PORTAL DE SALUD EN EL EJE CAFETERO ejesalud.com es el único portal de SALUD del EJE CAFETERO construido para permitir a las empresas y a los profesionales que presten servicios de salud animal, ambiental y humana, que estén a la vanguardia de la tecnología y dar a conocer sus productos y servicios de una forma limpia, seria y eficaz mediante un complejo directorio virtual con una completa descripción de sus productos y servicios, además de imágenes, videos, portafolio de negocios, los estudios realizados y especialidades de los profesionales, literatura recomendada para enfermedades; para así aumentar la rentabilidad de sus negocios y a la vez darse a conocer ante el mundo. Para más información visite su página www.ejesalud.com  Asociación Colombiana de Medicina de Emergencias Recientemente se creó la Asociación Colombiana de Medicina de Emergencias, que agrupa a los profesionales dedicados a la atención de urgencias en el país. Para más información visite su página www.ascome.org  Día Mundial de la Salud 2004: seguridad vial Día Mundial de la Salud 2004 Organización Mundial de la Salud El 7 de abril, en todo el mundo, centenares de organizaciones llevaron a cabo actividades para aumentar la sensibilización acerca de los traumatismos causados por los accidentes de tráfico, sus graves consecuencias y los enormes costos que suponen para la sociedad. Contribuyeron también a que se sepa que esos traumatismos pueden prevenirse. To go to the website. click here www.who.int/world-health-day/2004/es/  Consorcio Latinoamericano de Injuria Cerebral (Latinamerican Brain Injury Consortium) LABIC Consorcio Latinoamericano de Injuria Cerebral Latinamerican Brain Injury Consortium Es una Asociación sin fines de lucro integrada por profesionales con especial interés en el manejo de pacientes neurocríticos. El consorcio latinoamericano de injuria cerebral(LABIC) fue fundado en Octubre 2003, en la ciudad de Rosario , Argentina. Sus objetivos fundamentales son : Promover la capacitación de los profesionales que atienden pacientes con injuria cerebral, difusión de recomendaciones y guías para el manejo de diversas patologías cerebrales., cooperación con otros consorcios, grupos o asociaciones de injuria cerebral., promover y conducir investigaciones para mejorar los resultados de los pacientes con injuria cerebral aguda, adultos y pediátricos. To go to the website. click here www.labic.org/index.php  Unidad de Investigación de Neurotraumatología Unidad de Investigación de Neurotraumatología, Hospital Universitario Vall d'Hebron, Barcelona La Unidad de investigación de Neurotraumatología (UINT), Hospital Universitario Vall d'Hebron, Barcelona; se formó en el año 1990 y comprende dos grandes áreas de investigación, una dirigida al estudio de las alteraciones del metabolismo cerebral, alteraciones neuroquímicas, fisiopatología, nuevas técnicas de monitorización y tratamiento de los traumatismos craneoencefálicos (TCE) y una segunda dirigida al estudio de la fisiopatología de la presión intracraneal y de las alteraciones de la dinámica del líquido cefalorraquídeo en pacientes con una hidrocefalia u otras patologías intracraneales. To go to the website. click here www.neurotrauma.com  CARTA DE LA SALUD Por: Jorge H. Mejía, Director de Educación La Fundación Clinica Valle del Lili en su publicación periodica Carta de la Salud a publicado para el mes de Diciembre más indicaciones para el público sobre el Trauma Craneoencefálico, el autor del texto es el Dr. Ernest Senz Salazar, Neurocirujano de la Clínica Valle del Lili, que se encuentra asociado a Fundcoma desde hace 2 años. Para más información. click aquí http://clinicalili.org/esp/cartas/cartas.php?id_carta=72  PREHOSPITAL EMERGENCY CARE Official Journal of the National Association of EMS Physicians, Volume 6 - Number 4 October-December 2002 The National Association of State EMS Directors - The National Association of EMS Educators THE BRAIN TRAUMA FOUNDATION GUIDELINES FOR PREHOSPITAL MANAGEMENT OF TRAUMATIC BRAIN INJURY: EFFECTS OF EDUCATION AND IMPLEMENTATION ON EMS CARE PRACTICE Dorraine Watts, PhD, RN, Dan Hanfling, MD, Maureen A. Waller, MSN, RN, Arthur L. Trask, MD, Colleen gilmore, EMT-P, Samir M. Fakhry, MD, Inova Regional Trauma Center, Inova Fairfax Hospital, Falls Church, Virginia Purpose:Guidelines for the prehospital management of traumatic brain injury (TBI) were developed in 2000 by The Brain Trauma Foundation (BTF), in conjunction with national emergency medical services (EMS) organizations, to guide prehospital care of TBI patients. Hypothesis: Prehospital providers who are educated in the BTF guidelines will successfully integrate them into their practice. Methods:The study used an experimental crossover design. Data were colected prospectively from a large suburban EMS agency on all trauma patients from August 1 to December 31, 2000. EMS education, data were collected from March 1 to July 31, 2001. The key interventions of the BTF protocol are assessment of Glasgow Coma Scale score (GCS) (recognition of potential TBI) and measurement and treatment of the hypoxia and hypotension that exacerbate secondary brain