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Article ; Online: Prognostic value of metabolic parameters measured by first responders attending patients with severe trauma: associations with the New Injury Severity Score and mortality.

Corral Torres, Ervigio / Hernández-Tejedor, Alberto / Millán Estañ, Pablo / Valiente Fernández, Marcos / Bringas Bollada, María / Pérez Díaz, Dolores / Monforte-Escobar, Fernando / Vejo Gutiérrez, Javier / Orejón García, Lidia / Delgado Pascual, Ana / Rey Valcárcel, Cristina / Camacho Leis, Carmen

Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias

2023 Volume 35, Issue 2, Page(s) 90–96

Abstract: Objectives: Patients with severe or potentially severe trauma must be identified early, a challenge in prehospital settings. This study aimed to analyze the possible diagnostic and prognostic usefulness of analytical markers recorded in the early ... ...

Title translation	Valor pronóstico de los parámetros metabólicos medidos en la asistencia inicial a pacientes con trauma grave: asociación con la puntuación de la escala NISS y la mortalidad.
Abstract	Objectives: Patients with severe or potentially severe trauma must be identified early, a challenge in prehospital settings. This study aimed to analyze the possible diagnostic and prognostic usefulness of analytical markers recorded in the early moments of care. Material and methods: Observational study of information extracted from the prospective multicenter Code Trauma database for 2016-2019, excluding data for isolated head injuries. Using the New Injury Severity Score (NISS), we classified cases into 4 levels of severity. NISS and mortality were considered the dependent variables in inferential analyses. We calculated the areas under receiver operating characteristic curves, identified optimal cutoff points (Youden index), and calculated positive (PPV) and negative predictive values.. Results: Of the 1039 trauma patients in the registry, 709 were included in the study. Their mean (SD) age was 40.4 (17.3) years, and 77.3% were men. Motorcycle accidents were the most common causes of trauma (in 21%), and mortality was 12.1%. Lactate concentration, pH, PCO2, hemoglobin concentration, hematocrit, and blood sugar were significantly associated with severity and mortality. The PPVs corresponding to pH for the 4 NISS score groups (34-41, 42-49, 50-59, and $ 60) and mortality, respectively, were 61.2, 64.1, 70.7, 62.2, and 66.6. The PPVs of traditionally used clinical variables were lower. Conclusion: Patients with more severe trauma had lower pH values and higher PCO2, lactate, and base excess values. PCO2, pH, and blood sugar findings were the best predictors of severity. Metabolic variables are better predictors than traditionally recorded hemodynamic variables.
MeSH term(s)	Male ; Humans ; Adult ; Female ; Injury Severity Score ; Prognosis ; Prospective Studies ; Blood Glucose ; Emergency Responders
Chemical Substances	Blood Glucose
Language	Spanish
Publishing date	2023-04-10
Publishing country	Spain
Document type	Observational Study ; Multicenter Study ; Journal Article
ZDB-ID	2127173-2
ISSN	2386-5857 ; 2386-5857
ISSN (online)	2386-5857
ISSN	2386-5857
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Article ; Online: What trauma patients need: the European dilemma.

Hietbrink, Falco / Mohseni, Shahin / Mariani, Diego / Naess, Päl Aksel / Rey-Valcárcel, Cristina / Biloslavo, Alan / Bass, Gary A / Brundage, Susan I / Alexandrino, Henrique / Peralta, Ruben / Leenen, Luke P H / Gaarder, Tina

European journal of trauma and emergency surgery : official publication of the European Trauma Society

2022

Abstract: There is a need for implementation and maturation of an inclusive trauma system in every country in Europe, with patient centered care by dedicated surgeons. This process should be initiated by physicians and medical societies, based on the best ... ...

Abstract	There is a need for implementation and maturation of an inclusive trauma system in every country in Europe, with patient centered care by dedicated surgeons. This process should be initiated by physicians and medical societies, based on the best available evidence, and supported and subsequently funded by the government and healthcare authorities. A systematic approach to organizing all aspects of trauma will result in health gain in terms of quality of care provided, higher survival rates, better functional outcomes and quality of life. In addition, it will provide reliable data for both research, quality improvement and prevention programs. Severely injured patients need surgeons with broad technical and non-technical competencies to provide holistic, inclusive and compassionate care. Here we describe the philosophy of the surgical approach and define the necessary skills for trauma, both surgical and other, to improve outcome of severely injured patients. As surgery is an essential part of trauma care, surgeons play an important role for the optimal treatment of trauma patients throughout and after their hospital stay, including the intensive care unit (ICU). However, in most European countries, it might not be obvious to either the general public, patients or even the physicians that the surgeon must assume this responsibility in the ICU to optimize outcomes. The aim of this paper is to define key elements in terms of trauma systems, trauma-specific surgical skills and active critical care involvement, to organize and optimize trauma care in Europe.
Language	English
Publishing date	2022-07-07
Publishing country	Germany
Document type	Journal Article
ZDB-ID	2275480-5
ISSN	1863-9941 ; 1863-9933
ISSN (online)	1863-9941
ISSN	1863-9933
DOI	10.1007/s00068-022-02014-w
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Article ; Online: Relationship between the anatomical location and the selective non-operative management of penetrating stab wounds in the abdomen.

