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Objetivo: Determinar si el score de trauma revisado es predictor de mortalidad intrahospitalaria en pacientes politraumatizados atendidos en el Hospital Belén de Trujillo. Material y métodos: Se realizó un estudio observacional, analítico, retrospectivo, transversal de pruebas diagnósticas, se identificaron pacientes que fueron admitidos por politraumatismo y fueron hospitalizados en el Departamento de Cirugía General durante el periodo comprendido entre enero del 2017 a diciembre del 2021; en una muestra de 100 pacientes se evaluó la mortalidad. Resultados: La edad promedio fue 47,18 ± 20,40 vs 41,13 ± 18,37 en aquellos que fallecieron y sobrevivieron; el 55% y 63,33% de los fallecidos y sobrevivientes fueron varones en los grupos de estudio. La coagulopatía, acidosis metabólica y SRIS estuvieron asociadas a la mortalidad. Se observó una proporción de 72,50% y 3,33% de RTS < 6 en los pacientes politraumatizados que fallecieron y sobrevivieron (p = 0,001); se obtuvieron valores de sensibilidad: 73% IC 95% [59% - 86%], especificidad: 97% IC 95% [92% - 100%], valor predictivo positivo: 94% IC 95% [85% - 100%] y valor predictivo negativo: 84% IC 95% [75% - 93%]. El área bajo la curva fue del 96,50% en la predicción de mortalidad por el RTS en pacientes con politraumatismo. Conclusión: El score de trauma revisado es un buen predictor de mortalidad en politraumatizados.

Copyright of Acta Médica Peruana is the property of Colegio Medico del Peru and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introducción. El objetivo de este estudio fue evaluar el impacto sobre la mortalidad según el perfil de ingreso a un centro de trauma del suroccidente colombiano, como método para entender las dinámicas de atención del paciente con trauma. Métodos. Se realizó un subanálisis del registro de la Sociedad Panamericana de Trauma asociado a un centro de trauma en el suroccidente colombiano. Se analizaron los pacientes atendidos entre los años 2012 y 2021. Se compararon los pacientes con condición de ingreso directo y aquellos que ingresaron remitidos. Se hicieron análisis de poblaciones de interés como pacientes con trauma severo (ISS > 15) y pacientes con/sin trauma craneoencefálico. Se evaluó el impacto de los pacientes remitidos y su condición al ingreso sobre la mortalidad. Resultados. Se incluyeron 10.814 pacientes. La proporción de pacientes remitidos fue del 54,7 %. Los pacientes que ingresaron remitidos presentaron diferencias respecto a la severidad del trauma y compromiso fisiológico al ingreso comparado con los pacientes con ingreso directo. Los pacientes remitidos tienen mayor riesgo de mortalidad (RR: 2,81; IC95% 2,44-3,22); sin embargo, es el estado fisiológico al ingreso lo que impacta en la mortalidad. Conclusión. Los pacientes remitidos de otras instituciones tienen un mayor riesgo de mortalidad, siendo una inequidad en salud que invita a la articulación de actores institucionales en la atención de trauma. Un centro de trauma debe relacionarse con las instituciones asociadas para crear un sistema de trauma que optimice la atención de los pacientes y la oportunidad.

Introducción. La población mundial crece y con ello los accidentes de tránsito, incrementando la morbimortalidad. La combinación de factores clínicos y paraclínicos mediante las escalas de trauma impacta en los desenlaces al permitir tomar acciones oportunas. Métodos. Estudio de corte transversal en el que se incluyeron pacientes con lesiones por colisión en accidentes de tránsito, atendidos entre 2017 y 2018, en urgencias del Hospital Universitario San José de Popayán, Colombia, un hospital de alta complejidad. Se recolectaron variables sociodemográficas y biológicas y se aplicaron tres escalas de trauma, Revised Trauma Score, Injury Severity Score y New Injury Severity Score. Posteriormente, se evaluó su rendimiento para predecir mortalidad. Resultados. Se atendieron en el servicio de urgencias 650 pacientes con lesiones en accidentes de tránsito y se presentaron 16 muertes. Al evaluar el rendimiento de las escalas de trauma se encontró que la sensibilidad para mortalidad varía entre el 75 % para Revised Trauma Score y el 93,8 % para Injury Severity Score y New Injury Severity Score, con una especificidad que varía entre 89,1 % y 96,8 %. Se identificó que la mejor razón de verosimilitud positiva fue para Revised Trauma Score, mientras que la mejor razón de verosimilitud negativa fue para Injury Severity Score y New Injury Severity Score. Conclusiones. Los resultados evidencian un adecuado rendimiento de las escalas de trauma evaluadas para predecir mortalidad. La escala que presentó mejor rendimiento fue Injury Severity Score por su sensibilidad, especificidad y razón de verosimilitud positiva.

