«RETRATO» (REgistro de TRAuma grave de la provincia de TOledo): visión general y mortalidad / «RETRATO» (REgistro de TRAuma grave de la provincia de TOledo): General view and mortality

Objetivo: Análisis del tratamiento y de la evolución del enfermo traumático crítico. Diseño: Estudio descriptivo y retrospectivo. Ámbito: Las UCI de la provincia de Toledo. Pacientes: Todos los pacientes con enfermedad traumática ingresados durante el período 2001-2007 (7 años). Variables de interés principales: Variables en el lugar del accidente, prehospitalarias, durante el transporte; variables de ingreso hospitalario y de evolución hasta el alta o el fallecimiento. Resultados: Se incluyó a 1.090 pacientes traumáticos ingresados. El 79,5% eran varones. La edad mediana fue de 36,5 años (>65 años [16%]). El descenso fue progresivo desde el año 2001 (142 pacientes) hasta el año 2007 (133 pacientes). El 46,9% ingresó entre mayo y septiembre. El 29,4% no pertenecía al área sanitaria. Las causas fueron accidente de coche (43,3%), precipitación/caída (20,8%), accidente de moto (13,8%) y atropello de peatón (6,6%). Hubo 2.172 lesiones. El 30,1% tenía 3 lesiones y el 8,4% tenía 4 o más lesiones. La lesión más frecuente fue el traumatismo craneoencefálico (33,7%), seguido por el trauma torácico (20,2%) y el trauma ortopédico (15,6%). El 36,4% necesitó cirugía en el primer día. La estancia media en la UCI fue de 10,4±13,2 días. El tiempo de ventilación mecánica fue de 7,3±12 días (mediana de 1 día). El 15% falleció en la UCI. Permanecieron en modelo multivarible de predicción de mortalidad en la UCI incluyendo las variables prehospitalarias: edad (OR: 1,05; IC95%: 1,03-1,06), midriasis (OR: 2,6; IC95%:1,3-5,3), componente motor del Glasgow Coma Score (OR: 0,7; IC95%: 0,6-0,8), shock prehospitalario (OR: 3,2; IC95%: 1,8-5,5) e Injury Severity Score (OR: 1,1; IC95%: 1,05-1,1). Conclusiones: La utilización de registros de trauma multicéntricos da una idea global del tratamiento y permite incidir en la mejora de los cuidados (AU)

Objective: To analyze the management and progression of the critical trauma patient. Design: A retrospective, descriptive analysis. Setting: The ICU in the province of Toledo. Patients: All patients with traumatic injury admitted during the 2001-2007 period (7 years). Main variables of interest: These include the variables at the scene of the accident, pre-hospitalization, during transportation, variables on admission and during development until discharge or death. Results: A total of 1090 trauma patients admitted were included. Of these, 79.5% were male, with an average age of 36.5 years (16% >65 years). There was a progressive decrease of patients from 2001 (142 patients) to 2007 (133 patients), with 46.9% admissions between May and September. A total of 29.4% did not belong to the health area. The causes were car accident (43.3%), fall from a height/fall (20.8%), motorcycle accident (13.8%), pedestrian being run over (6.6%). There were 2172 injuries; 30.1% had 3 injuries and 8.4% >4. The most frequently occurring injury was a head injury (33.7%), followed by thoracic trauma (20.2%) and orthopedic trauma (15.6%). 36.4% required surgery on the first day. Average length of stay in the ICU was 10.4±13.2 days. Time on mechanical ventilation was 7.3±12 days (median 1 day). Fifteen percent died in the ICU. This remains within the multivariable ICU mortality prediction model, including the pre-hospitalization variables: age (OR 1.05; 95% CI: 1.03-1.06), mydriasis (OR 2.6; 95% CI: 1.3-5.3), motor component of the Glascow Coma Score (GCS) (OR 0.7; 95% CI: 0.6-0.8), pre-hospitalization shock (OR 3.2; 95% CI: 1.8-5.5) and Injury Severity Score (ISS) (OR 1.1; 95% CI: 1.05-1.1). Conclusions: The use of multicenter trauma registers gives an overall view of trauma management and helps improve the care (AU)

[<> (REgistro de TRAuma grave de la provincia de TOledo): general view and mortality]. / <> (REgistro de TRAuma grave de la provincia de TOledo): visión general y mortalidad.

