Recommendations of the Colombian Consensus Committee for the Management of Traumatic Brain Injury in Prehospital, Emergency Department, Surgery, and Intensive Care (Beyond One Option for Treatment of Traumatic Brain Injury: A Stratified Protocol [BOOTStraP]).

Background Traumatic brain injury (TBI) is a global public health problem. In Colombia, it is estimated that 70% of deaths from violence and 90% of deaths from road traffic accidents are TBI related. In the year 2014, the Ministry of Health of Colombia funded the development of a clinical practice guideline (CPG) for the diagnosis and treatment of adult patients with severe TBI. A critical barrier to the widespread implementation was identified-that is, the lack of a specific protocol that spans various levels of resources and complexity across the four treatment phases. The objective of this article is to present the process and recommendations for the management of patients with TBI in various resource environments, across the treatment phases of prehospital care, emergency department (ED), surgery, and intensive care unit. Methods Using the Delphi methodology, a consensus of 20 experts in emergency medicine, neurosurgery, prehospital care, and intensive care nationwide developed recommendations based on 13 questions for the management of patients with TBI in Colombia. Discussion It is estimated that 80% of the global population live in developing economies where access to resources required for optimum treatment is limited. There is limitation for applications of CPGs recommendations in areas where there is low availability or absence of resources for integral care. Development of mixed methods consensus, including evidence review and expertise points of good clinical practices can fill gaps in application of CPGs. BOOTStraP (Beyond One Option for Treatment of Traumatic Brain Injury: A Stratified Protocol) is intended to be a practical handbook for care providers to use to treat TBI patients with whatever resources are available. Results Stratification of recommendations for interventions according to the availability of the resources on different stages of integral care is a proposed method for filling gaps in actual evidence, to organize a better strategy for interventions in different real-life scenarios. We develop 10 algorithms of management for building TBI protocols based on expert consensus to articulate treatment options in prehospital care, EDs, neurological surgery, and intensive care, independent of the level of availability of resources for care.

[Prevalence and factors associated with suicidal thinking among university students]. / Prevalencia y factores asociados a ideación suicida en estudiantes universitarios.

OBJECTIVES: To quantify the prevalence of suicidal ideation in a population of university students, to characterize groups in connection with ideation and suicidal behavior, and to determine the variables associated with suicidal ideation and suicide attempts. METHODS: Observational, analytic and cross-sectional study of a probabilistic sample of the population studied. An instrument for measuring suicide risk and associated variables was applied to this sample. RESULTS: The prevalence of the current suicidal ideation was 3.6%, and 18% in the last year. Both suicidal ideation and history of suicide attempts were higher among female students. Rape history, being alone more than eight hours a day, and female gender were the factors more strongly related to suicidal ideation. A relationship suicidal ideation and awareness of the suicide of others was not found in this sample. CONCLUSION: A history of rape, remaining alone for more than eight hours during the day, and being a woman should alert the clinician about the possibility of suicidal ideation. It is recommended to explore and assess suicidal ideation in all people with these factors.

Prevalencia y factores asociados a ideación suicida en estudiantes universitarios / Prevalence and factors associated with suicidal ideation among university students

Objetivos: Cuantificar la prevalencia de ideación suicida en una población de estudiantes universitarios, caracterizar grupos en relación con la ideación y las conductas suicidas y determinar las variables que se asocian con ideación suicida e intentos de suicidio. Metodología: Estudio observacional, analítico y transversal en el cual se seleccionó una muestra probabilística de la población de estudio, a la cual se aplicó un instrumento para la medición del riesgo de suicidio y de las variables asociadas. Resultados: La prevalencia de ideación suicida actual fue 3.6/100 y 18/100 en el último año. Tanto la ideación como el antecedente de intento de suicidio fueron más frecuentes en estudiantes de género femenino. El antecedente de violación, permanecer mas de ocho horas diarias solo y el género femenino, fueron los factores mas fuertemente relacionados con la ideación suicida. En esta población no se observó relación entre ideación suicida y exposición al suicidio de otros. Conclusión: La presencia de antecedente de violación, permanecer mas de ocho horas al día solo y pertenecer al género femenino, debe alertar al clínico sobre la posibilidad de ideación suicida, siendo recomendables la exploración y evaluación de la misma en los sujetos que presenten estos factores.