An observational cross-sectional study of the possible relationship between high levels of cytokines (TNF and IL10) and healthcare-associated and other infections in patients with polytrauma / Beatriz Helena Aristizábal Bernal ; Edwin Alexander Vásquez Salazar ; Olga Lucía Rincón Caballero ; Gladys Stella Mejía Pineda ; Alfredo Constain Franco ; Paula María Jaramillo Gómez ; Nelson Darío Giraldo Ramírez ; Carlos Oliver Valderrama Molina    

Público ISBD Título : An observational cross-sectional study of the possible relationship between high levels of cytokines (TNF and IL10) and healthcare-associated and other infections in patients with polytrauma Tipo de documento : documento electrónico Autores : Beatriz Helena Aristizábal Bernal, ; Edwin Alexander Vásquez Salazar, ; Olga Lucía Rincón Caballero, ; Gladys Stella Mejía Pineda, ; Alfredo Constain Franco, ; Paula María Jaramillo Gómez, ; Nelson Darío Giraldo Ramírez, ; Carlos Oliver Valderrama Molina, Fecha de publicación : 2019 Títulos uniformes : MOJ Orthopedics & Rheumatology Idioma : Inglés (eng) Palabras clave : blunt trauma  proinflammatory and anti-inflammatory cytokines  infections Resumen : Background: The recognition of the relationship between cytokines and outcomes in trauma patients is important. It is possible that early detection of those patients who develop an imbalance in this dual immune response, which would be responsible for subsequent organ dysfunction and susceptibility to infections, allow differential management to reduce the occurrence of such complications. Methods: An observational cross-sectional study to describe the kinetics of cytokines/chemokines (IL-1B, IL-6, TNF-a, IL-12p70, IL-10, and IL-8) and to explore the possible relationship with the development of infectious complications during the first admission to the hospital in patients with multiple trauma admitted to the emergency room. Serum samples were used to measured cytokines/chemokines. Times of collection were: 0-6 hour’s postrauma, 24 hours and 72 hours postrauma. Results: 20 consecutive patients were included, 60% were male, the median age was 26.5 years , 90% had a traffic accident, 40% had a severe traumatic brain injury defined as Glasgow less than or equal to 8. The median ISS was 22(17,2–35,2). There was an incidence of shock defined as lactate greater than or equal to 4 of 40%. The admission to ICU was 80%. Of the 16 who entered the ICU, 94% required mechanical ventilation. There was only one hospital death. Cytokines shown to be significantly different between trauma patient’s groups; a greater severity of the trauma in the group that presented infection (ISS 27 vs 17, p=0.011). IL10 on admission and ISS are significantly associated with increased prevalence of infection in this sample of patients with multiple trauma. Conclusion: Peripheral cytokines could present a method for tracking the course of severe blunt trauma and for better understanding this process. Our results imply that measuring cytokine expression patterns after severe blunt trauma is meaningful to explore and potentially useful in developing innovative approaches for treating acute and subacute trauma. Mención de responsabilidad : Aristizabal-Bernal Beatriz Helena, Vasquez Edwin, Rincon-Caballero Olga Lucia, Mejía-Pineda Gladys S, Constain-Franco Alfredo, Jaramillo-Gomez Paula M, Giraldo Nelson, Valderrama-Molina Carlos Oliver DOI (Digital Object Identifier) : 10.15406/mojor.2019.11.00497 Derechos de uso : CC BY-NC En línea : https://medcraveonline.com/MOJOR/an-observational-cross-sectional-study-of-the-p [...] Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=5021 An observational cross-sectional study of the possible relationship between high levels of cytokines (TNF and IL10) and healthcare-associated and other infections in patients with polytrauma [documento electrónico] / Beatriz Helena Aristizábal Bernal, ; Edwin Alexander Vásquez Salazar, ; Olga Lucía Rincón Caballero, ; Gladys Stella Mejía Pineda, ; Alfredo Constain Franco, ; Paula María Jaramillo Gómez, ; Nelson Darío Giraldo Ramírez, ; Carlos Oliver Valderrama Molina,  . - 2019. Obra : MOJ Orthopedics & Rheumatology Idioma : Inglés (eng) Palabras clave : blunt trauma  proinflammatory and anti-inflammatory cytokines  infections Resumen : Background: The recognition of the relationship between cytokines and outcomes in trauma patients is important. It is possible that early detection of those patients who develop an imbalance in this dual immune response, which would be responsible for subsequent organ dysfunction and susceptibility to infections, allow differential management to reduce the occurrence of such complications. Methods: An observational cross-sectional study to describe the kinetics of cytokines/chemokines (IL-1B, IL-6, TNF-a, IL-12p70, IL-10, and IL-8) and to explore the possible relationship with the development of infectious complications during the first admission to the hospital in patients with multiple trauma admitted to the emergency room. Serum samples were used to measured cytokines/chemokines. Times of collection were: 0-6 hour’s postrauma, 24 hours and 72 hours postrauma. Results: 20 consecutive patients were included, 60% were male, the median age was 26.5 years , 90% had a traffic accident, 40% had a severe traumatic brain injury defined as Glasgow less than or equal to 8. The median ISS was 22(17,2–35,2). There was an incidence of shock defined as lactate greater than or equal to 4 of 40%. The admission to ICU was 80%. Of the 16 who entered the ICU, 94% required mechanical ventilation. There was only one hospital death. Cytokines shown to be significantly different between trauma patient’s groups; a greater severity of the trauma in the group that presented infection (ISS 27 vs 17, p=0.011). IL10 on admission and ISS are significantly associated with increased prevalence of infection in this sample of patients with multiple trauma. Conclusion: Peripheral cytokines could present a method for tracking the course of severe blunt trauma and for better understanding this process. Our results imply that measuring cytokine expression patterns after severe blunt trauma is meaningful to explore and potentially useful in developing innovative approaches for treating acute and subacute trauma. Mención de responsabilidad : Aristizabal-Bernal Beatriz Helena, Vasquez Edwin, Rincon-Caballero Olga Lucia, Mejía-Pineda Gladys S, Constain-Franco Alfredo, Jaramillo-Gomez Paula M, Giraldo Nelson, Valderrama-Molina Carlos Oliver DOI (Digital Object Identifier) : 10.15406/mojor.2019.11.00497 Derechos de uso : CC BY-NC En línea : https://medcraveonline.com/MOJOR/an-observational-cross-sectional-study-of-the-p [...] Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=5021

