Discusión

Epidemiological study of oral and maxillofacial emergencies
in a general hospital
Estudio epidemiológico de las urgencias en cirugía oral y maxilofacial
en un hospital general

From the study that is presented one deduces that there is great pressure for assistance, in general terms, with regard to the demand for emergency attention in Oral and Maxillofacial Surgery in the «Hospital Río Hortega» in Valladolid.

With regard to the design of the study described as transversal and observational, whether this is a prospective or retrospective study is not specified, nor are details given with precision as to how the data was collected (sources, methodology, etc). The variables that are measured are too generic with regard to pathologies as, although the aim is to set out the information, clearly much is lost. For example in table 1, the etiologic group «Illness» is too wide (45% - infections, dental emergencies, TMJ emergencies, tumors, post-exodontia emergencies), as opposed to the section called «Accidents» (55%-trauma). The distinction between etiological groups and diagnostic groups does not shed any light on the description of the daily reality in the emergency unit of a large hospital.

With regard to the results, the data related to the age range demanding the greatest assistance, which is up until the age of ten, stands out due to its infrequency when compared to other studies that the authors themselves refer to¹, suggesting that the «filter» for Pediatric Emergencies should be evaluated.

The importance of accidents (etiologic group «Accident/ trauma diagnosis») in etiology is evident. But «fortuitous accidents», such as those causing facial fractures, represent in this study 60.4% of cases, which also stands out when compared with other authors,¹ according to whom 66% of facial fractures are produced by traffic accidents.

The proportion of infectious pathology in the emergency area (6.6%) seems to have been underestimated, compared with other studies which put this at 22%,² which could lead us to think that at this point there had been a considerable «filter» by the Emergency Services. On the other hand dental pathology (20.2%) takes up a large proportion. Perhaps part of dental infections in initial stages are included (apical periodontitis, limited cellulitis, localized dental abscess) in the dental pathology section.

With regard to the section regarding distribution according to the hospital of origin (Table 3), information from the authors as to the health service planning of the autonomous community with regard to emergency attention for maxillofacial surgery (number of inhabitants in the

areas of the other two hospitals and in the remaining eight provinces of Castilla and León) is missed as, according to this [report], 90% of the emergencies come from the area around the hospital itself (235.000 inhabitants) and 10% are produced in the rest of the Community.

The high number of surgical interventions with local anesthesia stands out (41% of emergencies) as opposed to a very low number 0.5% (10 patients in one year) with general anesthesia. Again we miss some sort of reflection on the part of the authors as to how these results were established (on call or on duty, interventions carried out when on duty or delayed until the morning shift, presence or not of a resident doctor (MIR) etc.).

It is, to conclude, a correct study, although for comparative studies or for meta-analysis it presents difficulties due to the lack of precision in the description of the methodology and the excessively large diagnostic groups. From here I would encourage the authors to reach perhaps in a future study (observational, transverse and prospective),³ new and interesting conclusions that would, in short, be to the advantage of the quality of care in our hospitals.

Eugenio Fortis Sánchez
Servicio de Cirugía Oral y Maxilofacial.
Hospital Universitario Puerta del Mar, Cádiz, España