Age-related injury patterns in Spanish trauma ICU patients. Results from the RETRAUCI.

BACKGROUND: Injury patterns may differ in trauma patients when age is considered. This information is relevant in the management of trauma patients and for planning preventive measures. METHODS: We included in the study all patients admitted for traumatic disease in the participating ICUs from November 23rd, 2012 to July 31st, 2015 with complete records. Data on epidemiology, injury patterns, severity scores, acute management, resources utilisation and outcome were recorded and compared in the following groups of age: ≤55years (young adults), 56-65 years (adults), 66-75 years (elderly), >75years (very elderly). Quantitative data were reported as median (Interquartile Range (IQR) 25-75) and categorical data as number and percentage. Comparison between groups of age with quantitative variables was performed using the analysis of variance (ANOVA) test. Differences between groups with categorical variables were compared using the chi-square test. A value of p<0.05 was considered significant. RESULTS: We included 2700 patients (78.9% male). Median age was 46 (31-62) years. Blunt trauma was present in 93.7% of the patients. Median RTS was 7.55 (5.97-7.84). Median ISS was 20 (13-26). High-energy trauma secondary to motor-vehicle accident with rhabdomyolysis and drugs abuse showed an inverse linear association with ageing, whilst pedestrian falls with isolated brain injury, being run-over and pre-injury antiplatelets or anticoagulant treatment increased with age (in all cases p<0.001). Multiple injuries were more common in young adults (p<0.001). Acute kidney injury prevalence was higher in elderly and very elderly patients (p<0.001). ICU Mortality increased with age in spite of similar severity scores in all groups (p<0.001). The main cause of death in all groups was intracranial hypertension. CONCLUSIONS: Different injury patterns exist in relation with ageing in trauma ICU patients. Adult patients were more likely to present high-energy trauma with significant injuries in different areas whilst elderly patients were prone to low-energy falls, complicated by antiplatelets or anticoagulants use, resulting in severe brain injury and increased mortality.

[Prognosis of the sequels after brain injury]. / Pronóstico de las secuelas tras la lesión cerebral.

Acquired brain injury (ABI) is a major public health problem due to its high incidence and prevalence, long-term effects on patients and their families and enormous socioeconomical costs. In our country, this is treated unequally by the different institutions and specialties. Its etiology, by order of incidence, is due to stroke, traumatic brain injury and anoxic-ischemic encephalopathy and then, at a great distance, a miscellaneous group in which hypoxic encephalopathy stands out. ABI has two extreme poles: deep coma and full reintegration into the community with a similar level as prior to the lesion. Between these poles are the vegetative states, minimally conscious states and, when there is minimal cognitive recovery, a varying range of difficult-to classify impairments, disabilities and handicaps, due to their extreme heterogeneity. The long-term outcome is assessed by descriptive and functional scales, which usually have important feasibility and validity problems. Some scales (GOS, GOSE) classify functional deterioration during the acute and subacute lesional phase. Others analyze neurorehabilitation planning and monitoring (ERLA, Barthel Index). The International Classification of Impairments, Disabilities and Handicaps (ICIDH-2) describes disabilities and impairments. The efficacy of rehabilitation treatment depends on the how early they are done, their adaptation to each patient's needs, intensity and performance by qualified rehabilitation centers. It is difficult to quantify their results in order to compare them because of the serious methodological difficulties.

Pronóstico de las secuelas tras la lesión cerebral / Prognosis of the sequels after brain injury

El daño cerebral adquirido (DCA) es un grave problema de salud pública por su gran incidencia y prevalencia, prolongados efectos, repercusión individual y familiar y enormes costes socioeconómicos. En nuestro país lo atienden con desigual equidad distintas instituciones y especialidades. La etiología es, por orden de incidencia, el accidente cerebrovascular, el traumatismo craneoencefálico y, a gran distancia, un grupo misceláneo, en el que destaca la encefalopatía hipóxica. El DCA se sitúa entre dos polos extremos: el coma profundo y, en su opuesto, la reintegración completa en la comunidad en un grado similar al que precedía a la lesión. Entre medio quedan los estados vegetativos, los estados de mínima consciencia y, cuando se produce una recuperación cognitiva, toda una gama de deficiencias, desde los estados de gran dependencia a diferentes déficit cognitivos, conductuales, emocionales, motores, con las subsiguientes discapacidades y minusvalías de muy difícil clasificación por su heterogeneidad. Su pronóstico evolutivo se establece midiendo la situación funcional a partir de escalas descriptivas y funcionales, que tienen importantes problemas de validez y fiabilidad. Unas escalas (GOS, GOSE, etc.) clasifican el deterioro funcional en la fase aguda y subaguda lesional. Otras analizan la planificación y la monitorización de la neurorrehabilitación (ERLA, Barthel Index, SRS). La clasificación ICIDH-2 describe las discapacidades y minusvalías. La eficacia de los tratamientos rehabilitadores depende de su individualización, precocidad, intensidad y que los realicen centros acreditados. Sus resultados son difíciles de cuantificar y, por lo tanto, de comparar, a causa de problemas metodológicos graves(AU)

Acquired brain injury (ABI) is a major public health problem due to its high incidence and prevalence, long-term effects on patients and their families and enormous socioeconomical costs. In our country, this is treated unequally by the different institutions and specialities. Its etiology, by order of incidence, is due to stroke, traumatic brain injury and anoxic-ischemic encephalopathy and then, at a great distance, a miscellaneous group in which hypoxic encephalopathy stands out. ABI has two extreme poles: deep coma and full reintegration into the community with a similar level as prior to the lesion. Between these poles are the vegetative states, minimally conscious states and, when there is minimal cognitive recovery, a varying range of difficult-to classify impairments, disabilities and handicaps, due to their extreme heterogeneity. The long-term outcome is assessed by descriptive and functional scales, which usually have important feasibility and validity problems. Some scales (GOS, GOSE) classify functional deterioration during the acute and subacute lesional phase. Others analyze neurorehabilitation planning and monitoring (ERLA, Barthel Index). The International Classification of Impairments, Disabilities and Handicaps (ICIDH-2) describes disabilities and impairments. The efficacy of rehabilitation treatment depends on the how early they are done, their adaption to each patient's needs, intensity and performance by qualified rehabilitation centers. It is difficult to quantify their results in order to compare them because of the serious methodological difficulties(AU)