Perfil epidemiológico do traumatismo cranioencefálico no Nordeste do Brasil / Epidemiological profile of traumatic brain injury in Northeastern Brazil

O traumatismo cranioencefálico (TCE) se apresenta na realidade brasileira como importante causa de incapacitações e óbitos, sendo de especial interesse da saúde pública, também, devido à alta demanda de recursos para o tratamento de suas vítimas. Nesse contexto, análises sistemáticas sobre o tema são de grande relevância para o direcionamento de políticas preventivas. O presente trabalho tem por objetivo analisar o perfil do TCE na região Nordeste do Brasil, através de estudo exploratório, descritivo, epidemiológico, de série temporal, de janeiro de 2009 a dezembro de 2019, com dados secundários do DATASUS - Ministério da Saúde do Brasil. Foi constatado um aumento no número de internações e óbitos no período, sendo a maioria das vítimas do sexo masculino, da raça parda, com idade entre 20 e 39 anos. Os custos com internações são elevados e se encontram em ascensão.

raumatic brain injury (TBI) appears in the Brazilian reality as an important cause of disabilities and deaths, being of special interest to public health, also, due to the high demand for resources for the treatment of its victims. Based on this, systematic analyzes on the topic are of great relevance for the direction of preventive policies. The present work aims to analyze the profile of the TBI in Northeastern Brazil, through an exploratory, descriptive, epidemiological, time series study, from January 2009 to December 2019, with secondary data from DATASUS - Ministry of Health of Brazil. There was an increase in the number of hospitalizations and deaths in the period, with the majority of male victims, of brown race, aged between 20 and 39 years. Hospitalization costs are high and on the rise.

Perfil epidemiológico de pacientes adultos com traumatismo cranioencefálico grave na rede SUS do Distrito Federal: um estudo retrospectivo / Epidemiological profile of adult patients with severe traumatic brain injury in the SUS network in the Federal District: a retrospective study

INTRODUÇÃO: O traumatismo cranioencefálico (TCE) é considerado uma epidemia silenciosa e um grande problema de saúde pública mundial. Dados epidemiológicos precisos podem ajudar na formulação de políticas públicas e em estratégias para reduzir a incidência do TCE. O objetivo deste estudo foi descrever a epidemiologia do TCE grave de pacientes admitidos na unidade de terapia intensiva (UTI). MÉTODOS: Trata-se de um estudo retrospectivo com coleta de dados em prontuário eletrônico na UTI de um hospital da rede SUS do Distrito Federal. Foram analisados o perfil epidemiológico e os principais desfechos clínicos e funcionais de pacientes com TCE internados entre janeiro e dezembro de 2015. Uma análise estatística descritiva foi conduzida e os dados foram expressos em médias, intervalo de confiança de 95% (IC95%) e taxas. RESULTADOS: 227 pacientes foram estudados com média de idade de 38 anos (IC95% 36 a 40), sendo 84% (191/227) do sexo masculino. O principal mecanismo de trauma foi o acidente motociclístico, 19% (43/227) seguido dos atropelamentos, 18% (40/227). O tempo médio de ventilação mecânica foi de 14 dias, (IC95% 12 a 15) e os tempos médios de internação na UTI e hospitalar foram de 16 dias, (IC95% 14 a 18) e 42 dias, (IC95% 36 a 47), respectivamente. Apenas 16% (36/227) dos pacientes conseguiu permanecer em ortostase na alta da UTI. A taxa de mortalidade na UTI foi de 25% (57/227). CONCLUSÃO: Os homens jovens são os mais acometidos por TCE grave sendo o principal mecanismo o acidente motociclístico. Estes pacientes apresentam internação hospitalar prolongada e altas taxas de mortalidade

INTRODUCTION: traumatic brain injury (TBI) has been considered a silent epidemic and a major worldwide public health problem. Accurate epidemiological data can assist in the formulation of public policies and strategies to reduce the incidence of TBI. The aim of this study was to describe the epidemiology of severe TBI in patients admitted to the intensive care unit (ICU). METHODS: this is a retrospective study with data collected from electronic medical records from the ICU of a SUS hospital in the Federal District. The epidemiological profile and the main clinical and functional outcomes of patients with TBI hospitalized between January and December 2015 were analyzed. A descriptive statistical analysis was conducted and data were expressed as averages, 95% confidence interval (95% CI) and rates. RESULTS: 227 patients were studied with a mean age of 38 (95% CI 36 to 40), 84% (191/227) being male. The main mechanism of trauma was motorcycle collision, 19% (43/227) followed by pedestrian collision, 18% (40/227). The mean time of mechanical ventilation was 14 days, (95% CI 12 to 15) and the average length of stay in the ICU and hospital was 16 days, (95% CI 14 to 18) and 42 days, (95% CI 36 to 47), respectively. Only 16% (36/227) of patients managed to remain in orthostasis upon discharge from the ICU. The mortality rate in the ICU was 25% (57/227). CONCLUSION: Young men are the most affected by severe TBI, and the main mechanism was motorcycle accidents. These patients have prolonged hospital stays and high mortality rates

Progesterona para el tratamiento del trauma craneoencefálico grave: una revisión sistemática y metaanálisis / Progesterone to treat severe traumatic brain injury: a systematic review and meta-analysis / Progesterona para o tratamento do traumatismo crânio-encefálico grave: revisão sistemática e meta-análise

Resumen: Objetivo: revisar sistemáticamente la evidencia sobre la administración de progesterona tras un trauma craneoencefálico grave en adultos y su relación con mortalidad y pronóstico neurológico. Criterios de inclusión: ensayos clínicos aleatorizados que incluyan a pacientes adultos mayores de 18 años, haber sufrido un traumatismo craneal grave (Glasgow <8), donde se compare la administración de progesterona vs grupo control (placebo o no administración). Método: se realizó la búsqueda en las siguientes bases de datos: MEDLINE, the Central Register of Controlled Trials (CENTRAL); PubMed, HINARI, EMBASE; Cochrane Injuries group y lista de referencia de los artículos. Resultados: no hubo reducción de la mortalidad comparado con el grupo control (RR 0,93, IC95% 0,79-1,10 p= 0,41), no hubo diferencias entre progesterona y el grupo control en desenlaces neurológicos positivos ni negativos (RR 1,07, IC95% 0,97-1,17 p= 0,20; RR 0,94, IC 95% 0,81-1,08 p= 0,27), respectivamente. Conclusiones: no se encontró evidencia respecto a que la administración de progesterona posterior a un traumatismo craneoencefálico reduzca la mortalidad o mejore desenlaces neurológicos, aunque se necesitan más estudios de buena calidad para extraer conclusiones definitivas.

