Editorial
Recovered trauma patient: Good luck and… until next time!
Paciente traumatizado recuperado: buena suerte y… ¡hasta la próxima!
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"tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "205" "paginaFinal" => "206" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "E. Fernández Mondéjar, F. Guerrero López, S. Cordovilla Guardia" "autores" => array:3 [ 0 => array:4 [ "nombre" => "E." "apellidos" => "Fernández Mondéjar" "email" => array:1 [ 0 => "enrique.fernandez.mondejar.sspa@juntadeandalucia.es" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "F." "apellidos" => "Guerrero López" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "S." "apellidos" => "Cordovilla Guardia" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Intensiva, Hospital Universitario Virgen de las Nieves, Granada, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Instituto de Investigación Biosanitaria (IBS), Granada, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Departamento de Enfermería y Terapia Ocupacional, Extremadura, Cáceres, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Paciente traumatizado recuperado: buena suerte y… ¡hasta la próxima!" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Usually traumas are considered one-time incidents with a significant component of chance and unconnected with one another. However, we have known for some time now that in certain groups of patients, traumas represent one chronic and recurrent situation where modifiable risk factors can be identified.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a> Almost all studies confirm that fifty percent of the traumas have something to do with the use of alcohol, illegal drugs and/or psychodrugs.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">2,3</span></a> One characteristic of this group of patients is their high recurrence rate,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a> which gives them a sort of top-notch social-healthcare significance that translates into a higher short-medium term mortality rate.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">4</span></a> In our setting, the alcohol-and-drug-related recurrence rate of trauma patients is close to 61.5%<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a>; such a high percentage should make us look for alternatives aimed at reducing this phenomenon. From the ethical point of view, a passive attitude on this regard does not seem acceptable at all.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The tool suggested to reduce the recurrence rate consists of conducting one Brief Motivational Intervention (BMI) during the hospital stay with or without further reinforcement.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">5</span></a> This intervention can be conducted by nursing personnel with specific training and whose ultimate goal is to make patients think on their behavioral patterns, while enabling them to find arguments they can use to modify their habits. We studied the effectiveness of BMI while reducing the recurrence rate of new traumas, and after a follow-up period of between 10 and 52 months, the result was a reduced trauma recurrence rate of up to 50% (from 25.4 to 13.0 per every 100 patients/year)<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">6</span></a>; a percentage that is consistent with the one found in former studies<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">7</span></a> and contributes arguments in order to carry out this initiative. The centers that treat trauma patients should be involved in this field and establish mechanisms so that, in the first place, they can identify what trauma patients use alcohol, and drugs, or have other risk factors involved and, in the second place, look for the best chance, during the hospital stay, to carry out the motivational intervention.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Carrying out the BMI consists of a semi-structured interview for some 30 or 45<span class="elsevierStyleHsp" style=""></span>min in order to promote changes in unhealthy lifestyles or behavioral patterns by solving the ambiguities that may exist and always with a non-confrontational style. It comes as no surprise that the emotional situation suffered after a severe trauma is an excellent opportunity that makes the patient very receptive, which in turn facilitates the success of this kind of initiatives. In Spain, the initiatives carried out in this area are almost nonexistent,<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">8</span></a> and in our opinion, the only way to revert this situation would be a decisive effort made from the healthcare institutions. This initiative has no commercial purposes whatsoever but, instead of this being a bonus, it seems some sort of a disadvantage since there is no business behind it.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a> This is why the healthcare administration should take the lead, speak about its utility, and promote the necessary means to carry it out. We believe this is an important issue that has important social-healthcare repercussions, which is why it should be treated with decisiveness.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In well-structured organized healthcare institutions, the mortality rate profile of trauma patients shows a very characteristic pattern. Fifty per cent of deaths occur in the setting of the accident, and 80% of those who die at the hospital, do so within the first 24–48<span class="elsevierStyleHsp" style=""></span>h following the extremely serious lesions they sustained that are almost incompatible with survival.