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Research Article
Luca GA Pivetta, José G Parreira, Cristiano Below, Giovanna Z Rondini Jacqueline AG Perlingero, José C Assef

Optimizing Chest X-ray Indication in Blunt Trauma Patients using Clinical Criteria

[Year:2017] [Month:January-April] [Volumn:6 ] [Number:1] [Pages:57] [Pages No:30-34][No of Hits : 1082]


Abstract

Background: There is an excessive number of unnecessary chest X-rays (CXRs) in minor blunt trauma patients.

Objective: To identify, using routine clinical criteria, a subgroup of blunt trauma patients that do not require CXR for assessment.

Materials and methods: This was a retrospective analysis of trauma registry data collected over a 24-month period. Adult blunt trauma patients undergoing CXR on admission were analyzed. The following clinical criteria were assessed: Normal neurologic examination on admission (NNEx), hemodynamic stability (HS), normal physical examination of the chest on admission (NCEx), age = 60 years, and absence of distracting injuries (Abbreviated Injury Scale >2 in head, abdomen, and extremities). These clinical criteria were progressively merged to select a group with lowest risk of exhibiting abnormal CXR on admission.

Results: Out of 4,647 patients submitted to CXR on admission, 268 (5.7%) had abnormal findings on scans. Of 2,897 patients admitted with NNEx, 116 (4.0%) had abnormal CXR. Of 2,426 patients with NNEx and HS, 74 (3.0%) had abnormal CXR. Of 1,698 patients with NNEx, HS, and NCEx, 24 (1.4%) had abnormal CXR. Of 1,347 patients with NNEx, HS, NCEx, and age<60 years, 12 had thoracic injury (0.9% of total individuals receiving CXR). A total of 4 patients underwent chest drainage. Among 1,140 cases with all clinical criteria, 8 had confirmed thoracic injuries and 2 underwent chest drainage.

Conclusion: A subgroup of blunt trauma patients with low probability of exhibiting abnormalities on CXR at admission was identified. The need for CXR in this subgroup should be reviewed.

Keywords: Clinical protocols, Decision making, Emergency medical services, Multiple trauma, Practice guidelines as topic, Radiography, Thoracic.

How to cite this article: Pivetta LGA, Parreira JG, Below C, Rondini GZ, Perlingero JAG, Assef JC. Optimizing Chest X-ray Indication in Blunt Trauma Patients using Clinical Criteria. Panam J Trauma Crit Care Emerg Surg 2017;6(1):30-34.

Source of support: Nil

Conflict of interest: None


 
Research Article
Ezequiel Monteverde, Laura Bosque, Betina Lartigue, Emilio Maciá, Cristian Barbaro, Claudio Ortiz, Enrique Ginzburg, Jorge Neira

Evaluacién de la Nueva Definición de Politrauma en una Cohorte de Pacientes de 10 Hospitales Argentinos

[Year:2017] [Month:September-December] [Volumn:6 ] [Number:3] [Pages:88] [Pages No:182-189][No of Hits : 877]


ABSTRACT

Introduction: Berlin definition of polytrauma from 2014 combines injury severity with at least one of five ancillary parameters (age, systolic blood pressure, Glasgow coma score, coagulopathy and acidosis). Until now there is insufficient evidence of this definition’s capability to identify higher risk of mortality patients. The objective of this investigation was to evaluate this definition’s performance to identify severely injured patients as compared with other current measures.

Materials and methods: Retrospective observational analysis was done on prospectively admitted patients to Fundación Trauma Registry in 10 Argentine hospitals between 2010 and 2016. The inclusion criteria were age > 15 years and complete data for scores calculation. Patients were compared across four definitions: polytrauma, multiple trauma (MulT), major trauma by major trauma_injury severity score (MT_ISS), and by major trauma_new injury severity score (MT_NISS). Performance measures were applied.

Results: We identified 2143 cases meeting MT_NISS definition, 1349 for MT_ISS, 802 for MulT and 259 for polytrauma. Polytrauma group was heterogenous, with a mortality rate ranging from 44% to 71% (resulting from different component combinations). About 75% were transport-injured and 76% had at least one AIS3+ head injury. Hospital outcome was related to condition at admission, physiologic impact revised trauma score (RTS) and injury severity (ISS-NISS). Observed to predicted survival ratio method trauma and injury severity score (TRISS) was 0.73. The comparison with the other definitions showed statistically significant differences in mortality but not in ISS, NISS, and RTS. Performance evaluation showed that MT_NISS had the highest sensibility and negative predictive value and polytrauma had the highest predictive value (PPV). MT_ISS had the highest precision (89%) and a specificity of 97%.

Conclusion: Polytrauma definition used to identify patients with the highest probability of death did not show any benefit when compared with other current measures. We consider that this definition needs to be validated in multicentric studies before being recommended as a new standard.

Keywords: Definition, Multiple trauma, Score, Severity, Trauma


 
Original Article
María F Escobar, Javier A Carvajal, Juan M Burgos, Adriana Messa, Carlos A Ordoñez, Alberto F García, Marcela Granados, Angélica M Forero, José D Casallas, Laura S Thomas, Albaro J Nieto

Damage Control Surgery for the Management of Major Obstetric Hemorrhage: Experience from the Fundación Valle Del Lili, Cali, Colombia

[Year:2017] [Month:January-April] [Volumn:6 ] [Number:1] [Pages:57] [Pages No:1-7][No of Hits : 699]


Abstract

Objective: The aim of this case series is to describe the experience of implementing damage control resuscitation (DCR) in patients with major obstetric hemorrhage (MOH) between January 2005 and December 2015 in the Fundación Valle del Lili, Cali, Colombia.

Materials and methods: This is a prospective descriptive study of a case series from 108 patients with MOH who were subjected to DCR. All patients were operated on using a standardized surgical technique in accordance with the institutional protocol.

Results: The median age was 28 years, with a gestational age of 38 weeks. The principal associated diagnosis was severe preeclampsia (in 39% of cases). A total of 96 patients presented massive postpartum hemorrhage, and 75% of these cases presented after a cesarean section. In all patients, normal control of bleeding was achieved, 60% during the first surgical period. The Acute Physiology and Chronic Health Evaluation score was 14, with an overall mortality of 6.48%, far below the expected mortality according to the clinical severity of these patients.

Conclusion: This study includes the biggest series of pregnant women with MOH, in a critical condition, in whom DCR was used, during which rapid control of bleeding was achieved, associated with a significantly lower mortality than expected.

Keywords: Emergency treatment, Hypovolemic shock, Postpartum hemorrhage, Surgical intensive care.

How to cite this article: Escobar MF, Carvajal JA, Burgos JM, Messa A, Ordoñez CA, García AF, Granados M, Forero AM, Casallas JD, Thomas LS, Nieto AJ. Damage Control Surgery for the Management of Major Obstetric Hemorrhage: Experience from the Fundación Valle Del Lili, Cali, Colombia. Panam J Trauma Crit Care Emerg Surg 2017;6(1):1-7.

Source of support: Nil

Conflict of interest: None


 
Original Article
Laura J Delgado Mateus, Ada M Bustos Guerrero, Andrés G Barco Manrique, Juan P Serrano Pastrana, Oscar F Herrán Falla, Laura I Valencia-Ángel

Ventana Pericardica: Abordaje Subxifoideo vs Toracoscopico En Trauma Precordial Abierto

[Year:2017] [Month:September-December] [Volumn:6 ] [Number:3] [Pages:88] [Pages No:135-141][No of Hits : 684]


ABSTRACT

Introduction: The pericardial window is the gold standard in the diagnosis of cardiac trauma in precordial wounds and different approaches are described. The aim of this study is to compare the clinical characteristics, outcomes, and diagnostic performance of subxiphoid vs. thoracoscopy in patients with open precordial trauma.

Study design: A 56-month observational study of cohorts collected patients with penetrating wounds in the precordial region was conducted. These patients were hemodynamically stable and admitted to the Emergency Department. They were asked to perform a pericardial window to rule out cardiac lesions. The clinical characteristics, outcomes, and diagnostic performance of the tests were compared.

Results: A total of 256 patients were included in the study. Around 93.4% were injured by a sharp gunshot wound, 18.8% of the pericardial windows were thoracoscopic, 20.8% were positive for hemopericardium, and 11.5% were subxiphoid. The median length of hospital stay was 4 days, we had 16.0% complications, 17.8% in subxiphoid approach, and 8.3% in thoracoscopic patients, with coagulated hemothorax being the most frequent, 15.2% were submitted to reintervention, most of them thoracoscopy for clotted hemothorax drainage (62.5%), mortality was 1.6%, all cases in the subxiphoid group. The sensitivity of the subxiphoid pericardial window was 95.8% and thoracoscopic 90.9%, and the specificity was 99.5% and 100% respectively.

Conclusion: The thoracoscopic approach is a diagnostic option with subxiphoid-like performance. In spite of establishing a decrease in the median of the days as users of thoracostomy tube, no decrease was observed in the days of hospital stay.

Keywords: Open precordial trauma, Pericardial window, Precordial wounds, Subxiphoid approach, Thoracoscopic approach.


