Fatores associados ao tempo da morte de vítimas de trauma: estudo de coorte retrospectivo
DOI:
https://doi.org/10.5902/2179769247475Palavras-chave:
Ferimentos e lesões, Índices de gravidade do trauma, Autopsia, Fatores de risco, MortalidadeResumo
: Objetivo: identificar os fatores associados ao tempo da morte de vítimas de trauma. Método: coorte retrospectiva que analisou laudos de autópsia de vítimas de trauma admitidas em 2015 no Instituto Médico Legal Central de São Paulo, Brasil. O tempo da morte foi identificado a partir do momento da ocorrência do trauma até a confirmação do óbito. O modelo linear generalizado foi aplicado para análise dos dados. Resultados: entre as 1.500 vítimas fatais (75,7% homens; idade média 49,7 anos), prevaleceram as quedas (33,5%), seguidas das agressões (27,8%). Os fatores associados ao tempo da morte foram número de regiões corporais afetadas (p<0,001), tipo de trauma (p<0,001), sexo (p=0,009), gravidade do trauma segundo New Injury Severity Score (p<0,001), agressões (p<0,001) e lesões autoprovocadas intencionalmente (p<0,001). Conclusão: homens, vítimas de traumas que envolveram intencionalidade de provocar a morte e com elevada gravidade apresentaram tempo de sobrevida reduzido após a(s) lesão(ões).
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Referências
World Health Organization (WHO). WHO Mortality Database [Internet]. Geneva: WHO; 2020 [cited 2020 Jan 20]. Available from: https://www.who.int/data/data-collection-tools/who-mortality-database
Ministério da Saúde (BR), Departamento de Informática do Sistema Único de Saúde (Datasus). Estatísticas Vitais. Óbitos por ocorrência segundo capítulo CID-10 [Internet]. Brasília (DF): Datasus; 2019 [acesso em 2020 jan 20]. Disponível em: http://tabnet.datasus.gov.br/cgi/tabcgi.exe?sim/cnv/obt10br.def
Trunkey DD. Trauma. Accidental and intentional injuries account for more years of life lost in U.S. than cancer and heart disease. Among the prescribed remedies are improved preventive efforts, speedier surgery and further research. Sci Am. 1983;249(2):28-35.
Abbasi H, Bolandparvaz S, Yadollahi M, Anvar M, Farahgol Z. Time distribution of injury-related in-hospital mortality in a trauma referral center in South of Iran (2010-2015). Medicine (Baltimore). 2017;96(21):e6871. doi: https://doi.org/10.1097/MD.0000000000006871
Pfeifer R, Schick S, Holzmann C, Graw M, Teuben M, Pape HC. Analysis of injury and mortality patterns in deceased patients with road traffic injuries: an autopsy study. World J Surg. 2017;41(12):3111-9. doi: https://doi.org/10.1007/s00268-017-4122-4
Valdez C, Sarani B, Young H, Amdur R, Dunne J, Chawla LS. Timing of death after traumatic injury - a contemporary assessment of the temporal distribution of death. J Surg Res. 2015;200(2):604-9. doi: https://doi.org/10.1016/j.jss.2015.08.031
Bardes JM, Inaba K, Schellenberg M, Grabo D, Strumwasser A, Matsushima K, et al. The contemporary timing of trauma deaths. J Trauma Acute Care Surg. 2018;84(6):893-9. doi: https://doi.org/10.1097/TA.0000000000001882
Rauf R, Von Matthey F, Croenlein M, Zyskowski M, Van Griensven M, Biberthaler P, et al. Changes in the temporal distribution of in-hospital mortality in severely injured patients–an analysis of the TraumaRegister DGU. PLoS One. 2019;14(2):e0212095. doi: https://doi.org/10.1371/journal.pone.0212095
Hwang K, Jung K, Kwon J, Moon J, Heo Y, Lee JCJ, et al. Distribution of trauma deaths in a province of Korea: is “trimodal” distribution relevant today? Yonsei Med J. 2020;61(3):229-34. doi: https://doi.org/10.3349/ymj.2020.61.3.229
Wang T, Wang Y, Xu T, Li L, Huo M, Li X, et al. Epidemiological and clinical characteristics of 3327 cases of traffic trauma deaths in Beijing from 2008 to 2017: a retrospective analysis. Medicine (Baltimore). 2020;99(1):e18567. doi: https://doi.org/10.1097/MD.0000000000018567
Oyeniyi BT, Fox EE, Scerbo M, Tomasek JS, Wade CE, Holcomb JB. Trends in 1029 trauma deaths at a level 1 Trauma Center: impact of a bleeding control bundle of care. Injury. 2017;48(1):5-12. doi: https://doi.org/10.1016/j.injury.2016.10.037
Negoi I, Paun S, Hostiuc S, Stoica B, Tanase I, Negoi RI, et al. Mortality after acute trauma: progressive decreasing rather than a trimodal distribution. J Acute Dis. 2015;4(3):205-9. doi: https://doi.org/10.1016/j.joad.2015.03.001
Abhilash KPP, Sivanandan A. Early management of trauma: the golden hour. Curr Med Issues. 2020;18(1):36-9. doi: https://doi.org/10.4103/cmi.cmi_61_19
Cabral ELS, Castro WRS, Florentino DRM, Viana DA, Costa Junior JF, Souza RP, et al. Response time in the emergency services. Systematic review. Acta Cir Bras. 2018;33(12):1110-21. doi: https://doi.org/10.1590/s0102-865020180120000009
Clark DE, Qian J, Sihler KC, Hallagan LD, Betensky RA. The distribution of survival times after injury. World J Surg. 2012;36(7):1562-70. doi: https://doi.org/10.1007/s00268-012-1549-5
Pfeifer R, Teuben M, Andruszkow H, Barkatali BM, Pape HC. Mortality patterns in patients with multiple trauma: a systematic review of autopsy studies. PLoS One. 2016;11(2):e0148844. doi: https://doi.org/10.1371/journal.pone.0148844
Association for the Advancement of Automotive Medicine (AAAM). The Abbreviated Injury Scale (AIS): 2008, update 2015. Des Plaines: AAAM; 2015.
