Are we meeting current recommendations for the initial management of penetrating trauma? A preliminary analysis from a Colombian institutional registry

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A preliminary analysis from a Colombian institutional registry" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1275 "Ancho" => 2022 "Tamanyo" => 93400 ] ] "descripcion" => array:1 [ "es" => "Alcance de estándares al final de la cirugía en una cohorte de trauma penetrante toraco-abdominal. ISS: Ingury Severity Score; mL: mililitros; mm3: milímetros cúbicos; gr/dl: gramos por decilitro; mg/dl: miligramos por decilitro; °C: grados centígrados. 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Simón Bolívar, Carrera 98, No. 80-45, Cali, Colombia." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Estamos logrando las recomendaciones actuales en trauma penetrante? Análisis preliminar de un registro institucional colombiano" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1277 "Ancho" => 1939 "Tamanyo" => 90834 ] ] "descripcion" => array:1 [ "en" => "Standards reached at the end of surgery in a cohort of thoraco-abdominal penetrating trauma Source: authors." ] ] ] "textoCompleto" => "IntroductionIncreasing incidence of major and high impact trauma makes it a world public health problem,<a class="elsevierStyleCrossRefs" href="#bib0180">1,2</a> resulting in a growing number of up-to-dates, new concepts and guidelines based on the best available evidence about the optimal use of pharmacological/non-pharmacological strategies and devices for physiological stabilization.<a class="elsevierStyleCrossRefs" href="#bib0190">3,4</a> Early recognition and treatment of shock and coagulopathy are cornerstones in this setting. There have been important advances in these concepts leading to more specific recommendations about markers of adequate hemostasis and microcirculation.<a class="elsevierStyleCrossRef" href="#bib0200">5</a>Perioperative treatment of patients with severe trauma is quite heterogeneous among different institutions. This observation is even a fact among the healthcare providers within the same institution, in terms of the approach to the problem and the perception about the best therapeutic option for each situation, specially in the absence of institutional treatment guidelines to address this patients.<a class="elsevierStyleCrossRefs" href="#bib0205">6,7</a> Numerous publications recommend structuring a trauma team with clear objectives and the ability to define the role of each team member. However, initial caregivers in the OR are exceptionally important, both in the accomplishment of these goals, as well in helping to reduce the rate of adverse outcomes and mortality.This paper analyzed the achieving of the current recommendations<a class="elsevierStyleCrossRefs" href="#bib0215">8–10</a> by the surgical team of a referral center during the initial care of penetrating chest and/or abdomen trauma patients (TAPT) at the end of damage control surgery (DCS) globally and according to the severity of the injury based on the Injury Severity Score (ISS).<a class="elsevierStyleCrossRef" href="#bib0230">11</a>Design and study populationAn observational cohort study was performed based on a prospective trauma registry at a Colombian trauma referral center (CERATI registry – prospective Cohort study of Early Re-intervention in Abdominal and Thoracic Penetrating Injuries) approved by the Committee of Ethics in Biomedical Research of the Fundación Valle del Lili (Protocol No. 635). Subjects 18 years or older requiring DCS due to TAPT within the first 24hours after trauma occurrence or those who were admitted from other centers within 12 hours after initial treatment were prospectively enrolled. Patients admitted to the OR with no vital signs were excluded as well as those that did not survive to surgery; patients with a history of known hemostatic disorders and those who had been under systemic anticoagulation or platelet aggregation therapy.In order to implement this registry, a centralized database (DB) was developed under a Web platform (BD-Clinic, CIC-FVL, Cali, Colombia) with controlled access by two of the authors (BS & FA) to data uploading and reading. Through continued education sessions directed to the anesthetists and surgeons involved with the registry, some suggested principles for basic care for transfusion therapy, resuscitation drugs, hemostasis control and active warming were previously established. Assessment of shock, anemia and coagulopathy at admission (first 15mins of care) and at the end of DCS or admission to ICU was agreed and protocolized.Once the patient was identified, data was registered on a previous designed form including demographic characteristics, severity of the lesions, information about the time of care and preoperative treatment provided, characteristics of the fluids used for resuscitation, blood products administered (type and amount), use of rapid infusion systems, red blood cells salvage and shock markers [lactic acid, base deficit (BD)], erythrocyte mass and platelet count, and hemostatic profile [Thromboelastography (TEG®), serum fibrinogen) at the beginning and end of the procedure. A previously trained and independent assistant monitored the patients every 8h, either physically or reviewing the electronic medical record (SAP, Net Weaver GUI for Windows Business Software. Germany) and a laboratory reporting system (<a id="intr0010" class="elsevierStyleInterRef" href="http://datalabfvlapl/consulta/default.aspx">http://datalabfvlapl/consulta/default.aspx</a>) during the first three days and then everyday for the first week. After that, a weekly follow-up was done either physically or by call up to 30 days after the DCS. Quarterly reports and quality controls were performed in order to verifying the proper conduct of this prospective registry.Methods and variablesInformation was classified into three universal categories: (1) assessment and prophylaxis of hyperfibrinolysis (intraoperative monitoring of serum fibrinogen and administration of tranexamic acid at any time during the procedure), (2) protection against hypothermia (achieving a central temperature of >35°C at the end of surgery); (3) hemostatic resuscitation (serum fibrinogen levels of >150mg/dl at the end surgery and a platelet count of >50,000/mm3); (4) microcirculation and reed blood cells count improvement at the end of surgery (proportion of subjects with BD>6 and levels of hemoglobin >7.5mg/dl).Analysis planInformation recorded in the DB was edited and inconsistent data were corrected upon matching against the medical and laboratory records. STATA 10.1 (StataCorp 4905 Lakeway Dr., Texas, USA) package was used to perform descriptive and analytical statistics according to the ISS score estimated at admission, determining a severity cut point value of >25.Chi-square test was used for the analysis of categorical variables and Mann–Whitney test (two-sample Wilcoxon rank-sum test) for continuous ones. A sensitivity analysis was performed for potential values in individuals with some missing data. Results are expressed as frequencies for dichotomous variables and as means (interquartile ranges, ICR) for continuous ones given their non-parametric behavior. A p<0.05 value was considered statistically significant.ResultsFrom 338 patients who underwent surgery due to any type of trauma during this period of time, 103 subjects were identified as TAPT. There were 16 (15%) cases of intraoperative death. Additionally, 13 subjects was retired from analysis due to data omissions and/or failure to obtain results from tests considered extremely important to perform statistical correlations. Hence, 74 TAPT patients admitted for DCS were included, all of them treated within three hours following the trauma event. 55.4% of the subjects studied presented penetrating injuries of a high grade of severity at admission (ISS>25) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Global mortality due to TAPT, including subjects who died before, during and after the DCS was 18%, while for the cohort that survived to the DCS the rate or reoperation due to bleeding was 2.7% with an accumulated mortality of 4%. All of these patients died within the first 24 postoperative hours (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia>When comparing the group with severe lesions (ISS>25; n=41) against the subjects with lower severity scores (ISS≤25; n=33), there were significant differences in heart rate and systolic blood pressure measurements at admission [111 (94–122) vs. 101 (90–108) bpm, p=0.048 and 82 (65–121) vs. 124 (92–137) mmHg, p=0.002; respectively]. The analysis of some of the conventional diagnostic tests at the start of surgery showed statistically significant differences en the BD and serum fibrinogen levels [10 (3.8–18) vs. 7 (4–11), p=0.005 and 133 (70–190) vs. 164 (140–229) mg/dl, p=0.023; respectively]. Based on the thromboelastographic parameters at the start of the DCS, only K time and maximum amplitude (MA) were significantly correlated with the presence of critical lesions [2.7 (1.6–5.6) vs. 1.9 (1.3–2.7) min, p=0.006 and 54.6 (38.6–67.2) vs. 57.1mm (49.8–62.6) min, p=0.042; respectively].Overall, the use of tranesxamic acid at any time during the DCS was only reported in 52.7% of the patients with a significantly lower adherence in patients with low severity scores [65.8% vs. 36.3%. OR 3.37 (95% CI 1.2–9.85); p=0.01]. Furthermore, fibrinogen monitoring at the start of surgery was only evaluated in 59.5% of the cases, with no significant differences between groups [65.8% vs. 51%. OR 1.05 (0.40–2.7); p=0.89].Despite temperature monitoring was reported in 91% of cases, only 66.2–71.4% reached values above 35°C at the end of procedure, with no significant differences between groups [Group ISS>25 61% vs. Group ISS≤25 72.7%. OR 1.7 (95% CI 0.57–5.25); p=0.28] (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Up to 90–91.8% of the cases reached hemoglobin levels of >7.5g/dl with no differences between groups (90.9% vs. 92.6%). However, when analyzing perfusion markers at the end of surgery, only 40–43.4% of the subjects reached values of BD<6 overall, with a significant trend to reach lower levels in the group with high severity scores [35.9% vs. 53%. OR 2.04 (1.2–6.02); p=0.042].<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Between 91–94.5% of the subjects included in this analysis reached platelet levels of >50,000/mm3 at the end of DCS (Group ISS>25 87.1% vs. Group ISS≤25 96%). In contrast, for the case of serum fibrinogen at the end of surgery (reported in 74.3% of the subjects), levels of >150mg/dl were only reached in 52–55% overall, with a non-significant low rate in the group with more severe lesions [41.4% vs. 60.6%. OR 2.17 (95% CI 0.77–6.15); p=0.1]. Sensitivity analysis showed that in the best of the cases, minimum accepted levels of temperature and serum fibrinogen at the end of DCS was reached only in 72% and 65%, respectively.DiscussionThis safety analysis focused in patients with penetrating injuries is part of an institutional multidisciplinary effort to improve care results in these patients. This prospective registry was performed at a referral university center that continuously schedules multidisciplinary sessions and promotes a constant effort to assure availability of technologies for the care and diagnosis of specific situations for the treatment of severe trauma patients. There is enough evidence to support early monitoring and control of bleeding in patients with exsanguinating trauma as a determinant of the outcomes associated with morbidity and mortality.<a class="elsevierStyleCrossRefs" href="#bib0235">12,13</a> However, our study shows that a high rate of TAPT patients are in risk of not to meet the current recommendations on resuscitation, temperature preservation and management of hemostasis.Our data show expected differences in terms of blood pressure values, heart rate and BD between patients with higher severity scores.<a class="elsevierStyleCrossRefs" href="#bib0245">14,15</a> However, despite an observed high proportion of severe injuries in our study, we found that adherence to recommended strategies aimed at reducing major bleeding during DCS was unacceptably low, as shown in the reported rate of administration of tranexamic acid, which was only administer to a little more than a half of the subjects, despite scientific evidence endorsing its use.