Avaliação epidemiológica das vítimas de trauma abdominal submetidas ao tratamento cirúrgico

Mortality and its predictors in abdominal injury across sub-Saharan Africa: systematic review and meta-analysis

BACKGROUND

Abdominal injuries exert a significant impact on global morbidity and mortality. The aggregation of mortality data and its determinants across different regions holds immense importance for designing informed healthcare strategies. Hence, this study assessed the pooled mortality rate and its predictors across sub-Saharan Africa.

METHOD

This meta-analysis employed a comprehensive search across multiple electronic databases including PubMed, Africa Index Medicus, Science Direct, and Hinari, complemented by a search of Google Scholar. Subsequently, data were extracted into an Excel format. The compiled dataset was then exported to STATA 17 statistical software for analysis. Utilizing the Dersimonian-Laird method, a random-effect model was employed to estimate the pooled mortality rate and its associated predictors. Heterogeneity was evaluated via the I2 test, while publication bias was assessed using a funnel plot along with Egger's, and Begg's tests.

RESULT

This meta-analysis, which includes 33 full-text studies, revealed a pooled mortality rate of 9.67% (95% CI; 7.81, 11.52) in patients with abdominal injuries across sub-Saharan Africa with substantial heterogeneity (I2 = 87.21%). This review also identified significant predictors of mortality. As a result, the presence of shock upon presentation demonstrated 6.19 times (95% CI; 3.70-10.38) higher odds of mortality, followed by ICU admission (AOR: 5.20, 95% CI; 2.38-11.38), blunt abdominal injury (AOR: 8.18, 95% CI; 4.97-13.45), post-operative complications (AOR: 8.17, 95% CI; 4.97-13.44), and the performance of damage control surgery (AOR: 4.62, 95% CI; 1.85-11.52).

CONCLUSION

Abdominal injury mortality is notably high in sub-Saharan Africa. Shock at presentation, ICU admission, blunt abdominal injury, postoperative complications, and use of damage control surgery predict mortality. Tailored strategies to address these predictors could significantly reduce deaths in the region.

Nutritional status and evaluation of the perioperative fasting time among patients submitted to elective and emergency surgeries at a reference hospital

OBJECTIVE

to evaluate the clinical, surgical, and nutritional profile of surgical patients admitted to a reference hospital in Recife city, Pernambuco state, Brazil.

METHODS

a cross-sectional study carried out in the wards of the General Surgery Service of Hospital da Restauração Governador Paulo Guerra, from June to September 2018. We included adult and elderly patients (both genders) who were submitted to thoracoabdominal procedures and elective or emergency abdominal surgeries, and in which the assessment of nutritional status could be performed within 72 hours of hospital admission. Data on nutritional status and surgical procedures, as well as clinical and biochemical information, were collected.

RESULTS

we studied 140 patients with median age of 45 years. Among all, 59.3% were female and 23% malnourished, according to Subjective Global Assessment. The median preoperative fasting time was 15 hours for size I surgeries and 13.5 hours for size II ones. Longer postoperative hospital stay showed a strong correlation with the total length of hospital stay in both surgical sizes. Malnourished patients had a longer period of perioperative fasting and hospital stay when compared to well-nourished patients (p<0.001).

CONCLUSION

the perioperative fasting time for elective surgeries was longer than recommended by literature. Patients with longer fasting spent more time in hospital.

