Epidemiología de los desgarros de piel: revisión bibliográfica.

OBJETIVO: Identificar y describir la epidemiología de los desgarros de piel (DP) en el contexto latinoamericano. MÉTODO: Revisión bibliográfica de estudios epidemiológicos publicados entre 1946 y mayo de 2021, en inglés, español y portugués, consultados en texto completo. Para la búsqueda, se utilizaron descriptores correspondientes a la estrategia PCC: Población (adultos), Concepto (epidemiología de los DP) y Contexto (hospitalario e institucional). Los estudios fueron recuperados de las bases de datos Scielo, Lilacs, Embase, Cinahl, Medline y BDEnf, y evaluados por dos revisores independientes. Los instrumentos STROBE y Newcastle-Ottawa fueron usados para evaluar la calidad de estudios de prevalencia e incidencia, respectivamente. RESULTADOS: En total, 21 publicaciones fueron incluidas (siete de ellas, de origen latinoamericano). La prevalencia, reportada en 16 estudios, estuvo entre 0,97 y 28,7%. La incidencia, reportada en cinco estudios, varió entre 3,8 y 40%. Los factores de riesgo asociados al desarrollo de DP fueron: historia previa de la lesión, puntajes bajos en la escala de Braden, dependencia para actividades básicas de la vida diaria, y edad avanzada. En América latina, Brasil se destaca como el país con mayor número de publicaciones (n=5; 23,8%). CONCLUSIÓN: La mayoría de los DP pueden ser considerados eventos adversos evitables, por lo tanto, los valores de incidencia y prevalencia encontrados son elevados. La caracterización de la situación epidemiológica de los DP posibilita la creación de protocolos y políticas públicas para su prevención y detección precoz. CONFLICTO DE INTERÉS: Todos los autores son miembros del International Skin Tears Advisory Panel (ISTAP). CVBS es consultora técnica. CVSG es conferencista. KW es miembro del Canadian Pressure Injury Advisory Panel, consultor en centros de heridas en Canadá, y conferencista para varias empresas internacionales en la industria del cuidado de las heridas.

Calidad de vida asociada con polifarmacia en personas con lesiones cutáneas crónicas.

OBJETIVO: Analizar la asociación entre el uso de polifarmacia y la calidad de vida de personas con lesiones cutáneas crónicas. MÉTODO: Estudio transversal con una muestra conformada por 146 personas afectadas por lesiones cutáneas crónicas, vinculadas con la atención primaria de salud. La recolección de datos se realizó entre julio de 2017 y febrero de 2018. La información se recopiló mediante un cuestionario sociodemográfico y el cuestionario Cardiff Wound Impact Schedule (CWIS). RESULTADOS: Hubo predominio de hipertensión arterial sistémica en 86 personas (58,9%) y de diabetes mellitus en 50 (34,2%). La etiología de la lesión cutánea predominante fue vasculogénica (38,4%), y se identificó polifarmacia en el 46,7% de los pacientes. En el cuestionario CWIS, el dominio con el puntaje promedio más bajo fue el bienestar (promedio de 46,2±17,9). Hubo asociación estadísticamente significativa (p<0.05) entre polifarmacia y las siguientes variables: dominio de "síntomas físicos/vida diaria", dominio de "vida social" y "autosatisfacción con la calidad de vida". CONCLUSIÓN: La polifarmacia está asociada con un detrimento en la calidad de vida de personas con lesiones cutáneas crónicas. Por lo tanto, los profesionales de la salud que trabajan en la atención primaria deberían considerar la terapia farmacológica en sus planes de atención, coordinar con asistencia médica y farmacéutica la elaboración de estrategias de monitoreo de los riesgos que involucran la polifarmacia, y evaluar sus impactos en la calidad de vida. CONFLICTO DE INTERÉS: Ninguno.

Epidemiología de los desgarros de piel: revisión bibliográfica.