<a class="elsevierStyleCrossRefs" href="#bib0255">16,17</a> Achievement of thermoprotection goal shows a similar trend; despite the availability of active warming technologies such as warming console guided systems and forced air blankets, and of the awareness about hypothermia-related derangements in hemostasis, inflammation and tissue perfusion in severely injured patients,<a class="elsevierStyleCrossRefs" href="#bib0210">7,18,19</a> one third of the subjects failed to reach this goal at the end of surgery.This study also showed a broad heterogeneity in monitoring and intraoperative recovery of microcirculation approaches during massive bleeding and trauma. Newgard et al. showed that at least one third of trauma patients could present hemodynamic instability at the time of admission.<a class="elsevierStyleCrossRef" href="#bib0275">20</a> In this regard, we aimed to analyse the quality of resuscitative strategies in this cohort through results of a recognized marker for hypovolemic shock such as BD which has been described to be as useful as serum lactate measurements in this scenario.<a class="elsevierStyleCrossRefs" href="#bib0280">21,22</a> In a retrospective cohort of 1026 trauma patients, BD showed a high predictive value for death, particularly during the first 24 hours after injury.<a class="elsevierStyleCrossRef" href="#bib0290">23</a> Our study shows a poor success rate to achieve optimal levels of this microcirculatory surrogate, despite a high rate of success in correction of anemia. This observation may represent the need for studies that analyze microcirculation within the context of trauma and an opportunity to develop hospital care guidelines promoting early evaluation and the adequate use of fluid therapy strategies and goal-directed hemostatic resuscitation.<a class="elsevierStyleCrossRefs" href="#bib0295">24,25</a>We want to highlight the importance of assessment of fibrinogen as a factor independently associated to severity in major trauma.<a class="elsevierStyleCrossRefs" href="#bib0305">26–28</a> Our study shows a low proportion of subjects with an assessment of this so important substrate for hemostasis that could be explained at least in part by the limitations to obtain a quick result of the test. The usefulness of viscoelastic testing (TEG, ROTEM) and their predictive value are still a topic for debate due to the quality of the available evidence and non-conclusive results of recent reviews, despite our results ratify the association between thromboelastography components (K time and MA), fibrinogen levels and severity of injury reported in previous studies.<a class="elsevierStyleCrossRefs" href="#bib0320">29–31</a> Point of care fibrinogen assays have been recently developed and we think these technologies may be the future solution to current limitations to a timely assessment that could be associated with delayed recovery, particularly where only conventional tests for evaluating hemostasis are available.<a class="elsevierStyleCrossRefs" href="#bib0335">32,33</a>During the study period, the use of tranexamic acid (usual dose of 1g IV, whether or not followed by a continuous IV infusion of 1g/6h) was maintained as a consensus in all severe trauma patients requiring DCS, based on a clinical trial that reported a significant association between this drug and an overall reduction in the incidence of death from all causes in this subpopulation.<a class="elsevierStyleCrossRef" href="#bib0245">14</a> Very few studies on specific interventions in trauma have shown a significant change in this “hard” outcome. As described in a recent update of the European guidelines for care of severe bleeding and coagulopathy associated with severe trauma, we feel that the use of tranexamic acid within the first three hours is an important indicator of compliance with the current standards in trauma care associated with severe bleeding, that should be further evaluated for future studies.<a class="elsevierStyleCrossRef" href="#bib0345">34</a>The significant heterogeneity observed in this study also included a large variability in the transfusion patterns reported. This observation is similar to findings of a recent study that reported a wide range of approaches resulting in a broad variation in the proportions of blood components used without an established pattern, even under controlled research settings.<a class="elsevierStyleCrossRef" href="#bib0350">35</a> This situation may in part explain the low percentage of patients with fibrinogen targets above the current recommendation. However, we believe that this heterogenity may originate from a flaw in the continuous education processes that overcome the barriers of basic knowledge and the absence of specific trauma protocols that may integrate transfusional strategies with the other mainstays of therapy in this context.We think this prospective registry has important limitations. Mortality rate may be affected by not including subjects that were admitted but died during DCS and influenced potential associations that we were unable to identify or overestimated others. In spite of the fact that a proportion of patients (12%) had to be excluded from analysis because missing data, we think that the sample analyzed is a good representative of this problem, showing a wide variability in achieving the goals, despite having enough human resources and availability of resources for high quality care, at least at the center where this registry was developed. Further trials that confirm our results are required, since if these are true, it will be necessary to adopt an urgent action plan for hospitals and scientific societies around the world.In conclusion, this study suggests that currently a considerable proportion of penetrating trauma patients do not achieve the current minimum recommendations at the end of DCS. There is wide variability in assessment and interventional approaches related to resuscitative and hemostatic issues that affect early detection of independent markers for morbidity and mortality in this subpopulation. Institutions require not only to be focused toward getting resources and technologies for the attention of severe trauma, but also to optimize these resources through continuous education programs and institutional protocols to ensure a high level of compliance and adherence to recommendations.Ethical disclosuresProtection of human and animal subjectsThe authors declare that the procedures followed were in accordance with the regulations of the relevant clinical research ethics committee and with those of the Code of Ethics of the World Medical Association (Declaration of Helsinki).Confidentiality of dataThe authors declare that they have followed the protocols of their work center on the publication of patient data.Right to privacy and informed consentThe authors declare that no patient data appear in this article.Conflicts of interestThe authors have no conflicts of interest to declare.FundingThe authors’ resources." "textoCompletoSecciones" => array:1 [ "secciones" => array:14 [ 0 => array:3 [ "identificador" => "xres785810" "titulo" => "Abstract" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objectives" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec784521" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres785809" "titulo" => "Resumen" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivos" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec784520" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Design and study population" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Methods and variables" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Analysis plan" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Results" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Discussion" ] 10 => array:3 [ "identificador" => "sec0035" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0045" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0050" "titulo" => "Right to privacy and informed consent" ] ] ] 11 => array:2 [ "identificador" => "sec0055" "titulo" => "Conflicts of interest" ] 12 => array:2 [ "identificador" => "sec0060" "titulo" => "Funding" ] 13 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-10-22" "fechaAceptado" => "2016-09-26" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec784521" "palabras" => array:5 [ 0 => "Mortality" 1 => "Tranexamic acid" 2 => "Blood coagulation disorders" 3 => "Multiple trauma" 4 => "Abdomen" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec784520" "palabras" => array:5 [ 0 => "Mortalidad" 1 => "Ácido tranexámico" 2 => "Trastornos de la coagulación sanguínea" 3 => "Traumatísmo múltiple" 4 => "Abdomen" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "IntroductionTo achieve minimal physiological goals in patients with penetrating thoraco-abdominal trauma (TAPT) is essential to ensure adequate outcomes. ObjectivesTo determine the success in meting basic standards at the end of damage control surgery in subjects with TAPT: (1) Monitoring and prevention of hyperfibrinolysis; (2) central temperature >35°C; (3) platelet count >50,000/mm3 and serum fibrinogen >150mg/dl; (4) hemoglobin levels >7.5mg/dl and base deficit <6. MethodsSubjects >18 years old undergoing damage control surgery as a result of TAPT were prospectively collected at a referral center between October Oct-2012 and Dec-2014. Comparisons were done according to the Injury Severity Score (ISS) with a severity value indicator of >25. A p<0.05 value was considered significant. Results106 subjects with TAPT were enrolled. Administration of tranexamic acid was only reported in 52.7% of the patients, particularly in the group with low severity scores [Group ISS≤25 36.3% vs. group ISS>25 65.8%. OR 3.37 (95% CI 1.2–9.85); p=0.01]. Although the temperature was reported in 91% of the cases, only 66.2–71.4% reached the recommended goal. Serum fibrinogen was measured in 59.5% of the cases and only 52% met the recommended level. The base deficit values of <6 at the end of surgery were only accomplished in 40–43.8% of the subjects, with a significantly lower probability in the more severe patients [53% vs. 35.9%. OR 2.04 (95% CI 1.2–6.02); p=0.042]. ConclusionsA considerable proportion of patients with TAPT does not meet the current recommendations at the end of damage control surgery." "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objectives" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónEl logro de metas fisiológicas mínimas en pacientes con trauma toracoabdominal penetrante (TTAP) es fundamental para garantizar adecuados desenlaces. ObjetivosDeterminar el éxito en el logro de estándares básicos al final de la cirugía de control de daños en sujetos con TTAP: 1.Monitorización y prevención de hiperfibrinolisis; 2.Temperatura central>35°C; 3.Niveles plaquetarios>50.000/mm3 y de fibrinógeno sérico>150mg/dl; 4.Niveles de hemoglobina>7.5mg/dl y déficit de base<6. MétodosSe recolectaron prospectivamente sujetos>18 años llevados a cirugía de control de daños por TTAP en un centro de remisión entre Oct-2012 y Dic-2014. Las comparaciones se realizaron según el Injury severity score (ISS) teniendo como indicador de severidad un valor >25. Se consideró significativo un valor de p<0.05. ResultadosSe registraron 106 sujetos con TTAP. La aplicación de ácido tranexámico solo se reportó en 52.7% de los pacientes, especialmente en el grupo con puntajes de severidad bajos [Grupo ISS≤25 36.3% vs. grupo ISS>25 65.8%. OR 3.37 (IC95% 1.2-9.85); p=0.01]. A pesar de que la temperatura fue reportada en 91% de los casos, solo 66.2-71.4% alcanzaron la meta recomendada. El fibrinógeno sérico fue valorado en 59.5% de los sujetos y solo 52% alcanzaron la recomendación. Valores de déficit de base<6 Al final de cirugía solo se lograron en 40-43.8% de los sujetos, con una probabilidad significativamente menor en los sujetos más graves [53% vs. 35.9%. OR 2.04 (IC95% 1.2-6.02); p=0.042]. ConclusionesUna proporción considerable de pacientes con TTAP no logran las recomendaciones actuales al final de la cirugía de control de daños." "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivos" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Ariza F, Sánchez BE, García AF, Raffán-Sanabria F, Quintana-Díaz M, Mejía-Mantilla JH. ¿Estamos logrando las recomendaciones actuales en trauma penetrante? Análisis preliminar de un registro institucional colombiano. Rev Colomb Anestesiol. 2017;45:39–45." ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1277 "Ancho" => 1939 "Tamanyo" => 90834 ] ] "descripcion" => array:1 [ "en" => "Standards reached at the end of surgery in a cohort of thoraco-abdominal penetrating trauma Source: authors." ] ] 1 => 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" => "kg: kilograms; cm: centimeters; mmHg: millimeters of mercury; bpm: beats per minute; °C: degrees centigrade; g/dl: grams per deciliter; min: minutes; mm: millimeters; INR: international normalized ratio; ISS: Injury Severity Score; IQR: interquartile ranges. The comparative values that showed significant differences (p<0.05) between groups are marked with *.Source: authors." "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="left" valign="top" scope="col" style="border-bottom: 2px solid black">Characteristic \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Global median (RIC) (n=74) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">ISS≤25 median (RIC) (n=33) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Events registered \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">ISS>25 median (RIC) (n=41) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Events registered \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">Age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28 (18–61) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30 (19–59) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">27 (17–49) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41 \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">Weight, kg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">73 (60–97) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">75 (65–90) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">70 (60–89) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38 \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">Height, cm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">170 (160–180) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">171 (170–175) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">170 (162–178) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 \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">Men, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">67 (90.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">31 (94) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">36 (87) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41 \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">Systolic blood pressure mmHg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">108 (71–130) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">124 (92–137) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">82 (65–121) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41* \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">Heart rate, bpm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">105 (91–120) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">101 (90–118) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">111 (94–122) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41* \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">Temperature, °C \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35.3 (34.8–36) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">35.5 (35.1–36.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">35 (34.5–36) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37 \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">Base deficit \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (3–19) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 (4–11) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10 (3.8–18) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39* \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">Serum lactate, mmol/L \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.6 (1.2–8.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.9 (1.9–4.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.56 (2.1–7.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34 \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">Hemoglobin, g/dl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.8 (4.8–15.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11.6 (7.5–15.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10 (4.8–15) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39 \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">INR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.2 (0.9–1.73) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.2 (1–1.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.3 (1–1.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 \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">Prothrombin time, seconds \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34.7 (26.2–45.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">34 (39.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">37.6 (29.7–43) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 \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">ISS (% per group) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 (11–51) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(44.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(55.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41 \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">R time, min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.5 (2.8–8.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5.6 (2.9–7.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5.45 (3.3–8.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39 \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">K time, min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.1 (1.3–8.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.9 (1.3–2.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.7 (1.6–5.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39* \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">Alpha angel, degrees \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">62.7 (21–69.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">63.5 (47.3–68.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">59.8 (39.9–67.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39 \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">Maximum amplitude, mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">55.9 (35.8–67.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">57.1 (49.8–62.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">54.6 (38.6–67.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39* \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">Percentage lysis at 30min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.7 (0–7.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.7 (0–3.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.6 (0–5.42) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39 \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">Platelet count/mm3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">229 (76–360) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">249 (128–325) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">213 (83–342) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">32 \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">Fibrinogen, mg/dl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">147.5 (70–250) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">164 (140–229) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">133 (70–190) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27* \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1306372.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Global demographic data and based on the level of severity in a prospective cohort of thoracoabdominal penetrating trauma." ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "P.E.: packed erythrocytes; Unt: units of blood product; min: minutes; ml: milliliters. Comparative values with significant differences (p<0.05) between groups are marked *.Source: authors." "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="left" valign="top" scope="col" style="border-bottom: 2px solid black">Characteristics \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Global median (RIC) (n=74) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">ISS≤25 median (RIC) (n=33) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Events registered \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">ISS>25 median (RIC) (n=41) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Events registered \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top">At the end of surgery</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Intraoperative fluids, liters \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.3 (1–5.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (1.5–2.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.4 (1.5–4.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39 \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">Damage control time, min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">117 (50–240) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">120 (95–160) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">115 (80–210) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41 \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">Administration of tranexamic acid (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39 (52.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (36.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 (65.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41* \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">Estimated bleeding vol., liters \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.5 (0.8–3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.5 (0.6–2.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (1–3.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41 \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">P.E. Unt. (approx. 300ml) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (0–4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (0–4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.5 (1–6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40* \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">Plasma, Unt. (approx. 180ml) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0–2.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0–6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.9 (0–7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41 \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">Cryoprecipitates, Unt. (approx. 20ml) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0–11) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0–3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0–10) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41 \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">Platelet apheresis, Unt. (approx. 200ml) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0–1.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0–1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0–2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41 \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">Rapid infusion systems \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 (17.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (15.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (19.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41 \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">Cell salvage (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 (23) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (15.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (29.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41* \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">Re-transfused vol., ml \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">831 (508–1115) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">900 (508–960) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">924 (712–1057) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top">Outcomes</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Re-intervention due to bleeding (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2(2.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (4.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41* \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">Death 0–24h (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41* \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">Death 1–30 days (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1306373.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Characteristics at the end of surgery and outcomes of a prospective thoracoabdominal penetrating trauma cohort." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:35 [ 0 => array:3 [ "identificador" => "bib0180" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Alternative projections of mortality and disability by cause 1990–2020: Global Burden of Disease Study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C.J. 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Scientific and Technological Research

