Introduction: V iolence c ontinues t o b e o ne o f t he l eading causes of mortality in Colombia. We sought to describe and analyze a series of trauma patients that required intensive unit care in a high-complexity center in Cali, Colombia. Materials and methods: Using data from the Panamerican Trauma Registry, we reviewed all victims of trauma that were admitted with an injury severity score higher or equal to 9 or with at least 6 hours of observation in the emergency room and required intensive care unit admission from January 2002 to December 2014. Results: A total of 3,791 patients were included in the registry during the period observed, of which 1,202 corresponded to patients that required intensive care unit admission; 78.2% were male. Mean (standard deviation) age was 33.5 (21) years. A total of 43.1% suffered trauma with an injury severity score higher or equal to 15; 16.4% suffered traumatic brain injury and 35.7% suffered penetrating injuries. A total of 840 patients were taken to emergency surgery and 788 required mechanical ventilation. Median (interquartile range) of intensive care unit stay was 4 (2–7) days. Mortality in the intensive care unit was 11.2 vs 4.8 outside the intensive care unit. Multivariate regression analysis showed that factors associated with intensive care unit admission were a Glasgow coma scale <13, an injury severity score >15, the presence of polytrauma or polytrauma without traumatic brain injury, traumatic brain injury alone, and the presence of gunshot wounds. Conclusion: Our multivariate analysis showed several factors associated with intensive care unit admission in a large trauma population.

Introduction: Youth violence has been classified as a public health problem worldwide, due to its high incidence, high costs to health system and society in term of lost life years. Since 2012 a public policy has been implemented to decrease youth violence index, but the results have not been assessed from the perspective of health care. Objective: To describe the characterstics of youth violence in the period 2012 to 2014, in a public hospital level I of Cali, Colombia, after the implementation of a public policy. Materials and methods: Retrospective cohorts study. From International Trauma Register of Hospital Universitario del Valle, all consecutive patients between 14 to 26 years who entered with any external cause injury associated with violence, were included for study. Results: From the International Trauma Register, 32% (7715/24084) cases were reported as trauma injury in patients between 14 to 26 years old, and of these, 37.33% (2880/7715) were associated with violence. During 2012, cases were more frequently reported in the age group of 14 to18 years, and in 2013 and 2014, in 19 to 22 years age group. The main trauma type was penetrating (81.2%): firearm (54.1%) and thenwhite weapon (25.2%). There was alcohol consumption on 17.9%, and 29.8% of psychoactive substances. Youth violence rate changed significantly from 55.7% in 2012 to 37.8% in 2014, (p < 0.0001), and this resulted in the decrease of global mortality rate from 7.4% to 3.3%, p = 0.0349 respectively. Conclusion: Population between 14 to 26 years old had a significant decrease in annual incidence of trauma injuries between 2012 and 2014 (p < 0.0001) and a decrease in global mortality rate. Apparently, the observed trend could be explained by the impact generated due to the implementation of the public policy.

Introduction: The approach of penetrating neck trauma has evolved over time, from considering the expectant management in the 1950s, going through exploratory cervicotomy in the 1960s and 1970s, and later with the advanced technology to the selective management by zones or “no zone approach” (according to the symptomatology of the patient). Design: This is a descriptive cross-sectional observational study in 51 patients aged 18 years or older with penetrating neck trauma. Results: The median age was 29 years, and the majority of them were male (92.3%). Left laterality and zone 2 were the most common locations of the injury in 48.1 and 49% respectively. Stab wounds were the main cause of trauma (86.27%); 80.39% of the patients underwent neck angiography; 19.02% (n = 10) of the patients showed any hard signs of aerodigestive injury and were taken to surgery rooms. Within the intraoperative findings, 7 patients had vascular injury and 1 had a hypopharyngeal lesion. There were no airway injuries; 53% of the patients had associated injuries within which the upper limb, thorax, and face were the most frequent. Conclusions: Penetrating neck trauma is common in our environment; most patients come hemodynamically stable, allowing a selective evaluation to be made according to the affected area or symptoms. The most frequent surgical finding was venous vascular lesion.

