BackgroundAfter 52 years of war in 2012, the Colombian government began the negotiation of a process of peace, and by November 2012, a truce was agreed. We sought to analyze casualties who were admitted to the intensive care unit (ICU) before and during the period of the negotiation of the comprehensive Colombian process of peace.MethodsRetrospective study of hostile casualties admitted to the ICU at a Level I trauma center from January 2011 to December 2016. Patients were subsequently divided into two groups: those seen before the declaration of the process of peace truce (November 2012) and those after (November 2012–December 2016). Patients were compared with respect to time periods.ResultsFour hundred forty-eight male patients were admitted to the emergency room. Of these, 94 required ICU care. Sixty-five casualties presented before the truce and 29 during the negotiation period. Median injury severity score was significantly higher before the truce. Furthermore, the odds of presenting with severe trauma (ISS > 15) were significantly higher before the truce (OR, 5.4; (95% CI, 2.0–14.2); p < 0.01). There was a gradual decrease in the admissions to the ICU, and the performance of medical and operative procedures during the period observed.ConclusionWe describe a series of war casualties that required ICU care in a period of peace negotiation. Despite our limitations, our study presents a decline in the occurrence, severity, and consequences of war injuries probably as a result in part of the negotiation of the process of peace. The hysteresis of these results should only be interpreted for their implications in the understanding of the peace-health relationship and must not be overinterpreted and used for any political end.

Patients were subsequently divided into two groups: those seen before the declaration of the process of peace truce (November 2012) and those after (negotiation period). Variables were compared with respect to periods Results: A total of 448 hostile casualties were registered. There was a gradual decline in the number of admissions to the emergency department during the negotiation period. The number of soldiers suffering blast and rifle injuries also decreased over this period. In 2012 there were nearly 150 hostile casualties' admissions to the ER. This number decreased to 84, 63, 32 and 6 in 2013, 2014, 2015 and 2016 respectively. Both, the proportion of patients with an ISS ≥9 and admitted to the intensive care unit were significantly higher in the period before peace negotiation. From August to December/2016 no admissions of war casualties were registered. Conclusion:We describe a series of soldiers wounded in combat that were admitted to the emergency department before and during the negotiation of the Colombian process of peace. Overall, we found a trend toward a decrease in the number of casualties admitted to the emergency department possibly in part, as a result of the period of peace negotiation. Article history:Received: 18 July 2017 Revised: 14 November 2017 Accepted: 20 December 2017 Keywords:Military personnel, wounds and injuries, critical care, critical care outcomes, warfare Palabras clave:Policia militar, heridas y lesiones, cuidado critico, resultados en cuidado critico, guerra Este número disminuyó a 84, 63, 32 y 6 en los años 2013, 2014, 2015 y 2016 respectivamente. La proporción de pacientes con un ISS ≥9 y la proporción de admitidos a la unidad de cuidado intensivo fueron significativamente mayores en el periodo antes de la negociación.Desde Agosto a Diciembre/2016 no se registraron admisiones. Conclusión:Este estudio describe una disminución gradual en el número de soldados heridos en combate admitidos al departamento de emergencia en un periodo de 6 años. Este fenómeno pudo deberse al periodo de negociación del proceso de paz.

Damage control surgery principles allow delayed management of traumatic lesions and early metabolic resuscitation by performing abbreviated procedures and prompt resuscitation maneuvers in severely injured trauma patients. However, the initial physiological response to trauma and surgery, along with the hemostatic resuscitation efforts, causes important side effects on intracavitary organs such as tissue edema, increased cavity pressure, and hemodynamic collapse. Consequently, different techniques have been developed over the years for a delayed cavity closure. Nonetheless, the optimal management of abdominal and thoracic surgical closure remains controversial. This article aims to describe the indications and surgical techniques for delayed abdominal or thoracic closure following damage control surgery in severely injured trauma patients, based on the experience obtained by the Trauma and Emergency Surgery Group (CTE) of Cali, Colombia. We recommend negative pressure dressing as the gold standard technique for delayed cavity closure, associated with higher wall closure success rates and lower complication and mortality rates.

RESUMENIntroducción: Errase Colombia. la muerte por lesiones de causa externa es la segunda causa de muerte en Colombia y la primera en Cali. Parte de la atención de estos pacientes incluye la necesidad de procedimientos quirúrgicos y/o ingreso a Unidades de Cuidado Intensivo (UCI). Se describen las características de los pacientes que requirieron UCI. Material y métodos:A partir del Registro Internacional de Trauma de la Sociedad Panamericana de Trauma (ITR/SPT-ITSDP) en un hospital privado de primer nivel se revisan todos los registros consecutivos de los sujetos que ingresaron por lesión de causa externa con injury severity score (ISS) ≥ 9 o con al menos 6 horas en observación-urgencias entre enero-2012 a Diciembre-2014 y requirieron UCI.Resultados: De 3791 ingresos, el 31.71% (n = 1.202) correspondieron a sujetos que requirieron la UCI. El 78.2% fueron hombres. La edad promedio fue 33.5 ± 21 años. El 43.1% ingresaron con ISS ≥ 15. Solo el 16.4% de los lesionados tuvieron compromiso craneoencefálico, el 35.7% presentaron heridas penetrantes por arma de fuego o cortopunzantes. EL 69.88% (n = 840) fueron sometidos a cirugía. La mediana de estancia en UCI fue de 4 [IQR 2-7 días], el 65.56% (n = 788) requirieron uso de ventilador. La mortalidad total fue de 11.2% (133/1202) vs 4.8% (123/1900) por fuera de UCI. EL RR para mortalidad fue del 2.3 de los sujetos que ingresan a UCI comparado con los que no. Al ingreso a urgencias, los factores predictores de necesidad de UCI fueron Glasgow coma scale (GCS) < 13 (RR = 5.77), ISS > 15 (RR = 6.56), politraumatismo (RR = 1.86), politraumatismo sin trauma de cráneo (RR = 2.32), trauma craneoencefálico (RR = 2.55) y herida por arma de fuego (RR = 2.46). Conclusión:De los sujetos con lesiones de causa externa, con trauma con compromiso moderado o severo que ingresaron a un hospital de primer nivel, el 31.71% requirieron una UCI. La mortalidad fue del 11.2%. Factores asociado al ingreso a UCI fueron GCS < 13, ISS > 15, politraumatismo, trauma craneoencefálico y herida por arma de fuego.Palabras Clave: Indices de gravedad del trauma, Sistemas de datos, Trauma, Unidad de cuidados intensivos.How to cite this article: Ordoñez CA, García MAM, Cevallos C, Carpio JMV, Badiel M. Características clínicas y factores asociados a ingreso a Unidad de Cuidado Intensivo de pacientes con trauma en un hospital de alta complejidad en Cali, Colombia. Panam J Trauma Crit Care Emerg Surg 2018;7(1):1-3. ABSTRACTIntroduction: Violence continues to be one of the leading 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.