Introducción: Uruguay no cuenta con estudios que reporten resultados de alcoholemias en traumatizados y menos aún su asociación con la severidad del trauma. Desde el año 2016 nuestro país cuenta con la llamada ley de tolerancia cero en base al supuesto de que la alcoholemia positiva representa un factor de riesgo para la severidad del trauma. Objetivos: Describir el perfil epidemiológico de los traumatizados y estudiar la asociación existente entre el consumo de alcohol y la severidad del trauma. Material y método: Estudio transversal; se incluyeron todos los pacientes que presentaron un evento traumático y fueron asistidos en el Departamento de Emergencia del Hospital de Clínicas durante el período 1 de marzo al 31 de agosto de 2017. Los datos se recopilaron prospectivamente y se extrajo muestra de alcoholemia a cada uno de los pacientes. Se consideraron diversas variables relacionadas con los pacientes y la severidad del traumatismo Se analizó la asociación entre las alcoholemias positivas y la severidad del trauma. Resultados: Se incluyeron 121 pacientes, 28% presentaron alcoholemia positiva y 27% presentaron trauma severo. La alcoholemia positiva se asoció con la severidad del trauma (p < 0,0001). No se encontró asociación entre el nivel de alcoholemia y la severidad del trauma (p = 0,323). Conclusiones: El consumo de alcohol se asocia significativamente con la severidad del trauma. Nuestro estudio muestra que los traumatismos son severos solo por el hecho de presentar alcoholemias positivas independientemente de su nivel, apoyando la implementación de la ley de tolerancia cero.

Background: Penetrating cardiac injury (PCI) is a rare injury with high morbidity and mortality. Aim: To analyze the evolution of clinical and anatomical characteristics, severity, morbidity and mortality of patients operated on by PCI. Materials and Methods: Analytical study of patients surgically treated for PCI at the “Guillermo Grant Benavente” Regional Clinical Hospital, Concepción, Chile. Two periods were analyzed: January-1990 to December-2004 and January-2005 to December-2019. Sex, age, associated injuries, trauma agent and mechanism, pathophysiological behavior, anatomic location of the injury, classifications of cardiac trauma: Attar, Saadia and OIS-AAST, TSI (trauma severity indices): ISS, RTS-T and TRISS, morbidity and mortality were compared according to periods. Statistical analysis was performed with SPSS25®, the chi-square, Fisher exact and Mann-Whitney tests were used. A p value < 0.05 was considered significant. Results: Total 235 PCI, 112 in the first period and 123 in the second. Stab as mechanism in 96 (85.7%) and 104 (84.6%) according to periods. An increase in associated extra thoracic injuries, cardiorespiratory arrest, and injury to the left location were observed in the second period. The cardiac trauma classifications and the TSI ISS, RTS-T and TRISS showed greater severity and probability of death in the second period patients. Mortality did not show differences: 14 (12.5%) and 14 (11.4%) according to periods, p = 0.792. Discussion: In our series, patients treated with PCI have evolved towards a more severity profile in both, physiological and anatomical parameters. Mortality has been stable over time. [ABSTRACT FROM AUTHOR]

Background: Trauma is a public health issue with a significant social and economic impact. However, national data on its characterization and the role of nursing in its management is still scarce. Objective: To assess the effectiveness of prehospital nursing interventions in stabilizing trauma victims provided by nurses of Immediate Life Support Ambulances in Portugal. Methodology: Observational, prospective, and descriptive-correlational study. Data were collected by nurses of the Immediate Life Support Ambulances in mainland Portugal, from 01/03/2019 to 30/04/2020, and the Azores, from 01/10/2019 to 30/04/2020. Trauma severity indices were assessed before and after the nursing interventions. Results: This study included 606 cases (79.4% blunt trauma; 40.8% road accidents) reported by 171 nurses. Nurses performed mostly interventions for hemodynamic support (88.9%) and non-pharmacological pain control (90.6%) of trauma victims. The nursing interventions improved the Revised Trauma Score and the Shock Index (p<0.001). Conclusion: Prehospital nursing interventions improve trauma victims' clinical status. [ABSTRACT FROM AUTHOR]

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Introducción. El trauma es una de las entidades con mayor morbimortalidad en el mundo. Los equipos especializados en la atención del paciente traumatizado son llamados <>. Dichos equipos surgieron de la necesidad de brindar tratamiento oportuno multidisciplinario a individuos con heridas que condicionan gran severidad en la guerra; sin embargo, con el paso del tiempo se trasladaron al ámbito civil, generando un impacto positivo en términos de tiempos de atención, mortalidad y morbilidad. El objetivo de este estudio fue describir el proceso de desarrollo de los equipos de trauma a nivel mundial y la experiencia en nuestra institución en el suroccidente colombiano. Métodos. Se realizó una búsqueda en la base de datos PUBMED, que incluyó revisiones sistemáticas, metaanálisis, revisiones de Cochrane, ensayos clínicos y series de casos. Resultados. Se incluyeron 41 estudios para esta revisión narrativa, y se observó que el tiempo de permanencia en el Emergencias, el tiempo de traslado a cirugía, la mortalidad y las complicaciones asociadas al trauma fueron menores cuando se implementan equipos de trauma. Discusión. El diseño de un sistema de atención y valoración horizontal de un paciente con traumatismos severos produce un impacto positivo en términos de tiempos de atención, mortalidad y morbilidad. Se hace necesario establecer los parámetros operativos necesarios en las instituciones de salud de alta y mediana complejidad en nuestro país para implementar dichos equipos de trabajo.

