Trauma Leagues-A Novel Option to Attract Medical Students to a Surgical Career.

BACKGROUND: In Brazil, most medical schools do not offer trauma surgery in their undergraduate curriculum. The Trauma Leagues arose in Brazil as an important promoter of trauma education and stimulated activities related to surgical skills and practices. In recent decades, studies have demonstrated that the number of surgical residency applicants has decreased worldwide. Strategies to motivate medical students to choose surgery are needed. OBJECTIVE: To evaluate the impact of participation in the Unicamp Trauma League (UTL) during a 20-year period in the choice for a surgical career. METHODS: The study included 276 students in a Brazilian university hospital who were part of the Trauma League. Research of records in universities and medical societies about the specialties chosen during residency were evaluated. A Likert questionnaire was sent to participants to evaluate the impact of participating in the Trauma League in the student's professional career. RESULTS: The questionnaire was answered by 76% of the participants. Of those, 38.4% chose general surgery. About 55.1% did not know what medical career to choose when joined the league. Participation in the league had an influence on specialty choice in 79.1% of the students. Of those choosing surgery, 93.2% believed that participating in the league had positively influenced their career choice. Overall, 93.1% believed that participating in the league provided knowledge and information that the medical school curriculum was not able to provide. CONCLUSION: Participation in Trauma League has been an effective strategy to encourage medical students to choose a career in general surgery in Campinas, Brazil.

Bladder injuries after external trauma: 20 years experience report in a population-based cross-sectional view.

OBJECTIVES: Report 20 years experience of bladder injuries after external trauma. METHODS: Gender, age, mechanism/location of damage, associated injuries, systolic blood pressure (SBP), Revised Trauma Score (RTS), Injury Severity Score (ISS), Trauma Injury Severity Score (TRISS), complications, and length of stay (LOS) were analyzed in a prospective collected bladder injuries AAST-OIS grade ≥ II database (American Association for the Surgery of Trauma Organ Injury Scaling) from 1990 to 2009 in a trauma reference center. RESULTS: Among 2,575 patients experiencing laparotomy for trauma, 111 (4.3 %) presented bladder ruptures grade ≥ II, being 83.8 % (n = 93) males, mean age 31.5 years old (± 11.2). Blunt mechanism accounted for 50.5 % (n = 56)-motor vehicle crashes 47.3 % (n = 26), pedestrians hit by a car (29.1 %). Gunshot wounds represented 87.3 % of penetrating mechanism. The most frequent injury was grade IV (51 patients, 46 %). The mean ISS was 23.8 (± 11.2), TRISS 0.90 (± 0.24), and RTS 7.26 (± 1.48). Severity (AAST-OIS), mechanism (blunt/penetrating), localization of the bladder injury (intra/extraperitoneal, associated), and neither concomitant rectum lesion were related to complications, LOS, or death. Mortality rate was 10.8 %. ISS > 25 (p = 0.0001), SBP <90 mmHg (p = 0.0001), RTS <7.84 (p = 0.0001), and pelvic fracture (p = 0.0011) were highly associated with grim prognosis and death with hazard ratios of 5.46, 2.70, 2.22, and 2.06, respectively. CONCLUSIONS: Trauma scores and pelvic fractures impact survival in bladder trauma. The mortality rate has remained stable for the last two decades.

Penetrating cardiac trauma: 20-y experience from a university teaching hospital.

BACKGROUND: Penetrating traumas, including gunshot and stab wounds, are the major causes of cardiac trauma. Our aim was to describe and compare the variables between patients with penetrating cardiac trauma in the past 20 y in a university hospital, identifying risk factors for morbidity and death. METHODS: Review of trauma registry data followed by descriptive statistical analysis comparing the periods 1990-1999 (group 1, 54 cases) and 2000-2009 (group 2, 39 cases). Clinical data at hospital admission, Injury Severity Score (ISS), Glasgow Coma Scale (GCS), and Revised Trauma Score (RTS) were recorded. RESULTS: The incidences of penetrating cardiac injuries were steady within the period of study in the chosen metropolitan area. The two groups were similar regarding age, mechanism of trauma (gunshot × stab), and ISS. Group 1 showed lower systolic blood pressure at admission (mean 87 versus 109 mm Hg), lower GCS (12.9 versus 14.1), lower RTS (6.4 versus 7.3), higher incidence of grade IV-V cardiac lesions (74% versus 48.7%), and were less likely to survive (0.83 versus 0.93). The major risk factor for death was gunshot wound (13 times higher than stab wound), systolic blood pressure < 90 mm Hg, GCS < 8, RTS < 7.84, associated injuries, grade IV-V injury, and ISS > 25. We observed a tendency in mortality reduction from 20.3% to 10.3% within the period of observation. CONCLUSIONS: Several associated factors for mortality and morbidity were identified. In the last decade, patients were admitted in better physiological condition, perhaps reflecting an improvement on prehospital treatment. We observed a trend toward a lower mortality rate.

