Evaluation of quality of care in trauma patients using international scoring systems. / Valoración de la calidad asistencial al traumatismo grave mediante comparación con estándares internacionales.

OBJECTIVE: To evaluate the ability of the TRISS and PS14 models to predict mortality rates in our medical system and population. DESIGN: A retrospective observational study was carried out over a 66-month period. BACKGROUND: The study was conducted in the Trauma Intensive Care Unit (ICU) of a third level hospital. PATIENTS: All severe trauma patients (Injury Severity Score≥16 and/or Revised Trauma Score <12) aged> 14 years were included. VARIABLES OF INTEREST: Medical care data were prospectively recorded. The "W" statistic (difference between expected and observed mortality for every 100 patients) and its significance were calculated for each model. Discrimination and calibration were evaluated by means of receiver operating characteristic (ROC) curves, and the Hosmer-Lemeshow test and GiViTI calibration belt, respectively. RESULTS: A total of 1240 patients were included. Survival at hospital discharge was 81.9%. The "W" scores for the TRISS, TRISS 2010 and PS14 models were+6.72 (P<.01), +1.48 (P=.08) and +2.74 (P<.01) respectively. Subgroup analysis revealed significant favorable results for some populations. The areas under the ROC curve for the TRISS, TRISS 2010 and PS14 models were 0.915, 0.919 and 0.914, respectively. There were no significant differences among them (P>.05). Both the Hosmer-Lemeshow test and GiViTI calibration belt demonstrated poor calibration for the three models. CONCLUSIONS: These models are suitable tools for assessing quality of care in a Trauma ICU, affording excellent discrimination but poor calibration. In our institution, survival rates higher than expected were observed.

[Geriatric syndromes in patients with a non-recent hip fracture seen at a primary health care unit]. / Síndromes geriátricos en pacientes con fractura de cadera no reciente en una unidad de primer nivel de atención médica.

OBJECTIVE: To identify the frequency of geriatric syndromes in patients with a non- recent hip fracture seen at a primary health care unit in the state of Puebla, Mexico. MATERIAL AND METHODS: Cross-sectional study conducted in 376 patients with a non-recent hip fracture screened for geriatric syndromes. We included demographic variables, urinary incontinence, polypharmacy, sleep disorder, nutritional status, depression and autonomy. The two latter were assessed using the Yesavage geriatric depression scale and the Katz index. We used descriptive statistics. RESULTS: The total number of patients was 376; 219 (58%) were females and 157 (42%) were males; mean age was 72.57 years (65-95 +/- 7.08), and 98.7% had at least one geriatric syndrome. Depression was detected in 303 (80.9%), 282 (75%) were on polypharmacy, 262 (69.7%) had sleep disorders, 63 (16.8%) had experienced falls, 19 (5.1%) had urinary incontinence, 15 (4%) were obese, and 3 (0.8%) had loss of autonomy. CONCLUSION: 98.7% of the patients had at least one geriatric syndrome; females were the most affected sex; depression was the most frequent syndrome, followed by polypharmacy, sleep disorders, falls, urinary incontinence, obesity and loss of autonomy.

[Quality of life in patients with functional knee impairment at a primary health care unit]. / Calidad de vida en pacientes con limitación funcional de la rodilla por gonartrosis. En una unidad de primer nivel de atención médica.

OBJECTIVE: To assess the quality of life of patients with functional knee impairment at a primary health care unit. MATERIAL AND METHODS: Descriptive study of 317 primary health care patients with functional impairment due to gonarthrosis. The WOMAC and SF-36 questionnaires were used to assess functional impairment and quality of life, respectively. We used chi2 and Kendall's Tau-b to prove the hypothesis. RESULTS: 317 patients, 137 (43%) males, 180 (57%) females, mean age 72.46, standard deviation +/- 6.76 with a range of 65-95. Mild functional impairment occurred in 222 (70%) patients; 52.37% of patients had a fair quality of life. When the association between functional impairment and quality of life was studied, chi2 was 106.78, with p = 0.00, the application of Kendall's Tau-b to show a relation was -0.502 with a significant p = 0.00, thus showing the relation between both variables. Both variables were dichotomized and the degree of dependence of quality of life from functional impairment was assessed; 120 (37.85%) patients had poor quality of life and mild functional impairment with chi2 = 75.50, p = 0.00, Kendall's Tau-b = -0.428, p = 0.00. CONCLUSION: The quality of life of patients with gonarthrosis ranges from fair to poor and is directly dependent on the degree of functional impairment.