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Serna CA, Caicedo Y, Salcedo A, Rodríguez-Holguín F, Serna JJ, Palacios H, Pino LF, Leib P, Peláez JD, Fuertes-Bucheli J, García A, Ordoñez CA. De un centro de trauma a un sistema de trauma en el suroccidente colombiano. REVISTA COLOMBIANA DE CIRUGÍA 2022. [DOI: 10.30944/20117582.2287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
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.
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Quiroga-Centeno AC, Serrano-Pastrana JP, Neira-Triana KA, Valencia-Ángel LI, Jaimes-Sanabria MZ, Quiroga-Centeno CA, Gómez-Ochoa SA. Epidemiología del trauma en Bucaramanga, Colombia: análisis del registro institucional de trauma en el Hospital Universitario de Santander. REVISTA COLOMBIANA DE CIRUGÍA 2022. [DOI: 10.30944/20117582.2128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. El trauma es una de las principales causas de mortalidad a nivel mundial y representa un problema de salud pública. En Latinoamérica y particularmente en Colombia, son escasos los registros de trauma que se han desarrollado satisfactoriamente. El objetivo del presente estudio fue describir la epidemiología del trauma en el Hospital Universitario de Santander, en el primer año de implementación del registro de trauma institucional.
Métodos. Personal del Departamento de Cirugía General de la Universidad Industrial de Santander y el Hospital Universitario de Santander, iniciaron el diseño del registro de trauma en el año 2020. Se incluyeron todos los pacientes que ingresaron al hospital, incluso los que fallecieron en el servicio de urgencias. La implementación del registro se inició el 1 de agosto de 2020, previa realización de una prueba piloto. Los informes se recogieron automáticamente y se exportaron a una base de datos electrónica no identificada.
Resultados. Se evaluaron 3114 pacientes, el 78,1 % de ellos hombres, con una mediana de edad de 31 años. La mediana de tiempo prehospitalario fue de tres horas y lo más frecuente fue el ingreso por propios medios (51,2 %). El mecanismo de trauma más frecuente fue el penetrante (41,8 %), siendo la mayoría de heridas por arma cortopunzante (24,9 %). El trauma cerrado se presentó en el 41,7 % de los pacientes evaluados y el 14,4 % de la población se encontraba bajo el efecto de sustancias psicoactivas. El servicio de Cirugía general fue el más interconsultado (26,9 %), seguido del servicio de cirugía plástica (21,8 %). La mediana de estancia hospitalaria fue de dos días (Q1:0; Q3:4) y 75 pacientes (2,4 %) fallecieron durante su hospitalización.
Conclusión. El registro de trauma de nuestra institución se presenta como una plataforma propicia para el análisis de la atención prehospitalaria e institucional del trauma, y el desarrollo de planes de mejora en este contexto. Este registro constituye una herramienta sólida para la ejecución de nuevos de proyectos de investigación en esta área.
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Dasari M, Johnson ED, Montenegro JH, Griswold DP, Jiménez MF, Puyana JC, Rubiano AM. A consensus statement for trauma surgery capacity building in Latin America. World J Emerg Surg 2021; 16:4. [PMID: 33516227 PMCID: PMC7847173 DOI: 10.1186/s13017-021-00347-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 01/18/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Trauma is a significant public health problem in Latin America (LA), contributing to substantial death and disability in the region. Several LA countries have implemented trauma registries and injury surveillance systems. However, the region lacks an integrated trauma system. The consensus conference's goal was to integrate existing LA trauma data collection efforts into a regional trauma program and encourage the use of the data to inform health policy. METHODS We created a consensus group of 25 experts in trauma and emergency care with previous data collection and injury surveillance experience in the LA. region. Experts participated in a consensus conference to discuss the state of trauma data collection in LA. We utilized the Delphi method to build consensus around strategic steps for trauma data management in the region. Consensus was defined as the agreement of ≥ 70% among the expert panel. RESULTS The consensus conference determined that action was necessary from academic bodies, scientific societies, and ministries of health to encourage a culture of collection and use of health data in trauma. The panel developed a set of recommendations for these groups to encourage the development and use of robust trauma information systems in LA. Consensus was achieved in one Delphi round. CONCLUSIONS The expert group successfully reached a consensus on recommendations to key stakeholders in trauma information systems in LA. These recommendations may be used to encourage capacity building in trauma research and trauma health policy in the region.
