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    "titulo" => "Trauma craneal grave. Base datos Hospital 12 de Octubre. I Descripción base datos. Evolución final"
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        "titulo" => "Severe head injury&#46; Hospital 12 de Octubre data base&#46; Description of the data and analysis of the final outcome"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Creaci&#243;n de una base de datos de pacientes que han sufrido un traumatismo craneal grave &#40;TCEG&#41;&#44; que permita realizar una adecuada evaluaci&#243;n cl&#237;nico-radiol&#243;gica&#44; identificar factores pron&#243;sticos y establecer las bases para futuros ensayos cl&#237;nicos&#46;</p> <span class="elsevierStyleSectionTitle">Material y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se incluyen 810 pacientes con TCEG&#44; ingresados consecutivamente en Hospital 12 de Octubre&#44; entre 1987 y 1992&#46; Unicamente se excluyeron pacientes menores de 15 a&#241;os y aquellos con herida por arma de fuego o con grave inestabilidad hemodin&#225;mica a los que no se pudo realizar TC antes del fallecimiento&#46; Se eligi&#243; para la evaluaci&#243;n cl&#237;nica inicial la mejor puntuaci&#243;n en la Escala de Coma de Glasgow &#40;ECG&#41;&#46; Se definen las distintas variables demogr&#225;ficas&#44; cl&#237;nicas&#44; radiol&#243;gicas y de monitorizaci&#243;n&#44; correlacion&#225;ndose &#233;stas con la evoluci&#243;n final&#46; Comparamos nuestros resultados con otras series actuales de manejo del TCEG&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La mortalidad global fue del 49&#44;5&#37;&#44; siendo &#233;sta m&#225;s frecuente en pacientes que sufrieron ca&#237;da &#40;62&#44;5 &#37;&#41;&#44; pacientes con una puntuaci&#243;n en la Escala de Coma de Glasgow tras resucitaci&#243;n de 3 &#40;93&#37;&#41; &#243; 4 &#40;73 &#37;&#41;&#44; midriasis bilateral &#40;94&#44;8 &#37;&#41;&#44; TC al ingreso Tipo IV &#40;85&#44;4&#37;&#41; o Tipo VI &#40;100&#37;&#41; de la clasificaci&#243;n del &#8220;Traumatic Coma Data Bank&#8221; &#40;TCDB&#41; y en pacientes en los que se evacu&#243; un hematoma subdural &#40;66&#44;6&#37;&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Una base de datos de pacientes con TCEG&#44; recogida de forma &#8220;estandarizada&#8221;&#44; con variables claramente definidas&#44; con un n&#250;mero amplio de casos&#44; ofrece la posibilidad de mejorar el conocimiento de esta patolog&#237;a&#46; Al comparar la evoluci&#243;n final en series con un elevado n&#250;mero de casos&#44; se ha encontrado que existe una gran variabilidad&#44; dependiendo &#233;sta fundamentalmente de las caracter&#237;sticas y definici&#243;n de las variables empleadas para describir la poblaci&#243;n incluida en el estudio&#46;</p>"
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To create a Data Base of patients with severe head injury &#40;SHI&#41;&#44; that allows an appropiate clinical and radiological evaluation&#44; the definition of prognostic factors and setting the basis for prospective clinical trials&#46;</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">810 patients with SHI consecutively admited to the Hospital &#8220;12 de Octubre&#8221;&#44; between 1987 and 1992 were included&#46; Patients under 15 years of age and those with gunshot wounds or severe hemodynamic unstability&#44; precIuding CT scan examination before death&#44; were excIuded&#46; The most relevant clinical and radiological characteristics were sharply defined&#44; and correlated with the final outcome&#46; Our results are compared with other large series of SHI reported in the literature&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Overall mortality rate was 49&#44;5&#37;&#46; Fatal outcome was more frequent in patients suffering falls &#40;62&#44;5&#37; mortality&#41;&#44; patients with a GCS score of 3 &#40;93 &#37;&#41;&#44; or 4 &#40;73 &#37;&#41;&#44; patients with bilateral abnormal pupils after resuscitation &#40;94&#44;8 &#37;&#41;&#44; patients showing midline shift in the initial CT scan &#40;85&#44;4&#37;&#41; or non-evacuated mass &#40;100&#37;&#41; and in patients operated for a subdural hematoma&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A properly collected data base with sharply defined variables and an appropriate number of cases may improve our understanding of the clinical profile and the physiopathology of SHI&#46; When comparing large series of SHI&#44; we found marked differences in the final outcome&#44; which seem to be due to the great variability in inclusion criteria and thus the profile of the population of patients included in those studies&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara">G&#243;mez&#44; P&#46;A&#46;&#59; Lobato&#44; R&#46;D&#46;&#59; Oonz&#225;lez&#44; P&#46;&#59; Boto&#44; O&#46;R&#46;&#59; Lama&#44; A&#46; de la&#59; Cruz&#44; F&#46;J&#46; de la&#58; Trauma craneal grave&#46; Base datos Hospital 12 de Octubre I&#46; Descripci&#243;n base datos&#46; Evoluci&#243;n final&#46; Neurocirug&#237;a 1999&#59; 10&#58; 297&#8211;308&#46;</p>"
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Vol. 10. Núm. 4.
Páginas 297-308 (enero 1998)
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Vol. 10. Núm. 4.
Páginas 297-308 (enero 1998)
Trauma craneal grave. Base datos Hospital 12 de Octubre. I Descripción base datos. Evolución final
Severe head injury. Hospital 12 de Octubre data base. Description of the data and analysis of the final outcome
Visitas
2095
P.A. Gómez, R.D. Lobato, P. González, G.R. Boto, A. de la Lama
Servicio de Neurocirugía. Hospital 12 de Octubre. Madrid
E.J. de la Cruz*
* Servicio de Epidemiología Clínica. Hospital 12 de Octubre. Madrid
Este artículo ha recibido
Información del artículo
Resumen
Objetivo

