¿Podrían ayudarnos los algoritmos de machine learning en la predicción de hemorragia masiva a nivel prehospitalario? / Could machine learning algorithms help us in predicting massive hemorrhage at the prehospital level?

Objetivo: Comparación de la capacidad predictiva de diferentes algoritmos de machine learning (AML) respecto a escalas tradicionales de predicción de hemorragia masiva en pacientes con enfermedad traumática grave (ETG). Diseño: Sobre una base de datos de una cohorte retrospectiva con variables clínicas prehospitalarias y de resultado de hemorragia masiva se realizó un tratamiento de la base de datos para poder aplicar los AML, obteniéndose un conjunto total de 473 pacientes (80% entrenamiento, 20% validación). Para la modelización se realizó imputación proporcional y validación cruzada. El poder predictivo se evaluó con la métrica ROC y la importancia de las variables mediante los valores Shapley. Ámbito: Atención extrahospitalaria del paciente con ETG. Pacientes: Pacientes con ETG atendidos en el medio extrahospitalario por un servicio médico extrahospitalario desde enero de 2010 hasta diciembre de 2015 y trasladados a un centro de trauma en Madrid. Intervenciones: Ninguna. Variables de interés principales: Obtención y comparación de la métrica ROC de 4 AML: random forest, support vector machine, gradient boosting machine y neural network con los resultados obtenidos con escalas tradicionales de predicción. Resultados: Los diferentes AML alcanzaron valores ROC superiores al 0,85, teniendo medianas cercanas a 0,98. No encontramos diferencias significativas entre los AML. Cada AML ofrece un conjunto de variables diferentes, pero con predominancia de las variables hemodinámicas, de reanimación y de deterioro neurológico. Conclusiones: Los AML podrían superar a las escalas tradicionales de predicción en la predicción de hemorragia masiva. (AU)

Objective: Comparison of the predictive ability of various machine learning algorithms (MLA) versus traditional prediction scales for massive hemorrhage in patients with severe traumatic injury (ETG). Design: On a database of a retrospective cohort with prehospital clinical variables and massive hemorrhage outcome, a treatment of the database was performed to be able to apply the different MLA, obtaining a total set of 473 patients (80% training and 20% validation). For modeling, proportional imputation and cross validation were performed. The predictive power was evaluated with the ROC metric and the importance of the variables using the Shapley values. Setting: Out-of-hospital care of patients with ETG. Participants: Patients with ETG treated out-of-hospital by a prehospital medical service from January 2010 to December 2015 and transferred to a trauma center in Madrid. Interventions: None. Main variables of interest: Obtaining and comparing the ROC curve metric of 4 MLAs: random forest, support vector machine, gradient boosting machine and neural network with the results obtained with traditional prediction scales. Results: The different MLA reached ROC values higher than 0.85, having medians close to 0.98. We found no significant differences between MLAs. Each MLA offers a different set of more important variables with a predominance of hemodynamic, resuscitation variables and neurological impairment. Conclusions: MLA may be helpful in patients with massive hemorrhage by outperforming traditional prediction scales. (AU)

Could machine learning algorithms help us predict massive bleeding at prehospital level?

OBJECTIVE: Comparison of the predictive ability of various machine learning algorithms (MLA) versus traditional prediction scales (TPS) for massive hemorrhage (MH) in patients with severe traumatic injury (STI). DESIGN: On a database of a retrospective cohort with prehospital clinical variables and MH outcome, a treatment of the database was performed to be able to apply the different AML, obtaining a total set of 473 patients (80% training, 20% validation). For modeling, proportional imputation and cross validation were performed. The predictive power was evaluated with the ROC metric and the importance of the variables using the Shapley values. SETTING: Out-of-hospital care of patients with STI. PARTICIPANTS: Patients with STI treated out-of-hospital by a out-of-hospital medical service from January 2010 to December 2015 and transferred to a trauma center in Madrid. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: Obtaining and comparing the "Receiver Operating Characteristic curve" (ROC curve) metric of four MLAs: "random forest" (RF), "vector support machine" (SVM), "gradient boosting machine" (GBM) and "neural network" (NN) with the results obtained with TPS. RESULTS: The different AML reached ROC values higher than 0.85, having medians close to 0.98. We found no significant differences between AMLs. Each AML offers a different set of more important variables with a predominance of hemodynamic, resuscitation variables and neurological impairment. CONCLUSIONS: MLA may be helpful in patients with HM by outperforming TPS.

