Letter to the Editor
Severe traumatic disease register in Spain
Registro de enfermedad traumática grave en España
M. Chico-Fernándeza,
, J.A. Llompart-Poub, M. Sánchez-Casadoc, M.Á. Ballesteros-Sanzd
Corresponding author
a UCI de Trauma y Emergencias (UCITE), Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, Spain
b Servei de Medicina Intensiva, Hospital Universitari Son Espases, Instituto de Investigación Sanitaria de Palma (IdISPa), Palma de Mallorca, Balearic Islands, Spain
c Servicio de Medicina Intensiva, Hospital Virgen de la Salud, Toledo, Spain
d Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
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Chico-Fernández, J.A. Llompart-Pou, M. Sánchez-Casado, M.Á. Ballesteros-Sanz" "autores" => array:4 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Chico-Fernández" "email" => array:1 [ 0 => "murgchico@yahoo.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "J.A." "apellidos" => "Llompart-Pou" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "M." "apellidos" => "Sánchez-Casado" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "M.Á." "apellidos" => "Ballesteros-Sanz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "UCI de Trauma y Emergencias (UCITE), Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servei de Medicina Intensiva, Hospital Universitari Son Espases, Instituto de Investigación Sanitaria de Palma (IdISPa), Palma de Mallorca, Balearic Islands, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Medicina Intensiva, Hospital Virgen de la Salud, Toledo, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Registro de enfermedad traumática grave en España" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We appreciate the interest and comments of Sánchez-Pastor et al. on the preliminary results corresponding to the pilot phase of the Intensive Care Unit Trauma Registry (<span class="elsevierStyleItalic">REgistro de TRAuma en UCI</span> [RETRAUCI]).<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,2</span></a> The RETRAUCI has become consolidated as a reference in our setting and currently comprises almost 6000 registries corresponding to patients with acute trauma disease, with 49 participating hospitals and 102 investigators nationwide.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Since pre-hospital activation is not a variable contemplated in our registry, and the activation criteria differ among the participating centers, we cannot know how many prehospital activations were received among the 2242 patients included in the pilot phase. The prehospital activation code was present in 10/13 (76.9%) of the participating centers in the pilot phase, which included a total of 2030/2242 (90.5%) of the registered patients.</p><p id="par0015" class="elsevierStylePara elsevierViewall">As regards the origin of the patients, we deduce that the authors have not clearly understood this section, which indicates the origin of the patients upon admission to the Intensive Care Unit (ICU). An out-hospital origin (816 patients; 36.9%) refers to patients directly reaching the ICU from the out-hospital setting, without passing through the emergency care services. An origin from emergency care (784 patients; 35.4%) in turn refers to patients attended in the emergency care services before arriving in the ICU. In both cases, most of the patients were transferred by the out-hospital emergency services. Therefore, rather than an epidemiological difference referred to the characteristics of the patients, this point reflects the variability–not an organizational deficiency–of the severe traumatic disease care systems in our centers.</p><p id="par0020" class="elsevierStylePara elsevierViewall">We found the discussion referred to elderly patients to be particularly interesting. It is well known that the epidemiological profile of severe traumatic disease is changing, and a recent study by our group has illustrated different injury patterns stratified according to 10-year age increments.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> In this regard, elderly patients were more often affected by low-energy trauma complicated by the routine use of antiplatelet drugs and anticoagulants, and were moreover at a greater risk of being run over.