Hemólisis tras la transfusión de concentrados de hematíes en pacientes con trauma grave / Hemolysis following red cell concentrate transfusion in severe trauma patients

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Análisis del registro de un sistema de notificación de incidentes en una unidad de cuidados críticos / Analysis of an incident notification system and register in a critical care unit

Objetivo. Analizar los incidentes comunicados a través de un sistema de notificación y registro en una unidad de cuidados críticos. Metodología. Estudio transversal descriptivo. Se realizó un análisis de los registros de incidentes comunicados de manera anónima y voluntaria de enero de 2007 a diciembre de 2013 en una unidad de cuidados críticos de pacientes adultos con trauma grave. Variables de estudio: tipo y clase de incidente, profesional que notifica y sugerencias de medidas de mejora. Análisis descriptivo de variables. Resultados. Se comunicaron un total de 275 incidentes, de los cuales el 58,5% fueron eventos adversos. Los incidentes distribuidos por clases: medicación 33,7%; accesos vasculares-drenajes-sondas-sensores 19,6%; aparatos-equipos 13,3%; procedimientos 11,5%, vía aérea y ventilación mecánica 10%; cuidados enfermeros 4,1%; comunicación interprofesional 3%; pruebas diagnósticas 3%; identificación paciente 1,1% y transfusión 0,7%. En el grupo de medicación los errores de administración constituyeron el 62%; en el de accesos vasculares-drenajes-sondas-sensores las vías venosas centrales el 27%; en aparatos y equipos los respiradores un 46,9%; en vía aérea las autoextubaciones el 32,1%. En relación con los errores de medicación el 62% fueron incidentes sin daño. La notificación de incidentes por profesional: médicos 43%; residentes 5,6%; enfermeros 51%; técnicos auxiliares 0,4%. Conclusiones. Los incidentes que más se comunican son eventos adversos. Los sucesos relacionados con la administración de medicación son los más frecuentes, aunque la mayoría no ocasionaron daño. Los enfermeros y médicos comunican incidentes con similar frecuencia. Destaca la baja notificación de incidentes a pesar de ser un sistema anónimo y voluntario, por ello, se sugiere estudiar medidas para aumentar el grado de comunicación

Objective. To analyse the incident communicated through a notification system and register in a critical care unit. Methodology. A cross-sectional descriptive study was conducted by performing an analysis of the records of incidents communicated anonymously and voluntarily from January 2007 to December 2013 in a critical care unit of adult patients with severe trauma. Study variables: incident type and class, professional reports, and suggestions for improvement measures. A descriptive analysis was performed on the variables. Results. Out of a total of 275 incidents reported, 58.5% of them were adverse events. Incident distributed by classes: medication, 33.7%; vascular access-drainage-catheter-sensor, 19.6%; devices-equipment, 13.3%, procedures, 11.5%; airway tract and mechanical ventilation, 10%; nursing care, 4.1%; inter-professional communication, 3%; diagnostic test, 3%; patient identification, 1.1%, and transfusion 0.7%. In the medication group, administrative errors accounted for a total of 62%; in vascular access-drainage-catheter-sensor group, central venous lines, a total of 27%; in devices and equipment group, respirators, a total of 46.9%; in airway self-extubations, a total of 32.1%. As regards to medication errors, 62% were incidents without damage. Incident notification by profession: doctors, 43%, residents, 5.6%, nurses, 51%, and technical assistants, 0.4%. Conclusions. Adverse events are the most communicated incidents. The events related to medication administration are the most frequent, although most of them were without damage. Nurses and doctors communicate the incidents with the same frequency. In order to highlight the low incident notification despite it being an anonymous and volunteer system, therefore, it is suggested to study measurements to increase the level of communication

[Analysis of an incident notification system and register in a critical care unit]. / Análisis del registro de un sistema de notificación de incidentes en una unidad de cuidados críticos.