Objective: To identify the expense that was generated in the care of polytraumatized patients in the General Surgery service at the General Hospital “Dr. Gustavo Baz Prada” in Nezahualcóyotl, State of Mexico, in a period of 1 year (January 1, 2015–December 31, 2015), in Mexican pesos (PM). Design: Economic evaluation type estimation of costs. Data source:Registry of Traumatized Patients, clinical records. Target population: All patients who attended the General Surgery service of our hospital and who required hospitalization and/or surgical management for 1 year. Time horizon: Follow-up during the hospitalization, for a maximum of 5 months. Perspective: Provider of health services. Materials and methods: A micro-costing study in which the direct medical costs generated from the care of traumatized patients treated in the General Surgery service who deserved surgical management and/or hospitalization was done. Variables, such as age, gender, days of hospital stay and in the intensive care unit (ICU), cost of care, recovery fee, and intentionality of the injury were analyzed. Results: A total of 122 patients who required surgical and/ or hospital management were counted; 109 patients were male (89.2%) with a mean of 28 years (22–37), 13 female (10.7%) with a median of 29 years (27–40). An overall cost of $4,261,624.60 was estimated. Average expenditure per patient was $24,430.3 ($18,427.2–37,100.00). The overall recovery fee was $ 235,765.00, and the average recovery fee per patient was $1,755.0 PM ($810.00–3,332.0). A total of 77% (n = 94) of the patients treated presented injuries related to suspected violence, generating a total of $3,339,054.9 (78% of the global expenditure). Conclusion: The care of traumatized patients generates considerable revenue in our hospital. Violence-related injury care generates the highest percentage of this expenditure.

Background: The incidence of penetrating abdominal trauma (PAT) has increased in recent decades as a consequence of the violence, becoming a main reason for consultations in emergency services. Its evaluation and management are defiant and evolve over time. The objective is to ratify the safety of the nonoperative management (NOM) of PAT, describe the clinical results and characteristics of patients with PAT who were offered NOM in a first-level hospital. Study design: This is a prospective cohort study conducted during February and May 2016. It includes all patients with PAT admitted to first-level public hospital. A NOM protocol was established in hemodynamically stable patients; hemodynamic monitoring and physical examination were done every 4 hours, tomography according to case; This study was approved by institutional ethics committee. Statistical analysis: chi-square test or Wilcoxon according to variable, significance 0.05. Results: A total of 46 patients were registered, 91.30% (n = 42) were men, with mean age 25.6 ± 8.6 years; 50% gunshot and 50% stab wound (SW); exploratory laparotomy was done in 52.2% (n = 24), unnecessary laparotomy 2.2% (n = 1); about 47.82% (n = 22) were MNO; of these, 77.27% (n = 17) was for SW and 22.72% (n = 5) for gunshot. Mean systolic blood pressure 90 (90–91) mm Hg, hazard ratio 83 (73–88), relative risk 19 (18–20). The injury location: thoracoabdominal 50% (n = 11), 36.36% (n = 8) anterior abdomen, 13.64% (n = 3) posterior abdomen and flanks; 22.72% (n = 5) required abdominal tomography; 50% (n = 11) had accompanying injuries. Mean hospital stay was 2 (2–3) days. Mortality and complications at the first month posttrauma were 0% (n = 0). Conclusion: The NOM of PAT is safe if you make a strict selection and monitoring protocol. Patients with PAT and without hemodynamic compromise involvement were successfully submitted to NOM and without any complication at 30 days, independently of the injured abdominal region. The abdominal CT scan with contrast should not be routine. Avoiding unnecessary surgery decreases the morbidity and mortality and hospital costs as long as it is first-level hospital and has a trauma and emergency surgeon available.

