Lilia de Souza Nogueira

Mapping injuries in traffic accident victims: a literature review

O objetivo do estudo foi identificar as regioes corporeas mais atingidas em vitimas de acidentes de transporte e mapear a gravidade das lesoes e do trauma. Foi realizada revisao sistematica da literatura, utilizando-se descritores relacionados aos acidentes de trânsito, acidentes de transporte, ferimentos e lesoes, totalizando 248 artigos. As bases eletronicas pesquisadas foram LILACS, MEDLINE e PAHO, entre 1990 e dezembro de 2006. Essa revisao destacou uma serie de estudos conclusivos sobre as regioes corporeas mais frequentes e aquelas de maior gravidade atingidas nesses eventos e apontou lacunas de conhecimento na literatura nacional. Acredita-se que esses achados possam ser de grande valia para as equipes nos cenarios de pre-hospitalar e intra-hospitalar e apontem caminhos na direcao de novas pesquisas.The objective of this study was to identify the body regions most affected in traffic accident victims and to map the trauma and severity of the lesions. A systematic literature review using key words related to traffic accidents, transportation accidents, wounds and injuries found a total of 248 articles. The electronic bases LILACS, MEDLINE, and PAHO were surveyed between the years 1990 and December 2006. This review emphasized a series of conclusive studies about the most frequent body regions involved and the major injuries occurring in these situations. It also indicated information gaps in the Brazilian literature. We believe that these findings are valuable for pre-hospital and intra-hospital teams and point the way to new investigations.

Nursing Activities Score: comparação com o Índice APACHE II e a mortalidade em pacientes admitidos em unidade de terapia intensiva

BACKGROUND AND OBJECTIVES: Searching the literature, we found no studies which correlate the NAS (Nursing Activities Score), who determines the real time of nursing evaluation and patient care, with mortality for prognostic index. The objectives this study were to know the values of the NAS score at ours service, try to find correlations between this values and the APACHE II index and to analyze the mortality rates with NAS scores. METHODS: This is a prospective ICU inpatient study from July to November/2005. Our datas of the APACHE II score were recorded from the QuaTI system study. Qui-square test or equivalent was done to compare the proportions. For the analyses we utilized the EPI-INFO-6 software. RESULTS: The sample was 148 patients, mean age of 55.5 years with 59.4% males. The mean hospitalization time were 9.1 days, mortality rate of 29.7%, mean NAS score of 51.5% and mean APACHE II score of 13.4. There were a positive correlation ship between NAS and APACHE II index (R = 0.82). Selecting only the patients with NAS more than 51 we found that 41 in 83 died and 42 in 83 survived. Those whose NAS were under 51, only 3 in 65 died and 62 in 65 survived (p < 0.005), identifying an statistically significant group. CONCLUSIONS: In this study the mean value of NAS were 51.5%. There were good correlation with the APACHE II index and we shown that the mortality rate was high in the higher NAS values.

Ten years of new injury severity score (NISS): is it a possible change?

The article is a bibliographic review which intends to present the actual range of researches comparing the Injury Severity Score (ISS) and the New Injury Severity Score (NISS). Databases were searched using the keyword NISS, with 42 articles, 23 of which didn’t compare the two indexes. Most part of the 19 selected articles showed that NISS has been more accurate in predicting the outcomes (dependent variables) than ISS, moreover in severe and specific trauma. Studies with populations between 1,000 and 10,000 resulted in NISS-favorable results, whereas studies with populations larger than 10,000 or smaller than 1,000 showed either NISS-favorable results or no difference between the two groups. However, there were no studies showing ISS-favorable results. These results and the easier calculation of NISS lead to a future replacement of ISS by NISS.