Can trauma leagues contribute to better cognitive performance and technical skills of medical students? The experience of the Unicamp trauma league.

PURPOSE: Trauma leagues (TLs) are extracurricular programs that offer medical students supervised exposure to trauma and acute care surgery, mentorship, and participation in other academic activities. TLs are fully approved medical schools, and currently, over 100 TLs exist in Brazil. We hypothesized that the performance/competence of medical students who participated in TLs was superior compared to non-participants. This study evaluated and compared the cognitive performance and technical skills of the two groups. METHODS: This retrospective cohort study evaluated the performance of TL medical students to non-TL alumni from 2005 to 2017, using the students' academic performance coefficient, Clinical Competence Assessment, and Progress Test results. SigmaPlot 12.0 software was used to perform statistical analyses, including Mann-Whitney comparison tests and the Kruskal-Wallis test to confirm the data. RESULTS: Of the 1366 medical students who graduated from a Brazilian university, 966 were included, with 17.9% having participated in TL. Compared to non-TL participants, TL students demonstrated better cognitive performance according to the performance coefficient (p = 0.017) and Progress Test result (p < 0.001), and higher achievement in the Clinical Competence Assessment (p < 0.001). CONCLUSION: The academic performance of TL students was superior to that of non-TL students at the University of Campinas (Unicamp), suggesting a positive impact of TL in the preparation of future doctors. The study findings suggest that participation in TL at Unicamp was beneficial in preparing better doctors and should be considered by medical schools worldwide. EVIDENCE LEVEL: II (Retrospective cohort).

Use of Sengstaken-Blakemore intrahepatic balloon: an alternative for liver-penetrating injuries.

BACKGROUND: Severe lesions in the liver are associated with a high mortality rate. Alternative surgical techniques such as the use of an intrahepatic balloon may be effective and reduce mortality in severe hepatic lesions. This study aimed to demonstrate the experience of a university hospital in the use of the Sengstaken-Blakemore balloon in patients with transfixing penetrating hepatic injury as an alternative way to treat these challenging injuries. METHODS: A retrospective study based on the trauma registry of a university hospital was performed. All patients admitted with hepatic penetrating injuries and treated with the Sengstaken-Blakemore balloon within the period 1990-2010 were reviewed. RESULTS: Forty-six patients with transfixing hepatic injuries were treated with the Sengstaken-Blakemore balloon in the study period. The most frequent cause of injury was gunshot wound (87 % of the patients). The mean trauma scores on admission were Revised Trauma Score (RTS) = 7.12 ± 1.46, Injury Severity Score (ISS) = 22.4 ± 9.7, and Abdominal Trauma Index (ATI) = 19.5 ± 11. According to the severity of the hepatic trauma, 71.8 % of patients had grade III, 23.9 % grade IV, and 4.3 % grade V injuries. Associated abdominal injuries were found in 89.1 % of the patients. The most frequent liver-related complications were hepatic abscess postoperative bleeding (8.6 %), biliary fistula (8.6 %), (4.3 %), and biliary peritonitis (2.1 %). Surgical reintervention was necessary in 14 patients (31.1 %). From those 14, only 3 had the balloon removed. The overall morbidity and mortality rates were 56.5 % and 23.9 % (11 patients), respectively. CONCLUSION: The knowledge of alternative surgical techniques is essential in improving survival in patients with severe penetrating hepatic injuries. The use of intrahepatic balloon is a viable surgical strategy.

In-person and telemedicine course models for disaster preparedness: a comparative analysis.