 
Original Article
Erika TM Varona, Carlos AA Páez, Alejandro B Moreno

Artefactos Explosivos Improvisados, Atención En Ambientes Austeros

[Year:2017] [Month:May-August] [Volumn:6 ] [Number:2] [Pages:72] [Pages No:61-67][No of Hits : 650]


ABSTRACT

Introduction: The trauma of unconventional warfare has not yet been fully explored. The aim of this article is to identify the types of lesions in patients injured by improvised explosive devices (IED) in Colombia between February 2004 and May 2014 and tended to by a mobile surgical team in an austere environment (jungle), with limited resources. The patients were later admitted to a level four hospital for definitive managemen.

Materials and methods: This is an observational, descriptive study based on a historical cohort. Database of civilian patients and soldiers of Colombian military forces injured by explosive device and who received care in Advanced Groups of Trauma in austere environments near areas of war was analyzed; manual review of medical records was performed by recording injuries presented by patients on admission to level four health institution. Analysis was done with pivot tables, frequencies, trends, means, and modes of the data and the data were analyzed thereof.

Inclusion criteria: Patients who were registered in the database by participating physicians of Advanced Group of Trauma between 2004 and 2014 and patients who were victims of unconventional weapons of fragmentation were included.

Results: A total of 182 patients with age range of 23 years were reviewed. There were 158 orthopedic complications; the most common amputation occurred in 66.4%. Of these, infracondylar 64.2%, supracondylar 0.54%, and upper limbs 1.64%. According to military rank, soldiers consisted of 81.4% and officials 6%. The complications are as follows: Fat embolism 1.64%, osteomyelitis 2.94%, acoustic trauma 3.85%, ocular trauma 3.29%, facial trauma 7.14%, traumatic brain injury 0.54%, neuropathies 4.94%, no trauma 4.39%, sepsis by Klebsiella pneumoniae and Enterococcus faecalis 2.19%, fatality 0.54%.

Conclusion: In Colombia, between February 2004 and May 2014 IEDs were the most frequent cause of war wounded having musculoskeletal injuries, with predominance of infracondylar amputations with low infectious and deadly incidence.

Keywords: Austere, Improvised explosive devices, Landmines, Mobile surgical teams, Trauma, War wounded.


 
Original Research
Helena Facundo, Juan Manuel Troncoso

Abdomen Abierto y Presión Subatmosférica: Experiencia con un Sistema Artesanal

[Year:2016] [Month:January-April] [Volumn:5 ] [Number:1] [Pages:63] [Pages No:11-17][No of Hits : 1434]


ABSTRACT

Background: The need to keep an open abdominal cavity has been recognized and employed for 35 years ago. The development of continuous vacuum system has formed a new surgical approach to this problem.
Commercial systems are expensive, which limits its use. Several groups have reported local manufacturing systems with satisfactory results. Here, we report our experience in this regard and the technical details of the system we use.

Materials and methods: We described the technical aspects of artisanal vacuum system and a retrospective descriptive observational study in patients treated with abdominal continuous suction between January 2007 and March 2013.

Results: We described 77 cases. The first three diagnoses on admission were abdominal penetrating trauma (25 cases), intestinal obstruction (7 cases), and acute pancreatitis (6 cases). There were 42 cases with enterostomal fistula, 41 before the start of therapy. In 12 cases (28.6%), the fistula closed with medical treatment and in 14 (33.3%) with surgery. The percentage of closure of the abdominal cavity is 31%.

Conclusion: The complexity of patients with open abdomen and enterostomal fistulas, determined a significant morbidity and mortality. We consider the general principle of management with continuous vacuum system in the abdominal cavity and particularly to our system, is a valuable tool that enables skin protection, permanent drainage of the cavity and quantification of drainage; decreases the time to achieve abdominal closure and the number of surgeries.

Keywords: Intestinal fistula, Open abdomen, Subatmospheric pressure, Vacuum system.

How to cite this article: Facundo H, Troncoso JM. Abdomen Abierto y Presión Subatmosférica: Experiencia con un Sistema Artesanal. Panam J Trauma Crit Care Emerg Surg 2016;5(1): 11-17.

Source of support: Nil

Conflict of interest: None


 
Original Article
Lina V Mata, Francisco E Mora, Martha Quiodettis, Jaime Fischer, Gustavo M Machain, Juan C Salamea, Edgar B Rodas, Michel B Aboutanos

Panamerican Trauma Society Basic Trauma Education Course Administration in Resource-limited Areas

[Year:2016] [Month:May-August] [Volumn:5 ] [Number:2] [Pages:51] [Pages No:83-87][No of Hits : 1314]


ABSTRACT

Introduction and objectives: Injuries and noncommunicable diseases account for greater than 73% deaths and 76% disability adjusted life years (DALYs) in Latin America, where trauma care is challenging especially when resources are scarce. Education and training is a basic step in trauma systems development, which was shown to improve survival. Except for urban areas, trauma courses are unavailable and unaffordable in the Latin region. The aim of this study is to evaluate the feasibility of implementation of a basic trauma education course (BTC) for resource-limited areas adopted and promulgated by the Panamerican Trauma Society (PTS) since 2011.

Materials and methods: Basic trauma education course was administered in Paraguay, Medellin, Chile, and Panama during the PTS congresses (2011–2013). The two-day course was based on the patient’s pathway system, addressing the management of the patient through various echelon of care from rural health centers to local provincial hospital and tertiary treatment facilities. It contained 20 hours of didactic lectures and hands on skill labs on basic trauma resuscitation, stabilization, and transport, as well as trauma system-oriented teaching (triage, EMS, kinematics, trauma registries). Panamerican Trauma Society international and national instructors administered the courses. Course logistics and coordination were carried out by international and local coordinators and by trauma league medical students. Pre and post (30 multiple-choice questions) tests were used to assess participants. Paired t-test was used to compare scores.

Results: Fifty-four students (rural physicians, EMS providers, students, nurses, and administrators) participated. Pre and posttest score comparison showed significant improvement 74% vs 85% respectively, p-value < 0.0001.

Conclusion: A tailored trauma course and evaluation can be feasible in educating local providers. The PTS can promulgate the application of BTCs that may serve as a model for continuing trauma care education in developing countries. Course follow-up evaluation is pending.

Keywords: Basic trauma course, Trauma care in low and middle income countries, Trauma education.

How to cite this article: Mata LV, Mora FE, Quiodettis M, Fischer J, Machain GM, Salamea JC, Rodas EB, Aboutanos MB. Panamerican Trauma Society Basic Trauma Education Course Administration in Resource-limited Areas. Panam J Trauma Crit Care Emerg Surg 2016;5(2):83-87.

Source of support: Nil

Conflict of interest: None


 
Original Research
Juan S Calle Toro, Alvaro I Sanchez, Monica Morales, Alberto F Garcia

Trauma en ancianos – Experiencia de dos hospitales de referencia en Cali, Colombia

[Year:2016] [Month:January-April] [Volumn:5 ] [Number:1] [Pages:63] [Pages No:38-42][No of Hits : 1033]


ABSTRACT

Introduction: Trauma is a common cause of consultation to emergency service in Cali, Colombia. Among all emergency room visits 30% represent trauma, being 5th cause of death. The demographic characteristics and the pattern of trauma in the elderly have not been studied in detail in middle-income countries. The aim of our work is to characterize the lesions related trauma in elderly patients and identify possible preventive measures.

Methods: A secondary analysis of the database record of the Pan American Trauma Society implemented in two referral trauma centers in Cali, Colombia, during the period 2012-2013. A total of 65 patients were included. The variables analyzed were demographics, characteristics of injuries, trauma severity score (ISS), clinical admission information, and the final disposition of the patient.

Results: Of 14315 patients registered in the database, 1372 (10%) were older than 65 years. The average age of this group was 74 years (SD ± 9.7). 723 (53%) of patients studied were males. The mechanism of primary traumatic injury were falls in 984 (72%) followed by traffic-related events in 195 (14%). 95% of patients had an ISS <16. A total of 285 (20%) required surgery and 261 (19%) were transferred to another hospital for further medical management. The mortality in this group was 81 (6%) vs 715 patients (5%) overall mortality. The median hospital stay was 1 day (interquartile range 1-4).

Discussion: Elderly patients represent a proportion of patients had a low ISS. However, mortality of this age group outperformed the overall mortality. Many of elderly patients required surgery, taking this to increased morbidity / mortality and high economic costs. Primary prevention is necessary to reduce the impact on economic health and for the health system.

Keywords: Aged, Falls, Injury, Prevention, Trauma.

How to cite this article: Calle Toro JS, Sanchez AI, Morales M, Garcia AF. Trauma en ancianos - Experiencia de dos hospitales de referencia en Cali, Colombia. Panam J Trauma Crit Care Emerg Surg 2016;5(1):38-42.

Source of support: Nil

Conflict of interest: None


 
Original Research
Silvia Ines Guerrero, Juan Paulo Serrano, Laura Juliana Delgado, Dairon Gelvez

Prediccion de Morbilidad y Mortalidad de los Pacientes Con Trauma Penetrante Multiple A Traves de Diferentes Indices de Severidad en Trauma

[Year:2016] [Month:January-April] [Volumn:5 ] [Number:1] [Pages:63] [Pages No:31-37][No of Hits : 955]


ABSTRACT

Introduction: The severity of trauma indices are systems to classify and code lesions, describe objectively the conditions of each patient, indicating those with injuries more severe, the likelihood of survival and anticipate outcomes.

