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    "titulo" => "Protocolo de asistencia inmediata a los traumatismos de cráneo en los Hospitales de la Comunidad Valenciana"
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        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Presentamos un protocolo de asistencia inmediata de los traumatismos de cr&#225;neo&#44; aprobado por la Conseller&#237;a de Sanidad y Consumo de la Generalidad Valenciana y elaborado por los responsables de las &#225;reas de Urgencia y de los Servicios de Neurocirug&#237;a implicados&#46; Los objetivos son aumentar la calidad de la atenci&#243;n a los traumatizados de cr&#225;neo&#44; evitar las consultas de urgencia innecesarias al neurocirujano y reducir en lo posible el n&#250;mero de traslados interhospitalarios&#46; Est&#225; dise&#241;ado para que pueda ser realizado en un impreso estructurado&#46; Todos los pacientes se eval&#250;an con anamnesis&#44; exploraci&#243;n f&#237;sica y neurol&#243;gica&#44; puntuaci&#243;n en la escala de coma de Glasgow y radiograf&#237;a simple de cr&#225;neo&#46; Seg&#250;n el resultado de estas pruebas se decide el destino inmediato del enfermo seg&#250;n la siguiente clasificaci&#243;n en 4 grados&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">Grado 3&#58;</span><p id="par0005" class="elsevierStylePara elsevierViewall">Se avisa urgentemente al neurocirujano de guardia&#44; o se env&#237;a al enfermo urgentemente al hospital con neurocirug&#237;a de referencia&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">Grado 2&#58;</span><p id="par0010" class="elsevierStylePara elsevierViewall">Se practica una tomograf&#237;a axial computada &#40;TAC&#41; cerebral de urgencia&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">Grado 1&#58;</span><p id="par0015" class="elsevierStylePara elsevierViewall">Se ingresa en el propio hospital para ser sometido a observaci&#243;n neurol&#243;gica&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">Grado 0&#58;</span><p id="par0020" class="elsevierStylePara elsevierViewall">Se remite a su domicilio&#44; para ser sometido a observaci&#243;n por parte de su familia&#46;</p></li></ul></p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Los enfermos de grado 2&#44; seg&#250;n el resultado de la TAC&#44; pueden pasar a ser de grado 1&#44; 2 &#243; 3&#46; El grado 2 tras la pr&#225;ctica de la TAC se redefine como el paciente que debe ingresar en UCI sin indicaci&#243;n quir&#250;rgica de urgencia&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Adem&#225;s de la descripci&#243;n y el fundamento del protocolo&#44; se presenta el resultado de un estudio retrospectivo sobre los siete primeros meses de su aplicaci&#243;n&#46; Este ha sido una disminuci&#243;n del n&#250;mero de consultas con el neurocirujano de guardia de m&#225;s del 85&#37;&#46; No se han registrado lesiones o complicaciones que no hayan sido atendidas por un neurocirujano en el momento adecuado&#46; Por el contrario&#44; se ha reducido significativamente el n&#250;mero de reingresos de pacientes inicialmente dados de alta&#46;</p>"
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        "titulo" => "Summary"
        "resumen" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A protocol for emergency triage of head injuries is presented&#46; This was approved by the Health Department of the Valencian Autonomous Government and designed by the representatives of the involved Neurosurgical Services and Emergency areas&#46; Its objectives are to increase the quality of clinical assistance&#44; to avoid the unnecesary emergency neurosugical consultations and to reduce the interhospital transfer of patients&#46; It is designed to be performed by the medical personnel of the hospital emergency areas and it is included in a preprinted structured form&#46; All patients are evaluated with clinical history&#44; physical and neurological examination&#44; Glasgow coma score and plain xray skulI films&#46; Depending on the results&#44; they are classified into one of a four grade triage scale&#58;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">Grade 3&#58;</span><p id="par0025" class="elsevierStylePara elsevierViewall">Emergency consultation with the neurosurgeon or referral to a neurosurgical service&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">Grade 2&#58;</span><p id="par0030" class="elsevierStylePara elsevierViewall">Emergency head CT sean&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">Grade 1&#58;</span><p id="par0035" class="elsevierStylePara elsevierViewall">Hospital admission for neurological observation&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">Grade 0&#58;</span><p id="par0040" class="elsevierStylePara elsevierViewall">Hospital discharge&#44; to be controlIed by the patient&#39;s family at home&#46;</p></li></ul></p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Patients classified as grade 2 are reclassified into grade 1&#44; 2 &#40;ICU admission&#41; or 3 depending on the results of the CT sean&#46; Grade 2 after the CT sean is redefined as those patients requiring ICU admission without indication for emergency surgery&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Along with the description and foundation of the protocol&#44; the results of a retrospective study of the first seven months of its application is presented&#46; There was an 85&#37; reduction of the emergency neurosurgical consultations&#44; while no complications without an appropriate neurosurgical consultation were detected&#46; On the contrary&#44; a significative reduction of hospital readmissions was recorded&#46;</p>"
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Vol. 6. Núm. 4.
Páginas 259-272 (enero 1994)
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Vol. 6. Núm. 4.
Páginas 259-272 (enero 1994)
Protocolo de asistencia inmediata a los traumatismos de cráneo en los Hospitales de la Comunidad Valenciana
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2797
J.A. Barcia, J.M. González-Darder, J.V. Barberá-Alacreu, J. Cabanes, J.L. Gil-Salú, J.L. Llácer, J.L. Barcia-Salario
Servicios de Neurocirugía de los Hospitales General de Castellón, General Universitario de Valencia, La Fé de Valencia y Clínico Universitario de Valencia
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Resumen

