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Severity of trauma victims admitted in intensive care units: comparative study among different indexes
Nogueira, Lilia de Souza;Sousa, Regina Marcia Cardoso de;Domingues, Cristiane de Alencar;
Revista Latino-Americana de Enfermagem , 2009, DOI: 10.1590/S0104-11692009000600017
Abstract: this study compared the performance of the injury severity score (iss) with the new injury severity score (niss) and also the simplified acute physiology score ii (saps ii) with the logistic organ dysfunction system (lods) in trauma victims, in order to predict mortality and length of stay in intensive care units (icu), besides identifying which indexes have been the most effective to estimate these results. a retrospective analysis was done in the records of 185 victims admitted in icu between june and december 2006. none of the four indexes properly discriminated the patients according to length of stay at the icu. the iss and the niss did not show a good discriminating capacity in case of death, but the saps ii and the lods presented good performance to estimate mortality at the icu. results pointed towards the use of saps ii and lods when trauma victims are admitted in an icu.
Características clínicas e gravidade de pacientes internados em UTIs públicas e privadas
Nogueira, Lilia de Souza;Sousa, Regina Marcia Cardoso de;Padilha, Katia Grillo;Koike, Karina Mitie;
Texto & Contexto - Enfermagem , 2012, DOI: 10.1590/S0104-07072012000100007
Abstract: this study aimed to compare clinical characteristics, evolution and severity of adult patients admitted in public and private intensive care units. it is a retrospective, longitudinal and quantitative analysis of 600 patients admitted in four intensive care units of s?o paulo, brazil. differences were found between patients admitted in private and public hospitals regarding the following variables: age, origin, length of stay and mortality in the critical unit, cardiac, hematological, neurological and kidney failures and some comorbidities. the results reveal the importance of analyzing in detail clinical characteristics and healthcare of patients admitted in public institutions, because of the high mortality found. the intensive care nurse can contribute to change this scenario, because she/he has a leadership role in planning and provision of resources for intensive care.
Características clínicas e gravidade de pacientes internados em UTIs públicas e privadas
Lilia de Souza Nogueira,Regina Marcia Cardoso de Sousa,Katia Grillo Padilha,Karina Mitie Koike
Texto & Contexto - Enfermagem , 2012,
Abstract: La investigación tuvo como objetivo comparar las características clínicas, evolución y gravedad de pacientes adultos ingresados en Unidades de Cuidados Intensivos públicas y privadas. Este es un estudio retrospectivo, longitudinal y cuantitativo de 600 pacientes ingresados en cuatro Unidades de Cuidados Intensivos en S o Paulo, Brasil. Fueron encontradas diferencias entre los pacientes de los hospitales privados y públicos para las variables: edad, procedencia, tiempo de internación y mortalidad en la unidad crítica, insuficiencia cardiológica, hematológica, neurológica y renal, además de algunas comorbilidades. Los resultados revelan la importancia de se analizar las características clínicas y la asistencia prestada en las instituciones públicas, en comparación a la tasa de mortalidad. La Enfermera de Cuidados Intensivos puede ayudar a cambiar esta situación, ya que tiene un papel de liderazgo en la planificación de la atención y la provisión de recursos para cuidados intensivos.
Ten years of new injury severity score (NISS): is it a possible change?
Nogueira, Lilia de Souza;Domingues, Cristiane de Alencar;Campos, Miriam de Araújo;Sousa, Regina Márcia Cardoso de;
Revista Latino-Americana de Enfermagem , 2008, DOI: 10.1590/S0104-11692008000200022
Abstract: the article is a bibliographic review which intends to present the actual range of researches comparing the injury severity score (iss) and the new injury severity score (niss). databases were searched using the keyword niss, with 42 articles, 23 of which didn't compare the two indexes. most part of the 19 selected articles showed that niss has been more accurate in predicting the outcomes (dependent variables) than iss, moreover in severe and specific trauma. studies with populations between 1,000 and 10,000 resulted in niss-favorable results, whereas studies with populations larger than 10,000 or smaller than 1,000 showed either niss-favorable results or no difference between the two groups. however, there were no studies showing iss-favorable results. these results and the easier calculation of niss lead to a future replacement of iss by niss.
Mortes evitáveis em vítimas com traumatismos
Settervall,Cristina Helena Costanti; Domingues,Cristiane de Alencar; Sousa,Regina Marcia Cardoso de; Nogueira,Lilia de Souza;
Revista de Saúde Pública , 2012, DOI: 10.1590/S0034-89102012005000010
Abstract: objective: to describe methods of estimation and assess preventable deaths and types of errors related to health care. methods: a systematic review of articles on preventable trauma deaths published between 2000 and 2009 was conducted. lilacs, scielo and medline databases were searched using the keywords "trauma," "avoidable," "preventable," "interventions" and "complications" and the health sciences descriptors "death," "cause of death," and "hospitals." results: a total of 29 articles published during the study period were selected. most were retrospective studies (96.5%). the most common methods used to define avoidability of death were expert panel and injury severity scores. deaths were categorized as follows: preventable; potentially preventable; and not preventable. the mean preventable death rate was 10.7% (sd 11.5%). the most commonly reported errors were inadequate care management of injured patients and evaluation and treatment errors. conclusions: inconsistent terms were used to categorize deaths and related noncompliances. it is suggested to standardize the terminology for the classification of deaths and types of errors.