OBJECTIVE: To analyse the incident communicated through a notification system and register in a critical care unit. METHODOLOGY: A cross-sectional descriptive study was conducted by performing an analysis of the records of incidents communicated anonymously and voluntarily from January 2007 to December 2013 in a critical care unit of adult patients with severe trauma. STUDY VARIABLES: incident type and class, professional reports, and suggestions for improvement measures. A descriptive analysis was performed on the variables. RESULTS: Out of a total of 275 incidents reported, 58.5% of them were adverse events. Incident distributed by classes: medication, 33.7%; vascular access-drainage-catheter-sensor, 19.6%; devices-equipment, 13.3%, procedures, 11.5%; airway tract and mechanical ventilation, 10%; nursing care, 4.1%; inter-professional communication, 3%; diagnostic test, 3%; patient identification, 1.1%, and transfusion 0.7%. In the medication group, administrative errors accounted for a total of 62%; in vascular access-drainage-catheter-sensor group, central venous lines, a total of 27%; in devices and equipment group, respirators, a total of 46.9%; in airway self-extubations, a total of 32.1%. As regards to medication errors, 62% were incidents without damage. Incident notification by profession: doctors, 43%, residents, 5.6%, nurses, 51%, and technical assistants, 0.4%. CONCLUSIONS: Adverse events are the most communicated incidents. The events related to medication administration are the most frequent, although most of them were without damage. Nurses and doctors communicate the incidents with the same frequency. In order to highlight the low incident notification despite it being an anonymous and volunteer system, therefore, it is suggested to study measurements to increase the level of communication.

Seudoaneurisma proximal de la arteria innominada de origen traumático / Post-trauma pseudoaneurysm of the proximal innominate artery

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Fístula carótido-cavernosa tras traumatismo craneoencefálico / Development of carotid cavernous fistula after traumatic brain injury

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¿Están cambiando nuestros paradigmas en la enfermedad traumática? / Are the paradigms in trauma disease changing?

Aunque la mortalidad por trauma supera los 5 millones al año en todo el mundo, con innumerables incapacidades y enormes costes, faltan estándares globales y uniformes para su organización y manejo. Los cambios en el conocimiento y los cuidados del paciente con trauma grave han sido espectaculares en las últimas décadas, pero los recursos en investigación, organización y cuidados no han crecido de forma paralela. En nuestro medio, la enfermedad traumática se sitúa muy por debajo de la investigación y organización de otras enfermedades graves. En los últimos años hemos cambiado nuestros modelos en investigación en trauma, organización, cambios en la reanimación inicial, la presencia de la TC como pieza clave en el manejo inicial, etc. Estos cambios actuales y de futuro del manejo del paciente traumatizado generan una valoración y tratamiento multidisciplinares, siendo necesaria la presencia del especialista en Medicina Intensiva como parte fundamental en el equipo de atención al trauma grave y su posterior cuidado en la unidad de críticos

Despite an annual trauma mortality of 5 million people worldwide, resulting in countless physical disabilities and enormous expenses, there are no standardized guidelines on trauma organization and management. Over the last few decades there have been very notorious improvements in severe trauma care, though organizational and economical aspects such as research funding still need to be better engineered. Indeed, trauma lags behind other serious diseases in terms of research and organization. The rapid developments in trauma care have produced original models available for research projects, initial resuscitation protocols and radiological procedures such as CT for the initial management of trauma patients, among other advances. This progress underscores the need for a multidisciplinary approach to the initial management and follow-up of this complicated patient population, where intensivists play a major role in both the patient admission and subsequent care at the trauma unit

Are the paradigms in trauma disease changing?

Despite an annual trauma mortality of 5 million people worldwide, resulting in countless physical disabilities and enormous expenses, there are no standardized guidelines on trauma organization and management. Over the last few decades there have been very notorious improvements in severe trauma care, though organizational and economical aspects such as research funding still need to be better engineered. Indeed, trauma lags behind other serious diseases in terms of research and organization. The rapid developments in trauma care have produced original models available for research projects, initial resuscitation protocols and radiological procedures such as CT for the initial management of trauma patients, among other advances. This progress underscores the need for a multidisciplinary approach to the initial management and follow-up of this complicated patient population, where intensivists play a major role in both the patient admission and subsequent care at the trauma unit.

