[Long distance interhospital transport. Accuracy of severity scoring system]. / Transporte interhospitalario de largo recorrido. Utilidad de las escalas de gravedad.

OBJECTIVE: To evaluate the hospital mortality risk for patients transported from a regional hospital to its second-level reference hospital using several scoring systems: Rapid Acute Physiology Score (RAPS), Rapid Emergency Medicine Score (REMS), SAPS II and APACHE II. DESIGN AND SETTING: Prospective observational study of patients transferred from the Sant Hospital in la Seu d'Urgell to the University Hospital Arnau de Vilanova in Lleida, at a distance of 132 km. PATIENTS: Consecutive cohort of 134 patients transferred between October 2005 and July 2007. MAIN VARIABLES: Several data were collected, such as variables on demography, stay, severity score, diagnosis on admission, destination service and procedures, such as mechanical ventilation, inotropics, sedation, neuromuscular blockers and antiarrhythmics. Variable of result was hospital mortality. RESULTS: The average transfer time was 105 +/- 14 minutes; 31.6% of the patients were admitted to an ICU; 16 (11,9%) patients died during hospital stay. The APACHE II and SAPS II scores got significantly higher values in those patients who died. The RAPS and REMS scores showed no significant differences among dead and survivors. The higher the APACHE II and SAPS II scores, the higher the proportion of mortality. The RAPS and REMS scores did not prove to have that tendency. Area under ROC curve was higher for APACHE II (0.76; 95% CI, 0.63-0.89) and SAPS II (0.78; 95% CI, 0.67-0.89), compared to those of RAPS (0.59; 95% CI, 0.43-0.75) and REMS (0.63; 95% CI, 0.49-0.78). CONCLUSIONS: The severity of illness measured with APACHE II and SAPS II is able to identify those patients with a higher predictive of mortality. It is a priority to have the right previous stabilization and the adequately trained team to provide care during the transfer, when facing lengthy journey times.

Cerebral salt wasting syndrome in a patient affected of spontaneous frontoparietal subdural haematoma.

Ever since cerebral salt wasting syndrome (CSW) was first described in 1950, there have been debates over its existence and whether it has an important place in the differential diagnosis of hyponatraemia. We report the case of a neurosurgical patient with sustained hyponatraemia and abnormally high sodium loss in the urine, with signs of fluid volume depletion. Hyponatraemia was not corrected after an intravenous infusion of saline solution. Stable concentrations of blood sodium above 130 mmol/l were achieved with the administration of 100 mg of hydrocortisone daily, with an ensuing reduction in sodium elimination through the urine.