Most Downloaded Articles

Original Article
Jenny M Vidal, Laureano Quintero, Carlos A Ordoñez, Marisol Badiel, Monica A Morales García, Juan M Carrión, Paola A Calderón

Manejo No Operatorio Del Trauma Abdominal Penetrante; En Que Pacientes Realizarlo

[Year:2018] [Month:January-April] [Volumn:7 ] [Number:1] [Pages:81] [Pages No:24-32][No of Hits : 753]


Background: The incidence of penetrating abdominal trauma (PAT) has increased in recent decades as a consequence of the violence, becoming a main reason for consultations in emergency services. Its evaluation and management are defiant and evolve over time. The objective is to ratify the safety of the nonoperative management (NOM) of PAT, describe the clinical results and characteristics of patients with PAT who were offered NOM in a first-level hospital.

Study design: This is a prospective cohort study conducted during February and May 2016. It includes all patients with PAT admitted to first-level public hospital. A NOM protocol was established in hemodynamically stable patients; hemodynamic monitoring and physical examination were done every 4 hours, tomography according to case; This study was approved by institutional ethics committee.

Statistical analysis: chi-square test or Wilcoxon according to variable, significance 0.05.

Results: A total of 46 patients were registered, 91.30% (n = 42) were men, with mean age 25.6 ± 8.6 years; 50% gunshot and 50% stab wound (SW); exploratory laparotomy was done in 52.2% (n = 24), unnecessary laparotomy 2.2% (n = 1); about 47.82% (n = 22) were MNO; of these, 77.27% (n = 17) was for SW and 22.72% (n = 5) for gunshot. Mean systolic blood pressure 90 (90-91) mm Hg, hazard ratio 83 (73-88), relative risk 19 (18-20). The injury location: thoracoabdominal 50% (n = 11), 36.36% (n = 8) anterior abdomen, 13.64% (n = 3) posterior abdomen and flanks; 22.72% (n = 5) required abdominal tomography; 50% (n = 11) had accompanying injuries. Mean hospital stay was 2 (2-3) days. Mortality and complications at the first month posttrauma were 0% (n = 0).

Conclusion: The NOM of PAT is safe if you make a strict selection and monitoring protocol. Patients with PAT and without hemodynamic compromise involvement were successfully submitted to NOM and without any complication at 30 days, independently of the injured abdominal region. The abdominal CT scan with contrast should not be routine. Avoiding unnecessary surgery decreases the morbidity and mortality and hospital costs as long as it is first-level hospital and has a trauma and emergency surgeon available.

Keywords: Exploratory laparotomy, Hemodynamically stable, Nonoperative management, Penetrating abdominal trauma, Unnecessary surgery.

How to cite this article: Vidal JM, Quintero L, Ordoñez CA, Badiel M, García MAM, Carrión JM, Calderón PA. Manejo No Operatorio Del Trauma Abdominal Penetrante; En Que Pacientes Realizarlo. Panam J Trauma Crit Care Emerg Surg 2018;7(1):24-32.

Source of support: Nil

Conflict of interest: None

Research Article
Ezequiel Monteverde, Laura Bosque, Betina Lartigue, Emilio Maciá, Cristian Barbaro, Claudio Ortiz, Enrique Ginzburg, Jorge Neira

Evaluacién de la Nueva Definición de Politrauma en una Cohorte de Pacientes de 10 Hospitales Argentinos

[Year:2017] [Month:September-December] [Volumn:6 ] [Number:3] [Pages:88] [Pages No:182-189][No of Hits : 1667]


Introduction: Berlin definition of polytrauma from 2014 combines injury severity with at least one of five ancillary parameters (age, systolic blood pressure, Glasgow coma score, coagulopathy and acidosis). Until now there is insufficient evidence of this definition’s capability to identify higher risk of mortality patients. The objective of this investigation was to evaluate this definition’s performance to identify severely injured patients as compared with other current measures.

Materials and methods: Retrospective observational analysis was done on prospectively admitted patients to Fundación Trauma Registry in 10 Argentine hospitals between 2010 and 2016. The inclusion criteria were age > 15 years and complete data for scores calculation. Patients were compared across four definitions: polytrauma, multiple trauma (MulT), major trauma by major trauma_injury severity score (MT_ISS), and by major trauma_new injury severity score (MT_NISS). Performance measures were applied.

Results: We identified 2143 cases meeting MT_NISS definition, 1349 for MT_ISS, 802 for MulT and 259 for polytrauma. Polytrauma group was heterogenous, with a mortality rate ranging from 44% to 71% (resulting from different component combinations). About 75% were transport-injured and 76% had at least one AIS3+ head injury. Hospital outcome was related to condition at admission, physiologic impact revised trauma score (RTS) and injury severity (ISS-NISS). Observed to predicted survival ratio method trauma and injury severity score (TRISS) was 0.73. The comparison with the other definitions showed statistically significant differences in mortality but not in ISS, NISS, and RTS. Performance evaluation showed that MT_NISS had the highest sensibility and negative predictive value and polytrauma had the highest predictive value (PPV). MT_ISS had the highest precision (89%) and a specificity of 97%.

Conclusion: Polytrauma definition used to identify patients with the highest probability of death did not show any benefit when compared with other current measures. We consider that this definition needs to be validated in multicentric studies before being recommended as a new standard.

Keywords: Definition, Multiple trauma, Score, Severity, Trauma

Research Article
Luca GA Pivetta, José G Parreira, Cristiano Below, Giovanna Z Rondini Jacqueline AG Perlingero, José C Assef

Optimizing Chest X-ray Indication in Blunt Trauma Patients using Clinical Criteria

[Year:2017] [Month:January-April] [Volumn:6 ] [Number:1] [Pages:57] [Pages No:30-34][No of Hits : 1449]


Background: There is an excessive number of unnecessary chest X-rays (CXRs) in minor blunt trauma patients.

Objective: To identify, using routine clinical criteria, a subgroup of blunt trauma patients that do not require CXR for assessment.

Materials and methods: This was a retrospective analysis of trauma registry data collected over a 24-month period. Adult blunt trauma patients undergoing CXR on admission were analyzed. The following clinical criteria were assessed: Normal neurologic examination on admission (NNEx), hemodynamic stability (HS), normal physical examination of the chest on admission (NCEx), age = 60 years, and absence of distracting injuries (Abbreviated Injury Scale >2 in head, abdomen, and extremities). These clinical criteria were progressively merged to select a group with lowest risk of exhibiting abnormal CXR on admission.

Results: Out of 4,647 patients submitted to CXR on admission, 268 (5.7%) had abnormal findings on scans. Of 2,897 patients admitted with NNEx, 116 (4.0%) had abnormal CXR. Of 2,426 patients with NNEx and HS, 74 (3.0%) had abnormal CXR. Of 1,698 patients with NNEx, HS, and NCEx, 24 (1.4%) had abnormal CXR. Of 1,347 patients with NNEx, HS, NCEx, and age<60 years, 12 had thoracic injury (0.9% of total individuals receiving CXR). A total of 4 patients underwent chest drainage. Among 1,140 cases with all clinical criteria, 8 had confirmed thoracic injuries and 2 underwent chest drainage.

Conclusion: A subgroup of blunt trauma patients with low probability of exhibiting abnormalities on CXR at admission was identified. The need for CXR in this subgroup should be reviewed.

Keywords: Clinical protocols, Decision making, Emergency medical services, Multiple trauma, Practice guidelines as topic, Radiography, Thoracic.

