Pub Date : 2020-04-01DOI: 10.5005/jp-journals-10030-1258
M. Swaroop, E. Ludi, A. Reitz, Pablo O Peñaranda Dávalos, Gustavo Moraes dos Santos, M. E. Jackson, Lucy Lopez Quiroga, L. Tatebe, J. Gutierrez
Introduction: More than half of all trauma deaths occur in the prehospital setting with lowand middle-income countries assuming the greatest burden. Coordinated prehospital responses to trauma, including layperson first responders, can reduce the mortality. Trauma first responder courses (TFRCs) in Bolivia have improved participant knowledge and confidence levels. This study aims to analyze participant baseline characteristics and postworkshop evaluations to inform future course promotion and development. Materials and methods: Trauma responders unify to empower (TRUE)-Bolivia is a 4-hour didactic and practical TFRC covering scene safety, basic airway management, bleeding control, and pelvic binding. Participants, recruited from Santa Cruz, Bolivia, completing all preand post-course assessments were included. Quantitative data were aggregated and analyzed in SAS v9.4 with Chi-square analyses, and qualitative data were analyzed for thematic content in Microsoft Excel. Results: A total of 269 people, with an average age of 35.4 years, participated in 18 courses. Most participants were male (n = 211/269, 78.4%) with n = 149/253 (58.9%) working in public transportation, n = 64/253 (25.3%) in medical training, and n = 40/253 (15.8%) working in other fields. Of the 246 and 205 participants who responded to the safety behavior questions, respectively, 55.7% (n = 137/246) of participants wore seat belts less than 50% of the time and 60.5% (n = 124/205) wore helmets less than half the time while on a motorcycle. On post-course evaluation, n = 118/250 (47.2%) quoted skill acquisition to be the greatest benefit of the course, n = 37/250 (14.8%) quoted helping others, and n = 64/250 (25.6%) stated a combination of the two. Suggestions for improvement included adding content on burns, head injuries, and cardiopulmonary resuscitation. Conclusion: Understanding participants’ background and incorporating feedback allowed us to tailor the course to participants’ interests while maintaining the focus on trauma prevention and initial management. To maximize course impact, a local partnership has been formed with the municipal government to provide the courses to public transportation drivers who are likely to arrive first at a scene of trauma. Clinical significance: The didactic and practical content of TRUE-Bolivia empowers participants to save lives in the prehospital setting where ambulances can take over an hour to arrive.
{"title":"Trauma Responders Unify to Empower Communities in Santa Cruz, Bolivia: Course Participants and their Feedback","authors":"M. Swaroop, E. Ludi, A. Reitz, Pablo O Peñaranda Dávalos, Gustavo Moraes dos Santos, M. E. Jackson, Lucy Lopez Quiroga, L. Tatebe, J. Gutierrez","doi":"10.5005/jp-journals-10030-1258","DOIUrl":"https://doi.org/10.5005/jp-journals-10030-1258","url":null,"abstract":"Introduction: More than half of all trauma deaths occur in the prehospital setting with lowand middle-income countries assuming the greatest burden. Coordinated prehospital responses to trauma, including layperson first responders, can reduce the mortality. Trauma first responder courses (TFRCs) in Bolivia have improved participant knowledge and confidence levels. This study aims to analyze participant baseline characteristics and postworkshop evaluations to inform future course promotion and development. Materials and methods: Trauma responders unify to empower (TRUE)-Bolivia is a 4-hour didactic and practical TFRC covering scene safety, basic airway management, bleeding control, and pelvic binding. Participants, recruited from Santa Cruz, Bolivia, completing all preand post-course assessments were included. Quantitative data were aggregated and analyzed in SAS v9.4 with Chi-square analyses, and qualitative data were analyzed for thematic content in Microsoft Excel. Results: A total of 269 people, with an average age of 35.4 years, participated in 18 courses. Most participants were male (n = 211/269, 78.4%) with n = 149/253 (58.9%) working in public transportation, n = 64/253 (25.3%) in medical training, and n = 40/253 (15.8%) working in other fields. Of the 246 and 205 participants who responded to the