The Effect of Enteral Immunonutrition in the Intensive Care Unit: Does It Impact on Outcomes?

Background: The present research aimed to evaluate the effect on outcomes of immunonutrition (IMN) enteral formulas during the intensive care unit (ICU) stay. Methods: A multicenter prospective observational study was performed. Patient characteristics, disease severity, nutritional status, type of nutritional therapy and outcomes, and laboratory parameters were collected in a database. Statistical differences were analyzed according to the administration of IMN or other types of enteral formulas. Results: In total, 406 patients were included in the analysis, of whom 15.02% (61) received IMN. Univariate analysis showed that patients treated with IMN formulas received higher mean caloric and protein intake, and better 28-day survival (85.2% vs. 73.3%; p = 0.014. Unadjusted Hazard Ratio (HR): 0.15; 95% CI (Confidence Interval): 0.06−0.36; p < 0.001). Once adjusted for confounding factors, multivariate analysis showed a lower need for vasopressor support (OR: 0.49; 95% CI: 0.26−0.91; p = 0.023) and continuous renal replacement therapies (OR: 0.13; 95% CI: 0.01−0.65; p = 0.049) in those patients who received IMN formulas, independently of the severity of the disease. IMN use was also associated with higher protein intake during the administration of nutritional therapy (OR: 6.23; 95% CI: 2.59−15.54; p < 0.001), regardless of the type of patient. No differences were found in the laboratory parameters, except for a trend toward lower triglyceride levels (HR: 0.97; 95% CI: 0.95−0.99; p = 0.045). Conclusion: The use of IMN formulas may be associated with better outcomes (i.e., lower need for vasopressors and continuous renal replacement), together with a trend toward higher protein enteral delivery during the ICU stay. These findings may ultimately be related to their modulating effect on the inflammatory response in the critically ill. NCT Registry: 03634943.

Elevated monocyte distribution width in trauma: An early cellular biomarker of organ dysfunction.

INTRODUCTION: Traumatic injury elicits an inflammatory response such as the one occurring during systemic infection. Monocyte distribution width (MDW) has been found to distinguish sepsis in a pool of patients with suspected infection. We hypothesized that an elevated MDW in trauma patients would be associated with the development of multiple organ dysfunction syndrome (MODS) and an increased mortality. MATERIALS AND METHODS: Observational study in a dedicated trauma Intensive Care Unit (ICU) in Madrid during 2019-2020. Patients were classified according to their first MDW value on admission, as greater or lesser than 21 U. Clinical data was obtained and univariate and multivariate analysis were realized, as well as a test performance analysis. RESULTS: 354 patients were studied, with a median age of 46 years, 78% male. Half presented with severe trauma ISS > 15, mostly with a blunt mechanism of injury. A MDW ≥ 21 U on admission was found in 17% of cases. These patients were more likely to present with hemodynamic instability and MODS. They had a higher length of stay (3.8 vs 2 days) and higher mortality (21 vs 5%) compared to the low MDW group. These findings remained statistically significant in the multivariate analysis, with an OR 4.6 (IC 95% 1.7-12) for MODS and 3.1 (IC 95% 1.2-8.3) for mortality. CONCLUSIONS: In trauma patients, a MDW ≥ 21 U on admission was independently associated with a greater risk of MODS, a higher mortality and a higher length of stay. This biomarker could be useful in predicting severity in the initial evaluation of trauma patients.

[The efficacy of caloric intake in critically ill patients with traumatic pathology]. / Eficacia del aporte calórico en pacientes con patología traumática.

BACKGROUND: the effective contribution of enteral nutrition (EN) in intensive care units (ICU) is due to multiple factors. OBJECTIVES: to determine the efficacy of caloric intake in critically ill patients with traumatic pathology receiving enteral nutrition, and to analyze cause and time of interruption of EN. METHOD: prospective observational study (November 2015 - August 2016). INCLUSION CRITERIA: patient with EN ≥ 48 hours and age ≥ 18 years. EXCLUSION CRITERIA: patient with oral and/or parenteral nutrition. VARIABLES: demographic, day of EN, prescribed and administered kilocalories (kcal), caloric difference, caloric objective and variables related to the interruptions of the EN. The handling of EN and interruptions are made according to the unit's internal protocol. Kcal/patient are calculated according to the Harris-Benedict equation and multiplied by a stress factor depending on the type of trauma of the patient. RESULTS: sixty-nine patients were included, 79.71% were men, with a median age of 46 (34-58) years. A total of 1,112 days of EN were monitored. As of the third day of admission to the ICU (979 days monitored), the nutritional efficacy was optimal (caloric intake > 80%): 92.43% (72.8-97.5). The optimal caloric goal was maintained in 67.9% of these days. The most frequent causes of interruption of NE were procedures unrelated to airway, with holding time of three (1-7.25) hours. CONCLUSIONS at the third day, the patients with traumatic pathology received at least 80% of the prescribed caloric intake. Among the most frequent causes of interruption of EN were the procedures unrelated to airway.