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> In the pilot phase of the RETRAUCI, the elderly population (age ≥65 years) represented 21.8% of the total. With regard to pre-hospital care, we observed a greater percentage of patients without medical care or who were assisted by non-medicalized ambulance (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The literature is clear in underscoring the existence of <span class="elsevierStyleItalic">infra-triage</span> to reference centers or trauma centers among elderly patients.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> More aggressive management in the context of triage, transferring such patients to reference centers that deal with a larger number of elderly trauma cases, has been associated to improvements in terms of survival.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> The adequate management of this patient population undoubtedly will constitute a challenge over the coming years.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0030" class="elsevierStylePara elsevierViewall">The registry received financial support from the <span class="elsevierStyleGrantSponsor" id="gs1"><span class="elsevierStyleItalic">Fundación Mutua Madrileña</span></span> during three years for the development of an online data compilation tool, granted to the principal investigator of the project (Dr. Chico-Fernández, Reference no.: AP117892013) in representation of the Trauma Neurointensive Care Working Group of the SEMICYUC.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial support" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Chico-Fernández M, Llompart-Pou JA, Sánchez-Casado M, Ballesteros-Sanz MÁ. Registro de enfermedad traumática grave en España. Med Intensiva. 2017;41:324–325.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">ICU, Intensive Care Unit.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><65 years \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">≥65 years \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No care (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">192 (8.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">70 (14.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Non-medicalized ambulance (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">229 (10.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58 (12.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mobile ICU (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1551 (69.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">285 (60.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Helicopter (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">207 (9.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40 (8.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Not known (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">46 (2.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 (3.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1436668.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Type of out-hospital care among the included patients according to age group.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "pii:S0210-5691(16)30217-0. doi:10.1016/j.medin.2016.09.010 [in English, Spanish]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Major trauma in Spain" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Sánchez-Pastor" 1 => "M.J. Pérez-Díaz" 2 => "F. Rosell-Ortiz" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "Med Intensiva" "fecha" => "2017" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiology of severe trauma in Spain. Registry of trauma in the ICU (RETRAUCI). Pilot phase" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "en representación del Grupo de Trabajo de Trauma y Neurointensivismo SEMICYUC" "etal" => true "autores" => array:6 [ 0 => "M. Chico-Fernández" 1 => "J.A. Llompart-Pou" 2 => "F. Guerrero-López" 3 => "M. Sánchez-Casado" 4 => "I. García-Sáez" 5 => "M.D. Mayor-García" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medin.2015.07.011" "Revista" => array:6 [ "tituloSerie" => "Med Intensiva" "fecha" => "2016" "volumen" => "40" "paginaInicial" => "327" "paginaFinal" => "347" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26440993" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Age-related injury patterns in Spanish trauma ICU patients. Results from the RETRAUCI" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Trauma Neurointensive Care Working Group of the Spanish Society of Intensive Care Medicine (SEMICYUC)" "etal" => true "autores" => array:6 [ 0 => "J.A. Llompart-Pou" 1 => "M. Chico-Fernández" 2 => "M. Sánchez-Casado" 3 => "F. Alberdi-Odriozola" 4 => "F. Guerrero-López" 5 => "M.D. Mayor-García" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0020-1383(16)30608-8" "Revista" => array:7 [ "tituloSerie" => "Injury" "fecha" => "2016" "volumen" => "47" "numero" => "Suppl. 