OBJECTIVE: to compare the students' performance in face-to-face and telemedicine courses for the training and necessary action in disasters, using telemedicine as an effective training tool. METHODS: online research conducted after the end of the course of preparation in disasters, carried out in-person, as well as by videoconference. We compared the performance of students in the in-person course and through telemedicine. RESULTS: in the comparison of the results obtained with the pre- and post-test data between the students who attended via telemedicine and in-person, we observed that in the two modalities there was an increase in knowledge (p<0.001). We also observed no statistically significant differences in the posterior evaluation between the in-person and telemedicine courses (p=1.0), however, there was a significant difference at the pre-test evaluative moment (p<0.001). CONCLUSION: videoconferencing can be effectively used to train health professionals in disaster management, being able to provide adequate knowledge and become an important tool to distance reaching in continuing education.

Importance of multidisciplinary trauma prevention program for youth.

OBJECTIVE: present the experience of the P.A.R.T.Y. program in Campinas, thereby changing the habits of young people. METHODS: The organizers visited the participating schools talking to the students, who are aged between 14-18 years. These students spent an afternoon at the Clinics Hospital of Unicamp, where, for four hours, they attended lectures of the organizers, partners and municipal sectors, and also visited the hospital, talking with trauma victims. Questionnaires were evaluated between 2010-2012, being applied before and after the project. RESULTS: 2,450 high school students attended the program. The mean age is 16 ± 0,99 years and 37.6% were male. 3.6% of males already drive while drunk versus 0.8% of women. Before the project 116 (11.3%) thought that drunk driving wasn't a risk, and only 37 (3.6%) knew the alcohol effects. After the project, 441 (43%) began to consider drunk driving a risk and 193 (18.8%) know the alcohol effects when driving. 956 (93.3%) considered that prevention projects have a huge impact on their formation. CONCLUSION: It's expected that the attendees will act as multipliers of information, conveying the message of prevention to their entire social circles resulting in reduction in the number of trauma events involving the young, in the long term.

Extrahepatic duct injury in blunt trauma: two case reports and a literature review.

Traumatic injuries of the extrahepatic biliary tract are rare. Associated injuries are usually responsible for immediate indication for surgical treatment, the time when an injury to the extrahepatic biliary ducts may be diagnosed. However, missed injuries are often common. The primary aim of this paper is to describe the clinical features, diagnosis, treatment, and outcome of two patients with left hepatic duct injury after blunt abdominal trauma. As a secondary objective, a literature review is presented. The two cases presented in this study are as follows: (1) A young male, involved in a motor vehicle crash, was admitted with blunt hepatic trauma in a general hospital. Endoscopic retrograde cholangiography was conducted 3 weeks later and revealed a large leakage at the left hepatic duct. Exploratory laparotomy was performed 26 days after the initial traumatic event and identified a complete section of the left hepatic duct, treated with anastomosis. (2) A male fell from a height. On exploratory laparotomy, a 30 % partial injury of the left hepatic duct was found in addition to hemoperitoneum, liver injury, gallbladder detachment together with cystic duct rupture, retroperitoneal hematoma to the right, and cecum hematoma. A high level of suspicion is necessary to identify injuries to the hepatic ducts. Early diagnosis that occurs during laparotomy due to associated injuries is important to reduce complications.

Hepatic trauma: a 21-year experience.

OBJECTIVE: To evaluate the epidemiological aspects, behavior, morbidity and treatment outcomes for liver trauma. METHODS: We conducted a retrospective study of patients over 13 years of age admitted to a university hospital from 1990 to 2010, submitted to surgery or nonoperative management (NOM). RESULTS: 748 patients were admitted with liver trauma. The most common mechanism of injury was penetrating trauma (461 cases, 61.6%), blunt trauma occurring in 287 patients (38.4%). According to the degree of liver injury (AAST-OIS) in blunt trauma we predominantly observed Grades I and II and in penetrating trauma, Grade III. NOM was performed in 25.7% of patients with blunt injury. As for surgical procedures, suturing was performed more frequently (41.2%). The liver-related morbidity was 16.7%. The survival rate for patients with liver trauma was 73.5% for blunt and 84.2% for penetrating trauma. Mortality in complex trauma was 45.9%. CONCLUSION: trauma remains more common in younger populations and in males. There was a reduction of penetrating liver trauma. NOM proved safe and effective, and often has been used to treat patients with penetrating liver trauma. Morbidity was high and mortality was higher in victims of blunt trauma and complex liver injuries.

