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

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

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

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

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

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

Night admission is an independent risk factor for mortality in trauma patients - a systemic error approach.

OBJECTIVE: to assess the impact of the shift inlet trauma patients, who underwent surgery, in-hospital mortality. METHODS: a retrospective observational cohort study from November 2011 to March 2012, with data collected through electronic medical records. The following variables were statistically analyzed: age, gender, city of origin, marital status, admission to the risk classification (based on the Manchester Protocol), degree of contamination, time / admission round, admission day and hospital outcome. RESULTS: during the study period, 563 patients injured victims underwent surgery, with a mean age of 35.5 years (± 20.7), 422 (75%) were male, with 276 (49.9%) received in the night shift and 205 (36.4%) on weekends. Patients admitted at night and on weekends had higher mortality [19 (6.9%) vs. 6 (2.2%), p=0.014, and 11 (5.4%) vs. 14 (3.9%), p=0.014, respectively]. In the multivariate analysis, independent predictors of mortality were the night admission (OR 3.15), the red risk classification (OR 4.87), and age (OR 1.17). CONCLUSION: the admission of night shift and weekend patients was associated with more severe and presented higher mortality rate. Admission to the night shift was an independent factor of surgical mortality in trauma patients, along with the red risk classification and age.