Trauma mechanism predicts the frequency and the severity of injuries in blunt trauma patients. / Relação entre o mecanismo de trauma e lesões diagnosticadas em vítimas de trauma fechado.

OBJECTIVE: to study the correlation of trauma mechanism with frequency and severity of injuries in blunt trauma patients. METHODS: retrospective analysis of trauma registry in a 15-month period was carried out. Trauma mechanism was classified into six types: occupants of four-wheeled vehicles involved in road traffic accidents (AUTO), pedestrians struck by road vehicles (PED), motorcyclists involved in road traffic accidents (MOTO), falls from height (FALL), physical assault with blunt instruments (ASSA) and falls on same level (FSL). Injuries with AIS>2 were considered severe. One-way ANOVA, Students t and Chi-square tests were used for statistical analysis, considering p<0.05 significant. RESULTS: trauma mechanism was classified by group for 3639 cases, comprising 337 (9.3%) AUTO, 855 (23.5%) PED, 924 (25.4%) MOTO, 455 (12.5%) FALL, 424 (11.7%) ASSA and 644 (17.7%) FSL. There was significant difference among groups when comparing the Revised Trauma Score (RTS), the Injury Severity Score (ISS) and the Abbreviated Injury Scale (AIS) of the head, thorax, abdomen and extremities (p<0.001). Severe injuries in the head and in the extremities were more frequent in PED patients (p<0.001). Severe injuries to the chest were more frequent in AUTO (p<0.001). Abdominal injuries were less frequent in FSL (p=0.004). Complex fractures of the pelvis and spine were more frequent in FALL (p<0.001). Lethality was greater in PED, followed by FALL and AUTO (p<0.001). CONCLUSION: trauma mechanism analysis predicted frequency and severity of injuries in blunt trauma patients.

OBJETIVO: analisar a correlação do mecanismo de trauma com a frequência e a gravidade das lesões. MÉTODOS: análise retrospectiva das informações do registro de trauma em período de 15 meses. O mecanismo de trauma foi classificado em seis tipos: ocupantes de veículo de quadro rodas envolvidos em acidente de tráfego (AUTO), pedestres vítimas de atropelamento (ATRO), motociclistas vítimas de acidentes de tráfego (MOTO), vítimas de quedas de altura (QUED), vítimas de agressão física com instrumentos contundentes (AGRE) e vítimas de queda do mesmo nível (QMN). RESULTADOS: o mecanismo de trauma foi classificado em 3639 casos, sendo 337 (9,3%) AUTO, 855 (23,5%) ATRO, 924 (25,4%) MOTO, 455 (12,5%) QUED, 424 (11,7%) AGRE e 644 (17,7%) QMN. Houve diferença significativa na comparação entre os grupos das médias dos índices do Revised Trauma Score (RTS), do Injury Severity Score (ISS) e da Abbreviated Injury Scale (AIS) do segmento cefálico, torácico, abdominal e extremidades (p<0,05). Lesões graves em segmento cefálico foram mais frequentes nas vítimas de ATRO, seguidos de AGRE e QUED (p<0,001). Lesões graves em tórax foram mais frequentes em AUTO, seguidos de QUED e ATRO (p<0,001). As lesões abdominais foram menos frequentes nas vítimas de QMN (p=0,004). Lesões graves em extremidades foram mais frequentes em ATRO, seguidos de MOTO e QUED (p<0,001). CONCLUSÃO: com a análise do mecanismo de trauma é possível prever a frequência e a gravidade das lesões em vítimas de trauma fechado.