Tudela Lerma, María / Turégano Fuentes, Fernando / Pérez Díaz, María Dolores / Rey Valcárcel, Cristina / Martín Román, Lorena / Ruiz Moreno, Cristina / Fernández Vázquez, María Luz / Fernández Martínez, María

Cirugia espanola

2022 Volume 100, Issue 2, Page(s) 67–73

Abstract: Introduction: The relationship between the anatomical location of penetrating abdominal stab wounds (SW) and the rate of selective non-operative management (SNOM) based on that location is scarcely reflected in the specialized literature. Our main ... ...

Abstract	Introduction: The relationship between the anatomical location of penetrating abdominal stab wounds (SW) and the rate of selective non-operative management (SNOM) based on that location is scarcely reflected in the specialized literature. Our main objective has been to assess this rate based on the anatomical location, and our results. Methods: Retrospective review of a prospective registry of abdominal trauma from April 1993 to June 2020. The two study groups considered were the Operative Management (OM), and the SNOM, including in this one the use of diagnostic laparoscopy. Penetrating SWs in the abdomen were classified according to anatomical location. Results: We identified 259 patients who fulfilled the inclusion criteria. SNOM was applied in 31% of the patients with a success rate of 96%, and it was more frequent in the lumbar, flank, and thoraco-abdominal regions; within the anterior abdomen it was more applicable in the RH, followed by the LH and epigastrium, respectively. An unnecessary laparotomy was done in 21% of patients, with the highest number in the epigastrium. Taking into account the unnecessary laparotomies and the rates of successful SNOM, 70.5% of lumbar, 66.5% of epigastric, 62% of flank, and 59% of RH penetrating SW could have been managed without a laparotomy. Conclusions: SNOM of penetrating SW in the abdomen has been safer and more applicable in those located in the lumbar, flank, epigastric, and RH regions.
Language	English
Publishing date	2022-02-02
Publishing country	Spain
Document type	Journal Article
ISSN	2173-5077
ISSN (online)	2173-5077
DOI	10.1016/j.cireng.2022.01.006
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Article ; Online: Relevance of pneumoperitoneum in the conservative approach to complicated acute diverticulitis. A retrospective study identifying risk factors associated with treatment failure.

Martín-Román, Lorena / Fernández-Martínez, María / Kayser Mata, Silvia / Colombari, Renan / Pascual-Espinosa, Pablo / Rey-Valcárcel, Cristina / Jiménez-Gómez, Luis M / Turégano-Fuentes, Fernando

Minerva surgery

2021 Volume 77, Issue 4, Page(s) 327–334

Abstract: Background: The aim of this study is to evaluate the relevance of pneumoperitoneum on the success rate of non-operative management (NOM) of patients with complicated acute diverticulitis (AD), and the risk factors associated with failure.: Methods: ... ...