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Affiliation(s)
- Mohini Dasari
- University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | | | | | - Dylan P. Griswold
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital & University of Cambridge, Cambridge, UK
- Stanford School of Medicine, Stanford, CA USA
| | | | - Juan Carlos Puyana
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213 USA
| | - Andres M. Rubiano
- MEDITECH Foundation, Santiago de Cali, Valle de Cauca, Colombia
- Institute of Neuroscience, Universidad El Bosque, Bogotá, Colombia
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Uribe Buritica FL, Carvajal SM, Torres N, Bustamante Cristancho LA, García Marín AF. Equipos de trauma: realidad mundial e implementación en un país en desarrollo. Descripción narrativa. REVISTA COLOMBIANA DE CIRUGÍA 2021. [DOI: 10.30944/20117582.650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
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 <<equipos de trauma>>. 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.
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Carvajal S, Uribe-Buritica FL, Ángel-Isaza AM, López-Girón MC, González A, Chica J, Benitez M, García AF. Trauma team conformation in a war-influenced middle-income country in South America: is it possible? Int J Emerg Med 2020; 13:36. [PMID: 32664900 PMCID: PMC7362569 DOI: 10.1186/s12245-020-00297-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/23/2020] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Trauma teams (TTs) improve outcomes in trauma patients. A multidisciplinary TT was conformed in September 2015 in a tertiary level I trauma university hospital in southwestern Colombia, a middle-income war-influenced country. OBJECTIVE To evaluate the impact of a TT in admission-tomography and admission-surgery times as well as mortality in a tertiary center university hospital in a middle-income country war-influenced country. MATERIAL AND METHODS Retrospective analytical study. Patients older than 17 years admitted to the emergency room 15 months prior and 15 months after the TT implementation were included. Patients prior to the TT implementation were taken as controls. No exclusion criteria. Four hundred sixty-four patients were included, 220 before the TT implementation (BTT) and 244 after (ATT). Demographic data, trauma characteristics, admission-tomography, and admission-surgery time interval as well as mortality were recorded. Requirement of CT scan or surgery was based on physician decision. The analysis was made on Stata 15.1®. Categorical variables were described as quantities and proportions, and continuous variables as mean and standard deviation or median and interquartile range (IQR). Categorical variables were compared using χ2 or Fisher's test and continuous variables using Student's T test or Wilcoxon-Mann-Whitney. A multiple logistic regression model was created to evaluate the impact of being treated in the ATT group on mortality, adjusted by age, trauma severity, and physiological response upon admission. RESULTS The admission-tomography time interval was 56 min (IQR 39-100) in the BTT group and 40 min (IQR 24-76) in the ATT group, p < 0.001. The admission-surgery time interval was 116 min (IQR 63-214) in the BTT group and 52 min (IQR 24-76) in the ATT group, p < 0.001. Mortality in the BTT group was 18.1% and 13.1% in the ATT group. Adjusted OR was 0.406 (0.215-0.789) p = 0.006 CONCLUSIONS: A trauma team conformation in a war-influenced middle-income country is feasible and reduces mortality as well as admission-surgery and admission-tomography time intervals in trauma patients.
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Affiliation(s)
- Sandra Carvajal
- Fundación Valle del Lili, Emergency Department, Fundación Valle del Lili, Cra 98 No 18-49, Cali, 760032, Colombia
| | - Francisco L Uribe-Buritica
- Clinical Research Center, Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cra 98 No 18-49, Cali, 760032, Colombia.
