Background:In patients with severe traumatic brain injury (TBI), there is a lack of consensus about the need and time to perform a tracheostomy. Nowadays, the decision is individualized to each case. It is considered that patients that will need a tracheostomy profit by performing it earlier. Patients and methods: An observational and prospective study was performed. One hundred and twenty patients in a period of 18 months between 2016 and 2018, older than 18 years, with severe TBI at the first 24 h of trauma were analyzed. Clinical, biochemical, and radiological findings at admission were measured; patients were followed up until discharge. The statistical analysis was made with Student's t-test, χ 2 , and prevalence risk ratio. Results: Ten associated factors were grouped according to the prevalence risk ratio. The principal factors were CRASH score, IMPACT score, SAPS II score, APACHE II score, age, revised trauma score, Glasgow Coma Scale, subdural hematoma, uni or bilateral abnormal pupil reactivity, and collapse of basal cisterns. Conclusions: We conclude that there are multiple factors associated with the need for tracheostomy in adult patients with severe TBI and it is possible to predict according to our findings from admission which patients will profit by this procedure.

Background: Retroclival hematomas are rare and occur mostly in the pediatric population. They are variously attributed to trauma, apoplexy, and vascular lesions. With motor vehicle accidents (MVAs), the mechanism of traumatic injury is forced flexion and extension. There may also be associated cervical spinal and/or clivus fractures warranting fusion. Case Description: A 35-year-old male sustained a traumatic brain injury after a fall of 5 m at work. His Glasgow coma scale (GCS) on admission was 13 (M6V3O4). He had no cranial nerve deficits. The brain computed tomography (CT) showed a retroclival subdural hematoma that extended to the C2 level. Conclusions: Most retroclival hematomas are attributed to MVAs, and cranial CT and magnetic resonance studies typically demonstrate a combination of posterior fossa hemorrhage with retroclival hematomas (intra or extradural). Patients with retroclival hematomas but high GCS scores on admission usually have better prognoses following traumatic brain injuries attributed to MVA. Notable however is the frequent association with additional cervical and/or craniocervical injuries (e.g. such as odontoid fracture) that may warrant surgery/fusión.

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Introducción: Las estrategias nutricionales y dietéticas tienen por objetivo mejorar la salud. Los estudios de costos económicos permiten evaluar intervenciones, así como observar los costos y los beneficios. Se han desarrollado estrategias nutricionales cuyo costo sea bajo y cuya efectividad sea alta para disminuir la incidencia de enfermedades, por lo que desempeñan un papel importante en la recuperación y preservación de la salud. Material y métodos: Se realizó una búsqueda sistemática en las diferentes bases de datos, en la cual se incluyeron artículos costo-efectividad desde el punto de vista institucional, de intervenciones nutricionales y dietéticas desde 1980 a 2018. Los estudios se agruparon de acuerdo al tipo de intervención. Se comparó el objetivo de cada estudio con las diferencias de los estudios de simulación y de los estudios clínico-económicos. Resultados: Se incluyeron 34 artículos. Todos eran ensayos clínicos aleatorizados, tanto en los estudios tomados de la literatura para hacer los estudios de simulación como en los estudios clínico-económico. Conclusiones: No todas las publicaciones reportan las unidades de efectividad en el mismo sistema monetario, ni definen efectividad de la misma manera, sin embargo, las estrategias de intervención nutricionales y dietéticas demuestran ser efectivas al reducir los días de hospitalización y al mejorar los pronósticos vitales y el estado de salud en general de los pacientes, por lo que su costo no solo es amortizable, sino que debería considerarse como parte esencial de las intervenciones sanitarias.