INTRODUCCIÓN: el aporte efectivo de la nutrición enteral (NE) en las unidades de cuidados intensivos (UCI) se ve afectado por múltiples factores. OBJETIVOS: determinar la eficacia en el aporte calórico a los pacientes críticos con patología traumática que reciben nutrición enteral. Analizar causa y tiempo de interrupción de NE. MÉTODO: estudio observacional prospectivo (de noviembre de 2015 a agosto de 2016). Criterios de inclusión: paciente con NE ≥ 48 horas y edad ≥ 18 años. Criterios de exclusión: paciente con dieta oral y/o parenteral. Variables: demográficas, día de NE, kilocalorías (kcal) prescritas, administradas, diferencia calórica, objetivo calórico y relacionadas con las interrupciones de la NE. El manejo de NE e interrupciones se realiza según protocolo interno de la unidad. Las kcal/paciente se calculan según la ecuación de Harris-Benedict y multiplicando por un factor de estrés en función del tipo de trauma del paciente. RESULTADOS: se incluyeron 69 pacientes (el 79,71% eran hombres) con una mediana de edad de 46 (34-58) años. Se monitorizaron un total de 1.112 días de NE. A partir del tercer día de ingreso en UCI (979 días monitorizados) la eficacia nutricional fue óptima (aporte calórico > 80%): 92,43% (72,8-97,5). Mantenemos el objetivo calórico óptimo en el 67,9% de estos días. Observamos como causa más frecuente de interrupción de la NE los procedimientos no relacionados con la vía aérea, con un tiempo de parada de tres (1-7,25) horas. CONCLUSIÓN: el aporte calórico del paciente crítico con patología traumática se logra de forma óptima a partir del día 3. Entre las causas de interrupción de la NE más frecuentes se encuentran los procedimientos no relacionados con la vía aérea.

Eficacia del aporte calórico en pacientes con patología traumática / The efficacy of caloric intake in critically ill patients with traumatic pathology

Introducción: el aporte efectivo de la nutrición enteral (NE) en las unidades de cuidados intensivos (UCI) se ve afectado por múltiples factores. Objetivos: determinar la eficacia en el aporte calórico a los pacientes críticos con patología traumática que reciben nutrición enteral. Analizar causa y tiempo de interrupción de NE. Método: estudio observacional prospectivo (de noviembre de 2015 a agosto de 2016). Criterios de inclusión: paciente con NE ≥ 48 horas y edad ≥ 18 años. Criterios de exclusión: paciente con dieta oral y/o parenteral. Variables: demográficas, día de NE, kilocalorías (kcal) prescritas, administradas, diferencia calórica, objetivo calórico y relacionadas con las interrupciones de la NE. El manejo de NE e interrupciones se realiza según protocolo interno de la unidad. Las kcal/paciente se calculan según la ecuación de Harris-Benedict y multiplicando por un factor de estrés en función del tipo de trauma del paciente. Resultados: se incluyeron 69 pacientes (el 79,71% eran hombres) con una mediana de edad de 46 (34-58) años. Se monitorizaron un total de 1.112 días de NE. A partir del tercer día de ingreso en UCI (979 días monitorizados) la eficacia nutricional fue óptima (aporte calórico > 80%): 92,43% (72,8-97,5). Mantenemos el objetivo calórico óptimo en el 67,9% de estos días. Observamos como causa más frecuente de interrupción de la NE los procedimientos no relacionados con la vía aérea, con un tiempo de parada de tres (1-7,25) horas. Conclusión: el aporte calórico del paciente crítico con patología traumática se logra de forma óptima a partir del día 3. Entre las causas de interrupción de la NE más frecuentes se encuentran los procedimientos no relacionados con la vía aérea