safety behavior questions, respectively, 55.7% (n = 137/246) of participants wore seat belts less than 50% of the time and 60.5% (n = 124/205) wore helmets less than half the time while on a motorcycle. On post-course evaluation, n = 118/250 (47.2%) quoted skill acquisition to be the greatest benefit of the course, n = 37/250 (14.8%) quoted helping others, and n = 64/250 (25.6%) stated a combination of the two. Suggestions for improvement included adding content on burns, head injuries, and cardiopulmonary resuscitation. Conclusion: Understanding participants’ background and incorporating feedback allowed us to tailor the course to participants’ interests while maintaining the focus on trauma prevention and initial management. To maximize course impact, a local partnership has been formed with the municipal government to provide the courses to public transportation drivers who are likely to arrive first at a scene of trauma. Clinical significance: The didactic and practical content of TRUE-Bolivia empowers participants to save lives in the prehospital setting where ambulances can take over an hour to arrive.","PeriodicalId":74395,"journal":{"name":"Panamerican journal of trauma, critical care & emergency surgery","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78929287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-01DOI: 10.5005/jp-journals-10030-1265
G. Fraga, Thiago Calderan, A. Dorigatti, Diego M Gutierrez, J. A. Ramalho
{"title":"Yellow May: Worldwide Road Safety Injury Prevention Program","authors":"G. Fraga, Thiago Calderan, A. Dorigatti, Diego M Gutierrez, J. A. Ramalho","doi":"10.5005/jp-journals-10030-1265","DOIUrl":"https://doi.org/10.5005/jp-journals-10030-1265","url":null,"abstract":"","PeriodicalId":74395,"journal":{"name":"Panamerican journal of trauma, critical care & emergency surgery","volume":"34 1","pages":"45-48"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74171174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-01DOI: 10.5005/jp-journals-10030-1274
Ezequiel Monteverde, A. Francavilla, A. Simons, Deborah Turina, A. Gattari, Virginia Altuna, P. Neira
Introducción: El trauma es la principal causa de muerte en niños a nivel global. Aproximadamente el 10% de la admisiones a las unidades de cuidados intensivos pediátricos (UCIPs) se debe a trauma. Establecer un método de evaluación común de los resultados en UCIPs es un factor crítico para mejorar la calidad en la atención del paciente. En la población pediátrica no existe certeza si los scores de enfermedad crítica o los scores de trauma son los mejores predictores de mortalidad. Métodos: Revisión retrospectiva del registro de trauma de la UCIP del Hospital de Niños Ricardo Gutiérrez, que incluye datos anonimizados de todos los ingresos a la UCIP entre el 2005 y 2017. Los scores evaluados fueron: índice de trauma pediátrico (ITP), índice de severidad de lesiones (ISS), nuevo índice de severidad de lesiones (NISS), score de trauma revisado (RTS), índice de severidad en trauma (TRISS) e índice de mortalidad pediátrica (PIM2). Resultados: Se incluyeron 360 pacientes (56% varones) con una edad promedio de 60 meses, 30-116 (mediana, RIC). 73% sufrió traumatismo craneoencefálico, 26% tuvieron lesiones en extremidades, 19% en tórax, 14% en abdomen, 6% en la pelvis y 5% en la columna vertebral o médula espinal. 43% tuvo lesiones en una región corporal, 29% en dos regiones y 28% en más de dos. La combinación más frecuente fue una lesión craneoencefálica con una lesión en las extremidades (16%). Las principales causas de trauma fueron caídas (42%), seguidas por colisión vehicular contra peatones (20%) y lesiones en pasajeros de automotores (7%). La mortalidad general fue 6.0%. Para predecir el riesgo de muerte en UCIP se probó la capacidad de discriminación de los scores usando curva ROC (ABC e IC95%): NISS 0.749 (0.63-0.86), ISS 0.788 (0.69-0.89), PTS 0.899 (0.84-0.96), RTS 0.912 (0.84-0.98), TRISS 0.933 (0.86-0.99) y PIM2 0.973 (0.93-1.0). Conclusión: En esta muestra de una única institución, el score PIM2 tuvo una capacidad de discriminación superior a los scores de trauma usando mortalidad como variable resultado. Estos resultados necesitan probarse en un estudio con una muestra poblacional mayor. Palabras clave: Mortality, Pediatrics, Pediatric trauma, Prediction, Predictive scores, Trauma, Trauma registry.