Summary: Objective: to systematically review evidence on the administration of progesterone after a traumatic brain injury in adults and its relationship with mortality and neurological head prognosis. Inclusion criteria: randomized clinical trials that include: patients older than 12 years old, having had an injury (Glasgow <8), comparing the administration of Progesterone versus the control group (placebo or no administration). Methods: we searched the following databases: MEDLINE, the Central Register of Controlled Trials (CENTRAL); PubMed, HINARI, EMBASE; Cochrane Injury Group and reference list of articles. Results: there was no reduction in mortality in patients in the control group (RR 0.93, 95% CI 0.79-1.10 p = 0.41), there were no differences between progesterone and the control group in favorable or adverse neurological outcomes (RR 1.07, 95% CI: 0.97-1.17 p = 0.20, RR 0.94, 95% CI: 0.81 -1,08 p= 0.27), respectively. Conclusions: there is no evidence that the administration of progesterone after a traumatic brain injury reduces or improves neurological results, although further good quality studies are required to obtain conclusive results.

Resumo: Objetivo: realizar uma revisão sistemática da evidência sobre a administração de progesterona depois de traumatismo crânio-encefálico grave em adultos e sua relação com a mortalidade e o prognóstico neurológico. Critérios de inclusão: ensaios clínicos aleatorizados que incluam: pacientes adultos maiores de 18 anos, haver sofrido um traumatismo craniano grave (Glasgow <8) donde se compare a administração de progesterona versus grupo controle (placebo ou não administração). Métodos: foi feita uma pesquisa bibliográfica nas seguintes bases de dados: MEDLINE, Central Register of Controlled Trials (CENTRAL), PubMed, HINARI, EMBASE, Cochrane Injuries Group e nas referências bibliográficas dos artigos. Resultados: não foi observada uma redução da mortalidade comparada com o grupo controle (RR 0,93, IC del 95%: 0,79-1,10 p= 0,41), não foram observadas diferenças entre o grupo que recebeu progesterona e o grupo controle nos resultados neurológicos positivos ou negativos (RR 1,07, IC del 95%: 0,97-1,17 p= 0,20; RR 0,94, IC del 95%: 0,81-1,08 p= 0,27), respectivamente. Conclusões: não se encontrou evidência de que a administração de progesterona depois de um traumatismo crânio-encefálico reduza a mortalidade ou melhore os resultados neurológicos embora novos estudos de boa qualidade sejam necessários para chegar a conclusões definitivas.

EVENTS ASSOCIATED WITH THE OCCURRENCE OF INTRACRANIAL HYPERTENSION IN PEDIATRIC PATIENTS WITH SEVERE CRANIOENCEPHALIC TRAUMA AND MONITORING OF INTRACRANIAL PRESSURE.

OBJECTIVE: To determine the events associated with the occurrence of intracranial hypertension (ICH) in pediatric patients with severe cranioencephalic trauma. METHODS: This was a prospective cohort study of patients 18 years old and younger with cranioencephalic trauma, scores below nine on the Glasgow Coma Scale, and intracranial pressure monitoring. They were admitted between September, 2005 and March, 2014 into a Pediatric Intensive Care Unit. ICH was defined as an episode of intracranial pressure above 20 mmHg for more than five minutes that needed treatment. RESULTS: A total of 198 children and adolescents were included in the study, of which 70.2% were males and there was a median age of nine years old. ICH occurred in 135 (68.2%) patients and maximum intracranial pressure was 36.3 mmHg, with a median of 34 mmHg. A total of 133 (97.8%) patients with ICH received sedation and analgesia for treatment of the condition, 108 (79.4%) received neuromuscular blockers, 7 (5.2%) had cerebrospinal fluid drainage, 105 (77.2%) received mannitol, 96 (70.6%) received hyperventilation, 64 (47.1%) received 3% saline solution, 20 (14.7%) received barbiturates, and 43 (31.9%) underwent a decompressive craniectomy. The events associated with the occurrence of ICH were tomographic findings at the time of admission of diffuse or hemispheric swelling (edema plus engorgement). The odds ratio for ICH in patients with Marshall III (diffuse swelling) tomography was 14 (95%CI 2.8-113; p<0.003), and for those with Marshall IV (hemispherical swelling) was 24.9 (95%CI 2.4-676, p<0.018). Mortality was 22.2%. CONCLUSIONS: Pediatric patients with severe cranioencephalic trauma and tomographic alterations of Marshall III and IV presented a high chance of developing ICH.

Events associated with the occurrence of intracranial hypertension in pediatric patients with severe cranioencephalic trauma and monitoring of intracranial pressure / Eventos associados à ocorrência de hipertensão intracraniana em pacientes pediátricos com traumatismo cranioencefálico grave e monitoração da pressão intracraniana

ABSTRACT Objective: To determine the events associated with the occurrence of intracranial hypertension (ICH) in pediatric patients with severe cranioencephalic trauma. Methods: This was a prospective cohort study of patients 18 years old and younger with cranioencephalic trauma, scores below nine on the Glasgow Coma Scale, and intracranial pressure monitoring. They were admitted between September, 2005 and March, 2014 into a Pediatric Intensive Care Unit. ICH was defined as an episode of intracranial pressure above 20 mmHg for more than five minutes that needed treatment. Results: A total of 198 children and adolescents were included in the study, of which 70.2% were males and there was a median age of nine years old. ICH occurred in 135 (68.2%) patients and maximum intracranial pressure was 36.3 mmHg, with a median of 34 mmHg. A total of 133 (97.8%) patients with ICH received sedation and analgesia for treatment of the condition, 108 (79.4%) received neuromuscular blockers, 7 (5.2%) had cerebrospinal fluid drainage, 105 (77.2%) received mannitol, 96 (70.6%) received hyperventilation, 64 (47.1%) received 3% saline solution, 20 (14.7%) received barbiturates, and 43 (31.9%) underwent a decompressive craniectomy. The events associated with the occurrence of ICH were tomographic findings at the time of admission of diffuse or hemispheric swelling (edema plus engorgement). The odds ratio for ICH in patients with Marshall III (diffuse swelling) tomography was 14 (95%CI 2.8-113; p<0.003), and for those with Marshall IV (hemispherical swelling) was 24.9 (95%CI 2.4-676, p<0.018). Mortality was 22.2%. Conclusions: Pediatric patients with severe cranioencephalic trauma and tomographic alterations of Marshall III and IV presented a high chance of developing ICH.