Aim: To evaluate the efficacy of nonoperative treatment in blunt trauma liver. Materials and methods: A 1-year prospective study was conducted in the Department of Surgery, Indira Gandhi Medical College (IGMC), Shimla, Himachal Pradesh, India, on 31 patients with blunt trauma with liver injuries proved on ultrasonography (USG) focused assessment with sonography for trauma (FAST) and contrast-enhanced computed tomography (CECT) abdomen. Once admitted, patients with grades I or II liver injury with no other comorbidities and other associated injuries were managed conservatively. Patients with grades III, IV, or V liver injury or lower grade liver injury with other associated injuries were observed and monitored strictly. Patients were considered a failure if the patient developed signs of peritonitis. Results: Out of 83 patients with blunt abdominal trauma, 31 patients fulfilled the inclusion criteria for nonoperative management (NOM). The incidence of blunt liver trauma (BLT) was 37.34% Out of these, one patient required operative management (OM). Average age was 27 years. Out of 31 patients, 25 (80.6%) patients were males and 6 (19.4%) were females. Totally, 24 (77.4%) patients acquired injury due to road side accidents. Totally, 25 (80.6%) patients reported to the hospital within 6 hours of injury and 5 (16.1%) within 7 to 12 hours. On grading of liver injuries depending on CECT findings, 6 (19.4%) patients presented with grade I injury, 7 (22.6%) patients with grade II injury, 11 (35.5%) with grade III injury, and 6 (19.4%) with grade IV injury. Grade V injury was noted in 1 (3.2%) patient. Sixteen patients required blood transfusion. The NOM was successful in 96.8% of the patients. Liver-specific success rate of NOM was 100%. Mean hospital stay was 10.8 days for NOM. Conclusion: Patients of blunt liver injury who are hemodynamically stable should be considered for NOM. Clinical significance: The NOM is a highly feasible and safe method for being cost-effective, requiring shorter hospital stay, and avoiding high morbidity.

Background: We reviewed the orthopedic intervention in patients with blunt aortic injury over a 17-year period retrospectively, in order to evaluate the impact of aortic treatment options under the situation of concomitant orthopedic injuries. Materials and methods: Information on demographics, mechanisms of trauma, injury scores, diagnostic tools, orthopedic procedures, aortic procedures, associated injuries, and hospital events was collected retrospectively from a tertiary trauma center. We applied t test for continuous data, X² test for categorical data, and nonparametrical tests for data not following normal distribution. Adjusted hazard ratio, 95% confidence intervals, and p-values were derived from previously analyzed results. Results: Between October 1995 and June 2012, there were 59 (59/88, 67%) patients with concomitant fractures among 88 patients, who have been proven to have blunt traumatic aortic injury (BTAI) in our institution. Among them, 31 underwent no orthopedic procedure (group I), and 28 received orthopedic fixation for functional restoration (group II). Among the two groups, group I had higher mortality rate despite an earlier documentation of aortic lesions at arrival. For the patients in group II, 13 of them have received open aortic surgery and 6 of them have received endovascular aortic repair while the rest of the patients had minor BTAI, who were not indicated for invasive treatment. We compared demographic data, prognosis, and the timing of orthopedic procedures after aortic repair of patients with open aortic surgery (n = 13) and endovascular aortic repair (n = 6) to evaluate the impact of different aortic managements on these parameters. There was no difference between gender, age, injury severity, death, interval between injury to emergency room (ER), interval of trauma to orthopedic procedures, ER, intensive care unit and hospital stay. Nonetheless, patients treated with endovascular aortic repair tended to receive orthopedic procedure earlier after aortic intervention in comparison with those with open aortic surgery (2.2 ± 2.6 vs 6.9 ± 5.7 days, p = 0.03). Conclusion: Patients with multiple traumas including BTAI had better outcome when they could be treated for aortic lesions operatively. Patients with BTAI who were treated with endovascular method tended to receive faster orthopedic corrections in comparison with patients who were treated with open aortic surgery.

Introduction: Duodenal injuries from penetrating trauma are infrequent, and most are from gunshot wounds. They constitute a therapeutic challenge and the current evidence for recommending complex repair procedures continues to be scarce. Objectives: To review the surgical management of a series of patients with penetrating duodenal trauma assisted in the Emergency Department of Hospital Maciel in the period 2009 to 2016. Materials and methods: Retrospective, observational, and descriptive study. The study included 16 patients, and obtained data from the clinical histories. The main endpoints were: type of injury according to American Association for the Surgery of Trauma–Organ Injury Scaling classification, lesion association, type of duodenal repair, and repair failure. Results: The mean age was 25.6 years; 15 patients had type II lesions and 1 had type IV lesion. All were associated with other intra-abdominal injuries. The initial management was duodenorrhaphy in all cases, requiring duodenal exclusion later in a patient. In one case there was a failure of duodenorrhaphy and 5 patients died (31%). Discussion: Duodenorrhaphy is the procedure of choice for most duodenal lesions. Current evidence is not yet sufficient to recommend or abandon the use of adjacent techniques of greater complexity to decrease the rate of complications of duodenal repair. Conclusion: O ur s eries s howed r esults s imilar t o t hose described in the literature, with a high percentage of resolution by simple raphy, associated injuries in all cases, and bimodal mortality curve.