Relação entre o mecanismo de trauma e lesões diagnosticadas em vítimas de trauma fechado / Trauma mechanism predicts the frequency and the severity of injuries in blunt trauma patients

RESUMO Objetivo: analisar a correlação do mecanismo de trauma com a frequência e a gravidade das lesões. Métodos: análise retrospectiva das informações do registro de trauma em período de 15 meses. O mecanismo de trauma foi classificado em seis tipos: ocupantes de veículo de quadro rodas envolvidos em acidente de tráfego (AUTO), pedestres vítimas de atropelamento (ATRO), motociclistas vítimas de acidentes de tráfego (MOTO), vítimas de quedas de altura (QUED), vítimas de agressão física com instrumentos contundentes (AGRE) e vítimas de queda do mesmo nível (QMN). Resultados: o mecanismo de trauma foi classificado em 3639 casos, sendo 337 (9,3%) AUTO, 855 (23,5%) ATRO, 924 (25,4%) MOTO, 455 (12,5%) QUED, 424 (11,7%) AGRE e 644 (17,7%) QMN. Houve diferença significativa na comparação entre os grupos das médias dos índices do Revised Trauma Score (RTS), do Injury Severity Score (ISS) e da Abbreviated Injury Scale (AIS) do segmento cefálico, torácico, abdominal e extremidades (p<0,05). Lesões graves em segmento cefálico foram mais frequentes nas vítimas de ATRO, seguidos de AGRE e QUED (p<0,001). Lesões graves em tórax foram mais frequentes em AUTO, seguidos de QUED e ATRO (p<0,001). As lesões abdominais foram menos frequentes nas vítimas de QMN (p=0,004). Lesões graves em extremidades foram mais frequentes em ATRO, seguidos de MOTO e QUED (p<0,001). Conclusão: com a análise do mecanismo de trauma é possível prever a frequência e a gravidade das lesões em vítimas de trauma fechado.

ABSTRACT Objective: to study the correlation of trauma mechanism with frequency and severity of injuries in blunt trauma patients. Methods: retrospective analysis of trauma registry in a 15-month period was carried out. Trauma mechanism was classified into six types: occupants of four-wheeled vehicles involved in road traffic accidents (AUTO), pedestrians struck by road vehicles (PED), motorcyclists involved in road traffic accidents (MOTO), falls from height (FALL), physical assault with blunt instruments (ASSA) and falls on same level (FSL). Injuries with AIS>2 were considered severe. One-way ANOVA, Students t and Chi-square tests were used for statistical analysis, considering p<0.05 significant. Results: trauma mechanism was classified by group for 3639 cases, comprising 337 (9.3%) AUTO, 855 (23.5%) PED, 924 (25.4%) MOTO, 455 (12.5%) FALL, 424 (11.7%) ASSA and 644 (17.7%) FSL. There was significant difference among groups when comparing the Revised Trauma Score (RTS), the Injury Severity Score (ISS) and the Abbreviated Injury Scale (AIS) of the head, thorax, abdomen and extremities (p<0.001). Severe injuries in the head and in the extremities were more frequent in PED patients (p<0.001). Severe injuries to the chest were more frequent in AUTO (p<0.001). Abdominal injuries were less frequent in FSL (p=0.004). Complex fractures of the pelvis and spine were more frequent in FALL (p<0.001). Lethality was greater in PED, followed by FALL and AUTO (p<0.001). Conclusion: trauma mechanism analysis predicted frequency and severity of injuries in blunt trauma patients.

Update in the classification and treatment of complex renal injuries.

The "Evidence-Based Telemedicine - Trauma and Acute Care Surgery" (EBT-TACS) Journal Club performed a critical review of the literature and selected three up-to-date articles on the management of renal trauma defined as American Association for the Surgery of Trauma (AAST) injury grade III-V. The first paper was the proposal for the AAST grade 4renal injury substratification into grades 4a (Low Risk) and 4b (High Risk). The second paper was a revision of the current AAST renal injury grading system, expanding to include segmental vascular injuries and to establish a more rigorous definition of severe grade IV and V renal injuries.The last article analyses the diagnostic angiography and angioembolization in the acute management of renal trauma using a national data set in the USA. The EBT-TACS Journal Club elaborated conclusions and recommendations for the management of high-grade renal trauma.