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Grouping of body areas affected in traffic accidents. A cohort study / Carlos Oliver Valderrama Molina ; Nelson Darío Giraldo Ramírez ; Alfredo Constain Franco ; Jaime Andrés Puerta Gómez ; Fabián Alberto Jaimes Barragán  

Público ISBD Título : Grouping of body areas affected in traffic accidents. A cohort study Tipo de documento : documento electrónico Autores : Carlos Oliver Valderrama Molina, ; Nelson Darío Giraldo Ramírez, ; Alfredo Constain Franco, ; Jaime Andrés Puerta Gómez, ; Fabián Alberto Jaimes Barragán, Fecha de publicación : 2018 Títulos uniformes : Journal of Clinical Orthopaedics and Trauma Idioma : Inglés (eng) Palabras clave : Clustering  traffic accident  body trauma Resumen : Background: Traffic accidents are considered a public health problem and, according to the World Health Organization, currently is the eighth cause of death in the world. Specifically, pedestrians, cyclists and motorcyclists contribute half of the fatalities. Adequate clinical management in accordance with aggregation patterns of the body areas involved, as well as the characteristics of the accident, will help to reduce mortality and disability in this population. Methods: Secondary data analysis of a cohort of patients involved in traffic accidents and admitted to the emergency room (ER) of a high complexity hospital in Medellín, Colombia. They were over 15 years of age, had two or more injuries in different areas of the body and had a hospital stay of more than 24 h after admission. A cluster analysis was performed, using Ward's method and the linfinity similarity measure, to obtain clusters of body areas most commonly affected depending on the type of vehicle and the type of victim. Results: Among 2445 patients with traffic accidents, 34% (n = 836) were admitted into the Intensive Care Unit (ICU) and the overall hospital mortality rate was 8% (n = 201). More than 50% of the patients were motorcycle riders but mortality was higher in pedestrian-car accidents (16%, n = 34). The clusters show efficient performance to separate the population depending on the severity of their injuries. Pedestrians had the highest mortality after having accidents with cars and they also had the highest number of body parts clustered, mainly on head and abdomen areas. Conclusions: Exploring the cluster patterns of injuries and body areas affected in traffic accidents allow to establish anatomical groups defined by the type of accident and the type of vehicle. This classification system will accelerate and prioritize ER-care for these population groups, helping to provide better health care services and to rationalize available resources. Mención de responsabilidad : Alba Luz León, Johana Ascuntar-Tello, Carlos Oliver Valderrama-Molina, Nelson Darío Giraldo, Alfredo Constaín, Andrés Puerta, Camilo Restrepo, Fabián Jaimes Referencia : J Clin Orthop Trauma. 2018 Mar;9(Suppl 1):S49-S55. DOI (Digital Object Identifier) : 10.1016/j.jcot.2017.11.012 PMID : 29628699 En línea : https://linkinghub.elsevier.com/retrieve/pii/S0976-5662(17)30441-1 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=4183 Grouping of body areas affected in traffic accidents. A cohort study [documento electrónico] / Carlos Oliver Valderrama Molina, ; Nelson Darío Giraldo Ramírez, ; Alfredo Constain Franco, ; Jaime Andrés Puerta Gómez, ; Fabián Alberto Jaimes Barragán,  . - 2018. Obra : Journal of Clinical Orthopaedics and Trauma Idioma : Inglés (eng) Palabras clave : Clustering  traffic accident  body trauma Resumen : Background: Traffic accidents are considered a public health problem and, according to the World Health Organization, currently is the eighth cause of death in the world. Specifically, pedestrians, cyclists and motorcyclists contribute half of the fatalities. Adequate clinical management in accordance with aggregation patterns of the body areas involved, as well as the characteristics of the accident, will help to reduce mortality and disability in this population. Methods: Secondary data analysis of a cohort of patients involved in traffic accidents and admitted to the emergency room (ER) of a high complexity hospital in Medellín, Colombia. They were over 15 years of age, had two or more injuries in different areas of the body and had a hospital stay of more than 24 h after admission. A cluster analysis was performed, using Ward's method and the linfinity similarity measure, to obtain clusters of body areas most commonly affected depending on the type of vehicle and the type of victim. Results: Among 2445 patients with traffic accidents, 34% (n = 836) were admitted into the Intensive Care Unit (ICU) and the overall hospital mortality rate was 8% (n = 201). More than 50% of the patients were motorcycle riders but mortality was higher in pedestrian-car accidents (16%, n = 34). The clusters show efficient performance to separate the population depending on the severity of their injuries. Pedestrians had the highest mortality after having accidents with cars and they also had the highest number of body parts clustered, mainly on head and abdomen areas. Conclusions: Exploring the cluster patterns of injuries and body areas affected in traffic accidents allow to establish anatomical groups defined by the type of accident and the type of vehicle. This classification system will accelerate and prioritize ER-care for these population groups, helping to provide better health care services and to rationalize available resources. Mención de responsabilidad : Alba Luz León, Johana Ascuntar-Tello, Carlos Oliver Valderrama-Molina, Nelson Darío Giraldo, Alfredo Constaín, Andrés Puerta, Camilo Restrepo, Fabián Jaimes Referencia : J Clin Orthop Trauma. 2018 Mar;9(Suppl 1):S49-S55. DOI (Digital Object Identifier) : 10.1016/j.jcot.2017.11.012 PMID : 29628699 En línea : https://linkinghub.elsevier.com/retrieve/pii/S0976-5662(17)30441-1 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=4183

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Hemicorporectomy as a life-saving strategy for severe pelvic ring crush injury: a case report / Salín Pereira Warr ; Paula María Jaramillo Gómez ; Sebastián Tobón Franco ; Carlos Oliver Valderrama Molina ; Alfredo Constain Franco  

