale has been a strong indicator of poor prognosis of traumatic brain injury. Furthermore, the influence of factors such as brain injury, severity of injury, type of intracranial injury, age, hypoxia and hypotension were also presented as determinants of the evolution of patients and were related to the prognosis of traumatic brain injury. We observed that in recent years has deepened the studies in order to seek the prognostic factors for traumatic brain injury, where the identification of these indicators has represented a major breakthrough in the search for alternatives to guide patient treatment and to estimate the end result.

Pacientes com traumatismo cranioencefálico tratados cirurgicamente no serviço de neurocirurgia do Hospital de Base do Distrito Federal (Brasília-Brasil) / Patients with brain injury surgically treated in neurosurgery service at Hospital de Base do Distrito Federal (Brasilia, Brazil)

Objetivo: O traumatismo cranioencefálico (TCE) é uma agressão ao encéfalo causada por uma força física externa. No Brasil, é a principal causa de morte de crianças acima de 5 anos de idade e adolescentes. Apresentamos as características epidemiológicas de 194 pacientes com TCE operados no serviço de neurocirurgia do Hospital de Base do Distrito Federal. Métodos: Trata-se de um estudo descritivo, tipo corte transversal, baseado na revisão de prontuários médicos de pacientes com TCE tratadoscirurgicamente no período de julho de 2007 a julho de 2012. Resultados: Predomínio do sexo masculino (82,99%); a faixa etária mais comum é de 21-40 anos (67); a maioria apresentava TCE grave (108) e o principal mecanismo do trauma foi agressão física (57) seguida por queda da própria altura (49). Hematoma subdural crônico (63), hematoma extradural agudo (49) e fratura com afundamento (38) foram os principais achados tomográficos. Há uma relação entre hematoma subdural crônico (p < 0,05/OR = 1,272/IC 95%: 1,163-1,391), hematoma subdural agudo (p = 0,008/OR = 3,271/IC 95%: 1,309-8,172) e atropelamento (p < 0,05/OR = 8,804/IC 95%: 2,203-35,185) com TCE grave. Conclusão: A maioria dos pacientes era do sexo masculino, na faixa etária entre 21-40 anos, vítima de agressão física e admitida com TCE grave. Há relação entre atropelamento, hematoma subdural agudo e crônico com a gravidade do TCE.

Objective: Traumatic brain injury is an injury to the brain caused by an external physical force. In Brazil, it is the leading cause of death in children over 5 years old and teenagers. We present the epidemiologicalcharacteristics of 194 patients with traumatic brain injury treated at the Serviço de Neurocirurgia do Hospital de Base do Distrito Federal. Methods: This is a descriptive, cross-sectional type, based on review of medical records of patients with traumatic brain injury treated surgically in the period July 2007 to July 2012. Results: There was a predominance of males (82.99%), the most common age group is 21-40 years (67), the majority had severe traumatic brain injury (108), the main mechanism of traumawas physical assault (57) and followed by fall from height (49). Chronic subdural hematoma (63), acute epidural hematoma (49) and fracture dip (38) were the main CT findings. There is a relationship betweenchronic subdural hematoma (p < 0.05/OR = 1,272/95% CI: 1.163 to 1.391), acute subdural (p = 0.008/ OR = 3,271/95% CI: 1.309 to 8.172) and trampling (p < 0.05/OR = 8,804/95% CI: 2.203 to 35.185) with severe traumatic brain injury. Conclusion: Most patients were male, age range between 21-40 years, victims of physical assault and admitted with severe traumatic brain injury. There is a relationship between trampling, acute and chronic subdural hematoma with the severity of traumatic brain injury.

Estimación de prevalencia de niños con enfermedades limitantes de la vida en un hospital pediátrico de alta complejidad / Prevalence of patients with life-limiting conditions in a high complexity pediatric hospital