| | - Ana Maria Ángel-Isaza
- Fundación Valle del Lili, Emergency Department, Fundación Valle del Lili, Cra 98 No 18-49, Cali, 760032, Colombia
| | - María Camila López-Girón
- Clinical Research Center, Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cra 98 No 18-49, Cali, 760032, Colombia
| | - Andres González
- Universidad Icesi, Undergraduate Medicine Department, Universidad Icesi, Cl. 18 #122-135, Cali, Valle del Cauca, Colombia
| | - Julian Chica
- Clinical Research Center, Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cra 98 No 18-49, Cali, 760032, Colombia
| | - Manuel Benitez
- Fundación Valle del Lili, Emergency Department, Fundación Valle del Lili, Cra 98 No 18-49, Cali, 760032, Colombia
| | - Alberto F García
- Fundación Valle del Lili, Surgery Department, Fundación Valle del Lili, Cra 98 No 18-49, Cali, 760032, Colombia.,Fundación Valle del Lili, Intensive Care Unit, Fundación Valle del Lili, Cra 98 No 18-49, Cali, 760032, Colombia
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Sanjuán Marín JF, Medina R, Botache Capera WF, Montoya F, Ruiz G, García Marín AF, Badiel M, Ordoñez Delgado CA. Tendencia de los años perdidos de vida potencial por trauma en Colombia: análisis de un periodo de nueve años. REVISTA COLOMBIANA DE CIRUGÍA 2019. [DOI: 10.30944/20117582.513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. El trauma es reconocido como una epidemia global que varía según las regiones donde se presenta. Una parte de la carga de la enfermedad está determinada por los años perdidos de vida potencial, la cual es una estimación de amplio uso para la vigilancia en salud pública; sin embargo, existe poca información disponible en relación a esto. El objetivo de este estudio fue determinar la tendencia de los años perdidos de vida potencial por el trauma en un período de nueve años. Métodos. La información se obtuvo del Instituto Nacional de Medicina Legal y Ciencias Forenses en un período de nueve años (2007-2015). La población de referencia se determinó con base en las proyecciones del Departamento Administrativo Nacional de Estadística, que indicaron una expectativa de vida de 75 años. Resultados. En el 2015, a las lesiones por traumatismos en Colombia les correspondieron 1.920,7 años perdidos de vida potencial por cada 100.000 personas. Durante el período de estudio, las principales causas fueron los homicidios (rango, 51 a 68 %) y los accidentes de tránsito (rango, 19 a 28 %); la relación entre hombres y mujeres fue de 7:1, y la tendencia estadística fue hacia la disminución de los años perdidos de vida potencial. Conclusiones. Los homicidios siguen aportando el mayor número de lesiones por trauma y años perdidos de vida potencial. Los hombres jóvenes continuaron siendo la población mayormente afectada. Se conceptúa la necesidad de incrementar los esfuerzos para mejorar la vigilancia en salud pública y ahondar en las intervenciones oportunas relacionadas con el trauma.
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Contralateral Traumatic Hemopneumothorax. Case Rep Emerg Med 2018; 2018:4328704. [PMID: 30729046 PMCID: PMC6313992 DOI: 10.1155/2018/4328704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 11/26/2018] [Indexed: 12/03/2022] Open
Abstract
Pneumothorax is the entry of air into the virtual space between the visceral and the parietal pleurae, which can occur spontaneously or to a greater extent in a traumatic way. In daily clinical practice it is frequent to find injuries that generate traumatic pneumothorax that is ipsilateral to the lesion. However, there are case reports of contralateral pneumothorax that occurred in procedures such as insertion of pacemakers, or in cases of pneumonectomy. The following is the case report of a 37-year-old man who was admitted with a sharp wound to the right paravertebral region who developed a left haemopneumothorax due to a tangential course of the injuring agent. Adequate clinical judgment was followed, and several imaging studies were carried out, leading to the diagnosis of traumatic pneumothorax that was contralateral to the described injury.