Objective: To determine which index severity best predicts morbidity and mortality in patients with multiple penetrating trauma.

Study design: Prospective, observational study, cohort. In a period of 13 months, we collected trauma patients admitted for penetrating trauma in University Hospital of Santander. We evaluated the relationship between severity indices (STNR, ISS, TRISS) with outcomes using logistic regression curves and prediction of mortality from each according to sensitivity, specificity and ROC curve.

Results: A total of 111 patients were included, 72% were admitted by short-stabbing wounds (HACP) and 28% weapon weapon Fire (HPAF). Mortality was 9.9%, being higher in the HPAF (23% vs. 5%). In patients with HACP, the area under the curve (ROC) for the RTSC was 0.225, and 0.148 for TRISS for ISS 0.68. In the group with HPAF, the area under the curve for RTSC was 0.247, for TRISS 0.190 and 0.735 ISS.

Conclusion: ISS was the more significant discriminatory value for evaluating the outcome (mortality). Initial pre-admission of patients to resuscitation centers affects the predictive value of RTSC and TRISS.

Keywords: Anatomical index, Morbidity, Mortality, Penetrating trauma, Physiological index, Severity index.

How to cite this article: Guerrero SI, Serrano JP, Delgado LJ, Gelvez D. Prediccion de Morbilidad y Mortalidad de los Pacientes Con Trauma Penetrante Multiple A Traves de Diferentes Indices de Severidad en Trauma. Panam J Trauma Crit Care Emerg Surg 2016;5(1):31-37.

Source of support: Nil

Conflict of interest: None


 
Original Research
Max N Brondfield, Stanley Sciortino, Catherine Juillard, Paula Fleisher, Laura A Schmidt, Rochelle Dicker

The Influence of Alcohol Outlets on Urban Trauma: A Pilot Study for Geospatial Modeling at a Fine Scale

[Year:2016] [Month:January-April] [Volumn:5 ] [Number:1] [Pages:63] [Pages No:1-10][No of Hits : 863]


ABSTRACT

Background: The association between alcohol availability and injury is known. Our pilot study seeks to model rates of trauma at the individual and census tract level to better understand the role of alcohol outlets (AOs) relative to socioeconomic factors thought to influence injury. Correlating alcohol availability and injury in a multilevel model may better inform policy measures to prevent trauma and create a safer urban environment.

Study design: Traumas in January-April 2013 (300 injury events) from an urban level 1 trauma center were analyzed with regard to injury severity score and blood alcohol level. Injury events and AO data acquired from the state Alcoholic Beverage Control were projected onto a map of census tracts, which included socioeconomic and demographic data from the U.S. Census Bureau (2009-2013). Traumas were stratified according to age, intentionality, and BAL screening. Ordinary least squares regression was performed to understand the relative contributions of AO, other dependent variables, and spatial autocorrelation.

Results: Positive BAL screens were associated with higher ISS among trauma victims. At the census tract level, density of off-sale AO per capita was the strongest correlated variable with all traumas (Rt2 = 0.52, p < 0.01) and those for which BAL was elevated on admission (Rt2 = 0.74, p < 0.01). Violent trauma showed the strongest association with on-sale AO per capita (Rvt2 = 0.17). However, levels of spatial autocorrelation were too high to validate model results. Socioeconomic variables were not significant.

Conclusion: Despite extensive autocorrelation among census tracts, preliminary modeling of trauma shows significant promise in better understanding the geospatial predictors of these events. While the influence of alcohol on trauma has been presumed in previous spatial analysis, this pilot represents a more robust approach through direct measures of BAL that can better inform understanding of spatial predictors for trauma.

Keywords: Alcohol outlet, Blood alcohol level, Multilevel modeling, Spatial analysis, Trauma.

How to cite this article: Brondfield MN, Sciortino S, Juillard C, Fleisher P, Schmidt LA, Dicker R. The Influence of Alcohol Outlets on Urban Trauma: A Pilot Study for Geospatial Modeling at a Fine Scale. Panam J Trauma Crit Care Emerg Surg 2016;5(1):1-10.

Source of support: This publication was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through UCSF-CTSI Grant Number UL1 TR000004. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.

Conflict of interest: None.


 
RESEARCH ARTICLE
Aníbal Alfonso Teherán, Oscar Javier Castro, Leonardo Laverde Frade

Incidencia y Características del Trauma Raquimedular en un Hospital de III Nivel, Bogotá 2011–2014

[Year:2016] [Month:September-December] [Volumn:5 ] [Number:3] [Pages:59] [Pages No:140-147][No of Hits : 852]


ABSTRACT

Introduction: The incidence of Spinal Cord Injury (SCI) for Latin America has been estimated from epidemiological researches of Brazil, so we decided to measure the incidence, distribution and features related to SCI in a reference level 3 institution.

Materials and methods: A descriptive retrospective study was done with patients attended during 5 years at a level 3 hospital. Monthly and annual SCI (IoSCI, CI95%) incidence was estimated; they were categorized by sociodemographic and clinical variables, among these: Conditions at hospital admission, severity of injury classification (AO, ASIA) and 6-month functional follow-up; a multiple correspondence analysis (MCA) was done, to extract component related with functional improvement at 6 months.

Results: A total of 174 cases were identified, median age of 45 years, men 75.3%; 70% were injured during work activity, none of that with labor accident insurance. The Io-SCI from the period was 1.34 cases/100 person-year (CI95%, 1.51-1.55). The average in-hospital length of stay was 12 days (LOS), with differences among AO classification, ASIA-admission, type of management (medical/surgical) and admission to ICU (p:0.000). Falls and motor vehicle crashes, both were the main cause (88.5%, 95% CI, 83.5-93.5%); lumbar and thoracic injuries, both were present in 75.3% of the cases; admission ASIA was D or E in 75% of the patients. Functional improvement at 6-months was present when, at admission, ASIA classification it was D and AO was C.

Conclusion: The Io-SCI was higher than other local series, the LOS was related with the type, place of treatment and severity of the injury; in turn, severity of injury was related with functional improvement at 6 months.

Clinic relevance: Colombia needs to create a surveillance system adjusted to international standard, to evaluate the impact of this condition.

Keywords: Spinal cord injury, incidence, ASIA classification, AO classification.


 
CASE REPORT
Fernando Spencer Netto, Tiago Cesar Mierzwa, Mariana Thalita Bertolin Silva, Luan Geraldo Ocaña de Oliveira, Djoney Rafael dos Santos, Jean Carlo Barbosa

Hérnias Diafragmáticas Traumáticas com Lesão Pericárdica: Apresentação e Complicaçoes Específicas

[Year:2016] [Month:September-December] [Volumn:5 ] [Number:3] [Pages:59] [Pages No:161-165][No of Hits : 791]


ABSTRACT

Introduction: Traumatic diaphragmatic hernia (TDH) may develop several complications. Pericardial injury increases the severity of this entity and may lead to specific presentation and complications, that require immediate attention to avoid significant morbidity and mortality.

Objective: This study aims to report two cases of traumatic diaphragmatic hernia with pericardial extension with specific presentation or complication.

Clinical Case: Case 1: 34-year-old male suffered a fall of level of 8 meters high. Computed tomography (CT) scan showed herniation of the stomach into the left chest cavity, intraperitoneal fluid and pelvis and acetabulum fractures. He underwent exploratory laparotomy due to hemodynamic instability. In the immediate postoperative period, high amount of bloody output through chest tube was observed, requiring thoracotomy. At surgery, ligation of a bleeding vessel of the pericardium was performed. He showed good postoperative evolution, being discharged three weeks later. Case 2: 54-yearoldmale was hit by a motorcycle. Computed tomography scan showed herniation of the stomach into the pericardial sac. He developed clinical signs of cardiac tamponade and underwent laparotomy, which showed intrapericardial diaphragmatic hernia. It was reduced with immediate, but transient hemodynamic improvement. However, the patient developed multiple organ dysfunction, and died 2 days after admission.

Conclusion: Traumatic diaphragmatic hernia (TDH) with pericardial extension may show specific presentation and complications, such as pericardial tamponade by abdominal viscera and pericardial bleeding that can cause death if not identified and treated quickly.

Clinical significance: Due to the high morbidity and mortality of pericardial injury associated to diaphragmatic hernia, its early diagnosis through imaging or surgery has great importance, enabling adequate surgical approach and may improve the clinical outcome of the patients.

Keywords: Blunt trauma, Pericardial injury, Traumatic diaphragmatic hernia.


 
Case Report
Alejandro J Pérez-Alonso, Carlos del Olmo-Rivas, Ignacio Machado-Romero, Patrizio Petrone

Fístula Aortoentérica Secundaria A Prótesis De Dacron

[Year:2016] [Month:January-April] [Volumn:5 ] [Number:1] [Pages:63] [Pages No:58-60][No of Hits : 776]


ABSTRACT

Introduction: The fistula aortoenteric (FAE) secondary to Dacron prosthesis implantation, is a rare and extremely serious complication, that suppose a diagnostic challenge.

Presentation of the case: We report a patient who suddenly presented upper gastrointestinal bleeding that required urgent complementary tests that led to the diagnosis of a retroduodenal periprosthetic collection and air bubbles, supporting the existence of a secondary FAE.

