Epidemiology of severe trauma in Navarra for 10 years: out-of-hospital/ in-hospital deaths and survivors.

BACKGROUND: Major trauma is a leading cause of death. Due to the difficulties to keep a registry of these cases, few studies include all subjects, because they exclude out-of-hospital deaths. The purpose of this work was to compare the epidemiological profiles of out-of-hospital deaths, in-hospital deaths, and survivors over a 10-year period (2010-2019) of patients who had been treated by Navarre´s Health Service (Spain). METHODS: Retrospective longitudinal cohort study using data of patients injured by an external physical force of any intentionality and with a New Injury Severity Score above 15. Hangings, drownings, burns, and chokings were excluded. Intergroup differences of demographic and clinical variables were analysed using the Kruskal Wallis test, chi-squared test, or Fisher´s exact test. RESULTS: Data from 2,610 patients were analysed; 624 died out-of-hospital, 439 in-hospital, and 1,547 survived. Trauma incidences remained moderately stable over the 10-year period analysed, with a slight decrease in out-of-hospital deaths and a slight increase in in-hospital deaths. Patients of the out-of-hospital deaths group were younger (50.9 years) in comparison to in-hospital deaths and survivors. Death victims were predominantly male in all study groups. Intergroup differences regarding prior comorbidities and predominant type of injury were observed. CONCLUSIONS: There are significant differences among the three study groups. More than half of the deaths occur out-of-hospital and the causative mechanisms differ in each of them. Thus, when designing strategies, preventive measures were considered for each group on a case-by-case basis.

Severe head injury in elderly: 6-year comparison of treatment and outcome between southern Finland and Navarra (Spain).

PURPOSE: To compare the profile, treatment and outcome of elderly patients with severe traumatic brain injuries (TBI) between southern Finland and Navarra (Spain). METHODS: Data collected from, 2010 to 2015, in the Major Trauma Registry of Navarra (MTR-N) and the Helsinki Trauma Registry (HTR) were compared. Patients with New Injury Severity Score (NISS) ≥ 16 and age ≥ 65 with isolated severe TBI were considered. Patients who had been admitted to the hospital ≥ 24 h after the trauma, had been pronounced dead before hospital arrival, or had been injured by hanging, drowning or burns, were excluded. Outcome was defined by 30-day hospital mortality. The expected mortality was calculated using the Revised Injury Severity Classification score II (RISC II). Other compared data included demographics, injury mechanism, pre-hospital and hospital treatment, and time intervals. RESULTS: A total of 305 (MTR-N) and 137 (HTR) patients were included in the outcome analysis. The standardized mortality ratio with 95% confidence interval was for MTR-N 1.4 (1.1-1.6) and for HTR 0.8 (0.6-1.1). Patients in Navarra were older (average 79.7 vs. 75.0) while in southern Finland the percentage of pre-hospital intubation in patients with GCS ≤ 8 (75.0% vs 50.0%) and ICU admission (72.2% vs 22.0%) were higher. CONCLUSION: The better adjusted outcome of elderly patients with severe TBI in southern Finland in comparison to Navarra could be due to higher rate of pre-hospital intubation and/or higher rate of ICU admissions in southern Finland. Increasing number of elderly patients with severe TBI necessitate uniformly accepted protocols in pre- and in-hospital management.

Quality assessment of Major Trauma Registry of Navarra: completeness and correctness.

This study assessed the completeness of the Major Trauma Registry of Navarra (MTR-N) data and their concordance with the patients' medical files. It retrospectively reviewed all the MTR-N cases documented in June and July of 2014 and 2015. For each case, 42 parameters' values were taken from the MTR-N. To assess concordance between the MTR-N and medical files, the same variables values were re-recorded. Data completeness was calculated for all cases and data correctness for those documented in the MTR-N, separately for each variable. The overall average completeness rate for all variables was 92.8%. The percentages of completely missing data ranged from 0% (29 variables) to 76.8% (base excess). The overall average rate of correctness was 98.0%. Exact concordance ranged from 93.0% (7 variables) to 100% (22 variables). This study demonstrates the reliability and validity of the MTR-N data and its effectiveness for quality improvement and research in our community.