Carga de trabalho de enfermagem requerida por adultos, idosos e muito idosos em Unidade de Terapia Intensiva

The study’s objectives were to compare nursing workload among adults, elderly and very elderly patients, including in the analyses the interventions and evolution of the workload between admission and discharge. This prospective longitudinal study involved 600 adult patients in general ICU in four city hospitals in Sao Paulo. The results showed that, independent of the age, it had the similarity of the nursing workload in the admission, as well as in the evolution of the patients’ care. Differences between the groups were observed in the NAS on ICU’s discharge and the following instrument’s items: Monitoring and titration and Hygiene procedures in admission, Respiratory support and Intravenous hyperalimentation in discharge and Mobilization and positioning in discharge and admission. In conclusion, the results evidenced that the age interfered only in specific aspects of the nursing workload required by patients in ICUs.El objetivo fue comparar la carga de trabajo de enfermeria entre los pacientes adultos, ancianos y muy ancianos, incluyendo en las analisis las intervenciones y la evolucion de la carga de trabajo entre admision y alta. Estudio prospectivo longitudinal de 600 pacientes adultos internados en la UCI general de cuatro hospitales de Sao Paulo. Como resultados, independientemente de la edad, hubo similitud de la carga de trabajo de enfermeria en la admision y evolucion de las demandas de cuidados. Diferencias entre los grupos fueron observadas en el NAS en la alta de la UCI y en los siguientes apartados de esta herramienta: Monitorizacion y controles y Procedimientos de higiene, en la admision; Soporte ventilatorio e Iperalimentacion intravenosa en la alta; y Movilizacion y posicionamiento en la alta y admision. Se concluye, por tanto, que la edad interfiere solo en aspectos especificos de la carga de trabajo en enfermeria requeridos por los pacientes internados en la UCI.The study’s objectives were to compare nursing workload among adults, elderly and very elderly patients, including in the analyses the interventions and evolution of the workload between admission and discharge. This prospective longitudinal study involved 600 adult patients in general ICU in four city hospitals in Sao Paulo. The results showed that, independent of the age, it had the similarity of the nursing workload in the admission, as well as in the evolution of the patients’ care. Differences between the groups were observed in the NAS on ICU’s discharge and the following instrument’s items: Monitoring and titration and Hygiene procedures in admission, Respiratory support and Intravenous hyperalimentation in discharge and Mobilization and positioning in discharge and admission. In conclusion, the results evidenced that the age interfered only in specific aspects of the nursing workload required by patients in ICUs.

Severity of trauma victims admitted in intensive care units: comparative study among different indexes

This study compared the performance of the Injury Severity Score (ISS) with the New Injury Severity Score (NISS) and also the Simplified Acute Physiology Score II (SAPS II) with the Logistic Organ Dysfunction System (LODS) in trauma victims, in order to predict mortality and length of stay in Intensive Care Units (ICU), besides identifying which indexes have been the most effective to estimate these results. A retrospective analysis was done in the records of 185 victims admitted in ICU between June and December 2006. None of the four indexes properly discriminated the patients according to length of stay at the ICU. The ISS and the NISS did not show a good discriminating capacity in case of death, but the SAPS II and the LODS presented good performance to estimate mortality at the ICU. Results pointed towards the use of SAPS II and LODS when trauma victims are admitted in an ICU.3Este estudo objetivou comparar em vitimas de trauma o desempenho do Injury Severity Score (ISS), perante o New Injury Severity Score (NISS) e, tambem, do Simplified Acute Physiology Score II (SAPS II), perante o Logistic Organ Dysfunction System (LODS) para predizer a mortalidade e o tempo de permanencia em unidades de terapia intensiva (UTI), alem de identificar quais indices foram os mais efetivos para estimar esses desfechos. Foi realizada analise retrospectiva dos prontuarios de 185 vitimas, admitidas em UTI, entre junho e dezembro de 2006. Os quatro indices nao descriminaram adequadamente os pacientes segundo tempo de permanencia na UTI. ISS e NISS nao mostraram boa capacidade discriminatoria para ocorrencia de obito, diferente do SAPS II e LODS que apresentaram melhor performance para estimar a mortalidade em UTI. Resultados apontaram para o uso do SAPS II e do LODS quando vitimas de trauma sao internadas em UTI.

