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• W2057273046 abstract "Conocer la epidemiología, cronograma y causas de mortalidad tardía en los politraumatizados graves. Observacional prospectivo de cohortes integrado en un registro provincial de trauma. Provincia de Guipúzcoa. Unidad de cuidados intensivos (UCI) hospital terciario. Todos los traumatizados graves: Injury Severity Score (ISS) > 15, ingresados en UCI entre el 1 de enero de 1995 y el 31de diciembre de 2009, fallecidos tardíamente (> 7 días). Epidemiológicas, analíticas, hemodinámicas, transfusionales y escalas de gravedad Abbreviated Injury Scale (AIS) e ISS. Pacientes: 2.003. ISS: 24,3 ± 14,2. Exitus: 405 (20%). Fallecidos >7 días: 102 (25,2%) con 9 años más y 18 puntos menos de ISS que los fallecidos a las 48 h. Lesiones más graves: AIS-cabeza-columna cervical ≥ 4 (52%); AIS-abdomen ≥ 4 (19,65) AIS-tórax ≥ 4 (11,7%); AIS-extremidades ≥ 4 (4,9%). Causas de fallecimiento: 1) muerte encefálica (14,7%); 2) fracaso multiorgánico (FMO) (67,6%) presente en 2 contextos lesionales: a) TCE grave en estado vegetativo y lesiones agudas de médula espinal (LAME) cervicales altas con tetraplejía (35,3%) y b) lesiones no neurológicas (32,3%), con alta prevalencia de shock hipovolémico, politransfusión y coagulopatía; 3) una variada miscelánea (10,7%): encefalopatía hipóxica, embolia pulmonar e ictus masivo; 4) no evaluables (7%). La edad, la gravedad, y las características lesionales, influyen en la distribución temporal y causalidad de la mortalidad tardía. La muerte encefálica sigue siendo prevalente. El FMO es la causa más frecuente. Estos hallazgos pueden ayudar a una mejor planificación de los recursos estructurales y educativos, y a la reducción de la morbi-mortalidad del trauma. A study is made of the epidemiology, chronogramand causes of late mortality in traumatized patients. A prospective, observational cohort study of adult trauma patients was carried out. Province of Guipúzcoa (Basque Country, Spain). Intensive care unit of a tertiary hospital. Patients with severe trauma (Injury Severity Score > 15), admitted to the ICU from January 1995 to December 2009, with late death (> 7 days). Epidemiological, laboratory test, hemodynamic and transfusional data were collected. Severity scores: Abbreviated Injury Scale (AIS) and ISS. Patients: 2003; ISS: 24.3 ± 14.2. Total deaths: 405 (20%). Late mortality (>7 days): 102 (25.2%) patients, 9 years older and with a lower (18 points) ISS score than the patients who died early (48 hours). Most frequent injuries: AIS-Head-Cervical spine ≥ 4 (52%); AIS-Abdomen ≥ 4 (19.6%); AIS-Chest ≥ 4 (11.7%); AIS-Extremities ≥ 4 (4.9%). Causes of death: 1) brain death (14.7%); 2) multiorgan failure (67.6%), in two injury contexts: a) severe brain trauma in the vegetative state and high spinal cord injuries with tetraplegia (35.3%); and b) non-neurological injuries (32.3%) with a high prevalence of hypovolemic shock, multiple transfusion and coagulopathy; 3) miscellaneous (10.7%): post-resuscitation anoxic-ischemic encephalopathy, pulmonary embolism and massive stroke; 4) non-evaluable (7%). Age, severity and type of injuries have an influence upon the time distribution and causality of late mortality. Brain death remains predominant, with multiorgan failure as the most frequent cause. This knowledge should contribute to the identification of problems, and to better organization of the structural and educational resources, thereby reducing the likely factors leading to death from trauma." @default.
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• W2057273046 date "2013-08-01" @default.
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• W2057273046 title "Perfil epidemiológico de la mortalidad tardía de los politraumatismos graves" @default.
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