{"title":"Scores de Trauma vs Score de Enfermedad Crítica en Pacientes Traumatizados Críticamente Enfermos. Análisis de Un registro de Trauma de Un Hospital Pediátrico","authors":"Ezequiel Monteverde, A. Francavilla, A. Simons, Deborah Turina, A. Gattari, Virginia Altuna, P. Neira","doi":"10.5005/jp-journals-10030-1274","DOIUrl":"https://doi.org/10.5005/jp-journals-10030-1274","url":null,"abstract":"Introducción: El trauma es la principal causa de muerte en niños a nivel global. Aproximadamente el 10% de la admisiones a las unidades de cuidados intensivos pediátricos (UCIPs) se debe a trauma. Establecer un método de evaluación común de los resultados en UCIPs es un factor crítico para mejorar la calidad en la atención del paciente. En la población pediátrica no existe certeza si los scores de enfermedad crítica o los scores de trauma son los mejores predictores de mortalidad. Métodos: Revisión retrospectiva del registro de trauma de la UCIP del Hospital de Niños Ricardo Gutiérrez, que incluye datos anonimizados de todos los ingresos a la UCIP entre el 2005 y 2017. Los scores evaluados fueron: índice de trauma pediátrico (ITP), índice de severidad de lesiones (ISS), nuevo índice de severidad de lesiones (NISS), score de trauma revisado (RTS), índice de severidad en trauma (TRISS) e índice de mortalidad pediátrica (PIM2). Resultados: Se incluyeron 360 pacientes (56% varones) con una edad promedio de 60 meses, 30-116 (mediana, RIC). 73% sufrió traumatismo craneoencefálico, 26% tuvieron lesiones en extremidades, 19% en tórax, 14% en abdomen, 6% en la pelvis y 5% en la columna vertebral o médula espinal. 43% tuvo lesiones en una región corporal, 29% en dos regiones y 28% en más de dos. La combinación más frecuente fue una lesión craneoencefálica con una lesión en las extremidades (16%). Las principales causas de trauma fueron caídas (42%), seguidas por colisión vehicular contra peatones (20%) y lesiones en pasajeros de automotores (7%). La mortalidad general fue 6.0%. Para predecir el riesgo de muerte en UCIP se probó la capacidad de discriminación de los scores usando curva ROC (ABC e IC95%): NISS 0.749 (0.63-0.86), ISS 0.788 (0.69-0.89), PTS 0.899 (0.84-0.96), RTS 0.912 (0.84-0.98), TRISS 0.933 (0.86-0.99) y PIM2 0.973 (0.93-1.0). Conclusión: En esta muestra de una única institución, el score PIM2 tuvo una capacidad de discriminación superior a los scores de trauma usando mortalidad como variable resultado. Estos resultados necesitan probarse en un estudio con una muestra poblacional mayor. Palabras clave: Mortality, Pediatrics, Pediatric trauma, Prediction, Predictive scores, Trauma, Trauma registry.","PeriodicalId":74395,"journal":{"name":"Panamerican journal of trauma, critical care & emergency surgery","volume":"67 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87145001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-01DOI: 10.5005/jp-journals-10030-1266
Sebastián Sánchez, M. Pedraza, L. F. Cabrera, J. Ordoñez, P. Lopez, F. Bernal, Jean A. Pulido, Patricia Parra, Carlos Delgado López, L. Marroquin, G. Herrera
Ab s t r Ac t Introduction: Emergency pancreatoduodenectomy is a procedure that is indicated for the management of severe pancreaticoduodenal trauma after damage control surgery. Objectives: To present our experience of pancreaticoduodenal trauma management with emergency pancreatoduodenectomy and damage control surgery. Materials and methods: Retrospectively recorded data of patients with severe pancreaticoduodenal trauma who underwent a pancreatoduodenectomy and damage control for trauma at a high-volume trauma center. Results: In a period of 6 years, four patients (three men and one woman, median age 17.5 years, range: 16–21 years) with severe pancreaticoduodenal trauma underwent a pancreatoduodenectomy and damage control procedure (gunshot n = 4), and in a second surgical procedure underwent gastrointestinal tract reconstruction. In total, 75% incidence of surgical site infection (SSI) was reported, 25% healthcare-associated pneumonia, and 50% postoperative pancreatic fistula (POPF). Intensive care unit (ICU) of 12.25 and hospital stay of 29.5 days mean and no mortality. Conclusion: An emergency pancreatoduodenectomy can be a lifesaving procedure in patients with non-reconstructable duodenopancreatic injuries. Damage control surgery in pancreaticoduodenal trauma is an alternative for management although with high risk of morbidity.
