Complicações intra-hospitalares em pacientes com lesão medular traumática aguda
DOI:
https://doi.org/10.11606/issn.2317-0190.v25i1a158833Palavras-chave:
Traumatismos da Medula Espinal/Complicações, Tempo de Internação, Brasil, Estudos TransversaisResumo
Há poucos dados sobre complicações hospitalares em pacientes com LMT aguda. Objetivo: Reportar as características de complicações em pacientes com LMT em um grande centro de trauma. Método: Estudo transversal com 434 pacientes com LMT aguda de 2004 a 2014. Os desfechos foram a frequência e característica das complicações, o tempo de internação (TDI), e fatores associados com seu aumento. Resultados: Incidência de complicações foi 82,2%, sendo as mais frequentes: infecção do trato urinário (ITU)=64,4%, úlcera de pressão (UP)= 50,6% e pneumonia= 23,7%. Pneumonia, intubação, e ser submetido a qualquer cirurgia para UP foram independentemente associados com aumento do TDI. Conclusão: ITUs e UP foram as complicações mais prevalentes, e devem ser melhor estudadas para melhor atenção a LMT. As investigações sobre as complicações na lesão medular traumática devem ser mandatórias nos centros e unidades dedicadas ao tratamento da Lesão Medular.
Downloads
Referências
United Nations, Department of Economic and Social Affairs, Population Division. World population prospects: the 2012 revision highlights and advance tables. New York: United Nations; 2013.
World Health Organization. International perspectives on spinal cord injury. Geneva: WHO; 2013.
Jain NB, Ayers GD, Peterson EN, Harris MB, Morse L, O'Connor KC, et al. Traumatic spinal cord injury in the United States, 1993-2012. JAMA. 2015;313(22):2236-43. DOI: https://doi.org/10.1001/jama.2015.6250
Osterthun R, Post MW, van Asbeck FW, van Leeuwen CM, van Koppenhagen CF. Causes of death following spinal cord injury during inpatient rehabilitation and the first five years after discharge. A Dutch cohort study. Spinal Cord. 2014;52(6):483-8. DOI: https://doi.org/10.1038/sc.2014.28
Sothmann J, Stander J, Kruger N, Dunn R. Epidemiology of acute spinal cord injuries in the Groote Schuur Hospital Acute Spinal Cord Injury (GSH ASCI) Unit, Cape Town, South Africa, over the past 11 years. S Afr Med J. 2015;105(10):835-9. DOI: https://doi.org/10.7196/SAMJnew.8072
New PW, Jackson T. The costs and adverse events associated with hospitalization of patients with spinal cord injury in Victoria, Australia. Spine (Phila Pa 1976). 2010;35(7):796-802. DOI: https://doi.org/10.1097/BRS.0b013e3181be76f5
Brasil. Ministério da Saúde. Diretrizes de atenção à pessoa com lesão medular. Brasília: Ministério da Saúde; 2013.
Joseph C, Nilsson Wikmar L. Prevalence of secondary medical complications and risk factors for pressure ulcers after traumatic spinal cord injury during acute care in South Africa. Spinal Cord. 2016;54(7):535-9. DOI: https://doi.org/10.1038/sc.2015.189
Souza D, Yuan CC, Rached RVA. Lesiones de médula espinal en un centro de referencia en São Paulo-Brasil. Rev Col Med Fis Rehab. 2012;22(1):44-8.
Grossman RG, Frankowski RF, Burau KD, Toups EG, Crommett JW, Johnson MM, et al. Incidence and severity of acute complications after spinal cord injury. J Neurosurg Spine. 2012;17(1 Suppl):119-28. DOI: https://doi.org/10.3171/2012.5.AOSPINE12127
Maharaj MM, Stanford RE, Lee BB, Mobbs RJ, Marial O, Schiller M, et al. The effects of early or direct admission to a specialised spinal injury unit on outcomes after acute traumatic spinal cord injury. Spinal Cord. 2017;55(5):518-524. DOI: https://doi.org/10.1038/sc.2016.117
Carvajal C, Pacheco C, Gómez-Rojo C, Calderón J, Cadavid C, Jaimes F. Características clínicas y demográficas de pacientes con trauma raquimedular: Experiencia de seis años. Acta Med Colomb 2015;40(1):45-50.
van Weert KC, Schouten EJ, Hofstede J, van de Meent H, Holtslag HR, van den Berg-Emons RJ. Acute phase complications following traumatic spinal cord injury in Dutch level 1 trauma centres. J Rehabil Med. 2014;46(9):882-5. DOI: https://doi.org/10.2340/16501977-1858
Yang R, Guo L, Wang P, Huang L, Tang Y, Wang W, et al. Epidemiology of spinal cord injuries and risk factors for complete injuries in Guangdong, China: a retrospective study. PLoS One. 2014;9(1):e84733. DOI: https://doi.org/10.1371/journal.pone.0084733
Kang MS, Lee BS, Lee HJ, Hwang SW, Han ZA. Prevalence of and risk factors for multidrug-resistant bacteria in urine cultures of spinal cord injury patients. Ann Rehabil Med. 2015;39(5):686-95. DOI: https://doi.org/10.5535/arm.2015.39.5.686
Zakrasek EC, Creasey G, Crew JD. Pressure ulcers in people with spinal cord injury in developing nations. Spinal Cord. 2015;53(1):7-13. DOI: https://doi.org/10.1038/sc.2014.179
Scovil CY, Flett HM, McMillan LT, Delparte JJ, Leber DJ, Brown J, et al. The application of implementation science for pressure ulcer prevention best practices in an inpatient spinal cord injury rehabilitation program. J Spinal Cord Med. 2014;37(5):589-97. DOI: https://doi.org/10.1179/2045772314Y.0000000247
Krishnan S, Brick RS, Karg PE, Tzen YT, Garber SL, Sowa GA, et al. Predictive validity of the Spinal Cord Injury Pressure Ulcer Scale (SCIPUS) in acute care and inpatient rehabilitation in individuals with traumatic spinal cord injury. NeuroRehabilitation. 2016;38(4):401-9. DOI: https://doi.org/10.3233/NRE-161331
Ganuza JR, Garcia Forcada A, Gambarrutta C, Diez De La Lastra Buigues E, Merlo Gonzalez VE, Paz Fuentes F, et al. Effect of technique and timing of tracheostomy in patients with acute traumatic spinal cord injury undergoing mechanical ventilation. J Spinal Cord Med. 2011;34(1):76-84. DOI: https://doi.org/10.1179/107902610X12886261091875
Romero J, Vari A, Gambarrutta C, Oliviero A. Tracheostomy timing in traumatic spinal cord injury. Eur Spine J. 2009;18(10):1452-7. DOI: https://doi.org/10.1007/s00586-009-1097-3