Ações de enfermagem para prevenção e tratamento de complicações em estomias intestinais

Objetivo: Identificar na literatura as principais ações de enfermagem para prevenção e tratamento das complicações mais frequentes nas estomias de eliminação intestinal. Método: Revisão integrativa que seguiu as fases: identificação do tema e seleção da questão de pesquisa; estabelecimento de critérios para inclusão e exclusão de estudos; categorização dos estudos; avaliação dos estudos incluídos na revisão integrativa; interpretação dos resultados; e síntese do conhecimento. O período utilizado foi de janeiro de 2007 a junho de 2017, nas bases de dados e nos portais Medical Literature Analysis and Retrieval System Online (MEDLINE), Biblioteca Virtual em Saúde (BVS), Excerpta Medica database (Embase), Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL) e Scopus Info Site. Os descritores utilizados foram estomia, enfermagem e complicações pós-operatórias. Resultados: Onze artigos responderam à questão norteadora: quais ações de enfermagem podem ser utilizadas na prevenção e tratamento das complicações em estomias intestinais? As complicações mais abordadas foram hérnia paraestomal, estenose, retração da estomia e separação mucocutânea. As ações de enfermagem mais citadas foram demarcação pré-operatória e acompanhamento com enfermeiro especialista no pré- e pós-operatório. Conclusão: A atuação do enfermeiro estomaterapeuta é essencial para a prevenção e tratamento das complicações em estomias intestinais, porém mais estudos de alto impacto são necessários para nortear suas ações.

Nursing actions for prevention and treatment of complications in intestinal stomies

Objectives: To identify in the literature the main nursing actions for prevention and treatment of the most frequent complications in intestinal elimination stomies. Methods: Integrative review that followed the phases: identification of the theme and selection of the research question; establishment of criteria for inclusion and exclusion of studies; categorization of studies; evaluation of studies included in the integrative review; interpretation of results; and synthesis of knowledge. The period used was from January 2007 to June 2017, in the databases and in the portals Medical Literature Analysis and Retrieval System Online (MEDLINE), Biblioteca Virtual em Saúde (BVS), Excerpta Medica database (Embase), Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Scopus Info Site. The descriptors used were ostomy, nursing and postoperative complications. Results: Eleven articles answered the guiding question: which nursing actions can be used to prevent and treat complications in intestinal ostomies? The most commonly reported complications were a parastomal hernia, stenosis, retraction of the ostomy and mucocutaneous separation. The most cited nursing actions were preoperative demarcation and follow-up with specialist nurses in the pre- and postoperative periods. Conclusion: The role of the stomatherapist nurse is essential for the prevention and treatment of complications in the intestinal ostomies, but more studies of high impact are necessary to guide their actions.

Damage control surgery: are we losing control over indications?

OBJECTIVE

to analyze the surgeons' subjective indications for damage control surgery, correlating with objective data about the patients' physiological state at the time the surgery was chosen.

METHODS

we carried out a prospective study between January 2016 and February 2017, with 46 trauma victims who were submitted to damage control surgery. After each surgery, we applied a questionnaire to the attending surgeon, addressing the motivations for choosing the procedure. We collected data in the medical records to assess hemodynamic conditions, systolic blood pressure and heart rate on arrival at the emergency room (grade III or IV shock on arrival at the emergency room would partially justify the choice). We considered elevation of serum lactate level, prolonged prothrombin time and blood pH below 7.2 as laboratory indicators of worse prognosis, objectively corroborating the subjective choice of the procedure.

RESULTS

the main indications for damage control surgery were hemodynamic instability (47.8%) and high complexity lesions (30.4%). Hemodynamic and laboratory changes corroborated the choice in 65.2% of patients, regardless of the time; 23.9% presented hemodynamic changes compatible with degree III and IV shock, but without laboratory alterations; 4.3% had only laboratory abnormalities and 6.5% had no alterations at all.

CONCLUSION

in the majority of cases, there was early indication for damage control surgery, based mainly on hemodynamic status and severity of lesions, and in 65.2%, the decision was compatible with alterations in objective hemodynamic and laboratory data.

Risk factors for mortality in blunt abdominal trauma with surgical approach

OBJECTIVE

identify risk factors for mortality in patients who underwent laparotomy after blunt abdominal trauma.

METHODS

retrospective study, case-control, which were reviewed medical records of blunt trauma victims patients undergoing laparotomy, from March 2013 to January 2015, and compared the result of the deaths group with the group healed.