¿Estamos logrando las recomendaciones actuales en trauma penetrante? Análisis preliminar de un registro institucional colombiano

Fredy Arizaa,

Corresponding author

fredyariza@hotmail.com

Corresponding author at: Fundación Valle del Lili, Av. Simón Bolívar, Carrera 98, No. 80-45, Cali, Colombia.

, Beatriz Elena Sáncheza, Alberto Federico Garcíab, Fernando Raffán-Sanabriac, Manuel Quintana-Díazd, Jorge Humberto Mejía-Mantillaa

a Anesthesiology and Perioperative Medicine – Fundación Valle del Lili, Cali, Colombia

b Trauma Surgery and Intensive Care, Fundación Valle del Lili, Cali, Colombia

c Department of Anesthesiology and Resuscitation, Fundación Santa Fé de Bogotá, Bogotá D.C., Colombia

d Emergency and Intensive Care Service, Hospital Universitario La Paz, Madrid, Spain

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This observation is even a fact among the healthcare providers within the same institution&#44; in terms of the approach to the problem and the perception about the best therapeutic option for each situation&#44; specially in the absence of institutional treatment guidelines to address this patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">6&#44;7</span></a> Numerous publications recommend structuring a trauma team with clear objectives and the ability to define the role of each team member&#46; However&#44; initial caregivers in the OR are exceptionally important&#44; both in the accomplishment of these goals&#44; as well in helping to reduce the rate of adverse outcomes and mortality&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">This paper analyzed the achieving of the current recommendations<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">8&#8211;10</span></a> by the surgical team of a referral center during the initial care of penetrating chest and&#47;or abdomen trauma patients &#40;TAPT&#41; at the end of damage control surgery &#40;DCS&#41; globally and according to the severity of the injury based on the Injury Severity Score &#40;ISS&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">11</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Design and study population</span><p id="par0020" class="elsevierStylePara elsevierViewall">An observational cohort study was performed based on a prospective trauma registry at a Colombian trauma referral center &#40;CERATI registry &#8211; prospective Cohort study of Early Re-intervention in Abdominal and Thoracic Penetrating Injuries&#41; approved by the Committee of Ethics in Biomedical Research of the Fundaci&#243;n Valle del Lili &#40;Protocol No&#46; 635&#41;&#46; Subjects 18 years or older requiring DCS due to TAPT within the first 24<span class="elsevierStyleHsp" style=""></span>hours after trauma occurrence or those who were admitted from other centers within 12 hours after initial treatment were prospectively enrolled&#46; 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Net Weaver GUI for Windows Business Software&#46; Germany&#41; and a laboratory reporting system &#40;<a id="intr0010" class="elsevierStyleInterRef" href="http://datalabfvlapl/consulta/default.aspx">http&#58;&#47;&#47;datalabfvlapl&#47;consulta&#47;default&#46;aspx</a>&#41; during the first three days and then everyday for the first week&#46; After that&#44; a weekly follow-up was done either physically or by call up to 30 days after the DCS&#46; Quarterly reports and quality controls were performed in order to verifying the proper conduct of this prospective registry&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Methods and variables</span><p id="par0035" class="elsevierStylePara elsevierViewall">Information was classified into three universal categories&#58; &#40;1&#41; assessment and prophylaxis of hyperfibrinolysis &#40;intraoperative monitoring of serum fibrinogen and administration of tranexamic acid at any time during the procedure&#41;&#44; &#40;2&#41; protection against hypothermia &#40;achieving a central temperature of &#62;35<span class="elsevierStyleHsp" style=""></span>&#176;C at the end of surgery&#41;&#59; &#40;3&#41; hemostatic resuscitation &#40;serum fibrinogen levels of &#62;150<span class="elsevierStyleHsp" style=""></span>mg&#47;dl at the end surgery and a platelet count of &#62;50&#44;000&#47;mm<span class="elsevierStyleSup">3</span>&#41;&#59; &#40;4&#41; microcirculation and reed blood cells count improvement at the end of surgery &#40;proportion of subjects with BD<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>6 and levels of hemoglobin &#62;7&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Analysis plan</span><p id="par0040" class="elsevierStylePara elsevierViewall">Information recorded in the DB was edited and inconsistent data were corrected upon matching against the medical and laboratory records&#46; STATA 10&#46;1 &#40;StataCorp 4905 Lakeway Dr&#46;&#44; Texas&#44; USA&#41; package was used to perform descriptive and analytical statistics according to the ISS score estimated at admission&#44; determining a severity cut point value of &#62;25&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Chi-square test was used for the analysis of categorical variables and Mann&#8211;Whitney test &#40;two-sample Wilcoxon rank-sum test&#41; for continuous ones&#46; A sensitivity analysis was performed for potential values in individuals with some missing data&#46; Results are expressed as frequencies for dichotomous variables and as means &#40;interquartile ranges&#44; ICR&#41; for continuous ones given their non-parametric behavior&#46; A <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 value was considered statistically significant&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><p id="par0050" class="elsevierStylePara elsevierViewall">From 338 patients who underwent surgery due to any type of trauma during this period of time&#44; 103 subjects were identified as TAPT&#46; There were 16 &#40;15&#37;&#41; cases of intraoperative death&#46; Additionally&#44; 13 subjects was retired from analysis due to data omissions and&#47;or failure to obtain results from tests considered extremely important to perform statistical correlations&#46; Hence&#44; 74 TAPT patients admitted for DCS were included&#44; all of them treated within three hours following the trauma event&#46; 55&#46;4&#37; of the subjects studied presented penetrating injuries of a high grade of severity at admission &#40;ISS<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Global mortality due to TAPT&#44; including subjects who died before&#44; during and after the DCS was 18&#37;&#44; while for the cohort that survived to the DCS the rate or reoperation due to bleeding was 2&#46;7&#37; with an accumulated mortality of 4&#37;&#46; All of these patients died within the first 24 postoperative hours &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">When comparing the group with severe lesions &#40;ISS<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25&#59; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>41&#41; against the subjects with lower severity scores &#40;ISS<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25&#59; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>33&#41;&#44; there were significant differences in heart rate and systolic blood pressure measurements at admission &#91;111 &#40;94&#8211;122&#41; vs&#46; 101 &#40;90&#8211;108&#41; bpm&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;048 and 82 &#40;65&#8211;121&#41; vs&#46; 124 &#40;92&#8211;137&#41; mmHg&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;002&#59; respectively&#93;&#46; The analysis of some of the conventional diagnostic tests at the start of surgery showed statistically significant differences en the BD and serum fibrinogen levels &#91;10 &#40;3&#46;8&#8211;18&#41; vs&#46; 7 &#40;4&#8211;11&#41;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;005 and 133 &#40;70&#8211;190&#41; vs&#46; 164 &#40;140&#8211;229&#41; mg&#47;dl&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;023&#59; respectively&#93;&#46; Based on the thromboelastographic parameters at the start of the DCS&#44; only K time and maximum amplitude &#40;MA&#41; were significantly correlated with the presence of critical lesions &#91;2&#46;7 &#40;1&#46;6&#8211;5&#46;6&#41; vs&#46; 1&#46;9 &#40;1&#46;3&#8211;2&#46;7&#41; min&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;006 and 54&#46;6 &#40;38&#46;6&#8211;67&#46;2&#41; vs&#46; 57&#46;1<span class="elsevierStyleHsp" style=""></span>mm &#40;49&#46;8&#8211;62&#46;6&#41; min&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;042&#59; respectively&#93;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Overall&#44; the use of tranesxamic acid at any time during the DCS was only reported in 52&#46;7&#37; of the patients with a significantly lower adherence in patients with low severity scores &#91;65&#46;8&#37; vs&#46; 36&#46;3&#37;&#46; OR 3&#46;37 &#40;95&#37; CI 1&#46;2&#8211;9&#46;85&#41;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#93;&#46; Furthermore&#44; fibrinogen monitoring at the start of surgery was only evaluated in 59&#46;5&#37; of the cases&#44; with no significant differences between groups &#91;65&#46;8&#37; vs&#46; 51&#37;&#46; OR 1&#46;05 &#40;0&#46;40&#8211;2&#46;7&#41;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;89&#93;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Despite temperature monitoring was reported in 91&#37; of cases&#44; only 66&#46;2&#8211;71&#46;4&#37; reached values above 35<span class="elsevierStyleHsp" style=""></span>&#176;C at the end of procedure&#44; with no significant differences between groups &#91;Group ISS<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25 61&#37; vs&#46; Group ISS<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25 72&#46;7&#37;&#46; OR 1&#46;7 &#40;95&#37; CI 0&#46;57&#8211;5&#46;25&#41;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;28&#93; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Up to 90&#8211;91&#46;8&#37; of the cases reached hemoglobin levels of &#62;7&#46;5<span class="elsevierStyleHsp" style=""></span>g&#47;dl with no differences between groups &#40;90&#46;9&#37; vs&#46; 92&#46;6&#37;&#41;&#46; However&#44; when analyzing perfusion markers at the end of surgery&#44; only 40&#8211;43&#46;4&#37; of the subjects reached values of BD<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>6 overall&#44; with a significant trend to reach lower levels in the group with high severity scores &#91;35&#46;9&#37; vs&#46; 53&#37;&#46; OR 2&#46;04 &#40;1&#46;2&#8211;6&#46;02&#41;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;042&#93;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Between 91&#8211;94&#46;5&#37; of the subjects included in this analysis reached platelet levels of &#62;50&#44;000&#47;mm<span class="elsevierStyleSup">3</span> at the end of DCS &#40;Group ISS<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25 