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Severidad del trauma calculada con registros de necropsia en diferentes tipos de lesión, Bogotá, 2013


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2018-07-04

Directores
Martínez, Víctor M.

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Universidad del Rosario

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Resumen
Introducción. Colombia tiene un Sistema inmaduro de trauma, que influye en la presencia de muertes violentas con trauma severo; nosotros describimos la severidad del trauma calculando el ISS en diferentes tipos de trauma. Método: Con un estudio descriptivo retrospectivo, utilizando datos de necropsias por muertes violentas, realizadas en el Instituto Nacional de Medicina Legal y Ciencias Forenses durante el 2013 en Bogotá, se midió la frecuencia de ISS-75 o menos, caracterizando según variables sociodemográficas y clínicas (Chi-cuadrado, p:<0.05). La probabilidad de identificar características relacionadas con ISS-75 se calculó con un Modelo Bayesiano (MB). Resultados: Se identificaron 443/557 registros de necropsias, 86.7% hombres, edad mediana 33.8 años; la manera de muerte homicidio y el trauma penetrante ocurrieron en 62.8% y 61.6%, respectivamente; el trauma y la muerte nocturnas ocurrieron en 55.5% y 66.9%. Las heridas por proyectil de arma de fuego (HPPAF), contusiones y heridas por arma cortopunzante (HPAC) fueron las principales causas de muerte. La probabilidad de identificar ISS-75 fue 0.9 (MB) y las muertes causadas por HPPAF, HPAC, homicidio, trauma penetrante, entre 28.5-38.5 años y ocurrida en <0.5 horas desde el momento del trauma, aumentaron la probabilidad de identificar un ISS-75. Discusión: Con datos de necropsia se identificó una probabilidad elevada de muertes con ISS-75, posiblemente por la naturaleza del trauma o porque la necropsia identifica lesiones ocultas. Dada la elevada frecuencia de víctimas con ISS-75 y algunos factores relacionados con ISS-75, se deben evaluar determinantes sociales que disminuyan el impacto en materia de Salud Pública
Abstract
Aim: Colombia has an immature trauma system, that could result in the presence of factors related to death with severe injury (Injury Severity Score-ISS>15) or with highest ISS score (75 points); we determinate the probability of death with ISS-75 and factors related. Methods: A retrospective descriptive design it was carried out, using data obtained from necropsy records of violent deaths (veracious method to calculate ISS), make in National Institute of Legal Medicine and Forensic Sciences (INMLCF) during year 2013 (Bogota). Frequency of ISS-75 or minus was determinate and differences among socio-demographics and clinical factor were evaluated (X2, p<0.05). A Bayesian Model (BM) was applied to calculate the probability of ISS-75 among all factors evaluated (Orange – Data Mining Fruitful & Fun). Results: 443/557 necropsy records were selected after apply eligibility criteria; the median age 33.8 years, 86.7% were male; manner of death-homicide and penetrating type were present in 62.8% and 61.6%, respectively; injury occurred at night in 55.5% (CI95%,49.6-61.3%) and death at night in 66.9% (CI95%,61.2-72.2%) of victims (incomplete data). Firearm projectile (42.4%), blunt (35.9%) and cutting-stabbing (18.5%), were the main causes of deaths. According to BM, the probability of death with an ISS-75 was 90%; the factors positively related to ISS-75 were: cause of death (firearm projectile, cutting-stabbing), manner of death (homicide), penetrating injury, 28.5-38.5 years old and death occurred in <0.5 hours after of injury. Discussion: Using necropsy records to calculate ISS, we identify that most of victims had the highest ISS score, probably for the nature of injury or because with a necropsy could be identify the really severity of injury, including hidden or missed injuries. Nevertheless, proportion of victims with ISS-75 is very high, we identify some factors related to this threshold and that may imply an adjustment in the control measures of social determinants of trauma.
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ISS
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ISS
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