Público ISBD Título : Hemicorporectomy as a life-saving strategy for severe pelvic ring crush injury: a case report Tipo de documento : documento electrónico Autores : Salín Pereira Warr, ; Paula María Jaramillo Gómez, ; Sebastián Tobón Franco, ; Carlos Oliver Valderrama Molina, ; Alfredo Constain Franco, Fecha de publicación : 2018 Títulos uniformes : European Journal of Orthopaedic Surgery & Traumatology Idioma : Inglés (eng) Palabras clave : Hemicorporectomy  pelvic trauma  translumbar amputation Resumen : Hemicorporectomy is an ultra-radical surgery used only in extreme circumstances. Initially used for advanced pelvic neoplastic diseases and intractable pelvic infection, it may also be the only treatment option in patients with crushed pelvic trauma, in cases there are no reconstruction options. This procedure has a high mortality, and its success depends on the multidisciplinary approach, both in the initial phase and in the rehabilitation process. We present the case of a young patient with severe pelvic trauma that required a hemicorporectomy as the only treatment option and review of the literature. Mención de responsabilidad : Salin Pereira Warr, Paula M Jaramillo, Sebastian Tobon Franco, Carlos Oliver Valderrama-Molina, Alfredo Constain Franco Referencia : Eur J Orthop Surg Traumatol. 2018 May;28(4):735-739. DOI (Digital Object Identifier) : 10.1007/s00590-018-2140-z PMID : 29427094 En línea : https://link.springer.com/article/10.1007%2Fs00590-018-2140-z Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=4192 Hemicorporectomy as a life-saving strategy for severe pelvic ring crush injury: a case report [documento electrónico] / Salín Pereira Warr, ; Paula María Jaramillo Gómez, ; Sebastián Tobón Franco, ; Carlos Oliver Valderrama Molina, ; Alfredo Constain Franco,  . - 2018. Obra : European Journal of Orthopaedic Surgery & Traumatology Idioma : Inglés (eng) Palabras clave : Hemicorporectomy  pelvic trauma  translumbar amputation Resumen : Hemicorporectomy is an ultra-radical surgery used only in extreme circumstances. Initially used for advanced pelvic neoplastic diseases and intractable pelvic infection, it may also be the only treatment option in patients with crushed pelvic trauma, in cases there are no reconstruction options. This procedure has a high mortality, and its success depends on the multidisciplinary approach, both in the initial phase and in the rehabilitation process. We present the case of a young patient with severe pelvic trauma that required a hemicorporectomy as the only treatment option and review of the literature. Mención de responsabilidad : Salin Pereira Warr, Paula M Jaramillo, Sebastian Tobon Franco, Carlos Oliver Valderrama-Molina, Alfredo Constain Franco Referencia : Eur J Orthop Surg Traumatol. 2018 May;28(4):735-739. DOI (Digital Object Identifier) : 10.1007/s00590-018-2140-z PMID : 29427094 En línea : https://link.springer.com/article/10.1007%2Fs00590-018-2140-z Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=4192

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Validation of trauma scales: ISS, NISS, RTS and TRISS for predicting mortality in a Colombian population / Carlos Oliver Valderrama Molina ; Nelson Darío Giraldo Ramírez ; Alfredo Constain Franco ; Jaime Andrés Puerta Gómez ; Fabián Alberto Jaimes Barragán  