3" "paginaInicial" => "S61" "paginaFinal" => "S65" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27692109" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A position paper: the convergence of aging and injury and the need for a Geriatric Trauma Coalition (GeriTraC)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Z. Cooper" 1 => "C.A. Maxwell" 2 => "S.M. Fakhry" 3 => "B. Joseph" 4 => "N. Lundebjberg" 5 => "P. Burke" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/TA.0000000000001317" "Revista" => array:6 [ "tituloSerie" => "J Trauma Acute Care Surg" "fecha" => "2017" "volumen" => "82" "paginaInicial" => "419" "paginaFinal" => "422" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27893640" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Outcomes of trauma care at centers treating a higher proportion of older patients: the case for geriatric trauma centers" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.N. Zafar" 1 => "A. Obirieze" 2 => "E.B. Schneider" 3 => "Z.G. Hashmi" 4 => "V.K. Scott" 5 => "W.R. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 6 | 11 |
| 2024 October | 60 | 41 | 101 |
| 2024 September | 35 | 23 | 58 |
| 2024 August | 49 | 37 | 86 |
| 2024 July | 40 | 20 | 60 |
| 2024 June | 52 | 50 | 102 |
| 2024 May | 38 | 26 | 64 |
| 2024 April | 60 | 32 | 92 |
| 2024 March | 44 | 27 | 71 |
| 2024 February | 30 | 37 | 67 |
| 2024 January | 36 | 32 | 68 |
| 2023 December | 31 | 35 | 66 |
| 2023 November | 40 | 46 | 86 |
| 2023 October | 26 | 30 | 56 |
| 2023 September | 32 | 32 | 64 |
| 2023 August | 30 | 20 | 50 |
| 2023 July | 39 | 27 | 66 |
| 2023 June | 34 | 14 | 48 |
| 2023 May | 40 | 27 | 67 |
| 2023 April | 25 | 22 | 47 |
| 2023 March | 29 | 36 | 65 |
| 2023 February | 21 | 38 | 59 |
| 2023 January | 30 | 22 | 52 |
| 2022 December | 39 | 40 | 79 |
| 2022 November | 41 | 37 | 78 |
| 2022 October | 53 | 40 | 93 |
| 2022 September | 38 | 37 | 75 |
| 2022 August | 49 | 43 | 92 |
| 2022 July | 29 | 40 | 69 |
| 2022 June | 27 | 24 | 51 |
| 2022 May | 39 | 26 | 65 |
| 2022 April | 28 | 41 | 69 |
| 2022 March | 48 | 68 | 116 |
| 2022 February | 34 | 46 | 80 |
| 2022 January | 36 | 41 | 77 |
| 2021 December | 59 | 40 | 99 |
| 2021 November | 25 | 41 | 66 |
| 2021 October | 49 | 77 | 126 |
| 2021 September | 32 | 44 | 76 |
| 2021 August | 36 | 47 | 83 |
| 2021 July | 49 | 36 | 85 |
| 2021 June | 25 | 19 | 44 |
| 2021 May | 38 | 42 | 80 |
| 2021 April | 101 | 68 | 169 |
| 2021 March | 46 | 35 | 81 |
| 2021 February | 42 | 16 | 58 |
| 2021 January | 46 | 20 | 66 |
| 2020 December | 36 | 15 | 51 |
| 2020 November | 34 | 19 | 53 |
| 2020 October | 27 | 26 | 53 |
| 2020 September | 49 | 20 | 69 |
| 2020 August | 27 | 18 | 45 |
| 2020 July | 54 | 31 | 85 |
| 2020 June | 44 | 13 | 57 |
| 2020 May | 23 | 5 | 28 |
| 2020 April | 25 | 15 | 40 |
| 2020 March | 18 | 6 | 24 |
| 2020 February | 37 | 25 | 62 |
| 2020 January | 34 | 18 | 52 |
| 2019 December | 29 | 6 | 35 |
| 2019 November | 19 | 30 | 49 |
| 2019 October | 25 | 17 | 42 |
| 2019 September | 18 | 18 | 36 |
| 2019 August | 22 | 19 | 41 |
| 2019 July | 29 | 20 | 49 |
| 2019 June | 8 | 8 | 16 |
| 2019 May | 40 | 33 | 73 |
| 2019 April | 13 | 17 | 30 |
| 2019 March | 21 | 20 | 41 |
| 2019 February | 29 | 27 | 56 |
| 2019 January | 25 | 29 | 54 |
| 2018 December | 26 | 23 | 49 |
| 2018 November | 40 | 46 | 86 |
| 2018 October | 45 | 27 | 72 |
| 2018 September | 43 | 12 | 55 |
| 2018 August | 26 | 8 | 34 |
| 2018 July | 40 | 18 | 58 |
| 2018 June | 46 | 15 | 61 |
| 2018 May | 34 | 9 | 43 |
| 2018 April | 50 | 13 | 63 |
| 2018 March | 64 | 8 | 72 |
| 2018 February | 16 | 12 | 28 |
| 2018 January | 52 | 18 | 70 |
| 2017 December | 22 | 10 | 32 |
| 2017 November | 37 | 21 | 58 |
| 2017 October | 38 | 0 | 38 |
| 2017 September | 6 | 1 | 7 |
| 2017 July | 2 | 1 | 3 |
| 2017 June | 1 | 0 | 1 |
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