OBJETIVO: Identificar y describir la epidemiología de los desgarros de piel (DP) en el contexto latinoamericano. MÉTODO: Revisión bibliográfica de estudios epidemiológicos publicados entre 1946 y mayo de 2021, en inglés, español y portugués, consultados en texto completo. Para la búsqueda, se utilizaron descriptores correspondientes a la estrategia PCC: Población (adultos), Concepto (epidemiología de los DP) y Contexto (hospitalario e institucional). Los estudios fueron recuperados de las bases de datos Scielo, Lilacs, Embase, Cinahl, Medline y BDEnf, y evaluados por dos revisores independientes. Los instrumentos STROBE y Newcastle-Ottawa fueron usados para evaluar la calidad de estudios de prevalencia e incidencia, respectivamente. RESULTADOS: En total, 21 publicaciones fueron incluidas (siete de ellas, de origen latinoamericano). La prevalencia, reportada en 16 estudios, estuvo entre 0,97 y 28,7%. La incidencia, reportada en cinco estudios, varió entre 3,8 y 40%. Los factores de riesgo asociados al desarrollo de DP fueron: historia previa de la lesión, puntajes bajos en la escala de Braden, dependencia para actividades básicas de la vida diaria, y edad avanzada. En América latina, Brasil se destaca como el país con mayor número de publicaciones (n=5; 23,8%). CONCLUSIÓN: La mayoría de los DP pueden ser considerados eventos adversos evitables, por lo tanto, los valores de incidencia y prevalencia encontrados son elevados. La caracterización de la situación epidemiológica de los DP posibilita la creación de protocolos y políticas públicas para su prevención y detección precoz. CONFLICTO DE INTERÉS: Todos los autores son miembros del International Skin Tears Advisory Panel (ISTAP). CVBS es consultora técnica. CVSG es conferencista. KW es miembro del Canadian Pressure Injury Advisory Panel, consultor en centros de heridas en Canadá, y conferencista para varias empresas internacionales en la industria del cuidado de las heridas.

Calidad de vida asociada con polifarmacia en personas con lesiones cutáneas crónicas.

OBJETIVO: Analizar la asociación entre el uso de polifarmacia y la calidad de vida de personas con lesiones cutáneas crónicas. MÉTODO: Estudio transversal con una muestra conformada por 146 personas afectadas por lesiones cutáneas crónicas, vinculadas con la atención primaria de salud. La recolección de datos se realizó entre julio de 2017 y febrero de 2018. La información se recopiló mediante un cuestionario sociodemográfico y el cuestionario Cardiff Wound Impact Schedule (CWIS). RESULTADOS: Hubo predominio de hipertensión arterial sistémica en 86 personas (58,9%) y de diabetes mellitus en 50 (34,2%). La etiología de la lesión cutánea predominante fue vasculogénica (38,4%), y se identificó polifarmacia en el 46,7% de los pacientes. En el cuestionario CWIS, el dominio con el puntaje promedio más bajo fue el bienestar (promedio de 46,2±17,9). Hubo asociación estadísticamente significativa (p<0.05) entre polifarmacia y las siguientes variables: dominio de "síntomas físicos/vida diaria", dominio de "vida social" y "autosatisfacción con la calidad de vida". CONCLUSIÓN: La polifarmacia está asociada con un detrimento en la calidad de vida de personas con lesiones cutáneas crónicas. Por lo tanto, los profesionales de la salud que trabajan en la atención primaria deberían considerar la terapia farmacológica en sus planes de atención, coordinar con asistencia médica y farmacéutica la elaboración de estrategias de monitoreo de los riesgos que involucran la polifarmacia, y evaluar sus impactos en la calidad de vida. CONFLICTO DE INTERÉS: Ninguno.

Admission to Intensive Care for a trauma related to alcohol or drugs, a 'teachable moment' for the beginning of a change. / Ingreso en cuidados intensivos por un traumatismo relacionado con el consumo de alcohol o drogas, un «momento propicio de enseñanza¼ para el inicio del cambio.