How to cite this article: Pivetta LGA, Parreira JG, Below C, Rondini GZ, Perlingero JAG, Assef JC. Optimizing Chest X-ray Indication in Blunt Trauma Patients using Clinical Criteria. Panam J Trauma Crit Care Emerg Surg 2017;6(1):30-34.

Source of support: Nil

Conflict of interest: None

Original Article
Laura J Delgado Mateus, Ada M Bustos Guerrero, Andrés G Barco Manrique, Juan P Serrano Pastrana, Oscar F Herrán Falla, Laura I Valencia-Ángel

Ventana Pericardica: Abordaje Subxifoideo vs Toracoscopico En Trauma Precordial Abierto

[Year:2017] [Month:September-December] [Volumn:6 ] [Number:3] [Pages:88] [Pages No:135-141][No of Hits : 1195]


Introduction: The pericardial window is the gold standard in the diagnosis of cardiac trauma in precordial wounds and different approaches are described. The aim of this study is to compare the clinical characteristics, outcomes, and diagnostic performance of subxiphoid vs. thoracoscopy in patients with open precordial trauma.

Study design: A 56-month observational study of cohorts collected patients with penetrating wounds in the precordial region was conducted. These patients were hemodynamically stable and admitted to the Emergency Department. They were asked to perform a pericardial window to rule out cardiac lesions. The clinical characteristics, outcomes, and diagnostic performance of the tests were compared.

Results: A total of 256 patients were included in the study. Around 93.4% were injured by a sharp gunshot wound, 18.8% of the pericardial windows were thoracoscopic, 20.8% were positive for hemopericardium, and 11.5% were subxiphoid. The median length of hospital stay was 4 days, we had 16.0% complications, 17.8% in subxiphoid approach, and 8.3% in thoracoscopic patients, with coagulated hemothorax being the most frequent, 15.2% were submitted to reintervention, most of them thoracoscopy for clotted hemothorax drainage (62.5%), mortality was 1.6%, all cases in the subxiphoid group. The sensitivity of the subxiphoid pericardial window was 95.8% and thoracoscopic 90.9%, and the specificity was 99.5% and 100% respectively.

Conclusion: The thoracoscopic approach is a diagnostic option with subxiphoid-like performance. In spite of establishing a decrease in the median of the days as users of thoracostomy tube, no decrease was observed in the days of hospital stay.

Keywords: Open precordial trauma, Pericardial window, Precordial wounds, Subxiphoid approach, Thoracoscopic approach.

Original Article
Danilo M Razente, Bruno D Alvarez, Daniel AM Lacerda, João MDS Biscardi, Marcia Olandoski, Luiz CV Bahten

Mortality Prediction in Trauma Patients using Three Different Physiological Trauma Scoring Systems

[Year:2017] [Month:September-December] [Volumn:6 ] [Number:3] [Pages:88] [Pages No:160-168][No of Hits : 917]


Background: This study aims to compare mortality prediction capabilities of three different physiological trauma scoring systems (TSS): Revised Trauma Score (RTS); Glasgow Coma Scale, Age, and Systolic Blood Pressure (GAP); and Mechanism, Glasgow Coma Scale, Age, and Arterial Pressure (MGAP).

Study design: A descriptive, cross-sectional study of trauma victims admitted to the emergency service between December- 2013 and February-2014. Clinical and epidemiological information were gathered at admission and three TSS were calculated: RTS, GAP, and MGAP. The follow-up period to assess length of hospitalization and mortality lasted until August-2014. Two groups were created - survivals (S) and deaths (D) - and compared. P < 0.05 was considered statistically significant.

Results: A total of 668 trauma victims were analyzed. The mean age was 37 ± 18 and 69.8% were males. Blunt trauma prevailed (90.6%). The mean scores of RTS, GAP, and MGAP for group S (n = 657; 98.4%) were 7.77 ± 0.33, 22.8 ± 1.7, and 27.4 ± 2.3 respectively (p < 0.001), whereas group D (n = 11, 1.6%) achieved mean scores of 4.57 ± 2.95, 13 ± 7, and 15.5 ± 7 (p < 0.001). Regarding the Receiver Operating Characteristics (ROC) analysis, the areas under the curve were 0.926 (RTS), 0.941 (GAP), and 0.981 (MGAP). The three TSS demonstrated significant mortality prediction capabilities (p < 0.001). There was no statistically significant difference between the three ROC curves (p = 0.138). The MGAP achieved the highest sensitivity (100%), while GAP and RTS sensitivities were 81.8% (59-100%), and 90.9% (73.9-100%) respectively (p < 0.001). The observed specificities were 96.2% (94.77-97.7%) for GAP, 91.6% (89.5-93.7%) for MGAP, and 87.2% (84.7-89.8%) for RTS (p < 0.001). Age (p = 0.049), Glasgow Coma Scale (GCS) (p < 0.001), and trauma mechanism (p < 0.001) were different between the two groups.

Conclusion: Most patients were young males and victims of blunt trauma. The three TSS demonstrated reliability regarding mortality prediction. The MGAP achieved the highest sensitivity and GAP was the most specific score, which may indicate a potential use of both as valuable alternatives to RTS.

Keywords: Cross-sectional studies, Emergency medical services, Glasgow coma scale, Hospitalization, Mortality, Receiver operating characteristics curve, Sensitivity and specificity, Trauma severity indices, Triage.

How to cite this article: Razente DM, Alvarez BD, Lacerda DAM, Biscardi JMDS, Olandoski M, Bahten LCV. Mortality Prediction in Trauma Patients using Three Different Physiological Trauma Scoring Systems. Panam J Trauma Crit Care Emerg Surg 2017;6(3):160-168.

Source of support: Nil

Conflict of interest: None

Original Article
Erika TM Varona, Carlos AA Páez, Alejandro B Moreno

Artefactos Explosivos Improvisados, Atención En Ambientes Austeros

[Year:2017] [Month:May-August] [Volumn:6 ] [Number:2] [Pages:72] [Pages No:61-67][No of Hits : 917]


Introduction: The trauma of unconventional warfare has not yet been fully explored. The aim of this article is to identify the types of lesions in patients injured by improvised explosive devices (IED) in Colombia between February 2004 and May 2014 and tended to by a mobile surgical team in an austere environment (jungle), with limited resources. The patients were later admitted to a level four hospital for definitive managemen.

Materials and methods: This is an observational, descriptive study based on a historical cohort. Database of civilian patients and soldiers of Colombian military forces injured by explosive device and who received care in Advanced Groups of Trauma in austere environments near areas of war was analyzed; manual review of medical records was performed by recording injuries presented by patients on admission to level four health institution. Analysis was done with pivot tables, frequencies, trends, means, and modes of the data and the data were analyzed thereof.

Inclusion criteria: Patients who were registered in the database by participating physicians of Advanced Group of Trauma between 2004 and 2014 and patients who were victims of unconventional weapons of fragmentation were included.

Results: A total of 182 patients with age range of 23 years were reviewed. There were 158 orthopedic complications; the most common amputation occurred in 66.4%. Of these, infracondylar 64.2%, supracondylar 0.54%, and upper limbs 1.64%. According to military rank, soldiers consisted of 81.4% and officials 6%. The complications are as follows: Fat embolism 1.64%, osteomyelitis 2.94%, acoustic trauma 3.85%, ocular trauma 3.29%, facial trauma 7.14%, traumatic brain injury 0.54%, neuropathies 4.94%, no trauma 4.39%, sepsis by Klebsiella pneumoniae and Enterococcus faecalis 2.19%, fatality 0.54%.