Creación de una base de datos de pacientes que han sufrido un traumatismo craneal grave (TCEG), que permita realizar una adecuada evaluación clínico-radiológica, identificar factores pronósticos y establecer las bases para futuros ensayos clínicos.

Material y métodos

Se incluyen 810 pacientes con TCEG, ingresados consecutivamente en Hospital 12 de Octubre, entre 1987 y 1992. Unicamente se excluyeron pacientes menores de 15 años y aquellos con herida por arma de fuego o con grave inestabilidad hemodinámica a los que no se pudo realizar TC antes del fallecimiento. Se eligió para la evaluación clínica inicial la mejor puntuación en la Escala de Coma de Glasgow (ECG). Se definen las distintas variables demográficas, clínicas, radiológicas y de monitorización, correlacionándose éstas con la evolución final. Comparamos nuestros resultados con otras series actuales de manejo del TCEG.

Resultados

La mortalidad global fue del 49,5%, siendo ésta más frecuente en pacientes que sufrieron caída (62,5 %), pacientes con una puntuación en la Escala de Coma de Glasgow tras resucitación de 3 (93%) ó 4 (73 %), midriasis bilateral (94,8 %), TC al ingreso Tipo IV (85,4%) o Tipo VI (100%) de la clasificación del “Traumatic Coma Data Bank” (TCDB) y en pacientes en los que se evacuó un hematoma subdural (66,6%).

Conclusiones

Una base de datos de pacientes con TCEG, recogida de forma “estandarizada”, con variables claramente definidas, con un número amplio de casos, ofrece la posibilidad de mejorar el conocimiento de esta patología. Al comparar la evolución final en series con un elevado número de casos, se ha encontrado que existe una gran variabilidad, dependiendo ésta fundamentalmente de las características y definición de las variables empleadas para describir la población incluida en el estudio.

Palabras clave:
Trauma craneal grave
Base datos
Evolución final
Escala de Coma de Glasgow
Tomografía computerizada
Abstract
Objective

To create a Data Base of patients with severe head injury (SHI), that allows an appropiate clinical and radiological evaluation, the definition of prognostic factors and setting the basis for prospective clinical trials.

Methods

810 patients with SHI consecutively admited to the Hospital “12 de Octubre”, between 1987 and 1992 were included. Patients under 15 years of age and those with gunshot wounds or severe hemodynamic unstability, precIuding CT scan examination before death, were excIuded. The most relevant clinical and radiological characteristics were sharply defined, and correlated with the final outcome. Our results are compared with other large series of SHI reported in the literature.

Results

Overall mortality rate was 49,5%. Fatal outcome was more frequent in patients suffering falls (62,5% mortality), patients with a GCS score of 3 (93 %), or 4 (73 %), patients with bilateral abnormal pupils after resuscitation (94,8 %), patients showing midline shift in the initial CT scan (85,4%) or non-evacuated mass (100%) and in patients operated for a subdural hematoma.

Conclusions

A properly collected data base with sharply defined variables and an appropriate number of cases may improve our understanding of the clinical profile and the physiopathology of SHI. When comparing large series of SHI, we found marked differences in the final outcome, which seem to be due to the great variability in inclusion criteria and thus the profile of the population of patients included in those studies.

Key words:
Severe head injury
Data bank
Outcome
Glasgow Coma Scale
Computerized tomography

Artículo

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