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Background Little is known about the performance of severity indices for indicating intensive care and predicting mortality in the Intensive Care Unit (ICU) of trauma patients. This study aimed to compare the performance of severity indices to predict trauma patients’ ICU admission and mortality. Methods A retrospective cohort study which analyzed the electronic medical records of trauma patients aged ≥ 18 years, treated at a hospital in Brazil, between 2014 and 2017. Physiological [Revised Trauma Score (RTS), New Trauma Score (NTS) and modified Rapid Emergency Medicine Score (mREMS)], anatomical [Injury Severity Score (ISS) and New Injury Severity Score (NISS)] and mixed indices [Trauma and Injury Severity Score (TRISS), New Trauma and Injury Severity Score (NTRISS), Base-deficit Injury Severity Score (BISS) and Base-deficit and New Injury Severity Score (BNISS)] were compared in analyzing the outcomes (ICU admission and mortality) using the Area Under the Receiver Operating Characteristics Curves (AUC–ROC). Results From the 747 trauma patients analyzed (52.5% female; mean age 51.5 years; 36.1% falls), 106 (14.2%) were admitted to the ICU and 6 (0.8%) died in the unit. The ISS (AUC 0.919) and NISS (AUC 0.916) had better predictive capacity for ICU admission of trauma patients. The NISS (AUC 0.949), TRISS (AUC 0.909), NTRISS (AUC 0.967), BISS (AUC 0.902) and BNISS (AUC 0.976) showed excellent performance in predicting ICU mortality. Conclusions Anatomical indices showed excellent predictive ability for admission of trauma patients to the ICU. The NISS and the mixed indices had the best performances regarding mortality in the ICU.

Background Leukoreduction has been used to limit the risk of adverse events. The most commonly used methodology is filtration (pre- or post-storage). However, whether pre-storage filtration is better than post-storage filtration needs to be clearly defined, particularly for countries that still use post-storage filtration. This study aimed to synthesize the best available evidence on the effectiveness of pre-storage filters compared with post-storage filters for transfusion reactions, for the occurrence of infections, for the length of hospital stay, and for the death of patients undergoing leukoreduced transfusion. Methods We searched the MEDLINE (PubMed), CINAHL (EBSCO), PsycINFO (APA), Scopus (Elsevier), The Cochrane Library (J. Wiley), Web of Science Core Collection (Clarivate Analytics), Embase (Elsevier), and LILACS (VHL) databases and gray literature for eligible studies in August 2020 and updated the search in October 2023. The Joanna Briggs Institute critical assessment tools were applied to analyze the quality appraisal of the studies. GRADE was used to determine the certainty of the evidence. Results The meta-analysis showed that pre-storage filtration was a protective factor for the occurrence of febrile non-hemolytic transfusion reaction in red blood cells (RR 0.49, 95% CI 0.41–0.59) and platelet concentrate transfusions (RR 0.16, 95% CI 0.12–0.22). The same did not occur for post-surgical infection after platelet concentrate transfusions (RR 0.82, 95% CI 0.65–1.04). Only one study analyzed the length of hospital stay and showed no significant difference between patients who received leukoreduced transfusions according to the type of filter used. According to the GRADE criteria, the certainty of the evidence for febrile non-hemolytic transfusion reactions was low for red blood cells and very low for platelet concentrate due to the high risk of bias. Infection was a low risk due to imprecision. Conclusions The results of this review showed that the certainty of recommending the best type of filter (pre- or post-storage) for the benefit of the outcomes analyzed is still fragile; therefore, more robust evidence is needed. Systematic review registration PROSPERO CRD42020192202.

From the perspective of nurses, trauma patients in the Intensive Care Unit (ICU) demand a high degree of nursing workload due to hemodynamic instability and the severity of trauma injuries. This study aims to identify the factors related to the high nursing workload required for trauma victims admitted to the ICU. This is a prospective, cross-sectional study using descriptive and correlation analyses, conducted with 200 trauma patients admitted to an ICU in the city of São Paulo, Brazil. The nursing workload was measured using the Nursing Activities Score (NAS). The distribution of the NAS values into tertiles led to the identification of two research groups: medium/low workload and high workload. The Chi-square, Fisher's exact, Mann-Whitney and multiple logistic regression tests were utilized for the analyses. The majority of patients were male (82.0%) and suffered blunt trauma (94.5%), with traffic accidents (57.5%) and falls (31.0%) being prevalent. The mean age was 40.7 years (± 18.6) and the mean NAS was 71.3% (± 16.9). Patient gender, the presence of pulmonary failure, the number of injured body regions and the risk of death according to the Simplified Acute Physiology Score II were factors associated with a high degree of nursing workload in the first 24 hours following admission to the ICU. Workload demand was higher in male patients with physiological instability and multiple severe trauma injuries who developed pulmonary failure.