Conclusion: Although the exact mechanism of pathogenesis is unknown for now, mechanical and infectious factors seem to be the most common causes of post-surgical complication. The main aacepted theories are: bacterial infections at the staple line level of the prosthesis, damage to the small intestine during implantation, pseudoaneurysms, and intestinal ulcers.

Keywords: Aortic prosthesis, Aortoenteric fistula, Surgical treatment.

How to cite this article: Pérez-Alonso AJ, del Olmo-Rivas C, Machado-Romero I, Petrone P. Fístula Aortoentérica Secundaria A Prótesis De Dacron. Panam J Trauma Crit Care Emerg Surg 2016;5(1):58-60.

Source of support: Nil

Conflict of interest: None


 
Review Article
Andres M Rubiano, Raúl A Echeverri, Juan C Puyana

Fundamentos para la Elaboración de Manuscritos Científicos en Trauma y Cuidado Agudo de Emergencias (Parte 1): Cómo Elaborar y Cómo Presentar un Resúmen para Una Reunión Científica

[Year:2016] [Month:January-April] [Volumn:5 ] [Number:1] [Pages:63] [Pages No:52-57][No of Hits : 741]


ABSTRACT

Objective: Scientific abstracts are the most common way of show and share relevant information for advances in biomedical research. There are recomended methodologies for highquality abstract development in order to ensure a faster and optimal understanding by peer reviewers and the scientific community in general. The aim of this review is to discuss and present key elements for the development and presentation of scientific abstracts in trauma and acute emergency care.

Background: Over 10 million of biomedical scientific articles are published annually; these articles regularly comes from orally or written abstracts presented in scientific meetings. Many abstracts fails in ellaboration and does not allow an effective communication between the researcher and peer reviewers. Many of these failed abstracts does not successfully finish as a full article.

Results: A standardized methodology for the development of scientific abstracts is known as the IMRAD principle. This principle is an acronym that comes from the words, Introduction, Methods, Results, and Discussion. With the spread of this type of methodology, the quality of abstracts has improved dramatically. Still, only between 15 and 45% of the prepared abstracts become a full publication. The two most common reasons for nondeveloping the entire final document include the limited time availability of the principal investigator for the task and the difficulty in generating the entire document in a second language different to the native one.

Conclusion: There are standardized methodologies to produce high-quality scientific abstracts. It is duty of scientific associations from different specialties and subspecialties, to disseminate guidelines for the development of these abstracts.

Keywords: Acute care surgery, Research, Scientific abstract, Trauma.

How to cite this article: Rubiano AM, Echeverri RA, Puyana JC. Fundamentos para la Elaboración de Manuscritos Científicos en Trauma y Cuidado Agudo de Emergencias (Parte 1): Cómo Elaborar y Cómo Presentar un Resúmen para Una Reunión Científica. Panam J Trauma Crit Care Emerg Surg 2016;5(1):52-57.

Source of support: Nil

Conflict of interest: None


 
Original Article
Gerd D Pust, Marc M Grossman, David V Shatz, Fahim Habib, Louis Pizano, Tanya L Zakrison, Antonio Marttos, Gabriel Ruiz, Enrique Ginzburg, Nicholas Namias

The Rare Requirement of On-scene Extremity Amputations in the Entrapped Trauma Patient

[Year:2016] [Month:May-August] [Volumn:5 ] [Number:2] [Pages:51] [Pages No:93-100][No of Hits : 624]


ABSTRACT

Objectives: Entrapment of trauma patients in motor vehicle and other accidents is common. Frequently, Emergency Medical Services (EMS) personnel and firefighters are able to free the patient and initiate rapid transport to trauma centers. In rare circumstances, severe torso and extremity injuries combined with major entrapment may require complex rescue operations. These trauma patients spend the “Golden Hour” at the scene under difficult conditions. The objective of this review is to evaluate the role of the trauma surgeon leading the care at the scene of critically injured and entrapped trauma patients with possible need for surgical interventions.

Materials and methods: A 10-year review of all trauma surgeon to scene activations between 2005 and 2014 at the Ryder Trauma Center, an urban ACS Level 1 trauma center, was performed. An analysis of the trauma registry, individual cases, and surgical interventions was conducted.

Results: The University of Miami/Jackson Memorial Hospital (UM/JMH) Ryder Trauma Center and Miami Dade Fire Rescue have an established program in place for trauma surgeon to scene activations. During the study period, the on-call trauma surgeon was activated six times and traveled to the scene by air rescue helicopter four times, by ground in 1 case and in 1 case the patient expired before takeoff. One patient required on-scene amputation of an entrapped non-salvageable upper extremity. Two patients required on-scene amputation of bilateral lower mangled, entrapped extremities. One patient required a localized limb preserving surgical procedure to free him from entrapment. The incidence was 0.016% of 36,872 trauma alert activated patients evaluated at Ryder Trauma Center during the study period. Hemorrhagic shock, associated injuries, and long scene times were present in all patients. The survival of treated patients was 80%.

Conclusion: The need for on-scene amputations of nonsalvable extremities in entrapped trauma patients is rare. Experienced trauma surgeons should evaluate these patients and decide which interventions are necessary. All efforts should be made to salvage the limb. However, if the entrapped extremity appears nonsalvageable and the patient is in profound life-threatening shock requiring rapid transport, field amputation may be required. Policies, safety training and gear, supply kits, and partnerships with EMS are needed.

Keywords: Amputation, Entrapped, Extremity, Golden Hour, In-field, On-scene, Patient, Trauma.

How to cite this article: Pust GD, Grossman MM, Shatz DV, Habib F, Pizano L, Zakrison TL, Marttos A, Ruiz G, Ginzburg E, Namias N. The Rare Requirement of On-scene Extremity Amputations in the Entrapped Trauma Patient. Panam J Trauma Crit Care Emerg Surg 2016;5(2):93-100.

Source of support: Nil

Conflict of interest: None


 
Original Research
Álvaro I Sánchez, Alberto F García, Mauricio Velsquez, Juan Carlos Puyana

Predictors of Positive Subxiphoid Pericardial Window in Stable Patients with Penetrating Injuries to the Precordial Region

[Year:2016] [Month:January-April] [Volumn:5 ] [Number:1] [Pages:63] [Pages No:43-51][No of Hits : 578]


ABSTRACT

Background: Subxiphoid pericardial window (SPW) remains a valuable diagnostic tool for patients at risk of occult cardiac injuries. However, how to select patients that could benefit from this procedure remains unclear. We aimed to identify clinical predictors of positive SPW in patients with penetrating precordial injuries.

Materials and methods: Prospective data collection of 183 patients who underwent SPW for the exclusion of penetrating cardiac injuries during 2002 - 2004 at a level I trauma centre in Cali, Colombia. Patient’s demographics, clinical characteristics, and injury information were obtained. Independent predictors of positive SPW were assessed using stepwise logistic regressions.

Results: There were 41 positive SPW (22.4%). Unadjusted analyses demonstrated that stab/knife wounds (OR 2.48, 95% CI 1.17-5.25, p = 0.017), single wound (OR 14.61, 95% CI 1.9-110, p = 0.009), and clinical signs of pericardiac tamponade (OR 8.52, 95% CI 3.92-18.4, p < 0.001) were associated with increased odds of positive SPW. Conversely, systolic blood pressure (0.98, 95% CI 0.96-0.99) and stable physiological index (OR 0.31, 95% CI 0.14-0.65, p = 0.002) were associated with decreased odds. In multivariable analyses, signs of pericardiac tamponade (OR 6.37, 95% CI 2.78-14.6, p < 0.001), and single injuries (OR 12.99, 95% CI 1.6-102.7, p = 0.015) remained as independent predictors of positive SPW.

Conclusion: Emphasis on early recognition of the clinical signs of pericardiac tamponade could be the most important factor for the identification of occult cardiac injuries. Patients with multiple wounds to the precordial region who reached the hospital may not benefit from a SPW. However, high level of awareness is important because the incidence of occult cardiac injuries is not negligible.

Keywords: Cardiac tamponade, Penetrating cardiac injury, Precordial region, Subxiphoid pericardial window.

How to cite this article: Sánchez ÁI, García AF, Velásquez M, Puyana JC. Predictors of Positive Subxiphoid Pericardial Window in Stable Patients with Penetrating Injuries to the Precordial Region. Panam J Trauma Crit Care Emerg Surg 2015;4(3):43-51.

Source of support: Nil

Conflict of interest: None declared


 
Original Research
Paulo Raul Paglilla, Ruben Daniel Algieri, Maria Soledad Ferrante, Juan Pablo Fernandez, Juan Sebastián Ugartemendía, Ernesto Donnelly

Rol de la Simulación para la Conformación del Criterio y la Decisión en el Trauma

[Year:2016] [Month:January-April] [Volumn:5 ] [Number:1] [Pages:63] [Pages No:18-25][No of Hits : 571]


ABSTRACT

Introduction: Simulation workshops have been shown to promote learning basic skills in specialty and achieve psychomotor development. It is necessary to obtain adequate validation for application, security, and improving skills. The assessment accompanying the simulation must be done with criteria for reproducibility and continuous feedback that plays in critical thinking. The objective is to minimize adverse events.