Percepción de las enfermeras sobre la comunicación con la familia de pacientes ingresados en un servicio de medicina intensiva / Nursing perception of communication with intensive care unit patients family members

Introducción: En las unidades de cuidados intensivos (UCI) la familia considera la necesidad de comunicación como una de las más importantes. Objetivo Analizar la percepción de las enfermeras sobre el proceso de comunicación con los familiares de los pacientes adultos ingresados en un servicio de medicina intensiva (SMI). Método: Estudio transversal (diciembre 2012) mediante un cuestionario Nurse Activities for Communicating with families (NACF), adaptado transculturalmente por Santana Cabrera et al. Participantes: enfermeras de un SMI de un hospital universitario de nivel terciario. Análisis descriptivo de variables y estadística inferencial con Chi-cuadrado y Kruskal-Wallis, programa estadístico SPSS 17.0; significativo p < 0,05. Resultados: La cumplimentación fue del 80% (132 de 166 enfermeras). La media de experiencia fue de 9,6 ± 7,95 años. El 55,9% explican a los familiares el tratamiento y equipos del paciente algunas veces, y casi siempre el 37%. Las enfermeras hablan con la familia sobre la enfermedad y el tratamiento que se le está aplicando al paciente siempre/casi siempre en el 59%, y el 35,38% algunas veces. El 54,6% hablan con la familia acerca de sus sentimientos algunas veces, y el 28,46% casi siempre. El 47,8% comunican siempre/casi siempre los cambios en el plan de cuidados. El 87,9% aseguran la confortabilidad del paciente siempre/casi siempre. No existe asociación entre años de experiencia en UCI y las respuestas a los ítems. Se encuentran diferencias entre los tipos de UCI y la información sobre enfermedad y tratamiento. Conclusión: Las enfermeras comunican más aspectos técnicos que los relacionados con los sentimientos de la familia. La confortabilidad del paciente es el ítem que más comunica la enfermera, independientemente de la experiencia y del tipo de unidad de cuidados críticos

Introduction: Communication is referred as one of the most important needs by the families of intensive care unit patients. Aim of the study To analyze nursing perception of the communication process with the family members of an intensive care unit patient. Materials and methods: Transversal study (December 2012) with a questionnaire Nurse Activities for Communicating with Families (NACF), cross-culturally adapted by Santana Cabrera et al. Participants: intensive care unit nurses from a third level university hospital. Descriptive analysis of variables and inferential statistics with Chi-square and Kruskal-Wallis, statistic program SPSS 17.0; significant P < .05. Results: Complementation was of 80% (132 out of 166 nurses). The average experience was of 9.6 ± 7.95 years. 55.9% sometimes explain to families the treatment and equipment of the patient and a 37% almost always. Nurses talk to the families about the disease and the treatment given to the patient always/almost always in 59% of the cases and sometimes in a 35.38%. 54,6% talk to the family about their feelings sometimes and a 28.46% almost always. A 47.8% notify always/almost always changes on the care plan. 87.9% ensure patient comfort always/almost always. There is no relation between years of experience in ICU and the outcomes of the questionnaire. There is a relation between the different kinds of ICUs and the information given about disease and treatment. Discussion: Nurses tend to inform more about technical aspects than feelings related to the families. Patient comfort is the most referred item regardless of years of experience and the kind of intensive care unit

Auditoría de las alarmas del monitor de cabecera en una unidad de cuidados críticos / Audit of the bedside monitor alarms in a critical care unit

Objetivo: Recoger y evaluar la respuesta a las alarmas del monitor de cabecera (AMC) por parte de las enfermeras en una unidad de cuidados intensivos (UCI). Metodología: Estudio observacional prospectivo (octubre 2011-enero 2012). Auditoría aleatorizada y ciega del manejo de alarmas. Se relacionó la programación/límites de alarmas con la experiencia en UCI. Se evaluó la respuesta a AMC con las variables: tipo de alarma (relevante/no relevante/alerta) y tipo de respuesta. Análisis descriptivo de variables, Anova para análisis multivariante y Chi-cuadrado con SPSS 17.0. Resultados: Se analizaron 434 auditorías. La programación fue: tensión arterial (TA) 88,25%, frecuencia cardiaca (FC) 98,62%, saturación O2 (SatO2) 96,79%, frecuencia respiratoria (FR) 65,75%. Las alarmas originadas fueron: 49,73% TA, 10,75% FC, 39,25% SatO2, 3,27% FR. La enfermera atiende el 93,3% de las mismas y se atendieron un 50% antes de 10 segundos. Fueron alarmas no relevantes un 56,16%, relevantes 25,12% y alerta 18,72%. Por manipulación 41,8%. Conclusión: Las alarmas son programadas y atendidas por la enfermera existiendo uniformidad en la programación y selección de límites. Un 25% de AMC conllevaron actitud terapéutica

