Implementación de telerradiología en neurotrauma en áreas de difícil acceso-revisión sistemática / Implementation of teleradiology in neurotrauma in areas of difficult access - systematic review

ABSTRACT: Introduction: According to the world health organization, injuries represent more than 20% of health problems in the world. Head trauma and the absence of neurosurgery and radiology services in less populated areas make it difficult to assess and manage patients with brain injury. Objective: To describe the clinical findings and benefits derived from the implementation of teleradiology in neurotrauma in areas of difficult geographic access. Materials and methods: A systematic search was carried out in Pubmed, Scopus, Ebsco host, Sciencedirect, and Embase, with the thesauri "Teleradiology" and "Craniocerebral Trauma". Results: The decision to intervene in a patient with brain trauma and the period of time until surgery are essential for the clinical outcome. Those centers that use teleradiology require transfers to specialized hospitals, for which portable technological devices contribute to the response time of neurosurgery care. Conclusion: Teleradiology has a positive impact on patients with traumatic brain injury in geographical areas of difficult access, facilitating communication with specialists; providing timely care and optimizing transfers to high complexity centers.

RESUMEN: Introducción: Según la organización mundial de la saludlos traumatismos representan más del 20% de los pro-blemas en salud en el mundo. El trauma craneoencefálico y la ausencia de servicios de neurocirugía y radiología en zonas menos pobladas dificultan la valoración y manejo de pacientes con lesión cerebral. Objetivo: Describir los hallazgos clínicos y beneficios derivados de la implementación de la telerradiología en neurotrauma en áreas de difícil acceso geográfico. Materiales y métodos: Se realizó una búsqueda sistemática en Pubmed, Scopus, Ebsco host, Sciencedirect, y Embase, con los tesauros "Teleradiology" y "Craniocerebral Trauma". Resultados: La decisi-ón de intervenir a un paciente con traumatismo cerebral y el periodo de tiempo hasta la cirugía son fundamentales para el desenlace clínico. Aquellos centros que usan la telerradiología, precisan los traslados a los hospitales espe-cializados, por lo cual los dispositivos tecnológicos portátiles contribuyen en el tiempo de respuesta de la atención en neurocirugía. Conclusión: La telerradiología impacta positivamente en pacientes con trauma craneoencefálico en zonas geográficas de difícil acceso, facilitando la comunicación con especialistas; brindando atención oportuna y optimizando los traslados a centros de alta complejidad. (AU)

Impact of a multidimensional infection control strategy on central line-associated bloodstream infection rates in pediatric intensive care units of five developing countries: findings of the International Nosocomial Infection Control Consortium (INICC).

PURPOSE: To analyze the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional infection control strategy including a practice bundle to reduce the rates of central line-associated bloodstream infection (CLAB) in patients hospitalized in pediatric intensive care units (PICUs) of hospitals, which are members of the INICC, from nine cities of five developing countries: Colombia, India, Mexico, Philippines, and Turkey. METHODS: CLAB rates were determined by means of a prospective surveillance study conducted on 1,986 patients hospitalized in nine PICUs, over a period of 12,774 bed-days. The study was divided into two phases. During Phase 1 (baseline period), active surveillance was performed without the implementation of the multi-faceted approach. CLAB rates obtained in Phase 1 were compared with CLAB rates obtained in Phase 2 (intervention period), after implementation of the INICC multidimensional infection control program. RESULTS: During Phase 1, 1,029 central line (CL) days were recorded, and during Phase 2, after implementing the CL care bundle and interventions, we recorded 3,861 CL days. The CLAB rate was 10.7 per 1,000 CL days in Phase 1, and in Phase 2, the CLAB rate decreased to 5.2 per 1,000 CL days (relative risk [RR] 0.48, 95% confidence interval [CI] 0.29-0.94, P = 0.02), showing a reduction of 52% in the CLAB rate. CONCLUSIONS: This study shows that the implementation of a multidimensional infection control strategy was associated with a significant reduction in the CLAB rates in the PICUs of developing countries.