Do men perform better than women in trauma?

In recent decades, numerous studies have compared survival according to gender of patients admitted to general hospitals and particularly to intensive care units. In a previous issue of Critical Care, Schoeneberg and colleagues presented the results of a German observational study on a sample from a 10 year registry in a Level 1 trauma center. The conclusion is that there is a trend towards a higher mortality in women than in men.

Análisis del registro de la atención inicial al paciente con trauma grave / Analysis of the registry of the initial care given to the patient with severe trauma

Objetivo: analizar el cumplimiento del registro de atención inicial al paciente con trauma grave en la Unidad de Cuidados Intensivos de trauma y emergencias del Hospital 12 de Octubre de Madrid. Material y método: estudio descriptivo sobre los registros de atención inicial al paciente con trauma grave (RAIT), basados en la metodología Advanced Trauma Life Support. Se diseñaron 10 variables principales (VP): para evaluar el cumplimiento: demográfica, clínica, constantes atención inicial, constantes traslado intrahospitalario, constantes pruebas diagnósticas extra-unidad,equilibrio hídrico, atención prehospitalaria, atención en la unidad, pruebas diagnósticas-analíticas, equipo de atención. El nivel de cumplimentación total se relacionó con el Injurity Severity Score (ISS), turno y cambio-turno. Se realizó un análisis descriptivo de las variables y se utilizó el test de Kruskall-Wallis par el análisis bivariante. Resultados: se analizaron los registros del 331 pacientes. La cumplimentación total media fue 49,5%. No se daban diferencias significativas entre la cumplimentación total, ISS, turno y cambio-turno. El registro de VP: demográfica82,18%, clínica 3,63%, constantes en la atención inicial 44,4%, constantesy pruebas diagnósticas extra-unidad 16,9%, equilibrio hídrico 0,9%,ningún registro de constantes durante el traslado intrahospitalario, atención prehospitalaria 68,9%, atención en la unidad 91,8%, pruebas diagnósticas-analíticas95%, equipo de atención 90,3%.Conclusión: es necesario mejorar la cumplimentación del RAIT. Se detectan áreas de mejora como el incremento del registro de constantes atención inicial (temperatura), constantes pruebas diagnósticas extra-unidad, equilibriohídrico (pérdidas hemáticas) y grupo sanguíneo, por la importancia en el manejo del paciente con trauma grave (AU)

Objective: to analyse compliance with the registry of the initial care given to the patient with severe trauma at the Trauma and Emergency Intensive Care Unit of the Hospital 12 de Octubre in Madrid.Material and method: descriptive study of the registry of the initial caregiven to the patient with severe trauma (RAIT), based on the Advanced Trauma Life Support. 10 primary variables (PV) were designed (VP) to assess compliance:demographic, symptoms, initial care vital signs, vital signs during intrahospital transfer, diagnostic test outside the unit vital signs, water balance, prehospital care, care at the unit, diagnostic tests-laboratory work,care team. The level of total compliance was related to the Injury Severity Score(ISS), shift and shift-change. A descriptive analysis of the variables was carried and the Kruskall-Wallis test was used for bivariate analysis.Results: the registries of 331 patients were reviewed. Mean total compliancerate was 49,5%. No significant differences were found between total compliance, ISS, shift and shift-change. The registry of PV: demographic 82,18%, symptoms 3,63%, vital signs on initial care 44,4%, vital signs and diagnostic tests outside the unit 16,9%, water balance 0,9%, no recording of vital signs during intrahospital transfer, prehospital care 68,9%, care given at the unit 91,8%, diagnostic tests-laboratory work 95%, care team 90,3%.Conclusion: it is necessary to improve compliance with the RAIT protocol.Areas in need of improvement are detected such as increased recordings in the registry of vital signs at initial care (temperature), increased recordings of vital signs during diagnostic tests/laboratory work and increased recording of water balance (blood loss) and blood type, given the importance that these data have in the management of patients with severe trauma (AU)

[Updates on severe traumatic brain injury management]. / Actualizaciones en el manejo del traumatismo craneoencefálico grave.