En Chile fallecen aproximadamente 800 niños menores de 15 años por diversas causas, entre ellas, por enfermedades sin tratamiento curativo. La Sociedad Chilena de Pediatría creó el Comité de Niños y Adolescentes con Necesidades Especiales en Atención de Salud (NANEAS), que entregó las pautas para una atención integral de estos pacientes, incluyendo los cuidados paliativos (CP). Resulta indispensable conocer el número y características de los pacientes que padecen enfermedades limitantes de la vida (ELV) para elaborar programas de atención que prioricen por un cuidado ambulatorio bajo la supervisión de equipos multidisciplinarios. Objetivo: Estimar la prevalencia de pacientes con ELV en un hospital pediátrico de alta complejidad. Pacientes y método: Se revisaron los egresos de las Unidades de Pediatría General y Unidad de Paciente Crítico del Hospital Roberto del Río, durante el 2009 y 2010. Se seleccionaron los casos con diagnósticos de ELV según CIE-10, registrando datos demográficos y clasificándolos según los grupos de la ACT para ELV. Se excluyeron pacientes con cáncer avanzado. Resultados: De 6585 pacientes egresados, 190 tenían diagnóstico ELV (2.89 por ciento). Los lactantes fueron el grupo más numeroso (33 por ciento). El 51,6 por ciento de los pacientes pertenecían al grupo 4 (parálisis cerebral severa, genopatías complejas, TEC con secuelas graves) y todos fueron atendidos por 3 o más especialistas. Conclusión: Los niños con ELV constituyen un grupo emergente entre los pacientes pediátricos hospitalizados, demandando una atención de alta complejidad. Es un desafío implementar políticas públicas que optimicen su manejo y permitan planificar unidades especializadas para su atención, incluyendo los CP.

In Chile, approximately 800 children under the age of 15 years die from a variety of causes, including life-limiting conditions (LLC). The Chilean Society of Pediatrics established a Committee on Children and Adolescents with Special Health Care Needs (NANEAS), which established guidelines for comprehensive care of these patients, including palliative care (PC). It is essential to know the number and characteristics of patients with LLC, in order to develop programs for outpatient care under the supervision of multidisciplinary teams. Objective: To estimate the prevalence of patients with LLC in a high complexity pediatric hospital. Patients and methods: We reviewed the discharges from General Pediatric Units and the Critical Patient Unit at the Roberto del Rio Hospital during 2009 and 2010. We selected patients with LLC according to ICD-10. Their demographic characteristics were registered and classified into the four ACT groups. Patients with advanced cancer were excluded. Results: Of 6585 patients discharged, 190 were diagnosed as LLC (2.89 percent). Infants were the largest group (33 percent). 51.6 percent of patients belonged to group 4 (severe cerebral palsy, genopathies, serious sequelae of traumatic brain injury) and all were attended by at least three specialists. Conclusion: Children with LLC are an emerging group among hospitalized pediatric patients and they are demanding attention of high complexity. It is a challenge to design and implement public policies that can optimize health care for these patients, and facilitate the establishement of specialized units for this purpose, including PC.

Traumatismo cranioencefálico e sua associação com uso de canabinoides e cocaína: experiência de hospital universitário brasileiro / Traumatic brain injury and its association to marijuana and cocaine use: a Brazilian university hospital experience

Objetivo: Este estudo objetivou identificar aspectos da epidemiologia dos traumatismos cranioencefálicos (TCEs) moderados e graves dos pacientes admitidos no Hospital de Clínicas da Universidade Federal de Uberlândia, bem como sua associação com consumo de cocaína e canabinoides. Métodos: Para isso, foram coletados dados prospectivos sobre 139 vítimas assistidas nesse hospital, todas com idade igual ou superior a 18 anos. Os acidentes de transporte responderam pelo maior número de vítimas, seguidos daquelas pessoas que sofreram quedas acidentais. Resultados: Do total de pacientes avaliados, 84 (com casos de TCE moderado, grave e mesmo leve) tiveram amostra de urina coletada para detecção de maconha e cocaína. Os exames foram positivos para maconha em 8,2% dos pacientes e em 13,9% para cocaína. Conclusão: Não foram vistas diferenças significativas no tocante ao sexo e à idade, bem como à atividade realizada no momento do trauma. A maioria dos atendimentos desses pacientes, no entanto, se deu no período noturno. A alta frequência de consumo de substâncias ilícitas associada aos TCEs evidencia a importância de se incluírem esses dados quando da realização de estudos acerca desse tipo de traumatismo, bem como aponta para um problema de saúde pública.

Objective: This study aimed at identifying epidemiological aspects of moderate and severe traumatic brain injury (TBI) of patients who were admitted at the Clinics Hospital of the Federal University of Uberlândia, as well as its association with marijuana and cocaine intake. Methods: Prospective data were collected from 139 assisted patients, all of them aged 18 or more years. Traffic accidents were responsible for the greatest number of victims, followed by accidental drops. Results: Eighty-four patients (including moderate, severe and even light TBI) had a urine sample evaluated for the presence of marijuana and cocaine. Marijuana positive tests were found in 8.2% of patients, and there were 13.9% for cocaine. Conclusion: No significant differences were seen concerning age and sex, neither for the activity performed at the trauma time. However more patients were admitted at the hospital at night time. The high frequency of consumption of these illegal stuff associated with TBI shows the importance of having this information while performing trials about this kind of trauma. It also indicates this is public health problem.