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">10</span></a> Barely 2.5% can be considered avoidable deaths, meaning that, from the point of view of healthcare, mortality rate may have been reduced to its lowest, since, in order to achieve just marginal improvements, the investment required would be disproportionate. Without having to abandon the ambition to reduce mortality rate in the healthcare setting, other ways should be explored in order to show a more favorable cost-effective ratio. In this sense, there is no doubt that promoting prevention is the most effective alternative on this regard.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Prevention of trauma is a task shared by many administrations but, in Spain, the effort made in this area by the healthcare institutions cannot be compared to the one made by other administrations, leaving the impression that some organizations are more sensitive than others when it comes to carrying out their respective responsibilities.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The reduction of the accident rate in Spain has to do with several factors, among which we should mention how the Spanish road infrastructure has changed, and how safe vehicles have become during the last two decades, added to the various educational campaigns that have been carried out in the news media. The legal system has operated significant changes too by passing effective pieces of legislations in order to persecute or punish risky behavioral patterns that may jeopardize safety on the road, at work, at home, etc. We could go on and on listing the number of prevention achievements, but should never lose focus on what is considered primary prevention, and here healthcare institutions have had little to say. Healthcare institutions should and must invest in secondary prevention, which is the sole responsibility of healthcare personnel and, also, an inseparable aspect of their activity. We should admit that we have not been up to the challenge on this regard.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">8</span></a> In the healthcare setting, an extraordinary effort has been made in order to improve the care of trauma patients without cutting any investments aimed at the recovery of patients,<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">11</span></a> but there is something we have not controlled here, which is the “revolving door”, so to speak, that recurrence means; thus, today, after the trauma patient has recovered, we recommend wishing him well although, unfortunately, what we are really mean to say is… see you next time!</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Fernández Mondéjar E, Guerrero López F, Cordovilla Guardia S. Paciente traumatizado recuperado: buena suerte y… ¡hasta la próxima! Med Intensiva. 2018;42:205–206.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:11 [ 0 => array:3 [ "identificador" => "bib0060" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Urban trauma: a chronic recurrent disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "D.W. Sims" 1 => "B.A. Bivins" 2 => "F.N. Obeid" 3 => "H.M. Horst" 4 => "V.J. Sorensen" 5 => "J.J. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 7 | 12 |
| 2024 October | 48 | 42 | 90 |
| 2024 September | 33 | 27 | 60 |
| 2024 August | 55 | 52 | 107 |
| 2024 July | 42 | 29 | 71 |
| 2024 June | 35 | 44 | 79 |
| 2024 May | 49 | 42 | 91 |
| 2024 April | 51 | 32 | 83 |
| 2024 March | 46 | 34 | 80 |
| 2024 February | 39 | 33 | 72 |
| 2024 January | 27 | 31 | 58 |
| 2023 December | 27 | 34 | 61 |
| 2023 November | 29 | 43 | 72 |
| 2023 October | 35 | 36 | 71 |
| 2023 September | 36 | 36 | 72 |
| 2023 August | 20 | 13 | 33 |
| 2023 July | 33 | 32 | 65 |
| 2023 June | 23 | 24 | 47 |
| 2023 May | 49 | 42 | 91 |
| 2023 April | 32 | 19 | 51 |
| 2023 March | 54 | 34 | 88 |
| 2023 February | 56 | 41 | 97 |
| 2023 January | 45 | 30 | 75 |
| 2022 December | 67 | 30 | 97 |
| 2022 November | 63 | 47 | 110 |
| 2022 October | 72 | 41 | 113 |
| 2022 September | 47 | 43 | 90 |
| 2022 August | 44 | 36 | 80 |
| 2022 July | 33 | 29 | 62 |
| 2022 June | 43 | 34 | 77 |
| 2022 May | 56 | 45 | 101 |
| 2022 April | 75 | 39 | 114 |
| 2022 March | 92 | 45 | 137 |
| 2022 February | 88 | 36 | 124 |
| 2022 January | 72 | 53 | 125 |
| 2021 December | 52 | 43 | 95 |
| 2021 November | 57 | 34 | 91 |
| 2021 October | 57 | 91 | 148 |
| 2021 September | 31 | 28 | 59 |
| 2021 August | 29 | 40 | 69 |
| 2021 July | 33 | 38 | 71 |
| 2021 June | 31 | 25 | 56 |
| 2021 May | 49 | 46 | 95 |
| 2021 April | 64 | 57 | 121 |
| 2021 March | 56 | 39 | 95 |
| 2021 February | 44 | 25 | 69 |
| 2021 January | 59 | 22 | 81 |
| 2020 December | 43 | 23 | 66 |
| 2020 November | 45 | 16 | 61 |
| 2020 October | 47 | 33 | 80 |
| 2020 September | 47 | 12 | 59 |
| 2020 August | 36 | 22 | 58 |
| 2020 July | 47 | 16 | 63 |
| 2020 June | 27 | 14 | 41 |
| 2020 May | 25 | 15 | 40 |
| 2020 April | 57 | 8 | 65 |
| 2020 March | 19 | 12 | 31 |
| 2020 February | 65 | 39 | 104 |
| 2020 January | 50 | 27 | 77 |
| 2019 December | 29 | 23 | 52 |
| 2019 November | 39 | 25 | 64 |
| 2019 October | 41 | 19 | 60 |
| 2019 September | 23 | 20 | 43 |
| 2019 August | 34 | 20 | 54 |
| 2019 July | 29 | 16 | 45 |
| 2019 June | 18 | 13 | 31 |
| 2019 May | 51 | 36 | 87 |
| 2019 April | 14 | 17 | 31 |
| 2019 March | 19 | 23 | 42 |
| 2019 February | 22 | 24 | 46 |
| 2019 January | 40 | 45 | 85 |
| 2018 December | 21 | 37 | 58 |
| 2018 November | 26 | 47 | 73 |
| 2018 October | 36 | 25 | 61 |
| 2018 June | 0 | 1 | 1 |
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