87&#46;1&#37; vs&#46; Group ISS<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25 96&#37;&#41;&#46; In contrast&#44; for the case of serum fibrinogen at the end of surgery &#40;reported in 74&#46;3&#37; of the subjects&#41;&#44; levels of &#62;150<span class="elsevierStyleHsp" style=""></span>mg&#47;dl were only reached in 52&#8211;55&#37; overall&#44; with a non-significant low rate in the group with more severe lesions &#91;41&#46;4&#37; vs&#46; 60&#46;6&#37;&#46; OR 2&#46;17 &#40;95&#37; CI 0&#46;77&#8211;6&#46;15&#41;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;1&#93;&#46; Sensitivity analysis showed that in the best of the cases&#44; minimum accepted levels of temperature and serum fibrinogen at the end of DCS was reached only in 72&#37; and 65&#37;&#44; respectively&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">This safety analysis focused in patients with penetrating injuries is part of an institutional multidisciplinary effort to improve care results in these patients&#46; This prospective registry was performed at a referral university center that continuously schedules multidisciplinary sessions and promotes a constant effort to assure availability of technologies for the care and diagnosis of specific situations for the treatment of severe trauma patients&#46; There is enough evidence to support early monitoring and control of bleeding in patients with exsanguinating trauma as a determinant of the outcomes associated with morbidity and mortality&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">12&#44;13</span></a> However&#44; our study shows that a high rate of TAPT patients are in risk of not to meet the current recommendations on resuscitation&#44; temperature preservation and management of hemostasis&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Our data show expected differences in terms of blood pressure values&#44; heart rate and BD between patients with higher severity scores&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">14&#44;15</span></a> However&#44; despite an observed high proportion of severe injuries in our study&#44; we found that adherence to recommended strategies aimed at reducing major bleeding during DCS was unacceptably low&#44; as shown in the reported rate of administration of tranexamic acid&#44; which was only administer to a little more than a half of the subjects&#44; despite scientific evidence endorsing its use&#46;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">16&#44;17</span></a> Achievement of thermoprotection goal shows a similar trend&#59; despite the availability of active warming technologies such as warming console guided systems and forced air blankets&#44; and of the awareness about hypothermia-related derangements in hemostasis&#44; inflammation and tissue perfusion in severely injured patients&#44;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">7&#44;18&#44;19</span></a> one third of the subjects failed to reach this goal at the end of surgery&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">This study also showed a broad heterogeneity in monitoring and intraoperative recovery of microcirculation approaches during massive bleeding and trauma&#46; Newgard et al&#46; showed that at least one third of trauma patients could present hemodynamic instability at the time of admission&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">20</span></a> In this regard&#44; we aimed to analyse the quality of resuscitative strategies in this cohort through results of a recognized marker for hypovolemic shock such as BD which has been described to be as useful as serum lactate measurements in this scenario&#46;<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">21&#44;22</span></a> In a retrospective cohort of 1026 trauma patients&#44; BD showed a high predictive value for death&#44; particularly during the first 24 hours after injury&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">23</span></a> Our study shows a poor success rate to achieve optimal levels of this microcirculatory surrogate&#44; despite a high rate of success in correction of anemia&#46; This observation may represent the need for studies that analyze microcirculation within the context of trauma and an opportunity to develop hospital care guidelines promoting early evaluation and the adequate use of fluid therapy strategies and goal-directed hemostatic resuscitation&#46;<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">24&#44;25</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">We want to highlight the importance of assessment of fibrinogen as a factor independently associated to severity in major trauma&#46;<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">26&#8211;28</span></a> Our study shows a low proportion of subjects with an assessment of this so important substrate for hemostasis that could be explained at least in part by the limitations to obtain a quick result of the test&#46; The usefulness of viscoelastic testing &#40;TEG&#44; ROTEM&#41; and their predictive value are still a topic for debate due to the quality of the available evidence and non-conclusive results of recent reviews&#44; despite our results ratify the association between thromboelastography components &#40;K time and MA&#41;&#44; fibrinogen levels and severity of injury reported in previous studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">29&#8211;31</span></a> Point of care fibrinogen assays have been recently developed and we think these technologies may be the future solution to current limitations to a timely assessment that could be associated with delayed recovery&#44; particularly where only conventional tests for evaluating hemostasis are available&#46;<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">32&#44;33</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">During the study period&#44; the use of tranexamic acid &#40;usual dose of 1<span class="elsevierStyleHsp" style=""></span>g IV&#44; whether or not followed by a continuous IV infusion of 1<span class="elsevierStyleHsp" style=""></span>g&#47;6<span class="elsevierStyleHsp" style=""></span>h&#41; was maintained as a consensus in all severe trauma patients requiring DCS&#44; based on a clinical trial that reported a significant association between this drug and an overall reduction in the incidence of death from all causes in this subpopulation&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">14</span></a> Very few studies on specific interventions in trauma have shown a significant change in this &#8220;hard&#8221; outcome&#46; As described in a recent update of the European guidelines for care of severe bleeding and coagulopathy associated with severe trauma&#44; we feel that the use of tranexamic acid within the first three hours is an important indicator of compliance with the current standards in trauma care associated with severe bleeding&#44; that should be further evaluated for future studies&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">34</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">The significant heterogeneity observed in this study also included a large variability in the transfusion patterns reported&#46; This observation is similar to findings of a recent study that reported a wide range of approaches resulting in a broad variation in the proportions of blood components used without an established pattern&#44; even under controlled research settings&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">35</span></a> This situation may in part explain the low percentage of patients with fibrinogen targets above the current recommendation&#46; However&#44; we believe that this heterogenity may originate from a flaw in the continuous education processes that overcome the barriers of basic knowledge and the absence of specific trauma protocols that may integrate transfusional strategies with the other mainstays of therapy in this context&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">We think this prospective registry has important limitations&#46; Mortality rate may be affected by not including subjects that were admitted but died during DCS and influenced potential associations that we were unable to identify or overestimated others&#46; In spite of the fact that a proportion of patients &#40;12&#37;&#41; had to be excluded from analysis because missing data&#44; we think that the sample analyzed is a good representative of this problem&#44; showing a wide variability in achieving the goals&#44; despite having enough human resources and availability of resources for high quality care&#44; at least at the center where this registry was developed&#46; Further trials that confirm our results are required&#44; since if these are true&#44; it will be necessary to adopt an urgent action plan for hospitals and scientific societies around the world&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">In conclusion&#44; this study suggests that currently a considerable proportion of penetrating trauma patients do not achieve the current minimum recommendations at the end of DCS&#46; There is wide variability in assessment and interventional approaches related to resuscitative and hemostatic issues that affect early detection of independent markers for morbidity and mortality in this subpopulation&#46; Institutions require not only to be focused toward getting resources and technologies for the attention of severe trauma&#44; but also to optimize these resources through continuous education programs and institutional protocols to ensure a high level of compliance and adherence to recommendations&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Ethical disclosures</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Protection of human and animal subjects</span><p id="par0115" class="elsevierStylePara elsevierViewall">The authors declare that the procedures followed were in accordance with the regulations of the relevant clinical research ethics committee and with those of the Code of Ethics of the World Medical Association &#40;Declaration of Helsinki&#41;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Confidentiality of data</span><p id="par0120" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Right to privacy and informed consent</span><p id="par0125" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflicts of interest</span><p id="par0130" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Funding</span><p id="par0135" class="elsevierStylePara elsevierViewall">The authors&#8217; resources&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To achieve minimal physiological goals in patients with penetrating thoraco-abdominal trauma &#40;TAPT&#41; is essential to ensure adequate outcomes&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objectives</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To determine the