Mortality in severe trauma patients attended by emergency services in Navarre, Spain: validation of a new prediction model and comparison with the Revised Injury Severity Classification Score II. / Validación del Modelo de Predicción de Mortalidad de Navarra y comparación con el Revised Injury Severity Classification Score II en los pacientes con traumatismo grave atendidos por el Sistema de Emergencias de Navarra.

OBJECTIVES: To validate the Mortality Prediction Model of Navarre (MPMN) to predict death after severe trauma and compare it to the Revised Injury Severity Classification Score II (RISCII). MATERIAL AND METHODS: Retrospective analysis of a cohort of severe trauma patients (New Injury Severity Score >15) who were attended by emergency services in the Spanish autonomous community of Navarre between 2013 and 2015. The outcome variable was 30-day all-cause mortality. Risk was calculated with the MPMN and the RISCII. The performance of each model was assessed with the area under the receiver operating characteristic (ROC) curve and precision with respect to observed mortality. Calibration was assessed with the Hosmer-Lemeshow test. RESULTS: We included 516 patients. The mean (SD) age was 56 (23) years, and 363 (70%) were males. Ninety patients (17.4%) died within 30 days. The 30-day mortality rates predicted by the MPMN and RISCII were 16.4% and 15.4%, respectively. The areas under the ROC curves were 0.925 (95% CI, 0.902-0.952) for the MPMN and 0.941 (95% CI, 0.921-0.962) for the RISCII (P=0.269, DeLong test). Calibration statistics were 13.6 (P=.09) for the MPMN and 8.9 (P=.35) for the RISCII. CONCLUSION: Both the MPMN and the RISCII show good ability to discriminate risk and predict 30-day all-cause mortality in severe trauma patients.

OBJETIVO: Validar el Modelo de Predicción de Mortalidad de Navarra (MPMN), y compararlo con el Revised Injury Severity Classification Score II (RISC II) para predecir la mortalidad en los pacientes con traumatismo grave (PTG). METODO: Estudio analítico de cohorte retrospectivo de PTG (New Injury Severity Score ­NISS­ >15 puntos) atendidos por el Sistema de Emergencias de Navarra entre 2013-2015. La variable resultado fue la mortalidad por cualquier causa a los 30 días. Se calcularon los modelos de riesgo MPMN y RISC II. El rendimiento de los modelos se evaluó con la curva característica operativa del receptor (COR) y el área bajo la curva (ABC), la precisión con la mortalidad observada y predicha, y la calibración con la prueba de Hosmer-Lemeshow. RESULTADOS: Se incluyeron 516 pacientes con una edad media de 56 (DE 23) años, de los cuales 363 (70%) fueron varones. Noventa (17,4%) pacientes fallecieron a los 30 días. La mortalidad a 30 días predicha para el modelo MPMN y RISC II fue de un 16,4% y 15,4%, respectivamente. El ABC de la COR para el modelo MPMN fue de 0,925 (IC95% 0,902-0,952) y para el modelo RISC II fue de 0,941 (IC95% 0,921-0,962) (p de DeLong = 0,269). La calibración del modelo MPMN fue de 13,6 (p = 0,09) y del modelo RISC II fue de 8,9 (p = 0,35). CONCLUSIONES: Los modelos MPMN y RISC II muestran buena capacidad de discriminación para predecir la mortalidad global a los 30 días entre los PTG.

Epidemiological Characteristics and Overall Burden of Accidental Injuries in Navarra, Spain: Epidemiology of Injuries in Children.

Injuries caused by accidents or violent situations in pediatric patients are a serious social problem where prevention plays a key role. The aim of this study was to describe the epidemiological situation of pediatric injuries in Spain. A prospective study of pediatric patients receiving care in the Emergency Service of the Complejo Hospitalario de Navarra due to for reasons of accidental injury was conducted. The study covered a period of 1 year and assessed a total of 16 variables. There were a total of 8,876 patients, of whom 56.4% were males. Traumatic injuries such as fractures and craniocerebral trauma were identified as the most frequent injuries, occurring as a result of injuries mainly in the home. In females, there was a decrease in the incidence of injuries related to age. There was a greater incidence at the end of the day, during the weekend, and in the months of March to October. The epidemiological profile of pediatric patients who met with accidents in Navarra, Spain, is described. The knowledge of the main areas and factors related to injuries allows us to improve preventive measures, which would contribute to better control in this region of Spain.