Conclusion: In Colombia, between February 2004 and May 2014 IEDs were the most frequent cause of war wounded having musculoskeletal injuries, with predominance of infracondylar amputations with low infectious and deadly incidence.

Keywords: Austere, Improvised explosive devices, Landmines, Mobile surgical teams, Trauma, War wounded.

Original Article
María F Escobar, Javier A Carvajal, Juan M Burgos, Adriana Messa, Carlos A Ordoñez, Alberto F García, Marcela Granados, Angélica M Forero, José D Casallas, Laura S Thomas, Albaro J Nieto

Damage Control Surgery for the Management of Major Obstetric Hemorrhage: Experience from the Fundación Valle Del Lili, Cali, Colombia

[Year:2017] [Month:January-April] [Volumn:6 ] [Number:1] [Pages:57] [Pages No:1-7][No of Hits : 855]


Objective: The aim of this case series is to describe the experience of implementing damage control resuscitation (DCR) in patients with major obstetric hemorrhage (MOH) between January 2005 and December 2015 in the Fundación Valle del Lili, Cali, Colombia.

Materials and methods: This is a prospective descriptive study of a case series from 108 patients with MOH who were subjected to DCR. All patients were operated on using a standardized surgical technique in accordance with the institutional protocol.

Results: The median age was 28 years, with a gestational age of 38 weeks. The principal associated diagnosis was severe preeclampsia (in 39% of cases). A total of 96 patients presented massive postpartum hemorrhage, and 75% of these cases presented after a cesarean section. In all patients, normal control of bleeding was achieved, 60% during the first surgical period. The Acute Physiology and Chronic Health Evaluation score was 14, with an overall mortality of 6.48%, far below the expected mortality according to the clinical severity of these patients.

Conclusion: This study includes the biggest series of pregnant women with MOH, in a critical condition, in whom DCR was used, during which rapid control of bleeding was achieved, associated with a significantly lower mortality than expected.

Keywords: Emergency treatment, Hypovolemic shock, Postpartum hemorrhage, Surgical intensive care.

How to cite this article: Escobar MF, Carvajal JA, Burgos JM, Messa A, Ordoñez CA, García AF, Granados M, Forero AM, Casallas JD, Thomas LS, Nieto AJ. Damage Control Surgery for the Management of Major Obstetric Hemorrhage: Experience from the Fundación Valle Del Lili, Cali, Colombia. Panam J Trauma Crit Care Emerg Surg 2017;6(1):1-7.

Source of support: Nil

Conflict of interest: None

Research Article
Maria Alejandra Rubio, Juan Jose Rubio, Manuel Alejandro Ospitia, Juan Felipe Sanjuan Rolando Medina, Wilmer Fernando Botache

Complicaciones Asociadas Al Trauma Penetrante de Esófago, Experiencia De 11 Años En El Hospital Universitario de Neiva

[Year:2017] [Month:January-April] [Volumn:6 ] [Number:1] [Pages:57] [Pages No:25-29][No of Hits : 626]


Background: Penetrating esophageal lesions are extremely rare, less than 0.5%. They are related to high morbidity 30--66% and mortality ~20%. There is a diagnostic and therapeutic challenge, given its severity requires a timely approach and aggressive management to avoid sequelae and complications.

Study design: Descriptive subgroup analysis of a retrospective cohort (2003--2013) of patients with surgical trauma. The severity of the trauma was assessed using the AAST classification.

Results: Of the total 2,390 cases of registered surgical trauma, 10 (0.4%) corresponded to an esophageal trauma. All cases were observed in men with a median age of 26 years (IQR = 19--35). The cause of the most frequent injury was gunshot injury in six patients, followed by blunt gun injury in two patients and blast wave in the two remaining patients. The RTS in the majority of the patients was 7.84 (IQR = 7.47--7.84). The severity of esophageal trauma was grade II in seven patients and grade III in three patients. Associated vascular lesions were observed in two patients. All patients were taken to repair the primary lesion. The most frequent complication was esophageal tracheal fistula in four patients. A total of seven patients required reintervention, 71% for lesions directly related to esophageal lesion. No mortality was shown.

Conclusion: Esophageal lesions in surgical management trauma are infrequent, no deaths were observed in this series. Complications are common, the most commonly related is tra- cheoesofagic fistula, the reinterventions present an adequate evolution

Keywords: Esophageal trauma, Tracheoesofagic fistula, Tracheostomy, gastrostomy.

How to cite this article: Rubio MA, Rubio JJ, Ospitia MA, Sanjuan JF, Medina R, Botache WF. Complicaciones Asociadas Al Trauma Penetrante de Esófago, Experiencia De 11 Años En El Hospital Universitario de Neiva. Panam J Trauma Crit Care Emerg Surg 2017;6(1):25-29.

Source of support: Nil

Conflict of interest: None

Original Article
Marcelo AF Ribeiro Jr, Otto M Rosa, Orlando C Filho, Stephanie Santin, Alexandre Z Fonseca Bianca E Alvarez, Michael W Parra

Duodenal Trauma: Incidence and Management in Penetrating and Blunt Abdominal Trauma

[Year:2017] [Month:January-April] [Volumn:6 ] [Number:1] [Pages:57] [Pages No:13-16][No of Hits : 550]


Rationale: Duodenal injuries are rare and most common due to penetrating abdominal trauma, especially gunshot wounds, with greatest prevalence among young men. Achieving simpler and more effective surgical procedures also contributes to the reduction of mortality and morbidity rates.

Objective: Review cases of penetrating and blunt duodenal trauma, the complexity of the injuries, incidence, management as well as morbidity and mortality.

Materials and methods: At Grajaú General Hospital, between January 2010 and May 2014, a retrospective analysis of 1,039 patients’ medical records who had undergone emergency exploratory laparotomies was done. From these cases, 298 were caused by blunt and penetrating abdominal traumas, and 11 suffered duodenal traumas.

Results: It was observed that there was a predominance of young adults (mean age 26.48 years) and all patients were males (100%), of which one injury was from blunt abdominal trauma, three from stab wounds, and seven caused by firearm. Most of the duodenal injuries were classified as grade II injuries and most commonly involved the fourth portion of the duodenum. We emphasize the association with injuries to other organs, especially the liver and the small intestine. In the cases we analyzed, we highlight the importance of time between entry of service and surgery in all patients being less than 6 hours. The most common surgery performed to repair these injuries was duodenorrhaphy (90.9%). In this series, there were four deaths. Postoperative complications included duodenal fistulae with spontaneous resolution.

Conclusion: Duodenal injuries are rare, and are most commonly due to penetrating abdominal trauma, especially gunshot wounds, with the greatest prevalence among young men. There is a need for early diagnosis and rapid surgical intervention, shortened and effective surgical procedures, due to the morbidity/mortality and high complexity of these injuries. This emphasizes the importance of early intervention in the short time before surgical procedure takes place.

Keywords: Abdominal trauma, Duodenal/trauma, Duodenum/ injuries, Wounds and injuries.

How to cite this article: Ribeiro MAF Jr, Rosa OM, Filho OC, Santin S, Fonseca AZ, Alvarez BE, Parra MW. Duodenal Trauma: Incidence and Management in Penetrating and Blunt Abdominal Trauma. Panam J Trauma Crit Care Emerg Surg 2017;6(1):13-16.

