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.

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

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.

Association of isolated preauricular tags and nephrourological anomalies: case-control study.

Isolated preauricular tags (IPT) are considered minor malformations whereas nephrourological anomalies (NUA) are considered major malformations. Their incidences fluctuate between 5 and 10 per 1,000 and 1-3 per 100 live births, respectively. There is contradictory evidence regarding the incidence of NUA in infants with IPT. The objective of this study is to determine if there is a clinical association between IPT and NUA. A case-control study was made in a Pediatric hospital in Santiago, Chile, with infants born between April 2000 and April 2005, considering as cases those with IPT, and controls those infants born following the cases, paired by sex and without IPT. All subjects had a complete physical examination and a renal ultrasound to assess for the presence of congenital anomalies and NUA, respectively. One hundred cases and an equal number of controls were included. There were 41 females in each group. In the case group, two infants presented renal anomalies in the RUS: one left hydronephrosis and one case of left kidney agenesis. In the control group, two infants with anomaly were found: one with a left ureterocele and one case of bilateral duplex kidney. The observed incidence of NUA was similar in both groups to that reported in the literature for the general population. No significant statistical difference was found in the incidence of these abnormalities between patients who presented with IPT and those who did not. From our study, we suggest that RUS is not necessary in the routine evaluation of infants with IPT.

Fractura de clavícula en población pediátrica: diagnóstico radiológico / Clavicle fracture in pediatric population: radiological diagnosis

La fractura de clavícula es una lesión frecuente en la edad pediátrica. Es importante conocer los distintos tipos de lesiones que pueden ocurrir, su presentación radiológica y las condiciones especiales que pueden simular fracturas. En la mayoría de los casos (Grupo I) el tratamiento será ortopédico, no obstante habrá otros en que la resolución deberá ser quirúrgica dada la inestabilidad de la fractura (Grupo II y III), para lo cual un correcto diagnóstico es fundamental. La radiografía simple es el método indicado para la confirmación diagnóstica y no se requiere de otros estudios de imágenes.