Objective: to identify factors associated to the time of death of trauma victims. Method: a retrospective cohort that analyzed autopsy reports of trauma victims admitted in 2015 at the Central Institute of Forensic Medicine of São Paulo, Brazil. The time of death was identified from the trauma moment to the confirmation of death. The generalized linear model was applied to analyze the data. Results: among the 1,500 fatal victims (75.7% were men; mean age of 49.7 years old), falls prevailed (33.5%), followed by aggressions (27.8%). The factors associated with the time of death were the number of body areas affected (p<0.001), type of trauma (p<0.001), gender (p=0.009), trauma severity according to the New Injury Severity Score (p<0.001), assaults (p>0.001), and intentionally self-harm injuries (p<0.001). Conclusion: women, victims of traumas with the intention of causing death and with high severity presented a reduced survival time after the injury(ies). [ABSTRACT FROM AUTHOR]

Identification of the influence of trauma severity and the in-hospital care at death, in victims of motorcycle accidents. Cross-sectional, quantitative study, considering 31 victims referred to the Hospital in northern Paraná, between December 2016 and March 2017. 80.6% of the victims were men and 48.4% of the occurrences took place during the daytime. The trauma scales, Injury Severity Score (TRISS), Revised Trauma Score (RTS) and Injury Severity Score (ISS) presented soft scores of low risks of death. There was evidence of association between trauma severity and death, 61.3% of the patients arrived at the hospital with bodily immobilizations; the trauma care protocol was used in 45.2% of cases; surgery comprised 43.4% of cases; there was an association of surgeries with the outcome of death and 90.3% of the victims had no infection. The severity of trauma and surgeries were associated with the outcome of death; all trauma victims should be treated according to the protocol. [ABSTRACT FROM AUTHOR]

Background: Thoracic trauma by firearms (TTF) are increasingly frequent. Aim: To describe clinical characteristics, morbidity and mortality and the evolution over time of patients hospitalized due TTF. Materials and Method: Longitudinal analytical study. Period January 1981 - December 2018. Database review, prospective protocols and clinical files. Microsoft Excel® spreadsheet and SPSS24® program with chi square and Mann-Whitney tests were used. Description of characteristics of TTF in hospitalized patients and comparison of TTF by periods. Trauma severity indexes (TSI) were calculated: Injury Severity Score (ISS), Revised Trauma Score (RTS-T), Trauma Injury Severity Score (TRISS). Results: Total: 4306 hospitalized patients due thoracic trauma (TT), 205 (4.8%) hospitalized due TTF. Men: 188 (91.7%), average age 28.8 ± 11.2 years, isolated TTF 115 (56.1%), associated with extrathoracic lesions 90 (43.9%), and of these 55 (26.8%) were considered polytraumatism. Mechanisms: aggression 193 (94.1%), self-harm 11 (5.4%) and accidental 1 (0.5%). Frequent thoracic injuries and/or findings: hemothorax 127 (62.0%), pneumothorax 96 (46.8%) and pulmonary contusion 51 (24.9%). Definitive treatment: Pleurotomy 88 (42.9%), surgery 71 (34.6%) and medical treatment 46 (22.4%). Median hospitalization 7 days. According TSI: Average ISS 16.7 ± 11.7, average RTS-T 11.1 ± 2.1, average TRISS 9.6. Morbidity: 44 (21.5%). Mortality: 14 (6.8%). There is an increase in polytraumatism and average TRISS, without changes in mortality. Discussion: The majority of TTF were isolated TT. Approximately one third of patients required surgery. The observed mortality is lower than expected. Changes in TTF were observed over time. [ABSTRACT FROM AUTHOR]

RESUMO Objetivo identificar estudos que realizaram ajustes na equação do Trauma and InjurySeverity Score (TRISS) e compararam a capacidade discriminatória da equação modificada com a original. Método Revisão integrativa de pesquisas publicadas entre 1990 e 2014 nas bases de dados LILACS, MEDLINE, PubMed e SciELO utilizando-se a palavra TRISS. Resultados foram incluídos 32 estudos na revisão. Dos 67 ajustes de equações do TRISS identificados, 35 (52,2%) resultaram em melhora na acurácia do índice para predizer a probabilidade de sobrevida de vítimas de trauma. Ajustes dos coeficientes do TRISS à população de estudo foram frequentes, mas nem sempre melhoraram a capacidade preditiva dos modelos analisados. A substituição de variáveis fisiológicas do Revised Trauma Score (RTS) e modificações do Injury Severity Score (ISS) na equação original tiveram desempenho variado. A mudança na forma de inclusão da idade na equação, assim como a inserção do gênero, comorbidades e mecanismo do trauma apresentaram tendência de melhora do desempenho do TRISS. Conclusão Diferentes propostas de ajustes no TRISS foram identificadas nesta revisão e indicaram, principalmente, fragilidades do RTS no modelo original e necessidade de alteração da forma de inclusão da idade na equação para melhora da capacidade preditiva do índice.

Copyright of Colombia Forense is the property of Universidad Cooperativa de Colombia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objetivo: Comparar a gravidade das lesões e do trauma mensurada pelas versões da Abbreviated Injury Scale 1998 e 2005 e verificar a mortalidade nos escores Injury Severity Score e New Injury Severity Score nas duas versões.Método: Estudo transversal e retrospectivo analisou lesões de pacientes de trauma, de três hospitais universitários do município de São Paulo, Brasil. Cada lesão foi codificada com Abbreviated Injury Scale 1998 e 2005. Os testes estatísticos aplicados foram Wilcoxon, McNemar-Bowker, Kappa e teste Z.Resultados: A comparação das duas versões resultou em discordância significante de escores em algumas regiões corpóreas. Com a versão 2005 os níveis de gravidade da lesão e do trauma foram significantemente reduzidos e a mortalidade foi mais elevada em escores mais baixos. Conclusão: Houve redução da gravidade da lesão e do trauma e alteração no percentual de mortalidade com o uso da Abbreviated Injury Scale 2005.