Nursing Workload in Intensive Care Unit Trauma Patients: Analysis of Associated Factors

Background From the perspective of nurses, trauma patients in the Intensive Care Unit (ICU) demand a high degree of nursing workload due to hemodynamic instability and the severity of trauma injuries. This study aims to identify the factors related to the high nursing workload required for trauma victims admitted to the ICU. Methods This is a prospective, cross-sectional study using descriptive and correlation analyses, conducted with 200 trauma patients admitted to an ICU in the city of São Paulo, Brazil. The nursing workload was measured using the Nursing Activities Score (NAS). The distribution of the NAS values into tertiles led to the identification of two research groups: medium/low workload and high workload. The Chi-square, Fishers exact, Mann-Whitney and multiple logistic regression tests were utilized for the analyses. Findings The majority of patients were male (82.0%) and suffered blunt trauma (94.5%), with traffic accidents (57.5%) and falls (31.0%) being prevalent. The mean age was 40.7 years (±18.6) and the mean NAS was 71.3% (±16.9). Patient gender, the presence of pulmonary failure, the number of injured body regions and the risk of death according to the Simplified Acute Physiology Score II were factors associated with a high degree of nursing workload in the first 24 hours following admission to the ICU. Conclusion Workload demand was higher in male patients with physiological instability and multiple severe trauma injuries who developed pulmonary failure.

The role of the New Trauma and Injury Severity Score (NTRISS) for survival prediction

The objective of this study was to verify if replacing the Injury Severity Score (ISS) by the New Injury Severity Score (NISS) in the original Trauma and Injury Severity Score (TRISS) form would improve the survival rate estimation. This retrospective study was performed in a level I trauma center during one year. ROC curve was used to identify the best indicator (TRISS or NTRISS) for survival probability prediction. Participants were 533 victims, with a mean age of 38±16 years. There was predominance of motor vehicle accidents (61.9%). External injuries were more frequent (63.0%), followed by head/neck injuries (55.5%). Survival rate was 76.9%. There is predominance of ISS scores ranging from 9-15 (40.0%), and NISS scores ranging from 16-24 (25.5%). Survival probability equal to or greater than 75.0% was obtained for 83.4% of the victims according to TRISS, and for 78.4% according to NTRISS. The new version (NTRISS) is better than TRISS for survival prediction in trauma patients.

Mapeamento das lesões em vítimas de acidentes de trânsito: revisão sistemática da literatura

O objetivo do estudo foi identificar as regioes corporeas mais atingidas em vitimas de acidentes de transporte e mapear a gravidade das lesoes e do trauma. Foi realizada revisao sistematica da literatura, utilizando-se descritores relacionados aos acidentes de trânsito, acidentes de transporte, ferimentos e lesoes, totalizando 248 artigos. As bases eletronicas pesquisadas foram LILACS, MEDLINE e PAHO, entre 1990 e dezembro de 2006. Essa revisao destacou uma serie de estudos conclusivos sobre as regioes corporeas mais frequentes e aquelas de maior gravidade atingidas nesses eventos e apontou lacunas de conhecimento na literatura nacional. Acredita-se que esses achados possam ser de grande valia para as equipes nos cenarios de pre-hospitalar e intra-hospitalar e apontem caminhos na direcao de novas pesquisas.The objective of this study was to identify the body regions most affected in traffic accident victims and to map the trauma and severity of the lesions. A systematic literature review using key words related to traffic accidents, transportation accidents, wounds and injuries found a total of 248 articles. The electronic bases LILACS, MEDLINE, and PAHO were surveyed between the years 1990 and December 2006. This review emphasized a series of conclusive studies about the most frequent body regions involved and the major injuries occurring in these situations. It also indicated information gaps in the Brazilian literature. We believe that these findings are valuable for pre-hospital and intra-hospital teams and point the way to new investigations.

