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Llompart-Pou JA, Barea-Mendoza JA, Pérez-Bárcena J, Sánchez-Casado M, Ballesteros-Sanz MÁ, Chico-Fernández M. Survey of neurocritical patient care in Spain. Part 2: Cerebrovascular disease. Med Intensiva 2021; 45:e1-e3. [PMID: 34217639 DOI: 10.1016/j.medine.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 11/11/2019] [Indexed: 11/18/2022]
Affiliation(s)
- J A Llompart-Pou
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma de Mallorca, Spain.
| | - J A Barea-Mendoza
- UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - J Pérez-Bárcena
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - M Sánchez-Casado
- Servicio de Medicina Intensiva, Hospital Virgen de la Salud, Toledo, Spain
| | - M Á Ballesteros-Sanz
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - M Chico-Fernández
- UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, Spain
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Chico-Fernández M, Sánchez-Casado M, Barea-Mendoza JA, García-Sáez I, Ballesteros-Sanz MÁ, Guerrero-López F, Quintana-Díaz M, Molina-Díaz I, Martín-Iglesias L, Toboso-Casado JM, Pérez-Bárcena J, Llompart-Pou JA. Outcomes of very elderly trauma ICU patients. Results from the Spanish trauma ICU registry. Med Intensiva 2019; 44:210-215. [PMID: 30799042 DOI: 10.1016/j.medin.2019.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 12/05/2018] [Accepted: 01/11/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To analyze outcomes and factors related to mortality among very elderly trauma patients admitted to intensive care units (ICUs) participating in the Spanish trauma ICU registry. DESIGN A multicenter nationwide registry. Retrospective analysis. November 2012-May 2017. SETTING Participating ICUs. PATIENTS Trauma patients aged ≥80 years. INTERVENTIONS None. MAIN VARIABLES OF INTEREST The outcomes and influence of limitation of life sustaining therapy (LLST) were analyzed. Comparisons were established using the Wilcoxon test, Chi-squared test or Fisher's exact test as appropriate. Multiple logistic regression analysis was performed to analyze variables related to mortality. A p-value <0.05 was considered statistically significant. RESULTS The mean patient age was 83.4±3.3 years; 281 males (60.4%). Low-energy falls were the mechanisms of injury in 256 patients (55.1%). The mean ISS was 20.5±11.1, with a mean ICU stay of 7.45±9.9 days. The probability of survival based on the TRISS methodology was 69.8±29.7%. The ICU mortality rate was 15.5%, with an in-hospital mortality rate of 19.2%. The main cause of mortality was intracranial hypertension (42.7%). The ISS, the need for first- and second-tier measures to control intracranial pressure, and being admitted to the ICU for organ donation were independent mortality predictors. LLST was applied in 128 patients (27.9%). Patients who received LLST were older, with more severe trauma, and with more severe brain injury. CONCLUSIONS Very elderly trauma ICU patients presented mortality rates lower than predicted on the basis of the severity of injury.
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Affiliation(s)
- M Chico-Fernández
- UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - M Sánchez-Casado
- Servicio de Medicina Intensiva, Hospital Virgen de la Salud, Toledo, Spain
| | - J A Barea-Mendoza
- UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - I García-Sáez
- Servicio de Medicina Intensiva, Hospital Universitario Donostia, Donostia, Spain
| | - M Á Ballesteros-Sanz
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - F Guerrero-López
- Servicio de Medicina Intensiva, UCI Neurotraumatológica, Hospital Virgen de las Nieves, Granada, Spain
| | - M Quintana-Díaz
- Servicio de Medicina Intensiva, Hospital Universitario La Paz, Madrid, Spain
| | - I Molina-Díaz
- Servicio de Medicina Intensiva, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - L Martín-Iglesias
- Servicio de Medicina Intensiva, Hospital Universitario Central De Asturias, Asturias, Spain
| | - J M Toboso-Casado
- Servei de Medicina Intensiva, Hospital Universitari Germans Trias I Pujol, Barcelona, Spain
| | - J Pérez-Bárcena
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma, Spain
| | - J A Llompart-Pou
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma, Spain.