injury. Data were analyzed using the chi square test of independence to determine whether providers were using the key interventions more consistently after education. To prevent bias, providers were blinded to the fact that data were being collected. Results: Overall, 1.044 trauma patients were assessed. Results appear below. Conclusions:After guideline implementstion, GCS was measured with greater frequency and accuracy. significantly higher percentages of trauma patients had their oxygenation and blood pressure managed appropriately. Significantly lower percentages of patients arrived at the hospital hypoxic or hypotensive. Education and implementation of the BTF guidelines significantly improved the care rendered to trauma patients. All EMS providers should be educated in these potentiially lifesaving guidelines. To go to the web site. click here www.hanleyandbelfus.com  Restoring - Profoundly Brain-Injured Patients CLINICAL GUIDELINES LEAD TO DRAMATIC IMPROVEMENTS IN OUTCOMES September 2002 Mission Hospital Regional Medical Center MISSION VIEJO, CA In 1995, the Brain Trauma Foundation and the American Association of Neurologic Surgeons (AANS) issued a comprehensive set of national clinical guidelines spelling out optimal treatment for severe head injuries. The evidence-based guidelines, which scrupulously analyzed and ranked research in the medical literature based on its scientific validity, directly contradicted a number of long-established medical tenets. The majority of U.S. hospitals have yet to adopt the guidelines, which were revised in 2000. But one unit that embraced the clinical and management challenges posed by the AANS guidelines is the surgical intensive care unit (SICU) at 331-bed Mission Hospital Regional Medical Center, a Level Two Community Trauma Center in Mission Viejo, CA. After carefully crafting and implementing its own "Clinical Guidelines for the Management of Severe Traumatic Brain Injury" (TBI), based on the AANS document and subsequent medical research, the SICU has posted extraordinary improvements in treating a condition that too often results in demoralizingly bad outcomes. In the three-and-a-half years before Mission Hospital adopted its TBI guidelines in June 1997, 43 percent of severely brain-injured patients died, 30 percent ended up with severe disabilities or in a persistent vegetative state, and 27 percent experienced a good outcome or only moderate disabilities. While those numbers were not out of line with national averages for the treatment of TBI, the outcomes were not acceptable to the trauma team at Mission. Within a year after its new guidelines were adopted, the proportion of the SICU’s severe TBI patients achieving good outcomes or only moderate disabilities shot up to 64 percent. Cumulative figures for severely brain-injured patients in the four-and-a-half years since implementation show a mortality rate of 12.6 percent, with 11.6 percent having severe disabilities and 75.8 percent having good outcomes or moderate disabilities — and the proportion achieving good outcomes continues to rise. To state these accomplishments another way, since the guidelines were adopted at Mission, TBI patients have nearly nine times greater odds of a good outcome from treatment than equally injured patients prior to the guidelines— with no significant differences between the groups in other variables that might explain away the results. To go to the web site. click here www.ihi.org/newsandpublications/other/ICU.pdf  Management of severe head injury: Institutional variations in care Critical Care Medicine 2002 August; Vol.30, No 8:1870-1876 From the Department of Surgery (EMB, ABN, GJJ) and the Department of Pediatrics (FPR), University of Washington, Seattle, WA; University HealthSystem Consortium (MM); and Johns Hopkins School of Public Health (EM), Baltimore, MD. Eileen M.Bulger,MD; Avery B.Nathens, MD, PhD MPH; Frederick P. Rivara, MD, MPH; Maria Moore, MPH; Ellen J. MacKenzie, PhD; Gregory J. Jurkovich, MD. Considerable national variation in the care of severely head-injured patients persists. Objective: The purpose of this study was three-fold: a) to examine variations in care of patients with severe head injury in academic trauma centers across the United States; b) to determine the proportion of patients who received care according to the Brain Trauma Foundation guidelines; and c) to correlate the outcome from severe traumatic brain injury with the care received. Design: Retrospective data collection for consecutive patients with closed head injury and long bone fracture admitted over an 8-month period. Setting: Thirty-four academic trauma centers in the United States Patients: All patients admitted with a presenting Glasgow Coma Scale score 8. Measurements and Main Results: Variations in care were assessed, including prehospital intubation, intracranial pressure monitoring, use of osmotic agents, hyperventilation, and computed tomography scan utilization. Aggressive centers were defined as those placing intracranial pressure monitors in >50% of patients meeting the Brain Trauma Foundation criteria for intracranial