Características clínicas e gravidade de pacientes internados em UTIs públicas e privadas

This study aimed to compare clinical characteristics, evolution and severity of adult patients admitted in public and private Intensive Care Units. It is a retrospective, longitudinal and quantitative analysis of 600 patients admitted in four Intensive Care Units of Sao Paulo, Brazil. Differences were found between patients admitted in private and public hospitals regarding the following variables: age, origin, length of stay and mortality in the critical unit, cardiac, hematological, neurological and kidney failures and some comorbidities. The results reveal the importance of analyzing in detail clinical characteristics and healthcare of patients admitted in public institutions, because of the high mortality found. The Intensive Care Nurse can contribute to change this scenario, because she/he has a leadership role in planning and provision of resources for intensive care. DESCRIPTORS: Public sector. Private sector. Intensive Care Units. Clinical evolution. Nursing. CARACTERISTICAS CLINICAS Y GRAVEDAD DE PACIENTES INGRESADOS EN UCI PUBLICAS Y PRIVADAS RESUMEN: La investigacion tuvo como objetivo comparar las caracteristicas clinicas, evolucion y gravedad de pacientes adultos ingresados en Unidades de Cuidados Intensivos publicas y privadas. Este es un estudio retrospectivo, longitudinal y cuantitativo de 600 pacientes ingresados en cuatro Unidades de Cuidados Intensivos en Sao Paulo, Brasil. Fueron encontradas diferencias entre los pacientes de los hospitales privados y publicos para las variables: edad, procedencia, tiempo de internacion y mortalidad en la unidad critica, insuficiencia cardiologica, hematologica, neurologica y renal, ademas de algunas comorbilidades. Los resultados revelan la importancia de se analizar las caracteristicas clinicas y la asistencia prestada en las instituciones publicas, en comparacion a la tasa de mortalidad. La Enfermera de Cuidados Intensivos puede ayudar a cambiar esta situacion, ya que tiene un papel de liderazgo en la planificacion de la atencion y la provision de recursos para cuidados intensivos. DESCRIPTORES: Sector publico. Sector privado. Unidades de Terapia Intensiva. Evolucion clinica. Enfermeria. 59

Clinical evolution of adult, elderly and very elderly patients admitted in Intensive Care Units

This study compared clinical outcomes among adult, elderly and very elderly patients admitted to Intensive Care Units (ICUs) located in São Paulo, Brazil. This retrospective, longitudinal and comparative study included 279 adult (≥ 18 and <60 years), 216 elderly (≥ 60 and <80 years) and 105 very elderly (≥ 80 years) patients. Adult patients differed from other groups regarding the unit to which they were referred and severity, according to the Simplified Acute Physiology Score II. Adults were most frequently sent to hospitalization wards; elderly and very elderly patients who survived hospitalization in critical units showed sharper improvement before discharge. There were differences in relation to mortality between adult and elderly patients, with a higher rate in the elderly group; however, the mortality rate of very elderly and adult patients was similar. In general, the results indicated that older age was not associated with undesirable outcomes in ICUs.El estudio comparo la evolucion clinica de adultos, ancianos y muy ancianos internados en Unidades de Terapia Intensiva localizadas en Sao Paulo, Brasil. El estudio fue retrospectivo longitudinal, del tipo comparativo. Participaron 279 adultos (≥18 y <60 anos), 216 ancianos (≥60 y <80 anos) y 105 muy ancianos (≥80 anos). Los adultos difirieron de los otros grupos en relacion a la unidad de destino y evolucion de la gravedad, segun Simplified Acute Physiology Score II. Fue mas frecuente el encaminamiento de los adultos para unidades de internacion, sin embargo los ancianos y muy ancianos sobrevivientes de la internacion en la unidad critica presentaron mejoria mas acentuada antes del alta. Entre adultos y ancianos ocurrio diferencia en relacion a la mortalidad, con mayor tasa en el grupo mas viejo; entretanto, la mortalidad de los muy ancianos y adultos fue similar. En general, los resultados indicaron que la edad mas avanzada no fue factor asociado a los resultados indeseables de la asistencia intensiva.