RESUMO Objetivo: Determinar eventos associados à ocorrência de hipertensão intracraniana (HIC) em pacientes pediátricos com traumatismo cranioencefálico grave. Métodos: Trata-se de coorte prospectiva de pacientes de até 18 anos, com traumatismo cranioencefálico, pontuação abaixo de nove na Escala de Coma de Glasgow e monitoração da pressão intracraniana, admitidos entre setembro de 2005 e março de 2014 em unidade de terapia intensiva pediátrica. A HIC foi definida como episódio de pressão intracraniana acima de 20 mmHg por mais de cinco minutos e com necessidade de tratamento. Resultados: Incluídas 198 crianças e adolescentes, 70,2% masculinos, mediana de idade de nove anos. A HIC ocorreu em 135 (68,2%) pacientes; valor máximo de pressão intracraniana de 36,3; mediana 34 mmHg. Receberam sedação e analgesia para tratamento da HIC 133 (97,8%) pacientes, 108 (79,4%) receberam bloqueadores neuromusculares, 7 (5,2%) drenagem de líquor, 105 (77,2%) manitol, 96 (70,6%) hiperventilação, 64 (47,1%) solução salina a 3%, 20 (14,7%) barbitúricos e 43 (31,9%) foram submetidos à craniectomia descompressiva. Os eventos associados à ocorrência de HIC foram os achados tomográficos à admissão de swelling (edema mais ingurgitamento) difuso ou hemisférico. A razão de chance para que pacientes com classificação tomográfica Marshall III (swelling difuso) apresentassem HIC foi 14 (IC95% 2,8-113; p<0,003) e para aqueles com Marshall IV (hemisférico) foi 24,9 (IC95% 2,4-676; p<0,018). A mortalidade foi de 22,2%. Conclusões: Pacientes pediátricos com traumatismo cranioencefálico grave e alterações tomográficas tipo Marshall III e IV apresentaram grande chance de desenvolver HIC.

Trauma cranioencefálico: perfil dos pacientes atendidos em um hospital público de Teresina / Traumatic brain injury: profile of patients admitted in a public hospital from Teresina city / Trauma cranioencefálico: perfil de los pacientes atendidos en un hospital público de Teresina

Objetivo: Identificar o perfil dos pacientes acometidos com traumatismo cranioencefálico atendidas em um hospital público de Teresina. Método: Estudo descritivo, exploratório, retrospectivo, documental de abordagem quantitativa realizado em um hospital público de Teresina-PI. Os dados foram coletados no período set/out/ de 2016 e janeiro de 2017 por meio de pesquisa nos prontuários através do formulário elaborado pelas pesquisadoras. Resultados: Registraram-se 1603 internações com o diagnóstico de traumatismo cranioencefálico destes, 5,67% tiveram traumatismo cranioencefálico leve, 92,67% moderado e 1,67% grave. Houve predomínio da faixa etária de 18 a 29 anos, sexo masculino, solteiro e o ensino fundamental. Nesta busca, 19,33% dos pacientes foram a óbito. Conclusão: Conclui-se que o perfil do paciente acometido por trauma cranioencefálico, no hospital estudado, é caracterizado por um predomínio do sexo masculino com uma faixa etária de 19 a 29 anos, solteiros e com escolaridade de até o ensino fundamental

Objective: This study meant to identifying the traumatic brain injury patients' profile in a public hospital of Teresina city, Piauí State, Brazil. Methods: It is a descriptive-exploratory, retrospective and documental study with a quantitative approach, which was performed in a public hospital from Teresina city. Data collection took place from September 2016 to January 2017 by researching medical records based on a developed form. Results: Considering the total number of traumatic brain injury hospitalizations, 5.67% were mild, 92.67% were moderate, and 1.67% were severe injuries. There was a predominance of single males within the age group from 19 to 29 years old, holding at most elementary school education. According to the study results, 19.33% of the patients died. Conclusion: It was concluded that the traumatic brain injury patients' profile is characterized by a predominance of single males within the age group from 19 to 29 years old, holding at most elementary school education

Objetivo: identificar el perfil de los pacientes acometidos con traumatismo craneoencefálico atendidos en un hospital público de Teresina. Método: Estudio descriptivo, exploratorio, retrospectivo, documental de abordaje cuantitativo realizado en un hospital público de Teresina-PI. Los datos fueron recolectados en el período set / out / de 2016 y enero de 2017 por medio de investigación en los prontuarios a través del formulario elaborado por las investigadoras. Resultados: Se registraron 1603 internaciones con el diagnóstico de traumatismo craneoencefálico de éstos, 5,67% tuvieron traumatismo craneoencefálico leve, 92,67% moderado y 1,67% grave. Se observó predominio del grupo de edad de 18 a 29 años, sexo masculino, soltero y la enseñanza fundamental. En esta búsqueda, el 19,33% de los pacientes fueron a muerte. Conclusión: Se concluye que el perfil del paciente acometido por trauma craneoencefálico, en el hospital estudiado, se caracteriza por un predominio del sexo masculino con una franja etaria de 19 a 29 años, solteros y con escolaridad de hasta la enseñanza fundamental

Caracterización clínico-quirúrgico, neuroimagenológico y por neuromonitorización del trauma craneoencefálico en la provincia matanzas. 2016-2018 / Clinical-surgical, neuroimaging and neuromonitored characterization of the encephalococranial trauma in the province of Matanzas. 2016-2018