Aims: Quantifying and evaluating the response to the bedside monitor alarms (BMA) by nurses in intensive care unit (ICU). Metodology: Prospective observational study (October 2011-January 2012). Randomized blind audit on alarm management. Alarm programming and alarm limits were related to experience in ICU. We evaluated the response to BMA with the variables: alarm type (relevant/not relevant/alert) and response type. Descriptive analysis of variables for multivariate ANOVA and Chi-square test with SPSS 17.0. Results: 434 audits were analyzed. The programming was: Blood pressure (BP) 88.25%, heart rate (HR) 98.62% O2 saturation (SO) 96.79%, respiratory rate (FR) 65.75%. The alarms originated were BP 49.73%, 10.75% HR, 39.25% SO, 3.27% FS. The nurse responded to 93.3% of them and 50% were treated before 10sec. 56.16% of the alarms were not relevant, 25.12% relevant and 18.72% alerting. 41.8% were due to handling. Conclusion: The alarms are programmed/attended by the nurse and there is uniformity in programming/selection limits. 25% of BMA carried therapeutic attitude

Valoración del dolor en la aspiración de secreciones traqueales en pacientes con traumatismo craneal mediante la Escala de conductas indicadoras de dolor (ESCID) / Pain assessment of tracheal suctioning on brain injury patients by pain behavioral indicator scale (ESCID)

Objetivo: Evaluar la respuesta al dolor en el paciente con traumatismo craneal (TC) moderado-grave en la aspiración de secreciones traqueales. Material y método: Estudio piloto observacional longitudinal con muestreo consecutivo; septiembre-diciembre de 2012. Se valoró el dolor 5min antes, durante y 15min después de la aspiración de secreciones traqueales los días 1, 3 y 6 de estancia en la unidad de cuidados intensivos (UCI), así como un procedimiento no doloroso: roce con gasa en el antebrazo del paciente, mediante ESCID. También se registraron la sedoanalgesia y variables hemodinámicas. Análisis descriptivo de variables, estadística inferencial: «t» de Student y Anova con SPSS 17.0; los test estadísticos fueron considerados significativos si el nivel crítico observado era inferior al 5% (p < 0,05). Resultados: Se valoró el dolor en 27 pacientes. El 82% tenía TC-grave y el 18% moderado. La media de dolor durante la realización de la aspiración fue el día 1: 3,18 ± 2,6; el día 3: 2,59 ± 2; y el día 6: 3,94 ± 2,3. Hubo un aumento significativo en las medias de dolor durante la realización del procedimiento los 3 días de valoración (p<0,05), sin embargo al comparar las medias de dolor de los 3 días de valoración no se encontraron diferencias significativas (p>0,05). Durante el procedimiento no doloroso se obtuvieron diferencias significativas el día 6 de valoración (p < 0,05). Conclusión: Durante la aspiración de secreciones traqueales en pacientes con TC en los 6 primeros días de estancia en la UCI se objetiva un dolor leve-moderado mediante la escala ESCID

Objective: To assess pain response on patients with moderate to severe head injury before a common nursing procedure: tracheal suctioning. Material and method: An observational longitudinal pilot study with consecutive sampling performed from September to December of 2012. Pain was assessed by a pain behavioral indicator scale 5minutes before, meanwhile and 15minutes after tracheal suctioning the days 1, 3 and 6 of their intensive care unit (ICU) stay, as well as a non-painful procedure: rubbing with gauze the forearm of the patient. Pseudo-analgesia and hemodynamic variables were also recorded. Descriptive analysis of the variables, inferential statistics with t-student and Anova with SPSS 17.0; statistical tests were considered significant if the critical level observed was less than 5% (P < .05). Results: Pain was assessed on 27 patients. 82% suffered from severe head trauma and 18% moderate. The average pain value during nursing procedure day 1 was 3, 18 ± 2.6, day 3: 2, 59 ± 2 and day 6: 3, 94 ± 2.3. There was a significant increase in mean pain while performing suctioning during the three days of assessment (P < .05); however no significant differences between the average pain value on the three days of the assessment (P > .05) were shown. Data for the painless procedure were significantly different on day 6 (P < .05). Conclusion: During tracheal suctioning in patients with head injury in the first 6 days in the ICU, objective mild-moderate pain according to ESCID scale has been detected

[Audit of the bedside monitor alarms in a critical care unit]. / Auditoría de las alarmas del monitor de cabecera en una unidad de cuidados críticos.