The use of corticosteroid for the prophylaxis of fat embolism syndrome in patients with long bone fracture.

The "Evidence-based Telemedicine - Trauma & Acute Care Surgery" (EBT-TACS) Journal Club conducted a critical review of the literature and selected three recent studies on the use of corticosteroids for the prophylaxis of fat embolism syndrome. The review focused on the potential role of corticosteroids administration to patients admitted to the intensive care unit (ICU) at risk of developing post-traumatic fat embolism. The first study was prospective and aimed at identifying reliable predictors, which occurred early and were associated with the onset of fat embolism syndrome in trauma patients. The second manuscript was a literature review of the role of corticosteroids as a prophylactic measure for fat embolism syndrome (FES). The last manuscript was a meta-analysis on the potential for corticosteroids to prophylactically reduce the risk of fat embolism syndrome in patients with long bone fractures. The main conclusions and recommendations reached were that traumatized patients should be monitored with non-invasive pulse oximetry and lactate levels since these factors may predict the development of FES, and that there is not enough evidence to recommend the use of steroids for the prophylaxis of this syndrome.

In-person and telemedicine course models for disaster preparedness: a comparative analysis / Modelo de curso presencial e via telemedicina para preparação em desastres: uma análise comparativa

ABSTRACT Objective: to compare the students' performance in face-to-face and telemedicine courses for the training and necessary action in disasters, using telemedicine as an effective training tool. Methods: online research conducted after the end of the course of preparation in disasters, carried out in-person, as well as by videoconference. We compared the performance of students in the in-person course and through telemedicine. Results: in the comparison of the results obtained with the pre- and post-test data between the students who attended via telemedicine and in-person, we observed that in the two modalities there was an increase in knowledge (p<0.001). We also observed no statistically significant differences in the posterior evaluation between the in-person and telemedicine courses (p=1.0), however, there was a significant difference at the pre-test evaluative moment (p<0.001). Conclusion: videoconferencing can be effectively used to train health professionals in disaster management, being able to provide adequate knowledge and become an important tool to distance reaching in continuing education.

RESUMO Objetivo: comparar o desempenho dos alunos nos cursos presenciais e via telemedicina para a capacitação e atuação necessária em desastres, se valendo da telemedicina como uma ferramenta efetiva de treinamento. Métodos: pesquisa online realizada após o término do curso de preparação em desastres, realizado presencialmente, bem como, por videoconferência. Comparou-se o desempenho dos alunos do curso presencial e via telemedicina. Resultados: na comparação dos resultados obtidos com os dados pré e pós-teste entre os alunos que cursaram via telemedicina e presencialmente, observou-se que nas duas modalidades do curso houve aumento do conhecimento (p<0,001). Constatou-se ainda que não houve diferenças estatisticamente significativas na avaliação posterior entre os cursos presenciais e via telemedicina (p=1,0), no entanto, houve diferença com significância no momento avaliativo pré-teste (p<0,001). Conclusão: as videoconferências podem ser utilizadas de forma efetiva para a capacitação de profissionais da área de saúde na gestão de desastres, sendo capaz de prover o conhecimento de forma adequada e ser ferramenta importante para alcance à distância em educação continuada.

Blunt hepatic trauma: comparison between surgical and nonoperative treatment.

OBJECTIVE: To examine the outcomes of blunt hepatic trauma, and compare surgical and non-surgical treatment in patients admitted with hemodynamic stability and with no obvious indications of laparotomy. METHODS: This is a retrospective study of cases admitted to a university teaching hospital between the years 2000 and 2010. Patients undergoing surgical treatment were divided into two groups: (a) all patients undergoing surgical treatment, and (b) patients with obvious need for surgery. RESULTS: In this period, 120 patients were admitted with blunt hepatic trauma. Sixty five patients (54.1%) were treated non-operatively and fifty five patients were operated upon. Patients treated non-operatively had better physiologic conditions on admission, demonstrated less severe injuries (except the grade of hepatic injury), received less blood components and had lower morbidity and mortality than the patients operated upon. Patients who underwent non-operative treatment had a lower need for blood transfusion but higher rates of complications and mortality than the patients operated upon. Patients who were operated upon, with no obvious indications for surgery, had higher rates of complication and mortality than patients not operated upon. CONCLUSION: A non-operative approach resulted in lower complications, a lower need for blood transfusions and lower mortality.