Avaliação de 76 casos de traumatismo crânio-encefálico por queda da própria altura atendidos na emergência de um hospital geral / Evaluation of 76 cases of traumatic brain injury from falling from standing height in an Emergency

Objetivo: O objetivo deste estudo foi elaborar um perfil epidemiológico de pacientes que sofreram traumatismo crânio-encefálico (TCE) por queda da própria altura (QPA). Métodos: Foram selecionados os pacientes com TCE atendidos na emergência de um hospital geral em Florianópolis (SC) durante um período de dois meses. Os pacientes que apresentaram TCE por QPA foram avaliados. As variáveis deste estudo incluíram: idade, sexo, presença de comorbidades e pontuação na Escala de Coma de Glasgow (ECG) no momento da admissão à emergência. Resultados: Setenta e seis pacientes (44 homens e 32 mulheres) preencheram os nossos critérios de inclusão. As idades dos pacientes à admissão variaram de 15 a 98 anos (média: 45,8 anos). Aproximadamente 63% dos pacientes utilizaram o carro privado como meio de transporte préhospitalar; 15% tinham história de ingestão alcoólica recente; 37% perderam a consciência imediatamente antes ou logo após o trauma e 37% tinham uma ou mais comorbidades conhecidas no momento do trauma. De acordo com a ECG, cerca de 90% dos pacientes sofreram TCE leve(ECG>12). Conclusões: A maioria dos pacientes atendidos na emergência devido a TCE por QPA são homens eindivíduos com idade superior a 40 anos. O sexo masculino está mais freqüentemente associado com uma história de ingestão alcoólica. O consumo de álcool está associado com a perda de consciência e maior gravidade do TCE. As análises demonstraram não haver relação da gravidade do TCE com osexo, a idade, a perda da consciência ou a presença de comorbidades associadas.

Objective: The aim of this study was to elaborate an epidemiological profile of patients who suffered traumatic brain injury (TBI) from falling from standing height. Methods: We selected the patients with TBI presented to the emergency room (ER) of a generalhospital in Florianopolis (Brazil) during a time period of two months. Patients who suffered TBI caused by falling from standing height were evaluated. The variables analyzed included: age, sex,presence of comorbidities and the Glasgow Coma Scale score (GCS) at the time of admission to the ER.Results: Seventy six patients (44 men and 32 women) fulfilled our inclusion criteria. Ages at admission ranged from 15 to 98 years (mean: 45.8 years). Approximately 63% of patients arrived at the hospital by private car, 15% had a history of recent alcohol consumption, 37% lost consciousness immediately before or right after the trauma, and 37% had one or more known comorbidities. According to the CGS, about 90% of patients had a mild TBI (GCS>12). Conclusions: Most patients admitted into ER with TBI from falling from standing height are men andpeople older than 40 years old. Male sex is more often associated with a history of alcohol intake. Alcohol consumption is associated with loss of consciousness and severity of TBI. The analysisdemonstrated no correlation between sex, age, loss of conscioussness or comorbidities and the severity of TBI.

The aetiology of head injury in admitted patients in Jamaica / Aspectos etiológicos de la lesión cefálica en pacientes ingresados en Jamaica

This cross-sectional, descriptive study identified 857 head-injured patients who were admitted to the University Hospital of the West Indies (UHWI) over a four-year period. Their median age (IQR) was 28 (16, 45) years and 629 (73.5%) were males. Median length of hospital stay (IQR) was 2 (1, 6) days. Median ICU stay in the intensive care unit (IQR) was 6 (2, 12) days for the 59 (6.9%) patients admitted there. Most patients (73.3%) were admitted with unintentional injuries resulting from road traffic accidents (48.9%), of which passengers were the most commonly affected, and from falls which occurred in 24.4%. Intentional injuries accounted for 26.7% of those admitted, consisting mainly of assaults with blunt objects in 18.0% (154/857). Penetrating injuries were less common, accounting for 67 (7.8%) injuries. Among these, there were 23 gunshot wounds of the head (2.7%). Head injury in admitted patients is mainly due to road traffic accidents, falls and interpersonal violence. Prevention and interventional strategies including education, law enforcement, physical and social engineering must focus on these aetiologies. Current measures are clearly insufficient and more effective strategies are urgently warranted.