Abstract	Background: The aim of this study is to evaluate the relevance of pneumoperitoneum on the success rate of non-operative management (NOM) of patients with complicated acute diverticulitis (AD), and the risk factors associated with failure. Methods: Observational retrospective cohort study of patients attended at the emergency department for AD from January 2015-August 2019. Patient demographics, blood tests, radiological data and initial treatment strategies were registered. NOM, based on intravenous antibiotics (ATB) and bowel rest, was defined as unsuccessful when emergency surgery (ES) and/or infection-related death took place. Patients initially treated with ES were excluded. Analysis was done with the IBM SPSS statistics 23.0.0.2 software. Results: According to modified Hinchey and WSES criteria, 99 (12%) of 826 AD episodes were complicated, with pneumoperitoneum on the CT scan in 89 (90.5%). NOM was undertaken in 93 (94%) cases, with a 91.5% success rate. Multivariate analysis revealed ASA class III-IV, and the presence of fluid collections >3 cm in diameter, but not distant free air, to be associated with NOM failure. However, the success rate of NOM was significantly higher in patients with pericolic pneumoperitoneum (98.5%) than in those with distant free air (80%) (P=0.02). Risk factors of NOM failure were an advanced age, high CRP and WBC values, and the presence of free fluid in >2 abdominal quadrants. Conclusions: NOM in hemodynamically stable patients with complicated AD is a safe and feasible approach, even in the context of distant free air. Nevertheless, patients with isolated pericolic air did better in our series.
MeSH term(s)	Diverticulitis/therapy ; Humans ; Pneumoperitoneum/diagnostic imaging ; Retrospective Studies ; Risk Factors ; Treatment Failure
Language	English
Publishing date	2021-08-02
Publishing country	Italy
Document type	Journal Article ; Observational Study
ZDB-ID	3067899-7
ISSN	2724-5438
ISSN (online)	2724-5438
DOI	10.23736/S2724-5691.21.08997-8
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Article ; Online: Results of the Spanish National Polytrauma Registry. Where are we and where are we heading?

Campos-Serra, Andrea / Pérez-Díaz, Lola / Rey-Valcárcel, Cristina / Montmany-Vioque, Sandra / Artiles-Armas, Manuel / Aparicio-Sánchez, Daniel / Tallón-Aguilar, Luís / Gutiérrez-Andreu, Marta / Bernal-Tirapo, Julia / Garcia-Moreno Nisa, Francisca / Vera-Mansilla, Cristina / González-Conde, Ricardo / Gómez-Viana, Leticia / Titos-García, Alberto / Aranda-Narvaez, Jose

Cirugia espanola

2023 Volume 101, Issue 9, Page(s) 609–616

Abstract: Introduction: In 2017, the Spanish National Polytrauma Registry (SNPR) was initiated in Spain with the goal to improve the quality of severe trauma management and evaluate the use of resources and treatment strategies. The objective of this study is to ... ...

Abstract	Introduction: In 2017, the Spanish National Polytrauma Registry (SNPR) was initiated in Spain with the goal to improve the quality of severe trauma management and evaluate the use of resources and treatment strategies. The objective of this study is to present the data obtained with the SNPR since its inception. Methods: We conducted an observational study with prospective data collection from the SNPR. The trauma patients included were over 14 years of age, with ISS ≥ 15 or penetrating mechanism of injury, from a total of 17 tertiary hospitals in Spain. Results: From 1/1/17 to 1/1/22, 2069 trauma patients were registered. The majority were men (76.4%), with a mean age of 45 years, mean ISS 22.8, and mortality 10.2%. The most common mechanism of injury was blunt trauma (80%), the most frequent being motorcycle accident (23%). Penetrating trauma was presented in 12% of patients, stab wounds being the most common (84%). On hospital arrival, 16% of patients were hemodynamically unstable. The massive transfusion protocol was activated in 14% of patients, and 53% underwent surgery. Median hospital stay was 11 days, while 73.4% of patients required intensive care unit (ICU) admission, with a median ICU stay of 5 days. Conclusions: Trauma patients registered in the SNPR are predominantly middle-aged males who experience blunt trauma with a high incidence of thoracic injuries. Early addressed detection and treatment of these kind of injuries would probably improve the quality of trauma care in our environment.
MeSH term(s)	Middle Aged ; Male ; Humans ; Female ; Multiple Trauma/epidemiology ; Multiple Trauma/therapy ; Hospitalization ; Length of Stay ; Wounds, Nonpenetrating/epidemiology ; Wounds, Nonpenetrating/surgery ; Registries
Language	English
Publishing date	2023-03-20
Publishing country	Spain
Document type	Observational Study ; Journal Article
ISSN	2173-5077
ISSN (online)	2173-5077
DOI	10.1016/j.cireng.2023.03.007
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Article ; Online: Relationship between the anatomical location and the selective non-operative management of penetrating stab wounds in the abdomen.