Materials and methods: Retrospective, observational study. They were performed between 06/2013 and 05/2015, simulation workshops in 11 general surgery residents at Aeronautical Central Hospital. They were constantly evaluated, following international guidelines, using cognitive/surgical simulation.

Objectives: To demonstrate the usefulness of simulation in trauma for decision-making and the respective criteria.

Results: A total of 72.72% of residents were assessed. They participated in all simulation workshops. And 18.2% had participated in previous workshops. Before the simulation of the same case, 90.9% showed similar behaviors acquired previously and according to international guidelines. As for practical skills, substantial improvement was evident in proportion to the number of simulations.

Conclusion: Simulation is a useful tool, essential for training trauma surgeons. It should be supervised and with a continuous feedback. The results come from the use of checklists, based on international treatment standards.

Keywords: Aeronautical hospital, Checklist, Criterio, Education in trauma, Evaluation, Feedback, Simulation, Workshops.

How to cite this article: Paglilla PR, Algieri RD, Ferrante MS, Fernandez JP, Ugartemendía JS, Donnelly E. Rol de la Simulación para la Conformación del Criterio y la Decisión en el Trauma. Panam J Trauma Crit Care Emerg Surg 2016;5(1):18-25.

Source of support: Nil

Conflict of interest: None


 
Research Article
Marissa A Boeck, Kevin J Blair, J Esteban Foianini, Henry B Perry, Lina V Mata, Michel B Aboutanos, Adil H Haider, Mamta Swaroop

Implementation of a Hospital-based Trauma Registry in Santa Cruz de la Sierra, Bolivia: Methodology, Preliminary Results, and Lessons learned

[Year:2016] [Month:May-August] [Volumn:5 ] [Number:2] [Pages:51] [Pages No:101-112][No of Hits : 560]


ABSTRACT

Aim: Five million annual global deaths are attributable to injuries. Yet, a lack of reliable data leaves the true magnitude of injuries unknown in many low- and middle-income countries (LMICs), like Bolivia. Trauma registries provide a means of acquiring these data. We sought to evaluate methodology, preliminary results, and lessons learned during the implementation of a pilot, hospital-based trauma registry at one facility in Santa Cruz de la Sierra, Bolivia.

Materials and methods: Data collection occurred from January to September 2015 at Clínica Foianini, a private, 50-bed, third-level facility in Santa Cruz. A paper trauma registry form based on the Panamerican Trauma Society’s (ATS’s) essential elements model was utilized. Trained nurses completed forms at a trauma patient’s initial hospital presentation. Results were analyzed via descriptive statistics.

Results: The registry produced 91 forms over 8 months. An ICD-10 diagnosis code search of hospital visits showed 2,816 eligible patients, with a registry capture rate of 3.2%. Most were males (59.3%) in their mid-20s with head contusions (19.8%), penetrating/lacerating upper extremity (11.0%) or head (7.7%) wounds, or upper extremity fractures (6.6%). Many forms were missing critical data, with average omissions of 12.5 per form (26.0% of questions) and 23.7 per question (26.0% of subjects). Errors averaged 1.0 per form (2.1% of questions) and 2.0 per question (2.2% of subjects).

Conclusion: Early efforts to implement a paper-based trauma registry at one Bolivian hospital highlight areas for improvement, mainly within education, training, and oversight. Lessons learned will inform long-term objectives to make the registry a standard hospital program across the city, and eventually throughout Bolivia, arming decision-makers with data for targeted trauma initiatives that save lives.

Clinical significance: These results provide insight into trauma registry implementation in LMICs, which serves to further inform the Bolivian program and can be applied to comparable initiatives in similar settings.

Keywords: Bolivia, Burden of injuries, Developing world, Health system strengthening, Injury prevention, Other, Public health, Quality improvement, Trauma registry.

How to cite this article: Boeck MA, Blair KJ, Foianini JE, Perry HB, Mata LV, Aboutanos MB, Haider AH, Swaroop M. Implementation of a Hospital-based Trauma Registry in Santa Cruz de la Sierra, Bolivia: Methodology, Preliminary Results, and Lessons learned. Panam J Trauma Crit Care Emerg Surg 2016;5(2):101-112.

Source of support: Nil

Conflict of interest: None


 
Case Report
Apoorv Goel, Roli Bansal, Sarita Goel, Ayush Agarwal

Small Bowel Obstruction in a Young Female following an Unsafe Abortion: An Unusual Cause

[Year:2016] [Month:January-April] [Volumn:5 ] [Number:1] [Pages:63] [Pages No:61-63][No of Hits : 531]


ABSTRACT

The number of unsafe abortions has declined over the years in India but we still come across many cases and few of them with fatal complications. Usually such cases may present as bleeding per vaginum with features of sepsis and often instrumentation causing uterine or bowel injury. Our case is a 16 year old unmarried girl who had a history of 5 months of amenorrhea and underwent abortion by a quack in a village presented with features of frank small bowel obstruction due a rare unusual cause.

Keywords: Intra-abdominal fetus, Small bowel obstruction, Quacks, Unsafe abortion.

How to cite this article: Goel A, Bansal R, Goel S, Agarwal A. Small Bowel Obstruction in a Young Female following an Unsafe Abortion: An Unusual Cause. Panam J Trauma Crit Care Emerg Surg 2016;5(1):61-63.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Niveditha J Sagar, Chidananda Ramappa Devasamudra

Cheek Hematoma: A Rare Presentation

[Year:2015] [Month:January-April] [Volumn:4 ] [Number:1] [Pages:42] [Pages No:39-42][No of Hits : 4444]


ABSTRACT

Background: A 28-year-old lady presented with cheek hematoma on the right side after the self-fall. This patient had severe facial disfigurement due to diffuse swelling of cheek, discoloration of facial skin and sclera. The facial expressions were also compromised.

Materials and methods: Detailed history taken, examination done to rule out motor vehicle accident (MVA), domestic violence and central nervous system (CNS) involvement. Computed tomography scan was done to know the extent of hematoma and to rule out the oromaxillofacial bone fractures. Incision and drainage was done to remove the blood clot from the buccal space. Incision was given in the buccal mucosa to avoid external scar.

Result: Swelling was completely reduced on 3rd postoperative day. Facial movements and expressions were regained.

Conclusion: Intraoral Incision and drainage is the treatment of choice for cheek hematoma to reduce the size of the swelling and avoid external scar.

Keywords: Hematoma, Incision and drainage, External scar.

How to cite this article: Sagar NJ, Devasamudra CR. Cheek Hematoma: A Rare Presentation. Panam J Trauma Crit Care Emerg Surg 2015;4(1):39-42.

Source of support: Nil

Conflict of interest: None


 
CASE SERIES
Sofia Arízaga, Edgar Bruck Rodas, Raul Pino, Jeovanni Reinoso, Juan Carlos Salamea

Descending Necrotizing Cervicomediastinitis Secondary to Esophageal Perforation: Management in a Hospital with Limited Resources

[Year:2015] [Month:January-April] [Volumn:4 ] [Number:1] [Pages:42] [Pages No:23-29][No of Hits : 1496]


ABSTRACT

The esophageal perforation is the result of an iatrogenic cause, spontaneous cause or external trauma. The injury belonging to trauma can have different etiologies, such as the ones that are caused because of strange bodies or caustic substances. Within complications that can appear in esophageal perforation, we have the descending necrotizing mediastinitis, which is a mediastinal infection that starts in the oropharyngeal area. The spread of the infection through the anatomical spaces to the mediastinum can produce a mortality of 67%.

Keywords: Esophageal perforation, Trauma, Mediastinitis, Infection.

How to cite this article: Arízaga S, Rodas EB, Pino R, Reinoso J, Salamea JC. Descending Necrotizing Cervicomediastinitis Secondary to Esophageal Perforation: Management in a Hospital with Limited Resources. Panam J Trauma Crit Care Emerg Surg 2015;4(1):23-29.

Source of support: Nil

Conflict of interest: None


 
REVIEW ARTICLE
Luis Rafael Moscote-Salazar, Juan Camilo Pulido-Gutierrez, Sandy Zuleica Navas-Marrugo, Hernando Raphael Alvis-Miranda, Marticela Cabeza-Morales, Dagoberto Duarte-Misol, Gabriel Alcala-Cerra

Anemia y Traumatismo Craneoencefálico: Implicaciones Fisiopatologicas Para El Tratamiento Neurocritico

[Year:2015] [Month:January-April] [Volumn:4 ] [Number:1] [Pages:42] [Pages No:16-22][No of Hits : 1188]


ABSTRACT

Background: Traumatic brain injury (TBI) is a common entity worldwide, in the human body a series of events occur in the context of TBI, some occurimmediately and others are generated by the evolution of the injury and are, therefore, consequence of the severity. Within this contest, in this narrative review we will talk about the anemia associated to TBI, a highly alteration described in patients who have suffered TBI.

Keywords: Traumatic brain injury, Anemia, Hypoxia, Hemoglobin, Critical care, Transfusion.