Introduction: In 2013, the Turkish Statistical Institute Bulletin reported 3,685 people killed and 274,829 injured in 161,306 traffic collisions. The aim of this study was to determine medical doctors’ general attitudes, awareness, and knowledge regarding trauma. Methods: A s urvey q uestionnaire w as c onducted b etween February 2015 and April 2015. It comprised three demographic, seven attitude, and eight knowledge questions on trauma. Physicians were stratified as: group I—general practitioners; group II—surgical residents; group III—surgeons; group IV— academic surgical specialties. Results: A total of 476 (75%) of the 636 questionnaires were completed and analyzed. Median age was 36 years. General practitioners (38.7%) and surgeons (38.7%) represented the majority of respondents. Respondents’ medium level of confidence rate in performing life-saving interventions was 98 (53%), 25 (34%), 44 (24%), and 8 (24%) respectively. Moreover, 161 (88%), 68 (92%), 162 (88%), and 32 (94%) of respondents failed to choose the right order of prioritization in a threecasualty scenario respectively. Only 36 (20%) in group I, 22 (30%) in group II, 40 (22%) in group III, and 7 (21%) in group IV correctly estimated the percentage of blood loss in Class III hemorrhagic shock. Conclusions: The current study suggests that Turkey still requires a well-organized trauma system. Further studies are required to assess the capabilities of Turkish Emergency System.

Objective: Blunt esophageal trauma is a rare entity. The aim of this study is to examine current management strategies, and determine risk factors associated with complications and mortality in the National Trauma Data Bank (NTDB). Materials and methods: Using the NTDB from 2012, we identified adult patients who suffered blunt esophageal trauma. Patients were categorized undergoing early vs delayed management of esophageal injuries. Data collected included age, injury severity score (ISS), abbreviated injury score, length of stay, ventilation days, systolic blood pressure (SBP), time to procedure, comorbidities, esophageal-related procedures, complications, and disposition. Univariate and multivariable analysis were conducted to identify significant predictors of complications and mortality. Results: We identified 160 adult patients with blunt esophageal injuries in the NTDB, of which 78 patients (49%) had data on specific management of the esophageal injury. Forty-five patients (58%) underwent early operative management and 33 (42%) had delayed operative management. Of patients in the early group, 31 (63%) had primary repair, 11 (24.4%) esophageal graft, and 3 (6.6%) esophageal tube placement. In the delayed operative group, 4 (12%) had primary repair, 14 (42%) esophageal graft, 10 (30%) esophageal tube placement, and 5 (15%) had drainage. Early diagnosis was associated with a higher definitive primary repair rate. Mortality was similar between both groups (15.5 and 24.4%, p = 0.336). The delayed group was associated with increased risk of pulmonary complications. Both groups were similar in age, gender, and race. Significant predictors of esophageal-related complications were Abbreviated Injury Scale (AIS) .3 and ISS. Conclusion: Although rare, high index of suspicion for early detection of blunt esophageal injury must be maintained. Early operative management was associated with an increased rate of primary repair of the injury and decreased pulmonary complications.

Introduction: In the world, the violence against women and femicide is an important public health problem and a violation of the human rights, making the women more vulnerable and affecting their physical integrity and mental health. In this way, mechanisms have been established to warrant the gender equality. This study aims to describe the characteristics of external cause of injuries against women and femicide in a first level public hospital of Cali, Colombia between 2012–2014 before and after the implementation of a national public policy of gender equality and deduce about the possible impact on the incidence of these injuries Design and methods: Retrospective observational cohort study. The International Trauma Registry of the Hospital Universitario del Valle was used. It includes all records of women between 14 and 50 years, with trauma injury in the period 2012–2014. A descriptive analysis was performed according to demographic, clinical, and mortality variables. Results: In total of 23,945 records, 3245 (13.6%) are women between 14 and 50 years age with some type of trauma, mean age 29.3 ± 2 years; 57.6% between 19 and 35 years. The injuries associated with an intentionality have been reported in 542 (16.7%) cases. The mortality with intentionality was 3.9% (n = 21). The annual mortality rate for 2012, 2013 and 2014 was 1.2%, 0.8% and 0.3% respectively (p < 0,0001). Conclusion: Femicide was present in 3.9% of cases, in a higher frequency associated to gunshot. However, after the implementation of public policy in 2012, a significant reduction of annual mortality (1.2% vs 0.8% vs 0.3%, p<0,0001) has been observed. It allows to infer that the implementation of the public policy of gender equality facilitated this tendency