Cirugia espanola

2021

Title translation	Relación entre la localización anatómica y el manejo selectivo no operatorio de las heridas por arma blanca penetrantes en abdomen.
Abstract	Introduction: The relationship between the anatomical location of penetrating abdominal stab wounds (SW) and the rate of selective non-operative management (SNOM) based on that location is scarcely reflected in the specialized literature. Our main objective has been to assess this rate based on the anatomical location, and our results. Methods: Retrospective review of a prospective registry of abdominal trauma from April 1993 to June 2020. The two study groups considered were the Operative Management (OM), and the SNOM, including in this one the use of diagnostic laparoscopy. Penetrating SWs in the abdomen were classified according to anatomical location. Results: We identified 259 patients who fulfilled the inclusion criteria. SNOM was applied in 31% of the patients with a success rate of 96%, and it was more frequent in the lumbar, flank, and thoraco-abdominal regions; within the anterior abdomen it was more applicable in the RUQ, followed by the LUQ and epigastrium, respectively. An unnecessary laparotomy was done in 21% of patients, with the highest number in the epigastrium. Taking into account the unnecessary laparotomies and the rates of successful SNOM, 70,5% of lumbar, el 66,5% of epigastric, 62% of flank, and 59% of RUQ penetrating SWs could have been managed without a laparotomy. Conclusions: SNOM of penetrating SWs in the abdomen has been safer and more applicable in those located in the lumbar, flank, epigastric, and RUQ regions.
Language	Spanish
Publishing date	2021-02-13
Publishing country	Spain
Document type	Journal Article
ISSN	2173-5077
ISSN (online)	2173-5077
DOI	10.1016/j.ciresp.2020.12.003
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Article: Angiosarcoma hepático.

Bernardos, L / García Marín, A / Rey Valcárcel, C / Martín Gil, J / Turégano Fuentes, F

Revista espanola de enfermedades digestivas : organo oficial de la Sociedad Espanola de Patologia Digestiva

2008 Volume 100, Issue 12, Page(s) 804–806

Title translation	Hepatic angiosarcoma.
MeSH term(s)	Adult ; Female ; Hemangiosarcoma/pathology ; Humans ; Liver Neoplasms/pathology ; Male ; Middle Aged
Language	Spanish
Publishing date	2008-12-18
Publishing country	Spain
Document type	Case Reports ; Letter
ZDB-ID	1070381-0
ISSN	1130-0108 ; 0212-7512
ISSN	1130-0108 ; 0212-7512
DOI	10.4321/s1130-01082008001200017
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Article ; Online: Enterocele conteniendo ciego e íleon terminal a nivel de labio mayor.

Zarain Obrador, Leire / Cuadrado Ayuso, Marta / Rey Valcárcel, Cristina / Dolores Pérez Díaz, M

Cirugia espanola

2013 Volume 91, Issue 10, Page(s) 676

Title translation	Enterocele containing cecum and terminal ileum at labium majus level.
MeSH term(s)	Aged, 80 and over ; Cecum ; Female ; Hernia/diagnosis ; Herniorrhaphy ; Humans ; Ileum ; Vulva
Language	Spanish
Publishing date	2013-12
Publishing country	Spain
Document type	Case Reports ; Journal Article
ZDB-ID	730701-9
ISSN	1578-147X ; 0009-739X
ISSN (online)	1578-147X
ISSN	0009-739X
DOI	10.1016/j.ciresp.2013.06.009
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Article ; Online: Complicaciones quirúrgicas en los body-packers: una urgencia infrecuente pero potencialmente letal.

Álvarez Llano, Laura / Rey Valcárcel, Cristina / Mohamed Al-Lal, Yusef / Sánchez Rodríguez, Teresa / García Marín, Andrés / Pérez Díaz, María Dolores / Turégano Fuentes, Fernando

Cirugia espanola

2012 Volume 90, Issue 9, Page(s) 595–600

Abstract: Introduction: Drug trafficking by means of introducing packets of illegal substances in body cavities carries a risk of suffering from a gastrointestinal obstruction and/or severe poisoning in the person who transports them. Spain is considered as the ... ...