Clinical evolution of adult, elderly and very elderly patients admitted in Intensive Care Units
Oliveira, Ver?nica Cunha Rodrigues de;Nogueira, Lilia de Souza;Andolhe, Rafaela;Padilha, Katia Grillo;Sousa, Regina Marcia Cardoso de;
Revista Latino-Americana de Enfermagem , 2011, DOI: 10.1590/S0104-11692011000600010
Abstract: this study compared clinical outcomes among adult, elderly and very elderly patients admitted to intensive care units (icus) located in s?o paulo, brazil. this retrospective, longitudinal and comparative study included 279 adult (≥18 and <60 years), 216 elderly (≥60 and <80 years) and 105 very elderly (≥80 years) patients. adult patients differed from other groups regarding the unit to which they were referred and severity, according to the simplified acute physiology score ii. adults were most frequently sent to hospitalization wards; elderly and very elderly patients who survived hospitalization in critical units showed sharper improvement before discharge. there were differences in relation to mortality between adult and elderly patients, with a higher rate in the elderly group; however, the mortality rate of very elderly and adult patients was similar. in general, the results indicated that older age was not associated with undesirable outcomes in icus.
Desempenho de índices de gravidade para estimar risco de morte em Unidades de Terapia Intensiva Desempe o de índices de gravedad para estimar riesgo de muerte en Unidades de Terapia Intensiva The use of severity indexes to estimate the risk of death in Intensive Care
Lilian Carvalho da Silva,Lilia de Souza Nogueira,Cristina Helena Costanti Settervall,Regina Marcia Cardoso de Sousa
Revista da Escola de Enfermagem da USP , 2012, DOI: 10.1590/s0080-62342012000400009
Abstract: O Simplified Acute Physiology Score II (SAPS II) e o Logistic Organ Dysfunction System (LODS) s o instrumentos utilizados para classificar pacientes internados em Unidades de Terapia Intensiva (UTI) conforme a gravidade e o risco de morte, sendo um dos parametros da qualidade da assistência de enfermagem. Este estudo teve por objetivo avaliar e comparar as performances do SAPS II e do LODS para predizer mortalidade de pacientes admitidos em UTI. Participaram do estudo 600 pacientes de quatro diferentes UTIs de S o Paulo, Brasil. A curva Receiver Operator Characteristic (ROC) foi utilizada para comparar o desempenho discriminatório dos índices. Os resultados foram: as áreas sob a curva do LODS (0.69) e do SAPS II (0.71) apresentaram moderada capacidade discriminatória para predizer mortalidade. N o foi encontrada diferen a estatisticamente significativa entre as áreas (p=0,26). Concluiu-se que houve equivalência entre SAPS II e LODS para estimar risco de morte de pacientes em UTI. El Simplified Acute Physiology Score II (SAPS II) y el Logistic Dysfunction System (LODS) son instrumentos utilizados para clasificar pacientes internados en Unidades de Terapia Intensiva (UTI), conforme a la gravedad y riesgo de muerte, constituyéndose en uno de los parámetros de la calidad de atención de enfermería. Se objetivó evaluar y comparar la performance del SAPS II y del LODS para predicción de mortalidad de pacientes admitidos en UTI. Participaron del estudio 600 pacientes de cuatro UTI de S o Paulo, Brasil. La curva Receiver Operator Characteristic (ROC) fue utilizada para comparar el desempe o discriminatorio de los índices. Resultados: las áreas bajo la curva del LODS (0,69) y del SAPS II (0,71) presentaron moderada capacidad discriminatoria para predecir mortalidad. No se encontró diferencia estadísticamente significativa entre las áreas (p=0,26). Se concluyó en que existió equivalencia entre SAPS II y LODS para estimar riesgo de muerte para pacientes de UTI. The Simplified Acute Physiology Score II (SAPS II) and Logistic Organ Dysfunction System (LODS) are instruments used to classify Intensive Care Unit (ICU) inpatients according to the severity of their condition and risk of death, and evaluate the quality of nursing care. The objective of this study is to evaluate and compare the performance of SAPS II and LODS to predict the mortality of patients admitted to the ICU. The participants were 600 patients from four ICUs located in S o Paulo, Brazil. Receiver Operator Characteristic (ROC) curves were used to compare the performance of the indexes. Results: The ar
Vítimas de ocorrência de transito submetidas a procedimentos cirúrgicos: características e intercorrências transoperatórias Víctimas de accidente de tránsito sometidas a procedimientos quirúrgicos: características y complicaciones transoperatorios Victims of traffic occurrence submitted to surgery procedures: characteristics and perioperative complications
Lívia Ortiz Reiniger,Regina Marcia Cardoso de Sousa,Lilia de Souza Nogueira,Ana Lucia Siqueira Costa
Revista da Escola de Enfermagem da USP , 2012, DOI: 10.1590/s0080-62342012000700009
