Hypochloremia in Patients with Severe Traumatic Brain Injury: A Possible Risk Factor for Increased Mortality.

OBJECTIVE: To determine association between electrolyte disturbances and mortality in patients with severe traumatic brain injury. METHODS: Medical records of patients with severe traumatic brain injury and Glasgow Coma Scale score <8 and electrolyte alterations were reviewed in a retrospective cohort study. Electrolyte levels were analyzed to establish an association between patients who died and patients who survived. Bivariate analysis was performed using χ2 test with a statistical reliability of 95% for categorical variables. Analysis for electrolyte changes to determine association with mortality was performed using χ2 test with multiple comparisons. Logistic regression was performed between the electrolyte alterations and their association with mortality. The reliability of statistical tests was 95%. RESULTS: There was a significant relationship between hypochloremia and increased risk of mortality in 23.1% of deceased patients (P = 0.03). Furthermore, there was a significant correlation with age (P < 0.01) and with the Acute Physiology and Chronic Health Evaluation APACHE II (P < 0.01). CONCLUSIONS: Hypochloremia could be an important prognostic factor to determine mortality risk and to improve treatment in patients with severe traumatic brain injury.

Frecuencia y pertinencia del perfil lipídico como examen inicial en vértigo periférico / Lipid profile frequency and relevancy as an initial test for peripheral vertigo

Objetivos Determinar la prevalencia de la solicitud del perfil lipídico como ayuda diagnóstica de primera línea en pacientes con impresión clínica de vértigo periférico, así como un análisis de la relación costo-beneficio de dicha solicitud. Métodos Estudio de tipo corte transversal retrospectivo. Revisión de 201 historias de pacientes atendidos en la consulta externa tanto de especialistas como de médicos generales de la Clínica Universitaria Teletón y Casa chía, con diagnóstico de vértigo periférico, en el periodo comprendido entre enero de 2005 y julio de 2008. Resultados Las edades de los pacientes oscilaron entre 6 y 87 años, el 36 % de sexo masculino y el 64 % femenino. El perfil lipídico fue solicitado como prueba diagnóstica inicial para el manejo de vértigo a un 76 % de los pacientes. Los perfiles lipídicos hallados fueron normales en el 80 % de los pacientes a quienes se les solicitó. Se presenta el análisis de la relación costo-beneficio de esta prueba. Conclusiones Existe una alta prevalencia de solicitud de perfil lipídico como estudio de primera línea en el abordaje de pacientes con vértigo periférico, aunque no existe evidencia que avale esta solicitud, se requiere retroalimentación al cuerpo médico tanto de atención primaria como especialistas.

Objective Determining the prevalence of requesting lipid profile as a first-line diagnostic method in patients having a clinical impression of peripheral vertigo and also determining such request's cost- benefit ratio. Methods This was a retrospective cross-sectional study of 201 clinical charts regarding patients diagnosed as having peripheral vertigo at the Teletón teaching hospital's outpatient services in Chía between January 2005 and July 2008. Clinical charts drawn up by both general practitioners and medical specialists at first-time visit were compiled and analyzed Results The patients were aged 6 to 87 years old; 36 % were males and 64 % females. Lipid profile was requested for 76 % of the patients as initial diagnostic method; it was found that 80 % of the results revealed no abnormality. Conclusion Although a high prevalence regarding a request for lipid profile first-line study was found for patients having peripheral vertigo, there was no scientific evidence supporting such requirement. Ordering this kind of study not only increases unnecessary costs concerning diagnostic methods but also involves unjustified treatment. Feedback is needed for both doctors and first attention staff to ensure that this type of practice becomes changed.

[Lipid profile frequency and relevancy as an initial test for peripheral vertigo]. / Frecuencia y pertinencia del perfil lipídico como examen inicial en vértigo periférico.

OBJECTIVE: Determining the prevalence of requesting lipid profile as a first-line diagnostic method in patients having a clinical impression of peripheral vertigo and also determining such request's cost- benefit ratio. METHODS: This was a retrospective cross-sectional study of 201 clinical charts regarding patients diagnosed as having peripheral vertigo at the Teletón teaching hospital's outpatient services in Chía between January 2005 and July 2008. Clinical charts drawn up by both general practitioners and medical specialists at first-time visit were compiled and analyzed. RESULTS: The patients were aged 6 to 87 years old; 36 % were males and 64 % females. Lipid profile was requested for 76 % of the patients as initial diagnostic method; it was found that 80 % of the results revealed no abnormality. CONCLUSION: Although a high prevalence regarding a request for lipid profile first-line study was found for patients having peripheral vertigo, there was no scientific evidence supporting such requirement. Ordering this kind of study not only increases unnecessary costs concerning diagnostic methods but also involves unjustified treatment. Feedback is needed for both doctors and first attention staff to ensure that this type of practice becomes changed.