Este estudio transversal descriptivo identificó 857 pacientes con lesiones cefálicas, ingresados en el Hospital Universitario de West Indies (UHWI) por un periodo de cuatro años. Su edad mediana (IQR) fue 28 (16, 45) años y 629 (73.5%) eran varones. La longitud mediana de estancia hospitalaria (IQR) fue de 2 (1, 6) días. La estancia mediana en la unidad de cuidados intensivos fue de (IQR) 6 (2, 12) días para los 59 (6.9%) pacientes ingresados allí. La mayoría de los pacientes (73.3%) fueron ingresados con lesiones involuntarias a consecuencia de accidentes de tráfico (48.9%) ­ de los cuales los pasajeros fueron comúnmente los más afectados ­ y de caídas ocurridas en 24.4%. Las lesiones intencionales constituyeron el 26.7% de los casos ingresados, siendo el 18.0% (154/857) producidas principalmente por ataques con objetos contundentes. Las lesiones penetrantes fueron menos comunes, representadas por 67 (7.8%) de las lesiones. De estas, 23 fueron heridas de bala en la cabeza (2.7%). Las lesiones en la cabeza en los pacientes ingresados se debieron principalmente a accidentes de tráfico, caídas y violencia interpersonal. Las estrategias de prevención e intervención ­ incluyendo la educación, la imposición del cumplimiento de la ley, la ingeniería física y social ­ deben centrar su atención en estas etiologías. Las medidas actuales son a las claras insuficientes y se requiere con urgencia estrategias más efectivas

Análise da associação entre a presença de lesão estrutural do encéfalo e ocorrência de crise epiléptica e epilepsia / Trajectory of a Sentinel Event Assistance: evaluation of a full diabetic user attention in SUS from Severe Diabetic Retinopathy

A pesquisa de lesão estrutural do cérebro em pacientes com crise epiléptica e epilepsia é fundamental no diagnóstico e tratamento da síndrome epiléptica. O objetivo do estudo foi determinar freqüência e associação entre características clínicas e presença de lesões estruturais do encéfalo detectadas no exame de ressonância magnética, com o status e as formas clínicas da epilepsia. Avaliou-se o perfil clínico dos pacientes e das lesões estruturais do encéfalo na imagem por ressonância magnética em 140 pacientes com epilepsia ou crise epiléptica, encaminhados para exame de ressonância magnética e catalogados por demanda espontânea, desde outubro de 2003 até janeiro de 2005. O estudo foi do tipo caso-controle com casos prevalentes. A idade variou de um a 59 anos (mediana de 15,0 anos), sendo 51,6 por cento do gênero masculino. A crise epiléptica foi focal em 55 por cento, a freqüência mensal de até 10 crises foi registrada em 77,6 por cento e o exame neurológico foi normal em 64,2 por cento dos pacientes. Epilepsia farmacoresistente foi identificada em 76,3 por cento e crise epiléptica única em 15,7 por cento. A imagem por ressonância magnética foi anormal em 72,8 por cento dos pacientes. O lobo temporal foi local para 50,5 por cento das alterações. As mais encontradas foram: anormalidades no hipocampo (41,1 por cento); malformações do desenvolvimento cortical (19.6 por cento); isquemia (5,8 por cento); tumor (6,8 por cento); cavernoma(2,9 por cento); facomatose (4,9 por cento); cicatriz (4,9 por cento); inflamatório (4,9 por cento); outras (8,8 por cento). A alteração estrutural na imagem de ressonância magnética foi mais presente entre os pacientes com epilepsia focal e farmacorresistente, sendo o lobo temporal a região com mais alterações. Os pacientes com tumor cerebral apresentaram mais CE focal e a atrofia do córtex cerebral foi alteração freqüente na IRM de pacientes com epilepsia farmacorresistente. Os pacientes com idade maior de 15 anos, número mensal maior de crises e epilepsia sintomática apresentaram maior risco para CE focal e aqueles com crise epiléptica única apresentaram mais CE generalizada. O risco para epilepsia farmacorresistente foi maior entre os pacientes com anormalidades no exame de ressonância magnética, antecedente pessoal e exame neurológico anormais.