OBJECTIVE: to describe the quality of life of victims of traumatic brain injury six months after the event and to show the relationship between the results observed and the clinical, sociodemographic and return to productivity data. METHOD: data were analyzed from 47 victims assisted in a trauma reference hospital in the municipality of Aracaju and monitored in an outpatient neurosurgery clinic. The data were obtained through analysis of the patient records and structured interviews, with the application of the World Health Organization Quality of Life, brief version, questionnaire. RESULTS: the victims presented positive perceptions of their quality of life, and the physical domain presented the highest mean value (68.4±22.9). Among the sociodemographic characteristics, a statistically significant correlation was found between marital status and the psychological domain. However, the return to productivity was related to all the domains. CONCLUSION: the return to productivity was an important factor for the quality of life of the victims of traumatic brain injury and should direct the public policies in promoting the health of these victims.

Introducción. En el mundo se reconoce la importancia de los sistemas de registro de trauma. En Latinoamérica los sistemas disponibles de este tipo son poco confiables y no tienen continuidad. El del International Trauma System Development Program es el primero en implementarse en Colombia. Objetivo. Describir la experiencia de la implementación entre el 6 de enero y el 31 de julio de 2012 de un sistema de registro de trauma en dos hospitales de nivel III (equivalente al nivel I en complejidad de los hospitales en Estados Unidos) en Cali, Colombia. Método. El sistema de registro de trauma incluye información prehospitalaria y hospitalaria, y el estado al egreso del paciente, en tiempo real. Cada hospital tiene una estrategia para la captura electrónica de datos. Se presenta un análisis descriptivo y exploratorio de un ensayo piloto de siete meses. Resultados. Se registraron 9.080 pacientes en ambos hospitales. En el análisis global, el 67,1 % eran hombres; la edad promedio fue de 30 ± 20 años; el 68% eran mayores de 18 años. El 24,5 % de los pacientes fueron hospitalizados; de estos, 300 (13,5%) requirieron hospitalización en la unidad de cuidados intensivos. En cuanto a la gravedad del trauma, el 5,6 % de los pacientes tenía un puntaje de gravedad de las lesiones (Injury Severity Score, ISS) igual o mayor de 15. La tasa de mortalidad global fue del 3 %. Conclusión. Se logró la implementación del sistema de registro de trauma e identificar las causas de consulta, morbilidad y muerte por trauma. Esto contribuye al desarrollo de la investigación sobre pacientes con trauma, y a reorientar los servicios de urgencias y los del sistema regional de trauma y emergencias. Palabras clave: centros traumatológicos; índices de gravedad del trauma; puntaje de gravedad del traumatismo; registros electrónicos de salud.Introduction: The importance of the Trauma Registry System is recognized worldwide. The available TRS in Latin America are unreliable and have no continuity. The International Trauma Registry of the Panamerican Trauma Society – International Trauma System Developing Program (ITSDP) is the first one to be implemented in Colombia. Objective: To describe the experience with the implementation of a TRS at two third level of care hospitals (equivalent to complexity level I in the United States) in Cali, Colombia, in the period January 6 to July 31, 2012. Method: TRS includes prehospital, hospital, and discharge status in real-time. Each hospital has its own electronic data capture strategy. A seven-month period pilot trial descriptive analysis is presented. Results: 9,080 patients were registered, 67,1% were male; mean age was 30,2 ± 20 years, 68,0% older than 18 years; 24.5% were hospitalized, of which 300 (13,5%) required ICU. Regarding severity of trauma, 5,6% of patients had ISS ≥ 15. Overall mortality rate was 3,0%. Conclusion: Implementation of the SRT was feasible and allowed the identification the cause of presentation, morbidity, and mortality rates. This improves research on trauma better direction of the emergency and trauma services.

OBJETIVO: Descrever métodos e estimativas de mortalidade proporcional por mortes evitáveis e tipos de não conformidades do atendimento relacionadas a esses eventos. MÉTODOS: Revisão sistemática de publicações sobre mortes evitáveis em vítimas com traumatismos entre 2000 e 2009. Foi realizada pesquisa nas bases de dados Lilacs, SciELO e Medline utilizando-se a estratégia de busca com as palavras-chave "trauma", "avoidable", "preventable", "interventions" e "complications", e os descritores em ciências da saúde "death", "cause of death" e "hospitals". RESULTADOS: Identificaram-se 29 artigos publicados no período, com predomínio de estudos retrospectivos (96,5%). Os métodos mais comumente utilizados para definir a evitabilidade do óbito foram painel de especialistas ou pontuação de índices de gravidade, tendo sido empregadas as seguintes categorias: evitável, potencialmente evitável e não evitável. A média da mortalidade proporcional por mortes evitáveis dos estudos foi de 10,7% (dp 11,5%). As não conformidades mais comumente relatadas nas publicações foram sistema inadequado de atendimento ao traumatizado e erro na avaliação e tratamento. CONCLUSÕES: Observaram-se falhas na uniformização dos termos empregados para categorizar as mortes e as não conformidadades encontradas. Portanto, sugere-se a padronização da taxonomia da classificação das mortes e dos tipos de não conformidades observadas.OBJETIVO: Describir métodos y estimativas de mortalidad proporcional por muertes evitables y tipos de no concordancias de la atención relacionadas con tales eventos. MÉTODOS: Revisión sistemática de publicaciones sobre muertes evitables en víctimas con traumatismos entre 2000 y 2009. Se realizó investigación en las bases de datos Lilacs, SciELO y Medline utilizándose la estrategia de búsqueda con las palabras clave "trauma", "avoidable", "preventable", "interventions" y "complications" y los descriptores en ciencias de la salud "death", "cause of death" y "hospitals". RESULTADOS: Se identificaron 29 artículos publicados en el período, con predominio de estudios retrospectivos (96,5%). Los métodos más comúnmente utilizados para definir la prevención del óbito fueron grupo de especialistas o puntuación de índices de gravedad, y empleadas las siguientes categorías: evitable, potencialmente evitable, y no evitable. El promedio de la mortalidad proporcional por muertes evitables de los estudios fue de 10,7% (de 11,5%). Las no concordancias más comúnmente relatadas en las publicaciones fueron sistema inadecuado de atención al traumatizado y error en la evaluación y tratamiento. CONCLUSIONES: Se observó fallas en la uniformización de los términos empleados para categorizar las muertes y las no concordancias encontradas. Por lo tanto, se sugiere la estandarización de la taxonomía de la clasificación de las muertes y de los tipos de no concordancias observadas.OBJECTIVE: To describe methods of estimation and assess preventable deaths and types of errors related to health care. METHODS: A systematic review of articles on preventable trauma deaths published between 2000 and 2009 was conducted. Lilacs, SciELO and Medline databases were searched using the keywords "trauma," "avoidable," "preventable," "interventions" and "complications" and the health sciences descriptors "death," "cause of death," and "hospitals." RESULTS: A total of 29 articles published during the study period were selected. Most were retrospective studies (96.5%). The most common methods used to define avoidability of death were expert panel and injury severity scores. Deaths were categorized as follows: preventable; potentially preventable; and not preventable. The mean preventable death rate was 10.7% (SD 11.5%). The most commonly reported errors were inadequate care management of injured patients and evaluation and treatment errors. CONCLUSIONS: Inconsistent terms were used to categorize deaths and related noncompliances. It is suggested to standardize the terminology for the classification of deaths and types of errors.