Initial experience at a university teaching hospital from using telemedicine to promote education through video conferencing.

CONTEXT AND OBJECTIVE: Telehealth and telemedicine services are advancing rapidly, with an increasing spectrum of information and communication technologies that can be applied broadly to the population's health, and to medical education. The aim here was to report our institution's experience from 100 videoconferencing meetings between five different countries in the Americas over a one-year period. DESIGN AND SETTING: Retrospective study at Universidade Estadual de Campinas. METHODS: Through a Microsoft Excel database, all conferences in all specialties held at our institution from September 2009 to August 2010 were analyzed retrospectively. RESULTS: A total of 647 students, physicians and professors participated in telemedicine meetings. A monthly mean of 8.3 (± 4.3) teleconferences were held over the analysis period. Excluding holidays and the month of inaugurating the telemedicine theatre, our teleconference rate reached a mean of 10.3 (± 2.7), or two teleconferences a week, on average. Trauma surgery and meetings on patient safety were by far the most common subjects discussed in our teleconference meetings, accounting for 22% and 21% of the total calls. CONCLUSION: Our experience with telemedicine meetings has increased students' interest; helped our institution to follow and discuss protocols that are already accepted worldwide; and stimulated professors to promote telemedicine-related research in their own specialties and keep up-to-date. These high-technology meetings have shortened distances in our vast country, and to other reference centers abroad. This virtual proximity has enabled discussion of international training with students and residents, to increase their overall knowledge and improve their education within this institution.

Publication of papers presented in a Brazilian Trauma Congress.

OBJECTIVE: To assess the proportion of papers presented at the XXI Panamerican Congress of Trauma, VIII Congress of the Brazilian Society of Integrated Assistance to the Traumatized (SBAIT) and X Brazilian Congress of Trauma Leagues (CoLT) that were published in full. METHODS: In the events cited, based in Campinas in 2008, 347 papers abstracts of were presented and published. To evaluate the proportion of complete published works a retrospective observational study was conducted, reviewing the biomedical databases PubMed and SciELO, with support from Google, from the title of the abstracts and list of authors. RESULTS: Of 347 papers considered, 25 (7.3%) were from foreign services and 322 (92.7%) national. Ten (2.9%) papers were published, of which six (1.7%) of nursing and four (1.2%) medical. Among these, four thesis publications were identified and only one international work has been published. CONCLUSION: Despite a large number of papers presented at trauma conferences in Brazil, the publications in this area are rare. The academy and the societies of surgery need to encourage the submission of scientific papers even before the presentation in Congresses in order for them to be evaluated for publication in indexed journals.

Importance of multidisciplinary trauma prevention program for youth / Importância de programa multiprofissional de prevenção de trauma para jovens

OBJECTIVE: present the experience of the P.A.R.T.Y. program in Campinas, thereby changing the habits of young people. METHODS: The organizers visited the participating schools talking to the students, who are aged between 14-18 years. These students spent an afternoon at the Clinics Hospital of Unicamp, where, for four hours, they attended lectures of the organizers, partners and municipal sectors, and also visited the hospital, talking with trauma victims. Questionnaires were evaluated between2010-2012, being applied before and after the project. RESULTS: 2,450 high school students attended the program. The mean age is 16 ± 0,99 years and 37.6% were male. 3.6% of males already drive while drunk versus 0.8% of women. Before the project 116 (11.3%) thought that drunk driving wasn't a risk, and only 37 (3.6%) knew the alcohol effects. After the project, 441 (43%) began to consider drunk driving a risk and 193 (18.8%) know the alcohol effects when driving. 956 (93.3%) considered that prevention projects have a huge impact on their formation. CONCLUSION: It's expected that the attendees will act as multipliers of information, conveying the message of prevention to their entire social circles resulting in reduction in the number of trauma events involving the young, in the long term. .