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Implementing Electronic Surgical Registries in Lower-Middle Income Countries: Experiences in Latin America. Ann Glob Health 2018; 82:639-643. [PMID: 27986233 DOI: 10.1016/j.aogh.2016.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Ramachandran A, Ranjit A, Zogg CK, Herrera-Escobar JP, Appelson JR, Pino LF, Aboutanous MB, Haider AH, Ordonez CA. Comparison of Epidemiology of the Injuries and Outcomes in Two First-Level Trauma Centers in Colombia Using the Pan-American Trauma Registry System. World J Surg 2018; 41:2224-2230. [PMID: 28417184 DOI: 10.1007/s00268-017-4013-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION The aim of this study was to compare the epidemiology of traumatic injuries and mortality outcomes between two tertiary-care trauma centers in Colombia using data from Pan-American Trauma Registry (PATR). METHODS January 1-December 31, 2012, data from the Hospital Universitario del Valle (HUV, public) and Fundacion Valle del Lili (FVL, private) in Cali, Colombia, were considered. Differences in demographic and clinical information were compared using descriptive statistics. Propensity score matching was used to match patients on age, gender, and ISS. Within matched cohorts, multivariable logistic regression models were used to assess for differences in in-hospital mortality, further adjusting for insurance type, employment, heart rate, presence of hypotension (SBP < 90), and GCS score. RESULTS HUV (8539; 78% male) and FVL (10,456; 60% male) had a combined total of 18,995 trauma cases in 2012 with comparable mean ages of 29.7 years. There were significant differences in insurance status, injury severity, and mechanism of injury between patients at HUV and FLV. On risk-adjusted logistic regression analyses with propensity score matched cohorts, the odds of death in HUV was higher compared to patients presenting at FVL hospital (OR [95% CI]:4.93 [3.37-7.21], p < 0.001). CONCLUSION The study established the utility of the PATR and revealed important trends in patient demographics, injury epidemiology, and mortality outcomes, which can be used to target trauma initiatives throughout the region. It underscores the profound importance that differences in case mix play in the risk of trauma-related mortality, further emphasizing the need to monitor and evaluate unique aspects of trauma in LMIC. LEVEL OF EVIDENCE III.
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Affiliation(s)
| | - Anju Ranjit
- Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School and Harvard School of Public Health, Boston, MA, USA
| | | | - Juan P Herrera-Escobar
- Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School and Harvard School of Public Health, Boston, MA, USA
| | - Jessica R Appelson
- Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School and Harvard School of Public Health, Boston, MA, USA
| | - Luis F Pino
- Department of Surgery from Division of Trauma and Acute Care Surgery, Hospital Universitario del Valle, Universidad del Valle, Cali, Colombia
| | - Michel B Aboutanous
- Division of Acute Care Surgery, Virginia Commonwealth University Trauma Center, Virginia Commonwealth University Medical Center, Richmond, VA, USA
| | - Adil H Haider
- Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School and Harvard School of Public Health, Boston, MA, USA.
| | - Carlos A Ordonez
- Department of Surgery from Division of Trauma and Acute Care Surgery, Hospital Universitario del Valle, Universidad del Valle, Cali, Colombia
- Department of Surgery From Division of Trauma and Acute Care Surgery, Fundación Valle del Lili, Cali, Colombia
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Bommakanti K, Feldhaus I, Motwani G, Dicker RA, Juillard C. Trauma registry implementation in low- and middle-income countries: challenges and opportunities. J Surg Res 2018; 223:72-86. [DOI: 10.1016/j.jss.2017.09.039] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 09/07/2017] [Accepted: 09/28/2017] [Indexed: 10/18/2022]
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León AL, Ascuntar-Tello J, Valderrama-Molina CO, Giraldo ND, Constaín A, Puerta A, Restrepo C, Jaimes F. Grouping of body areas affected in traffic accidents. A cohort study. J Clin Orthop Trauma 2018; 9:S49-S55. [PMID: 29628699 PMCID: PMC5883909 DOI: 10.1016/j.jcot.2017.11.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/13/2017] [Accepted: 11/23/2017] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Traffic accidents are considered a public health problem and, according to the World Health Organization, currently is the eighth cause of death in the world. Specifically, pedestrians, cyclists and motorcyclists contribute half of the fatalities. Adequate clinical management in accordance with aggregation patterns of the body areas involved, as well as the characteristics of the accident, will help to reduce mortality and disability in this population. METHODS Secondary data analysis of a cohort of patients involved in traffic accidents and admitted to the emergency room (ER) of a high complexity hospital in Medellín, Colombia. They were over 15 years of age, had two or more injuries in different areas of the body and had a hospital stay of more than 24 h after admission. A cluster analysis was performed, using Ward's method and the linfinity similarity measure, to obtain clusters of body areas most commonly affected depending on the type of vehicle and the type of victim. RESULTS Among 2445 patients with traffic accidents, 34% (n = 836) were admitted into the Intensive Care Unit (ICU) and the overall hospital mortality rate was 8% (n = 201). More than 50% of the patients were motorcycle riders but mortality was higher in pedestrian-car accidents (16%, n = 34). The clusters show efficient performance to separate the population depending on the severity of their injuries. Pedestrians had the highest mortality after having accidents with cars and they also had the highest number of body parts clustered, mainly on head and abdomen areas. CONCLUSIONS Exploring the cluster patterns of injuries and body areas affected in traffic accidents allow to establish anatomical groups defined by the type of accident and the type of vehicle. This classification system will accelerate and prioritize ER-care for these population groups, helping to provide better health care services and to rationalize available resources.
