Ávila-Macías Z, Bravo-Cuéllar L

Language: Spanish
References: 11
Page: 16-21
PDF size: 574.17 Kb.

ABSTRACT

Introduction.The legal medicine surgery service of the Civil Hospital of Guadalajara Fray Antonio Alcalde is one of the main reference centers in the west of the country that provides specialized attention to patients suffering from abdominal trauma in its different causes. Here is presented the first database created from the need of generating academic material sustained on the service productivity, attention characteristics, as well as detecting the opportunity zones to improve the medical attention.
Material and Methods.A cross-sectional descriptive study during the period of January- April 2012 in which the electronic medical history of patients admitted during this time was used. It is described the demographic data, reference centers, lesion mechanisms, time of evolution prior admittance besides describing the main causes of lesion, its correlation with the abdominal exploring through exploratory laparotomy, main injured organs, mortality, time of hospital stay and the complications developed on the patients. As well as detecting opportunity zones for the improvement of the quality of the attention on patients with abdominal trauma.
Results.During the period of study there were a total of 217 patients: 20 females (9%) and 197 males (91%). The age group admitted with higher frequency was 21 to 30 years of age (41.2%). 31.6% of the cases documented breath alcohol. 127 (58.5%) patients underwent exploratory laparotomy, 34 (15.6%) did not require surgical procedure, 31 (14.3%) other procedures like cholecystectomy and appendectomy, 18 patients (8.3%) required intestinal reinstalling and only in 7 (3.3%) was performed a hernioplasty. The causing agent of abdominal trauma who required exploratory laparotomy was wound by firearm with 20.7% and 22.5% with bladed weapons. The most common type of aggression was physical (63%). The time lapsed from the injury to the laparotomy was ‹ 5 hours in 25.75%, 6-10 hours in 24%, 11-15 hours in 28.75%, and finally › 15 hours in 19.17%. The injured organs in order of frequency were: colon, small intestine, liver, kidney, diaphragm and spleen. The stay at the unit of intensive care was required on 22 (10.32%) patient. The mortality during the period of study was 7.37% (16 patients), being hypovolaemic shock the main cause.
Conclusion.Mexico is within the least peaceful nations in the world, classified as the 135 of 158 with registered violence. The service of legal medicine surgery of the Civil Hospital of Guadalajara is a reference center in the west of the country for the attention of patients with abdominal trauma. It was observed an increase on the monthly admittance of 30% associated to the social situation in which our country is, correlated with alcoholism and use of drugs as a triggering factor physical aggression present in 35% of the cases. We should implement an immediate system of regulation of poly-traumatized patients in our institution and service to cut the transferring time and offer a better prognostic and higher benefit to the patient's health, giving specialized attention on intermediate cares after damage control decreasing the morbidity-mortality.

REFERENCES

1. 1-.Gómez-García M, Basilio-Olivares A, Vallejo- Sandoval MG, Cárdenas-Martínez G, Vega-Rivera F. Tratamiento no operatorio en trauma abdominal. Experiencia en un centro de trauma de la Ciudad de México; Hospital ABC Vol. 49, Núm. 2.

2. 2-.Gianluca Costa et al, The epidemiology and clinical evaluation of abdominal trauma, Ann Ital Chir, 2010, 81: 95-102.

3. 3-.Jennifer L. Isenhour MD, John Marx MD, Advances in Abdominal Trauma; Emerg Med Clin N Am 25 (2007) 713–733.

4. 4-.H. Baradaran, J. Salimi, M. Nassaji-Zavareh, A. Khaji and A. Rabbani; Epidemiological study of patients with penetrating abdominal trauma in Tehran-Iran, Acta Medica Iranica 2007; 45(4): 305-308.

5. 5-.Goins WA, Anderson BA; Abdominal trauma revisited; J Nati Med Assoc. 1991 ;83:883-888.

6. 6-.Georgiou A, Lockey DJ; The performance and assessment of hospital trauma teams; Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2010, 18:66. 7-.Mudhafar K Murad, Stig Larsen and Hans Husum; Prehospital trauma care reduces mortality. Ten year results from a time-cohort and trauma audit study in Iraq; Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2012, 20:13.

7. 8-.Jan O Jansen, Steven R Yule, Malcolm A Loudon; Investigation of blunt abdominal trauma; BMJ 2008;336:938-42.

8. 9-.Calderale SM, Sandru R, Tugnoli G, Di Saverio S, Beuran M, Ribaldi S, et al; Comparison of quality control for trauma management between Western and Eastern European trauma center; World Journal of Emergency Surgery 2008, 3:32.

9. 10-.Yilmaz TH, Ndofor BC, Smith MD, Degiannis E; A heuristic approach and heretic view on the technical issues and pitfalls in the management of penetrating abdominal injuries; Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2010, 18:40.

10. 11-.JE Smith, M Midwinter, AW Lambert; Avoiding cavity surgery in penetrating torso trauma: the role of the computed tomography scan; Ann R Coll Surg Engl 2010; 92: 486–488.

11. 12-.Cheatham ML; Abdominal Compartment Syndrome: pathophysiology and definitions; Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2009, 17:10.