OBJETIVO: identificar o perfil dos jovens que participaram do programa P.A.R.T.Y. na cidade de Campinas e apresentar o impacto deste projeto desde a sua implantação em 2010. MÉTODOS: os organizadores realizam visita às escolas participantes, conversando com os alunos, que tem idade entre 14-18 anos. Esses alunos passam a tarde no Hospital de Clínicas da Unicamp, onde, durante quatro horas participam de palestras ministradas pelos organizadores, parceiros e setores municipais, e também visitam o hospital, conversando com vítimas de trauma. Foram avaliadas as visitas no período de 2010 a 2012, sendo um questionário aplicado antes e logo após o projeto. RESULTADOS: participaram do projeto 2450 estudantes do ensino médio. A média de idade foi 16 ± 0,99 anos e 37,6% eram do sexo masculino. Entre os homens, 3,6% do total de participantes já dirigiu alcoolizado e 0,8% no sexo feminino. Antes do projeto 116 (11,3%) acreditavam que dirigir após beber não era um risco e apenas 37 (3,6%) sabiam dos efeitos do álcool. Após, 441 (43%) passaram a considerar um risco e 193 (18,8%) sabiam os efeitos do álcool. CONCLUSÃO: o surgimento de programas de prevenção possibilita a mudança de comportamento na população participante, principalmente realizada por equipe multidisciplinar, que apresenta o assunto estudado sobre diferentes pontos de vista, de acordo com sua área de atuação. .

Uso de corticoide na profilaxia para síndrome de embolia gordurosa em pacientes com fratura de osso longo / The use of corticosteroid for the prophylaxis of fat embolism syndrome in patients with long bone fracture

A reunião de revista "Telemedicina Baseada em Evidência - Cirurgia do Trauma e Emergência" (TBE-CiTE) realizou uma revisão crítica da literatura e selecionou três artigos recentes sobre o uso de corticoide para a profilaxia da síndrome de embolia gordurosa. O foco desta revisão foi a indicação ou não do uso de corticoide nos pacientes admitidos na unidade de terapia intensiva (UTI) com risco de desenvolverem embolia gordurosa pós traumática. O primeiro artigo foi um estudo prospectivo com o objetivo de estabelecer fatores preditivos confiáveis, precoces e úteis associados ao aparecimento da síndrome da embolia gordurosa (SEG) em pacientes traumatizados. O segundo artigo foi uma revisão de literatura sobre o papel do corticoide como medida profilática à síndrome de embolia gordurosa. O último artigo foi uma meta-análise sobre a capacidade do corticoide em reduzir o risco de síndrome da embolia gordurosa nos pacientes com fraturas de ossos longos. As principais conclusões e recomendações foram que pacientes traumatizados devem ser monitorizados na UTI com oximetria de pulso e medida do lactato já que estes fatores podem predizer o aparecimento de SEG e que não existe evidência suficiente para recomendar o uso de corticoide para a profilaxia desta síndrome.

The "Evidence-based Telemedicine - Trauma & Acute Care Surgery" (EBT-TACS) Journal Club conducted a critical review of the literature and selected three recent studies on the use of corticosteroids for the prophylaxis of fat embolism syndrome. The review focused on the potential role of corticosteroids administration to patients admitted to the intensive care unit (ICU) at risk of developing post-traumatic fat embolism. The first study was prospective and aimed at identifying reliable predictors, which occurred early and were associated with the onset of fat embolism syndrome in trauma patients. The second manuscript was a literature review of the role of corticosteroids as a prophylactic measure for fat embolism syndrome (FES). The last manuscript was a meta-analysis on the potential for corticosteroids to prophylactically reduce the risk of fat embolism syndrome in patients with long bone fractures. The main conclusions and recommendations reached were that traumatized patients should be monitored with non-invasive pulse oximetry and lactate levels since these factors may predict the development of FES, and that there is not enough evidence to recommend the use of steroids for the prophylaxis of this syndrome.