Traumatic brain injury (TBI) is an important reason of morbidity-mortality all over the world, affecting young males more and generating Public Health problem. Unfortunately, the advances in the pathophysiology knowledge have not followed a similar development in therapeutic options, there currently not being any contrasted neuroprotectants. In this article, we have reviewed the epidemiology, pathophysiology and therapeutic measures used in the management of patient with severe TBI. The general measures as well as those aimed at controlling intracranial hypertension, the role of the surgery and some more innovative therapeutic options currently under evaluation in these patients are analyzed.

Actualizaciones en el manejo del traumatismo craneoencefálico grave / Updates of severe traumatic brain injury management

El traumatismo craneoencefálico (TCE) es una importante causa de morbimortalidad en cualquier lugar del mundo; afecta más a varones jóvenes y genera un problema de salud pública. Desafortunadamente, los avances en los conocimientos fisiopatológicos no han ido seguidos de similar desarrollo en las opciones terapéuticas, y no se dispone en la actualidad de fármacos neuroprotectores contrastados. En este artículo revisamos la epidemiología, la fisiopatología y las medidas terapéuticas utilizadas en el manejo del paciente con TCE grave. Se analizan tanto las medidas generales como las dirigidas al control de la hipertensión intracraneal, el papel de la cirugía y algunas opciones terapéuticas más innovadoras actualmente en fase de valoración en estos pacientes

Traumatic brain injury (TBI) is an important reason of morbidity-mortality all over the world, affecting young males more and generating Public Health problem. Unfortunately, the advances in the pathophysiology knowledge have not followed a similar development in therapeutic options, there currently not being any contrasted neuroprotectants. In this article, we have reviewed the epidemiology, pathophysiology and therapeutic measures used in the management of patient with severe TBI. The general measures as well as those aimed at controlling intracranial hypertension, the role of the surgery and some more innovative therapeutic options currently under evaluation in these patients are analyzed

[Injury pattern in all-terrain vehicle accidents]. / Patrón lesional por accidentes de quad (vehículos todoterreno).

OBJECTIVE: To define the epidemiological and injury profile of patients severely injured due to all-terrain vehicle accidents admitted to the Trauma ICU of a tertiary hospital. METHODS: Descriptive observational study including all patients admitted to our ICU who suffered an all-terrain vehicle accident in the last three years, included prospectively in our data base. We recorded demographic variables, clinical condition at admission, outcome, injury pattern, severity scores and survival probability by TRISS. RESULTS: Between 2004 and 2006 twelve patients who suffered an all-terrain vehicle accident were admitted. All of them were male and had a median age of 28.5 years (18-37.75). The median ISS was 25 points (17-27). Cranium and brain (AIS region 1) were present in 75% of the patients, face (AIS 2) in 41.6%, upper limbs (AIS 7) in 33%, thorax (AIS 4) in 25%, spine (AIS 6) and lower limbs (AIS 8) in 16.7% and there were no injures in AIS region 3 (neck) and 5 (abdomen-pelvis). Mortality at ICU and at day 28 was 16.7% and hospital mortality was 25%. Median ICU stay was 8 days (1.75-17) and median hospital stay was 21.5 days (8.25-27). ICU stay was shorter in patients without traumatic brain injury (1 [1-1.5] vs 12 [5-23]; p < 0.05). CONCLUSIONS: All-terrain vehicle use is a growing source of high morbidity and mortality accidents. Injury patterns associated to these accidents are described. Traumatic brain injuries are common and have a poorer prognosis. New epidemiological and clinical studies are needed for a better knowledge of the problem.

Patrón lesional por accidentes de quad (vehículos todoterreno) / Injury pattern in all-terrain vehicle accidents