success in meting basic standards at the end of damage control surgery in subjects with TAPT&#58; &#40;1&#41; Monitoring and prevention of hyperfibrinolysis&#59; &#40;2&#41; central temperature &#62;35<span class="elsevierStyleHsp" style=""></span>&#176;C&#59; &#40;3&#41; platelet count &#62;50&#44;000&#47;mm<span class="elsevierStyleSup">3</span> and serum fibrinogen &#62;150<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#59; &#40;4&#41; hemoglobin levels &#62;7&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;dl and base deficit &#60;6&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Subjects &#62;18 years old undergoing damage control surgery as a result of TAPT were prospectively collected at a referral center between October Oct-2012 and Dec-2014&#46; Comparisons were done according to the Injury Severity Score &#40;ISS&#41; with a severity value indicator of &#62;25&#46; A <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 value was considered significant&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">106 subjects with TAPT were enrolled&#46; Administration of tranexamic acid was only reported in 52&#46;7&#37; of the patients&#44; particularly in the group with low severity scores &#91;Group ISS<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25 36&#46;3&#37; vs&#46; group ISS<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25 65&#46;8&#37;&#46; OR 3&#46;37 &#40;95&#37; CI 1&#46;2&#8211;9&#46;85&#41;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#93;&#46; Although the temperature was reported in 91&#37; of the cases&#44; only 66&#46;2&#8211;71&#46;4&#37; reached the recommended goal&#46; Serum fibrinogen was measured in 59&#46;5&#37; of the cases and only 52&#37; met the recommended level&#46; The base deficit values of &#60;6 at the end of surgery were only accomplished in 40&#8211;43&#46;8&#37; of the subjects&#44; with a significantly lower probability in the more severe patients &#91;53&#37; vs&#46; 35&#46;9&#37;&#46; OR 2&#46;04 &#40;95&#37; CI 1&#46;2&#8211;6&#46;02&#41;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;042&#93;&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A considerable proportion of patients with TAPT does not meet the current recommendations at the end of damage control surgery&#46;</p></span>"
        "secciones" => array:5 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Objectives"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Methods"
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          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Results"
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          4 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Conclusions"
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introducci&#243;n</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El logro de metas fisiol&#243;gicas m&#237;nimas en pacientes con trauma toracoabdominal penetrante &#40;TTAP&#41; es fundamental para garantizar adecuados desenlaces&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Determinar el &#233;xito en el logro de est&#225;ndares b&#225;sicos al final de la cirug&#237;a de control de da&#241;os en sujetos con TTAP&#58; 1&#46;Monitorizaci&#243;n y prevenci&#243;n de hiperfibrinolisis&#59; 2&#46;Temperatura central<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>35<span class="elsevierStyleHsp" style=""></span>&#176;C&#59; 3&#46;Niveles plaquetarios<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>50&#46;000&#47;mm3 y de fibrin&#243;geno s&#233;rico<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>150<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#59; 4&#46;Niveles de hemoglobina<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>7&#46;5<span class="elsevierStyleHsp" style=""></span>mg&#47;dl y d&#233;ficit de base<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>6&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se recolectaron prospectivamente sujetos<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>18 a&#241;os llevados a cirug&#237;a de control de da&#241;os por TTAP en un centro de remisi&#243;n entre Oct-2012 y Dic-2014&#46; Las comparaciones se realizaron seg&#250;n el Injury severity score &#40;ISS&#41; teniendo como indicador de severidad un valor &#62;25&#46; Se consider&#243; significativo un valor de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Se registraron 106 sujetos con TTAP&#46; La aplicaci&#243;n de &#225;cido tranex&#225;mico solo se report&#243; en 52&#46;7&#37; de los pacientes&#44; especialmente en el grupo con puntajes de severidad bajos &#91;Grupo ISS&#8804;25 36&#46;3&#37; vs&#46; grupo ISS<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25 65&#46;8&#37;&#46; OR 3&#46;37 &#40;IC95&#37; 1&#46;2-9&#46;85&#41;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#93;&#46; A pesar de que la temperatura fue reportada en 91&#37; de los casos&#44; solo 66&#46;2-71&#46;4&#37; alcanzaron la meta recomendada&#46; El fibrin&#243;geno s&#233;rico fue valorado en 59&#46;5&#37; de los sujetos y solo 52&#37; alcanzaron la recomendaci&#243;n&#46; Valores de d&#233;ficit de base<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>6 Al final de cirug&#237;a solo se lograron en 40-43&#46;8&#37; de los sujetos&#44; con una probabilidad significativamente menor en los sujetos m&#225;s graves &#91;53&#37; vs&#46; 35&#46;9&#37;&#46; OR 2&#46;04 &#40;IC95&#37; 1&#46;2-6&#46;02&#41;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;042&#93;&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Una proporci&#243;n considerable de pacientes con TTAP no logran las recomendaciones actuales al final de la cirug&#237;a de control de da&#241;os&#46;</p></span>"
        "secciones" => array:5 [
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            "identificador" => "abst0030"
            "titulo" => "Introducci&#243;n"
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            "identificador" => "abst0035"
            "titulo" => "Objetivos"
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          2 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "M&#233;todos"
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          3 => array:2 [
            "identificador" => "abst0045"
            "titulo" => "Resultados"
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          4 => array:2 [
            "identificador" => "abst0050"
            "titulo" => "Conclusiones"
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    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Ariza F&#44; S&#225;nchez BE&#44; Garc&#237;a AF&#44; Raff&#225;n-Sanabria F&#44; Quintana-D&#237;az M&#44; Mej&#237;a-Mantilla JH&#46; &#191;Estamos logrando las recomendaciones actuales en trauma penetrante&#63; An&#225;lisis preliminar de un registro institucional colombiano&#46; Rev Colomb Anestesiol&#46; 2017&#59;45&#58;39&#8211;45&#46;</p>"
      ]
    ]
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      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
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        "figura" => array:1 [
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        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Standards reached at the end of surgery in a cohort of thoraco-abdominal penetrating trauma</p> <p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Source&#58; authors&#46;</p>"
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        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">kg&#58; kilograms&#59; cm&#58; centimeters&#59; mmHg&#58; millimeters of mercury&#59; bpm&#58; beats per minute&#59; &#176;C&#58; degrees centigrade&#59; g&#47;dl&#58; grams per deciliter&#59; min&#58; minutes&#59; mm&#58; millimeters&#59; INR&#58; international normalized ratio&#59; ISS&#58; Injury Severity Score&#59; IQR&#58; interquartile ranges&#46; The comparative values that showed significant differences &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; between groups are marked with &#42;&#46;</p><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Source&#58; authors&#46;</p>"
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                  <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="left" valign="top" scope="col" style="border-bottom: 2px solid black">Characteristic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Global median &#40;RIC&#41; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>74&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">ISS<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25 median &#40;RIC&#41; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Events registered&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">ISS<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25 median &#40;RIC&#41; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>41&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Events registered&nbsp;\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">Age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28 &#40;18&#8211;61&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30 &#40;19&#8211;59&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27 &#40;17&#8211;49&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41&nbsp;\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">Weight&#44; kg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">73 &#40;60&#8211;97&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">75 &#40;65&#8211;90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">70 &#40;60&#8211;89&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38&nbsp;\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">Height&#44; cm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">170 &#40;160&#8211;180&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">171 &#40;170&#8211;175&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">170 &#40;162&#8211;178&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&nbsp;\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">Men&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">67 &#40;90&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31 &#40;94&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36 &#40;87&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41&nbsp;\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">Systolic blood pressure mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">108 &#40;71&#8211;130&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">124 &#40;92&#8211;137&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">82 &#40;65&#8211;121&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41&#42;&nbsp;\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">Heart rate&#44; bpm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">105 &#40;91&#8211;120&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">101 &#40;90&#8211;118&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">111 &#40;94&#8211;122&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41&#42;&nbsp;\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">Temperature&#44; &#176;C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35&#46;3 &#40;34&#46;8&#8211;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&#46;5 &#40;35&#46;1&#8211;36&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35 &#40;34&#46;5&#8211;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&nbsp;\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">Base deficit&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;3&#8211;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;4&#8211;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 &#40;3&#46;8&#8211;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39&#42;&nbsp;\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">Serum lactate&#44; mmol&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;6 &#40;1&#46;2&#8211;8&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;9 &#40;1&#46;9&#8211;4&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;56 &#40;2&#46;1&#8211;7&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34&nbsp;\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">Hemoglobin&#44; g&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;8 &#40;4&#46;8&#8211;15&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#46;6 &#40;7&#46;5&#8211;15&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 &#40;4&#46;8&#8211;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39&nbsp;\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">INR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;2 &#40;0&#46;9&#8211;1&#46;73&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;2 &#40;1&#8211;1&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;3 &#40;1&#8211;1&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&nbsp;\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">Prothrombin time&#44; seconds&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34&#46;7 &#40;26&#46;2&#8211;45&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34 &#40;39&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">37&#46;6 &#40;29&#46;7&#8211;43&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&nbsp;\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">ISS &#40;&#37; per group&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27 &#40;11&#8211;51&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;44&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;55&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41&nbsp;\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">R time&#44; min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;5 &#40;2&#46;8&#8211;8&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#46;6 &#40;2&#46;9&#8211;7&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#46;45 &#40;3&#46;3&#8211;8&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39&nbsp;\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">K time&#44; min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;1 &#40;1&#46;3&#8211;8&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;9 &#40;1&#46;3&#8211;2&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;7 &#40;1&#46;6&#8211;5&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39&#42;&nbsp;\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">Alpha angel&#44; degrees&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62&#46;7 &#40;21&#8211;69&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">63&#46;5 &#40;47&#46;3&#8211;68&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">59&#46;8 &#40;39&#46;9&#8211;67&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39&nbsp;\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">Maximum amplitude&#44; mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&#46;9 &#40;35&#46;8&#8211;67&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">57&#46;1 &#40;49&#46;8&#8211;62&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">54&#46;6 &#40;38&#46;6&#8211;67&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39&#42;&nbsp;\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">Percentage lysis at 30<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;7 &#40;0&#8211;7&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;7 &#40;0&#8211;3&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;6 &#40;0&#8211;5&#46;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39&nbsp;\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">Platelet count&#47;mm<span class="elsevierStyleSup">3</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">229 &#40;76&#8211;360&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">249 &#40;128&#8211;325&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">213 &#40;83&#8211;342&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32&nbsp;\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">Fibrinogen&#44; mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">147&#46;5 &#40;70&#8211;250&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">164 &#40;140&#8211;229&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">133 &#40;70&#8211;190&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">P&#46;E&#46;&#58; packed erythrocytes&#59; Unt&#58; units of blood product&#59; min&#58; minutes&#59; ml&#58; milliliters&#46; Comparative values with significant differences &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; between groups are marked &#42;&#46;</p><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Source&#58; authors&#46;</p>"
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                  <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="left" valign="top" scope="col" style="border-bottom: 2px solid black">Characteristics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Global median &#40;RIC&#41; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>74&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">ISS<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>25 median &#40;RIC&#41; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Events registered&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">ISS<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25 median &#40;RIC&#41; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>41&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Events registered&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">At the end of surgery</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Intraoperative fluids&#44; liters&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;3 &#40;1&#8211;5&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;1&#46;5&#8211;2&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;4 &#40;1&#46;5&#8211;4&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Damage control time&#44; min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">117 &#40;50&#8211;240&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">120 &#40;95&#8211;160&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">115 &#40;80&#8211;210&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Administration of tranexamic acid &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39 &#40;52&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;36&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27 &#40;65&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41&#42;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Estimated bleeding vol&#46;&#44; liters&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;5 &#40;0&#46;8&#8211;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;5 &#40;0&#46;6&#8211;2&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;1&#8211;3&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>P&#46;E&#46; Unt&#46; &#40;approx&#46; 300<span class="elsevierStyleHsp" style=""></span>ml&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;0&#8211;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;0&#8211;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;5 &#40;1&#8211;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&#42;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Plasma&#44; Unt&#46; &#40;approx&#46; 180<span class="elsevierStyleHsp" style=""></span>ml&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#8211;2&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#8211;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;9 &#40;0&#8211;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Cryoprecipitates&#44; Unt&#46; &#40;approx&#46; 20<span class="elsevierStyleHsp" style=""></span>ml&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#8211;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#8211;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Platelet apheresis&#44; Unt&#46; &#40;approx&#46; 200<span class="elsevierStyleHsp" style=""></span>ml&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#8211;1&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#8211;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#8211;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Rapid infusion systems&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13 &#40;17&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;15&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;19&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Cell salvage &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17 &#40;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;15&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;29&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41&#42;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Re-transfused vol&#46;&#44; ml&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">831 &#40;508&#8211;1115&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">900 &#40;508&#8211;960&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">924 &#40;712&#8211;1057&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Outcomes</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Re-intervention due to bleeding &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#40;2&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;4&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41&#42;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Death 0&#8211;24<span class="elsevierStyleHsp" style=""></span>h &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41&#42;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Death 1&#8211;30 days &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Characteristics at the end of surgery and outcomes of a prospective thoracoabdominal penetrating trauma cohort&#46;</p>"
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      "titulo" => "References"
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Article information