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Chico-Fernández M, Llompart-Pou JA, Sánchez-Casado M, Ballesteros-Sanz MÁ. Severe traumatic disease register in Spain. Med Intensiva 2017; 41:324-325. [PMID: 28465072 DOI: 10.1016/j.medin.2017.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 02/27/2017] [Indexed: 10/19/2022]
Affiliation(s)
- M Chico-Fernández
- UCI de Trauma y Emergencias (UCITE), Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España.
| | - J A Llompart-Pou
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Instituto de Investigación Sanitaria de Palma (IdISPa), Palma de Mallorca, Islas Baleares, España
| | - M Sánchez-Casado
- Servicio de Medicina Intensiva, Hospital Virgen de la Salud, Toledo, España
| | - M Á Ballesteros-Sanz
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
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Llompart-Pou JA, Chico-Fernández M, Sánchez-Casado M, Salaberria-Udabe R, Carbayo-Górriz C, Guerrero-López F, González-Robledo J, Ballesteros-Sanz MÁ, Herrán-Monge R, Servià-Goixart L, León-López R, Val-Jordán E. Scoring severity in trauma: comparison of prehospital scoring systems in trauma ICU patients. Eur J Trauma Emerg Surg 2016; 43:351-357. [PMID: 27089878 DOI: 10.1007/s00068-016-0671-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 04/02/2016] [Indexed: 12/19/2022]
Abstract
PURPOSE We evaluated the predictive ability of mechanism, Glasgow coma scale, age and arterial pressure (MGAP), Glasgow coma scale, age and systolic blood pressure (GAP), and triage-revised trauma Score (T-RTS) scores in patients from the Spanish trauma ICU registry using the trauma and injury severity score (TRISS) as a reference standard. METHODS Patients admitted for traumatic disease in the participating ICU were included. Quantitative data were reported as median [interquartile range (IQR), categorical data as number (percentage)]. Comparisons between groups with quantitative variables and categorical variables were performed using Student's T Test and Chi Square Test, respectively. We performed receiving operating curves (ROC) and evaluated the area under the curve (AUC) with its 95 % confidence interval (CI). Sensitivity, specificity, positive predictive and negative predictive values and accuracy were evaluated in all the scores. A value of p < 0.05 was considered significant. RESULTS The final sample included 1361 trauma ICU patients. Median age was 45 (30-61) years. 1092 patients (80.3 %) were male. Median ISS was 18 (13-26) and median T-RTS was 11 (10-12). Median GAP was 20 (15-22) and median MGAP 24 (20-27). Observed mortality was 17.7 % whilst predicted mortality using TRISS was 16.9 %. The AUC in the scores evaluated was: TRISS 0.897 (95 % CI 0.876-0.918), MGAP 0.860 (95 % CI 0.835-0.886), GAP 0.849 (95 % CI 0.823-0.876) and T-RTS 0.796 (95 % CI 0.762-0.830). CONCLUSIONS Both MGAP and GAP scores performed better than the T-RTS in the prediction of hospital mortality in Spanish trauma ICU patients. Since these are easy-to-perform scores, they should be incorporated in clinical practice as a triaging tool.
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Affiliation(s)
- J A Llompart-Pou
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Carretera Valldemossa, 79, 07010, Palma de Mallorca, Spain.
| | - M Chico-Fernández
- UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - M Sánchez-Casado
- Servicio de Medicina Intensiva, Hospital Virgen de la Salud, Toledo, Spain
| | - R Salaberria-Udabe
- Servicio de Medicina Intensiva, Hospital Universitario de Donostia, San Sebastián, Spain
| | - C Carbayo-Górriz
- Servicio de Medicina Intensiva, Complejo Hospitalario de Torrecárdenas, Almería, Spain
| | - F Guerrero-López
- Servicio de Medicina Intensiva, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - J González-Robledo
- Servicio de Medicina Intensiva, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - M Á Ballesteros-Sanz
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - R Herrán-Monge
- Servicio de Medicina Intensiva, Hospital Universitario Río Hortega, Valladolid, Spain
| | - L Servià-Goixart
- Servicio de Medicina Intensiva, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - R León-López
- Servicio de Medicina Intensiva, Ciudad Sanitaria Reina Sofia, Córdoba, Spain
| | - E Val-Jordán
- Servicio de Medicina Intensiva, Hospital Universitario Miguel Servet, Zaragoza, Spain