The objective of this study was to verify if replacing the Injury Severity Score (ISS) by the New Injury Severity Score (NISS) in the original Trauma and Injury Severity Score (TRISS) form would improve the survival rate estimation. This retrospective study was performed in a level I trauma center during one year. ROC curve was used to identify the best indicator (TRISS or NTRISS) for survival probability prediction. Participants were 533 victims, with a mean age of 38±16 years. There was predominance of motor vehicle accidents (61.9%). External injuries were more frequent (63.0%), followed by head/neck injuries (55.5%). Survival rate was 76.9%. There is predominance of ISS scores ranging from 9-15 (40.0%), and NISS scores ranging from 16-24 (25.5%). Survival probability equal to or greater than 75.0% was obtained for 83.4% of the victims according to TRISS, and for 78.4% according to NTRISS. The new version (NTRISS) is better than TRISS for survival prediction in trauma patients.

Due to the threat postpartum hemorrhage poses, and the big magnitude it has had in our municipality, its behavior in seriously ill obstetric patients was described in a period of seven years at the 26 de Diciembre General Teaching Hospital in the municipality of Remedios . For it, a retrospective, descriptive and longitudinal study was carried out with 28 patients who presented this condition. The following results were obtained: the medical treatment needed the restoration of the volume in 100% of the patients and the surgical treatment showed that the hysterectomy was the main procedure (71.4%); the anesthesia used -according to the treatment- was the general endotracheal anesthesia (83.3%); 96.4 percent of the patients evolved satisfactorily, and the indicators of mortality and lethality appeared with 115 percent and 3.6 percent respectively. It was concluded that the restoration of volume was used in all the patients and the response to the emergency treatment and the evolution of the ill women with postpartum hemorrhage was satisfactory.

Introducción. Existe un amplio uso de la escala Injury Severity Score (ISS) como factor predictor de mortalidad en trauma. Algunos reportes han mostrado que es pobre factor predictor en pacientes con lesiones penetrantes graves. Recientemente, se ha usado el New Injury Severity Score (NISS) y se ha comparado con el ISS en trauma cerrado grave y trauma penetrante. Objetivo. Evaluar el comportamiento del NISS y del ISS en pacientes con trauma penetrante grave llevados a laparotomía de control de daños y en laparotomía convencional no de control de daños. Materiales y métodos. Se incluyeron pacientes adultos del Registro DAMACON. El NISS fue calculado retrospectivamente. Mediante un modelo de regresión logística se construyó la curva ROC (receiver operating characteristics) y el área bajo la curva (AUC) para comparar la capacidad discriminatoria de ambas escalas. Resultados. Se incluyeron 214 pacientes, 93 (43,4%) necesitaron laparotomía de control de daños. Entre los grupos, no hubo diferencias en la edad (32,3±10 años Vs. 30,3±10, p=0,12); ni en el sexo masculino (92,5% Vs. 90,1%, p=0,45). La gravedad del trauma por Revised Trauma Score (RTS) fue mayor en el grupo de laparotomía de control de daños comparado con el grupo de laparotomía convencional no de control de daños (6,21,9 Vs. 7,1±1,2, p=0,0022) al igual que la mortalidad a 30 días (35,5% Vs. 3,3%, pIntroduction. Despite the wide use of ISS as a mortality predictive score in trauma, several reports have shown that ISS is a poor predictor of outcome especially in patients with severe penetrating injuries. More recently, the use of New ISS (NISS) has been compared with ISS in blunt severe trauma and mild penetrating trauma. The purpose of this study was to evaluate the performance of NISS and ISS in patients with severe penetrating trauma, both in damage control (DC) and not damage control (no-DC) surgery. Methods. Consecutive adult patients with penetrating trauma and surgery were identified over a 6-years period (2003-2008) in our prospective trauma single center registry (DAMACON). NISS was estimated retrospectively. Logistic regression was used to construct ROC curves and areas under the curve (AUC) in order to compare the discriminative capacity among scores by type of surgical approach. Results. A total of 214 patients with penetrating trauma, 93 (%) needed DC surgery. Mean age for DC group was of 32.3±10 years old, RTS was 6.2±1.9, and 30 days mortality was of 35.5%. Compared with non-DC patients with mean age of 30.3±10.9 years old, RTS was 7.1±1.2 and 30 days mortality of 3.3%. NISS and ISS AUC were 0.86 and 0.72 respectively (P=0.01), for non-DC group; and 0.71 and 0.76 in DC group. Conclusion. NISS showed an improved performance for mortality prediction over ISS in the subgroup of patients with non-DC surgery for penetrating trauma, but not in DC setting. Furthermore, overall performance of the scores was sub-optimal in this setting. More efforts have to be made to identify new prognostic factors for this subgroup of very ill patients.