How to cite this article: Moscote-Salazar LR, Pulido-Gutierrez JC, Navas-Marrugo SZ, Alvis-Miranda HR, Cabeza-Morales M, Duarte-Misol D, Alcala-Cerra G. Anemia y Traumatismo Craneoencefálico: Implicaciones Fisiopatologicas Para El Tratamiento Neurocritico. Panam J Trauma Crit Care Emerg Surg 2015;4(1):16-22.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Leonardo Serrano, Daniel Sacoto, Hernán Sacoto, Juan Carlos Salamea

Incidente de Múltiples Víctimas, Una Prueba Para un Sistema de Emergencias Nuevo, Sur de Ecuador, 2014

[Year:2015] [Month:January-April] [Volumn:4 ] [Number:1] [Pages:42] [Pages No:30-35][No of Hits : 1077]


ABSTRACT

Background: As cities grow, managing security is more complex, the government has invested more than 6 times in security, the creation of the integrated security system SIS ECU-911, articulates all agencies to respond to any situation contingency.1 Nevertheless, road safety statistics of national transit agency (ANT) indicate an increase in traffic accidents.2 The present study attempts to show the flaws that still has the security system in terms of operational coordination of response.

Design: Observational descriptive: a case report.

Results: The incident occurred 44 injured. The SIS ECU-911 was alerted. The first ambulance arrived 45 minutes. Triage and initial management was performed by paramedics, but this could not take control of the other victims, producing a nonsystematic evacuation of the remaining injured through the use of private vehicles. The SIS ECU-911 failed, causing delays in the transmission of information between them and the trauma center. In the reference hospitals, there was the unexpected arrival of the injured without prior training of personnel; while it could make proper initial in-hospital triage, was evident lack of material resources. In this case, the patient is the motor and driver, with a list of problems: (1) Lack of maintenance, (2) imprudence and inexperience and (3) excessive passengers.

Conclusion: The SIS ECU-911 in our country is new. There are shortcomings, to be resolved; however, we consider that targets on track. The implementation of periodic drills helps to detect flaws in the system in order to have a safer society. Equally, prevention campaigns, such as those currently being developed with the draft leagues trauma, could prevent future accidents.

Keywords: Accidents, Traffic, Trauma center, Emergency plans, Emergency medical services.

How to cite this article: Serrano L, Sacoto D, Sacoto H, Salamea JC. Incidente de Múltiples Víctimas, Una Prueba Para un Sistema de Emergencias Nuevo, Sur de Ecuador, 2014. Panam J Trauma Crit Care Emerg Surg 2015;4(1):30-35.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL RESEARCH
Camila Issa Azevedo, Aparecida Andrade Ribeiro Franciscani, Amanda Baraldi Souza, Fabio Mendes Botelho Filho, Sizenando Vieira Starling, Domingos André Fernandes Drumond

Blunt Hepatic Trauma: Suggested Algorithm for Surgical and Nonoperative Management

[Year:2015] [Month:January-April] [Volumn:4 ] [Number:1] [Pages:42] [Pages No:1-5][No of Hits : 1000]


ABSTRACT

Objective: This study aims to analyze the outcomes of blunt hepatic trauma, and compare operative treatment (OT) and nonoperative management (NOM) emphasizing the stratified results by grade of injury and failure rate.

Materials and methods: This is a prospective study of cases admitted to João XXIII Hospital, located in Belo Horizonte, Brazil, from January 2013 to December 2013. Patients were admitted with blunt hepatic trauma on emergency room (ER) and were divided into two groups. One group contained patients who met the criteria for NOM, and the other group was formed by patients with surgical indication.

Results: During the study period, 47 patients were admitted with blunt liver injury and 43 (91.4%) met the inclusion criteria for NOM. The rate of NOM failure was 9.3%: 50% of them had grade II injury and 50% had grade V. The patients with grade II injury had also extrahepatic lesions and, in those with grade V, the failure was due to bleeding.

Conclusion: Nonoperative management has become the standard of care for patients with blunt liver injuries in trauma centers. However, as grade V injuries have a higher failure rate, they might receive special attention from the surgical team.

Keywords: Liver, Wounds, Wounds and injuries, Nonoperative, Laparotomy.

How to cite this article: Azevedo CI, Franciscani AAR, Souza AB, Filho FMB, Starling SV, Drumond DAF. Blunt Hepatic Trauma: Suggested Algorithm for Surgical and Nonoperative Management. Panam J Trauma Crit Care Emerg Surg 2015;4(1):1-5.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL RESEARCH
Aparecida Andrade Ribeiro Franciscani, Camila Issa Azevedo, Amanda Baraldi Souza, Maria Helena Almeida Costa, Sizenando Vieira Starling, Domingos André Fernandes Drumond

Nonoperative Management of Blunt Renal Trauma

[Year:2015] [Month:January-April] [Volumn:4 ] [Number:1] [Pages:42] [Pages No:6-10][No of Hits : 914]


ABSTRACT

Objective: To analyze patients with blunt renal trauma who were managed conservatively, with emphasis on clinical presentation, grade of injury, complication and failure rates.

Materials and methods: A prospective observational study was conducted in Hospital João XXIII, between January and December 2013. Patients with blunt renal trauma and nonoperative management (NOM) were analyzed during this period. Data were collected in respect to: age, gender, mechanism of trauma, grade of injury, clinical presentation, revised trauma score (RTS), associated abdominal injuries, length of hospital stay and failure, complication and mortality rates.

Results: During this period, 27 patients with blunt renal trauma were suitable for nonoperative approach. The most common mechanisms of trauma were motor vehicle accidents (59.2%) and falls (22.2%) and the mean length of hospital stay was 10.5 days. The majority of the patients had grade II (48.1%) and III (29.6%) injuries, with mean RTS of 6.93. The complication rate was 3.7% and the mortality rate was 7.4%. All deaths were related to associated injuries. One patient with grade II injury required nephrectomy. This patient had concurrent injuries.

Conclusion: Blunt renal trauma can be successfully managed conservatively, with low complication rates. Nonoperative management is safe in stable patients and in environments with appropriated protocol for this approach.

Keywords: Kidney, Blunt injuries, Renal trauma, Nonoperative.

How to cite this article: Franciscani AAR, Azevedo CI, Souza AB, Costa MHA, Starling SV, Drumond DAF. Nonoperative Management of Blunt Renal Trauma. Panam J Trauma Crit Care Emerg Surg 2015;4(1):6-10.

Source of support: Nil

Conflict of interest: None


 
Original Research
Raúl Barros Gruezo, Jair Díaz Martínez

Manejo Conservador del Trauma Penetrante de Tórax, Casuística de 2 Años en Hospital Universitario del Valle en Cali, Colombia, un Importante Centro de Trauma

[Year:2015] [Month:September-December] [Volumn:4 ] [Number:3] [Pages:92] [Pages No:188-193][No of Hits : 834]


ABSTRACT

Chest injury represents one of the greatest challenges in the comprehensive management of trauma patients because of the high morbidity and mortality caused by complications and high costs of healthcare. Most chest injuries are managed by simple maneuvers such as tube thoracostomy, only 10 to 15% of patients need surgical treatment. Hemopneumothorax is most commonly found in chest trauma with a prevalence of 52.3%, followed by 23.4% hemothorax and pneumothorax in 20%. Up to 30 to 80% of patients with tracheobronchial injury die at the scene. This study of a retrospective collection of data included patients from trauma registry, who suffered penetrating chest trauma over a period of 2 years and were treated at the university hospital. A total of 587 patients had this type of trauma, a total of 257 were operated, of which 224 were discharged and 33 died; of the 330 patients who were not operated 262 were discharged and 62 died. Most were men; 247 were injured by gun fire. Penetrating chest trauma is fatal depending on the compromised structure and yet conservative management is feasible in selected patients. As against global statistics, operated cases exceed 15%. The importance is that the volume of critically ill patients with surgical need is great and it is a priority to identify those who would benefit from conservative management.

Keywords: Casuistry major chest trauma, Conservative management of chest trauma, Penetrating chest trauma.

How to cite this article: Gruezo RB, Martínez JD. Manejo Conservador del Trauma Penetrante de Tórax, Casuística de 2 Años en Hospital Universitario del Valle en Cali, Colombia, un Importante Centro de Trauma. Panam J Trauma Crit Care Emerg Surg 2015;4(3):188-193.

Source of support: Nil

Conflict of interest: None


 
Observational Retrospective Study
Ana Cláudia Marchi Barros, Guilherme Damaceno Pereira, Marília França Madeira Manfrinato, Mariane Christina Savio, Camila de Souza Justini, Rafaela de Araujo Molteni, Fábio Henrique de Carvalho, Adonis Nasr

Análise Retrospectiva de Pacientes Vítimas de Trauma Cervical Penetrante Submetidos À Cervicotomia

[Year:2015] [Month:May-August] [Volumn:4 ] [Number:2] [Pages:65] [Pages No:96-102][No of Hits : 815]


ABSTRACT

Objectives: Penetrating neck injuries are, for the majority caused by firearms or knives and the concept of a selective surgical management is the current approach in treating these patients. The present work aims to evaluate the demographic profile of patients suffering from cervical penetrating trauma for the presence or absence of injury, the type of injury found during surgery, plus the outcomes.

Materials and methods: We studied 57 patients with cervical trauma penetrating treated at Hospital worker in Curitiba (Brazil), in the period April 2009 to March 2014.