AIMS: Quantifying and evaluating the response to the bedside monitor alarms (BMA) by nurses in intensive care unit (ICU). METODOLOGY: Prospective observational study (October 2011-January 2012). Randomized blind audit on alarm management. Alarm programming and alarm limits were related to experience in ICU. We evaluated the response to BMA with the variables: alarm type (relevant/not relevant/alert) and response type. Descriptive analysis of variables for multivariate ANOVA and Chi-square test with SPSS 17.0. RESULTS: 434 audits were analyzed. The programming was: Blood pressure (BP) 88.25%, heart rate (HR) 98.62% O(2) saturation (SO) 96.79%, respiratory rate (FR) 65.75%. The alarms originated were BP 49.73%, 10.75% HR, 39.25% SO, 3.27% FS. The nurse responded to 93.3% of them and 50% were treated before 10 sec. 56.16% of the alarms were not relevant, 25.12% relevant and 18.72% alerting. 41.8% were due to handling. CONCLUSION: The alarms are programmed/attended by the nurse and there is uniformity in programming/selection limits. 25% of BMA carried therapeutic attitude.

Análisis del estreñimiento en pacientes con traumatismo grave / Analysis of constipation in severe trauma patients

Objetivos: Valorar la incidencia y factores de riesgo del estreñimiento en pacientes con traumatismo grave (TG). Material y método: Estudio observacional retrospectivo (enero a diciembre de 2011) de las historias clínicas de pacientes con TG y estancia ≥ 5 días. Análisis descriptivo de variables, análisis inferencial: «t» de Student y Chi cuadrado con SPSS 17.0. Significación p < 0,05. Resultados: Ochenta pacientes cumplieron los criterios de inclusión; solo se pudieron analizar 69. Presentaron estreñimiento el 84,06% de acuerdo con la definición proporcionada por el Grupo de Trabajo de Metabolismo y Nutrición de la SEMYCIUC. El día más frecuente de la primera deposición fue el 7.° y el 9.° tras tolerancia de nutrición enteral. Hubo significación estadística de la presencia de estreñimiento con: estancia, días de sedación/relajación/opiáceos y ventilación mecánica (VM). No se dio significación estadística entre nutrición enteral precoz (NEP) y estreñimiento. Conclusiones: La frecuencia de estreñimiento en los pacientes con TG es muy elevada. La estancia en UCI, los días de sedoanalgesia, relajación y la VM son factores de riesgo que se asocian a la aparición de esta complicación. Deberían prescribirse laxantes de forma profiláctica

Objectives: To evaluate the incidence and risk factors of constipation in patients with severe trauma (ST). Materials and method: A retrospective observational study (January-December 2011) of medical records in ST-patients with a minimum stay of 5 days was performed. Descriptive analysis of variables, inferential analysis: Student’s T test and Chi-square of SPSS 17.0. Significance level P < .05. Results: A total of 80 patients filled the inclusion criteria, but only 69 could be analyzed. Of these, 84.06% showed constipation (according to its definition by the Work Group for Metabolism and Nutrition SEMICYUC). The most frequent day of first stool was day 7 and 9 after tolerance of enteral nutrition. Statistical significance (S.S.) of constipation was found with stay, days of sedation/relaxation/opiates, and mechanical ventilation. There was no S.S. between early enteral nutrition (EEN) and constipation (P > .05). Conclusions: There is a very high incidence of constipation in ST patients. ICU stay, days of analgesic sedation, relaxation, and mechanical ventilation are risk factors that influence the occurrence of this problem. Laxatives should be prescribed prophylactically

[Pain assessment of tracheal suctioning on brain injury patients by pain behavioral indicator scale (ESCID)]. / Valoración del dolor en la aspiración de secreciones traqueales en pacientes con traumatismo craneal mediante la Escala de conductas indicadoras de dolor (ESCID).