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Affiliation(s)
| | | | | | | | - Alfredo Constaín
- Universidad de Antioquia and Hospital Pablo Tobón Uribe, Medellín, Colombia
| | | | | | - Fabián Jaimes
- Universidad de Antioquia and Senior Investigator Research Unit, Hospital Pablo Tobón Uribe, Medellín, Colombia,Corresponding author at: Department of Internal Medicine, Universidad de Antioquia, Calle 64 Nº 51D-154 – Block 7 - Second floor, Medellín, Colombia.
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Domínguez LC, Sierra D, Pepín JJ, Moros G, Villarraga A. Effect of the Extended Inverted Classroom on clinical simulation for the resuscitation of trauma patients: Pilot study of student perceptions of learning. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rcae.2017.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Domínguez LC, Sierra D, Pepín JJ, Moros G, Villarraga A. Efecto del Aula Invertida Extendida a simulación clínica para la resucitación del paciente traumatizado: estudio piloto de las percepciones estudiantiles sobre el aprendizaje. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rca.2017.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Effect of the Extended Inverted Classroom on clinical simulation for the resuscitation of trauma patients: Pilot study of student perceptions of learning☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1097/01819236-201712002-00002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Lactate serial measurements and predictive validity of early mortality in trauma patients admitted to the intensive care unit. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rcae.2017.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Mediciones seriadas del lactato y su validez predictiva de la mortalidad temprana en los pacientes con politrauma que ingresan a la unidad de cuidado intensivo. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rca.2017.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Lactate serial measurements and predictive validity of early mortality in trauma patients admitted to the intensive care unit☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1097/01819236-201707000-00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Valderrama-Molina CO, Giraldo N, Constain A, Puerta A, Restrepo C, León A, Jaimes F. Validation of trauma scales: ISS, NISS, RTS and TRISS for predicting mortality in a Colombian population. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2016; 27:213-220. [PMID: 27999959 DOI: 10.1007/s00590-016-1892-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 12/07/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Our purpose was to validate the performance of the ISS, NISS, RTS and TRISS scales as predictors of mortality in a population of trauma patients in a Latin American setting. MATERIALS AND METHODS Subjects older than 15 years with diagnosis of trauma, lesions in two or more body areas according to the AIS and whose initial attention was at the hospital in the first 24 h were included. The main outcome was inpatient mortality. Secondary outcomes were admission to the intensive care unit, requirement of mechanical ventilation and length of stay. A logistic regression model for hospital mortality was fitted with each of the scales as an independent variable, and its predictive accuracy was evaluated through discrimination and calibration statistics. RESULTS Between January 2007 and July 2015, 4085 subjects were enrolled in the study. 84.2% (n = 3442) were male, the mean age was 36 years (SD = 16), and the most common trauma mechanism was blunt type (80.1%; n = 3273). The medians of ISS, NISS, TRISS and RTS were: 14 (IQR = 10-21), 17 (IQR = 11-27), 4.21 (IQR = 2.95-5.05) and 7.84 (IQR = 6.90-7.84), respectively. Mortality was 9.3%, and the discrimination for ISS, NISS, TRISS and RTS was: AUC 0.85, 0.89, 0.86 and 0.92, respectively. No one scale had appropriate calibration. CONCLUSION Determining the severity of trauma is an essential tool to guide treatment and establish the necessary resources for attention. In a Colombian population from a capital city, trauma scales have adequate performance for the prediction of mortality in patients with trauma.