RESUMEN Introducción: el traumatismo encefalocraneano es una causa frecuente de mortalidad y morbilidad. Según datos epidemiológicos aporta la mayor cantidad de fallecidos en menores de 45 años a nivel mundial. Objetivo: caracterizar el trauma craneoencefálico desde el punto de vista clínico-quirúrgico, neuroimagenológico y por neuromonitorización en los pacientes investigados. Materiales y métodos: estudio observacional, descriptivo, transversal, en el Servicio de Neurocirugía del Hospital Provincial Clínico Quirúrgico Docente José Ramón López Tabrane y Comandante Faustino Pérez Hernández, de Matanzas, durante el periodo comprendido entre enero del 2016 a enero del 2018. Resultados: predominó el sexo masculino con el 71,7% de los casos, la mayor prevalencia estuvo en edades inferiores a 48 años con el 80,1 %. La mayor cantidad presentaba un traumatismo encefalocraneano leve con el 56% de los casos seguido del traumatismo encefalocraneano moderado y severo con el 29% y 15% de los casos respectivamente. Predominaron las fracturas lineales (45,8%), seguido de las contusiones sin efecto de masa y los hematomas subdurales con el 24,2% y 23,3%. La mayoría de los pacientes presentó una escala de Marshall II con el 40,8%. Las cifras de presión intracraneal entre de 20-40 mmHg se presentó con mayor frecuencia (44,4 %). Conclusiones: la mitad de los pacientes neuromonitorizados presentaron una saturación del golfo de la vena yugular dentro de parámetros normales con el 50%. La operación más practicada fue la evacuación de hematomas subdurales con el 29,4% (AU).

ABSTRACT Introduction: the encephalocranial trauma (ECT) is a frequent cause of mortality and morbidity. According to epidemiological data, it causes the highest number of deaths in people aged less than 45 years worldwide. Objective: to characterize the encephalocranial trauma from the clinical-surgical, neuroimaging and neuromonitoring point of view in the studied patients. Materials and methods: observational, descriptive, cross-sectional study carried out in the Neurosurgery Service of the Provincial Teaching Surgical Clinical Hospitals "Jose Ramon Lopez Tabrane" and "Comandante Faustino Perez Hernandez", of Matanzas, during the period from January 2016 to January 2018. Results: male sex predominated with 71.7% of the cases; the highest prevalence was in ages below 48 years with 80.1%. Most of them presented a mild encephalocranial trauma with 56% of the cases followed by moderate and severe encephalocranial trauma with 29% and 15% of the cases respectively. Linear fractures predominated (45.8%), followed by contusions without mass effect and subdural hematomas with 24.2% and 23.3%. Most of patients presented a Marshall II scale with 40.8%. The intracranial pressure between 20-40 mmHg occurred more frequently (44.4%). Conclusions: half of the neuromonitored patients presented jugular vein gulf saturation within normal parameters with 50%. The most practiced operation was the evacuation of subdural hematomas with 29.4% (AU).

Caracterización clínico-quirúrgico, neuroimagenológico y por neuromonitorización del trauma craneoencefálico en la provincia matanzas. 2016-2018 / Clinical-surgical, neuroimaging and neuromonitored characterization of the encephalococranial trauma in the province of Matanzas. 2016-2018

RESUMEN Introducción: el traumatismo encefalocraneano es una causa frecuente de mortalidad y morbilidad. Según datos epidemiológicos aporta la mayor cantidad de fallecidos en menores de 45 años a nivel mundial. Objetivo: caracterizar el trauma craneoencefálico desde el punto de vista clínico-quirúrgico, neuroimagenológico y por neuromonitorización en los pacientes investigados. Materiales y métodos: estudio observacional, descriptivo, transversal, en el Servicio de Neurocirugía del Hospital Provincial Clínico Quirúrgico Docente José Ramón López Tabrane y Comandante Faustino Pérez Hernández, de Matanzas, durante el periodo comprendido entre enero del 2016 a enero del 2018. Resultados: predominó el sexo masculino con el 71,7% de los casos, la mayor prevalencia estuvo en edades inferiores a 48 años con el 80,1 %. La mayor cantidad presentaba un traumatismo encefalocraneano leve con el 56% de los casos seguido del traumatismo encefalocraneano moderado y severo con el 29% y 15% de los casos respectivamente. Predominaron las fracturas lineales (45,8%), seguido de las contusiones sin efecto de masa y los hematomas subdurales con el 24,2% y 23,3%. La mayoría de los pacientes presentó una escala de Marshall II con el 40,8%. Las cifras de presión intracraneal entre de 20-40 mmHg se presentó con mayor frecuencia (44,4 %). Conclusiones: la mitad de los pacientes neuromonitorizados presentaron una saturación del golfo de la vena yugular dentro de parámetros normales con el 50%. La operación más practicada fue la evacuación de hematomas subdurales con el 29,4%.

ABSTRACT Introduction: the encephalocranial trauma (ECT) is a frequent cause of mortality and morbidity. According to epidemiological data, it causes the highest number of deaths in people aged less than 45 years worldwide. Objective: to characterize the encephalocranial trauma from the clinical-surgical, neuroimaging and neuromonitoring point of view in the studied patients. Materials and methods: observational, descriptive, cross-sectional study carried out in the Neurosurgery Service of the Provincial Teaching Surgical Clinical Hospitals "Jose Ramon Lopez Tabrane" and "Comandante Faustino Perez Hernandez", of Matanzas, during the period from January 2016 to January 2018. Results: male sex predominated with 71.7% of the cases; the highest prevalence was in ages below 48 years with 80.1%. Most of them presented a mild encephalocranial trauma with 56% of the cases followed by moderate and severe encephalocranial trauma with 29% and 15% of the cases respectively. Linear fractures predominated (45.8%), followed by contusions without mass effect and subdural hematomas with 24.2% and 23.3%. Most of patients presented a Marshall II scale with 40.8%. The intracranial pressure between 20-40 mmHg occurred more frequently (44.4%). Conclusions: half of the neuromonitored patients presented jugular vein gulf saturation within normal parameters with 50%. The most practiced operation was the evacuation of subdural hematomas with 29.4%.

Analysis of accidents and injuries on motorcycles in Mexico.