Atualização da classificação e tratamento das lesões renais complexas / Update in the classification and treatment of complex renal injuries

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 atuais sobre o tratamento do trauma renaldefinido como graus III a V pela classificação da Associação Americana de Cirurgia do Trauma (AAST). O primeiro trabalho propõe subestratificação da lesão renal AAST grau IV em 4a (baixo risco) e 4b (alto risco). O segundo trabalho revisa o atual sistema de classificação de lesão renal AASTpara incluir lesões vasculares segmentares e estabelecer uma definição mais detalhada dos graus IV e V. O último artigo analisa a angiografia diagnóstica e angioembolização na fase aguda do trauma renal utilizando dados americanos. A reunião de revista TBE-CiTE elaborou as conclusões e recomendações para o tratamento do trauma renal de alto grau.

The "Evidence-Based Telemedicine - Trauma and Acute Care Surgery" (EBT-TACS) Journal Club performed a critical review of the literature and selected three up-to-date articles on the management of renal trauma defined as American Association for the Surgery of Trauma (AAST) injury grade III-V. The first paper was the proposal for the AAST grade 4renal injury substratification into grades 4a (Low Risk) and 4b (High Risk). The second paper was a revision of the current AAST renal injury grading system, expanding to include segmental vascular injuries and to establish a more rigorous definition of severe grade IV and V renal injuries.The last article analyses the diagnostic angiography and angioembolization in the acute management of renal trauma using a nationaldata set in the USA. The EBT-TACS Journal Club elaborated conclusions and recommendations for the management of high-grade renal trauma.

Abordagem do trauma renal - artigo de revisão: review of the literature / Management of renal trauma: review of the literature

A incidência de traumatismo é uma realidade crescente nos dias de hoje. O acometimento dos reina ocorre em cerca de 10 por cento dos pacientes com trauma abdominal fechado ou penetrante, podendo elevar muito a morbimortalidade quando não bem conduzido. Os autores fizeram um levantamento de artigos recentes para esclarecimentos no diagnóstico e na conduta no traumatismo renal, desde os detalhes anatômicos até o tratamento definitivo. A correta condução do paciente é fundamental para a preservação e manutenção da função do órgão, sobretudo da vida, após o evento traumático.

Trauma incidence is increasing nowadays. Kidney injuries occur in about 10 percent of patients with blunt or penetrating trauma, and those lesions add morbidity and mortality when not appropriate care is carried out. A literature review of the most recent papers was done by the authors to clarify diagnosis and final treatment. The correct management is a must to preserve and keep the kidney function, moreover, the quality of life after a trauma event.

[Management of renal trauma]. / Abordagem do trauma renal - artigo de revisão: review of the literature.

Trauma incidence is increasing nowadays. Kidney injuries occur in about 10% of patients with blunt or penetrating trauma, and those lesions add morbidity and mortality when not appropriate care is carried out. A literature review of the most recent papers was done by the authors to clarify diagnosis and final treatment. The correct management is a must to preserve and keep the kidney function, moreover, the quality of life after a trauma event.

Blunt intraabdominal arterial injury in pediatric trauma patients: injury distribution and markers of outcome.

BACKGROUND: The epidemiology of pediatric blunt intraabdominal arterial injury is ill defined. We analyzed a multiinstitutional trauma database to better define injury patterns and predictors of outcome. METHODS: The American College of Surgeons National Trauma Database was evaluated for all patients younger than 16 years with blunt intraabdominal arterial injury from 2000 to 2004. Injury distribution, operative treatment, and variables associated with mortality were considered. RESULTS: One hundred twelve intraabdominal arterial injuries were identified in 103 pediatric blunt trauma patients. Single arterial injury (92.2%) occurred most frequently: renal (36.9%), mesenteric (24.3%), and iliac (23.3%). Associated injuries were present in 96.1% of patients (abdominal visceral, 75.7%; major extraabdominal skeletal/visceral, 77.7%). Arterial control was obtained operatively (n = 46, 44.7%) or by endovascular means (n = 6, 5.8%) in 52 patients. Overall mortality was 15.5%. Increased mortality was associated with multiple arterial injuries (P = .049), intraabdominal venous injury (P = .011), head injury (P = .05), Glasgow Coma Score less than 8 (P < .001), cardiac arrest (P < .001), profound base deficit (P = .007), and poor performance on multiple injured outcomes scoring systems (Revised Trauma Score [P < .001], Injury Severity Score [P = .001], and TRISS [P = .002]). CONCLUSION: Blunt intraabdominal arterial injury in children usually affects a single vessel. Associated injuries appear to be nearly universal. The high mortality rate is influenced by serious associated injuries and is reflected by overall injury severity scores.