Resumo Objetivo Analisar os indicadores de qualidade de um Serviço de Atendimento Móvel de Urgência (SAMU), referentes aos chamados clínicos e traumáticos. Métodos Estudo analítico realizado em um SAMU no Paraná, que atende 21 municípios. A coleta ocorreu em 13.326 Relatórios de Atendimento do Socorrista (RAS), referentes aos anos de 2019 e 2020, fundamentados na tríade de Donabedian: estrutura (RAS, nº de recursos móveis e dimensionamento de pessoal), processo (quantidade de chamadas, nº geral de ocorrências, motivos dos chamados para atendimento, taxa de saída dos recursos móveis e localização do atendimento) e resultado (tempo de resposta e desfecho do atendimento - óbito), associados pelo teste de Qui-Quadrado de Pearson. Resultados A associação demonstrou significância para os indicadores sexo, faixa etária e ano de atendimento. O indicador RAS evidenciou incompletude de dados (35,5%); o nº de recursos móveis totalizou 16 Unidades de Suporte Básico (USB) e quatro Unidades de Suporte Avançado, superior ao preconizado pelo Ministério da Saúde, mas com falhas mecânicas (36). O dimensionamento de pessoal identificou baixa rotatividade, pois os profissionais eram estatutários (92,3%). A taxa média de chamadas foi 168,2 por mil habitantes, destas 70,67% culminaram com despacho de recurso móvel por motivos clínicos (86,3%) atendidos pela USB (78,9%). O tempo médio de resposta foi de 58,7 minutos, e o desfecho apresentou maior nº de óbitos no Polo B (83,2%), por limitação de acesso ao serviço. Conclusão A análise sinaliza a necessidade de revisão do sistema organizacional, para reduzir o tempo de resposta e melhorar o acesso ao serviço. Resumen Objetivo Analizar los indicadores de calidad de un Servicio de Atención Móvil de Emergencia (SAMU), referentes a las solicitudes clínicas y traumáticas. Métodos Estudio analítico realizado en un SAMU en el estado de Paraná, que atiende 21 municipios. La recopilación de datos se realizó a partir de 13.326 Informes de Atención del Paramédico (RAS, por sus siglas en portugués), referentes a los años 2019 y 2020, fundamentados en el método de Donabedian: estructura (RAS, número de recursos móviles y dotación de personal), proceso (cantidad de solicitudes, número general de casos, motivos de las solicitudes de asistencia, índice de salida de los recursos móviles y lugar de asistencia) y resultado (tiempo de respuesta y desenlace de la asistencia – fallecimiento), asociados mediante la prueba ji cuadrado de Pearson. Resultados La asociación demostró significación en los indicadores sexo, grupo de edad y año de asistencia. El indicador RAS evidenció incompletitud de datos (35,5 %). El número de recursos móviles totalizó 16 Unidades de Soporte Básico (USB) y cuatro Unidades de Soporte Avanzado, superior a lo recomendado por el Ministerio de Salud, pero con fallas mecánicas (36). La dotación de personal identificó baja rotación, ya que los profesionales eran estatutarios (92,3 %). El índice promedio de solicitudes fue 168,2 cada mil habitantes, de las cuales el 70,67 % terminó con el envío del recurso móvil por motivos clínicos (86,3 %) atendidos por la USB (78,9 %). El tiempo promedio de respuesta fue de 58,7 minutos, y el desenlace presentó un mayor número de fallecimientos en el Polo B (83,2 %), por restricción de acceso al servicio. Conclusión El análisis indica la necesidad de revisar el sistema organizativo, para reducir el tiempo de respuesta y mejorar el acceso al servicio. Abstract Objective To analyze the quality indicators of a Mobile Emergency Care Service (Serviço de Atendimento Móvel de Urgência -SAMU) regarding clinical and traumatic calls. Methods This is an analytical study carried out in a SAMU in Paraná that serves 21 municipalities. Collection took place in 13,326 First Responder Service Reports (FRSRs), referring to 2019 and 2020, based on Donabedian’s triad: structure (FRSRs, number of mobile resources and staffing), process (number of calls, overall number of occurrences, reasons for calls for service, departure rate of mobile resources and location of service) and outcome (response time and outcome of service - death), associated by Pearson’s chi-square test. Results The association demonstrated significance for the indicators of sex, age group and year of service. The FRSR indicator showed incomplete data (35.5%), the number of mobile resources totaled 16 Basic Support Units (BSUs) and four Advanced Support Units, higher than that recommended by the Ministry of Health, but with mechanical failures (36). Staffing sizing identified low turnover, as professionals were statutory (92.3%). The mean call rate was 168.2 per thousand inhabitants; of these, 70.67% culminated in the dispatch of a mobile resource for clinical reasons (86.3%) assisted by BSUs (78.9%). The mean response time was 58.7 minutes, and the outcome showed a higher number of deaths in Pole B (83.2%) due to limited access to the service. Conclusion The analysis indicates the need to review the organizational system to reduce response time and improve access to the service.