OBJECTIVE: To analyze the type of injuries and the characteristics and geographical distribution of road accidents where motorcycles were involved in Mexico. METHODS: A descriptive analysis of second-hand information sources was conducted, including the number of accidents (N = 41,881), total number of injured people (N = 13,916) and medical expenses (N = 9,111) associated to motorcycle accidents during 2014. RESULTS: Motorcycles represent 13.14% of the total number of deaths in road accidents in Mexico, and the Southeast region of Mexico registers the highest proportion of fatal injuries. Of the total number of motorcycles, 1.84% (95% confidence interval [CI]: 1.83-1.86) were involved in a collision. 3.64 (95% CI: 3.39-3.89) people died and 105.5 (95% CI: 104.1-106.8) were injured in every 10,000. Out of the total number of injuries, 76.6% were male and 53.74% were women. 55.1% of deaths were caused by intracranial trauma. Only 16.6% wore a helmet at the time of the accident, and those not wearing a helmet had a 2.11 (odds ratio [OR]: 2.1; CI 95%: 1.8-2.4) higher chance of head injury. Regarding the severity of the crash, those occurred in suburban areas (OR: 6.58; CI 95%: 5.69-7.60), in unpaved surfaces (OR: 4.13; CI 95%: 3.04-5.61), after low alcohol consumption (OR: 1.89; CI 95%: 1.46-2.44), at night (OR: 2.24; CI 95%: 1.95-2.57) and on weekends (OR: 1.65; CI 95%: 1.44-1.90), had the highest chance of turning into a fatal accident. CONCLUSIONS: In spite of the progress made in terms of road safety, motorcycle accidents are still increasing, and the use of a helmet is still proportionally low. More information on these groups and risk factors needs to be available so people are better informed. Also, regulations need improvements regarding the use of security equipment like helmets in order to reduce injuries and fatal accidents.

Epidemiologia do traumatismo cranioencefálico no Brasil / Epidemiology of traumatic brain injury in Brazil

Introdução: O traumatismo cranioencefálico (TCE) é considerado a maior causa de morte e incapacidade em todo mundo, principalmente entre adultos jovens. No Brasil, estima-se que mais de um milhão de pessoas vivam com sequelas neurológicas decorrentes do TCE. Apesar da sua alta prevalência e taxas de incidência em constante elevação, estudos epidemiológicos permanecem escassos. Objetivo: Discutir as evidências disponíveis em relação ao perfil epidemiológico da população brasileira acometida por TCE. Métodos: Realizou- se uma revisão de literatura nas bases de dados SciELO, LILACS e PubMed. Os termos utilizados na busca foram traumatismo cranioencefálico, e/ou epidemiologia, e/ou Brasil. Para a busca no PubMed foram utilizados os termos em inglês traumatic brain injury, e/ou epidemiology, e/ou Brazil. Foram incluídos artigos originais, descritivos e de revisão que não restringiram a causa, a gravidade do TCE e a faixa etária estudada. Resultados: Foram encontrados oito estudos de 1993 a 2015, todos retrospectivos, sendo cinco deles realizados em hospitais de emergência e três baseados em bancos de dados. Indivíduos com menos de 40 anos, do sexo masculino foram os mais acometidos e as causas principais foram quedas e os acidentes de trânsito, destacando-se os motociclísticos. Conclusão: Estudos epidemiológicos robustos sobre o TCE no Brasil ainda são escassos. Todos os estudos foram retrospectivos e apenas dois apresentaram dados nacionais. Nesse contexto, estudos epidemiológicos de caráter prospectivo que investiguem de forma sistemática os fatores associados ao TCE, são urgentemente recomendados. (AU)

Introduction: Traumatic brain injury (TBI) is the leading cause of death and disability worldwide, especially among young adults. In Brazil, it is estimated that more than one million people live with disabilities due to TBI. Despite the high incidence of TBI and related socioeconomic burden, epidemiological studies are scarce. Objective: To discuss the available evidence regarding the epidemiological profile of Brazilian people victims of TBI. Methods: A literature review was conducted on the SciELO, LILACS and PubMed databases. The terms used were traumatic brain injury and/or epidemiology, and/or Brazil. Original, descriptive and review studies that investigated only one specific cause of TBI, only one level of severity or a specific age group were not included in the current review. Results: Eight retrospective articles published between 1993 and 2015 were included. Five studies were conducted in emergency hospitals and three studies were based on databases records. Men under 40 years old were the most affected group, and the main causes of TBI were falls and traffic accidents, especially involving motorcycle. Conclusion: Sound epidemiological studies on TBI are still rare. All studies included were retrospective and only two reported national data. In this scenario, prospective epidemiological studies that systematically investigate the profile of TBI victims in Brazil are urgently necessary. (AU)

Valoracion médico legal de las secuelas de TCE moderado a severo: a propósito de un caso / Medical-legal assessment of the sequelae of moderate to severe TCE: a case report

Resumen:Los Trauma Cranéo Encefálicos son actualmente uno de los principales y más frecuentes valoraciones de daño corporal que se realiza diariamente, en la actualidad la gran mayoría de los accidentes tiene implicado un trauma de cranéo aunado a daño cerebral.Este artículo se basa en identificar cuales son las principales secuelas que debemos tener presentes en aquellos evaluados que sufren TCE con pérdida de la consciencia y en que momento deben de valorarse para definir si estamos frente a un deficit neurológico transitorio o ya una secuela establecida.Caso: Presentamos el caso de un masculino de 36 años de edad, con alto nivel acádemico el cual posterior a un TCE en el año 2014, es valorado un año después para determiner posibles secuelas. Con un examen mental que aporta datos con escasa alteraciones en su desempeño general, se le realizan pruebas específicas de memoria y funciones ejecutivas detectando secuelas neuropsicológicas que tiene una relación causal con el TCE previo.Además de detectaron secuelas en algunos pares craneales esperables por el tipo de trauma sufrido (fractura de cranéo y fractura del techo de la órbita) como reducción del olfato (anosmia) y pérdida de la agudeza visual (PC más afectados en casos de TCE).Se destaca la importancia de valorar exámenes complementarios como radiografías, RM y otros. Además de entrevitas a los familiares para conocer el estado previo del evaluado antes del TCE, para ayudar con el diagnóstico clínico.Así como la importancia de realizar estos estudios luego de un año de ocurrido el TCE para estar frente a una secuela y no ante un déficits neurológicos transitorios que son frecuentes en este tipo de traumas.

