RESUMEN
This study aimed to identify the factors associated with interhospital transfer of trauma victims treated in the emergency department of a nontertiary hospital. Retrospective analysis of medical records of trauma victims treated from January to July 2014 in the emergency department of a hospital not specialized in trauma care and located in Brazil was undertaken. The inclusion criteria were as follows: being 15 years or older; being a trauma victim; having received prehospital care; and being admitted to the hospital directly from the scene of the accident. Pearson's chi-square, Mann-Whitney U, Fisher's exact tests, and multiple logistic regression were used in the analyses. The sample was made up of 246 patients, mostly men (67.9%) and blunt trauma victims (97.6%). The mean age of the trauma victims was 44.2 (SD = 22.1). Falls were the most frequent external cause (41.1%). Forty patients were transferred to a tertiary care center, mostly for orthopedic treatment (70%). The factors associated with interhospital transfer of victims were severity of the trauma according to the Injury Severity Score ([ISS]; mean ±SD of ISS = 8.1 ± 4.5; odds ratio = 1.14; 95% confidence interval [1.06, 1.24]; p = .001) and extremities/pelvic girdle as the body region most severely injured (mean ±SD of extremities/pelvic girdle Abbreviated Injury Scale score = 2.9 ± 0.5; odds ratio = 3.86; 95% confidence interval [1.71, 8.72; p = .001). Identification of the risk factors for interhospital transfer of trauma victims treated in hospitals without a trauma center provides important information for the creation of referral and counter-referral policies to facilitate the process and ensure definitive early treatment and improved patient survival.
Asunto(s)
Transferencia de Pacientes/estadística & datos numéricos , Adolescente , Adulto , Brasil/epidemiología , Estudios de Cohortes , Servicio de Urgencia en Hospital , Femenino , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Centros Traumatológicos , Heridas y Lesiones/epidemiología , Heridas y Lesiones/enfermería , Heridas y Lesiones/terapia , Adulto JovenRESUMEN
BACKGROUND: Functional mitral regurgitation (MR) can occur secondary to severe aortic regurgitation (AR). However, data on the overall impact of mitral surgical intervention after aortic valve replacement (AVR) are scarce. We sought to study the left ventricular (LV) remodeling process and determine predictors of clinical outcomes of patients with pure severe AR in presence or absence of significant functional MR. METHODS: Patients were categorized into AR-MR group (≤ mild MR; n = 51, 76%) and AR + MR group (≥ moderate MR; n = 16, 24%). All patients in the AR + MR group underwent AVR and MR correction. Serial echocardiographic measurements and clinical follow-up up to 5 years were obtained in all patients. RESULTS: Significant reverse LV remodeling occurred in both groups compared with baseline. No 30-day deaths occurred. Mortality and heart failure-related hospitalization rates, at follow-up, were significantly higher in the AR + MR group (19% vs. 2%, P = 0.04 and 38% vs. 12% P = 0.03, respectively), but a similar proportion of patients from both groups was in New York Heart Association class I or II (87% vs. 92%, P = 0.62). Preoperative indexed stroke volume (SV) <50 mL/m2 was the only independent predictor of death and/or rehospitalization after surgery (odds ratio: 61.1, [95% CI, 12.6425.2]; P < 0.0001). CONCLUSION: Despite being a higher risk population, patients with moderate-to-severe functional MR secondary to severe AR experience similar postoperative mortality at the expense of a moderately higher 5-year overall mortality, rate of hospitalization for congestive heart failure, and medication use. Preoperative indexed SV < 50 mL/m2 may be helpful in predicting long-term outcomes.