Morbimortalidade por traumatismo crânio-encefálico no município de São Paulo, 1997

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Abstract

Estudos epidemiológicos sobre traumatismos crânio-encefálicos (TCE) são poucos,e mais escassos ainda os que permitem análises comparativas da magnitude desta problemática, devido obstáculos metodológicos. No geral, os estudos são de trauma cefálico (incluem envoltórios e conteúdo craniano) mas reportam-se como de TCE, dada a dificuldade de mútua exclusão. É usual também estarem centrados em níveis específicos de gravidade, somente em vítimas hospitalizadas, ou de acordo com a causa externa como o acidente de trânsito. Respeitadas tais limitações, este estudo teve como objetivo estimar a incidência de TCE nas vítimas residentes e internadas na rede hospitalar do Município de São Paulo, em 1997, bem como, estimar a mortalidade por TCE dentre as mortes por causas externas, neste mesmo período e local. O material de estudo constou de dados do Ministério da Saúde relativos às saídas hospitalares analisadas a partir das Autorizações de Internação Hospitalar (AIH) e dados de óbitos por causas externas contidas no banco de dados do Programa de Aprimoramento das Informações de Mortalidade (PROAIM). Constatou-se que 29 717 pacientes foram internados devido lesões e envenamentos e destes, 3.635 (12%) tinham TCE; a taxa de internação foi 0,36/1 000 habitantes e a de mortalidade hospitalar foi 10%. O coeficiente de mortalidade por causas externas foi de 87,3/100 000 habitantes. Estima-se que a taxa de mortalidade por TCE seja no mínimo de 26,2 e no máximo de 39,3/100 000 habitantes.

Translated abstract

There are few epidemiological studies on traumatic brain injury (TBI), and those that allow broad comparative analyses of this problem are even more scarce, due to methodological obstacles. Usually, the studies address head injury (they include the cranial envelopments and content) but are reported as TBI, given the difficulty of mutual exclusion. It is also common for them to be centered at specific severity levels, only for hospitalized victims or according to the external cause, such as traffic accidents. With full respect to these limits, this study had as its objective the estimation of the TBI incidence in patients resident and in-hospital, in the hospital network in the city of São Paulo, Brazil, in 1997, as well as the estimation of TBI-caused mortality amongst external causes, at this same time and locale. Data for the study consisted of Ministério da Saúde data on hospital discharges, analyzed based on Autorizações de Internação Hospitalar (AIH) and obituary data on external causes, contained in the Programa de Aprimoramento das Informações de Mortalidade (PROAIM) data base. It was found that 29 717 patients were hospitalized due to lesions and poisoning; of these 3 635 (12%) had TBI; the hospitalization rate was 0.36/1000 pop.; and hospital mortality was 10%. The mortality coefficient due to external causes was 87.3/100 000 pop. Minimum TBI mortality rate is estimated at a minimum of 26.2 and a maximum of 39.3/100000 pop.

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Most cited references 27

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Epidemiology of trauma deaths: a reassessment.

A Sauaia, F Moore, E. E. Moore … (1995)

Recognizing the impact of the 1977 San Francisco study of trauma deaths in trauma care, our purpose was to reassess those findings in a contemporary trauma system. Cross-sectional. All trauma deaths occurring in Denver City and County during 1992 were reviewed; data were obtained by cross-referencing four databases: paramedic trip reports, trauma registries, coroner autopsy reports and police reports. There were 289 postinjury fatalities; mean age was 36.8 +/- 1.2 years and mean Injury Severity Score (ISS) was 35.7 +/- 1.2. Predominant injury mechanisms were gunshot wounds in 121 (42%), motorvehicle accidents in 75 (38%) and falls in 23 (8%) cases. Seven (2%) individuals sustained lethal burns. Ninety eight (34%) deaths occurred in the pre-hospital setting. The remaining 191 (66%) patients were transported to the hospital. Of these, 154 (81%) died in the first 48 hours (acute), 11 (6%) within three to seven days (early) and 26 (14%) after seven days (late). Central nervous system injuries were the most frequent cause of death (42%), followed by exsanguination (39%) and organ failure (7%). While acute and early deaths were mostly due to the first two causes, organ failure was the most common cause of late death (61%). In comparison with the previous report, we observed similar injury mechanisms, demographics and causes of death. However, in our experience, there was an improved access to the medical system, greater proportion of late deaths due to brain injury and lack of the classic trimodal distribution.