OBJECTIVES: To estimate how many of the trauma patients admitted to ICU would be candidates for a secondary prevention programme for trauma related to alcohol or drug use by brief motivational intervention and to define what factors prevent that intervention being performed. METHODS: All 16-70year old trauma patients (n=242) admitted to ICU in 32 non-consecutive months (November 2011 to March 2015) were included in the study, coinciding with the implementation of a screening and brief motivational intervention programme for trauma patients related to substance consumption. The programme includes screening for exposure to substances at admission. Sociodemographic and clinical variables were collected prospectively. RESULTS: The screening for substances was not performed in 38 (15.7%) of all admitted patients. Of the patients screened, 101 (49.5%) were negative. The variables that in greater proportion impeded intervention between screening positive patients were neurological damage due to the trauma with 23 patients (37.1%) and prior psychiatric disorder with 18 (29%). Both variables were associated with substance consumption: negatives 9.9% vs positive 22.3% (P=.001) and negatives 3% vs positive 17.5% (P=.016) respectively. The number of candidates for motivational intervention was 41, 16.9% of all admitted patients. CONCLUSIONS: Almost 2 out of 10 patients were potential candidates. The factors that in a greater proportion precluded the intervention were the same as those associated with consumption. Mortality in ICU was associated with non-compliance with the screening protocol.

Spinal trauma. / Traumatismo espinal.

The treatment of a patient with a vertebral fracture requires an accurate diagnosis and categorization of the problem. Treatment decisions must be based on clinical data and information about the lesion itself, which is provided by imaging studies and their interpretation.

Quality of trauma care and trauma registries.

Traumatic disease is a major public health concern. Monitoring the quality of services provided is essential for the maintenance and improvement thereof. Assessing and monitoring the quality of care in trauma patient through quality indicators would allow identifying opportunities for improvement whose implementation would improve outcomes in hospital mortality, functional outcomes and quality of life of survivors. Many quality indicators have been used in this condition, although very few ones have a solid level of scientific evidence to recommend their routine use. The information contained in the trauma registries, spread around the world in recent decades, is essential to know the current health care reality, identify opportunities for improvement and contribute to the clinical and epidemiological research.

Scoring systems of severity in patients with multiple trauma.

Trauma is a major cause of morbidity and mortality; hence severity scales are important adjuncts to trauma care in order to characterize the nature and extent of injury. Trauma scoring models can assist with triage and help in evaluation and prediction of prognosis in order to organise and improve trauma systems. Given the wide variety of scoring instruments available to assess the injured patient, it is imperative that the choice of the severity score accurately match the application. Even though trauma scores are not the key elements of trauma treatment, they are however, an essential part of improvement in triage decisions and in identifying patients with unexpected outcomes. This article provides the reader with a compendium of trauma severity scales along with their predicted death rate calculation, which can be adopted in order to improve decision making, trauma care, research and in comparative analyses in quality assessment.

[Challenges in care of trauma patient in Spain. The need for implementation of scientific evidence including secondary prevention]. / Retos asistenciales en la atención al paciente traumatizado en España. La necesidad de implementación de la evidencia científica incluyendo la prevención secundaria.

The mortality of trauma patients has improved significantly in recent decades due to a combination of factors: medical care, educational campaigns and structural changes. Generalization of out-of hospital emergence medical services and the hospital care in specific centers for traumatized has undoubtedly contributed to this decline, but other factors such as periodic campaigns to prevent workplace and traffic accidents, as well as improvements in the road network have played a key role. The challenge now is to continue to decrease mortality, for which is essential an analysis of the situation to detect potential areas of improvement. The application of diagnostic or therapeutic actions with scientific evidence is associated with lower mortality, but as in other areas of medicine, the application of scientific evidence in trauma patients is barely 50%. Moreover, nearly 90% of trauma deaths occur in the crash site or in the first 72h of hospitalization, the vast majority as a result of injuries incompatible with life. In these circumstances it is clear that prevention is the most cost-effective activity. As medical practitioners, our role in prevention is mainly focused on the secondary prevention to avoid recidivism, for which it is necessary to identify risk factor (frequently alcohol, illegal drugs, psychotropic medication etc.) and implement a brief motivational intervention. This activity can reduce recidivism by nearly 50%. In Spain, the activity in this field is negligible therefore measures should be implemented for dissemination of secondary prevention in trauma.

[Translated article] Peripheral trauma treated in the paediatric emergency department: Descriptive study.