Background: the effective contribution of enteral nutrition (EN) in intensive care units (ICU) is due to multiple factors. Objectives: to determine the efficacy of caloric intake in critically ill patients with traumatic pathology receiving enteral nutrition, and to analyze cause and time of interruption of EN. Method: prospective observational study (November 2015 - August 2016). Inclusion criteria: patient with EN ≥ 48 hours and age ≥ 18 years. Exclusion criteria: patient with oral and/or parenteral nutrition. Variables: demographic, day of EN, prescribed and administered kilocalories (kcal), caloric difference, caloric objective and variables related to the interruptions of the EN. The handling of EN and interruptions are made according to the unit’s internal protocol. Kcal/patient are calculated according to the Harris-Benedict equation and multiplied by a stress factor depending on the type of trauma of the patient. Results: sixty-nine patients were included, 79.71% were men, with a median age of 46 (34-58) years. A total of 1,112 days of EN were monitored. As of the third day of admission to the ICU (979 days monitored), the nutritional efficacy was optimal (caloric intake > 80%): 92.43% (72.8-97.5). The optimal caloric goal was maintained in 67.9% of these days. The most frequent causes of interruption of NE were procedures unrelated to airway, with holding time of three (1-7.25) hours. Conclusions: at the third day, the patients with traumatic pathology received at least 80% of the prescribed caloric intake. Among the most frequent causes of interruption of EN were the procedures unrelated to airway

[Emergency treatment for traumatic cardiac arrest: prognostic factors and hospital outcome]. / Factores pronóstico y resultados intrahospitalarios de la parada cardiaca traumática atendida en un servicio de urgencias.

OBJECTIVES: To identify prehospital and on-arrival factors associated with hospital outcome in patients with traumatic cardiac arrest (TCA) discharged with recovered spontaneous circulation from the emergency department. MATERIAL AND METHODS: Multipurpose prospective cohort study of patients with TCA who recovered after treatment at a tertiary care hospital emergency department between 2003 and 2016. We gathered data on epidemiologic variables, type and cause of injuries, and prehospital and hospital emergency care. The outcome was overall hospital mortality. RESULTS: A total of 130 TCA cases were included; 123 patients (94.6%) had received blunt trauma injuries and 65 (50%) had been in traffic accidents. The mean (SD) age was 39 (16) years, and 96 (73.8%) were male. Fifty patients (65%) were in asystole and 42 (32.3%) had pulseless electrical activity. Sixteen (12.3%) survived to be discharged; 13 of the survivors (81.3%) had recovered neurological activity. Factors that were independently associated with hospital mortality were asystole on arrival of first responders (odds ratio [OR], 25; 95% CI, 2.5-247; P=.006), nonreactive pupils on arrival at the hospital (OR, 13; 95% CI, 2.0-79; P=.006), and an Injury Severity Score over 25 (OR, 13; 95% CI, 1.8-94; P=.011). CONCLUSION: Twelve percent of patients in this cohort survived to discharge after TCA and 8 out of 10 of the surviving patients recovered neurologically. Asystole at start of prehospital care, nonreactive pupils on hospital arrival, and a severity score over 25 may indicate poor prognosis after TCA.

OBJETIVO: Identificar los factores pronóstico a la llegada a urgencias y los resultados al alta hospitalaria de los pacientes en parada cardiaca traumática (PCT), documentada por un servicio de emergencias médicas (SEM), con posterior recuperación de la circulación espontánea (RCE). METODO: Estudio de cohorte multipropósito de pacientes con PCT recuperada atendidos en un servicio de urgencias (SU) de un hospital universitario de tercer nivel de 2003 a 2016. Se recogieron variables epidemiológicas, tipo y mecanismo del traumatismo, datos de la atención extrahospitalaria y del SU. La variable de resultado fue la mortalidad global intrahospitalaria. RESULTADOS: Se incluyeron 130 PCT, de los cuales 123 (94,6%) sufrieron un traumatismo cerrado y 65 (50%) tuvieron un accidente de tráfico. La edad media fue de 39 (DE 16) años y 96 (73,8%) fueron varones. Cincuenta pacientes (65%) presentaron asistolia y 42 (32,3%) actividad eléctrica sin pulso (AESP). Dieciséis (12,3%) sobrevivieron al alta, de los cuales 13 (81,3%) tuvieron recuperación neurológica favorable. Un ritmo de asistolia en la primera atención de extrahospitalaria (OR = 25; IC 95% 2,5-247; p = 0,006), las pupilas arreactivas a la llegada al hospital (OR = 13; IC 95% 2,0-79; p = 0,006), y una puntuación > 25 de la Injury Severity Score (ISS) (OR = 13; IC 95% 1,8-94; p = 0,011) se asociaron de forma independiente con la mortalidad intrahospitalaria. CONCLUSIONES: En nuestra serie, la supervivencia intrahospitalaria de la PCT fue un 12% siendo la recuperación neurológica favorable en ocho de cada diez vivos. El ritmo inicial en asistolia en la atención extrahospitalaria, la pupilas arreactivas a la llegada al hospital y una puntuación > 25 de ISS podrían implicar un mal pronóstico.