{"title":"Damage Control Pancreatoduodenectomy for Severe Pancreaticoduodenal Trauma: A Multicentric Case Series in Colombia","authors":"Sebastián Sánchez, M. Pedraza, L. F. Cabrera, J. Ordoñez, P. Lopez, F. Bernal, Jean A. Pulido, Patricia Parra, Carlos Delgado López, L. Marroquin, G. Herrera","doi":"10.5005/jp-journals-10030-1266","DOIUrl":"https://doi.org/10.5005/jp-journals-10030-1266","url":null,"abstract":"Ab s t r Ac t Introduction: Emergency pancreatoduodenectomy is a procedure that is indicated for the management of severe pancreaticoduodenal trauma after damage control surgery. Objectives: To present our experience of pancreaticoduodenal trauma management with emergency pancreatoduodenectomy and damage control surgery. Materials and methods: Retrospectively recorded data of patients with severe pancreaticoduodenal trauma who underwent a pancreatoduodenectomy and damage control for trauma at a high-volume trauma center. Results: In a period of 6 years, four patients (three men and one woman, median age 17.5 years, range: 16–21 years) with severe pancreaticoduodenal trauma underwent a pancreatoduodenectomy and damage control procedure (gunshot n = 4), and in a second surgical procedure underwent gastrointestinal tract reconstruction. In total, 75% incidence of surgical site infection (SSI) was reported, 25% healthcare-associated pneumonia, and 50% postoperative pancreatic fistula (POPF). Intensive care unit (ICU) of 12.25 and hospital stay of 29.5 days mean and no mortality. Conclusion: An emergency pancreatoduodenectomy can be a lifesaving procedure in patients with non-reconstructable duodenopancreatic injuries. Damage control surgery in pancreaticoduodenal trauma is an alternative for management although with high risk of morbidity.","PeriodicalId":74395,"journal":{"name":"Panamerican journal of trauma, critical care & emergency surgery","volume":"99 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80751136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-01DOI: 10.5005/jp-journals-10030-1259
J. Duchesne, S. Ninokawa, Manuel Terrazas, P. Ortiz, Francisco de Salles Collet e Silva, Terence O 'Keefe
Aim: To discuss important interventions and techniques to control hemorrhage in trauma patients. Background: Although there have been dramatic advances in trauma care over the last two decades, there are still a significant number of patients each year who succumb to death from hemorrhagic shock. Hemorrhage due to trauma is the leading preventable cause of death in the military setting, accounting for up to 90% of potentially preventable deaths; in the civilian setting, hemorrhage is second only to neurologic injuries as a cause of death due to trauma. In April 2013, the American College of Surgeons released the Hartford Consensus, with recommendations to enhance survivability from mass casualty incidents and active shooter scenarios. One of the four reports recommended an improvement in the implementation of bleeding control to prevent death from hemorrhage in patients with traumatic injuries. Review results: Advances in hemostatic resuscitation, antifibrinolytic medications, and more rapid transport times have all decreased mortality from hemorrhage. There has also been better bystander training through the more recent “Stop the Bleed” campaign, with its emphasis on early extremity hemorrhage control, including tourniquet use in the field. While previous studies have shown a decreased mortality in patients who were transported to the hospital quicker, decreasing the time to hemorrhage control remains one of the greatest barriers to improving patient mortality. Conclusion: In this consensus, the methods of hemorrhage control are discussed for use in the prehospital setting and the emergency department. Additionally, surgical procedures are described that may enhance hemostatic control in the operating room and lead to better outcomes during and after damage control surgeries.