Resumo Objetivo: identificar fatores associados à contaminação e internação hospitalar por COVID-19 em profissionais de enfermagem. Método: estudo transversal, realizado em hospital especializado em cardiologia, com 415 profissionais de enfermagem. Foram avaliadas as variáveis sociodemográficas, comorbidades, condições de trabalho e questões relacionadas ao adoecimento pela COVID-19. Na análise dos dados, utilizaram-se os testes Qui-Quadrado, Fisher, Wilcoxon, Mann-Whitney e Brunner Munzel, a razão de chances para internação hospitalar, além de regressão logística binária. Resultados: a taxa de profissionais de enfermagem acometidos pela COVID-19 foi de 44,3% e os fatores associados à contaminação foram o número de pessoas no mesmo domicílio com COVID-19 (OR 36,18; p<0,001) e o uso de transporte público (OR 2,70; p=0,044). Ter sintomas graves (OR 29,75), pertencer ao grupo de risco (OR 3,00), apresentar taquipneia (OR 6,48), falta de ar (OR 5,83), cansaço (OR 4,64), febre (OR 4,41) e/ou mialgia (OR 3,00) aumentou as chances de internação hospitalar dos profissionais com COVID-19. Conclusão: habitar o mesmo domicílio que outras pessoas com a doença e usar transporte público aumentou o risco de contaminação pelo novo coronavírus. Os fatores associados à internação hospitalar dos profissionais contaminados foram a presença de fatores de risco para doença, a gravidade e o tipo dos sintomas apresentados. Resumen Objetivo: identificar los factores asociados al contagio y la hospitalización por COVID-19 en los profesionales de enfermería. Método: estudio transversal, realizado en un hospital especializado en cardiología, con 415 profesionales de enfermería. Se evaluaron las variables sociodemográficas, comorbilidades, condiciones de trabajo y preguntas relacionadas con la enfermedad por COVID-19. En el análisis de los datos, se utilizaron las pruebas de Chi-Cuadrado, Fisher, Wilcoxon, Mann-Whitney y Brunner Munzel, la razón de chance para la hospitalización, además de la regresión logística binaria. Resultados: la tasa de profesionales de enfermería afectados por el COVID-19 fue del 44,3% y los factores asociados al contagio fueron el número de personas en una misma vivienda con COVID-19 (OR 36,18; p<0,001) y el uso de transporte público (OR 2,70; p=0,044). Presentar síntomas graves (OR 29,75), pertenecer al grupo de riesgo (OR 3,00), tener taquipnea (OR 6,48), dificultad para respirar (OR 5,83), cansancio (OR 4,64), fiebre (OR 4,41) y/o mialgia (OR 3,00) aumentó las chances de hospitalización de los profesionales con COVID-19. Conclusión: vivir en el mismo domicilio que otras personas que tienen la enfermedad y utilizar el transporte público aumentó el riesgo de contagio por el nuevo coronavirus. Los factores asociados a la hospitalización de los profesionales contagiados fueron la presencia de factores de riesgo para enfermarse, la gravedad y el tipo de síntomas presentados. Abstract Objective: to identify factors associated with infection and hospitalization due to COVID-19 in nursing professionals. Method: a cross-sectional study carried out with 415 nursing professionals in a hospital specialized in cardiology. The sociodemographic variables, comorbidities, working conditions and issues related to illness due to COVID-19 were evaluated. Chi-Square, Fisher’s, Wilcoxon, Mann-Whitney and Brunner Munzel tests were used in data analysis, as well as Odds Ratio for hospitalization, in addition to binary logistic regression. Results: the rate of nursing professionals affected by COVID-19 was 44.3% and the factors associated with infection were the number of people living in the same household infected by COVID-19 (OR 36.18; p<0.001) and use of public transportation (OR 2.70; p=0.044). Having severe symptoms (OR 29.75), belonging to the risk group (OR 3.00), having tachypnea (OR 6.48), shortness of breath (OR 5.83), tiredness (OR 4.64), fever (OR 4.41) and/or myalgia (OR 3.00) increased the chances of hospitalization in professionals with COVID-19. Conclusion: living in the same household as other people with the disease and using public transportation increased the risk of infection by the new coronavirus. The factors associated with the hospitalization of contaminated professionals were presence of risk factors for the disease, severity and type of the symptoms presented.