Trauma hepático: uma experiência de 21 anos / Hepatic trauma: a 21-year experience

OBJETIVO: avaliar os aspectos epidemiológicos, conduta, morbidade e resultados do tratamento trauma hepático. MÉTODOS: estudo retrospectivo de doentes com mais de 13 anos de idade admitidos em um hospital universitário de 1990 a 2010, submetidos ao tratamento cirúrgico ou não operatório (TNO). RESULTADOS: foram admitidos 748 pacientes com trauma hepático. O mecanismo de trauma mais frequente foi o trauma penetrante (461 casos; 61,6%). O trauma fechado ocorreu em 287 pacientes (38,4%). De acordo com o grau de lesão hepática (AAST-OIS), no trauma fechado foi observada uma predominância dos graus I e II e no trauma penetrante, uma predominância do grau III. O TNO foi realizado em 25,7% dos pacientes com trauma hepático contuso. Entre os procedimentos cirúrgicos, a sutura foi realizada com maior frequência (41,2%). A morbidade relacionada ao fígado foi 16,7%. A taxa de sobrevida para pacientes com trauma hepático fechado foi 73,5% e no trauma penetrante de 84,2%. A mortalidade no trauma complexo foi 45,9%. CONCLUSÃO: o trauma permanece mais incidente nas populações mais jovens e no sexo masculino. Houve uma redução dos traumas hepáticos penetrantes. O TNO se mostrou seguro e efetivo, e, frequentemente, foi empregado para tratar os pacientes com trauma hepático penetrante. A morbidade foi elevada e a mortalidade foi maior em vítimas de traumas contusos e em lesões hepáticas complexas.

OBJECTIVE: To evaluate the epidemiological aspects, behavior, morbidity and treatment outcomes for liver trauma. METHODS: We conducted a retrospective study of patients over 13 years of age admitted to a university hospital from 1990 to 2010, submitted to surgery or nonoperative management (NOM). RESULTS: 748 patients were admitted with liver trauma. The most common mechanism of injury was penetrating trauma (461 cases, 61.6%), blunt trauma occurring in 287 patients (38.4%). According to the degree of liver injury (AAST-OIS) in blunt trauma we predominantly observed Grades I and II and in penetrating trauma, Grade III. NOM was performed in 25.7% of patients with blunt injury. As for surgical procedures, suturing was performed more frequently (41.2%). The liver-related morbidity was 16.7%. The survival rate for patients with liver trauma was 73.5% for blunt and 84.2% for penetrating trauma. Mortality in complex trauma was 45.9%. CONCLUSION: trauma remains more common in younger populations and in males. There was a reduction of penetrating liver trauma. NOM proved safe and effective, and often has been used to treat patients with penetrating liver trauma. Morbidity was high and mortality was higher in victims of blunt trauma and complex liver injuries.

Trauma hepático contuso: comparação entre o tratamento cirúrgico e o não operatório / Blunt hepatic trauma: comparison between surgical and nonoperative treatment

OBJETIVO: Analisar a evolução do trauma hepático fechado e comparar o tratamento operatório e não operatório em pacientes admitidos com estabilidade hemodinâmica e nenhuma indicação óbvia de laparotomia. MÉTODOS: Estudo retrospectivo de casos admitidos em um hospital universitário entre 2000 e 2010. Os pacientes submetidos ao tratamento operatório foram distribuídos em dois grupos: a) todos os pacientes submetidos ao tratamento cirúrgico e b) pacientes sem indicações óbvias de laparotomia. RESULTADOS: Neste período, 120 pacientes foram admitidos com trauma hepático fechado. Sessenta e cinco pacientes (54,1%) foram submetidos ao tratamento não operatório e 55 pacientes foram operados. Pacientes submetidos ao tratamento não operatório tiveram melhores parâmetros fisiológicos na admissão, menor gravidade de lesões (exceto pelo grau de lesão hepática), menor necessidade de transfusão sanguínea e menor morbidade e mortalidade quando comparados aos pacientes operados. Os pacientes operados sem indicação óbvia de cirurgia tiveram maiores taxas de complicações e mortalidade do que os pacientes submetidos ao tratamento não operatório. CONCLUSÃO: O tratamento não operatório resultou em menor taxa de complicações, menor necessidade de transfusão sanguínea e menor mortalidade.