{"title":"Stop the Bleed Consensus","authors":"J. Duchesne, S. Ninokawa, Manuel Terrazas, P. Ortiz, Francisco de Salles Collet e Silva, Terence O 'Keefe","doi":"10.5005/jp-journals-10030-1259","DOIUrl":"https://doi.org/10.5005/jp-journals-10030-1259","url":null,"abstract":"Aim: To discuss important interventions and techniques to control hemorrhage in trauma patients. Background: Although there have been dramatic advances in trauma care over the last two decades, there are still a significant number of patients each year who succumb to death from hemorrhagic shock. Hemorrhage due to trauma is the leading preventable cause of death in the military setting, accounting for up to 90% of potentially preventable deaths; in the civilian setting, hemorrhage is second only to neurologic injuries as a cause of death due to trauma. In April 2013, the American College of Surgeons released the Hartford Consensus, with recommendations to enhance survivability from mass casualty incidents and active shooter scenarios. One of the four reports recommended an improvement in the implementation of bleeding control to prevent death from hemorrhage in patients with traumatic injuries. Review results: Advances in hemostatic resuscitation, antifibrinolytic medications, and more rapid transport times have all decreased mortality from hemorrhage. There has also been better bystander training through the more recent “Stop the Bleed” campaign, with its emphasis on early extremity hemorrhage control, including tourniquet use in the field. While previous studies have shown a decreased mortality in patients who were transported to the hospital quicker, decreasing the time to hemorrhage control remains one of the greatest barriers to improving patient mortality. Conclusion: In this consensus, the methods of hemorrhage control are discussed for use in the prehospital setting and the emergency department. Additionally, surgical procedures are described that may enhance hemostatic control in the operating room and lead to better outcomes during and after damage control surgeries.","PeriodicalId":74395,"journal":{"name":"Panamerican journal of trauma, critical care & emergency surgery","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83419557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-01DOI: 10.5005/jp-journals-10030-1275
C. Ordoñez, A. García, D. Burbano, Julian Chica, C. Orlas, F. Ariza, R. Manzano, Camilo J Salazar, S. Carvajal
Introduction: Massive transfusion (MT) is defined as the administration of ≥ 10 U of packed red blood cells (PRBCs) in 24 hours. Alternative definitions have been proposed which have not been compared regarding mortality or multiorgan failure (MOF). The objective is to compare the discriminative ability of proposed definitions of MT concerning mortality and MOF. Materials and methods: Patients with trauma team activation in a level I trauma hospital of Cali, Colombia, between 2015 and 2017 were included. Demographics and trauma characteristics were evaluated. The following MT definitions were measured: ≥ 50 U of total blood products in 24 hours (MT50-24), ≥ 6 U of PRBCs in 6 hours (MT6-6), ≥ 10 U of PRBCs in 6 hours (MT10-6), a combination of MT10-24 plus MT6-6 (MTcombi), ≥ 5 U of PRBC in 4 hours (MT5-4), ≥ 4 U of PRBC in 1 hour (MT4-1), and the critical administration threshold (CAT) which is 3 U of PRBCs in 1 hour. The operative characteristics were calculated for each definition. Multiorgan failure was defined as a sequential organ failure assessment (SOFA) score of ≥ 6 points. Results: We included 394 subjects. A total of 266 (67%) received at least 1 unit of PRBCs in the first 24 hours, from which trauma mechanism was penetrating in 84.6%; 86.8% were male, with a median [interquartile range (IQR)] age of 29 (22–38) years and injury severity score (ISS) of 25 (25–29). A positive ABC score for massive transfusion score was positive in 87.2%. Sensitivity and specificity were as follows: multiorgan failure: MT10-24 18.6% and 98.2%, MT6-6 34.3% and 91.3%, MTcombi 38.2% and 91.3%, MT5-4 38.2% and 92.2%, and MT4-1 48% and 78.4%. Mortality: MT10-24 40.6% and 92.2%, MT6-6 62.7% and 82.6%, MTcombi 64.4% and 80.6%, MT5-4 61% and 81.1% and MT4-1 71.1% and 68.6%. Conclusion: All definitions showed an association with a higher risk of mortality and MOF, generally with low sensitivity but high specificity. The MT definition of ≥ 10 PRBCs in 24 hours should be revised.