[This corrects the article DOI: 10.1371/journal.pone.0112125.].

RESUMO Objetivo: identificar na literatura evidências da efetividade e eficácia de intervenções educativas na redução de complicações metabólicas e/ou vasculares em adultos com diabetes mellitus. Método: revisão sistemática realizada nas bases de dados LILACS, IBECS, CUMED, CINAHL e Medline e na biblioteca on-line SciELO com estudos de 2004 a 2014. Resultados: incluídos 11 estudos (5 ensaios clínicos randomizados e 6 quase experimentais). Apenas pesquisas que analisaram complicações vasculares foram identificadas. Conclusão: dois ensaios clínicos mostraram eficácia na redução de complicações cardiovasculares, da catarata ou retinopatia e nefropatia e todos os estudos quase experimentais revelaram efetividade na redução das úlceras nos pés, da vasculopatia e da neuropatia periféricas e manutenção da função renal. ABSTRACT Objective: To identify in the literature evidence of the effectiveness and efficacy of educational interventions in reducing metabolic and/or vascular complications in adults with diabetes mellitus. Method: A systematic review performed in LILACS, IBECS, CUMED, CINAHL and Medline databases and in the online library SciELO with studies published from 2004 to 2014. Results: Eleven studies were included (5 randomized clinical trials and 6 quasi-experimental). We only identified studies that analyzed vascular complications. Conclusion: Two clinical trials demonstrated efficacy in reducing cardiovascular complications, of cataract or retinopathy and nephropathy and all the quasi-experimental studies showed effectiveness in reducing feet ulcers, peripheral neuropathy and vasculopathy, and maintenance of kidney function. RESUMEN Objetivo: identificar en la literatura evidencias de la efectividad y eficacia de intervenciones educativas en la reducción de complicaciones metabólicas y/o vasculares en adultos con diabetes mellitus. Método: revisión sistemática realizada en las bases de datos LILACS, IBECS, CUMED, CINAHL y Medline, y en la biblioteca online SciELO, consultado estudios de entre 2004 y 2014. Resultados: fueron incluidos 11 estudios (5 ensayos clínicos randomizados y 6 cuasiexperimentales). Solamente fueron identificadas investigaciones que analizaron complicaciones vasculares. Conclusión: dos ensayos clínicos mostraron eficacia en la reducción de complicaciones vasculares, de la catarata o retinopatía y de la nefropatía; y todos los estudios cuasiexperimentales revelaron efectividad en la reducción de las úlceras de pie, la vasculopatía y la neuropatía periféricas, y en el mantenimiento de la función renal.