The research of structural lesion of the brain in patients with epilepsy is fundamental to diagnosis and treatment of the epileptic syndrome. The authors evaluated the patients clinical profile and structural lesions of the brain in magnetic resonance image of 140 patients with epilepsy and classified by spontaneous demand, since October of 2003 to January of 2005. The study was a case-control with prevalent cases and aged between 1 and 59 years (medium 15,0 years), being 51,6% of masculine gender. Epileptic seizure was focal in 55%, monthly frequency of 10 or less was registered in 77,6% and neurological exam was normal in 64,2% of patients. Refractory Epilepsy was identified in 76,3% and single seizure in 15,7%. Magnetic resonance image was abnormal in 72,8% of patients. Temporal lobe was the local for 50,5% of the alterations, presented as: hypocampal abnormalities (41,1%); malformations of the cortical development (19.6%); stroke (5,8%); tumor (6,8%); cavernoma (2,9%); facomatoses (4,9%); scar (4,9%); inflammatory (4,9%); others (8,8%). The structural alteration in the image of magnetic resonance was more present among patients with focal and refractory epilepsy, being the temporal lobe the area with more alterations. Patiensts with focal seizures presented more cerebral tumor and those with refractory epilepsy presented cerebral cortex atrophy in magnetic resonance image. Patients more than 15 years old had high frequency of seizures and with syntomatic epilepsy,also presented more risk for focal seizures. Generalized seizure was presented mostin those with a single resonance image, abnormal personal antecedent and neurological alterations.

Comportamiento de la presión intracraneal en niños con traumatismo craneoencefálico severo / Behavior of intracranial pressure in children with severe cranioencephalic traumatism

El traumatismo craneoencefálico severo en niños se relaciona con un alto porcentaje de mortalidad y secuelas. Se realizó un estudio descriptivo retrospectivo para valorar el comportamiento de la presión intracraneal en niños con este traumatismo en un período de 4 años, desde enero 1999 hasta 2003. La muestra estuvo conformada por 58 pacientes, la totalidad de los niños ingresados con esta afección en el período de estudio. De las historias clínicas se tomaron los datos para caracterizarla. El grupo de edad entre 11 y 15 años y el sexo masculino fueron las particularidades predominantes. Los accidentes de tránsito y las caídas de alturas, las causas más frecuentes. En 38 niños la escala de coma de Glasgow estuvo entre 6 y 8 puntos, los valores de presión intracraneal de mayor incidencia fueron los menores de 15 mmHg en 42 niños (72,4 por ciento y el valor predominante de la presión de perfusión cerebral fue de más de 70 mmHg en 27 pacientes (46,6 por ciento. El factor de daño neurológico más relevante fue la fiebre presente en 49 pacientes (84,5 por ciento y egresaron vivos 41 niños que representaron el 70,7 por ciento. Se corroboró que la importancia de la atención de enfermería en el control de la presión intracraneal en el traumatismo craneoencefálico severo radica en el buen manejo de los factores que se asocian al daño neurológico que agravan las condiciones de estos niños, en evolucionarlos clínicamente y comunicar los cambios que se aprecien(AU)

The traumatism severe craneoencefálico in children is related with a high percentage of mortality and sequels. He/she was carried out a retrospective descriptive study to value the behavior of the pressure intracraneal in children with this traumatism in a 4 year-old period, from January 1999 up to 2003. The sample was conformed by 58 patients, the entirety of the children entered with this affection in the period of study. Of the clinical histories they took the data to characterize it. The age group between 11 and 15 years and the masculine sex was the predominant particularities. The traffic accidents and the falls of heights, the most frequent causes. In 38 children the scale of coma of Glasgow was between 6 and 8 points, the values of pressure intracraneal of more incidence were those smaller than 15 mmHg in 42 children (72,4 percent and the predominant value of the pressure of cerebral perfusión was of more than 70 mmHg in 27 patients (46,6 percent. The factor of more excellent neurological damage was the present fever in 49 patients (84,5 percent and egresaron alive 41 children that represented 70,7 percent. It was corroborated that the importance of the infirmary attention in the control of the pressure intracraneal in the traumatism severe craneoencefálico resides in the good handling of the factors that you/they associate to the neurological damage that you/they increase the conditions of these children, in to evolve them clinically and to communicate the changes that are appreciated(AU)

Traumas múltiplos em vítimas de traumatismo craniencefálico / Multiple traumas in head injured patients

Objetivos: verificar a frequência de pacientes com trauma craniencefálico que apresentaram lesões em outros locais do corpo, assim como definir quais os segmentos mais afetados e principais causas de trauma neste grupo. Metodologia: estudo descritivo, tipo corte transversal, através da revisão de 555 prontuários médicos de vítimas de trauma craniano internadas no Hospital Geral do Estado da Bahia, durante o ano de 2001. Trabalho avaliado e aprovado pela diretoria do hospital, assim como pelo Comitê de Ética em Pesquisa. Conclusão: os traumas múltiplos foram observados em 31,9 por cento das vítimas de trauma craniano e tiveram, como principal causa, o atropelamento, sendo as lesões facias e ortopédicas dos membros as mais frequentes.