[Inclusion of prehospital mortality statistics in severe trauma registries: a study of the influence of inclusion on trauma lethality rates and survival prediction]. / La importancia de incluir las muertes prehospitalarias en los registros de traumatismo grave y su relación con la letalidad y la capacidad de predicción de la supervivencia.

OBJECTIVES: To compare the frequency and characteristics of prehospital and hospital deaths and assess whether injury severity and age can predict mortality when prehospital deaths are included or excluded from total mortality. MATERIAL AND METHODS: Descriptive analysis of a retrospective cohort of 918 patients with multiple injuries attended by emergency medical services in Navarre, Spain, in 2010-2013. We analyzed prehospital and hospital deaths by cause of injuries and developed and compared the precision of logistic regression models to predict mortality. RESULTS: Most deaths occurred before arrival at a hospital. Three quarters of prehospital deaths occurred in patients under the age of 65 years. When prehospital deaths were included in the analysis, the lethality rate after traffic accidents rose from 16% to 42%; lethality from firearm injuries rose from 13% to 70%. When the model using the new injury severity score and age as independent variables was asked to predict survival with and without data for deaths at the scene or during transfer to a hospital, the model's performance differed only slightly. CONCLUSION: Most deaths from injuries occur before patients reach a hospital. The main characteristics of prehospital and hospital deaths differ. Including data for prehospital deaths in regression models does not change survival prediction based on injury severity and age.

OBJETIVO: Comparar la frecuencia y características de las muertes por traumatismo grave prehospitalarias y hospitalarias, así como conocer la capacidad de la gravedad de la lesión asociada a la edad para predecir la muerte y su variación según se incluyan o no las muertes prehospitalarias. METODO: Estudio descriptivo, analítico de cohorte retrospectiva realizado en Navarra sobre 918 pacientes politraumatizados atendidos por los servicios médicos de emergencia durante 2010-2013. Se estudió la letalidad por causas y se modeló la predicción de la mortalidad a través de regresión logística para comparar la precisión de los modelos. RESULTADOS: La mayoría de las muertes fueron prehospitalarias. Tres cuartas partes de las muertes ocurrieron en el ámbito prehospitalario en menores de 65 años. Al incorporar las muertes prehospitalarias las tasas de letalidad de los mecanismos relacionados con el tráfico pasaron del 16 al 42% y las producidas por armas del 13 al 70%. Al realizar la predicción del fallecimiento a través de la regresión logística tomando como variable independiente el NISS (New Injury Severity Score) y como variable de control la edad, existen mínimas variaciones si se compara el grupo de pacientes que llegan vivos al hospital con el de la suma de estos pacientes con los fallecidos in situ. CONCLUSIONES: Las muertes prehospitalarias constituyen la mayoría de las muertes por traumatismo y difieren en las características principales con los fallecimientos que se producen en el hospital. La incorporación de las muertes prehospitalarias no modifica la capacidad predictiva de mortalidad de un modelo de regresión logística que incluya la edad y el NISS.

Differences in the treatment and evolution of acute coronary syndromes according to gender: what are the causes?

AIMS AND OBJECTIVES: The objectives of this study were to analyse the differences in the treatment and the evolution of acute coronary syndromes according to the gender of the patient and to determine the likely causes of these differences. BACKGROUND: Epidemiological studies confirm the differences in the course and treatment of acute coronary syndromes according to factors such as gender and age. The factors associated with the observed gender-based differences are not known. DESIGN AND METHODS: This prospective study was conducted on 596 patients treated in the Hospital Emergency Service of the Hospital Complex of Navarra, Spain, from 1 January 2012 to April 2013 with acute coronary syndromes. A bivariate and logistic analysis has been made by adjusting the age and severity of process to know the differences by gender. RESULTS: A total of 71·8% (n = 428) were men, and the remaining 28·2% (168) were women. The mean age of the men was 66·4 ± 12·7 years, and the mean age of the women was 72·5 ± 13·9 years. We found that antiplatelet drugs (68·4 vs. 22·7%), blockers (70 vs. 25·4%), ACE inhibitors (56·2 vs. 15·6%), fibrinolysis (17·2 vs. 4·5%, p = 0·025) and primary angioplasty (AP) (38·7 vs. 16·3%, p = 0·008) were less frequently administered to women compared with men. We observed an additional delay in the demand for health care in women with acute coronary syndromes compared with men. CONCLUSIONS: There is an association between treatment differences and gender. The delay in the request of health care in women is observed to be the largest correlating factor, in addition to voluntary discharge in women affected by acute coronary syndromes. RELEVANCE TO CLINICAL PRACTICE: Delays in seeking medical care or voluntary discharge are likely factors related to worse outcomes in women. These factors should be explored, and the results should be made available to the public, particularly to women.