Abstract: Esta pesquisa objetivou caracterizar as vítimas de ocorrência de transito submetidas a procedimentos anestésico-cirúrgicos, segundo dados demográficos e clínicos, e identificar os preditores de intercorrências no período transoperatório (choque hemorrágico ou óbito). Estudo de corte transversal desenvolvido a partir de consulta aos prontuários dos pacientes submetidos à cirurgia, no Instituto Central do Hospital das Clínicas da FMUSP. Nos 69 pacientes, predominaram os jovens, do sexo masculino, vítimas de acidentes motociclísticos/ciclísticos e que receberam atendimento pré-hospitalar. As variáveis: abdome como regi o mais gravemente lesada pelo Injury Severity Score e as cirurgias geral e ortopédica, apresentaram associa o estatística significativa com choque e óbito. A idade associou-se apenas com choque. No modelo final, o Injury Severity Score foi preditor para choque e óbito e a cirurgia geral, apenas para choque. A cirurgia ortopédica foi fator de prote o para óbito. Esses achados subsidiam a equipe cirúrgica no planejamento de estratégicas que visem à redu o de desfechos indesejados. Esta investigación tuvo como objetivo caracterizar las víctimas de accidente de tránsito sometidas a procedimientos anestésicos y quirúrgicos según datos demográficos y clínicos e identificar predictores de complicaciones en el periodo transoperatorio (choque hemorrágico o óbito). Estudio de cohorte transversal desarrollado a partir de la consulta de archivos de los pacientes sometidos a cirugía en un hospital de Sao Paulo. De los 69 pacientes, predominaron jóvenes, de sexo masculino, víctimas de accidentes de motocicleta/bicicleta y que recibieron atención prehospitalaria. Abdomen como región más gravemente lesionada, Injury Severity Score, cirugías general y ortopédica tuvieron correlación estadística significativa con choque y óbito. Edad se correlacionó apenas con choque. En el modelo final, Injury Severity Score fue predictor para choque y óbito; y cirugía general para choque. Cirugía ortopédica fue factor de protección de óbito. Estos resultados auxilian al equipo quirúrgico en el planeamiento de estrategias orientadas a la reducción de consecuencias indeseables. This study aimed to characterize the victims of traffic occurrence submitted to anesthetic-surgical procedures according to demographics and clinical data and identify the predictors of complications during the perioperative period (hemorrhagic shock and death). A cross-longitudinal analysis developed from the consultations of patients′ records submitted to surgery at a hospital in S o Paulo city. T
The role of the New Trauma and Injury Severity Score (NTRISS) for survival prediction
Domingues, Cristiane de Alencar;Sousa, Regina Marcia Cardoso de;Nogueira, Lilia de Souza;Poggetti, Renato Sérgio;Fontes, Belchor;Mu?oz, Daniele;
Revista da Escola de Enfermagem da USP , 2011, DOI: 10.1590/S0080-62342011000600011
Abstract: the objective of this study was to verify if replacing the injury severity score (iss) by the new injury severity score (niss) in the original trauma and injury severity score (triss) form would improve the survival rate estimation. this retrospective study was performed in a level i trauma center during one year. roc curve was used to identify the best indicator (triss or ntriss) for survival probability prediction. participants were 533 victims, with a mean age of 38±16 years. there was predominance of motor vehicle accidents (61.9%). external injuries were more frequent (63.0%), followed by head/neck injuries (55.5%). survival rate was 76.9%. there is predominance of iss scores ranging from 9-15 (40.0%), and niss scores ranging from 16-24 (25.5%). survival probability equal to or greater than 75.0% was obtained for 83.4% of the victims according to triss, and for 78.4% according to ntriss. the new version (ntriss) is better than triss for survival prediction in trauma patients.
Carga de trabalho de enfermagem requerida por adultos, idosos e muito idosos em Unidade de Terapia Intensiva
Sousa, Regina Marcia Cardoso de;Padilha, Katia Grillo;Nogueira, Lilia de Souza;Miyadahira, Ana Maria Kazue;Oliveira, Ver?nica Cunha Rodrigues de;
Revista da Escola de Enfermagem da USP , 2009, DOI: 10.1590/S0080-62342009000600024
Abstract: the study's objectives were to compare nursing workload among adults, elderly and very elderly patients, including in the analyses the interventions and evolution of the workload between admission and discharge. this prospective longitudinal study involved 600 adult patients in general icu in four city hospitals in sao paulo. the results showed that, independent of the age, it had the similarity of the nursing workload in the admission, as well as in the evolution of the patients' care. differences between the groups were observed in the nas on icu's discharge and the following instrument's items: monitoring and titration and hygiene procedures in admission, respiratory support and intravenous hyperalimentation in discharge and mobilization and positioning in discharge and admission. in conclusion, the results evidenced that the age interfered only in specific aspects of the nursing workload required by patients in icus.
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