INTRODUCTION: Peripheral trauma is a very frequent cause of consultation in paediatric emergency departments but few studies have been published describing the characteristics of these patients. MATERIAL AND METHODS: We performed a retrospective descriptive study by reviewing computerised emergency department forms during January and February 2020. OBJECTIVE: To describe the characteristics of traumatic injuries in our area and to detect possible areas for improvement. RESULTS: A total of 714 peripheral trauma cases were attended, which represents 9.5% of the total consultations. A total of 52.7% were schoolchildren (6-11 years). The most frequent locations were the ankle (27.5%) and fingers (17.2%). Fracture was detected in 6.7% of cases. Radiographs were requested in 78.6% of the patients, with pathological findings in 9.6% of them. Half of the X-rays were requested due to ankle or finger trauma. Referral to traumatology was made in 16.4% of patients, mainly for elbow and knee trauma, and the most commonly used treatment was general measures (49%) and bandaging (29.4%). CONCLUSIONS: Peripheral trauma is very common and, in general, banal. A large number of X-rays are requested with a very low yield, so it seems necessary to establish new protocols to reduce the number of requests. Improving training in elbow and knee trauma could improve paediatricians' autonomy in dealing with these more complex injuries.

Peripheral trauma treated in the pediatric emergency department: Descriptive study. / Traumatismos periféricos atendidos en el Servicio de Urgencias Pediátricas. Estudio descriptivo.

INTRODUCTION: Peripheral trauma is a very frequent cause of consultation in paediatric emergency departments but few studies have been published describing the characteristics of these patients. MATERIAL AND METHODS: We performed a retrospective descriptive study by reviewing computerised emergency department forms during January and February 2020. OBJECTIVE: To describe the characteristics of traumatic injuries in our area and to detect possible areas for improvement. RESULTS: A total of 714 peripheral trauma cases were attended, which represents 9.5% of the total consultations. A total of 52.7% were schoolchildren (6-11 years). The most frequent locations were the ankle (27.5%) and fingers (17.2%). Fracture was detected in 6.7% of cases. Radiographs were requested in 78.6% of the patients, with pathological findings in 9.6% of them. Half of the X-rays were requested due to ankle or finger trauma. Referral to traumatology was made in 16.4% of patients, mainly for elbow and knee trauma, and the most commonly used treatment was general measures (49%) and bandaging (29.4%). CONCLUSIONS: Peripheral trauma is very common and, in general, banal. A large number of X-rays are requested with a very low yield, so it seems necessary to establish new protocols to reduce the number of requests. Improving training in elbow and knee trauma could improve paediatricians' autonomy in dealing with these more complex injuries.

[Clinical practice guideline. Traumatic urethral stenosis in males]. / Guía de práctica clínica. La estenosis de uretra postraumática en el hombre.

The incidence of urethral stenosis in Mexico had not been documented. At the Centro Médico Nacional La Raza, during the year 2010, 629 patients with urethral stenosis were attended as outpatient consultation: 85 % with previous urethral stenosis and 15 % with urethral treatment complication. Urethral stenosis is a chronic illness, with multiple etiological origins and the handling is controversial. It has a great negative impact for the patients and the recurrence reaches 85 %. The treatment consisted of an invasive approach (urethral dilations, endoscopy procedure) and open surgery (urethroplasty). The World Health Organization and World Alliance take the world challenge about the urinary tract infections associated with the attention of patients, focused on urethral stenosis. The objective of the following clinical guide is to offer to the health professional a clinical tool for making decisions in the handling of the hardship or masculine urethral stenosis, based on the best available evidence, carrying out in systematized form with bibliographical research using validated terms of the MeSH: urethral structures, in the databases Trip database, PubMed, Guideline Clearinghouse, Cochrane Library and Ovid.

En México no está documentada la incidencia de la estenosis de uretra en forma consistente. En 2010, en el Centro Médico Nacional La Raza se reportaron 629 pacientes en consulta externa, 85 % de uretra anterior y 15 % de uretra posterior. La estenosis uretral es una enfermedad crónica, de etiología variada y manejo controvertido, con gran impacto negativo para los pacientes y recurrencia hasta de 85 %. El tratamiento puede ser instrumentado (dilataciones, cirugía endoscópica) y por cirugía abierta (uretroplastia). La Organización Mundial de la Salud y Alianza Mundial la consideran un reto de la atención de la salud. El objetivo de la siguiente guía es ofrecer al profesional de la salud, una herramienta clínica para la toma de decisiones en la atención de la estenosis uretral masculina, basada en la mejor evidencia identificada mediante la búsqueda bibliográfica sistematizada en las bases de datos Tripdatabase, PubMed, Guideline Clearinghouse, Cochrane Library y Ovid.