[Changes in the characteristics and incidence of multiple-injury accidents in the Navarre community over a 10-year period]. / Cambios durante la última década en la incidencia y las características de los pacientes politraumatizados en Navarra.

OBJECTIVES: To compare morbidity and mortality rates, the epidemiologic profile, and survival of patients with multiple injuries attended by the emergency services in the Navarre autonomous community in Spain in the periods of 2002-2003 and 2010-2012. MATERIAL AND METHODS: Observational analysis of 2 cohorts of accident patients with Injury Severity Scores of 15 points or more. Logistic regression was used to identify variables related to mortality. RESULTS: A total of 651 patients were attended in the first period; 626 were attended in the second. The annual multiple-injury incidence rate decreased from 58.1 per 100 000 population in the first period to 33.5 per 100 000 population in the second; mortality decreased from 30.3 to 15.3 per 100 000 population. The mean (SD) age was 45 (22) years in the first cohort and 52 (23) years in the second. The gender distribution (75% male) did not change. The percentage injured in traffic accidents decreased from 44% to 24%; the percentage of elderly patients hurt in falls increased from 9% to 26%. CONCLUSION: The problem of the number of young people injured in accidents in our community has been brought under control, but the proportion of older patients injured in falls has risen. This change may slow the effort to improve mortality rates in patients with multiple injuries and it obliges us to introduce measures to prevent falls in the elderly.

OBJETIVO: Comparar las tasas de morbimortalidad, el perfil epidemiológico y la supervivencia de los pacientes politraumatizados atendidos en Navarra por el sistema de emergencias en los períodos 2002-2003 y 2010-2012. METODO: Estudio observacional, analítico, de dos cohortes de pacientes accidentados con un Injury Severity Score superior a 15 puntos. Se utiliza la regresión logística para identificar las variables involucradas en la mortalidad. RESULTADOS: Se incluyen 651 pacientes atendidos en el primer periodo y se comparan con los 626 del segundo. La tasa de incidencia descendió de 58,1 a 33,5/100.000 habitantes y año, así como la de mortalidad, que descendió de 30,3 a 15,3. La edad media de los accidentados pasó de 45 (22) a 52 (23) años y se mantuvo su distribución por sexos (75% varones). Disminuyeron los accidentados de tráfico del 44 al 24% y se incrementaron las caídas en ancianos del 9 al 26%. CONCLUSIONES: En los últimos años se ha controlado en Navarra el problema de los jóvenes accidentados de tráfico y ha surgido el grupo de ancianos que se caen accidentalmente. Esto puede ralentizar la mejora en las tasas de mortalidad de los politraumatizados y obliga a poner en marcha medidas preventivas en relación con este mecanismo en este colectivo.

[Seroprevalence of Lyme disease in Navarra, Spain]. / Seroprevalencia de la enfermedad de Lyme en Navarra.

BACKGROUND AND OBJECTIVE: To establish the seroprevalence of infection by Borrelia burgdorferi in Navarre (Spain). PATIENTS AND METHOD: Serum samples of 1,429 individuals considered representative of the population of Navarre were analyzed. The individuals were recruited from a list issued by the government of Navarre. The subjects were stratified according to three variables: age, sex and the health zone to which they belonged. In all cases a written informed consent was obtained. RESULTS: The global seroprevalence in Navarre was 4.4%. Being a stockbreeder (13.2%) in contact with cows and sheep was found to be a risk factor after the analysis of different variables such as sex, age, contact with cattle, profession, living in rural areas, a prior history of having been bitten by a tick or the size of the city. CONCLUSIONS: Navarre provides suitable conditions for the prevalence and development of Lyme disease, with a global seroprevalence or 4.4%. No differences were found between the different areas analyzed, while being a stockbreeder represents a risk factor.