Source of support: Nil

Conflict of interest: None

Research Article
Ane KS Bonfim, Lilia de S Nogueira, Cristiane de A Domingues

Alcoholic Beverage and Traffic Accidents: Impact of the Drunk-Driving Law in Severity and Mortality of Victims

[Year:2017] [Month:January-April] [Volumn:6 ] [Number:1] [Pages:57] [Pages No:17-24][No of Hits : 535]


Objectives: To analyze the impact of the Drunk-Driving Law on the characteristics and severity of traffic accident victims and to identify risk factors for mortality before and after law enforcement.

Materials and methods: A retrospective, quantitative study that analyzed victims of traffic accidents attended at a hospital in São Paulo, Brazil, between 2006 and 2010, through the analysis of medical records. The Drunk-Driving Law was considered the time frame of this research, and the victims were distributed in two groups: Before the law (January 2006 to June 2008) and after the law (July 2008 to December 2010). Pearson chi-square, Mann–Whitney, and multiple logistic regression tests were used, with a significance level of 5%.

Results: The sample consisted of 1,405 victims, the majority being males (78.01%), with a mean age of 37.39 years. In the group comparison (before and after the Drunk-Driving Law), there was a significant difference related to the external cause, admission to the ICU, and discharge conditions. Factors associated with prelaw mortality were age, number of injured body regions, and New Injury Severity Score. The length of hospital stay and the Revised Trauma Score were considered as protective factors for this outcome. After the validity of the law, in addition to the variables described earlier, the head/ neck and abdomen regions most severely injured were added as risk factors for mortality.

Conclusion: The impact of the Drunk-Driving Law set a positive outcome in the survival of the victims. However, when it comes to the statistics and severity of the trauma, it is necessary to sustain the law with reinforcement of the inspection so that more lives are saved.

Clinical significance: The results of this study provide support to managers on the importance of sustaining the law and the need of implementing new trauma prevention strategies.

Keywords: Accidents, Alcoholic beverages, Law enforcement, Patient acuity, Retrospective study, Traffic.

How to cite this article: Bonfim AKS, Nogueira LS, Domingues CA. Alcoholic Beverage and Traffic Accidents: Impact of the Drunk-Driving Law in Severity and Mortality of Victims. Panam J Trauma Crit Care Emerg Surg 2017;6(1):17-24.

Source of support: The Foundation for Research Support of the State of São Paulo (FAPESP) for sponsoring this study.

Conflict of interest: None

Original Research
Helena Facundo, Juan Manuel Troncoso

Abdomen Abierto y Presión Subatmosférica: Experiencia con un Sistema Artesanal

[Year:2016] [Month:January-April] [Volumn:5 ] [Number:1] [Pages:63] [Pages No:11-17][No of Hits : 1595]


Background: The need to keep an open abdominal cavity has been recognized and employed for 35 years ago. The development of continuous vacuum system has formed a new surgical approach to this problem.
Commercial systems are expensive, which limits its use. Several groups have reported local manufacturing systems with satisfactory results. Here, we report our experience in this regard and the technical details of the system we use.

Materials and methods: We described the technical aspects of artisanal vacuum system and a retrospective descriptive observational study in patients treated with abdominal continuous suction between January 2007 and March 2013.

Results: We described 77 cases. The first three diagnoses on admission were abdominal penetrating trauma (25 cases), intestinal obstruction (7 cases), and acute pancreatitis (6 cases). There were 42 cases with enterostomal fistula, 41 before the start of therapy. In 12 cases (28.6%), the fistula closed with medical treatment and in 14 (33.3%) with surgery. The percentage of closure of the abdominal cavity is 31%.

Conclusion: The complexity of patients with open abdomen and enterostomal fistulas, determined a significant morbidity and mortality. We consider the general principle of management with continuous vacuum system in the abdominal cavity and particularly to our system, is a valuable tool that enables skin protection, permanent drainage of the cavity and quantification of drainage; decreases the time to achieve abdominal closure and the number of surgeries.

Keywords: Intestinal fistula, Open abdomen, Subatmospheric pressure, Vacuum system.

How to cite this article: Facundo H, Troncoso JM. Abdomen Abierto y Presión Subatmosférica: Experiencia con un Sistema Artesanal. Panam J Trauma Crit Care Emerg Surg 2016;5(1): 11-17.

Source of support: Nil

Conflict of interest: None

Original Article
Lina V Mata, Francisco E Mora, Martha Quiodettis, Jaime Fischer, Gustavo M Machain, Juan C Salamea, Edgar B Rodas, Michel B Aboutanos

Panamerican Trauma Society Basic Trauma Education Course Administration in Resource-limited Areas

[Year:2016] [Month:May-August] [Volumn:5 ] [Number:2] [Pages:51] [Pages No:83-87][No of Hits : 1388]


Introduction and objectives: Injuries and noncommunicable diseases account for greater than 73% deaths and 76% disability adjusted life years (DALYs) in Latin America, where trauma care is challenging especially when resources are scarce. Education and training is a basic step in trauma systems development, which was shown to improve survival. Except for urban areas, trauma courses are unavailable and unaffordable in the Latin region. The aim of this study is to evaluate the feasibility of implementation of a basic trauma education course (BTC) for resource-limited areas adopted and promulgated by the Panamerican Trauma Society (PTS) since 2011.

Materials and methods: Basic trauma education course was administered in Paraguay, Medellin, Chile, and Panama during the PTS congresses (2011–2013). The two-day course was based on the patient’s pathway system, addressing the management of the patient through various echelon of care from rural health centers to local provincial hospital and tertiary treatment facilities. It contained 20 hours of didactic lectures and hands on skill labs on basic trauma resuscitation, stabilization, and transport, as well as trauma system-oriented teaching (triage, EMS, kinematics, trauma registries). Panamerican Trauma Society international and national instructors administered the courses. Course logistics and coordination were carried out by international and local coordinators and by trauma league medical students. Pre and post (30 multiple-choice questions) tests were used to assess participants. Paired t-test was used to compare scores.

Results: Fifty-four students (rural physicians, EMS providers, students, nurses, and administrators) participated. Pre and posttest score comparison showed significant improvement 74% vs 85% respectively, p-value < 0.0001.

Conclusion: A tailored trauma course and evaluation can be feasible in educating local providers. The PTS can promulgate the application of BTCs that may serve as a model for continuing trauma care education in developing countries. Course follow-up evaluation is pending.

Keywords: Basic trauma course, Trauma care in low and middle income countries, Trauma education.

How to cite this article: Mata LV, Mora FE, Quiodettis M, Fischer J, Machain GM, Salamea JC, Rodas EB, Aboutanos MB. Panamerican Trauma Society Basic Trauma Education Course Administration in Resource-limited Areas. Panam J Trauma Crit Care Emerg Surg 2016;5(2):83-87.

Source of support: Nil

Conflict of interest: None

Original Research
Juan S Calle Toro, Alvaro I Sanchez, Monica Morales, Alberto F Garcia

Trauma en ancianos – Experiencia de dos hospitales de referencia en Cali, Colombia

[Year:2016] [Month:January-April] [Volumn:5 ] [Number:1] [Pages:63] [Pages No:38-42][No of Hits : 1253]


Introduction: Trauma is a common cause of consultation to emergency service in Cali, Colombia. Among all emergency room visits 30% represent trauma, being 5th cause of death. The demographic characteristics and the pattern of trauma in the elderly have not been studied in detail in middle-income countries. The aim of our work is to characterize the lesions related trauma in elderly patients and identify possible preventive measures.