Hepatic injury.

Hepatic trauma occurs in approximately 5% of all admissions in emergency rooms. The anatomic location and the size of the liver make the organ even more susceptible to trauma and frequently in penetrating injuries. The American Association for the Surgery of Trauma established a detailed classification system that provides for uniform comparisons of hepatic injury. Diagnosis of hepatic injury can be sometimes easy; however the use diagnostic modalities as diagnostic peritoneal lavage, ultrasound and computed tomography allow faster and more accurate diagnosis. Nonoperative management of the hemodynamically stable patient with blunt injury has become the standard of care in most trauma centers. Few penetrating abdominal lesions allow conservative management; exceptions can be some penetrating wounds to right upper abdominal quadrant. Operative treatment of minor liver injuries requires no fixation or can only be managed with eletrocautery or little sutures. Major liver injuries continue, despite technical advances, a challenge to surgeons. Many procedures can be done as direct repair, debridement associated to resections, or even in more severe lesions, packing. This constitutes a damage control which can allow time to recovery of patient and decreasing mortality shortly after trauma.

Hepatic injury / Trauma hepático

Hepatic trauma occurs in approximately 5 percent of all admissions in emergency rooms. The anatomic location and the size of the liver make the organ even more susceptible to trauma and frequently in penetrating injuries. The American Association for the Surgery of Trauma established a detailed classification system that provides for uniform comparisons of hepatic injury. Diagnosis of hepatic injury can be sometimes easy; however the use diagnostic modalities as diagnostic peritoneal lavage, ultrasound and computed tomography allow faster and more accurate diagnosis. Nonoperative management of the hemodynamically stable patient with blunt injury has become the standard of care in most trauma centers. Few penetrating abdominal lesions allow conservative management; exceptions can be some penetrating wounds to right upper abdominal quadrant. Operative treatment of minor liver injuries requires no fixation or can only be managed with eletrocautery or little sutures. Major liver injuries continue, despite technical advances, a challenge to surgeons. Many procedures can be done as direct repair, debridement associated to resections, or even in more severe lesions, packing. This constitutes a damage control which can allow time to recovery of patient and decreasing mortality shortly after trauma.

O trauma hepático corresponde a aproximadamente 5 por cento das admissões das salas de urgência. A localização anatômica do fígado e o seu tamanho o tornam mais susceptível ao trauma contuso e freqüentemente às lesões penetrantes. A associação Americana para a Cirurgia do Trauma estabeleceu uma classificação detalhada, o que possibilita comparações uniformes do trauma hepático. O diagnóstico destas lesões pode ser muitas vezes fácil, contudo a utilização de modalidades diagnósticas como o lavado peritoneal, a ultrassonografia e a tomografia computadorizada, permite o diagnóstico mais rápido e acurado. O tratamento conservador não operatório do trauma hepático contuso em pacientes com estabilidade hemodinâmica tornou-se padrão na maioria dos centros de trauma. Poucas lesões penetrantes do abdome permitem o tratamento conservador. As exceções podem ser justamente aquelas localizadas no quadrante superior direito do abdome que atinjam apenas o fígado. O tratamento cirúrgico de pequenas lesões hepáticas geralmente necessita de nenhum reparo ou podem ser tratadas com cauterização ou pequenas suturas. As lesões mais graves, a despeito dos avanços tecnológicos, constituem ainda um desafio aos cirurgiões. Muitos procedimentos podem ser realizados como: simples suturas, ressecções associadas a desbridamentos ou mesmo em lesões ainda mais graves, o empacotamento. Este constitui o controle do dano, o qual pode permitir a recuperação do paciente com diminuição da mortalidade precoce após o trauma.

Outpatient management of traumatic hyphema in children: prospective evaluation.

