Anesthesiology
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Since cricoid pressure was introduced into clinical practice, controversial issues have arisen, including necessity, effectiveness in preventing aspiration, quantifying the cricoid force, and its reliability in certain clinical entities and in the presence of gastric tubes. Cricoid pressure-associated complications have also been alleged, such as airway obstruction leading to interference with manual ventilation, laryngeal visualization, tracheal intubation, placement of supraglottic devices, and relaxation of the lower esophageal sphincter. This review synthesizes available information to identify, address, and attempt to resolve the controversies related to cricoid pressure. ⋯ Most of these complications are caused by excessive or inadequate force or by misapplication of cricoid pressure. Because a simple-to-use and reliable cricoid pressure device is not commercially available, regular training of personnel, using technology-enhanced cricoid pressure simulation, is required. The current status of cricoid pressure and objectives for future cricoid pressure-related research are also discussed.
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The Risk Stratification Index was developed from 35 million Medicare hospitalizations from 2001 to 2006 but has yet to be externally validated on an independent large national data set, nor has it been calibrated. Finally, the Medicare Analysis and Provider Review file now allows 25 rather than 9 diagnostic codes and 25 rather than 6 procedure codes and includes present-on-admission flags. The authors sought to validate the index on new data, test the impact of present-on-admission codes, test the impact of the expansion to 25 diagnostic and procedure codes, and calibrate the model. ⋯ Risk stratification performance was largely unchanged by additional diagnostic and procedure codes and only slightly worsened by restricting analysis to codes present on admission. The Risk Stratification Index, after calibration, thus provides excellent discrimination and calibration for important health services outcomes and thus appears to be a good basis for making hospital comparisons.