Methods: A secondary analysis of the database record of the Pan American Trauma Society implemented in two referral trauma centers in Cali, Colombia, during the period 2012-2013. A total of 65 patients were included. The variables analyzed were demographics, characteristics of injuries, trauma severity score (ISS), clinical admission information, and the final disposition of the patient.

Results: Of 14315 patients registered in the database, 1372 (10%) were older than 65 years. The average age of this group was 74 years (SD ± 9.7). 723 (53%) of patients studied were males. The mechanism of primary traumatic injury were falls in 984 (72%) followed by traffic-related events in 195 (14%). 95% of patients had an ISS <16. A total of 285 (20%) required surgery and 261 (19%) were transferred to another hospital for further medical management. The mortality in this group was 81 (6%) vs 715 patients (5%) overall mortality. The median hospital stay was 1 day (interquartile range 1-4).

Discussion: Elderly patients represent a proportion of patients had a low ISS. However, mortality of this age group outperformed the overall mortality. Many of elderly patients required surgery, taking this to increased morbidity / mortality and high economic costs. Primary prevention is necessary to reduce the impact on economic health and for the health system.

Keywords: Aged, Falls, Injury, Prevention, Trauma.

How to cite this article: Calle Toro JS, Sanchez AI, Morales M, Garcia AF. Trauma en ancianos - Experiencia de dos hospitales de referencia en Cali, Colombia. Panam J Trauma Crit Care Emerg Surg 2016;5(1):38-42.

Source of support: Nil

Conflict of interest: None

Original Research
Silvia Ines Guerrero, Juan Paulo Serrano, Laura Juliana Delgado, Dairon Gelvez

Prediccion de Morbilidad y Mortalidad de los Pacientes Con Trauma Penetrante Multiple A Traves de Diferentes Indices de Severidad en Trauma

[Year:2016] [Month:January-April] [Volumn:5 ] [Number:1] [Pages:63] [Pages No:31-37][No of Hits : 1098]


Introduction: The severity of trauma indices are systems to classify and code lesions, describe objectively the conditions of each patient, indicating those with injuries more severe, the likelihood of survival and anticipate outcomes.

Objective: To determine which index severity best predicts morbidity and mortality in patients with multiple penetrating trauma.

Study design: Prospective, observational study, cohort. In a period of 13 months, we collected trauma patients admitted for penetrating trauma in University Hospital of Santander. We evaluated the relationship between severity indices (STNR, ISS, TRISS) with outcomes using logistic regression curves and prediction of mortality from each according to sensitivity, specificity and ROC curve.

Results: A total of 111 patients were included, 72% were admitted by short-stabbing wounds (HACP) and 28% weapon weapon Fire (HPAF). Mortality was 9.9%, being higher in the HPAF (23% vs. 5%). In patients with HACP, the area under the curve (ROC) for the RTSC was 0.225, and 0.148 for TRISS for ISS 0.68. In the group with HPAF, the area under the curve for RTSC was 0.247, for TRISS 0.190 and 0.735 ISS.

Conclusion: ISS was the more significant discriminatory value for evaluating the outcome (mortality). Initial pre-admission of patients to resuscitation centers affects the predictive value of RTSC and TRISS.

Keywords: Anatomical index, Morbidity, Mortality, Penetrating trauma, Physiological index, Severity index.

How to cite this article: Guerrero SI, Serrano JP, Delgado LJ, Gelvez D. Prediccion de Morbilidad y Mortalidad de los Pacientes Con Trauma Penetrante Multiple A Traves de Diferentes Indices de Severidad en Trauma. Panam J Trauma Crit Care Emerg Surg 2016;5(1):31-37.

Source of support: Nil

Conflict of interest: None

Original Research
Max N Brondfield, Stanley Sciortino, Catherine Juillard, Paula Fleisher, Laura A Schmidt, Rochelle Dicker

The Influence of Alcohol Outlets on Urban Trauma: A Pilot Study for Geospatial Modeling at a Fine Scale

[Year:2016] [Month:January-April] [Volumn:5 ] [Number:1] [Pages:63] [Pages No:1-10][No of Hits : 966]


Background: The association between alcohol availability and injury is known. Our pilot study seeks to model rates of trauma at the individual and census tract level to better understand the role of alcohol outlets (AOs) relative to socioeconomic factors thought to influence injury. Correlating alcohol availability and injury in a multilevel model may better inform policy measures to prevent trauma and create a safer urban environment.

Study design: Traumas in January-April 2013 (300 injury events) from an urban level 1 trauma center were analyzed with regard to injury severity score and blood alcohol level. Injury events and AO data acquired from the state Alcoholic Beverage Control were projected onto a map of census tracts, which included socioeconomic and demographic data from the U.S. Census Bureau (2009-2013). Traumas were stratified according to age, intentionality, and BAL screening. Ordinary least squares regression was performed to understand the relative contributions of AO, other dependent variables, and spatial autocorrelation.

Results: Positive BAL screens were associated with higher ISS among trauma victims. At the census tract level, density of off-sale AO per capita was the strongest correlated variable with all traumas (Rt2 = 0.52, p < 0.01) and those for which BAL was elevated on admission (Rt2 = 0.74, p < 0.01). Violent trauma showed the strongest association with on-sale AO per capita (Rvt2 = 0.17). However, levels of spatial autocorrelation were too high to validate model results. Socioeconomic variables were not significant.

Conclusion: Despite extensive autocorrelation among census tracts, preliminary modeling of trauma shows significant promise in better understanding the geospatial predictors of these events. While the influence of alcohol on trauma has been presumed in previous spatial analysis, this pilot represents a more robust approach through direct measures of BAL that can better inform understanding of spatial predictors for trauma.

Keywords: Alcohol outlet, Blood alcohol level, Multilevel modeling, Spatial analysis, Trauma.

How to cite this article: Brondfield MN, Sciortino S, Juillard C, Fleisher P, Schmidt LA, Dicker R. The Influence of Alcohol Outlets on Urban Trauma: A Pilot Study for Geospatial Modeling at a Fine Scale. Panam J Trauma Crit Care Emerg Surg 2016;5(1):1-10.

Source of support: This publication was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through UCSF-CTSI Grant Number UL1 TR000004. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.

Conflict of interest: None.

Aníbal Alfonso Teherán, Oscar Javier Castro, Leonardo Laverde Frade

Incidencia y Características del Trauma Raquimedular en un Hospital de III Nivel, Bogotá 2011–2014

[Year:2016] [Month:September-December] [Volumn:5 ] [Number:3] [Pages:59] [Pages No:140-147][No of Hits : 951]


Introduction: The incidence of Spinal Cord Injury (SCI) for Latin America has been estimated from epidemiological researches of Brazil, so we decided to measure the incidence, distribution and features related to SCI in a reference level 3 institution.

Materials and methods: A descriptive retrospective study was done with patients attended during 5 years at a level 3 hospital. Monthly and annual SCI (IoSCI, CI95%) incidence was estimated; they were categorized by sociodemographic and clinical variables, among these: Conditions at hospital admission, severity of injury classification (AO, ASIA) and 6-month functional follow-up; a multiple correspondence analysis (MCA) was done, to extract component related with functional improvement at 6 months.