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Chico-Fernández M, Llompart-Pou JA, Sánchez-Casado M, Alberdi-Odriozola F, Guerrero-López F, Mayor-García MD, Egea-Guerrero JJ, Fernández-Ortega JF, Bueno-González A, González-Robledo J, Servià-Goixart L, Roldán-Ramírez J, Ballesteros-Sanz MÁ, Tejerina-Alvarez E, Pino-Sánchez FI, Homar-Ramírez J. Mortality prediction using TRISS methodology in the Spanish ICU Trauma Registry (RETRAUCI). Med Intensiva 2016; 40:395-402. [PMID: 27068001 DOI: 10.1016/j.medin.2015.11.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 11/09/2015] [Accepted: 11/20/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To validate Trauma and Injury Severity Score (TRISS) methodology as an auditing tool in the Spanish ICU Trauma Registry (RETRAUCI). DESIGN A prospective, multicenter registry evaluation was carried out. SETTING Thirteen Spanish Intensive Care Units (ICUs). PATIENTS Individuals with traumatic disease and available data admitted to the participating ICUs. INTERVENTIONS Predicted mortality using TRISS methodology was compared with that observed in the pilot phase of the RETRAUCI from November 2012 to January 2015. Discrimination was evaluated using receiver operating characteristic (ROC) curves and the corresponding areas under the curves (AUCs) (95% CI), with calibration using the Hosmer-Lemeshow (HL) goodness-of-fit test. A value of p<0.05 was considered significant. MAIN VARIABLES OF INTEREST Predicted and observed mortality. RESULTS A total of 1405 patients were analyzed. The observed mortality rate was 18% (253 patients), while the predicted mortality rate was 16.9%. The area under the ROC curve was 0.889 (95% CI: 0.867-0.911). Patients with blunt trauma (n=1305) had an area under the ROC curve of 0.887 (95% CI: 0.864-0.910), and those with penetrating trauma (n=100) presented an area under the curve of 0.919 (95% CI: 0.859-0.979). In the global sample, the HL test yielded a value of 25.38 (p=0.001): 27.35 (p<0.0001) in blunt trauma and 5.91 (p=0.658) in penetrating trauma. TRISS methodology underestimated mortality in patients with low predicted mortality and overestimated mortality in patients with high predicted mortality. CONCLUSIONS TRISS methodology in the evaluation of severe trauma in Spanish ICUs showed good discrimination, with inadequate calibration - particularly in blunt trauma.
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Affiliation(s)
- M Chico-Fernández
- Trauma and Emergencies ICU, Department of Intensive Care Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - J A Llompart-Pou
- Department of Intensive Care Medicine, Hospital Universitari Son Espases, Palma de Mallorca, Spain.
| | - M Sánchez-Casado
- Department of Intensive Care Medicine, Hospital Virgen de la Salud, Toledo, Spain
| | - F Alberdi-Odriozola
- Department of Intensive Care Medicine, Hospital Universitario de Donostia, San Sebastián, Spain
| | - F Guerrero-López
- Department of Intensive Care Medicine, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - M D Mayor-García
- Department of Intensive Care Medicine, Complejo Hospitalario de Torrecárdenas, Almería, Spain
| | - J J Egea-Guerrero
- Department of Intensive Care Medicine, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - J F Fernández-Ortega
- Department of Intensive Care Medicine, Hospital Universitario Carlos Haya, Málaga, Spain
| | - A Bueno-González
- Department of Intensive Care Medicine, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - J González-Robledo
- Department of Intensive Care Medicine, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - L Servià-Goixart
- Department of Intensive Care Medicine, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - J Roldán-Ramírez
- Department of Intensive Care Medicine, Complejo Hospitalario de Pamplona, Navarra, Spain
| | - M Á Ballesteros-Sanz
- Department of Intensive Care Medicine, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - E Tejerina-Alvarez
- Department of Intensive Care Medicine, Hospital Universitario de Getafe, Madrid, Spain
| | - F I Pino-Sánchez
- Department of Intensive Care Medicine, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - J Homar-Ramírez
- Department of Intensive Care Medicine, Hospital Universitari Son Espases, Palma de Mallorca, Spain