Results: The main trauma mechanisms were: stab wound (52.6%), injury by firearm (40%); 61% of them occurred in zone II. 91% of patients were male, with an average age of 33.1 years. 43.8% of them had some associated injury. 46% underwent preoperative imaging. In 82.5% who had surgery injury was found. Common were: vascular (68%), airway (47%) and esophagus (11%). Mean operative time was 118 minutes. 17.5% of patients had some type of complication postoperatively. The average time of hospitalization was 9 days. Death occurred in 7% of patients, all of them had associated injuries.

Conclusion: Men young adults are the most affected. All patients who died presented some type of injury associated. Operation was therapeutic when there were isolated cervical lesions. However, in 17.5% of patients undergoing surgery, no lesion was found. More studies are needed to guide the management of patients with cervical penetrating trauma.

Keywords: Cervical trauma, Cervicotomy, Hard signs.

How to cite this article: Barros ACM, Pereira GD, Manfrinato MFM, Savio MC, de Souza Justini C, de Araujo Molteni R, de Carvalho FH, Nasr A. Análise Retrospectiva de Pacientes Vítimas de Trauma Cervical Penetrante Submetidos À Cervicotomia. Panam J Trauma Crit Care Emerg Surg 2015; 4(2):96-102.

Source of support: Nil

Conflict of interest: None


 
Original Research
Silvia Inés Guerrero Macías, Juan Paulo Serrano Pastrana, Dairon Gelves Lizcano, Laura Juliana Delgado Mateus

Indices de Trauma: Prediccion del Desenlace

[Year:2015] [Month:September-December] [Volumn:4 ] [Number:3] [Pages:92] [Pages No:172-179][No of Hits : 790]


ABSTRACT

Introduction: The severity of trauma indexes are systems to assess, classify and code injuries. They describe objectively the conditions of each patient, indicating those with more severe injuries, the probability of survival and help to provide morbid outcomes.

Objective: To establish the severity trauma index which best predicts morbidity and mortality in patients with multiple penetrating trauma.

Study design: Prospective, observational, cohort study. During 13 months, we collected all patients admitted for multiple trauma penetrating in the Universitary Santander’s Hospital. We evaluated the association between the severity trauma indexes (RTSc, ISS, TRISS) and the outcomes, using logistic regression curves and the mortality prediction of each one, according to the sensitivity, specificity and ROC curve.

Results: One hundred and eleven patients were included, 72% were admitted for stab wounds (SW) and 28% by gunshot wounds (GW). Mortality was 9.9%, more common in the SW group (23 vs 5%). In the SW group, the area under the curve (ROC) for RTSc was 0.225, for TRISS 0.148 and ISS 0.68. In the group with GW, the area under the curve (ROC) was 0.247 for RTSc, 0.190 for TRISS and 0.735 for ISS.

Conclusion: The ISS had the most significant and discriminatory value. In our local clinical context, the ISS has proven to be of good value in predicting clinical outcomes (mortality). The initial resuscitation of the trauma patient, before arriving to the healthcare centers, affects the predictive value of RTSc and TRISS at the initial evaluation.

Keywords: Anatomic index, Mortality, Penetrating trauma, Physiologic index, Trauma severity index.

How to cite this article: Macías SIG, Pastrana JPS, Lizcano DG, Mateus LJD. Indices de Trauma: Prediccion del Desenlace. Panam J Trauma Crit Care Emerg Surg 2015;4(3):172-179.

Source of support: Nil

Conflict of interest: None


 
REVIEW ARTICLE
Alan Henry Tyroch, Kinzie Matlock

Pediatric and Adult Blunt Traumatic Bladder Rupture: A Comparative Review

[Year:2015] [Month:January-April] [Volumn:4 ] [Number:1] [Pages:42] [Pages No:11-15][No of Hits : 778]


ABSTRACT

Background: To determine the incidence, features and associated injuries of pediatric bladder rupture (BR) vs adult BR due to blunt trauma.

Materials and methods: A retrospective study from 1st January 2001 to 31st December 2012 was performed for blunt traumatic BR in pediatric and adult patients. Demographics, mean injury severity score, mean length of stay, incidence, mortality, diagnostic modality, management and associated injuries were evaluated.

Results: Of 4,884 pediatric blunt trauma admissions, eight children had BR. Sixty-six adults sustained BR out of 18,283 blunt trauma admissions. Gross hematuria was present in a majority of both groups. Computed tomography (CT) cystogram was the most frequent diagnostic modality utilized. Pelvic fracture and intra-abdominal injury were the most commonly associated injuries in both groups.

Conclusion: Although blunt traumatic BR is extremely rare, BR is associated with high injury severity score, prolonged length of stay and associated injuries. Diagnosis and treatment are essentially identical for both population. All patients with gross hematuria (with or without pelvic fracture), microscopic hematuria with anterior pelvic fracture and pelvic fracture with pelvic fluid on CT scan warrant evaluation with cystography. Intraperitoneal BR and combined intraperitoneal and extraperitoneal BR should be repaired operatively. Most extraperitoneal BR may be treated nonoperatively with transurethral catheter.

Keywords: Bladder rupture, Bladder injury, Urologic trauma, Urologic injury, Pediatric, Adult, Trauma.

How to cite this article: Tyroch AH, Matlock K. Pediatric and Adult Blunt Traumatic Bladder Rupture: A Comparative Review. Panam J Trauma Crit Care Emerg Surg 2015;4(1):11-15.

Source of support: Nil

Conflict of interest: None


 
REVIEW ARTICLE
Frederico José Ribeiro Teixeira Jr, Sérgio Dias do Couto Netto, Francisco Salles Collet e Silva, Newton Djin Mori, Belchor Fontes, Renato Sergio Poggetti, Dario Birolini, Celso Oliveira Bernini, Edivaldo M Utiyama

Complex Perineal Injuries in Blunt Trauma Patients: The Value of a Damage Control Approach

[Year:2015] [Month:May-August] [Volumn:4 ] [Number:2] [Pages:65] [Pages No:87-95][No of Hits : 760]


ABSTRACT

Purpose: In a previous work, we presented a protocol for the management of patients with complex pelviperineal injuries (CPI) resulting from blunt trauma. This treatment protocol included: early hemorrhage control, surgical debridement of devitalized tissue, selective loop transverse colostomy according to the location of the perineal wound, distal colonic irrigation with saline solution, pulsatile saline solution irrigation of the perineal wound, maintenance of the perineal wound open, management of bone fractures and visceral injuries, surgical revisions at intervals of 24 to 48 hours, presumptive antibiotic therapy, early nutritional support, and definitive repair of wound defect and visceral injuries after infection control and metabolic recovery. In order to determine whether the evolution of the authors’s protocol for the assessment and management of patients with CPI is associated with improved patient outcome we conduct this review.

Materials and methods: The medical records of 42 patients with CPI resulting from blunt trauma admitted in the level I trauma center at the HC-USPSM, were reviewed. Demographic data, mechanism of trauma, revised trauma score (RTS) and injury severity score (ISS), classification of perineal injuries, associated systemic trauma, infection complications and mortality rates (overall, early and late) were collected.

Results: The early mortality was 19% and the late mortality was 17%. The overall mortality was 36%. Patients who died had higher average ISS (average ISS = 45) comparing to patients who survived (average ISS = 25) with significant statistical difference (p < 0.05). Damage control principles applied to CPI was the standard of care and a selective approach to perform fecal stream diversion were used.

Conclusion: The results of this study showed that the use of this protocol was effective and reinforced the importance of the priority in early control of hemorrhage, early fecal diversion in selected cases, multiple surgical perineal revisions, and avoidance of complex visceral injury repair at the first surgical intervention.

Keywords: Blunt trauma, Complex pelviperineal injuries, Open pelvic fracture, Pelvic injury, Perineum.

How to cite this article: Teixeira Jr FJR, do Couto Netto SD, Collete e Silva FS, Mori ND, Fontes B, Poggetti RS, Birolini D, Bernini CO, Utiyama EM. Complex Perineal Injuries in Blunt Trauma Patients: The Value of a Damage Control Approach. Panam J Trauma Crit Care Emerg Surg 2015;4(2):87-95.

Source of support: Nil

Conflict of interest: None


 
Original Research
Amadeus Uribe, Claudia Steiia Rodriguez, Carlos A Ordoñez, Mónica Morales, Raó Ivatury, Michael Aboutanos

Reporte del Registro de Trauma de la Sociedad Panamericana de Trauma. Un año de Experiencia en dos Hospitales de la Ciudad de Cali

[Year:2015] [Month:September-December] [Volumn:4 ] [Number:3] [Pages:92] [Pages No:109-123][No of Hits : 745]


ABSTRACT

Introduction: In Latin America, trauma is the leading cause of death. This social situation requires optimization of information systems to implement trauma care systems. The SPT trauma registry began in Cali. The report of the first year in two hospitals of high complexity of the city presented.

Methodology: A descriptive analysis of trauma registry data in two hospitals in the city, private one (FVL) and other public (HUV) took place in the period between 01-01-12 and 31-12-12, including demographic information, mechanisms of trauma, severity (ISS) and mortality.