Results: A total of 174 cases were identified, median age of 45 years, men 75.3%; 70% were injured during work activity, none of that with labor accident insurance. The Io-SCI from the period was 1.34 cases/100 person-year (CI95%, 1.51-1.55). The average in-hospital length of stay was 12 days (LOS), with differences among AO classification, ASIA-admission, type of management (medical/surgical) and admission to ICU (p:0.000). Falls and motor vehicle crashes, both were the main cause (88.5%, 95% CI, 83.5-93.5%); lumbar and thoracic injuries, both were present in 75.3% of the cases; admission ASIA was D or E in 75% of the patients. Functional improvement at 6-months was present when, at admission, ASIA classification it was D and AO was C.

Conclusion: The Io-SCI was higher than other local series, the LOS was related with the type, place of treatment and severity of the injury; in turn, severity of injury was related with functional improvement at 6 months.

Clinic relevance: Colombia needs to create a surveillance system adjusted to international standard, to evaluate the impact of this condition.

Keywords: Spinal cord injury, incidence, ASIA classification, AO classification.

Fernando Spencer Netto, Tiago Cesar Mierzwa, Mariana Thalita Bertolin Silva, Luan Geraldo Ocaña de Oliveira, Djoney Rafael dos Santos, Jean Carlo Barbosa

Hérnias Diafragmáticas Traumáticas com Lesão Pericárdica: Apresentação e Complicaçoes Específicas

[Year:2016] [Month:September-December] [Volumn:5 ] [Number:3] [Pages:59] [Pages No:161-165][No of Hits : 920]


Introduction: Traumatic diaphragmatic hernia (TDH) may develop several complications. Pericardial injury increases the severity of this entity and may lead to specific presentation and complications, that require immediate attention to avoid significant morbidity and mortality.

Objective: This study aims to report two cases of traumatic diaphragmatic hernia with pericardial extension with specific presentation or complication.

Clinical Case: Case 1: 34-year-old male suffered a fall of level of 8 meters high. Computed tomography (CT) scan showed herniation of the stomach into the left chest cavity, intraperitoneal fluid and pelvis and acetabulum fractures. He underwent exploratory laparotomy due to hemodynamic instability. In the immediate postoperative period, high amount of bloody output through chest tube was observed, requiring thoracotomy. At surgery, ligation of a bleeding vessel of the pericardium was performed. He showed good postoperative evolution, being discharged three weeks later. Case 2: 54-yearoldmale was hit by a motorcycle. Computed tomography scan showed herniation of the stomach into the pericardial sac. He developed clinical signs of cardiac tamponade and underwent laparotomy, which showed intrapericardial diaphragmatic hernia. It was reduced with immediate, but transient hemodynamic improvement. However, the patient developed multiple organ dysfunction, and died 2 days after admission.

Conclusion: Traumatic diaphragmatic hernia (TDH) with pericardial extension may show specific presentation and complications, such as pericardial tamponade by abdominal viscera and pericardial bleeding that can cause death if not identified and treated quickly.

Clinical significance: Due to the high morbidity and mortality of pericardial injury associated to diaphragmatic hernia, its early diagnosis through imaging or surgery has great importance, enabling adequate surgical approach and may improve the clinical outcome of the patients.

Keywords: Blunt trauma, Pericardial injury, Traumatic diaphragmatic hernia.

Case Report
Alejandro J Pérez-Alonso, Carlos del Olmo-Rivas, Ignacio Machado-Romero, Patrizio Petrone

Fístula Aortoentérica Secundaria A Prótesis De Dacron

[Year:2016] [Month:January-April] [Volumn:5 ] [Number:1] [Pages:63] [Pages No:58-60][No of Hits : 866]


Introduction: The fistula aortoenteric (FAE) secondary to Dacron prosthesis implantation, is a rare and extremely serious complication, that suppose a diagnostic challenge.

Presentation of the case: We report a patient who suddenly presented upper gastrointestinal bleeding that required urgent complementary tests that led to the diagnosis of a retroduodenal periprosthetic collection and air bubbles, supporting the existence of a secondary FAE.

Conclusion: Although the exact mechanism of pathogenesis is unknown for now, mechanical and infectious factors seem to be the most common causes of post-surgical complication. The main aacepted theories are: bacterial infections at the staple line level of the prosthesis, damage to the small intestine during implantation, pseudoaneurysms, and intestinal ulcers.

Keywords: Aortic prosthesis, Aortoenteric fistula, Surgical treatment.

How to cite this article: Pérez-Alonso AJ, del Olmo-Rivas C, Machado-Romero I, Petrone P. Fístula Aortoentérica Secundaria A Prótesis De Dacron. Panam J Trauma Crit Care Emerg Surg 2016;5(1):58-60.

Source of support: Nil

Conflict of interest: None

Review Article
Andres M Rubiano, Raúl A Echeverri, Juan C Puyana

Fundamentos para la Elaboración de Manuscritos Científicos en Trauma y Cuidado Agudo de Emergencias (Parte 1): Cómo Elaborar y Cómo Presentar un Resúmen para Una Reunión Científica

[Year:2016] [Month:January-April] [Volumn:5 ] [Number:1] [Pages:63] [Pages No:52-57][No of Hits : 791]


Objective: Scientific abstracts are the most common way of show and share relevant information for advances in biomedical research. There are recomended methodologies for highquality abstract development in order to ensure a faster and optimal understanding by peer reviewers and the scientific community in general. The aim of this review is to discuss and present key elements for the development and presentation of scientific abstracts in trauma and acute emergency care.

Background: Over 10 million of biomedical scientific articles are published annually; these articles regularly comes from orally or written abstracts presented in scientific meetings. Many abstracts fails in ellaboration and does not allow an effective communication between the researcher and peer reviewers. Many of these failed abstracts does not successfully finish as a full article.

Results: A standardized methodology for the development of scientific abstracts is known as the IMRAD principle. This principle is an acronym that comes from the words, Introduction, Methods, Results, and Discussion. With the spread of this type of methodology, the quality of abstracts has improved dramatically. Still, only between 15 and 45% of the prepared abstracts become a full publication. The two most common reasons for nondeveloping the entire final document include the limited time availability of the principal investigator for the task and the difficulty in generating the entire document in a second language different to the native one.

Conclusion: There are standardized methodologies to produce high-quality scientific abstracts. It is duty of scientific associations from different specialties and subspecialties, to disseminate guidelines for the development of these abstracts.

Keywords: Acute care surgery, Research, Scientific abstract, Trauma.

How to cite this article: Rubiano AM, Echeverri RA, Puyana JC. Fundamentos para la Elaboración de Manuscritos Científicos en Trauma y Cuidado Agudo de Emergencias (Parte 1): Cómo Elaborar y Cómo Presentar un Resúmen para Una Reunión Científica. Panam J Trauma Crit Care Emerg Surg 2016;5(1):52-57.

Source of support: Nil

Conflict of interest: None

Original Article
Gerd D Pust, Marc M Grossman, David V Shatz, Fahim Habib, Louis Pizano, Tanya L Zakrison, Antonio Marttos, Gabriel Ruiz, Enrique Ginzburg, Nicholas Namias

The Rare Requirement of On-scene Extremity Amputations in the Entrapped Trauma Patient

[Year:2016] [Month:May-August] [Volumn:5 ] [Number:2] [Pages:51] [Pages No:93-100][No of Hits : 749]


Objectives: Entrapment of trauma patients in motor vehicle and other accidents is common. Frequently, Emergency Medical Services (EMS) personnel and firefighters are able to free the patient and initiate rapid transport to trauma centers. In rare circumstances, severe torso and extremity injuries combined with major entrapment may require complex rescue operations. These trauma patients spend the “Golden Hour” at the scene under difficult conditions. The objective of this review is to evaluate the role of the trauma surgeon leading the care at the scene of critically injured and entrapped trauma patients with possible need for surgical interventions.