PURPOSE: To evaluate the clinical outcome of children with traumatic hyphema treated on an outpatient basis. METHODS: A prospective cases series. Thirty-five children with traumatic hyphema were treated as outpatients for the ocular injury from February 2002 to February 2003. Data regarding initial and final visual acuity, slit-lamp biomicroscopy, hyphema size,ophthalmoscopy, intraocular pressure, rebleeding, clearance time, and medical and surgical intervention were recorded. RESULTS: Thirty (85.7%) children were male, and the major cause of traumatic hyphema was domestic tools (14 cases, 40.0%). Twenty-four patients (68.6%) presented low grades of hyphema. Seventeen patients (48.6%) had intraocular pressures higher than 24 mm Hg. The most common lesions associated with traumatic hyphema were corneal injuries (16 cases, 45.7%). The median final visual acuity was 20/25. Unsatisfactory final visual acuity (worse than 20/30) was statistically associated with ocular posterior segment lesions (P = 0.009) and grade of hyphema (P = 0.004). The grade of hyphema was also related to intraocular hypertension (P = 0.018) and time for hemorrhage absorption (P < 0.001). Nine patients (25.7%) underwent surgical intervention. Rebleeding occurred in three patients (8.6%). CONCLUSIONS: Outpatient management is a feasible option for children with hyphema. Associated posterior ocular segment injuries and hyphema of greater magnitude were related to the worst final visual acuities.

Possiveis lesoes musculares e ou articulares causadas por sobrecarga na pratica da musculacao / Muscular and or articulations injuries caused by the overweight in body building

Nas academias de musculacao,e comum encontramos problemas diversos relacionados a lesoes de ordem muscular e/ou articular.Sendo assim,abordamos a questao das lesoes causadas pelo uso de sobrecarga nos aparelhos de musculacao.Desta forma,o objetivo desta pesquisa e levantar o problema que atinge os praticantes de musculacao e que as vezes,leva-os a desistencia da pratica.O estudo foi realizado em academias de musculacao,onde foi verificado uma infraestrutura adequada para um bom desenvolvimento da modalidade e a presenca de profissionais de Educacao Fisica para ministrar as aulas.Das 55 entrevistas realizadas,40 foram com homens e 15 com mulheres,pertencentes a uma faixa etaria que variou entre 24 a 43 anos de idade e com um tempo de pratica da referida atividade nao inferior a 6 meses.A maior procura pela pratica de musculacao foi pelo periodo da noite e pela frequencia de 3 treinos semanais,tendo como objetivo,na maioria dos casos,o condicionamento fisico,seguido pela estetica corporal.Do conjunto de dados analisados percebemos que mais da metade dos entrevistados(55 por cento)relataram algum tipo de lesao em decorrencia unicamente do treinamento de musculacao somamdo um total de 46 lesoes,sendo que 2 entrevistados acusaram ate 3 lesoes cada e outros 2 relataram 4 lesoes cada.O maior acometimento foi no ombro(28 por cento)seguido pela coluna lombar e musculos dorsais superiores 13 por cento joelho e cotovelo(11 por cento)musculos peitorais(7 por cento)e tambem lesoes na coluna cervical,no punho,nos musculos da panturrilha,nos musculos abdominais,nos musculos adutores de quadril e nos musculos do deltoide.Foi verificado ainda que a metade dos praticantes ja treinou sentindo algum tipo de dor e que varios deles nao comunicaram ao treinador sobre a dor e,pior,em alguns casos eles nao tiveram sei treinamento alterado mesmo apos o treinador ter sido comunicado sobre o ocorrido.Em relacao as lesoes sofridas,36 por cento dos praticantes lesionados tiveram que abandonar od treinamentos em virtude de tais lesoes,sendo que o tempo de afastamento variou entre uma semana ate various meses.Desses praticantes lesionados,22 por cento tiveram que fazer tratamento para se recuperar.Foi ainda questionado se os praticantes de musculacao usavam algum tipo de suplemento alimentar para melhorar sua performance na modalidade e obteve-se como resposta afirmativa 42 por cento.