Acute medicine
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Comparative Study
The increased mortality associated with a weekend emergency admission is due to increased illness severity and altered case-mix.
A weekend emergency medical admission has been associated with a higher mortality. We have examined all weekend admissions to St James' Hospital, Dublin between 2002 and 2009. ⋯ Patients admitted at the weekend had an approximate 11% increased 30-day in-hospital mortality, compared with a weekday admission. However, admission at the weekend was not independently predictive in a risk model that included Illness Severity (age and biochemical markers) and co-morbidity. Sicker patients, with a worse outcome, are admitted over the weekend; these considerations should inform the allocation of healthcare resources.
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Review Case Reports
An unusual cause of bilateral deep vein thrombosis in a young adult patient.
We describe the case of a 17 year old male who presented with severe groin pain leading to inability to weight bear on his left leg. Investigation revealed extensive bilateral and proximal deep vein thrombosis, in association with an absent inferior vena cava and anomalous venous drainage system. We present a review of the literature surrounding this association, summarise the typical clinical presentation and common characteristics in this group of patients and discuss its management.
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Comparative Study
Safe discharge of patients with low-risk upper gastrointestinal bleeding (UGIB): can the use of Glasgow-Blatchford Bleeding Score be extended?
Risk stratification of patients with suspected upper gastrointestinal bleeding (UGIB) using either Glasgow-Blatchford Bleeding Score (GBS) or preendoscopy Rockall score to facilitate early safe discharge (GBS=0, pre-Rockall=0) has been reported. This observational study compared score utility and considered the impact of extending the range of GBS or pre-Rockall scores permitting safe discharge. ⋯ GBS is superior to pre-Rockall score in identifying patients with suspected UGIB who have a low likelihood of an adverse clinical outcome and can be considered for early discharge. Diagnostic performance at different thresholds suggests that patients with GBS≤2 could be considered for early discharge, doubling the number of eligible patients (15.2 to 32.5%). This has important patient safety and resource implications.
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We evaluated the effectiveness of MEWS and biochemical parameters in predicting outcomes for acute medical admissions. Data from consecutive admissions to the Acute Medical Unit (AMU) of National Hospital of Sri Lanka were collected. C-reactive protein (CRP), albumin, white cell count, platelet count and haemoglobin values were collected. ⋯ A MEWS score of >=5 together with increasing age,pulse rate, respiratory rate, AVPU score, CRP,CRP/Albumin ratio and reduced platelet and albumin levelall increased the odds of reaching "adverse endpoints". Adding a score for biochemical parameters increased the area under the ROC curve for reaching "adverse endpoints" Biochemical parameters better predicted length of hospital stay and adverse outcomes. A combined scoring system improved the sensitivity of prediction.
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Isolated Pelvic vein Deep Venous Thrombosis (DVT) is a relatively rare phenomenon, but is usually not identified by conventional lower limb duplex Ultrasound scanning. We present two cases of isolated iliac vein thrombosis; the first resulting in the patient's death from Pulmonary Embolism (PE) after normal lower limb duplex scan. The second case was identified and successfully treated after introduction of a revised investigation algorithm following the first case. The literature supports the use of magnetic resonance imaging, CT venography, or ascending venography, to diagnose this condition.