Materials and methods: A 10-year review of all trauma surgeon to scene activations between 2005 and 2014 at the Ryder Trauma Center, an urban ACS Level 1 trauma center, was performed. An analysis of the trauma registry, individual cases, and surgical interventions was conducted.

Results: The University of Miami/Jackson Memorial Hospital (UM/JMH) Ryder Trauma Center and Miami Dade Fire Rescue have an established program in place for trauma surgeon to scene activations. During the study period, the on-call trauma surgeon was activated six times and traveled to the scene by air rescue helicopter four times, by ground in 1 case and in 1 case the patient expired before takeoff. One patient required on-scene amputation of an entrapped non-salvageable upper extremity. Two patients required on-scene amputation of bilateral lower mangled, entrapped extremities. One patient required a localized limb preserving surgical procedure to free him from entrapment. The incidence was 0.016% of 36,872 trauma alert activated patients evaluated at Ryder Trauma Center during the study period. Hemorrhagic shock, associated injuries, and long scene times were present in all patients. The survival of treated patients was 80%.

Conclusion: The need for on-scene amputations of nonsalvable extremities in entrapped trauma patients is rare. Experienced trauma surgeons should evaluate these patients and decide which interventions are necessary. All efforts should be made to salvage the limb. However, if the entrapped extremity appears nonsalvageable and the patient is in profound life-threatening shock requiring rapid transport, field amputation may be required. Policies, safety training and gear, supply kits, and partnerships with EMS are needed.

Keywords: Amputation, Entrapped, Extremity, Golden Hour, In-field, On-scene, Patient, Trauma.

How to cite this article: Pust GD, Grossman MM, Shatz DV, Habib F, Pizano L, Zakrison TL, Marttos A, Ruiz G, Ginzburg E, Namias N. The Rare Requirement of On-scene Extremity Amputations in the Entrapped Trauma Patient. Panam J Trauma Crit Care Emerg Surg 2016;5(2):93-100.

Source of support: Nil

Conflict of interest: None

Original Research
Paulo Raul Paglilla, Ruben Daniel Algieri, Maria Soledad Ferrante, Juan Pablo Fernandez, Juan Sebastián Ugartemendía, Ernesto Donnelly

Rol de la Simulación para la Conformación del Criterio y la Decisión en el Trauma

[Year:2016] [Month:January-April] [Volumn:5 ] [Number:1] [Pages:63] [Pages No:18-25][No of Hits : 657]


Introduction: Simulation workshops have been shown to promote learning basic skills in specialty and achieve psychomotor development. It is necessary to obtain adequate validation for application, security, and improving skills. The assessment accompanying the simulation must be done with criteria for reproducibility and continuous feedback that plays in critical thinking. The objective is to minimize adverse events.

Materials and methods: Retrospective, observational study. They were performed between 06/2013 and 05/2015, simulation workshops in 11 general surgery residents at Aeronautical Central Hospital. They were constantly evaluated, following international guidelines, using cognitive/surgical simulation.

Objectives: To demonstrate the usefulness of simulation in trauma for decision-making and the respective criteria.

Results: A total of 72.72% of residents were assessed. They participated in all simulation workshops. And 18.2% had participated in previous workshops. Before the simulation of the same case, 90.9% showed similar behaviors acquired previously and according to international guidelines. As for practical skills, substantial improvement was evident in proportion to the number of simulations.

Conclusion: Simulation is a useful tool, essential for training trauma surgeons. It should be supervised and with a continuous feedback. The results come from the use of checklists, based on international treatment standards.

Keywords: Aeronautical hospital, Checklist, Criterio, Education in trauma, Evaluation, Feedback, Simulation, Workshops.

How to cite this article: Paglilla PR, Algieri RD, Ferrante MS, Fernandez JP, Ugartemendía JS, Donnelly E. Rol de la Simulación para la Conformación del Criterio y la Decisión en el Trauma. Panam J Trauma Crit Care Emerg Surg 2016;5(1):18-25.

Source of support: Nil

Conflict of interest: None

Original Research
Álvaro I Sánchez, Alberto F García, Mauricio Velsquez, Juan Carlos Puyana

Predictors of Positive Subxiphoid Pericardial Window in Stable Patients with Penetrating Injuries to the Precordial Region

[Year:2016] [Month:January-April] [Volumn:5 ] [Number:1] [Pages:63] [Pages No:43-51][No of Hits : 654]


Background: Subxiphoid pericardial window (SPW) remains a valuable diagnostic tool for patients at risk of occult cardiac injuries. However, how to select patients that could benefit from this procedure remains unclear. We aimed to identify clinical predictors of positive SPW in patients with penetrating precordial injuries.

Materials and methods: Prospective data collection of 183 patients who underwent SPW for the exclusion of penetrating cardiac injuries during 2002 - 2004 at a level I trauma centre in Cali, Colombia. Patient’s demographics, clinical characteristics, and injury information were obtained. Independent predictors of positive SPW were assessed using stepwise logistic regressions.

Results: There were 41 positive SPW (22.4%). Unadjusted analyses demonstrated that stab/knife wounds (OR 2.48, 95% CI 1.17-5.25, p = 0.017), single wound (OR 14.61, 95% CI 1.9-110, p = 0.009), and clinical signs of pericardiac tamponade (OR 8.52, 95% CI 3.92-18.4, p < 0.001) were associated with increased odds of positive SPW. Conversely, systolic blood pressure (0.98, 95% CI 0.96-0.99) and stable physiological index (OR 0.31, 95% CI 0.14-0.65, p = 0.002) were associated with decreased odds. In multivariable analyses, signs of pericardiac tamponade (OR 6.37, 95% CI 2.78-14.6, p < 0.001), and single injuries (OR 12.99, 95% CI 1.6-102.7, p = 0.015) remained as independent predictors of positive SPW.

Conclusion: Emphasis on early recognition of the clinical signs of pericardiac tamponade could be the most important factor for the identification of occult cardiac injuries. Patients with multiple wounds to the precordial region who reached the hospital may not benefit from a SPW. However, high level of awareness is important because the incidence of occult cardiac injuries is not negligible.

Keywords: Cardiac tamponade, Penetrating cardiac injury, Precordial region, Subxiphoid pericardial window.

How to cite this article: Sánchez ÁI, García AF, Velásquez M, Puyana JC. Predictors of Positive Subxiphoid Pericardial Window in Stable Patients with Penetrating Injuries to the Precordial Region. Panam J Trauma Crit Care Emerg Surg 2015;4(3):43-51.

Source of support: Nil

Conflict of interest: None declared

Research Article
Marissa A Boeck, Kevin J Blair, J Esteban Foianini, Henry B Perry, Lina V Mata, Michel B Aboutanos, Adil H Haider, Mamta Swaroop

Implementation of a Hospital-based Trauma Registry in Santa Cruz de la Sierra, Bolivia: Methodology, Preliminary Results, and Lessons learned

[Year:2016] [Month:May-August] [Volumn:5 ] [Number:2] [Pages:51] [Pages No:101-112][No of Hits : 611]


Aim: Five million annual global deaths are attributable to injuries. Yet, a lack of reliable data leaves the true magnitude of injuries unknown in many low- and middle-income countries (LMICs), like Bolivia. Trauma registries provide a means of acquiring these data. We sought to evaluate methodology, preliminary results, and lessons learned during the implementation of a pilot, hospital-based trauma registry at one facility in Santa Cruz de la Sierra, Bolivia.

