Background: Emergency care information systems in trauma are essential to improve the decision making and identify potential areas of intervention. Objective: To describe the first year of experience of trauma registry in two reference trauma centers of the southwestern Colombia. Methods: A study conducted in two reference trauma centers of Cali city. There were included those patients with any injury from external causes or trauma occurred between January 1st and December 31st of 2012. Information related with demographics, injury mechanism, severity injury (ISS) and mortality were collected. We presented a descriptive analysis. Results: There were registered 17,431 patients whereof 67.8% were male with a mean of 30 (±20) years old. Workplace injuries were the 28.2% cause of emergency consultation, and falls were the most prevalent trauma mechanism. Majority of patients with a ISS ≥15 were in a range age of 18-35 years (6.4%). The 28% of patients with gunshot wounds had a ISS ≥15. An overall of 2.5% of included patients died and those who had a ISS ≥15 and gunshot wounds showed a mortality of 54%. Conclusion: Upon the implementation of the trauma registry in two main hospitals of Cali city, we identify that falls and workplace injuries were the leading cause of admission to the emergency room. Severely compromised patients are in the range age of 18-35 years old. Mortality was higher for those patients who suffered gunshot wounds.

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The increased use of damage control surgery in complex trauma patients requires accurate prognostic indicators. We compared the discriminatory capacity of commonly used trauma and intensive care unit (ICU) scores, including revised trauma score, injury severity scores, trauma score-injury severity scores, acute physiology and chronic health evaluations II, and clinical and laboratory parameters, on 83 consecutive trauma patients admitted to the ICU, undergoing damage control. Logistic regressions were built for mortality prediction within 30 days. Performances of the models were assessed in terms of discrimination and calibration. Areas under the receiver operating characteristic curve from the models were compared. Overall mortality was 38.5 per cent. A “clinical” model was constructed including ICU admission pH and hypothermia (≤ 35 C °) and the number of packed red blood cells during the first 24 hours. This model was adjusted for age and demonstrated better discrimination for mortality prediction (areas under the receiver operating characteristic curve = 0.8054) than injury severity score ( P value = 0.049), abdominal trauma index ( P value = 0.049), and acute physiology and chronic health evaluations II ( P value = 0.001). There was no statistically significant difference in discrimination for mortality prediction between the “clinical” model and revised trauma score ( P value = 0.4) and trauma score-injury severity score ( P value = 0.4). We concluded that the combination of ICU admission pH and hypothermia and blood transfusions during 24 hours provided an excellent discriminatory capacity for mortality prediction in this complex patient population.

RESUMEN Introducción El trauma es un problema de salud pública a nivel mundial. En Colombia, el país más violento de América Latina, no hay sistemas de registro que permitan conocer las tendencias en la atención del trauma, desde el manejo prehospitalario hasta el estatus final. En Colombia, se tienen registros de mortalidad por entes estatales pero hay una deficiencia de sistemas de información que permita conocer la situación real de la atención del paciente con trauma. Objetivo Describir la epidemiología de la atención por trauma en los servicios de urgencias de dos hospitales de referencia en la ciudad de Cali. Metodología Entre 21 noviembre 2011 y 30 abril 2012 se implementó el piloto del Registro Internacional de Trauma de la Sociedad Panamericana de Trauma; la captura de la información se realiza en tiempo real. Incluye la información socio-demográfica, etiologia, severidad del trauma y estatus al egreso. Resultados Se registraron 5432 pacientes. El promedio de edad fue 30,2 (±20,3) años, el 67,5% fueron <35 años. Las principales causas de consulta fueron las caídas (38,1%), lesiones de tránsito (12,2%) y heridas por arma de fuego (8,5%). El 34,4% (n = 1,867) requirieron procedimientos quirúrgicos, se hospitalizaron 18,9% (n = 1,029). La mortalidad global fue del 2,6%, mayormente secundarias a heridas por arma de fuego 54,3% (76/140). La mortalidad según severidad para ISS<15 fue 0,3%(13/5183) y con ISS>15 fue 64,5% (89/138). Conclusiones La mayor causa de consulta fueron las caídas (38,1%), la mayor proporción de muertes fue secundaria a heridas por arma de fuego. La implementación de un registro de trauma permite conocer la realidad de la atención del trauma en los servicios de urgencias, logrando identificar debilidades en el sistema de trauma, permitiendo la generación de nuevas estrategias para mejorar la atención del trauma que se traduce en impactos en las políticas públicas y en la optimización de recursos al interior de los hospitales. Objetivo Describir la situación actual de las consultas por trauma a los servicios de urgencias de dos hospitales de referencia de la ciudad de Cali, que en los cuales se ha adelantado el programa piloto del registro de trauma de la sociedad Panamericana de trauma. Y mostrar que la mayor causa de consulta a los servicios de urgencias son las caídas en todas en todos los rangos de edad.

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.