O trauma crânio-encefálico contuso (TCEC) é freqüentemente seguido pela amnésia pós-traumática (APT), caracterizada como um estado transitório de confusão e desorientação. Sua duração tem sido utilizada para quantificar a gravidade do TCEC e prever distúrbios nas funções cognitivas, assim como para antever as alterações na capacidade funcional das vítimas pós-trauma. O Galveston Orientation Amnesia Test (GOAT) é o primeiro instrumento sistematizado criado e o mais amplamente utilizado para avaliar a APT. Este artigo apresenta esse instrumento, as bases conceituais para seu desenvolvimento e a adaptação e validação do GOAT para cultura brasileira. Além disso, descreve sua aplicação e comenta as restrições do seu uso. Resultados de pesquisas realizadas em nosso meio contribuíram para as evidências sobre a validade do GOAT. Também apontaram os indicadores do momento pós-trauma em que o GOAT deve ser aplicado e destacaram as dificuldades no uso desse instrumento.El trauma cráneo-encefálico contuso (TCEC) es frecuentemente seguido por la amnesia pos-traumática (APT), caracterizada como un estado transitorio de confusión y desorientación. Su duración ha sido utilizada para cuantificar la severidad del TCEC y prever alteraciones en las funciones cognitivas, tanto como para antever las dificultades en la capacidad funcional de las víctimas pos-trauma. El Galveston Orientation Amnésia Test (GOAT) es la primera encuesta sistematizada que fue creada y el mas ampliamente utilizada para evaluar la APT. Esta publicación presenta esta encuesta, las bases conceptuales para su desarrollo y la adaptación y validación del GOAT para la cultura brasileña. Además, describe su aplicación y limitaciones en el uso. Resultados de pesquisas brasileñas contribuyeron para las evidencias sobre la validad del GOAT. También apuntaron los indicadores del momento pos-trauma en que el GOAT debe ser aplicado y destacaron las dificultades en el uso de esa encuesta.Closed head injury (CHI) is frequently followed by post-traumatic amnesia (PTA) and is characterized by a transitory state of confusion and disorientation. The PTA duration has been used to quantify the CHI severity and to predict disorders in cognitive functions, as well as to foresee any alteration in the functional capacity of post-trauma victims. The Galveston Orientation Amnesia Test (GOAT) is the first systematized instrument created, and the most broadly applied, to assess PTA. This article presents the GOAT, the conceptual basis for the development of the instrument, and its adaptation and validation to the Brazilian culture. In addition, the article describes the application of the instrument and makes comments on the restrictions of its use. Brazilian research results showed evidences of the GOAT's validity. They also point to the indicators of post-trauma conditions in which the GOAT must be applied, and highlight the difficulties in the application of the instrument.

The article is a bibliographic review which intends to present the actual range of researches comparing the Injury Severity Score (ISS) and the New Injury Severity Score (NISS). Databases were searched using the keyword NISS, with 42 articles, 23 of which didn't compare the two indexes. Most part of the 19 selected articles showed that NISS has been more accurate in predicting the outcomes (dependent variables) than ISS, moreover in severe and specific trauma. Studies with populations between 1,000 and 10,000 resulted in NISS-favorable results, whereas studies with populations larger than 10,000 or smaller than 1,000 showed either NISS-favorable results or no difference between the two groups. However, there were no studies showing ISS-favorable results. These results and the easier calculation of NISS lead to a future replacement of ISS by NISS.Estudio de revisión bibliográfica cuyo objetivo es presentar el panorama sobre investigaciones que utilizan el Injury Severity Score (ISS) en comparación con el New Injury Severity Score (NISS). Las búsquedas fueron realizadas en las bases de datos, utilizando el término NISS. Encontrados 42 artículos, 23 de los cuales no realizaron la comparación de los índices en cuestión. Gran parte de los 19 artículos seleccionados, encontraron que el NISS al ser comparado, mostró una mejor relación con los resultados del ISS, principalmente en lesiones graves y específicas. Para estudios cuyas muestras variaron entre 1.000 y 10.000 casos, se observaron resultados favorables para el NISS. Muestras superiores a 10.000 e inferiores a 1.000 mostraron tanto preferencia como igualdad para el NISS. En ningún estudio el ISS superó al NISS, para el caso del diagnósticos de situaciones analizadas. Estas observaciones y un mejor cálculo del NISS frente al ISS, parecen indicar la futura substitución del ISS por el NISS.Trata-se de revisão bibliográfica, cujo objetivo é apresentar o panorama das pesquisas que utilizam o New Injury Severity Score (NISS) e que o comparam com o Injury Severity Score (ISS). Foram realizadas buscas em bases de dados utilizando-se o termo NISS. Foram localizados 42 artigos, 23 não comparavam os índices em questão. A maioria dos 19 artigos selecionados afirmou que NISS se relacionou melhor com os resultados do que o ISS, principalmente em ferimentos graves e específicos. Em estudos, cuja amostra variou de 1.000 a 10.000 casos, observou-se resultado favorável ao NISS; amostras maiores que 10.000 e menores que 1.000 indicaram ora preferência ao NISS, ora igualdade. Em nenhum estudo o ISS superou o NISS para prever os eventos analisados. Essas observações e maior facilidade do cálculo do NISS em relação ao ISS direcionam a futura substituição do ISS pelo NISS.