Materials and methods: Data collection occurred from January to September 2015 at Clínica Foianini, a private, 50-bed, third-level facility in Santa Cruz. A paper trauma registry form based on the Panamerican Trauma Society’s (ATS’s) essential elements model was utilized. Trained nurses completed forms at a trauma patient’s initial hospital presentation. Results were analyzed via descriptive statistics.

Results: The registry produced 91 forms over 8 months. An ICD-10 diagnosis code search of hospital visits showed 2,816 eligible patients, with a registry capture rate of 3.2%. Most were males (59.3%) in their mid-20s with head contusions (19.8%), penetrating/lacerating upper extremity (11.0%) or head (7.7%) wounds, or upper extremity fractures (6.6%). Many forms were missing critical data, with average omissions of 12.5 per form (26.0% of questions) and 23.7 per question (26.0% of subjects). Errors averaged 1.0 per form (2.1% of questions) and 2.0 per question (2.2% of subjects).

Conclusion: Early efforts to implement a paper-based trauma registry at one Bolivian hospital highlight areas for improvement, mainly within education, training, and oversight. Lessons learned will inform long-term objectives to make the registry a standard hospital program across the city, and eventually throughout Bolivia, arming decision-makers with data for targeted trauma initiatives that save lives.

Clinical significance: These results provide insight into trauma registry implementation in LMICs, which serves to further inform the Bolivian program and can be applied to comparable initiatives in similar settings.

Keywords: Bolivia, Burden of injuries, Developing world, Health system strengthening, Injury prevention, Other, Public health, Quality improvement, Trauma registry.

How to cite this article: Boeck MA, Blair KJ, Foianini JE, Perry HB, Mata LV, Aboutanos MB, Haider AH, Swaroop M. Implementation of a Hospital-based Trauma Registry in Santa Cruz de la Sierra, Bolivia: Methodology, Preliminary Results, and Lessons learned. Panam J Trauma Crit Care Emerg Surg 2016;5(2):101-112.

Source of support: Nil

Conflict of interest: None

Case Report
Apoorv Goel, Roli Bansal, Sarita Goel, Ayush Agarwal

Small Bowel Obstruction in a Young Female following an Unsafe Abortion: An Unusual Cause

[Year:2016] [Month:January-April] [Volumn:5 ] [Number:1] [Pages:63] [Pages No:61-63][No of Hits : 590]


The number of unsafe abortions has declined over the years in India but we still come across many cases and few of them with fatal complications. Usually such cases may present as bleeding per vaginum with features of sepsis and often instrumentation causing uterine or bowel injury. Our case is a 16 year old unmarried girl who had a history of 5 months of amenorrhea and underwent abortion by a quack in a village presented with features of frank small bowel obstruction due a rare unusual cause.

Keywords: Intra-abdominal fetus, Small bowel obstruction, Quacks, Unsafe abortion.

How to cite this article: Goel A, Bansal R, Goel S, Agarwal A. Small Bowel Obstruction in a Young Female following an Unsafe Abortion: An Unusual Cause. Panam J Trauma Crit Care Emerg Surg 2016;5(1):61-63.

Source of support: Nil

Conflict of interest: None

Ajay K Pal, Maulana M Ansari, Najmul Islam

Combination of Serum C-reactive Protein and D-lactate: Predictors of Strangulation in Intestinal Obstruction

[Year:2016] [Month:September-December] [Volumn:5 ] [Number:3] [Pages:59] [Pages No:134-139][No of Hits : 537]


Introduction: Serum C-reactive protein (CRP) and D-lactate have been proposed as markers of intestinal ischemia. The purpose of this prospective observational study is to find whether serum CRP and serum D-lactate can help in predicting strangulation in cases of acute intestinal obstruction.

Materials and methods: A total of 50 consecutive patients were included in the study after excluding patients of comorbid medical illness and patients with findings other than obstruction or strangulation. The serum values of CRP and D-lactate were measured and compared between obstruction with strangulation and obstruction without strangulation. Receiver operating characteristic (ROC) curve was drawn and cutoff values for the diagnosis of strangulation were calculated along with calculation of sensitivity, specificity, positive predictive values (PPVs), and negative predictive values (NPVs).

Results: A total of 14 patients who were diagnosed with strangulated bowel obstruction had significantly higher values of serum CRP and D-lactate when compared with 36 patients with simple bowel obstruction (116 vs 40 mg/L and 5.4 vs 2.7 mmol/L respectively, p < 0.05). Using ROC analysis, the area under the curve of serum CRP and D-lactate was found to be 0.785 and 0.775 respectively, for bowel strangulation. Using a cutoff value of 60 mg/L for CRP, the sensitivity, specificity, PPV, and NPV were 87.5, 58.3, 48.3, 91.3% respectively. Using a cutoff value of 4.5 mmol/L for D-lactate, the sensitivity, specificity, PPV, and NPV were 75.0, 69.4, 52.7, 86.2% respectively.

Conclusion: Serum CRP and D-lactate can be useful and reasonable markers for predicting strangulation in cases of acute intestinal obstruction in an emergency setting.

Keywords: Celiotomy, C-reactive protein, D-lactate, Intestine, Ischemia, L-lactate, Markers.

How to cite this article: Pal AK, Ansari MM, Islam N. Combination of Serum C-reactive Protein and D-lactate: Predictors of Strangulation in Intestinal Obstruction. Panam J Trauma Crit Care Emerg Surg 2016;5(3):134-139.

Source of support: Nil

Conflict of interest: None

Albaro J Nieto, Mauricio Velásquez, María F Escobar, Javier A Carvajal, Marcela Granados

Unstable Chest Surgical Management in Pregnancy: Case Report and Literature Review

[Year:2016] [Month:September-December] [Volumn:5 ] [Number:3] [Pages:59] [Pages No:155-160][No of Hits : 531]


Introduction: Present a review of the case, management, and progress of an obstetric patient who suffered a car accident with subsequent severe blunt thoracic trauma (BTT) resulting in flail chest (FC).

Case report: This is a case of Hispanic female of 44 years involved in a car accident at 14 weeks of gestation, who presented with FC, sternal fracture, and severe respiratory compromise.
This woman received surgical management and care in an intensive obstetric care unit management, presenting osteomyelitis as a complication, along with physical deconditioning and prolonged hospital stay, finally with an obstetric and functional favorable outcome.

Conclusion: Although severe BTT in pregnant patients is uncommon, it is important to highlight the appropriate medical management required for these patients in order to achieve a successful outcome, as was in this case. This is the only case report of FC surgical management in pregnancy that we have in our institution so far.

Keywords: Flail chest, Pregnancy, Rib fracture.

How to cite this article: Nieto AJ, Velásquez M, Escobar MF, Carvajal JA, Granados M. Unstable Chest Surgical Management in Pregnancy: Case Report and Literature Review. Panam J Trauma Crit Care Emerg Surg 2016;5(3):155-160.

Source of support: Nil

Conflict of interest: None

Original Research
Phillipe Abreu-Reis, Adonis Nasr, Flavio Saavedra Tomasich, Iwan Augusto Collaco, Tayron Bassani, Gustavo Moreira Clivatti, Alana Padilha Fontanella, Juliana Midori Ito, Marília França Madeira Manfrinato, Ivilin Hammerschmidt