Público ISBD Título : Validation of trauma scales: ISS, NISS, RTS and TRISS for predicting mortality in a Colombian population Tipo de documento : documento electrónico Autores : Carlos Oliver Valderrama Molina, ; Nelson Darío Giraldo Ramírez, ; Alfredo Constain Franco, ; Jaime Andrés Puerta Gómez, ; Fabián Alberto Jaimes Barragán, Fecha de publicación : 2017 Títulos uniformes : European Journal of Orthopaedic Surgery & Traumatology Idioma : Inglés (eng) Palabras clave : Trauma Severity Indices  multiple trauma  mortality Resumen : Background: Our purpose was to validate the performance of the ISS, NISS, RTS and TRISS scales as predictors of mortality in a population of trauma patients in a Latin American setting. Materials and methods: Subjects older than 15 years with diagnosis of trauma, lesions in two or more body areas according to the AIS and whose initial attention was at the hospital in the first 24 h were included. The main outcome was inpatient mortality. Secondary outcomes were admission to the intensive care unit, requirement of mechanical ventilation and length of stay. A logistic regression model for hospital mortality was fitted with each of the scales as an independent variable, and its predictive accuracy was evaluated through discrimination and calibration statistics. Results: Between January 2007 and July 2015, 4085 subjects were enrolled in the study. 84.2% (n = 3442) were male, the mean age was 36 years (SD = 16), and the most common trauma mechanism was blunt type (80.1%; n = 3273). The medians of ISS, NISS, TRISS and RTS were: 14 (IQR = 10–21), 17 (IQR = 11–27), 4.21 (IQR = 2.95–5.05) and 7.84 (IQR = 6.90–7.84), respectively. Mortality was 9.3%, and the discrimination for ISS, NISS, TRISS and RTS was: AUC 0.85, 0.89, 0.86 and 0.92, respectively. No one scale had appropriate calibration. Conclusion: Determining the severity of trauma is an essential tool to guide treatment and establish the necessary resources for attention. In a Colombian population from a capital city, trauma scales have adequate performance for the prediction of mortality in patients with trauma. Mención de responsabilidad : Carlos Oliver Valderrama-Molina, Nelson Giraldo, Alfredo Constain, Andres Puerta, Camilo Restrepo, Alba León, Fabián Jaimes Referencia : Eur J Orthop Surg Traumatol. 2017 Feb;27(2):213-220. DOI (Digital Object Identifier) : 10.1007/s00590-016-1892-6 PMID : 27999959 En línea : https://link.springer.com/article/10.1007%2Fs00590-016-1892-6 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=4042 Validation of trauma scales: ISS, NISS, RTS and TRISS for predicting mortality in a Colombian population [documento electrónico] / Carlos Oliver Valderrama Molina, ; Nelson Darío Giraldo Ramírez, ; Alfredo Constain Franco, ; Jaime Andrés Puerta Gómez, ; Fabián Alberto Jaimes Barragán,  . - 2017. Obra : European Journal of Orthopaedic Surgery & Traumatology Idioma : Inglés (eng) Palabras clave : Trauma Severity Indices  multiple trauma  mortality Resumen : Background: Our purpose was to validate the performance of the ISS, NISS, RTS and TRISS scales as predictors of mortality in a population of trauma patients in a Latin American setting. Materials and methods: Subjects older than 15 years with diagnosis of trauma, lesions in two or more body areas according to the AIS and whose initial attention was at the hospital in the first 24 h were included. The main outcome was inpatient mortality. Secondary outcomes were admission to the intensive care unit, requirement of mechanical ventilation and length of stay. A logistic regression model for hospital mortality was fitted with each of the scales as an independent variable, and its predictive accuracy was evaluated through discrimination and calibration statistics. Results: Between January 2007 and July 2015, 4085 subjects were enrolled in the study. 84.2% (n = 3442) were male, the mean age was 36 years (SD = 16), and the most common trauma mechanism was blunt type (80.1%; n = 3273). The medians of ISS, NISS, TRISS and RTS were: 14 (IQR = 10–21), 17 (IQR = 11–27), 4.21 (IQR = 2.95–5.05) and 7.84 (IQR = 6.90–7.84), respectively. Mortality was 9.3%, and the discrimination for ISS, NISS, TRISS and RTS was: AUC 0.85, 0.89, 0.86 and 0.92, respectively. No one scale had appropriate calibration. Conclusion: Determining the severity of trauma is an essential tool to guide treatment and establish the necessary resources for attention. In a Colombian population from a capital city, trauma scales have adequate performance for the prediction of mortality in patients with trauma. Mención de responsabilidad : Carlos Oliver Valderrama-Molina, Nelson Giraldo, Alfredo Constain, Andres Puerta, Camilo Restrepo, Alba León, Fabián Jaimes Referencia : Eur J Orthop Surg Traumatol. 2017 Feb;27(2):213-220. DOI (Digital Object Identifier) : 10.1007/s00590-016-1892-6 PMID : 27999959 En línea : https://link.springer.com/article/10.1007%2Fs00590-016-1892-6 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=4042

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Puntajes de gravedad en trauma / Carlos Oliver Valderrama Molina ; Nelson Darío Giraldo Ramírez ; Alfredo Constain Franco ; Jaime Andrés Puerta Gómez    

