[Predictors of outcome in blunt chest trauma]. / Marcadores pronósticos en los pacientes con traumatismo torácico cerrado.

INTRODUCTION: Thoracic trauma is often associated with polytrauma. Because mortality is high, the search for prognostic tools is useful. PATIENTS AND METHODS: A total of 108 patients with blunt thoracic trauma, 73 of whom had multiple injuries, were studied in an intensive care unit (ICU). The variables named as potential predictors of outcome were the need for mechanical ventilation, duration of ventilation, and high positive end-expiratory pressure (PEEP); the presence of rib fractures, pulmonary contusion, pleural involvement (hemo- and/or pneumothorax), or lung infection; the need for emergency surgery; mean duration of ICU stay, and age. We also studied whether or not the mortality rate was higher in polytrauma patients. Student t and chi2 tests (95% confidence level) and multiple regression analysis (Hosmer-Lemeshow goodness of fit) were used to analyze the results. RESULTS: The need for mechanical ventilation, radiographic evidence of pulmonary contusion, emergency surgery, and hemodynamic instability were risk factors for increased mortality. Higher risk of mortality was not demonstrated for patients with multiple injuries. For patients in need of mechanical ventilation, high PEEP was a predictor of poor prognosis. CONCLUSIONS: The presence of the aforementioned predictors (mechanical ventilation, high PEEP, pulmonary contusion, emergency surgery, and hemodynamic instability) indicate serious injury to the lung parenchyma, which is the main determinant of outcome for patients with thoracic trauma.

[The length of stay in hospital emergency medical care]. / Tiempo de estancia asistencial en la atención urgente médica hospitalaria.

The length of stay in emergency services has been considered as a quality control and evaluation index of emergency care. The impact of several factors on its magnitude is analyzed. The age of the patient, the time of admission, the performance of complementary explorations (simple radiology, analytic tests, abdominal echography), as well as the disease group including the diagnosis of the emergency service, significantly modify the length of stay. The age and performance of such tests seem to be the most relevant factors, although they may not be independent. The length of stay of the patients in the emergency service may be shortened by reducing the complementary explorations just to the ones mentioned above. The adequacy of the functional organization, the material and human resources, as well as the adequate staff skills and attitudes, may also reduce the length of stay of these patients in the hospital emergency care.