Publication: Análisis de índices de gravedad en la baja de combate. Experiencia del cuerpo militar de sanidad en el conflicto de Afganistán
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2021-07-15
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Universidad Complutense de Madrid
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Abstract
El presente estudio analiza y compara los índices de gravedad (mISS, mNISS, MCIS-ISS y MCIS-NISS) en las bajas de combate atendidas en el hospital militar o Role 2 español desplegado en Herat (Afganistán) durante el periodo de tiempo comprendido entre el 1 de mayo de 2005 y el 31 de diciembre de 2014. La evaluación de la asistencia al paciente traumatizado requiere de una valoración, mediante una metodología cuantitativa, de la estructura asistencial empleada, del manejo terapéutico y de la evolución del paciente. Estimar la gravedad de una baja es un elemento fundamental dentro de su proceso asistencial ya que proporciona información numérica de utilidad para establecer un pronóstico, fundamentalmente en términos de mortalidad, nos permitirá conocer el perfil de nuestros pacientes, y de ese modo compararlos con los de otras instituciones, y facilita la investigación sobre los resulta-dos. Para estandarizar esta medida de la gravedad se diseñaron las escalas de gravedad. Tradicionalmente empleadas en el ámbito civil, en los últimos años se han desarrollado escalas específicas de gravedad para la baja de combate. Por otro lado, el término «índice de gravedad en el trauma» es definido como «aquel sistema que evalúa, clasifica y codifica lesiones», siendo estos índices considerados como clasificaciones numéricas, vinculadas a una o más características del trauma, como parte del resultado clínico observado en el paciente, en las que existe una relación entre el incremento de la gravedad de los traumatismos y un aumento en la puntuación. Su uso tiene como objetivo final reducir los datos complejos de las lesiones a un número que represente el nivel de gravedad del paciente.
La baja de combate representa un reto para la medicina militar por tratarse de pacientes habitualmente heridos por armas de fuego o explosivos, con lesiones múltiples y complejas, en un entorno hostil, y en un ambiente austero y limitado en recursos humanos y materiales. La estimación de la gravedad de estas bajas de combate es un elemento de gran utilidad y a tener en cuenta en la preparación, en la planificación y en el despliegue del apoyo sanitario a las operaciones militares. El objetivo principal de este trabajo es determinar si existen diferencias estadística-mente significativas en las puntuaciones de los índices de gravedad Injury Severity Score y New Injury Severity Score, utilizando las escalas de gravedad Abbreviated Injury Scale 2005-Military y Military Combat Injury Scale...
This study analyzes and compares the injury severity scores (mISS, mNISS, MCIS-ISS y MCIS-NISS) in the combat casualties attended at the Spanish Role 2 medical treat-ment facility deployed in Herat (Afghanistan) during the period of time between May 1, 2005 and December 31, 2014. The assistance evaluation to trauma patients requires an assessment, through a quan-titative methodology, of the healthcare structure used, the therapeutic management and the patient clinical evolution. Estimating the severity of a casualty is a fundamental element within its care process since it provides useful numerical information to es-tablish a prognosis, mainly in terms of mortality, it will allow us to know the profile of our patients, and thus compare them with those of other institutions, and facilitates research on the results. To standardize this measure of severity, severity scales were designed. Traditionally used in the civilian sphere, in recent years specific injury sever-ity scales have been developed for combat casualties. On the other hand, the term «trauma severity score» is defined as «that system that evaluates, classifies and codes injuries», these scores being considered as numerical classifications, linked to one or more characteristics of the trauma, as part of the result observed in the patient, in which there is a relationship between the increase in the severity of the trauma and an increase in the score. Its use is intended to reduce com-plex injury data to a number that represents the severity level of the patient. Combat casualties represent a challenge for military medicine because they are patients who are typically injured by firearms or explosives, with multiple and complex injuries, in a hostile and austere environment with limited human and material resources. Es-timating the severity of these casualties is a very useful element to take into account in the preparation, planning and deployment of medical support to military operations. The main objective of this study is to determine if there are statistically significant differences in the punctuations of the Injury Severity Score and New Injury Severity Score, using the severity scales Abbreviated Injury Scale 2005-Military and Military Combat Injury Scale...
This study analyzes and compares the injury severity scores (mISS, mNISS, MCIS-ISS y MCIS-NISS) in the combat casualties attended at the Spanish Role 2 medical treat-ment facility deployed in Herat (Afghanistan) during the period of time between May 1, 2005 and December 31, 2014. The assistance evaluation to trauma patients requires an assessment, through a quan-titative methodology, of the healthcare structure used, the therapeutic management and the patient clinical evolution. Estimating the severity of a casualty is a fundamental element within its care process since it provides useful numerical information to es-tablish a prognosis, mainly in terms of mortality, it will allow us to know the profile of our patients, and thus compare them with those of other institutions, and facilitates research on the results. To standardize this measure of severity, severity scales were designed. Traditionally used in the civilian sphere, in recent years specific injury sever-ity scales have been developed for combat casualties. On the other hand, the term «trauma severity score» is defined as «that system that evaluates, classifies and codes injuries», these scores being considered as numerical classifications, linked to one or more characteristics of the trauma, as part of the result observed in the patient, in which there is a relationship between the increase in the severity of the trauma and an increase in the score. Its use is intended to reduce com-plex injury data to a number that represents the severity level of the patient. Combat casualties represent a challenge for military medicine because they are patients who are typically injured by firearms or explosives, with multiple and complex injuries, in a hostile and austere environment with limited human and material resources. Es-timating the severity of these casualties is a very useful element to take into account in the preparation, planning and deployment of medical support to military operations. The main objective of this study is to determine if there are statistically significant differences in the punctuations of the Injury Severity Score and New Injury Severity Score, using the severity scales Abbreviated Injury Scale 2005-Military and Military Combat Injury Scale...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Cirugía, leída el 06/05/2021