Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 4 de 4
Filter
Add more filters










Publication year range
1.
Med Intensiva ; 40(7): 395-402, 2016 Oct.
Article in English, Spanish | MEDLINE | ID: mdl-27068001

ABSTRACT

OBJECTIVES: To validate Trauma and Injury Severity Score (TRISS) methodology as an auditing tool in the Spanish ICU Trauma Registry (RETRAUCI). DESIGN: A prospective, multicenter registry evaluation was carried out. SETTING: Thirteen Spanish Intensive Care Units (ICUs). PATIENTS: Individuals with traumatic disease and available data admitted to the participating ICUs. INTERVENTIONS: Predicted mortality using TRISS methodology was compared with that observed in the pilot phase of the RETRAUCI from November 2012 to January 2015. Discrimination was evaluated using receiver operating characteristic (ROC) curves and the corresponding areas under the curves (AUCs) (95% CI), with calibration using the Hosmer-Lemeshow (HL) goodness-of-fit test. A value of p<0.05 was considered significant. MAIN VARIABLES OF INTEREST: Predicted and observed mortality. RESULTS: A total of 1405 patients were analyzed. The observed mortality rate was 18% (253 patients), while the predicted mortality rate was 16.9%. The area under the ROC curve was 0.889 (95% CI: 0.867-0.911). Patients with blunt trauma (n=1305) had an area under the ROC curve of 0.887 (95% CI: 0.864-0.910), and those with penetrating trauma (n=100) presented an area under the curve of 0.919 (95% CI: 0.859-0.979). In the global sample, the HL test yielded a value of 25.38 (p=0.001): 27.35 (p<0.0001) in blunt trauma and 5.91 (p=0.658) in penetrating trauma. TRISS methodology underestimated mortality in patients with low predicted mortality and overestimated mortality in patients with high predicted mortality. CONCLUSIONS: TRISS methodology in the evaluation of severe trauma in Spanish ICUs showed good discrimination, with inadequate calibration - particularly in blunt trauma.


Subject(s)
Hospital Mortality , Trauma Severity Indices , Humans , Intensive Care Units , Predictive Value of Tests , Prospective Studies , ROC Curve , Registries , Spain
3.
Med Intensiva ; 39(2): 114-23, 2015 Mar.
Article in English, Spanish | MEDLINE | ID: mdl-25241631

ABSTRACT

Traumatic disease is a major public health concern. Monitoring the quality of services provided is essential for the maintenance and improvement thereof. Assessing and monitoring the quality of care in trauma patient through quality indicators would allow identifying opportunities for improvement whose implementation would improve outcomes in hospital mortality, functional outcomes and quality of life of survivors. Many quality indicators have been used in this condition, although very few ones have a solid level of scientific evidence to recommend their routine use. The information contained in the trauma registries, spread around the world in recent decades, is essential to know the current health care reality, identify opportunities for improvement and contribute to the clinical and epidemiological research.


Subject(s)
Quality Indicators, Health Care , Registries , Wounds and Injuries/therapy , Humans , Quality Improvement
4.
Med Intensiva ; 32(7): 342-53, 2008 Oct.
Article in Spanish | MEDLINE | ID: mdl-18842226

ABSTRACT

Aneurysmal subarachnoid hemorrhage (SAH) is a neurologic emergency and often a neurologic catastrophe. Nontraumatic subarachnoid hemorrhage is characterized by the extravasation of blood into the spaces covering the central nervous system. The leading cause of SAH is rupture of an intracranial aneurysm, which accounts for about 80-85% of cases. Mortality and morbidity can be reduced if SAH is treated urgently. Sudden, explosive headache is a cardinal but nonspecific feature in the diagnosis of SAH; computered tomography (CT) scanning is mandatory in all the patients with symp toms that are suggestive of SAH. Catheter angiography for detecting aneurysms is gradually being replaced by CT angiography. Diagnosing SAH can be challenging and treatment is complex, sophisticated and multidisciplinary. Reble eding is the most imminent danger, which must be prevented by endovascular occlusion with detachable coils (coiling) or by surgical clipping of the aneurysm; the risk of delayed cerebral ischemia is reduced with nimodipine and avoiding hypovolemia; hydrocephalus can be treated by ventricular drainage. Intensive care plays a more important role in the management of SAH than in any other neurological disorder. Excellence in neurologic diagnosis, in operative neurosurgery or neuroradiologic procedures must be accompanied by excellence in Intensive Care. This review emphasizes treatment in the Intensive Care Unit, surgical and endovascular therapeutic options and the current state of treatment of major complications such as rebleeding, cerebral vasospasm and acute hydrocephalus.


Subject(s)
Critical Care/methods , Subarachnoid Hemorrhage/therapy , Algorithms , Aneurysm, Ruptured/complications , Brain Ischemia/diagnosis , Brain Ischemia/etiology , Brain Ischemia/prevention & control , Cerebral Angiography , Combined Modality Therapy , Diagnostic Imaging/methods , Diagnostic Imaging/statistics & numerical data , Disease Management , Emergencies , Headache/etiology , Humans , Hydrocephalus/epidemiology , Hydrocephalus/etiology , Intracranial Aneurysm/complications , Multicenter Studies as Topic , Recurrence , Rupture, Spontaneous , Subarachnoid Hemorrhage/diagnosis , Subarachnoid Hemorrhage/etiology , Vasospasm, Intracranial/etiology , Vasospasm, Intracranial/prevention & control
SELECTION OF CITATIONS
SEARCH DETAIL
...