OBJECTIVE: To assess pain response on patients with moderate to severe head injury before a common nursing procedure: tracheal suctioning. MATERIAL AND METHOD: An observational longitudinal pilot study with consecutive sampling performed from September to December of 2012. Pain was assessed by a pain behavioral indicator scale 5 minutes before, meanwhile and 15 minutes after tracheal suctioning the days 1, 3 and 6 of their intensive care unit (ICU) stay, as well as a non-painful procedure: rubbing with gauze the forearm of the patient. Pseudo-analgesia and hemodynamic variables were also recorded. Descriptive analysis of the variables, inferential statistics with t-student and Anova with SPSS 17.0; statistical tests were considered significant if the critical level observed was less than 5% (P<.05). RESULTS: Pain was assessed on 27 patients. 82% suffered from severe head trauma and 18% moderate. The average pain value during nursing procedure day 1 was 3, 18±2.6, day 3: 2, 59±2 and day 6: 3, 94±2.3. There was a significant increase in mean pain while performing suctioning during the three days of assessment (P<.05); however no significant differences between the average pain value on the three days of the assessment (P>.05) were shown. Data for the painless procedure were significantly different on day 6 (P<.05) CONCLUSION: During tracheal suctioning in patients with head injury in the first 6 days in the ICU, objective mild-moderate pain according to ESCID scale has been detected.

[Analysis of constipation in severe trauma patients]. / Análisis del estreñimiento en pacientes con traumatismo grave.

OBJECTIVES: To evaluate the incidence and risk factors of constipation in patients with severe trauma (ST). MATERIALS AND METHOD: A retrospective observational study (January-December 2011) of medical records in ST-patients with a minimum stay of 5 days was performed. Descriptive analysis of variables, inferential analysis: Student's T test and Chi-square of SPSS 17.0. Significance level P<.05. RESULTS: A total of 80 patients fulfilled the inclusion criteria, but only 69 could be analyzed. Of these, 84.06% showed constipation (according to its definition by the Work Group for Metabolism and Nutrition SEMICYUC). The most frequent day of first stool was day 7 and 9 after tolerance of enteral nutrition. Statistical significance (S.S.) of constipation was found with stay, days of sedation/relaxation/opiates, and mechanical ventilation. There was no S.S. between early enteral nutrition (EEN) and constipation (P>.05). CONCLUSIONS: There is a very high incidence of constipation in ST patients. ICU stay, days of analgesic sedation, relaxation, and mechanical ventilation are risk factors that influence the occurrence of this problem. Laxatives should be prescribed prophylactically.

[Pain behaviour indicator scale (ESCID) application in severe non-communicative trauma patients receiving mechanical ventilation]. / Aplicación de la Escala de conductas indicadoras de dolor (ESCID) en el paciente con trauma grave no comunicativo y ventilación mecánica.

OBJECTIVE: To assess pain in non-communicative patients with severe trauma undergoing mechanical ventilation prior to, during and after tracheal suctioning, mobilization and wound care. MATERIAL AND METHOD: A prospective and observational study from October to December 2011 was performed. Study variables were ESCID scale and monitoring of vital signs (blood pressure, heart rate, and respiratory rate). Data were gathering 5 minutes before, during and 15 minutes after the 3 procedures. The nursing evolutive report recorded pain assessment, administration and effectiveness of the analgesia. Descriptive analysis of variables included Student's T test/ANOVA for multivariate analysis with SPSS 17.0. RESULTS: A hundred eighty four observations: 46.8% tracheal suctioning, 38.5% mobilization and 14.7% wound care were performed in 29 patients. ESCID score was 0.4±1 before, 3.4±2.7 during and 0.4±1 after for wound care; 0.4±1.1 before, 3.6±2.2 during and 1.1±0.5 for tracheal suctioning; 0.5±1.1 before, 3±2.8 during and 0.2±0.8 after for mobilization. These increased significantly during the performance of the 3 procedures before-during/during-after: P=.000. All the hemodynamic variables were significantly modified during mobilization and tracheal suctioning: before-during/during-after: P=.000, with the exception of the cures that only affected respiratory rate. 27% of the procedures received analgesia: 9% received it before, 15% during and 3.2% after, with more analgesia being required for the wound care (33.3%). The data collected in the nursing report on the evaluation of pain/effectiveness of the analgesia showed 20.66%. CONCLUSION: An increase on the ESCID score was observed while performing the procedures.