Background. Burns have become an increasing problem of public health, in developping countries.. Objetive. To identify the epidemiology of burns trauma in the population that consults to the emergency room in children hospital “Rafael Henao Toro” of Manizales the city between 2004 and 2005 years. Materials and methods. A retrospective descriptive study was made based in the revision of 439 clinical histories, evaluating the of age, sex, social security, origin, geographic area, cause, depth, seriousness, percentage, and corporal area concerned. Results. Burns happened in patients of one year old (21,6%), masculine genre (59%) predominated. Most of the patients did not have social security, corresponding to 52,2%. 44,9% of patients living in the city. The main etiology were hot foods in 194 patients (44,2%). Burn of first degree in 78.1% was the most frequent, with moderate seriousness in 314 patients (71,5%). The most frequent corporal burned extension was of 2% in 15,3% of the total of the studied population, while the corporal region of greater commitment was the superior member in 111 patients (25,3%). The average of hospitalization was 11,99 days. Conclusions. Burns trauma was of greater frequency in children under, five years old, caused by hot foods, in superior member, and of moderate seriousness.

Introduction: Throughout the years, several methods have been developed to help determine injury severity and obtain accurate prognoses in trauma patients. Trauma scores that have been used for more than 40 years are extremely useful in clinical practice as well as in research. Objective: To conduct a review of the most relevant literature on trauma and to make a description of each of the scoring tools, focusing on their limitations and their application in clinical trials. Materials and methods: Narrative review conducted in different databases such as PubMed, ScienceDirect and OVID. A manual search was also conducted of articles on the subject in both English and Spanish. Results: The review articles provided an adequate description of each of the scores, the way they are calculated, the main limitations in their application, and the most relevant findings in the literature. Conclusion: There is a wide range of severity scores used in trauma patients for anticipating clinically significant outcomes with varying degrees of accuracy. Creating and validating a single, universally valid score is a huge challenge; consequently, the selection of the scoring tool is based, to a large extent, on experience, the context and the available evidence. [ABSTRACT FROM AUTHOR]

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Trata-se da análise das lembranças do período de internação referidas pelos pacientes que sofreram TCE de diferentes gravidades. O estudo foi realizado no ambulatório de Trauma de Crânio do Instituto Central do HC-FMUSP com amostra de 45 pacientes conscientes e capazes de manter entrevista. Predominaram pacientes do sexo masculino, adultos jovens, que tiveram como causas acidentes de trânsito e quedas. A maioria (86,0%) informou ter ficado desacordada em diferentes tempos de duração e nada recordar deste período. Naqueles que sempre estiveram alertas ou que acordaram ainda internados as lembranças relacionaram-se com ter visto, sentido, ouvido ou reagido a sons e procedimentos.Se estudiaron los recuerdos que enfermos de TCE de distinta gravedad tienen del periodo de hospitalización. El estudio fue realizado en el servicio de consulta externa de traumatismo del Cráneo del Instituto Central del HC - FMUSP y fueron entrevistados 45 enfermos conscientes y capaces de contestar preguntas. La mayoría de los enfermos eran del sexo masculino, jóvenes y víctimas de accidentes de tránsito y caídas. La mayoría de los enfermos (86%) dijeron no estar despiertos en todos los momentos y que no se recordaban de nada del periodo. Los recuerdos relatados por los que estuvieron despiertos y también por aquellos que se despertaron durante la hospitalización, eran sobre todo mirar, sentir, oír o reaccionar a sonidos y procedimientos.Traumatic brain injured (TBI) patients with different trauma severity were analyzed about their recollection concerning the period of hospitalization. The study was carried out in the Head Injury Outpatient Clinic at the Central Institute of the FMUSP Hospital including 45 conscious patients able to sustain an interview. Most patients were male, young adults with the major cause of trauma such as traffic accidents and falls. Most patients (86%) reported uncosciouness state of different time duration in their hospitalization period and were unable to remember anything related to that period. The predominant recollection reported by the patients who never had consciousness decreased after the trauma and that ones who had it but awoke during the hospitalization were: seeing, feeling, hearing, and reacting either to sounds and procedures.

Introducción. El manejo no operatorio del trauma esplénico cerrado es el método preferencial para la preservación esplénica; sin embargo, los criterios para decidir qué pacientes pueden ser manejados sin cirugía sigue siendo materia de debate. El objetivo de este estudio fue describir las características generales de estos pacientes, los resultados del manejo no operatorio y explorar los factores asociados a su falla. Métodos. Es un estudio descriptivo de los pacientes con diagnóstico de trauma esplénico cerrado, admitidos a un centro de atención de alta complejidad, durante el periodo comprendido entre enero de 2003 y marzo de 2009. Los pacientes se clasificaron en dos grupos: manejo operatorio y manejo no operatorio; en el último se analizaron los pacientes en los que falló dicho manejo. Un valor de p menor de 0,05 se consideró de significancia estadística. Resultados. Se incluyeron 82 pacientes. Después de la evaluación primaria o secundaria, el 25,6 % recibió manejo operatorio y, el 74,4 %, manejo no operatorio; el tratamiento no quirúrgico falló en el 22,9 %. Esta falla se asoció con un puntaje Injury Severity Score (ISS) mayor o igual a 20 (RR=6,4; IC95% 2,34-17,86), presencia de hemoperitoneo en la tomografía axial de ingreso (p=0,02) y el grado de lesión esplénica (p

