Severidad del trauma calculada con registros de necropsia en diferentes tipos de lesión, Bogotá, 2013

Abstract

Aim: Colombia has an immature trauma system, that could result in the presence of factors related to death with severe injury (Injury Severity Score-ISS>15) or with highest ISS score (75 points); we determinate the probability of death with ISS-75 and factors related. Methods: A retrospective descriptive design it was carried out, using data obtained from necropsy records of violent deaths (veracious method to calculate ISS), make in National Institute of Legal Medicine and Forensic Sciences (INMLCF) during year 2013 (Bogota). Frequency of ISS-75 or minus was determinate and differences among socio-demographics and clinical factor were evaluated (X2, p<0.05). A Bayesian Model (BM) was applied to calculate the probability of ISS-75 among all factors evaluated (Orange – Data Mining Fruitful & Fun). Results: 443/557 necropsy records were selected after apply eligibility criteria; the median age 33.8 years, 86.7% were male; manner of death-homicide and penetrating type were present in 62.8% and 61.6%, respectively; injury occurred at night in 55.5% (CI95%,49.6-61.3%) and death at night in 66.9% (CI95%,61.2-72.2%) of victims (incomplete data). Firearm projectile (42.4%), blunt (35.9%) and cutting-stabbing (18.5%), were the main causes of deaths. According to BM, the probability of death with an ISS-75 was 90%; the factors positively related to ISS-75 were: cause of death (firearm projectile, cutting-stabbing), manner of death (homicide), penetrating injury, 28.5-38.5 years old and death occurred in <0.5 hours after of injury. Discussion: Using necropsy records to calculate ISS, we identify that most of victims had the highest ISS score, probably for the nature of injury or because with a necropsy could be identify the really severity of injury, including hidden or missed injuries. Nevertheless, proportion of victims with ISS-75 is very high, we identify some factors related to this threshold and that may imply an adjustment in the control measures of social determinants of trauma.