Factores pronóstico y resultados intrahospitalarios de la parada cardiaca traumática atendida en un servicio de urgencias / Emergency treatment for traumatic cardiac arrest: prognostic factors and hospital outcome

Objetivo: Identificar los factores pronóstico a la llegada a urgencias y los resultados al alta hospitalaria de los pacientes en parada cardiaca traumática (PCT), documentada por un servicio de emergencias médicas (SEM), con posterior recuperación de la circulación espontánea (RCE). Métodos: Estudio de cohorte multipropósito de pacientes con PCT recuperada atendidos en un servicio de urgencias (SU) de un hospital universitario de tercer nivel de 2003 a 2016. Se recogieron variables epidemiológicas, tipo y mecanismo del traumatismo, datos de la atención extrahospitalaria y del SU. La variable de resultado fue la mortalidad global intrahospitalaria. Resultados: Se incluyeron 130 PCT, de los cuales 123 (94,6%) sufrieron un traumatismo cerrado y 65 (50%) tuvieron un accidente de tráfico. La edad media fue de 39 (DE 16) años y 96 (73,8%) fueron varones. Cincuenta pacientes (65%) presentaron asistolia y 42 (32,3%) actividad eléctrica sin pulso (AESP). Dieciséis (12,3%) sobrevivieron al alta, de los cuales 13 (81,3%) tuvieron recuperación neurológica favorable. Un ritmo de asistolia en la primera atención de extrahospitalaria (OR = 25; IC 95% 2,5-247; p = 0,006), las pupilas arreactivas a la llegada al hospital (OR = 13; IC 95% 2,0-79; p = 0,006), y una puntuación > 25 de la Injury Severity Score (ISS) (OR = 13; IC 95% 1,8-94; p = 0,011) se asociaron de forma independiente con la mortalidad intrahospitalaria. Conclusión: En nuestra serie, la supervivencia intrahospitalaria de la PCT fue un 12% siendo la recuperación neurológica favorable en ocho de cada diez vivos. El ritmo inicial en asistolia en la atención extrahospitalaria, la pupilas arreactivas a la llegada al hospital y una puntuación > 25 de ISS podrían implicar un mal pronóstico (AU)

Objective: To identify prehospital and on-arrival factors associated with hospital outcome in patients with traumatic cardiac arrest (TCA) discharged with recovered spontaneous circulation from the emergency department. Material and methods: Multipurpose prospective cohort study of patients with TCA who recovered after treatment at a tertiary care hospital emergency department between 2003 and 2016. We gathered data on epidemiologic variables, type and cause of injuries, and prehospital and hospital emergency care. The outcome was overall hospital mortality. Results: A total of 130 TCA cases were included; 123 patients (94.6%) had received blunt trauma injuries and 65 (50%) had been in traffic accidents. The mean (SD) age was 39 (16) years, and 96 (73.8%) were male. Fifty patients (65%) were in asystole and 42 (32.3%) had pulseless electrical activity. Sixteen (12.3%) survived to be discharged; 13 of the survivors (81.3%) had recovered neurological activity. Factors that were independently associated with hospital mortality were asystole on arrival of first responders (odds ratio [OR], 25; 95% CI, 2.5-247; P=.006), nonreactive pupils on arrival at the hospital (OR, 13; 95% CI, 2.0-79; P=.006), and an Injury Severity Score over 25 (OR, 13; 95% CI, 1.8-94; P=.011). Conclusions: Twelve percent of patients in this cohort survived to discharge after TCA and 8 out of 10 of the surviving patients recovered neurologically. Asystole at start of prehospital care, nonreactive pupils on hospital arrival, and a severity score over 25 may indicate poor prognosis after TCA (AU)

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.

Damage control orthopaedics in severe polytrauma with femur fracture.