Objetivos. Definir el perfil epidemiológico y lesional de los pacientes graves atendidos por accidente de quad en la UCI de traumatología de un hospital terciario de referencia. Métodos. Estudio observacional descriptivo que incluye a todos los pacientes ingresados por accidente de quad en los últimos 3 años, recogidos prospectivamente en la base de datos de nuestra UCI de traumatología. Se registraron variables relativas a datos demográficos, situación al ingreso, evolución, lesiones por regiones corporales, índices de gravedad y probabilidad de supervivencia por TRISS. Resultados. Entre 2004 y 2006 se recibió a 12 pacientes accidentados por quad, todos varones, con una mediana de edad de 28,5 (18-37,75) años. La mediana del ISS fue de 25 (17-27) puntos. En cuanto a las lesiones, el 75% de los pacientes presentaron lesiones craneales y encefálicas (región AIS 1); el 41,6%, faciales (AIS 2); el 33%, en las extremidades superiores (AIS 7); el 25%, torácicas (AIS 4); el 16,7%, raquimedulares (AIS 6) y en extremidades inferiores (AIS 8), y ninguno cervicales y abdominales (AIS 3 y 5). La mortalidad en UCI y a los 28 días alcanzó el 16,7%, y la mortalidad hospitalaria fue del 25%. La mediana de la estancia en UCI fue 8 (1,75-17) días y la estancia hospitalaria fue de 21,5 (8,25-27) días. La estancia en UCI fue menor en los pacientes sin traumatismo craneoencefálico (TCE) que en los pacientes con TCE (1 [1-1,5] frente a 12 [5-23]; p < 0,05). Conclusiones. El uso de quad es una fuente de accidentes con alta morbimortalidad y está en aumento. Se describen los patrones lesionales relaciona-dos con estos accidentes. El TCE es frecuente y empeora el pronóstico. Se necesitan nuevos estudios epidemiológicos y clínicos para definir mejor el problema The increased use of biomaterials for the repair of abdominal wall hernias has achieved a significant reduction in recurrences and consequently improved the quality of life of patients. However, the appearance of complications such as infection may require the implanted prosthetic material to be removed in a considerable number of patients. A possible treatment option in areas compromised by infection is the implant a biocompatible prosthetic material to generate, or induce the formation of a support tissue so that, in a second stage, the definitive repair of the parietal defect may be undertaken. This is the main goal of bioprostheses. These implants are composed of collagen of animal (usually porcine) or human origin. They should be acellular and fully biocompatible so that they induce a minimal foreign body reaction and immune response (AU)

Objective. To define the epidemiological and injury profile of patients severely injured due to all-terrain vehicle accidents admitted to the Trauma ICU of a tertiary hospital. Methods. Descriptive observational study including all patients admitted to our ICU who suffered an all-terrain vehicle accident in the last three years, included prospectively in our data base. We recorded demographic variables, clinical condition at admission, outcome, injury pattern, severity scores and survival probability by TRISS. Results. Between 2004 and 2006 twelve patients who suffered an all-terrain vehicle accident were admitted. All of them were male and had a median age of 28.5 years (18-37.75). The median ISS was 25 points (17-27). Cranium and brain (AIS region 1) were present in 75% of the patients, face (AIS 2) in 41.6%, upper limbs (AIS 7) in 33%, thorax (AIS 4) in 25%, spine (AIS 6) and lower limbs (AIS 8) in 16.7% and there were no injures in AIS region 3 (neck) and 5 (abdomen-pelvis). Mortality at ICU and at day 28 was 16.7% and hospital mortality was 25%. Median ICU stay was 8 days (1.75-17) and median hospital stay was 21.5 days (8.25-27). ICU stay was shorter in patients without traumatic brain injury (1 [1-1.5] vs 12 [5-23]; p < 0.05). Conclusions. All-terrain vehicle use is a growing source of high morbidity and mortality accidents. Injury patterns associated to these accidents are described. Traumatic brain injuries are common and have a poorer prognosis. New epidemiological and clinical studies are needed for a better knowledge of the problem The increased use of biomaterials for the repair of abdominal wall hernias has achieved a significant reduction in recurrences and consequently improved the quality of life of patients. However, the appearance of complications such as infection may require the implanted prosthetic material to be removed in a considerable number of patients. A possible treatment option in areas compromised by infection is the implant a biocompatible prosthetic material to generate, or induce the formation of a support tissue so that, in a second stage, the definitive repair of the parietal defect may be undertaken. This is the main goal of bioprostheses. These implants are composed of collagen of animal (usually porcine) or human origin. They should be acellular and fully biocompatible so that they induce a minimal foreign body reaction and immune response (AU)