大量输血(MT)被定义为24小时内输入≥10u的红细胞(红细胞)。关于死亡率或多器官衰竭(MOF)，已经提出了几种不同的定义，但尚未进行比较。目的是比较提出的MT关于死亡率和MOF的定义的判别能力。材料与方法:纳入2015 - 2017年在哥伦比亚卡利某一级创伤医院开展创伤小组活动的患者。评估人口统计学和创伤特征。测量以下MT定义:24小时总血制品≥50 U (MT50-24)， 6小时PRBC≥6 U (MT6-6)， 6小时PRBC≥10 U (MT10-6)， MT10-24 + MT6-6 (MTcombi)， 4小时PRBC≥5 U (MT5-4)， 1小时PRBC≥4 U (MT4-1)，以及关键给药阈值(CAT)，即1小时PRBC≥3 U。计算每个定义的手术特征。多器官衰竭定义为顺序器官衰竭评估(SOFA)评分≥6分。结果:纳入394名受试者。266例(67%)患者在24小时内接受了至少1单位的红细胞，其中84.6%的患者创伤机制穿透;86.8%为男性，中位年龄为29(22-38)岁，损伤严重程度评分(ISS)为25(25 - 29)岁。大量输血ABC评分阳性占87.2%。多器官衰竭:MT10-24分别为18.6%和98.2%，MT6-6分别为34.3%和91.3%，MTcombi分别为38.2%和91.3%，MT5-4分别为38.2%和92.2%，MT4-1分别为48%和78.4%。死亡率:MT10-24分别为40.6%和92.2%，MT6-6分别为62.7%和82.6%，MTcombi分别为64.4%和80.6%，MT5-4分别为61%和81.1%，MT4-1分别为71.1%和68.6%。结论:所有的定义都显示与较高的死亡率和MOF风险相关，通常具有低敏感性但高特异性。24小时内红细胞≥10个的MT定义应予修订。
{"title":"Performance of Multiple Massive Transfusion Definitions in Trauma Patients","authors":"C. Ordoñez, A. García, D. Burbano, Julian Chica, C. Orlas, F. Ariza, R. Manzano, Camilo J Salazar, S. Carvajal","doi":"10.5005/jp-journals-10030-1275","DOIUrl":"https://doi.org/10.5005/jp-journals-10030-1275","url":null,"abstract":"Introduction: Massive transfusion (MT) is defined as the administration of ≥ 10 U of packed red blood cells (PRBCs) in 24 hours. Alternative definitions have been proposed which have not been compared regarding mortality or multiorgan failure (MOF). The objective is to compare the discriminative ability of proposed definitions of MT concerning mortality and MOF. Materials and methods: Patients with trauma team activation in a level I trauma hospital of Cali, Colombia, between 2015 and 2017 were included. Demographics and trauma characteristics were evaluated. The following MT definitions were measured: ≥ 50 U of total blood products in 24 hours (MT50-24), ≥ 6 U of PRBCs in 6 hours (MT6-6), ≥ 10 U of PRBCs in 6 hours (MT10-6), a combination of MT10-24 plus MT6-6 (MTcombi), ≥ 5 U of PRBC in 4 hours (MT5-4), ≥ 4 U of PRBC in 1 hour (MT4-1), and the critical administration threshold (CAT) which is 3 U of PRBCs in 1 hour. The operative characteristics were calculated for each definition. Multiorgan failure was defined as a sequential organ failure assessment (SOFA) score of ≥ 6 points. Results: We included 394 subjects. A total of 266 (67%) received at least 1 unit of PRBCs in the first 24 hours, from which trauma mechanism was penetrating in 84.6%; 86.8% were male, with a median [interquartile range (IQR)] age of 29 (22–38) years and injury severity score (ISS) of 25 (25–29). A positive ABC score for massive transfusion score was positive in 87.2%. Sensitivity and specificity were as follows: multiorgan failure: MT10-24 18.6% and 98.2%, MT6-6 34.3% and 91.3%, MTcombi 38.2% and 91.3%, MT5-4 38.2% and 92.2%, and MT4-1 48% and 78.4%. Mortality: MT10-24 40.6% and 92.2%, MT6-6 62.7% and 82.6%, MTcombi 64.4% and 80.6%, MT5-4 61% and 81.1% and MT4-1 71.1% and 68.6%. Conclusion: All definitions showed an association with a higher risk of mortality and MOF, generally with low sensitivity but high specificity. The MT definition of ≥ 10 PRBCs in 24 hours should be revised.","PeriodicalId":74395,"journal":{"name":"Panamerican journal of trauma, critical care & emergency surgery","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77254424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-01DOI: 10.5005/jp-journals-10030-1267
L. Tallón-Aguilar, F. Pareja-Ciuró, Alejandro Sánchez-Arteaga, J. Tinoco-González, Javier Padillo-Ruiz, V. Durán-Muñoz-Cruzado, M. J. Tamayo-López, E. Pozo
with the average of complaints by third parties of 2,585 (DS 569.93). In the period after the plan, the average number of total complaints was 229,495 (DS 88436.43) ( p = 0.257), with the average number of complaints by third parties being 7026.5 (DS 1265.01) ( p = 0.45). The percentage of convictions for violence against women during the first period was 59.5 and 68.94% in the subsequent period ( p = 0.028). Conclusion: Strategies against gender violence in Spain have obtained an ostensible increase in public awareness of the problem and an increase in the number of complaints and convictions. However, the number of victims and mortality due to gender violence has not achieved a statistically significant decrease. In view of these data, it is necessary to continue insisting on the application of new strategies to achieve a greater impact on this important social problem.