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Affiliation(s)
| | | | | | | | | | - Alba León
- Universidad de Antioquia, Medellín, Colombia
| | - Fabián Jaimes
- Universidad de Antioquia and Hospital Pablo Tobón Uribe, Medellín, Colombia
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Closing the data gaps for surgical care delivery in LMICs. LANCET GLOBAL HEALTH 2016; 4:e138-9. [PMID: 26916816 DOI: 10.1016/s2214-109x(16)00042-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 01/26/2016] [Indexed: 11/22/2022]
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Boughton O, Jones GG, Lavy CBD, Grimes CE. Young, male, road traffic victims: a systematic review of the published trauma registry literature from low and middle income countries. SICOT J 2015; 1:10. [PMID: 27163066 PMCID: PMC4849265 DOI: 10.1051/sicotj/2015007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Trauma contributes significantly to the global burden of disease. We analysed published trauma registries to assess the demographics of those most affected in low and middle-income countries (LMICs). METHODS We performed a systematic review of published trauma registry studies according to PRISMA guidelines. We included published full-text articles from trauma registries in low and middle-income countries describing the demographics of trauma registry patients. Articles from military trauma registries, articles using data not principally derived from trauma registry data, articles describing patients of only one demographic (e.g. only paediatric patients), or only one mechanism of injury, trauma registry implementation papers without demographic data, review papers and conference proceedings were excluded. RESULTS The initial search retrieved 1868 abstracts of which 1324 remained after duplicate removal. After screening the abstracts, 78 full-text articles were scrutinised for their suitability for inclusion. Twenty three papers from 14 countries, including 103,327 patients, were deemed eligible and included for analysis. The median age of trauma victims in these articles was 27 years (IQR 25-29). The median percentage of trauma victims who were male was 75 (IQR 66-84). The median percentage of road traffic injuries (RTIs) as a percentage of total injuries caused by trauma was 46 (IQR 21-71). CONCLUSIONS Young, male, road traffic victims represent a large proportion of the LMIC trauma burden. This information can inform and be used by local and national governments to implement road safety measures and other strategies aimed at reducing the injury rate in young males.
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Affiliation(s)
| | | | - Christopher B D Lavy
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University Oxford OX1 2JD UK
| | - Caris E Grimes
- King's Centre for Global Health, King's College London London WC2R 2LS UK
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Ferrada P, Anand RJ, Aboutanos M, Ivatury R. Catheter-based endovascular damage-control (CDET): current status and future directions. World J Surg 2014; 38:330-4. [PMID: 24081541 DOI: 10.1007/s00268-013-2263-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Endovascular technology during the past decade has introduced innovative strategies to manage vascular trauma. The purpose of this study was to evaluate the current use catheter-based endovascular damage-control techniques (CDET) in North, Central, and South America. METHODS A survey was sent to the presidents of local societies in Latin America, members of the board, and past presidents of the Pan-American Trauma Society. The survey was sent using the Research Electronic Data Capture collection tool. RESULTS A total of 67 surveys were sent with an 85 % response rate. Surgeons from 15 countries participated in the survey. All of the centers in North America had capabilities to perform these procedures. In none of these centers, however, were they performed by trauma and acute care surgeons. In Central and South America, 64 % of the surgeons responded that they have an interventional radiology service, and in 56 % of the cases, trauma and acute care surgeons were already performing CDET. Eight-eight percent of those surveyed thought that the addition of CDET to trauma would improve patient care; 86 % would be interested in further training in this technique if such programs were available. Finally, 68 % thought that the addition of CDET would help the field of acute care surgery and trauma financially. CONCLUSIONS CDET is being performed already by trauma and acute care surgeons in Latin American countries. More research is necessary to evaluate the role of the trauma surgeon in the endovascular suite as well as training requirements.
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Affiliation(s)
- Paula Ferrada
- Trauma, Critical Care and Emergency Surgery, West Hospital, Virginia Commonwealth University, P.O. Box 980454, 15th Floor East, 1200 E. Broad Street, Richmond, VA, 23298, USA,
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