A neuropsychological approach in a paediatric acquired brain injury unit under the public health system.

INTRODUCTION: Paediatric acquired brain injury (ABI) causes cognitive and behavioural difficulties and alters the course of child development. The ABI unit at Hospital Infantil Universitario Niño Jesús is the first within the public Spanish health system to provide comprehensive coverage to these patients and their families. OBJECTIVE: This study aims to show the working methodology followed with patients and their families, and to describe the clinical characteristics of the patients treated and the outcomes of treatment. PATIENTS: Fifty-three patients aged between 3 months and 16 and a half years received treatment. The conditions treated were brain tumours, stroke, traumatic brain injury, damage secondary to epilepsy surgery, and hypoxia. METHODS: All patients were evaluated at admission and at discharge. Treatments were adapted to each patient's difficulties and their severity, as well as to the patient's age. Families received individual and group therapy. RESULTS: Older age was associated with better cognitive recovery and shorter duration of treatment. Different conditions show differential impact on intelligence quotient and developmental quotient scores at the beginning of treatment, with hypoxia and encephalitis being associated with greatest severity. Intelligence quotient and developmental quotient scores and visual memory and attention scores at discharge improved significantly after the faceted neuropsychological treatment with respect to scores registered at admission. CONCLUSIONS: The care of patients with ABI should include neuropsychological rehabilitation programmes and provide emotional support to the family so that they may actively participate in the recovery of the child or adolescent.

Quality of life at 3 and 6 months in military personnel with a history of thoracic trauma suffered in combat.

OBJECTIVE: To measure the score and variation in the SF-36 quality of life questionnaire at 3 and 6 months of evaluation in military personnel with a history of chest trauma in combat. METHOD: Comparative study between military with chest trauma and healthy military personnel from 2011 to 2016, evaluating the SF-36 quality of life questionnaire. RESULTS: 45 subjects were analyzed, 25 with a history of chest trauma and 10 healthy controls with combat experience. 25 of the cases were evaluated at 3 months and 11 at 6 months. The average age was 28.2 years (standard deviation: 7.22), and 76% had projectile wounds with a high-speed firearm. 44 % (11/25) of the subjects with chest trauma at three months of assessment presented a lot of limitation for the performance of moderate activities (p < 0.001) and only 5% (1/20) of the controls reported a lot of limitation (p < 0.001). CONCLUSIONS: There is significant deterioration in the quality of life in all domains through the SF-36 questionnaire in patients with chest trauma at 3 and 6 months after the evaluation.

OBJETIVO: Medir el puntaje y la variación en el cuestionario de calidad de vida SF-36 a los 3 y 6 meses de valoración en militares con antecedente de trauma de tórax en combate. MÉTODO: Estudio comparativo entre militares con trauma de tórax y militares sanos entre los años 2011 y 2016, evaluando el cuestionario de calidad de vida SF-36. RESULTADOS: Se analizaron 45 sujetos, 25 con antecedente de trauma de tórax y 10 controles sanos con experiencia en combate. De los sujetos con trauma, 25 se evaluaron a los 3 meses y 11 a los 6 meses. El promedio de edad fue de 28.2 años (desviación estándar: 7.22). El 76% tuvieron heridas por proyectil con arma de fuego de alta velocidad. El 44% (11/25) de los sujetos con trauma de tórax, a los 3 meses de valoración, presentaba mucha limitación para la realización de actividades moderadas (p < 0.001) y solo el 5% (1/20) de los controles referían mucha limitación (p < 0.001). CONCLUSIONES: Hay un deterioro significativo en la calidad de vida en todos los dominios del cuestionario SF-36 en pacientes con trauma de tórax a los 3 y 6 meses de la valoración.

Early postoperative complications of thoracolumbar fractures in patients with multiple trauma according to the surgical timing. / Complicaciones posoperatorias de fracturas toracolumbares en pacientes con traumatismo múltiple según el momento de la cirugía.