RESULTS

of 86 patients, 63% were healed, 36% died, and one patient was excluded from the study. Both groups had similar epidemiology and trauma mechanism, predominantly young adults males, automobilistic accident. Most cases that evolved to death had hemodynamic instability as laparotomy indication - 61% against 38% in the other group (p=0.02). The presence of solid organ injury was larger in the group of deaths - 80% versus 48% (p=0.001) and 61% of them had other associated abdominal injury compared to 25% in the other group (p=0.01). Of the patients who died 96% had other serious injuries associated (p=0.0003). Patients requiring damage control surgery had a higher mortality rate (p=0.0099). Only one of 18 patients with isolated hollow organ lesion evolved to death (p=0.0001). The mean injury score of TRISS of cured (91.70%) was significantly higher than that of deaths (46.3%) (p=0.002).

CONCLUSION

the risk factors for mortality were hemodynamic instability as an indication for laparotomy, presence of solid organ injury, multiple intra-abdominal injuries, need for damage control surgery, serious injury association and low index of trauma score.

Profile of renal trauma victims treated at a university hospital in Curitiba

Objective:

to study the profile of victims of kidney trauma who underwent surgical and medical treatment in a hospital in Curitiba.

Methods:

we conducted a retrospective, analytical, quantitative, cross-sectional study of patients with renal trauma admitted to the Evangelical Hospital of Curitiba between February 2011 and January 2014.

Results:

participated in the study 38 patients, four women and 34, men with a mean age of 28.4 years. Most injuries (60.5%) was due to closed mechanisms, especially motorcycle accidents. Injuries were treated conservatively in most cases. Patients who required surgical treatment had severe kidney damage or some other associated lesion, usually intra-abdominal. Hospital stay was lower in the conservative treatment group (10.8 days) compared with the surgical treatment one (18.8 days); mortality was also lower in the conservative treatment group (8.3%) compared with the surgical (14.3%). There were no deaths associated to kidney damage itself.

Conclusion:

patients with renal trauma in this study were young men, victims of motorcycle accidents, taking place during the night and early morning. Most injuries were treated conservatively.

Objetivo:

estudar o perfil das vítimas de traumas renais submetidos a tratamento cirúrgico e clínico em um hospital de Curitiba.

Métodos:

estudo transversal quantitativo analítico retrospectivo de pacientes com trauma renal admitidos no Hospital Universitário Evangélico de Curitiba entre fevereiro de 2011 e janeiro de 2014.

Resultados:

fizeram parte do estudo 38 pacientes, sendo quatro mulheres e 34 homens, com média de idade de 28,4 anos. A maior parte dos traumas (60,5%) foi decorrente de mecanismo fechado, em especial acidentes automobilísticos envolvendo motos, tratados de maneira conservadora na maior parte dos casos. Os pacientes que necessitaram de tratamento cirúrgico possuíam lesões renais graves ou alguma outra lesão associada, geralmente intra-abdominal. O tempo de internamento foi menor no grupo de tratamento conservador (10,8 dias) em relação ao grupo de tratamento cirúrgico (18,8 dias), assim como a mortalidade também foi menor no grupo de tratamento conservador (8,3%) comparada ao cirúrgico (14,3%). Nenhuma morte foi relacionada à lesão renal em si.

Conclusão:

os pacientes com traumatismo renal neste estudo foram homens jovens, vítimas de acidentes automobilísticos com motos, ocorrendo durante a noite e madrugada. A maioria das lesões foi tratada de modo conservador.