Title translation	Surgical complications in drug body-packers: an uncommon but potentially lethal emergency.
Abstract	Introduction: Drug trafficking by means of introducing packets of illegal substances in body cavities carries a risk of suffering from a gastrointestinal obstruction and/or severe poisoning in the person who transports them. Spain is considered as the port of entry to Europe for drugs, and some Spanish hospitals have experience in managing these types of patients. Two hospitals in Madrid, including the Gregorio Marañón University General Hospital (HGUGM), received these potential patients from the Madrid Barajas airport. Objective: To analyse the results of the conservative treatment and the need for surgery in "body-packers". Material and methods: A retrospective, observational study of patients diagnosed as a body-packer between January 2000 and December 2008. Those with gastrointestinal symptoms, signs of poisoning, or positive for drugs of abuse, were admitted to the Custodial Unit of our hospital. The conservative treatment consisted of digestive rest and imaging studies until expulsion from the body. Asymptomatic patients were discharged from the Emergency Department. Results: A total of 549 patients, with a median age of 31 years, and of whom 81% were males, were hospitalised during this period. Less than half (40%) showed positive for drugs in the urine, with cocaine in 80% of the cases. Of the 549 patients with initial conservative treatment, 27 (4.9%) had serious complications (16, bowel obstruction, and 11 with signs of poisoning). Of these, 23 required surgery (the 16 obstructions and 7 of the poisonings); 2 were successfully treated in ICU, and 2 died before surgery (0.4%) of the cases. The most frequent surgical treatment was enterotomy and/or gastrostomy to extract the packets. Thirteen (56%) of those operated on had associated morbidity (11 abdominal infections and 2 nosocomial infections). Conclusions: Conservative treatment is safe in 95% of the patients. A small percentage required surgical treatment, basically for gastrointestinal obstruction or severe poisoning.
MeSH term(s)	Adult ; Drug Trafficking ; Emergencies ; Emergency Treatment ; Female ; Gastrointestinal Diseases/chemically induced ; Gastrointestinal Diseases/surgery ; Humans ; Intestinal Obstruction/etiology ; Intestinal Obstruction/surgery ; Male ; Postoperative Complications/etiology ; Retrospective Studies ; Spain ; Street Drugs/poisoning
Chemical Substances	Street Drugs
Language	Spanish
Publishing date	2012-11
Publishing country	Spain
Document type	English Abstract ; Journal Article
ZDB-ID	730701-9
ISSN	1578-147X ; 0009-739X
ISSN (online)	1578-147X
ISSN	0009-739X
DOI	10.1016/j.ciresp.2012.02.005
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Article: Lesiones gastrointestinales y mesentéricas en el paciente politraumatizado: incidencia, demora diagnóstica y pronóstico.

Rey Valcárcel, Cristina / Turégano Fuentes, Fernando / Carlín Gatica, Jorge / Ruiz de la Hermosa, Alicia / Vásquez Jiménez, Wenceslao / Pérez Díaz, Dolores / Sanz Sánchez, Mercedes

Cirugia espanola

2009 Volume 86, Issue 1, Page(s) 17–23

Abstract: Background: Gastrointestinal and mesenteric injuries (GIMI) are uncommon in trauma patients, and their diagnosis are often delayed. Our aims were to determine the reliability of CT scan in our centre, and to assess the clinical significance of a delayed ...

Title translation	Gastrointestinal and mesenteric injuries in the trauma patient: incidence, diagnosis delay and prognosis.
Abstract	Background: Gastrointestinal and mesenteric injuries (GIMI) are uncommon in trauma patients, and their diagnosis are often delayed. Our aims were to determine the reliability of CT scan in our centre, and to assess the clinical significance of a delayed diagnosis. Materials and method: Retrospective analysis of cases confirmed at laparotomy. Patients were identified at the Severe Trauma Registry of Gregorio Marañón University General Hospital, between 1993 and 2006. Results: We found 105 (16.6%) GIMI out of 632 patients with abdominal trauma, in a Registry with 1495 severe trauma cases included. A total of 46% had blunt injuries. The mean injury severity score (ISS) and new ISS (NISS) were 20 and 25, respectively. There were 9 (8.5%) deaths, 4 of which were unexpected. A CT scan was performed in 56 (53%) cases, and only in 37 there were signs suggestive of a GIMI. In another 43 (41%) patients an urgent laparotomy was indicated because of positive clinical findings or instability. Surgery was delayed for more than 8 hours in 21 (20%) patients, the most common reason being a false negative result in the CT scan. Conclusions: The overall incidence of GIMI was high in our centre (31% due to penetration and 10.7% blunt trauma). Several factors, such as the initial lack of symptoms, a low diagnostic sensitivity of the CT scan (34% false negatives), and the non-surgical management of solid organ injuries, have contributed to a delayed diagnosis and treatment in one out of each five patients in our series, but this has not led to a significant increase in septic complications in this group.
MeSH term(s)	Adult ; Decision Trees ; Female ; Gastrointestinal Tract/injuries ; Humans ; Male ; Mesentery/injuries ; Middle Aged ; Prognosis ; Retrospective Studies ; Time Factors ; Wounds and Injuries/diagnosis ; Wounds and Injuries/epidemiology ; Wounds and Injuries/surgery
Language	Spanish
Publishing date	2009-07
Publishing country	Spain
Document type	English Abstract ; Journal Article
ZDB-ID	730701-9
ISSN	0009-739X
ISSN	0009-739X
DOI	10.1016/j.ciresp.2009.01.015
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