INTRODUCTION AND OBJECTIVES: Our objective was to compare the rate of complications in thoracolumbar fractures that occurred during the early postoperative period in patients with multiple high-energy trauma according to the time of surgery. As a secondary objective, to estimate which variables were associated with surgery before 72 h. MATERIAL AND METHODS: Retrospective analysis of a series of patients with thoracolumbar fractures and multiple associated injuries in other anatomical regions due to high energy trauma. Surgically treated in an occupational trauma referral center, by the same surgical team and during the period between January 2013 and December 2019. RESULTS: We analyzed a sample of 40 patients (39 men and 1 woman). The rate of complications was independent of surgical delay (before and after 72 h) (p = 0.827). There were statistically significant differences between early and later surgery groups in the variables age, systolic blood pressure, initial SOFA score and presence of neurological damage (p = 0.014; p = 0.029; p = 0.032; p = 0.012). The overall surgical delay was correlated with the SOFA score (p = 0.007). CONCLUSION: The rate of early postoperative complications did not show significant differences between the early and late surgery groups. We observed that the patients who had been operated before 72 h from trauma were younger, had more association with neurological syntoms, presented higher blood pressure values and less physiological damage. Surgical delay was positively correlated with SOFA score on arrival.

Early postoperative complications of thoracolumbar fractures in patients with multiple trauma according to the surgical timing.

INTRODUCTION AND OBJETCTIVES: Our objective was to compare the rate of complications in thoracolumbar fractures that occurred during the early postoperative period in patients with multiple high-energy trauma according to the time of surgery. As a secondary objective, to estimate which variables were associated with surgery before 72h. MATERIAL AND METHODS: Retrospective analysis of a series of patients with thoracolumbar fractures and multiple associated injuries in other anatomical regions due to high energy trauma. Surgically treated in an occupational trauma referral center, by the same surgical team and during the period between January 2013 and December 2019. RESULTS: We analyzed a sample of 40 patients (39 men and 1 woman). The rate of complications was independent of surgical delay (before and after 72h) (p=0.827). There were statistically significant differences between early and later surgery groups in the variables age, systolic blood pressure, initial SOFA score and presence of neurological damage (p=0.014; p=0.029; p=0.032; p=0.012). The overall surgical delay was correlated with the SOFA score (p=0.007). CONCLUSION: The rate of early postoperative complications did not show significant differences between the early and late surgery groups. We observed that the patients who had been operated before 72h from trauma were younger, had more association with neurological syntoms, presented higher blood pressure values and less physiological damage. Surgical delay was positively correlated with SOFA score on arrival.

[Patient simulation for hand therapy in an anesthesiologist after an occupational injury: A case study]. / Simulación clínica para la rehabilitación de la mano en un anestesiólogo después de una lesión ocupacional: un estudio de caso.

We described the use of clinical simulation for hand therapy in an anesthesiologist that accidentally suffered from entrapment with the surgical table in the right thumb and underwent a partial toe-to-hand autograft. At week 14 after surgery, the patient practiced anesthetic tasks and clinical scenarios using a patient simulator instead undergoing a regular occupational therapy regimen. Quantifiable physical, functional and psychological measures improved during and after the simulation intervention, and there was no decline one month after the patient returned to work. The use of clinical simulation as part of the rehabilitation process of an anesthesiologist after hand injury contributed to improving the range of motion, strength, sensibility, and functional tests. Overall, it played an important role in determining the worker's potential to withstand the demands of anesthesia practice.

[Return to work in patients with traumatic spinal cord injury in a medical center in Mexico]. / Retorno laboral en pacientes con lesión medular traumática en un centro hospitalario de México.