ISSN: 22562087
Original language: English

DOI:10.1016/j.rcae.2016.11.004

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	4	1	5
2024 October	10	4	14
2024 September	14	4	18
2024 August	18	6	24
2024 July	22	2	24
2024 June	20	4	24
2024 May	35	4	39
2024 April	30	3	33
2024 March	21	9	30
2024 February	7	5	12
2024 January	13	5	18
2023 December	28	6	34
2023 November	7	4	11
2023 October	10	5	15
2023 September	15	4	19
2023 August	9	3	12
2023 July	11	5	16
2023 June	13	0	13
2023 May	32	4	36
2023 April	36	0	36
2023 March	30	4	34
2023 February	31	2	33
2023 January	16	6	22
2022 December	21	8	29
2022 November	15	9	24
2022 October	13	6	19
2022 September	21	10	31
2022 August	22	4	26
2022 July	21	6	27
2022 June	34	5	39
2022 May	36	10	46
2022 April	49	6	55
2022 March	87	4	91
2022 February	88	5	93
2022 January	49	4	53
2021 December	35	14	49
2021 November	44	7	51
2021 October	15	10	25
2021 September	14	8	22
2021 August	15	5	20
2021 July	8	5	13
2021 June	9	7	16
2021 May	15	6	21
2021 April	17	9	26
2021 March	35	7	42
2021 February	11	9	20
2021 January	14	10	24
2020 December	7	6	13
2020 November	5	5	10
2020 October	4	3	7
2020 September	4	10	14
2020 August	7	8	15
2020 July	8	10	18
2020 June	6	6	12
2020 May	8	5	13
2020 April	3	2	5
2020 March	3	4	7
2020 February	5	2	7
2020 January	6	4	10
2019 December	5	6	11
2019 November	4	2	6
2019 October	5	0	5
2019 September	3	2	5
2019 July	4	9	13
2019 June	0	4	4
2019 May	1	18	19
2019 January	1	0	1
2018 September	1	0	1
2018 June	5	3	8
2018 May	27	3	30
2018 April	35	7	42
2018 March	41	8	49
2018 February	16	8	24
2018 January	35	7	42
2017 December	21	12	33
2017 November	24	7	31
2017 October	31	8	39
2017 September	28	15	43
2017 August	14	10	24
2017 July	18	11	29
2017 June	24	8	32
2017 May	32	7	39
2017 April	68	24	92
2017 March	51	8	59
2017 February	28	6	34
2017 January	42	11	53
2016 December	6	12	18

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