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1.  Research Article
Optimizing Chest X-ray Indication in Blunt Trauma Patients using Clinical Criteria
Luca GA Pivetta, José G Parreira, Cristiano Below, Giovanna Z Rondini Jacqueline AG Perlingero, José C Assef
[Year:2017] [Month:January-April] [Volume:6 ] [Number:1] [Pages:57] [Pages No:30-34] [No of Hits : 915]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10030-1169 | FREE


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

2.  Original Article
Damage Control Surgery for the Management of Major Obstetric Hemorrhage: Experience from the Fundación Valle Del Lili, Cali, Colombia
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
[Year:2017] [Month:January-April] [Volume:6 ] [Number:1] [Pages:57] [Pages No:1-7] [No of Hits : 566]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10030-1164 | FREE


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

3.  Original Research
Abdomen Abierto y Presión Subatmosférica: Experiencia con un Sistema Artesanal
Helena Facundo, Juan Manuel Troncoso
[Year:2016] [Month:January-April] [Volume:5 ] [Number:1] [Pages:63] [Pages No:11-17] [No of Hits : 1227]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10030-1137 | FREE


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

4.  Original Article
Panamerican Trauma Society Basic Trauma Education Course Administration in Resource-limited Areas
Lina V Mata, Francisco E Mora, Martha Quiodettis, Jaime Fischer, Gustavo M Machain, Juan C Salamea, Edgar B Rodas, Michel B Aboutanos
[Year:2016] [Month:May-August] [Volume:5 ] [Number:2] [Pages:51] [Pages No:83-87] [No of Hits : 1188]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10030-1149 | FREE


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

5.  Original Research
Trauma en ancianos – Experiencia de dos hospitales de referencia en Cali, Colombia
Juan S Calle Toro, Alvaro I Sanchez, Monica Morales, Alberto F Garcia
[Year:2016] [Month:January-April] [Volume:5 ] [Number:1] [Pages:63] [Pages No:38-42] [No of Hits : 873]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10030-1141 | FREE


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

6.  Original Research
Prediccion de Morbilidad y Mortalidad de los Pacientes Con Trauma Penetrante Multiple A Traves de Diferentes Indices de Severidad en Trauma
Silvia Ines Guerrero, Juan Paulo Serrano, Laura Juliana Delgado, Dairon Gelvez
[Year:2016] [Month:January-April] [Volume:5 ] [Number:1] [Pages:63] [Pages No:31-37] [No of Hits : 801]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10030-1140 | FREE


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

Incidencia y Características del Trauma Raquimedular en un Hospital de III Nivel, Bogotá 2011–2014
Aníbal Alfonso Teherán, Oscar Javier Castro, Leonardo Laverde Frade
[Year:2016] [Month:September-December] [Volume:5 ] [Number:3] [Pages:59] [Pages No:140-147] [No of Hits : 776]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10030-1157 | FREE


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.

8.  Original Research
The Influence of Alcohol Outlets on Urban Trauma: A Pilot Study for Geospatial Modeling at a Fine Scale
Max N Brondfield, Stanley Sciortino, Catherine Juillard, Paula Fleisher, Laura A Schmidt, Rochelle Dicker
[Year:2016] [Month:January-April] [Volume:5 ] [Number:1] [Pages:63] [Pages No:1-10] [No of Hits : 767]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10030-1136 | FREE


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.

Hérnias Diafragmáticas Traumáticas com Lesão Pericárdica: Apresentação e Complicaçoes Específicas
Fernando Spencer Netto, Tiago Cesar Mierzwa, Mariana Thalita Bertolin Silva, Luan Geraldo Ocaña de Oliveira, Djoney Rafael dos Santos, Jean Carlo Barbosa
[Year:2016] [Month:September-December] [Volume:5 ] [Number:3] [Pages:59] [Pages No:161-165] [No of Hits : 694]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10030-1160 | FREE


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.

10.  Case Report
Fístula Aortoentérica Secundaria A Prótesis De Dacron
Alejandro J Pérez-Alonso, Carlos del Olmo-Rivas, Ignacio Machado-Romero, Patrizio Petrone
[Year:2016] [Month:January-April] [Volume:5 ] [Number:1] [Pages:63] [Pages No:58-60] [No of Hits : 683]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10030-1144 | FREE


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

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