Avaliação da mortalidade de pacientes admitidos por transporte secundário em centro de trauma inserido no sistema médico de emergência brasileiro
Date
2021
Authors
Costa, Fernando Fonseca [UNIFESP]
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Abib, Simone de Campos Vieira [UNIFESP]
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Dissertação de mestrado
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Abstract
Introdução: o sistema de emergência médico brasileiro apresentou grande ampliação com investimento em unidades de pronto atendimento elevando a capilaridade do sistema, mas, com base na hierarquização por complexidade, houve também grande aumento da necessidade da transferência secundária de pacientes, sendo o elo comum de uma vasta teia de acesso aos hospitais terciários. Objetivo: avaliar se o transporte secundário altera a mortalidade de pacientes vítimas de trauma. Métodos: estudo prospectivo observacional transversal comparando o desfecho dos pacientes internados por trauma encaminhados por transferência secundária (grupo estudo) ou acesso direto (grupo controle) na Unidade de Emergência do Hospital Municipal Dr. José de Carvalho Florence, São José dos Campos, Brasil. Resultados: 2302 pacientes foram incluídos, sendo 565 do grupo estudo e 1737 do grupo controle. Quanto ao mecanismo de trauma, houve predomínio de traumatismo fechado (93,3%), 34,5% eram idosos, 12,4% sofreram traumatismo cranioencefálico grave e 18,4% apresentaram o escore de gravidade de lesões considerado grave (ISS> 15). O desfecho óbito não apresentou diferença significante entre os grupos, mesmo quando avaliados considerando possíveis fatores de risco tais como o grupo etário idoso e índice de trauma. Conclusão: o transporte secundário não apresentou diferença significativa em relação ao grupo controle quanto a mortalidade geral, mas gerou aumentos na mortalidade em menos de 24 horas e no tempo de permanência hospitalar.
The Brazilian Medical Emergency Services presented a significant extension due to investment in emergency care units, increasing the expansion of the services. However, there was a surge in the need for moving patient transfers, which served as the common link in a wide web of trauma center access. Objective The study assesses the outcome of trauma patients who required transfer. Methods: A prospective observational cross-sectional study comparing the outcome of patients hospitalized for trauma referred by transfer (study group) or direct access (control group) in the Emergency Unit of the Municipal Hospital Dr. José de Carvalho Florence, São José dos Campos, Brazil. Results: 2302 patients were included, 565 from the study group and 1737 from the control group. As for the trauma mechanism, there was a predominance of blunt trauma (93.3%), 34.5% were elderly, 12.4% suffered severe traumatic brain injury and 18.4% had severe trauma rate (ISS> 15). The outcome of death did not present a significant difference between the groups, even when evaluated considering possible risk factors such as the elderly age group and trauma index. Conclusion: The group of patients who underwent transfer did not show any significant difference in relation to patients with direct access in global mortality, but it generated increases in mortality in less than 24 hours and the length of hospital stay.
The Brazilian Medical Emergency Services presented a significant extension due to investment in emergency care units, increasing the expansion of the services. However, there was a surge in the need for moving patient transfers, which served as the common link in a wide web of trauma center access. Objective The study assesses the outcome of trauma patients who required transfer. Methods: A prospective observational cross-sectional study comparing the outcome of patients hospitalized for trauma referred by transfer (study group) or direct access (control group) in the Emergency Unit of the Municipal Hospital Dr. José de Carvalho Florence, São José dos Campos, Brazil. Results: 2302 patients were included, 565 from the study group and 1737 from the control group. As for the trauma mechanism, there was a predominance of blunt trauma (93.3%), 34.5% were elderly, 12.4% suffered severe traumatic brain injury and 18.4% had severe trauma rate (ISS> 15). The outcome of death did not present a significant difference between the groups, even when evaluated considering possible risk factors such as the elderly age group and trauma index. Conclusion: The group of patients who underwent transfer did not show any significant difference in relation to patients with direct access in global mortality, but it generated increases in mortality in less than 24 hours and the length of hospital stay.