OBJECTIVE: To examine the outcomes of blunt hepatic trauma, and compare surgical and non-surgical treatment in patients admitted with hemodynamic stability and with no obvious indications of laparotomy. METHODS: This is a retrospective study of cases admitted to a university teaching hospital between the years 2000 and 2010. Patients undergoing surgical treatment were divided into two groups: (a) all patients undergoing surgical treatment, and (b) patients with obvious need for surgery. RESULTS: In this period, 120 patients were admitted with blunt hepatic trauma. Sixty five patients (54.1%) were treated non-operatively and fifty five patients were operated upon. Patients treated non-operatively had better physiologic conditions on admission, demonstrated less severe injuries (except the grade of hepatic injury), received less blood components and had lower morbidity and mortality than the patients operated upon. Patients who underwent non-operative treatment had a lower need for blood transfusion but higher rates of complications and mortality than the patients operated upon. Patients who were operated upon, with no obvious indications for surgery, had higher rates of complication and mortality than patients not operated upon. CONCLUSION: A non-operative approach resulted in lower complications, a lower need for blood transfusions and lower mortality.

Initial experience at a university teaching hospital from using telemedicine to promote education through video conferencing / Experiência inicial de um hospital universitário utilizando a telemedicina na promoção de educação através de vídeo-conferências

CONTEXT AND OBJECTIVE: Telehealth and telemedicine services are advancing rapidly, with an increasing spectrum of information and communication technologies that can be applied broadly to the population's health, and to medical education. The aim here was to report our institution's experience from 100 videoconferencing meetings between five different countries in the Americas over a one-year period. DESIGN AND SETTING: Retrospective study at Universidade Estadual de Campinas. METHODS: Through a Microsoft Excel database, all conferences in all specialties held at our institution from September 2009 to August 2010 were analyzed retrospectively. RESULTS: A total of 647 students, physicians and professors participated in telemedicine meetings. A monthly mean of 8.3 (± 4.3) teleconferences were held over the analysis period. Excluding holidays and the month of inaugurating the telemedicine theatre, our teleconference rate reached a mean of 10.3 (± 2.7), or two teleconferences a week, on average. Trauma surgery and meetings on patient safety were by far the most common subjects discussed in our teleconference meetings, accounting for 22 percent and 21 percent of the total calls. CONCLUSION: Our experience with telemedicine meetings has increased students' interest; helped our institution to follow and discuss protocols that are already accepted worldwide; and stimulated professors to promote telemedicine-related research in their own specialties and keep up-to-date. These high-technology meetings have shortened distances in our vast country, and to other reference centers abroad. This virtual proximity has enabled discussion of international training with students and residents, to increase their overall knowledge and improve their education within this institution.

CONTEXTO E OBJETIVO: Serviços de telessaúde e telemedicina estão avançando rapidamente, com um espectro cada vez maior de tecnologias da informação e comunicação que podem ser aplicadas de forma ampla para a saúde da população, bem como para a educação médica. O objetivo deste artigo é relatar a experiência da nossa instituição com 100 reuniões por videoconferência entre cinco diferentes países das Américas no período de um ano. TIPO DE ESTUDO E LOCAL: Estudo retrospectivo na Universidade Estadual de Campinas. MÉTODOS: Através de um banco de dados do Microsoft Excel, foram analisadas retrospectivamente todas as conferências realizadas em nossa instituição, de setembro de 2009 a agosto de 2010, em todas as especialidades. RESULTADOS: Um total de 647 alunos, médicos e professores participaram das reuniões de telemedicina. Em média, 8,3 (± 4,3) teleconferências foram realizadas mensalmente durante o período analisado. Excluindo os feriados e o mês de inauguração do anfiteatro de telemedicina, as nossas taxas de teleconferência atingiram a média de 10,3 (± 2,7), ou duas teleconferências sobre uma média semanal. Cirurgia do Trauma e reuniões sobre segurança dos pacientes foram, de longe, os temas mais comuns discutidos em nossas reuniões de teleconferência, correspondendo por 22 por cento e 21 por cento do total de chamadas. CONCLUSÃO: Nossa experiência com as reuniões de telemedicina aumentou o interesse dos alunos, ajudou a nossa instituição a acompanhar e discutir protocolos que já são aceitos em todo o mundo e estimulou nossos professores a promover pesquisas relacionadas à telemedicina em suas próprias especialidades, mantendo-os atualizados. Essas reuniões com envolvimento de alta tecnologia encurtaram as distâncias dentro de nosso país vasto e com outros centros de referência no exterior. Esta proximidade virtual permitiu discussões com alunos e residentes sobre estágios internacionais a fim de aumentar seu conhecimento global e melhorar a sua educação dentro da própria instituição.