The impact of malnutrition on morbidity, mortality and length of hospital stay in trauma patients.

BACKGROUND AND AIM: To asses the nutritional status of hospitalised trauma patients and the repercussion on the clinical follow up. METHODS: In a prospective way 161 adult patients admitted to the units of Intensive Care (ICU), General Surgery, Maxillofacial Surgery and Orthopedics of the Centro de Emergencias Médicas in Asunción, Paraguay, from March 2002 to March 2004 were evaluated at admission by using the Subjective Global Assessment (SGA). Patients were followed to determine length of hospital stay, complications and in-hospital mortality. RESULTS: From the trauma patients median age was 27 (14-92) years and 94% were males. Most patients (74%) were from the countryside. The most frequent anatomic sites of trauma were: head 25%, thorax 16.6%, limbs 15.4%, abdomen 14%. The median Injury Severity Score (ISS) was 20 (1-39). From this population of patients, 40% were malnourished or at risk of malnutrition according to the SGA. Multivariate analysis identified as significant risk factors for mortality: malnutrition according to the SGA (p = 0.04, RR = 4 (1-15), and admission to the ICU (p = 0.0001, RR 53 (12-234). Risk factors for complications were malnutrition according to the SGA (p = 0.003, RR 2.9 (1.4-5.8) and ISS over 20 (p = 0.001, RR = 8.4 (2.3-29.9). The risk factors for length of stay were malnutrition according to the Subjective Global Assesment (p = 0.01, RR = 2.3 (1.2-4.7) and Injury Severity Score over 20, p = 0.03, RR = 2.8 (1-7.3). CONCLUSIONS: In the conditions of this study, malnutrition is frequent on admission in trauma patients, and is an independent risk factor for morbidity, mortality, and prolongs the length of hospitalisation. Efforts should be made to quickly assess the nutritional status of these patients and early start nutritional intervention.

[Clinical nutrition knowledge in health care members of University Hospitals of Paraguay]. / Nivel de conocimiento en nutrición clínica en miembros del Equipo de Salud de Hospitales Universitarios del Paraguay.

BACKGROUND: Adequate clinical nutrition care is an integral part of the complete treatment of hospitalised patients, requiring specific knowledge from the health care team. The aim of this study is to assess, in Paraguay, the health care team ability in clinical care nutrition. MATERIALS AND METHODS: A survey was made including 174 people of Paraguay university hospitals (29% physicians, 29% medicine graduating students, 11% pharmaceutics, 24% nurses, 7% dieticians), by answering voluntarily a multiple choice questionnaire of 20 items. RESULTS: The median score of the 20 questions was 6 (0-15). Physicians obtained a median of 6 (2-15), graduating students 7 (2-14), pharmaceutics 7 (0-15), nurses 3 (0-11), and dieticians 9 (4-13). The dieticians obtained a significantly higher score than the other groups (p < 0.005). CONCLUSIONS: The knowledge about clinical nutrition in the health care members from university hospitals is not adequate. The level of education in clinical nutrition is better in the dietician.

Comparación de diferentes criterios de diagnóstico poblacional de la deficiencia de yodo (DDY). Prevalencia de bocio endémico en la axarquía (málaga) / Comparison of different criteria for the diagnosis of iodine deficiency (ID) in the population. Prevalence of endemic goitre in the Axarquía (Málaga), Spain