Presentamos un protocolo de asistencia inmediata de los traumatismos de cráneo, aprobado por la Consellería de Sanidad y Consumo de la Generalidad Valenciana y elaborado por los responsables de las áreas de Urgencia y de los Servicios de Neurocirugía implicados. Los objetivos son aumentar la calidad de la atención a los traumatizados de cráneo, evitar las consultas de urgencia innecesarias al neurocirujano y reducir en lo posible el número de traslados interhospitalarios. Está diseñado para que pueda ser realizado en un impreso estructurado. Todos los pacientes se evalúan con anamnesis, exploración física y neurológica, puntuación en la escala de coma de Glasgow y radiografía simple de cráneo. Según el resultado de estas pruebas se decide el destino inmediato del enfermo según la siguiente clasificación en 4 grados:

  • Grado 3:

    Se avisa urgentemente al neurocirujano de guardia, o se envía al enfermo urgentemente al hospital con neurocirugía de referencia.

  • Grado 2:

    Se practica una tomografía axial computada (TAC) cerebral de urgencia.

  • Grado 1:

    Se ingresa en el propio hospital para ser sometido a observación neurológica.

  • Grado 0:

    Se remite a su domicilio, para ser sometido a observación por parte de su familia.

Los enfermos de grado 2, según el resultado de la TAC, pueden pasar a ser de grado 1, 2 ó 3. El grado 2 tras la práctica de la TAC se redefine como el paciente que debe ingresar en UCI sin indicación quirúrgica de urgencia.

Además de la descripción y el fundamento del protocolo, se presenta el resultado de un estudio retrospectivo sobre los siete primeros meses de su aplicación. Este ha sido una disminución del número de consultas con el neurocirujano de guardia de más del 85%. No se han registrado lesiones o complicaciones que no hayan sido atendidas por un neurocirujano en el momento adecuado. Por el contrario, se ha reducido significativamente el número de reingresos de pacientes inicialmente dados de alta.

Palabras clave:
Traumatismos craneoencefálicos
Protocolos clínicos
«Triage»
Urgencias quirúrgicas
Summary

A protocol for emergency triage of head injuries is presented. This was approved by the Health Department of the Valencian Autonomous Government and designed by the representatives of the involved Neurosurgical Services and Emergency areas. Its objectives are to increase the quality of clinical assistance, to avoid the unnecesary emergency neurosugical consultations and to reduce the interhospital transfer of patients. It is designed to be performed by the medical personnel of the hospital emergency areas and it is included in a preprinted structured form. All patients are evaluated with clinical history, physical and neurological examination, Glasgow coma score and plain xray skulI films. Depending on the results, they are classified into one of a four grade triage scale:

  • Grade 3:

    Emergency consultation with the neurosurgeon or referral to a neurosurgical service.

  • Grade 2:

    Emergency head CT sean.

  • Grade 1:

    Hospital admission for neurological observation.

  • Grade 0:

    Hospital discharge, to be controlIed by the patient's family at home.

Patients classified as grade 2 are reclassified into grade 1, 2 (ICU admission) or 3 depending on the results of the CT sean. Grade 2 after the CT sean is redefined as those patients requiring ICU admission without indication for emergency surgery.

Along with the description and foundation of the protocol, the results of a retrospective study of the first seven months of its application is presented. There was an 85% reduction of the emergency neurosurgical consultations, while no complications without an appropriate neurosurgical consultation were detected. On the contrary, a significative reduction of hospital readmissions was recorded.

Key words:
Head injuries
Clinical protocols
Triage
Surgical emergencies

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