OBJECTIVE: To analyze the management and progression of the critical trauma patient. DESIGN: A retrospective, descriptive analysis. SETTING: The ICU in the province of Toledo. PATIENTS: All patients with traumatic injury admitted during the 2001-2007 period (7 years). MAIN VARIABLES OF INTEREST: These include the variables at the scene of the accident, pre-hospitalization, during transportation, variables on admission and during development until discharge or death. RESULTS: A total of 1090 trauma patients admitted were included. Of these, 79.5% were male, with an average age of 36.5 years (16% ≥ 65 years). There was a progressive decrease of patients from 2001 (142 patients) to 2007 (133 patients), with 46.9% admissions between May and September. A total of 29.4% did not belong to the health area. The causes were car accident (43.3%), fall from a height/fall (20.8%), motorcycle accident (13.8%), pedestrian being run over (6.6%). There were 2172 injuries; 30.1% had 3 injuries and 8.4% ≥ 4. The most frequently occurring injury was a head injury (33.7%), followed by thoracic trauma (20.2%) and orthopedic trauma (15.6%). 36.4% required surgery on the first day. Average length of stay in the ICU was 10.4+/-13.2 days. Time on mechanical ventilation was 7.3+/-12 days (median 1 day). Fifteen percent died in the ICU. This remains within the multivariable ICU mortality prediction model, including the pre-hospitalization variables: age (OR 1.05; 95% CI: 1.03-1.06), mydriasis (OR 2.6; 95% CI: 1.3-5.3), motor component of the Glascow Coma Score (GCS) (OR 0.7; 95% CI: 0.6-0.8), pre-hospitalization shock (OR 3.2; 95% CI: 1.8-5.5) and Injury Severity Score (ISS) (OR 1.1; 95% CI: 1.05-1.1). CONCLUSIONS: The use of multicenter trauma registers gives an overall view of trauma management and helps improve the care.

[Ischemic optic neuropathy in the multiple trauma victim]. / Neuropatía óptica isquémica en el paciente politraumatizado.

Ischemic optic neuropathy is an uncommon of blindness in the critically ill patient that occurs especially in multiple trauma victims with no direct injury of the eyeball. We present the case of a young male patient with total bilateral blindness after profound hemorrhagic shock secondary to thoracoabdominal non-penetrating traumatism caused by crushing. A search of the literature was conducted, identifying prolonged arterial hypotension and sudden drop in hematocrit value as the most important risk factors.

Neuropatía óptica isquémica en el paciente politraumatizado / Ischemic optic neuropathy in the multiple trauma victim

neuropatía óptica isquémica es una causapoco conocida de ceguera en el paciente crítico yespecialmente en el politraumatizado sin daño directodel globo ocular. Presentamos el caso de unpaciente joven que desarrolla una ceguera bilateralcompleta tras sufrir un profundo shock hemorrágicosecundario a un traumatismo toracoabdominalcerrado por aplastamiento. Se ha realizado una revisión de la literatura relacionada y se han identificado como factores de riesgo más importantes la hipotensión arterial prolongada y el descenso brusco del hematocrito

Ischemic optic neuropathy is an uncommon ofblindness in the critically ill patient that occurs especially in multiple trauma victims with no directinjury of the eyeball. We present the case of ayoung male patient with total bilateral blindnessafter profound hemorrhagic shock secondary tothoracoabdominal non-penetrating traumatismcaused by crushing. A search of the literature wasconducted, identifying prolonged arterial hypotensionand sudden drop in hematocrit value as the most important risk factors (AU)

Manifestaciones electrocardiográficas en la hipotermia / Electrocaridographic manifestations of hypotermia

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