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Chico-Fernández M, Llompart-Pou JA, Alberdi-Odriozolo F, Guerrero-López F, Sánchez-Casado M, Mayor-García MD, Egea-Guerrero J, Fernández-Ortega JF, Bueno-González A, González-Robledo J, Servià-Goixart L, Roldán-Ramírez J, Ballesteros-Sanz MÁ, Tejerina-Álvarez E. Spanish trauma icu registry (RETRAUCI). final results of the pilot phase. Intensive Care Med Exp 2015. [PMCID: PMC4798319 DOI: 10.1186/2197-425x-3-s1-a377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Chico-Fernández M, Sánchez-Casado M, Alberdi-Odriozola F, Guerrero-López F, Mayor-García MD, Egea-Guerrero J, Fernández-Ortega JF, Bueno-González A, González-Robledo J, Servià-Goixart L, Roldán-Ramírez J, Ballesteros-Sanz MÁ, Tejerina-Álvarez E, Llompart-Pou JA. Validation of the probability of survival using the triss methodology in the Spanish Trauma ICU registry (RETRAUCI). Intensive Care Med Exp 2015. [PMCID: PMC4798491 DOI: 10.1186/2197-425x-3-s1-a856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
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Chico-Fernández M, Llompart-Pou JA, Guerrero-López F, Sánchez-Casado M, García-Sáez I, Mayor-García MD, Egea-Guerrero J, Fernández-Ortega JF, Bueno-González A, González-Robledo J, Servià-Goixart L, Roldán-Ramírez J, Ballesteros-Sanz MÁ, Tejerina-Alvarez E, García-Fuentes C, Alberdi-Odriozola F. Epidemiology of severe trauma in Spain. Registry of trauma in the ICU (RETRAUCI). Pilot phase. Med Intensiva 2015; 40:327-47. [PMID: 26440993 DOI: 10.1016/j.medin.2015.07.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Revised: 07/20/2015] [Accepted: 07/25/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To describe the characteristics and management of severe trauma disease in Spanish Intensive Care Units (ICUs). Registry of trauma in the ICU (RETRAUCI). Pilot phase. DESIGN A prospective, multicenter registry. SETTING Thirteen Spanish ICUs. PATIENTS Patients with trauma disease admitted to the ICU. INTERVENTIONS None. MAIN VARIABLES OF INTEREST Epidemiology, out-of-hospital attention, registry of injuries, resources utilization, complications and outcome were evaluated. RESULTS Patients, n=2242. Mean age 47.1±19.02 years. Males 79%. Blunt trauma 93.9%. Injury Severity Score 22.2±12.1, Revised Trauma Score 6.7±1.6. Non-intentional in 84.4% of the cases. The most common causes of trauma were traffic accidents followed by pedestrian and high-energy falls. Up to 12.4% were taking antiplatelet medication or anticoagulants. Almost 28% had a suspected or confirmed toxic influence in trauma. Up to 31.5% required an out-of-hospital artificial airway. The time from trauma to ICU admission was 4.7±5.3hours. At ICU admission, 68.5% were hemodynamically stable. Brain and chest injuries predominated. A large number of complications were documented. Mechanical ventilation was used in 69.5% of the patients (mean 8.2±9.9 days), of which 24.9% finally required a tracheostomy. The median duration of stay in the ICU and in hospital was 5 (range 3-13) and 9 (5-19) days, respectively. The ICU mortality rate was 12.3%, while the in-hospital mortality rate was 16.0%. CONCLUSIONS The pilot phase of the RETRAUCI offers a first impression of the epidemiology and management of trauma disease in Spanish ICUs.
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Affiliation(s)
- M Chico-Fernández
- UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España.
| | - J A Llompart-Pou
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Palma de Mallorca, España
| | - F Guerrero-López
- Servicio de Medicina Intensiva, Hospital Universitario Virgen de las Nieves, Granada, España
| | - M Sánchez-Casado
- Servicio de Medicina Intensiva, Hospital Virgen de la Salud, Toledo, España
| | - I García-Sáez
- Servicio de Medicina Intensiva, Hospital Universitario de Donostia, San Sebastián, España
| | - M D Mayor-García
- Servicio de Medicina Intensiva, Complejo Hospitalario de Torrecárdenas, Almería, España
| | - J Egea-Guerrero
- Servicio de Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - J F Fernández-Ortega
- Servicio de Medicina Intensiva, Hospital Universitario Carlos Haya, Málaga, España
| | - A Bueno-González
- Servicio de Medicina Intensiva, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - J González-Robledo
- Servicio de Medicina Intensiva, Complejo Asistencial Universitario de Salamanca, Salamanca, España
| | - L Servià-Goixart
- Servei de Medicina Intensiva, Hospital Universitari Arnau de Vilanova, Lérida, España
| | | | - M Á Ballesteros-Sanz
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - E Tejerina-Alvarez
- Servicio de Medicina Intensiva, Hospital Universitario de Getafe, Getafe (Madrid), España
| | - C García-Fuentes
- UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España
| | - F Alberdi-Odriozola
- Servicio de Medicina Intensiva, Hospital Universitario de Donostia, San Sebastián, España
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