Implementation of a major trauma team. Analysis of activation and care times in patients admitted to the ICU.

OBJECTIVE: To analyze the factors associated with the activation of the severe trauma care team (STAT) in patients admitted to the ICU, to measure its impact on care times, and to analyze the groups of patients according to activation and level of anatomical involvement. DESIGN: Prospective cohort study of severe trauma admitted to the ICU. From June 2017 to May 2019. Risk factors for the activation of the STAT analysed with logistic regression and CART type classification tree. SETTING: Second level hospital ICU. PATIENTS: Patients admitted consecutively. INTERVENTIONS: No. MAIN VARIABLES OF INTEREST: STAT activation. Demographic variables. Injury severity (ISS), intentionality, mechanism, assistance times, evolutionary complications, and mortality. RESULTS: A total of 188 patients were admitted (46.8% of STAT activation), median age of 52 (37-64) years (activated 47 (27-62) vs not activated 55 (42-67) P = 0.023), males 84.0%. No difference in mortality according to activation. The logistic model finds as factors: care (16.6 (2.1-13.2)) and prehospital intubation (4.2 (1.8-9.8)) and severe lower extremity injury (4.4 (1.6-12.3)). Accidental fall (0.2 (0.1-0.6)) makes activation less likely. The CART model selects the type of trauma mechanism and can separate high and low energy trauma. CONCLUSIONS: Factors associated with STAT activation were prehospital care, requiring prior intubation, high-energy mechanisms, and severe lower extremity injuries. Shorter care times if activated without influencing mortality. We must improve activation in older patients with low-energy trauma and without prehospital care.

[Atypical presentations of primary hypothyroidism in primary care]. / Formas "atípicas" de presentación del hipotiroidismo primario en atención primaria.

OBJECTIVE: To present three cases of primary Hypothyroidism with an atypical beginning. DESIGN: Retrospective clinical observations. SITE. Health Centre (Primary Care). PATIENTS OR OTHERS PARTICIPANTS: Three women (aged 38, 43 and 51) who were studied in the consulting room: one who presented Macrocytosis and Hypercholesterolemia; the second, a bilateral palpebral oedema; and the third, dysfonia unaccompanied by any other symptom of Hypothyroidism. MAIN MEASUREMENTS AND RESULTS: In the three cases, hypercholesterolemia was objectified, I4 diminished and TSH raised; in one of them T3 was normal, while it was low in the remainder. CONCLUSIONS: The alteracions observed are frequent in primary Hypothyroidism. But it is rare to find them on their own in the presentation of the clinical picture. Given this pathology's high prevalence, it is important to think of the pathology when presented with these atypical symptoms, and possibly to request the determination of TSH in isolation.

[An epidemiological and clinical study of malignant cutaneous melanoma in the catchment area of León]. / Estudio epidemiológico y clínico del melanoma maligno cutáneo en el área sanitaria de León.

BACKGROUND: During the last decade the incidence of cutaneous malignant melanoma (CMM) has increased in different geographic areas around the world. The aim of this study is to know the incidence and clinical characteristics of CMM in the area of Leon between 1980-1989. METHODS: One hundred nineteen cases corresponding to the total CMM cases diagnosed over the aforementioned period were reviewed. Clinical characteristics were studied and the annual and five-year incidence were calculated. Results were compared between two five year period (1980-1984 and 1985-1989). RESULTS: The mean annual incidence rose from 1.9 in the first five year period to 4.4 cases per one hundred thousand cases per year in the second period (p less than 0.01). Furthermore, in this period a diminution was observed in the diagnosis of CMM with an elevated Clark level (III-V), with an increase of the lowest levels (p less than 0.05). There was a high predominance of women (76%) which increased in the second five year period (p less than 0.05). The mean age was 61.7 years which was higher than that reported by other authors with the most frequent sites being: head-neck (40%) and trunk (25%) The predominant histology was melanoma of superficial spread (46%). These variables did not vary significantly throughout the period studied.