Objetivos. a) Evaluar la prevalencia de bocio y de deficiencia de yodo (DDY) en la comarca de la Axarquía (Málaga) (el último estudio data de 1980), y b) comparar los diferentes criterios (bocio, yoduria, concentraciones de TSH neonatal, tiroglobulina y volumen tiroideo) propuestos para identificar los DDY. Material y método. Población de referencia: población escolar de la comarca de la Axarquía (sureste de la provincia de Málaga). Muestra: 756 niños. Error muestral del 3,4 por ciento (intervalo de confianza del 95 por ciento; 3,3-3,5 por ciento). Procedimientos: se calcula la prevalencia de bocio y DDY a partir de: a) palpación de tiroides y yoduria (criterios de las agencias internacionales); b) concentraciones de tiroglobulina > 10 ng/ml; c) valores de TSH de cribado de hipotiroidismo congénito (TSH > 5 µU/ml), y d) volumen tiroideo (ecografía) > percentil 97 (Delange, OMS). Resultados. La prevalencia de bocio por palpación ha sido del 37 por ciento. El 20,8 por ciento presentó un bocio grado Ia y el 16,3 por ciento, grado Ib. El bocio ha sido más frecuente en los pueblos del interior especialmente en la zona de la sierra de Almijara (59,7 por ciento). La yoduria media fue de 121,5 µg/l y la mediana de 120 µg/l. El 48,5 por ciento de los niños excretaron menos de 100 µg/l. La variable que más ha contribuido al riesgo de tener bocio ha sido la zona en la que se vive dentro de la comarca (odds ratio [OR] = 2,06). La tiroglobulina fue más alta en el grupo de niños con yodurias menores de 50 µg/dl. El 34,1 por ciento de los niños tuvieron la tiroglobulina entre 10 y 19,9 ng/ml y el 7 por ciento por encima de 20 ng/ml. La mediana de la tiroglobulina para toda la muestra ha sido de 8,9 ng/ml. La prevalencia de niños con TSH > 5 µU/ml en el programa de detección precoz de hipotiroidismos congénitos ha sido del 9,3 por ciento, en la Axarquía y 9,8 por ciento, en la comarca limítrofe de Antequera, frente al 6,6 y al 7,4 por ciento de dos distritos de Málaga capital. La prevalencia de bocio a partir del P-97 del volumen tiroideo por ecografía siguiendo los criterios propuestos por Delange fue del 3,2-3,8 por ciento. Discusión. En la comarca de la Axarquía (Málaga) persiste, en 1999, una endemia bociosa de grado I, a pesar de presentar una mediana de yoduria de 120 µg/l. De haber utilizado la tiroglobulina y los puntos de corte de volumen tiroideo grande propuestos por Delange como indicadores de DDY, se habría desestimado la existencia de esta endemia (AU)

[The quality of the care in parenteral nutrition: the benefits after the incorporation of a nutritional support team]. / Calidad asistencial en nutrición parenteral: beneficios tras la incorporación de un equipo de soporte nutricional.

GOALS: The purpose of the study was to analyze the quality of the prescription and follow-up of the total parenteral nutrition (PNT) before and after the incorporation of a nutritional support team (NST). MATERIAL AND METHODS: A random sample of 96 patients was selected retrospectively, with 48 prior to the incorporation of the NST (the Non-NST group) and 48 after its incorporation (the NST group), to whom TPN was prescribed. The following points were assessed: 1. The existence of a minimum analytical and nutritional assessment, prior to the incorporation of TPN; 2. The follow-up of the same. RESULTS: The average duration of TPN per patient was 13.8 days without differences between the two groups. There is a written record of the weight and height in 15% and 10% of cases, respectively, in the Non-NST group as opposed to 100% and 99% in the NST group (p < 0.0001). Prior to the incorporation of the NST, the nutritional requirement was not verified in any patients (0%) as opposed to 97% afterwards. Statistically significant differences were detected in the measurement of albumin prior to the start of TPN (p < 0.01). During the analytical follow-up, statistically significant differences were detected in the measurement of: blood tests (p < 0.05); basic biochemistry (p < 0.01); general biochemistry, magnesium, zinc, pre-albumin, transferrin and nitrogen balance (p < 0.0001). In the TPN follow-up, the Non-NST group did not change any of the components contained in it (in terms of volume, macro or micronutrients) in 81% of patients, while 17% had one change and 2% had 2 or more changes, as opposed to 27%, 42% and 31%, respectively in the NST group (p < 0.0001). There were no significant differences in metabolic complications between the two groups. CONCLUSIONS: The implementation of a nutritional support team in charge of the prescription and follow-up of TPN has notably improved the quality of these follow-up studies.