Shock index combined with age and the Glasgow Coma Scale during the initial care of polytraumatized patients as a predictor of mortality. / Shock Index asociado a la edad y al Glasgow Coma Score como predictor de mortalidad en la atención inicial del paciente politraumatizado.

OBJECTIVES: To study whether combining age and the Glasgow Coma Scale (GCS) with the shock index (SI) - SIA/G - during the initial care of polytraumatized patients can improve the ability of the SI alone to predict mortality. To compare the predictive performance of the SIA/G combination to other prognostic scales: the addition of points for the GCS, age and systolic blood pressure (GAP); the Revised Trauma Score (RTS); and the Injury Severity Score (ISS). MATERIAL AND METHODS: Observational cohort study of patients with severe trauma admitted to the intensive care unit of a tertiary care hospital between 2015 and 2020. We calculated the SI (heart rate/systolic blood pressure), the SI/G ratio, the product of the SI and age SIA, and the combined index: SIA/G. The areas under the receiver operating characteristic curves (AUROCs) for hospital mortality and 24-hour mortality were calculated for the SIA/G combination and compared to the AUROCs for the GAP, the RTS, and the ISS. RESULTS: We analyzed data for 433 patients, 47 of whom (10.9%) died. All the prognostic indexes were significantly related to mortality but the SIA/G was the best predictor of both hospital and 24-hour mortality, with AUROCs of 0.879 (95% CI, 0.83-0.93) and 0.875 (95% CI, 0.82-0.93), respectively. A score of 3.3 for the SIA/G showed 82% sensitivity and 80% specificity for hospital mortality (86% and 78%, respectively, for 24-hour mortality). The AUROCs for the GAP, RTS, and ISS indexes were lower for hospital mortality. CONCLUSION: The combined SIA/G score is a better predictor in hospital of mortality in patients with multiple injuries than the SI or the traditional GAP, RTS, and ISS indexes.

OBJETIVO: Estudiar si la edad y la puntuación Glasgow Coma Score (GCS) incrementan la predicción de mortalidad del Shock Index (SI) en la atención inicial del paciente politraumatizado y compararlo con las escalas pronósticas, GAP (Glasgow Coma Score-Age-Systolic Blood Pressure), RTS (Revised Trauma Score) e ISS (Injury Severity Score). METODO: Estudio observacional sobre una cohorte de pacientes de la unidad de cuidados críticos de un hospital de tercer nivel con diagnóstico de trauma grave entre 2015 y 2020. Se recogió el SI (FC/TAS) y el SI asociado al GCS (SI/G), a la edad (SIA) y a ambos (SIA/G). Se calculó el área bajo la curva (ABC) de la característica operativa del receptor (COR) para cada uno de ellos para la mortalidad hospitalaria (MH) y en las primeras 24 horas (M24). También se comparó el ABC COR del SIA/G con las de las escalas GAP, RTS e ISS. RESULTADOS: Se analizaron 433 pacientes de los cuales fallecieron 47 (10,9%). Todos los SI se relacionaron significativamente con la mortalidad, pero el SIA/G presentó la mayor ABC COR para MH (0,879, IC 95% 0,83-0,93) y para M24 (0,875, IC 95% 0,82-0,93). El valor SIA/G de 3,3 puntos mostró una sensibilidad del 82% y especificidad del 80% para MH y del 86% y 78% para M24. El ABC COR del SIA/G para la MH fue superior a las de las escalas GAP, RTS e ISS. CONCLUSIONES: SIA/G es superior al SI y a las escalas clásicas GAP, RTS e ISS como predictor de MH del paciente politraumatizado.

Executive summary of the SEPAR recommendations for the diagnosis and treatment of non-small cell lung cancer. / Sumario ejecutivo de las recomendaciones SEPAR de diagnóstico y tratamiento del cáncer de pulmón de células no pequeñas.

The Thoracic Surgery and Thoracic Oncology groups of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) have backed the publication of a handbook on recommendations for the diagnosis and treatment of non-small cell lung cancer. Due to the high incidence and mortality of this disease, the best scientific evidence must be constantly updated and made available for consultation by healthcare professionals. To draw up these recommendations, we called on a wide-ranging group of experts from the different specialties, who have prepared a comprehensive review, divided into 4 main sections. The first addresses disease prevention and screening, including risk factors, the role of smoking cessation, and screening programs for early diagnosis. The second section analyzes clinical presentation, imaging studies, and surgical risk, including cardiological risk and the evaluation of respiratory function. The third section addresses cytohistological confirmation and staging studies, and scrutinizes the TNM and histological classifications, non-invasive and minimally invasive sampling methods, and surgical techniques for diagnosis and staging. The fourth and final section looks at different therapeutic aspects, such as the role of surgery, chemotherapy, radiation therapy, a multidisciplinary approach according to disease stage, and other specifically targeted treatments, concluding with recommendations on the follow-up of lung cancer patients and surgical and endoscopic palliative interventions in advanced stages.