Abstract:Craneoencephalic traumas are currently one of the main and more frequent assessments of bodily harm that is done daily, today the vast majority of accidents has meant a head injury combined with brain damage.This article is based on the principals identify what consequences that must be considered in those who suffer evaluated TCE with loss of consciousness and that time must be assessed to determine whether we are facing a transient neurological deficit or already an established sequel.Case: We present the case of a male 36 years of age, with high academic standards which after TBI in 2014, is worth a year later to determine possible consequences. With a mental test that provides data with little changes in its overall performance, you will perform specific tests of memory and executive functions detect neuropsychological sequelae that is causally associated with the prior TCE.Besides detected sequelae in some expected cranial by the type of trauma (fractured skull and broken roof of the orbit) and reduction of smell (anosmia) and loss of visual acuity (PC most affected in cases of TEC).The importance of assessing complementary tests like X-rays, MRI and other highlights. Besides entrevitas relatives to know the previous state of the evaluated before TEC, to help with clinical diagnosis.As the importance of these studies after a year of TCE happened to be facing a sequel and not to a transient neurological deficits that are common in this type of trauma.

Una revisión sistemática del monitoreo de la presión intracraneana en adultos con trauma craneoencefálico severo / A systematic review of intracranial pressure monitoring in adults with severe traumatic brain injury

Objetivos: Revisar sistemáticamente la evidencia relacionada con el monitoreo de la presion intracraneana en unidades de cuidado neurocrítico en el contexto de trauma craneoencefálico severo. Criterios de elección: Ensayos clínicos aleatorizados que comparen el uso del monitoreo de la presión intracraneana (PIC) que muestren un estimado de mortalidad/discapacidad a 6 meses, en pacientes mayores de 12 años de edad con trauma craneoencefálico severo (escala de Glasgow menor a 8). Método de búsqueda: En Medline, el Registro Central de Ensayos Controlados (CENTRAL); PubMed, HINARI, EMBASE; Grupo Cochrane de Lesiones y las listas de referencias de artículos. De acuerdo con el Manual Cochrane para meta-análisis y revisión sistemática. Resultados: No hubo diferencias entre el grupo de PIC y el control en el pronóstico de discapacidad (RR [Riesgo Relativo]1.01, 95 por ciento CI 0.87 to 1.18). Sin embargo, el monitoreo de la PIC reduce la estancia en UCI en comparación con otros métodos. La estancia en UCI con tratamiento cerebral específico también se redujo en comparación con grupo control. Conclusiones: En pacientes con trauma craneoencefálico, no hubo diferencia entre el monitoreo de la PIC y el examen clínico sin embargo, para mantener una PIC baja, hubo una sustancial reducción de requerimiento de solución salina hipertónica y un descenso en la hiperventilación trayendo consigo beneficios para pacientes en UCI.

Objectives: To systematically review the evidence of intracranial pressure monitoring in neuro critical care unit in the context of a severe head injury. Study eligibility criteria: Patients were older than 12 years ,had a severe traumatic brain injury (Glasgow coma scale < 8), that compared the use of ICP monitoring with control, that presented an estimate of mortality/ disability prognosis 6 months after injury.only randomized clinical trials. Methods: Searched MEDLINE, the Central Registerof Controlled Trials (CENTRAL); PubMed, HINARI,EMBASE; Cochrane Injuries group and the reference lists of articles. In accordance with the Cochrane handbook for meta-analysis and systematic review. Results: In the ICP and control groups there was no difference in the prognosis of disability (RR [Relative Risk]1.01, 95 percent CI 0.87 to 1.18). However, ICP monitoring reduced the duration of stay in ICU compared to other surveillance methods. The stay in the ICU with specific medical support for brain injury was also reduced compared to the control group. Conclusions: In patients with severe traumatic brain injury, the ICP monitoring was not difference to imaging and clinical examination. However, by keeping the ICP low there was a substantial reduction in the requirement for hypertonic saline and a decrease in hyperventilation providing benefits to thepatient in the ICU.

Acceptance of Shaken Baby Syndrome and Abusive Head Trauma as Medical Diagnoses.

OBJECTIVE: To assess the current general acceptance within the medical community of shaken baby syndrome (SBS), abusive head trauma (AHT), and several alternative explanations for findings commonly seen in abused children. STUDY DESIGN: This was a survey of physicians frequently involved in the evaluation of injured children at 10 leading children's hospitals. Physicians were asked to estimate the likelihood that subdural hematoma, severe retinal hemorrhages, and coma or death would result from several proposed mechanisms. RESULTS: Of the 1378 physicians surveyed, 682 (49.5%) responded, and 628 were included in the final sample. A large majority of respondents felt that shaking with or without impact would be likely or highly likely to result in subdural hematoma, severe retinal hemorrhages, and coma or death, and that none of the alternative theories except motor vehicle collision would result in these 3 findings. SBS and AHT were comsidered valid diagnoses by 88% and 93% of the respondents, respectively. CONCLUSIONS: Our empirical data confirm that SBS and AHT are still generally accepted by physicians who frequently encounter suspected child abuse cases, and are considered likely sources of subdural hematoma, severe retinal hemorrhages, and coma or death in young children. Other than a high-velocity motor vehicle collision, no alternative theories of causation for these findings are generally accepted.

Did Emperor Moctezuma II's head injury and subsequent death hasten the fall of the Aztec nation?

This article analyzes the head injury of Emperor Moctezuma as one of those injuries that affected the course of history. The Emperor's death arguably changed the fate of an entire nation and led to the destruction of the Aztec civilization. Moctezuma died in the evening hours of June 30, 1520, in his palace in the Aztec capital, Tenochtitlan, while a prisoner of the Spanish conquistadors. The Emperor had been speaking to his people in an effort to persuade them to cease hostilities against Hernán Cortés, his Spanish soldiers, and Indian allies. Both Spanish and Indian contemporary sources document that he sustained a severe head injury when one of his own warriors hit him with a rock thrown from a sling. However, after the Conquest of Mexico some of the information collected by Spanish friars from Indian stories, songs, and pictorial representations raised the possibility that Moctezuma died of strangulation or stabbing at the hands of the Spaniards. There is even a suggestion of suicide. This issue remains unresolved and emotionally charged. The historical and clinical analysis of the events surrounding Moctezuma's death indicates that the Emperor most likely died as a consequence of head injury. The author has attempted to present a neutral analysis but agrees with Benjamin Keen that neutrality may be unattainable, no matter how remote the subject of historical inquiry is from the present.