Atención inicial al trauma grave. Utilidad de la videograbación en la valoración de la calidad asistencial / Trauma initial management. Usefulness of the video recording in the evaluation of the quality of care

Objetivo: Determinar la utilidad de la videograbación en la monitorización de la calidad asistencial. Pacientes y método: Estudio descriptivo prospectivo observacional durante un periodo de seis meses. Se incluyeron todos los pacientes adultos con lesión traumática admitidos en la UCI procedentes del medio extrahospitalario. Se realizó grabación continua en vídeo de la resucitación inicial, con posterior revisión por un grupo multidisciplinar. Se analizaron las características epidemiológicas, adhesión al protocolo establecido, tiempos de actuación y la incidencia de errores y/o fallos del sistema. Resultados: 117 pacientes, edad media 43 años, varones 71%, índice de gravedad (ISS) 19.8 ± 15.6. El promedio de cumplimentación del protocolo en el reconocimiento primario y secundario fue del 79.9% y el 70% respectivamente. En la valoración del trabajo en equipo se mantuvieron: liderazgo 87%, organización del equipo 88%, organización de la asistencia 75% y seguimiento de roles 76%. La asistencia se realizó en 43 minutos. Conclusiones: La utilización de la videograbación durante la atención inicial al paciente traumatizado permite analizar la presencia de errores o retrasos que influyen en la calidad de la asistencia prestada (AU)

Objective: To study usefulness of the video recording in the evaluation of the quality of care in hospital initial care of patients with severe trauma. Patients and methods: Prospective observational study over a period of 6 months. We included all adult patients with traumatic injury admitted to the ICU from the pre-hospital means. Continuous recording took place in video of the initial resuscitation, with subsequent review by a multidisciplinary group. Epidemiological characteristics, adherence to the established protocol, time management and the incidence of errors or system failures were analyzed. Results: 117 patients admitted were included. Of these, 71% were male, with an average age of 43 years and Injury Severity Score (ISS) 19.8 ± 15.6. Overall protocol compliance in the primary and secondary survey was 79.9% and 70% respectively. The evaluation of trauma team performance were: leadership 87%, team organization 88%, care organization 75% and roles follow-up 76%. Resuscitation took 43 minutes. Conclusion: The video-recording of trauma resuscitation allows to analyze the presence of errors and/or delays affecting the quality of the assistance provided (AU)

Contralateral extraaxial hematomas after urgent neurosurgery of a mass lesion in patients with traumatic brain injury.

PURPOSE: The development of a contralateral extraaxial hematoma has repeatedly been described in small series and descriptive studies. However, the evidence available to date is limited. OBJECTIVES: To evaluate the incidence and risk factors leading to the development of a contralateral extraaxial hematoma and to describe the characteristics of cases. METHODS: A retrospective cohort study with prospective data collection was undertaken. All patients admitted to an intensive care unit (ICU) from 2006 to 2010 were studied. The inclusion criteria were as follows: severe trauma [Injury Severity Score (ISS ≥ 16)], neurosurgery (NeuroSx) in the first 24 h. The following were excluded: subacute/chronic subdural hematomas, first bilateral NeuroSx. Cases were those who required immediate contralateral NeuroSx after the first NeuroSx due to the occurrence of a new extraaxial injury or significant growth of a previous one. Controls were those patients those who did not require second NeuroSx or who required reoperation due to ipsilateral lesions. The variables considered were: demographics, neurological assessment, traumatic injuries and severity, image and surgical findings, clinical course, and outcome. Statistics analysis comprised descriptive, inferential, and multivariate analysis by logistic regression. RESULTS: A total of 120 patients were included, among which there were 11 cases (incidence 9.2 %). The cases showed a significantly higher frequency of coma or severe traumatic brain injury (TBI) at admission, contralateral injury and contralateral skull fracture in the preoperative computed tomography (CT) scan, as well as decompressive craniectomy. There were no significant differences in the severity scores, clinical course, or outcomes. The presence of contralateral fracture was identified as an independent risk factor [relative risk (RR) 47.9, 95 % confidence interval (CI) 5.2-443]. CONCLUSIONS: Contralateral extraaxial hematoma is a rare entity, although it has a high mortality rate. Therefore, it requires a high index of suspicion, especially in patients with severe TBI, with minimal contralateral injury and mainly with contralateral skull fracture on the initial CT scan.