Results: Out of 17,288 patients, 10,417 (60.26%) in the FVL and 6,871 (39.74%) were recorded at the University Hospital, the mean age was 29.9 ± 19.8 years [patients under 18,4920 (28.5%), and 6,777 (39.2%) between 18 and 35 years]. Suspicion of violence was 0.8% vs 28.7% in FVL in HUV. Accidents at work were 49% at FVL vs 5.6% HUV. 29.7% (5131) were hospitalized, of which 1251 (12%) in the FVL and 3880 (56.5%) were hospitalized in HUV. At FVL 463 patients required ICU (4.4%) and at HUV 194 (2.8%). The most common mechanism falls corresponded to 37.2%. The deadliest was the HPAF mechanism. The overall mortality was 444 (2.6%), 112 (112%) in the FVL and 332 (4.8%) in the HUV.

Conclusion: In the first year, 17,288 patients were registered, trauma characteristics are very similar in the public and private hospital. Finding low mortality in both, but more hospitalizations in the public, associated with an increased number of deaths of moderate severity. The implementation of a trauma registry was achieved in Colombia.

How to cite this article: Uribe A, Rodriguez CS, Ordoñez CA, Morales M, Ivatury R, Aboutanos M. Reporte del Registro de Trauma de la Sociedad Panamericana de Trauma. Un año de Experiencia en dos Hospitales de la Ciudad de Cali. Panam J Trauma Crit Care Emerg Surg 2015;4(3):109-123.

Source of support: Nil

Conflict of interest: None


 
Original Research
Diego Alejandro Vivas-Giraldo, Gerardo Linares-Mendoza, Norberto Navarrete-Aldana, Carlos Hernan Carmargo-Mila, Karen Stephany-Perdomo, Luis Arcadio Cortés-Puentes

FAST-E en Pacientes con Trauma Abdominal Cerrado Estable, en un Departamento de Urgencias en Colombia

[Year:2015] [Month:May-August] [Volumn:4 ] [Number:2] [Pages:65] [Pages No:59-65][No of Hits : 662]


ABSTRACT

To improve and adapt different types of trauma care systems, based on international guidelines and to avoid significant increase in mortality and disability, we focus on a subgroup of patients who are abdominal trauma patients that present with hemodynamic stability. In recent years abdominal ultrasonography (FAST has managed to reduce time in decision-making, and reduce complication rate in these patients. In our observational study of 65 patients with high mechanism blunt thoracoabdominal trauma and negative EFAST, only 3% required further investigation after an observational period with CT scan.

Keywords: Blunt abdominal trauma, FAST.

How to cite this article: Vivas-Giraldo DA, Linares-Mendoza G, Navarrete-Aldana N, Carmargo-Mila CH, Stephany-Perdomo K, Cortés-Puentes LA. FAST-E en Pacientes con Trauma Abdominal Cerrado Estable, en un Departamento de Urgencias en Colombia. Panam J Trauma Crit Care Emerg Surg 2015;4(2):59-65.

Source of support: Nil

Conflict of interest: None


 
Original Research
Adalid González, Pablo Ottolino, Noedvith Rosendi, Luis Rodríguez, Laura Medina, Emilio Bello, Luis Camacho, Luis Richard

Características Clínico—Epidemiológicas del Trauma en Adolescentes, Durante el Período 2012 – 2013 en el Hospital General Del Este ‘Dr Domingo Luciani’ Caracas, Venezuela

[Year:2015] [Month:September-December] [Volumn:4 ] [Number:3] [Pages:92] [Pages No:180-187][No of Hits : 660]


ABSTRACT

Worldwide injuries are the leading cause of death in children, adolescents and young adults, being an important public health problem because its consequences are transcendent in magnitude and impact.

Objective: To determine the clinical-epidemiological features of trauma in adolescents during the period 2012 to 2013 in the East General Hospital ‘Dr Domingo Luciani ‘aracas- Venezuela.

Methods: A retrospective descriptive study, where 1,521 adolescents ages between 13 and 18 years old were included, admitted to the Multiple Trauma Unit ‘Dr Fernando Rodriguez Montalvo’ at East General Hospital, during the period January 2012 to December 2013, taken as variables age group, sex and kinematics of trauma, such as automobile accidents, motorcycle, bicycle, rollovers, falls from height, burns, stab wounds and fire as well as unknown mechanism.

Results: A prevalence of trauma in males of 77.9% and the most frequent age group was 18 years with 30.8% was found. According to the mechanism of injury obtained, they were with higher percentages motorcycle accidents (39.5%) and injuries by firearms (28.4%).

Conclusion: The number of trauma adolescent patients has been rising, leading to permanent disability and loss of productive future of the country, so, it is important to increase the number of educational, preventive measures and security and compliance, in order to reduce all the known consequences.

Keywords: Traffic accidents in adolescents, Trauma in adolescents, Use safety belt and helmet, Youth violence.

How to cite this article: González A, Ottolino P, Rosendi N, Rodríguez L, Medina L, Bello E, Camacho L, Richard L. Características Clínico-Epidemiológicas del Trauma en Adolescentes, Durante el Período 2012 - 2013 en el Hospital General Del Este ‘Dr Domingo Luciani’ Caracas, Venezuela. Panam J Trauma Crit Care Emerg Surg 2015;4(3):180-187.

Source of support: Nil

Conflict of interest: None


 
Original Research
Catrina Cropano, Tomaz Mesar, David Turay, David King, Daniel Yeh, Peter Fagenholz, George Velmahos, Marc A de Moya

Pneumothoraces on Computed Tomography Scan: Observation using the 35 Millimeter Rule is Safe

[Year:2015] [Month:May-August] [Volumn:4 ] [Number:2] [Pages:65] [Pages No:48-53][No of Hits : 635]


ABSTRACT

Introduction: The management of a pneumothorax (PTX) either by observation or with a tube thoracostomy (TT) has long been dictated by practitioner discretion rather than objective criteria. Many physicians elect to routinely place a TT for traumatic PTX, particularly when patients undergo positive pressure ventilation (PPV). Placement of unnecessary TT exposes patients to avoidable morbidity and may prolong hospitalization. Based on prior work establishing a cutoff, we hypothesized that all PTXs ≤ 35 mm in patients who have no physiologic derangement may be safely observed without TT regardless of the need for PPV.

Materials and methods: Retrospective review of all patients diagnosed with a PTX between 1/2009 and 2/2013. All PTXs visible on chest computed tomography (CT) were identified. Any patient with an associated significant hemothorax or those patients who were moribund were excluded. All PTXs were measured by measuring the perpendicular distance of the largest air pocket between the chest wall and the mediastinal or pulmonary structure. Management of the PTX was categorized as observation or TT. Observed PTXs were labeled as success or failure with failure defined as enlargement of the PTX or physiologic deterioration, requiring a TT.

Results: Out of 165 PTXs, 17 (10.3%) measured >35 mm, whereas 148 (89.7%) measured ≤35 mm. Of the 17 > 35 mm, 15 (88.2%) received immediate TT. Of the two PTXs >35 mm which were observed, one received a delayed TT for a pleural effusion (6 days after PTX diagnosis) and one (5.9 %) was safely observed. Of the 148 PTXs which measured ≤ 35 mm, 10 (6.8%) received immediate TT. Of the 138 remaining PTXs, 129 (93.5%) were safely managed without TT. Six (4.3%) of the PTXs initially observed eventually required TT placement for enlargement of the PTX. Only one of those six had manifested ongoing desaturations prior to TT. The remaining three cases received TT for reasons unrelated to the PTX. Of the 27 PPV cases in the ≤35 mm cohort, none contributed to the six failures. A cutoff measurement of 35 mm demonstrated a negative predictive value (NPV) of 95.7% in its ability to predict successful observation of the PTX with an area under the receiver operating characteristic (ROC) curve of 0.90.

Conclusion: All PTXs measuring ≤35 mm perpendicular to the chest wall without physiologic derangement may be safely observed independent of the need for mechanical ventilation.

Keywords: Chest tube, Drainage, Pneumothorax.

How to cite this article: Cropano C, Mesar T, Turay D, King D, Yeh D, Fagenholz P, Velmahos G, de Moya MA. Pneumothoraces on Computed Tomography Scan: Observation using the 35 Millimeter Rule is Safe. Panam J Trauma Crit Care Emerg Surg 2015;4(2):48-53.

Source of support: Nil

Conflict of interest: None


 
Original Research
Claudia Stella Rodríguez Gómez, Amadeus Uribe, Carlos A Ordoñez, Mónica Morales, Rao Ivatury, Michael Aboutanos

Reporte de la Tendencia del Trauma Pediátrico en dos Hospitales de Cali en el 2012

[Year:2015] [Month:September-December] [Volumn:4 ] [Number:3] [Pages:92] [Pages No:124-135][No of Hits : 598]


ABSTRACT

Introduction: Accidents are the leading cause of mortality and major public health problem worldwide in children over one year, given the impact of the permanent disabilities that cause traumatic injuries in children. In Colombia, most pediatric injuries can be avoided, so, it is important to implement and promote prevention strategies that could reduce the incidence of trauma cases up to 80%.

Objective: To estimate the landscape of pediatric trauma and injury mechanisms, identifying possible future prevention strategies in two hospitals in the city of Cali in 2012.

Methodology: Retrospective descriptive study population of age <18 from trauma registry in 2012 at two hospitals in Cali (HUV and FVL). The sociodemo