Heridas por proyectil de arma de fuego en cráneo: revisión de la literatura / Firearm projectile wounds on skull: literature review

El trauma craneoencefálico es una de las principales causas de muerte en el mundo, y gran parte de estos se asocian a heridas por arma de fuego en cráneo. Conocer el manejo, las características y fisiopatología de la lesión nos permitirá saber abordar estos casos cuando se presenten a los diferentes centros asistenciales, al tiempo que nos permitirá tener en cuenta las posibles complicaciones, para evitar su aparición y así buscar mejorar la morbilidad por esta causa. Siempre acompañado de un manejo integral que permita abarcar todas las dimensiones afectadas.

Traumatic brain injury is a of the leading causes of death in the world, and many of these are associated with gunshot wounds in the skull. To know management the characteristics and pathophysiology of the lesion will tell as deal with these cases when presented to medical centers, while enabling us to take into account of possible complications, to prevent its occurrence and so try to improve morbidity from this cause. Always accompanied by an integrated management that can encompass all affected dimensions.

Exploración neuropsicológica y manifestaciones de ansiedad y depresión en pacientes con traumatismo cráneo-encefálico. Huambo, 2012 / Neuropsychological Examination and Anxiety and Depression Expressions on Patients Suffering from Skull Encephalon Trauma. Huambo, 2012

Introducción: El trauma es considerado un problema de salud pública a nivel mundial, siendo la mortalidad el principal indicador de su magnitud. Sin embargo, existen muchas personas sobrevivientes que quedan con secuelas físicas y emocionales, afectándose no solamente la víctima, sino también sus familias, comunidades y la sociedad en general. Objetivo: Determinar los principales síndromes neuropsicológicos, así como manifestaciones de ansiedad y depresión, en los adolescentes y jóvenes afectados por traumatismos craneoencefálicos ingresados en el Hospital General de Huambo, República de Angola. Método: Se realizó un diseño no experimental, con alcance descriptivo. La muestra estuvo integrada por 156 pacientes ingresados en el Hospital General de Huambo, en el período julio-diciembre de 2012. Para la recogida de información se empleó: la revisión de documentos oficiales (Historia Clínica), observación, entrevista psicológica semiestructurada dirigida a pacientes y especialistas en Neurocirugía que conformaban el equipo de salud, Batería Neuropsicológica Breve, Inventario de Ansiedad Rasgo- Estado (IDARE) e Inventario de Depresión Rasgo- Estado (IDERE).Resultados: Existió un predominio de traumas cráneo-encefálicos abiertos, de severidad moderada, con daños, predominantemente, en los lóbulos frontales. Las mayores afectaciones se relacionan con las funciones: Cálculo (92,9 por ciento), Semejanzas y compresión (91,50 por ciento), Lecto escritura (83,3 por ciento) y Funciones de Orientación (82,05 por ciento). Existió un predominio de niveles altos de ansiedad (63,64 por ciento) y depresión (67.53 por ciento) como estado. Conclusión: Los pacientes con traumas cráneo-encefálicos estudiados presentaron alteraciones neuropsicológicas, sobre todo relacionadas con las funciones ejecutivas, además de elevados niveles de malestar emocional(AU)

Introduction: Trauma is considered as a word wild problem on the public health and mortality is the main indicator of it. Nevertheless, there are a lot of survivors that have physical and emotional consequences that affect not only the victim, but also their relatives, communities and society. Objective: to define the main neuropsychological syndromes, as well asanxiety and depression expressions on teenagers and young people affected by skull encephalon trauma admitted in the General Hospital of Huambo, Angola Republic.Methods: It was carried out a non-experimental design with descriptive range on a sample of 156 patients admitted in the General Hospital of Huambo from July to December, 2012. To obtain information clinical records were reviewed and observation, psychological semi structured interview (directed to patients and also to specialists on Neurosurgery as part of the health team), Brief Neuropsychological Series, Feature State Anxiety Inventory (IDARE) and Feature State Depression Inventory (IDERE) were applied.Results: There was a predominance of open skull ? encephalon trauma of moderate severity with damages mainly on the front lobes. The majority affectations were related with the Functions: Mental arithmetic (92, 9 percent), Similarities and Comprehension (91,5 percent) Reading-Writing (83, 3) and Orientations Functions) 82,05 percent). There was a predominance of high levels of Anxiety (63,64 percent) and Depression (67,53 percent) as state. Conclusion: The studied patient with skull-encephalon trauma presented neuropsychological alterations mainly related with the execution functions and also high levels of emotional discomfort(AU)

Hiperglicemia y morbimortalidad en pacientes no diabéticos con traumatismo craneoencefálico grave en la Unidad de Cuidados Intensivos del Hospital María Auxiliadora. Enero 2010-diciembre 2012 / Hyperglycemia and mortality in non-diabetic patients with severe head injury in the intensive care of the María Auxiliadora Hospital Unit. January 2010-December 2012

Objetivos: Determinar si la hiperglicemia incrementa la morbimortalidad en los pacientes no Diabéticos con traumatismo craneoencefálico en el Hospital María Auxiliadora. Método: Se estudiaron a los pacientes con diagnóstico de traumatismo encéfalo craneano grave en el hospital María Auxiliadora, durante Enero del 2010 hasta Diciembre 2012. Se describe las variables demográficas y clínicas de los pacientes, además se utilizó el modelo de regresión logística para determinar los factores asociados a la morbimortalidad en los pacientes. Resultados: Se analizaron 55 pacientes, que presentaron una media de edad de 37,82 años, el 80 por ciento fueron hombres. Se calculó una proporción de muertos del 7.2 por ciento. IC 95 por ciento (0,24-0,058). El análisis demostró que la hiperglicemia representan asociación significativa con la neumonía intrahospitalaria (p-valor=0,048) con un RR 1,9. La hiperglicemia de ingreso se ha relacionado con mayor número de días de necesidad de ventilación mecánica y mayor estancia hospitalaria permitiendo afirmar que la relación entre las variables es directa y significativa para un nivel de confianza del 99 por ciento. Conclusiones: La hiperglicemia incrementa el riesgo de presentar Neumonía Intrahospitalaria, mayor número de días de soporte ventilatorio y mayor estancia en la unidad de cuidados intensivos en pacientes con traumatismo craneoencefálico grave. No se encontró asociación entre hiperglicemia y mortalidad, fiebre, convulsiones e hipertensión endocraneana.