Accurate assessment of traumatic brain injury (TBI) severity is essential for clinical management and outcome prediction. Traditional tools, like the Glasgow Coma Scale (GCS) and Maximum Abbreviated Injury Scale for head injuries (MAIS/Head), have limitations, particularly in cases involving sedation, complex injuries, or diffuse brain injuries. This study evaluates the diagnostic accuracy of plasma and salivary S100B levels as biomarkers for TBI severity, based on GCS and MAIS/Head, with emphasis on emergency settings. Multicenter prospective cohort study enrolled 57 adult patients with blunt TBI. TBI severity was assessed using GCS and MAIS/Head. Plasma and salivary S100B samples were collected 2–4h post-injury and measured via ELISA. Receiver operating characteristic (ROC) curves assessed S100B's discriminative capacity for TBI severity. Plasma and salivary S100B concentrations were higher in moderate and severe TBI cases. ROC analysis revealed strong discriminative performance for plasma (AUC = 0.87 and 0.83) and salivary S100B (AUC = 0.85 and 0.83), for GCS and MAIS/HEAD, respectively. Salivary S100B showed 100 % specificity for mild TBI and 100 % sensitivity for moderate TBI (MAIS/Head). Plasma S100B exhibited 100 % sensitivity for severe TBI (GCS ≤8). Both biomarkers did not distinguish between moderate and severe injuries. Plasma and salivary S100B levels effectively discriminate mild from severe TBI, complementing current clinical severity scales. Their use may support rapid decision-making in emergency departments, especially given the simplicity, non-invasiveness, and feasibility of salivary sampling. These findings support integrating S100B measurement into TBI management protocols to enhance clinical accuracy and patient outcomes. •Salivary and plasma S100B levels accurately identify mild and severe TBI cases.•Salivary S100B shows high specificity (86.7 %) for mild traumatic brain injury.•Plasma S100B demonstrates excellent sensitivity (100 %) for severe TBI detection.•Saliva collection emerges as a viable, non-invasive option in trauma settings.•S100B biomarker can complement clinical and anatomical TBI severity scales.

Background The Trauma and Injury Severity Score (TRISS) has been criticized for being based on data from the USA and Canada—high-income countries—and therefore, it may not be applicable to low-income and middle-income countries. The present study evaluated the accuracy of three adjustments to the TRISS equation model (NTRISS-like; TRISS SpO 2 ; NTRISS-like SpO 2 ) in a high-income and a middle-income country to compare their performance when derived and applied to different groups. Methods This was a retrospective study of trauma patients admitted to two institutions: a university medical center in São Paulo, Brazil (a middle-income country), and a level 1 university trauma center in San Diego, USA (a high-income country). Patients were admitted between January 1, 2006, and December 31, 2010. The subjects were 2416 patients from Brazil and 8172 patients from the USA. All equations had adjusted coefficients for São Paulo and San Diego and for blunt and penetrating trauma. Receiver operating characteristic (ROC) curves were used to evaluate performance of the models. Results Regardless of the population where the equation was generated, it performed better when applied to patients in the USA (AUC from 0.911 to 0.982) compared to patients in Brazil (AUC from 0.840 to 0.852). When the severity was considered and homogenized, the performance of equations were similar to both application in the USA and Brazil. Conclusions Survival probability models showed better performance when applied in data collected in the high-income countries (HIC) regardless the country they were derived. The severity is an important factor to consider when using non-adjusted survival probability models for the local population. Adjusted models for severely traumatized patients better predict survival probability in less severely traumatized populations. Other factors besides physiological and anatomical data may impact final outcomes and should be identified in each environment if they are to be used in the development of the trauma care performance improvement process in middle-income countries.

Background The objective of this study is to propose three new adjustments to the Trauma and Injury Severity Score (TRISS) equation and compare their performances with the original TRISS as well as this index with coefficients adjusted for the study population. Methods This multicenter, retrospective study evaluated trauma victims admitted to two hospitals in São Paulo-Brazil and San Diego-EUA between January 1st, 2006, and December 31st, 2010. The proposed models included a New Trauma and Injury Severity Score (NTRISS)-like model that included Best Motor Response (BMR), systolic blood pressure (SBP), New Injury Severity Score (NISS), and age variables; a TRISS peripheral oxygen saturation (SpO 2 ) model that included Glasgow Coma Scale (GCS), SBP, SpO 2 , Injury Severity Score, and age variables; and a NTRISS-like SpO 2 model that included BMR, SBP, SpO 2 , NISS, and age variables. All equations were adjusted for blunt and penetrating trauma coefficients. The model coefficients were established by logistic regression analysis. Receiver operating characteristic (ROC) curve analysis was used to evaluate the performance of the models. Results The original TRISS (area under the curve (AUC) = 0.90), TRISS with adjusted coefficients (AUC = 0.89), and the new proposals (NTRISS-like, TRISS SpO 2 , and NTRISS-like SpO 2 ) showed no difference in performance (AUC = 0.89, 0.89, and 0.90, respectively). Conclusions The new models demonstrated good accuracy and similar performance to the original TRISS and TRISS adjusted for coefficients in the study population; therefore, the new proposals may be useful for the assessments of quality of care in trauma patients using variables that are routinely measured and recorded.