pressure monitoring. The primary outcome variables were mortality, functional status at discharge, and length of stay. Kaplan-Meier survival analysis was performed for aggressive vs. nonaggressive centers. A Cox proportional hazard model was used to evaluate the association between type of center and mortality rate. Length of stay was evaluated by using linear regression. Results: There was considerable variation in the rates of prehospital intubation, intracranial pressure monitoring, intracranial pressure-directed therapy, and head computed tomography scan utilization across centers. Management at an aggressive center was associated with a significant reduction in the risk of mortality (hazard ratio, 0.43; 95% confidence interval, 0.27-0.66). There was no statistically significant difference in functional status at the time of discharge for survivors. Adjusted length of stay for survivors at aggressive centers was shorter, compared with the length of stay at nonaggressive centers: -6 days (95% confidence interval, -14 to 2 days). Conclusion: Considerable national variation in the care of severely head-injured patients persists. An "aggressive" management strategy is associated with decreased mortality rate for patients with severe head injury, with no significant difference in functional status at discharge among survivors. Key Words: head injury; intracranial pressure monitoring; neurosurgery; traumatic brain injury; Glasgow Coma Scale To go to the web site. click here www.ccmjournal.com  Development and Implementation of a Clinical Pathway for Severe Traumatic Brain Injury The Journal of Trauma Volume 51, Number 2, August 2001 From the Departments of Neurological Surgery (T.W.V., G.H.R., C.B.S.) and General Surgery (D.S.), University of Louisville School of Medicine, and University Health Care (T.W.V., L.M., G.H.R., D.S., C.B.S.), Louisville, Kentucky. Todd W. Vitaz, MD, Laura McIlvoy, RN, MSN, George H. Raque, Md, David Spain, MD, and Christopher B. Shields, MD. Background: Clinical pathways (CPs) have been shown to be beneficial in optimizing patient care and resource use. Methods:A multidisciplinary CP for the treatment of severe traumatic brain injury (Glasgow Coma Scale score of 3-7) was developed. Data from these patients (group I) were collected prospectively and compared with a retrospective database (group II). Results: There were a total of 119 patients managed in conjunction with the CP and 43 patients in the control group. No statistical differences were found between the groups in age, Glasgow Coma Scale score at 24 hours, or Injury Severity Scores. There was a significant decrease in the length of hospital stay, intensive care unit stay, and length of ventilator support in the study group (group I: 22.5, 16.8, and 11.5 days, respectively; group II: 31.0, 21.2, and 14.4 days, respectively; p < 0.03). Conclusion: The use of this CP helped to standardize and improve patient care with fewer complications and a potential cost savings of approximately $14,000 per patient. Key Words: Clinical pathway; Severe traumatic brain injury To go to the web site click here: www.jtrauma.com  The Influence of Prehospital Trauma Care on Motor Vehicle Crash Mortality Antonio Cesar Marson, MD; João Carlos Thomson, MD From the Department of Surgery, State University of Londrina, Londrina, Paraná, Brazil. JOURNAL OF TRAUMA ,May 2001;50:917-921 Background: This study evaluated the impact of the prehospital trauma care system on the mortality from motor vehicle crashes and on the temporal distribution between the crash and related death. Methods: Autopsies performed by the Forensic Medical Institute on all deaths caused by motor vehicle crashes 1 year before and 1 year after the beginning of the prehospital trauma care system were evaluated. : In the first period, 128 deaths occurred, 53.9% of them in the first hour after the crash, 36.7% between the first hour and the seventh day, and 9.4% after 1 week. In the second period, 115 deaths occurred, 40.8% of them in the first hour, 52.2% between the first hour and the seventh day, and 7% after 1 week. Central nervous system injury was the most frequent cause of death in both periods. Mortality was greatest among young people as well as male victims in both periods. Conclusion: After starting the prehospital trauma care system in our city, there was a decrease in the deaths occurring before hospital admission, a change in temporal distribution of deaths, and a reduction in the motor vehicle crash mortality rate. To go to the website click here www.jtrauma.com  The Impact on Outcomes in a Community Hosp. Setting of Using the AANS Traumatic Brain Injury Guide The Journal of Trauma Volume 50, Number 4, April 2001 From Mission Hospital Regional Medical Center (S.P., M.K.B., J.P., T.S., M.B., S.C.), Mission Viejo, and St. Joseph Health System (A.Q.), Sisters of St. Joseph of Orange Corporation, Orange, California. Sylvain Palmer, MD, FACS, Mary Kay Bader, RN, MSN, Azhar Qureshi, Md, DrPh, Jacques Palmer, MD, Thomas Shaver, MD, Marcello Borzatta, MD, and Connie Stalcup, RN, MSN Background: Traumatic brain injury poses a serious