Traumatismo craneoencefálico en circunstancias no precisadas: presentación de un caso / Cranioencephalic trauma in unclear conditions: presentation of a case

Los traumatismos cráneoencefálicos constituyen la cuarta causa de muerte en nuestro país, y la primera en la población menor de 41 años de edad, responsables estos de dos tercios de las muertes, que se producen en un hospital general. Su tasa de incidencia global es aproximadamente de 200 x 100 000 habitantes. Teniendo en consideración la incidencia de este traumatismo en nuestro medio y la elevada mortalidad que alcanza, se aborda el caso que nos ocupa. Se trata de un adulto masculino de 43 años, que según datos aportados por la instrucción penal actuante, fue remitido al Hospital Provincial Docente Clínico Quirúrgico José R. López Tabrane, de Matanzas, el día 16 de mayo, después de haberse caído cuando iba para su casa y golpearse la cabeza con una columna situada afuera de la vivienda. Fue recogido inconsciente por el Sistema Integrado de Urgencias Médicas, remitido a nuestro centro, donde llega en coma profundo, arrefléctico, con escala de Glasgow en 3 puntos y acoplado a ventilador mecánico. Presentaba al ingreso gran aumento de volumen epicraneal extendido por toda la sutura sagital, sin otros signos de violencia en el exterior del cuerpo. Le realizaron tomografía axial computarizada de cráneo simple, observándose múltiples fracturas lineales en la bóveda craneana (parietal bilateral y frontal), diastasis de suturas coronal, sagital y lambdoidea, inundación del espacio subaracnoideo, cisternas de la base inundadas de sangre, sin efecto de masa o lesión expansiva. Fue trasladado a la Unidad de Terapia Intensiva, falleciendo el día 22 de mayo después de una parada cardiorrespiratoria(AU)

Cranioencephalic traumas are the fourth cause of death in our country, and the first one among the population aged less than 41 years, who are two thirds of the deaths taking place in a general hospital. Its global incidence rate is around 200 x 100 000 inhabitants. We present this case taking into consideration the incidence of this trauma in our environment and the high mortality it reaches. It is the case of a male patient aged 43 years who, according to data given by the acting penal instruction, was sent to the Provincial Teaching Clinicosurgical Hospital José Ramón López Tabrane, of Matanzas, on May 16, after falling in his way home and hitting his head against a column located outside of his house. He was unconsciously picked up by the Integrated Service of Medical Emergencies, and brought to our hospital, where he arrived in a deep coma, without reflexes, with 3 points in the Glasgow scale and mechanical ventilation. Entering the hospital he showed a great increase of the epicranial volume extended alongside the sagittal suture, without any other violence sign in the external part of the body. A computerized axial tomography of the simple cranium was carried out, showing multiple lineal fractures of the cranium (bilateral parietal and frontal), diastasis of coronal, sagittal and lambdoidal sutures, subarachnoid space flood, base cisterns flooded of blood, without mass effect or expansive lesion. He was remitted to the Intensive Care Unit, dying on May 22nd after a cardio pulmonary arrest(AU)

Internações por traumatismo cranioencefálico em Sergipe, de 2000 a 2011 / Hospitalization for traumatic brain injury in Sergipe, of 2000 to 2011

Objetivo: Avaliar o perfil epidemiológico das vítimas de traumatismo cranioencefálico (TCE) que tiveram internação hospitalar em instituições cobertas pelo Sistema Único de Saúde ? SUS, de 2000 a 2011. Método: Pesquisa descritiva com abordagem quantitativa. Utilizaram-se dados secundários provenientes do Sistema de Informações Hospitalares (SIH-SUS). Para o estudo, foram utilizados: taxa de internações por TCE por idade, sexo, ano, mês e duração da internação, óbitos hospitalares,diagnóstico secundário e valor da internação. Para fins de análise, foi utilizado o programa Tabwin. Resultados: O coeficiente de hospitalização em Sergipe variou de 22,8 a 38,1 por 100.000 habitantes e o coeficiente de mortalidade hospitalar foi de 4,5 por 100.000 habitantes por ano. As internações concentraram-se em homens (82,2%) e entre 20 a 39 anos (43,3%). A maior causa de internação e óbitos foram as causas cuja intenção é indeterminada (36,6% das internações e 42,4% dos óbitos),seguidas pelos acidentes de trânsito (33,2% e 32%, respectivamente). A letalidade hospitalar foi de 13,7%, sendo as agressões físicas e a faixa etária idosa as circunstâncias mais relacionadas ao óbito hospitalar. Conclusões: É necessário conhecer perfil da população acometida para traçar estratégiasindividuais e coletivas de prevenção desses agravos. O uso dos bancos de dados disponíveis é uma ferramenta valiosa nesse contexto

Objective: To evaluate the epidemiology of traumatic brain injury (TBI) who had hospitalization in institutions covered by the Unified Health System ? SUS, 2000-2011. Method: Descriptive research with quantitative approach. We used secondary data from the Hospital Information System (SIH-SUS).For this study, were used: rate of hospitalizations for TBI by age, sex, year, month and duration of stay, in-hospital deaths, secondary diagnosis and value of hospitalization. For purposes of analysis Tabwin was used. Results: The coefficient of hospitalization in Sergipe ranged from 22.8 to 38.1 per 100,000 inhabitants in the period and the Coefficient of in-hospital Mortality in period was 4.5 per 100,000 inhabitants per year. The hospitalizations were most on men (82.2%) and between 20 and 39 years (43.3%). The leading cause of hospitalization and death were the causes of indeterminate intent (36.6% of hospitalizations and 42.4% of deaths), followed by traffic accidents (33.2% and 32%, respectively). Hospital lethality was 13.7%, with assaults and elderly age group as the circumstances most related to hospital death. Conclusions: It is necessary to know the profile of the affected population to trace individual and collective strategies for prevention of these diseases. The use of available databases is a valuable tool in this context.