World Health Organization (WHO). International Statistical Classification of Diseases and Related Health Problems - 10th Revision [Internet]. Geneva: WHO; 2010 [cited 2020 Jan 10]. Available from: https://www.who.int/classifications/classification-of-diseases
Osler T, Baker SP, Long W. A modification of the injury severity score that both improves accuracy and simplifies scoring. J Trauma Acute Care Surg. 1997;43(6):922-5. doi: https://doi.org/10.1097/00005373-199712000-00009
Miller RT, Nazir N, McDonald T, Cannon CM. The modified rapid emergency medicine score: a novel trauma triage tool to predict in-hospital mortality. Injury. 2017;48(9):1870-77. doi: https://doi.org/10.1016/j.injury.2017.04.048
Kimura A, Tanaka N. Reverse shock index multiplied by Glasgow Coma Scale score (rSIG) is a simple measure with high discriminant ability for mortality risk in trauma patients: an analysis of the Japan Trauma Data Bank. Crit Care. 2018;22(1):87. doi: https://doi.org/10.1186/s13054-018-2014-0
Serviá L, Badia M, Montserrat N, Trujillano J. Gravedad em pacientes traumáticos ingressados em UCI. Modelos fisiológicos y anatómicos. Med Intensiva. 2019;43(1):26-34. doi: https://doi.org/10.1016/j.medin.2017.11.008
Callcut RA, Kornblith LZ, Conroy AS, Robles AJ, Meizoso JP, Namias N, et al. The why & how our trauma patients die: a prospective Multicenter Western Trauma Association study. J Trauma Acute Care Surg. 2019;86(5):864-70. doi: https://doi.org/10.1097/TA.0000000000002205
Gunst M, Ghaemmaghami V, Gruszeki A, Urban J, Frankel H, Shafi S. Changing epidemiology of trauma deaths leads to a bimodal distribution. Proc (Bayl Univ Med Cent). 2010;23(4):349-54. doi: https://doi.org/10.1080/08998280.2010.11928649
Whiteman C, Davidov DM, Sikora R, Paulson D, Schaefer G. Major Trauma and the Elder West Virginian: a six-year review at a Level I Trauma Center. W V Med J [Internet]. 2016 [cited 2020 Feb 20];112(3):94-9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4926309/pdf/nihms-796357.pdf
Estado de São Paulo, Secretaria de Segurança Pública. Dados estatísticos do estado de São Paulo [Internet]. São Paulo (SP): Secretaria de Segurança Pública; 2020 [acesso em 2020 set 05]. Disponível em: https://www.ssp.sp.gov.br/estatistica/mapas.aspx
Soreide K, Krüger AJ, Vardal AL, Ellingsen CL, Soreide E, Lossius HM. Epidemiology and contemporary patterns of trauma deaths: changing place, similar place, older face. World J Surg. 2007;31(11):2092-103. doi: https://doi.org/10.1007/s00268-007-9226-9
Abe T, Komori A, Shiraishi A, Sugiyama T, Iriyama H, Kainoh T, et al. Trauma complications and in-hospital mortality: failure-to-rescue. Crit Care. 2020;24:223. doi: https://doi.org/10.1186/s13054-020-02951-1
Hutchings L, Watkinson P, Young JD, Willett K. Defining multiple organ failure after major trauma: a comparison of the Denver, Sequential Organ Failure Assessment and Marshall scoring systems. J Trauma Acute Care Surg. 2017;82(3):534-41. doi: https://doi.org/10.1097/TA.0000000000001328
Veras RP, Oliveira M. Envelhecer no Brasil: a construção de um modelo de cuidado. Ciênc Saúde Colet. 2018;23(6):1929-36. doi: https://doi.org/10.1590/1413-81232018236.04722018
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