OBJECTIVE: To evaluate the rate of systemic complications and mortality in severe polytrauma patients with associated femur fracture treated by early external fixation of femur. PATIENTS AND METHODOLOGY: We made a retrospective cohort study with forty-one adult multitrauma patients (New Injury Severity Score ≥ 19) with femur fracture treated by external fixation following Damage Control Orthopaedic surgery. The mortality rates, TRISS analysis, incidence of ARDS and MOF were analysed. RESULTS: The mean NISS was 41.2 and the mean age 32.7. 50% of patients were in shock on admission. All patients were treated in the first 12 hours with external fixation. 30% of patients developed ARDS and six patients had MOF. Five patients treated by external fixation died. Difference between predicted mortality by TRISS and actual mortality showed a reduction of 15.9% (0.71 predicted survival versus 0.88 real survival). CONCLUSIONS: An aggressive and early Damage Control approach to treat femur fractures in severe polytrauma patients led to low mortality rate comparing to the predicted mortality by TRISS.

[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)

[Pressure sores secondary to immobilization with cervical collar: a complication of acute cervical injury]. / Ulceras por presión secundarias a la inmovilización con collarín cervical: una complicación de la lesión cervical aguda.

Cervical collars are essential in the treatment of patients with suspicion or verification of acute cervical spine injury (ACSI). One of the complications of these devices is the development of pressure scores (PS). This study aims to determine its incidence in our unit, the characteristics of patients with ACSI who suffer PS due to the collar and to describe aspects related with these injuries. We include 92 patients with ACSI hospitalized more than 24 hours from January 2002 to December 2003. We analyze demographic variables, incidence, risk factors and characteristics of the PS that develop. The incidence of these lesions was 23.9%. Patients with PS presented: a higher injury severity score (ISS) (37.5 9.8 vs. 31.3 14.9), a greater percentage of catheter carriers of intracraneal pressure (ICP) (55.6% vs. 16.2%), longer time of mechanical ventilation (15.4 8.2 vs. 6.1 9) and longer stays (24.6 10.9 vs. 10 10.3), all statistically significant (p< 0.05). A total of 38 PS were detected, 7 (RI 5-13.8) being the median of the detection day. The chin, occipital and suprascapular zone were the most frequent locations. A total of 42.1% were grade II and 39.5% grade III. The occipital injuries were the most serious and those detected the latest. We conclude that a high index of suspicion of PS due to collar in patients with ACSI, elevated ISS, monitoring of ICP, mechanical ventilation and prolonged stays is required. The occipital zone requires special attention due to the seriousness of the injuries recorded. We suggest a specific multidisciplinary protocol for this problem.

Úlceras por presión secundarias a la inmovilización con collarín cervical: una complicación de la lesión cervical aguda / Pressure scores secondary to immobilization with cervical collar: a complication of acute cervical injury

Los collarines cervicales son indispensables en el manejo de pacientes con sospecha o confirmación de lesión cervical aguda (LCA). Una de las complicaciones de estos dispositivos es el desarrollo de úlceras por presión (UPP). Este estudio pretende determinar su incidencia en nuestra unidad, las características de los pacientes con LCA que presentan UPP por collarín y describir aspectos relacionados con estas lesiones. Incluimos 92 pacientes con LCA ingresados más de 24 h, desde enero del 2000 hasta diciembre de 2003. Analizamos variables demográficas, incidencia, factores de riesgo y características de las UPP que desarrollaron. La incidencia de estas lesiones fue del 23,9 por ciento. Los pacientes con UPP presentaban: un ISS (Injury Severity Score) más elevado (37,5 ñ 9,8 frente a 31,3 ñ 14,9), un mayor porcentaje de portadores de catéteres de presión intracraneal (PIC) (el 55,6 frente al 16,2 por ciento), más tiempo de ventilación mecánica (15,4 ñ 8,2 frente a 6,1 ñ 9) y estancias más prolongadas (24,6 ñ 10,9 frente a 10 ñ 10,3), todos estadísticamente significativos (p < 0,05). Se detectaron 38 UPP, y la mediana del día de detección fue 7 (RI = 5-13,8). La barbilla, la zona occipital y la supraescapular fueron las localizaciones más frecuentes. El 42,1 por ciento fueron de grado II y el 39,5 por ciento de grado III. Las lesiones occipitales fueron más graves y las que se detectaron más tardíamente. Concluimos que se requiere un alto índice de sospecha de UPP por collarín en pacientes con LCA, elevado ISS, monitorización de PIC, ventilación mecánica y estancias prolongadas. La zona occipital requiere especial atención por la gravedad de las lesiones registradas. Frente a este problema planteamos un protocolo multidisciplinar específico (AU)