Introduction: Currently ocular combat injuries are complex and associated with poor visual outcomes. Our objective is to characterize the military population that suffer land mine combat ocular trauma in Colombia and indentify the type of wound, treatment and visual outcomes. Methods: Retrospectively review of medical history of soldiers evaluated in Pablo Tobon Uribe Hospital, whom had land mine trauma during January of 2004 and December 2012. Results: 635 soldiers had land mine trauma, 153 of them had ocular trauma (226 eyes). Open ocular trauma was observed in 29.6%. The Ocular Trauma Score was calculated in 183 eyes, the initial visual acuity was not possible to be reported in the rest of them; the 45% of the eyes were classified in category 3. Three patients had no light perception in both eyes. 97.3% of the eyes received medical treatment and 49.1% had surgery also. Primary evisceration was made in 5.8% and enucleation in 1.8%. Intraocular foreign body was observed by ultrasonography in 11.1% and in 5.8% by orbital tomography. Eleven patients were legally blind at discharge. Conclusions: The ocular trauma related to a landmine is highly destructive at an ocular level. The treatments associated with better visual outcomes are primary closure of globe and systemic antibiotics; although the characteristics of the wound itself are the main prognostic factor. The Ocular trauma score is a useful tool for determining visual outcome in combat ocular trauma. [ABSTRACT FROM AUTHOR]

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Copyright of Journal of Nursing UFPE / Revista de Enfermagem UFPE is the property of Revista de Enfermagem UFPE and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

El Hospital Militar es el centro de referencia nacional del trauma de guerra. Se buscó identificar si los predictores de falla orgánica múltiple descritos se aplicaban a nuestra población: jóvenes con lesiones traumáticas severas. Se realizó un estudio observacional analítico de casos y controles anidado en una cohorte histórica, para lo cual se analizaron las historias clínicas de los pacientes con trauma entre enero de 1995 y diciembre de 1999. Se dividieron tres grupos: aquellos que desarrollaron falla orgánica múltiple, los que presentaron falla de órgano y los que no la presentaron. Se aplicaron escalas de severidad como APACHE lI, lnjury Severity Score, Revised Trauma Score; tiempos de atención, duración de procedimientos y base exceso, todos predictores de falla orgánica múltiple. Mediante un análisis de varianza se evaluaron los resultados así: recolección de datos completos en 124 pacientes. Edad promedio 27 años, discriminados así: 50 falla orgánica múltiple, 55 sin falla orgánica múltiple y 19 en falla de órgano. Mecanismos de trauma: proyectil de alta velocidad 47 pacientes (37,9%), accidente automovilístico 39 (31,4%), proyectil de baja velocidad 14 (11,2%), arma de fragmentación 13 (10,4%), caídas 8 (6,4%), arma cortopunzante 3 (2,4%). Valores de Apache II : falla orgánica múltiple: 15,4, falla de órgano 10,3, sin falla orgánica múltiple 8,8. Valor de lnjury Severity Score: falla orgánica múltiple 32,6, órgano: 18,5, sin falla orgánica múltiple: 15,6. Valor de Revised Trauma Score: falla orgánica múltiple: 5,37, órgano: 6,6, sin falla orgánica múltiple: 6,4. Duración de la primera cirugía: falla orgánica múltiple: 2,7 horas, órgano: 2,2h, sin falla orgánica múltiple: 2,2h. El desarrollo de falla orgánica múltiple se asoció a: Apache mayor de 15, base exceso menor de -11, lnjury Severity Score mayor de 32, proyectiles de alta velocidad, Revised Trauma Score menor de 5,37 y tiempos de atención prolongados.

El trauma vascular es causa común de consulta en los grandes centros de trauma del mundo y la lesión vascular es la razón más frecuente de síndrome compartimental que tratan los cirujanos. (1,2) Durante muchos años la fasciotomía ha sido la herramienta terapéutica más aceptada para el manejo del síndrome compartimental yen múltiples estudios se han demostrado sus bondades. (4·5) No obstante su utilidad, se convierte en la puerta de entrada para la infección en áreas musculares previamente afectadas por la isquemia. Mucho se ha escrito acerca de la fasciotomía como una herramienta terapéutica en cualquier extremidad, pero se acepta que esta muestra sus mejores resultados en la extremidad superior, teóricamente con base en la mayor tolerancia de la extremidad superior a los efectos del síndrome compartimental; las series muestran desproporción en el porcentaje de fasciotomías en pacientes con trauma vascular de las extremidades superiores en comparación con las inferiores. (57) Esta mejor tolerancia o la isquemia determinaría una mejor evolución clínica de las extremidades superiores que han requerido fasciotomía, con respecto a las extremidades inferiores. Sin embargo, en la literatura mundial no existen estudios que establezcan dicha diferencia ni que analicen que factores son responsables de ella. El objetivo del presente trabajo fue comprobar los características clínicas y complicaciones de los pacientes con trauma vascular de los extremidades superiores que requerido fasciotomía con respecto o las inferiores, para detector si existe diferencio en el pronóstico e identificar qué factores pueden explicar esto diferencia.