Público ISBD Título : Puntajes de gravedad en trauma Tipo de documento : documento electrónico Autores : Carlos Oliver Valderrama Molina, ; Nelson Darío Giraldo Ramírez, ; Alfredo Constain Franco, ; Jaime Andrés Puerta Gómez, Fecha de publicación : 2016 Títulos uniformes : Revista Colombiana de Anestesiología Idioma : Español (spa) Palabras clave : Índices de gravedad del trauma  Pronóstico  Anestesia  Índice de severidad de la enfermedad  Heridas y traumatismos Resumen : Introducción: A lo largo de la historia se han creado varios métodos para evaluar la gravedad de las lesiones y brindar un pronóstico exacto en pacientes con trauma. Los puntajes en trauma que se han utilizado por más de 40 anos son una herramienta de gran utilidad tanto para el contexto clínico como investigativo. Objetivo: Elaborar una revisión de la literatura más relevante sobre los puntajes en trauma y hacer una descripción de cada una de estas herramientas, haciendo énfasis en sus limitaciones y en la aplicación en estudios clínicos. Materiales y métodos: Revisión narrativa; se consultaron diferentes bases de datos como Pub-Med, ScienceDirect y OVID. Además, se hizo una búsqueda manual de artículos en inglés y en español sobre el tema. Resultados: Los artículos revisados permitieron hacer una descripción adecuada de cada uno de los puntajes, de la forma en que se calculan, sus principales limitaciones en el momento de aplicarlos y los hallazgos más notables en la literatura. Conclusión: Existe una gran variedad de puntajes de gravedad para pacientes con trauma que permiten anticipar con diferente exactitud los desenlaces clínicamente significativos.La creación y validación de un único puntaje universalmente válido es todo un reto; por ello, la selección de esta herramienta está basada en gran parte en la experiencia, el contexto y la evidencia disponible. Mención de responsabilidad : Camilo Andrés Restrepo-Álvarez, Carlos Oliver Valderrama-Molina, Nelson Giraldo-Ramírez, Alfredo Constain-Franco, Andrés Puerta, Alba Luz León y Fabián Jaimes Referencia : Rev Colomb Anestesiol. 2016;44(4):317–23. DOI (Digital Object Identifier) : 10.1016/j.rca.2016.05.005 Derechos de uso : CC BY-NC-ND En línea : https://linkinghub.elsevier.com/retrieve/pii/S012033471630065X Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=4006 Puntajes de gravedad en trauma [documento electrónico] / Carlos Oliver Valderrama Molina, ; Nelson Darío Giraldo Ramírez, ; Alfredo Constain Franco, ; Jaime Andrés Puerta Gómez,  . - 2016. Obra : Revista Colombiana de Anestesiología Idioma : Español (spa) Palabras clave : Índices de gravedad del trauma  Pronóstico  Anestesia  Índice de severidad de la enfermedad  Heridas y traumatismos Resumen : Introducción: A lo largo de la historia se han creado varios métodos para evaluar la gravedad de las lesiones y brindar un pronóstico exacto en pacientes con trauma. Los puntajes en trauma que se han utilizado por más de 40 anos son una herramienta de gran utilidad tanto para el contexto clínico como investigativo. Objetivo: Elaborar una revisión de la literatura más relevante sobre los puntajes en trauma y hacer una descripción de cada una de estas herramientas, haciendo énfasis en sus limitaciones y en la aplicación en estudios clínicos. Materiales y métodos: Revisión narrativa; se consultaron diferentes bases de datos como Pub-Med, ScienceDirect y OVID. Además, se hizo una búsqueda manual de artículos en inglés y en español sobre el tema. Resultados: Los artículos revisados permitieron hacer una descripción adecuada de cada uno de los puntajes, de la forma en que se calculan, sus principales limitaciones en el momento de aplicarlos y los hallazgos más notables en la literatura. Conclusión: Existe una gran variedad de puntajes de gravedad para pacientes con trauma que permiten anticipar con diferente exactitud los desenlaces clínicamente significativos.La creación y validación de un único puntaje universalmente válido es todo un reto; por ello, la selección de esta herramienta está basada en gran parte en la experiencia, el contexto y la evidencia disponible. Mención de responsabilidad : Camilo Andrés Restrepo-Álvarez, Carlos Oliver Valderrama-Molina, Nelson Giraldo-Ramírez, Alfredo Constain-Franco, Andrés Puerta, Alba Luz León y Fabián Jaimes Referencia : Rev Colomb Anestesiol. 2016;44(4):317–23. DOI (Digital Object Identifier) : 10.1016/j.rca.2016.05.005 Derechos de uso : CC BY-NC-ND En línea : https://linkinghub.elsevier.com/retrieve/pii/S012033471630065X Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=4006

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Manual de líquidos y electrolitos / Jaime Borrero Ramírez

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