Introduction: Rider education that stresses helmet usage has not reached the scooter population. The impression that scooters are a safe, low-speed means of transport often results in poor helmet compliance. However, severe head injuries are common in scooter crashes. We chose to evaluate whether helmet use in the scooter rider population is associated with a reduction of traumatic brain injury (TBI), skull, and c-spine injuries. Materials and methods: A retrospective analysis of our Level I trauma center registry was performed identifying all patients treated for scooter crash-related injuries from 2003 to 2015. Helmet data were collected from Emergency Medical Services, police, and hospital records. Statistical analysis was performed using ÷2, Mann–Whitney U-test, and z-test for proportions. Results: Of 1,006 scooter crash patients, 13.3% of patients wore helmets at the time of their crash. Their mean age was 34.2 ± 16 years with an 80% male population. The Glasgow Coma Scale (GCS) in the unhelmeted group was nominally lower (13.11 ± 3.7) when compared with the helmeted group (13.92 ± 2.8). There were more TBIs (61.6%) in unhelmeted patients vs helmeted patients (36.6%; p < 0.0001). Of all helmeted patients, none presented with epidural hematomas, and helmeted patients suffered significantly fewer subdural hemorrhages, subarachnoid hemorrhages, and skull fractures when compared with unhelmeted patients (p = 0.008, p = 0.005, p < 0.0001 respectively). Mortality was 4.0% in the unhelmeted group and 1.5% in the helmeted group (p = 0.215), but this difference did not reach statistical significance. Conclusion: Helmet use significantly lowers the risk of TBI in scooter crashes. Additional multicenter trials are needed to study a possible survival benefit associated with helmet use. Educational and community outreach programs are needed urgently to improve helmet use compliance among scooter riders in order to reduce the TBI incidence.

Introduction: Splenic abscess is a rare and highly morbid extracardiac manifestation of infective endocarditis (IE) and has only been described in small case series in the literature. Emergency surgeons are often consulted for splenectomy; however, the optimal timing (before or after valve) of this intervention remains unclear. We hypothesized that definitive valve intervention, prior to splenectomy, would lead to superior patient outcomes. Study design: A retrospective review of patients with IE and splenic abscess from June 2011 to June 2016 was performed at a quaternary referral center in the United States. Demographics, comorbid conditions, echocardiography results, intensive care unit (ICU)/hospital length of stay, operative interventions, splenectomy and valve replacement, and complications were collected. Patients were divided based on operation performed first: spleen first (SF) or valve first (VF). The primary outcome was mortality, with secondary outcomes including in-hospital morbidity. Results: Ten patients met criteria for inclusion (8 SF, 2 VF). Median age was 45 years. About 90% were male, 60% were active intravenous drug abusers, and 100% had bacteremia (most commonly Enterococcus), with 50% of the patients having single-valve disease and 50% of the patients multivalvular disease. Total 90% had preserved cardiac function [ejection fraction (EF) > 40%]. All patients had splenic abscess diagnosed on HD 1, with 40% undergoing preoperative angioembolization. There was no difference in mortality between the groups (SF 25% vs VF 0%). There was no difference in the splenectomy portion of the operation, regardless of preoperative angioembolization. Conclusions: Representing the largest modern case series on the topic, a 25% overall 6-month mortality rate was observed; however, there was no difference in the order of operation noted in our population. Splenic abscess in conjunction with IE is a highly mortal combination; therefore, a large-scale multi-institutional approach should be utilized to delineate this population and address the order of operation as well as the role of splenic angioembolization in this subset of patients.