BACKGROUND AND OBJECTIVE: One of the most important outcomes regarding social reintegration after a traumatic spinal cord injury is social reinsertion; despite its huge impact, very few studies in Mexico have measured community reintegration in these patients. The objective of this study was to analyse the working situation of patients with traumatic spinal cord injury at a hospital centre in Mexico. MATERIAL AND METHODS: Cross-sectional descriptive study. Working patients, aged 19-55 years, diagnosed with traumatic spinal cord injury at a hospital centre in Mexico were included; a telephone survey was performed. RESULTS: Eighteen patients were included (15 men, 3 women), with a mean age of 38 years (± 10.3). The most common levels of injury were cervical and thoracic; the most common Asia Impairment Scale grades were A and E; 17 patients were included at a rehabilitation programme at discharge; the average Spinal Cord Independence Measure score was 65.22 (± 35.11). Five patients were hired after the injury in a mean period of 7 months (± 2.9). The main factors associated with occupational reintegration were young age, lower injury levels, an adequate rehabilitation programme, high Spinal Cord Independence Measure scale score, and being married or cohabiting. CONCLUSION: This study shows the low return to work rate after a traumatic spinal cord injury, as well as the main factorsa affecting it; highlighting the importance of an adeaquate rehabilitation program with a multidisciplinary approach.

Management of Splenic Injuries Utilizing a Multidisciplinary Protocol in 110 Consecutive Patients at a Level II Hospital. / Resultados en el tratamiento de traumatismos esplénicos utilizando un protocolo multidisciplinar en 110 pacientes consecutivos en un hospital de nivel II.

INTRODUCTION: Non-operative treatment (NOM) of splenic trauma is the management of choice in hemodynamically stable patients. The aim of the present study was to assess the failure rate of NOM after implementation of a multidisciplinary protocol for splenic injuries compared to literature results. METHODS: A retrospective study was performed over a 16-year period. Patient data and management of splenic trauma was recorded according to our hospital protocol: demographic data, blood pressure, respiratory rate, Glasgow Coma Scale(GCS), Revised Trauma Score(RTS), Injury Severity Score(ISS), injury grade according to the American Association for the Surgery of Trauma(AAST), failure of NOM, morbidity and mortality. RESULTS: One hundred ten patients were included: 90(81.8%) men, 20(18.2%) women; mean age 37 years; 106(96.5%) cases were blunt and four(3.5%) penetrating by knife. The diagnosis was established by US/CT. AAST classification: 14(13%) grade I; 24(22%) grade II; 34(31%) grade III; 37(34%) grade IV. Emergency laparotomy was performed in 54 patients: 37 due to grade IV injuries, 17 due to hemodynamic instability. NOM was utilized in 56 patients, spleen-preserving surgery in 16, and splenectomy in 38. Ten patients had postoperative complications: seven in the splenectomy group, two in the spleen-preserving surgery group, and one in the NOM group. One patient died. Average hospital stay: 22.8 days- NOM 17.6 days, conservative surgery 29 days, splenectomy 22.4 days. CONCLUSIONS: Although we continue with a high hospital stay, the literature reports support our results. The implementation of the protocol by consensus contributed to the change towards NOM.

A neuropsychological approach in a paediatric acquired brain injury unit under the public health system. / Abordaje neuropsicológico en una unidad pediátrica de daño cerebral adquirido del sistema público de salud.

INTRODUCTION: Paediatric acquired brain injury (ABI) causes cognitive and behavioural difficulties and alters the course of child development. The ABI unit at Hospital Infantil Universitario Niño Jesús is the first within the public Spanish health system to provide comprehensive coverage to these patients and their families. OBJECTIVE: This study aims to show the working methodology followed with patients and their families, and to describe the clinical characteristics of the patients treated and the outcomes of treatment. PATIENTS: Fifty-three patients aged between three months and 16 and a half years received treatment. The conditions treated were brain tumours, stroke, traumatic brain injury, damage secondary to epilepsy surgery, and hypoxia. METHODS: All patients were evaluated at admission and at discharge. Treatments were adapted to each patient's difficulties and their severity, as well as to the patient's age. Families received individual and group therapy. RESULTS: Older age was associated with better cognitive recovery and shorter duration of treatment. Different conditions show differential impact on intelligence quotient and developmental quotient scores at the beginning of treatment, with hypoxia and encephalitis being associated with greatest severity. Intelligence quotient and developmental quotient scores and visual memory and attention scores at discharge improved significantly after the faceted neuropsychological treatment with respect to scores registered at admission. CONCLUSIONS: The care of patients with ABI should include neuropsychological rehabilitation programmes and provide emotional support to the family so that they may actively participate in the recovery of the child or adolescent.