Associated factors to empyema in post-traumatic hemotorax

ABSTRACTObjective:to analyze the associated factors with empyema in patients with post-traumatic retained hemothorax.Methods:prospective observational study. Data were collected in patients undergoing PD during emergency duty. Variables analyzed were age, sex, mechanism of injury, side of the chest injury, intrathoracic complications of RH, laparotomy, specific injuries, rib fractures, trauma scores, days to diagnosis, diagnostic method of RH, primary indication of PD, initial volume drained, length of the first tube removal, surgical procedure. Cumulative incidence of empyema, pneumonia and pulmonary contusion and the proportion of patients with empyema or without empyema in each category of each variable analyzed were obtained.Results: the cumulative incidence of PD among trauma patients was 1.83% and the RH among those with PD was 10.63%. There were 20 cases of empyema (32.8%). Most were male in the age from 20 to 29, victims of injury by firearm on the left side of the thorax. The incidence of empyema in patients with injury by firearms was lower compared to those with stab wound or blunt trauma; higher among those with drained volume between 300 and 599 ml. The median hospital lenght of stay was higher among those with empyema.Conclusion:the incidence of PD was 1.83% and RH was 10.63%, these results are consistent with the low severity of the patients involved in this study and consistent with the literature. The incidence of empyema proved to be negatively associated with the occurrence of injury by firearms and positively associated with a drained volume between 300 and 599 ml, compared with lower or higher volumes.

Implementation of a trauma registry in a brazilian public hospital: the first 1,000 patients

OBJECTIVE: Show the steps of a Trauma Registry (TR) implementation in a Brazilian public hospital and evaluate the initial data from the database.METHODS: Descriptive study of the a TR implementation in João XXIII Hospital (Hospital Foundation of the state of Minas Gerais) and analysis of the initial results of the first 1,000 patients.RESULTS: The project was initiated in 2011 and from January 2013 we began collecting data for the TR. In January 2014 the registration of the first 1000 patients was completed. The greatest difficulties in the TR implementation were obtaining funds to finance the project and the lack of information within the medical records. The variables with the lowest completion percentage on the physiological conditions were: pulse, blood pressure, respiratory rate and Glasgow coma scale. Consequently, the Revised Trauma Score (RTS) could be calculated in only 31% of cases and the TRISS methodology applied to 30.3% of patients. The main epidemiological characteristics showed a predominance of young male victims (84.7%) and the importance of aggression as a cause of injuries in our environment (47.5%), surpassing traffic accidents. The average length of stay was 6 days, and mortality 13.7%.CONCLUSION: Trauma registries are invaluable tools in improving the care of trauma victims. It is necessary to improve the quality of data recorded in medical records. The involvement of public authorities is critical for the successful implementation and maintenance of trauma registries in Brazilian hospitals.

Pattern of splenectomy indications in kashan shahid-beheshti hospital: a 5-year study

BACKGROUND

The spleen is amongst the most vulnerable organs which are easily injured in abdominal trauma. Nowadays, blunt trauma is the most prevalent indication of splenectomy.

OBJECTIVES

We conducted this study to determine the pattern of indications for open splenectomies carried out during the past five years in Shahid-Beheshti hospital, a central hospital in Kashan, Iran.

PATIENTS AND METHODS

Demographic data of all patients who had undergone an open splenectomy in Kashan Shahid-Beheshti hospital during the past five years (2007-2012), indications for this type of surgery and outcome of patients were collected and entered into the study.

RESULTS

During the study period, the data from a total of 99 open splenectomies were entered in our study. Sixty-eight (68.7%) patients were male and 31 (31.1%) female. The mean age was 31.64 years, 75.8% of the cases had indications of trauma and 24.2% were elective. The most prevalent indication for trauma was motor-bike rider accidents and for elective ones portal hypertension.

CONCLUSIONS

Most cases of splenectomy in our center caused by trauma, and among the different types of trauma, blunt trauma is the dominant cause. Road traffic accidents, in particular motor vehicle accidents, especially motorbike injures, are the most frequent cause of splenectomy. Due to the instability of trauma patients, a mortality rate of 8% seems to be reasonable for splenectomy. We recommend that more research be conducted in this area and more cases enrolled with a reasonable follow-up period for splenectomy complications in this study.