{"title":"Análisis Del Impacto Del Plan De Prevención Nacional Contra La Violencia De Genero En España","authors":"L. Tallón-Aguilar, F. Pareja-Ciuró, Alejandro Sánchez-Arteaga, J. Tinoco-González, Javier Padillo-Ruiz, V. Durán-Muñoz-Cruzado, M. J. Tamayo-López, E. Pozo","doi":"10.5005/jp-journals-10030-1267","DOIUrl":"https://doi.org/10.5005/jp-journals-10030-1267","url":null,"abstract":"with the average of complaints by third parties of 2,585 (DS 569.93). In the period after the plan, the average number of total complaints was 229,495 (DS 88436.43) ( p = 0.257), with the average number of complaints by third parties being 7026.5 (DS 1265.01) ( p = 0.45). The percentage of convictions for violence against women during the first period was 59.5 and 68.94% in the subsequent period ( p = 0.028). Conclusion: Strategies against gender violence in Spain have obtained an ostensible increase in public awareness of the problem and an increase in the number of complaints and convictions. However, the number of victims and mortality due to gender violence has not achieved a statistically significant decrease. In view of these data, it is necessary to continue insisting on the application of new strategies to achieve a greater impact on this important social problem.","PeriodicalId":74395,"journal":{"name":"Panamerican journal of trauma, critical care & emergency surgery","volume":"54 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84467887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-01DOI: 10.5005/jp-journals-10030-1272
A. Marttos
{"title":"The Panamerican Trauma Society and the Global Response to COVID-19","authors":"A. Marttos","doi":"10.5005/jp-journals-10030-1272","DOIUrl":"https://doi.org/10.5005/jp-journals-10030-1272","url":null,"abstract":"","PeriodicalId":74395,"journal":{"name":"Panamerican journal of trauma, critical care & emergency surgery","volume":"33 1","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79346327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-01DOI: 10.5005/jp-journals-10030-1273
R. Ivatury
{"title":"Four Decades of Trauma: Blood, Sweat, and Tears","authors":"R. Ivatury","doi":"10.5005/jp-journals-10030-1273","DOIUrl":"https://doi.org/10.5005/jp-journals-10030-1273","url":null,"abstract":"","PeriodicalId":74395,"journal":{"name":"Panamerican journal of trauma, critical care & emergency surgery","volume":"94 1","pages":"85-89"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83875087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-01DOI: 10.5005/jp-journals-10030-1263
Vinay Sharma, S. Jayaraman, M. Wojick, Cody McHargue, A. Rosenberg, M. Dworkin, J. Uwitonze, I. Kabagema, T. Dushime, J. Nyinawankusi
{"title":"Standardization of Prehospital Care in Kigali, Rwanda","authors":"Vinay Sharma, S. Jayaraman, M. Wojick, Cody McHargue, A. Rosenberg, M. Dworkin, J. Uwitonze, I. Kabagema, T. Dushime, J. Nyinawankusi","doi":"10.5005/jp-journals-10030-1263","DOIUrl":"https://doi.org/10.5005/jp-journals-10030-1263","url":null,"abstract":"","PeriodicalId":74395,"journal":{"name":"Panamerican journal of trauma, critical care & emergency surgery","volume":"43 1","pages":"32-37"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73557656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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