public health challenge. Treatment paradigms have dramatically shifted with the introduction of the American Association of Neurologic Surgeons (AANS) Guidelines for the Management of Severe Head Injury. Implementation of the AANS guidelines positively affects patient outcomes and can be successfully introduced in a community hospital setting. Methods: Data were collected both retrospectively and prospectively from the records of all trauma patients between 1994 and 1999. A cohort of 93 patients was selected. Thirty-seven patients were treated before the implementation of the AANS guidelines, and these were statistically compared with 56 patients treated after the implementation of the guidelines. Results: Implementation of the recommendations in the AANS guidelines in a standardized protocol resulted in a 9.13 times higher odds ratio of a good outcome relative to the odds of a poor outcome or death compared with a group managed before the practice change. A Glasgow Coma Scale (GCS) admission score > 8 was associated with a 6.58 times higher odds ratio of a good outcome compared with a GCS admission score 8. Odds ratio of a good outcome decreased by a factor of 0.92 for each year increase in age of patients starting at age 9. A dedicated neurotrauma team and comprehensive treatment algorithms are critical elements to this success. Hospital charges increased by more than $97,000 per patient, but are justifiable in the face of significantly improved outcomes. Conclusion: Implementation of a traumatic brain injury protocol in a community hospital setting is practical and efficacious. Appropriate invasive monitoring of systemic and cerebral parameters guides care decisions. The protocol results in an increase in resource usage, but it also results in statistically improved outcomes justifying the increase in expenditures. Key Words: Traumatic brain injury; Intracranial pressure; Neurotrauma; SjO2 monitoring. To go to the web site click here: www jtrauma.com  Traumatic Brain Injury THE LANCET Saturday 9 September 2000 Vol. 356 No. 9233 :Pages 923-929 Brain Trauma Foundation and Weill Medical College of Cornell University, New York, NY 100221, USA (J Ghajar MD, PhD, FACS) Dr. Jamshid Ghajar Advances in critical care, imaging, and the reorganisation of trauma systems have led to a pronunced reduction in deaths and disability resulting from traumatic brain injury.The decrease in mortality and improved outcome for patients with severe traumatic brain injury over the past 25 years can be attributed to the approach of "squeezing oxygenated blood through a swollen brain". Quantification of cerebral perfusion by monitoring of intracranial pressure and treatment of cerebral hypoperfusion decrease secondary injury. Before the patient reaches hospital, an organised trauma system that allows rapid resuscitation and transport directly to an experienced trauma centre significantly lowers mortality and morbidity. Only the education of medical personnel and the institution of trauma hospital systems can achieve further improvements in outcome for patients with traumatic brain injuries. To go to the Web site click here: www.thelancet.com  Effect of Clinical Pathway for Severe Traumatic Brain Injury on Resource Utilization THE JOURNAL OF TRAUMA: INJURY, INFECTION, AND CRITICAL CARE July 1998;Vol45:pages101-105 This study was funded in part by the Trauma Institute, University of Louisville Hospital. David A. Spain, MD; Laura H. McIloy, RN, MSN; Susanne E. Fix, MD; Eddy H. Carrillo, MD; Phillip W. Boaz, RN, MSN; John E. Harpring, MD; George H. Raque, MD; Frank B. Miller, MD. Background: The usefulness of clinical pathways for the complex trauma patient is unclear. We analyzed the effect of a clinical pathway for severe traumatic brain injury (TBI) on resource utilization. Methods: A clinical pathway for severe TBI (Glasgow Coma Scale (GCS) score < 48 hours were excluded. Results: The clinical pathway was used for 84 patients with severe TBI and compared with 49 historical controls. No differences in Injury Severity Scores (27 vs. 27) or GCS scores at 24 hours (6.2 vs. 6.5) existed between control or pathway patients. There was an overall increase in the mortality rate of pathway patients (from 12.2 to 21.4%), but this was entirely attributable to withdrawal of care that was initiated by family members in patients with an average age of 71 years, an average GCS score of 4.7, and an average Injury Severity Score of 29. Among survivors, pathway patients had a significant decrease in ventilator days (11.5 +/- 0.9 vs. 14.6 +/- 1.2; p < 0.05), intensive care unit days (16.7 +/- 1.0 vs. 21.2 +/- 1.4; p < 0.05), and hospital days (23.4 +/- 1.2 vs. 31.0 +/- 3.0; p < 0.05). There were no differences in the incidence of complications or functional outcomes. Conclusion: The use of a clinical pathway for severe TBI resulted in a significant reduction in resource utilization. This study suggests that clinical pathways may be a useful component of patient care after blunt trauma. Key Words: Traumatic brain injury, Multiple injuries, Clinical pathway. To go to the web site click here: www.jtrauma.com