The American surgeon
-
The American surgeon · Jul 2001
Review Case ReportsAmyand's hernia: a case report of an incarcerated and perforated appendix within an inguinal hernia and review of the literature.
Appendicitis within an Amyand's hernia is rare; when it occurs it is often misdiagnosed as a strangulated inguinal hernia. We present a case report of such a case and a review of the literature. It is our recommendation that repair should be undertaken without the use of synthetic mesh through a properitoneal incision that gives access to the peritoneal cavity and the inguinal regions.
-
The American surgeon · Jul 2001
Clinical TrialEfficacy of thoracic computerized tomography in blunt chest trauma.
Studies suggest that thoracic computed tomography (TCT) is superior to plain chest X-ray (CXR) in the detection of blunt chest injury. This study examined whether TCT provides additional information to routine CXR findings, whether the additional information results in a management change, and whether TCT is more useful in patients with particular mechanisms of injury. Level I trauma patients were prospectively placed into two groups. ⋯ Identification of these injuries resulted in a highly significant (P < 0.001) change in clinical management in 20 per cent of the CTL group and 5 per cent of the MECH group. TCT appears to be most helpful in the acute evaluation of trauma patients when roentgenographic evidence of chest injury exists and provides additional information impacting on the care of the patient 20 per cent of the time. In patients with severe mechanisms of injury and normal CXRs TCT expeditiously identifies occult chest injuries that require treatment in 5 per cent of this population.
-
The American surgeon · Jul 2001
Trauma-specific intensive care units can be cost effective and contribute to reduced hospital length of stay.
Our hypothesis was that clinical outcomes are improved and cost and hospital length of stay (LOS) reduced as a result of the opening of a closed trauma intensive care unit (ICU). We conducted a cross-sectional study in a university-affiliated Level I trauma center. Our study population comprised trauma patients admitted to the ICU between June 1, 1996 and July 1, 1998 for at least 24 hours and with an Injury Severity Score (ISS) >16 (excluding those with severe brain injury). ⋯ The two groups were not statistically different in age, ISS, mechanism of injury, infection rate, and mortality; however, the TICU patients had a lower number of ventilator hours (83.1 vs 100.0; P = 0.007), lower ICU LOS (9.4 vs 12.1 days; P = 0.06), and lower total hospital LOS (15.6 vs 22.3 days; P = 0.01). Although this was not of statistical significance TICU patients had lower hospital charges ($125,383 vs $152,994; P = 0.06) and lower cost per case ($42,306 vs $47,548; P = 0.35) for a net savings of $314,520 during the first 6 months of operation of the TICU. This study suggests that improved clinical outcomes and decreases in cost and LOS are directly related to the opening of a closed trauma ICU.
-
The American surgeon · Jul 2001
The impact of pre-existing end-stage renal disease on survival in acutely injured trauma patients.
End-stage renal disease and associated dialysis procedures alter homeostatic mechanisms and adversely affect the respiratory, cardiac, and central nervous systems. Currently outcomes research in acutely injured trauma patients utilizes Trauma and Injury Severity Score methodology with the Injury Severity Score and Revised Trauma Score, which do not account for comorbidities. Literature has yet to emerge that analyzes the effects of end-stage renal disease on acutely injured trauma patients. ⋯ A prospective multicentered study comparing renal patients with nonrenal patients is warranted. This would confirm the need for databases to account for the increased morbidity and mortality associated with end-stage renal disease when calculating probability of survival values for acutely injured trauma patients. Similarly future studies analyzing the affects of other comorbidities such as diabetes, chronic obstructive pulmonary disease, and hypertension on acutely injured trauma patients would help develop a more accurate method of predicting outcomes.
-
The American surgeon · Jul 2001
Thermal injury in the elderly: when is comfort care the right choice?
The factors contributing to a higher mortality rate in elderly thermal injury victims are not well delineated. The purpose of this study is to determine the impact of the initial injury, medical comorbidities, and burn size on patient outcome and to determine a level of injury in this population when comfort care is an appropriate first choice. Individual medical records of patients over 65 years of age admitted to our burn center over a 10-year interval were reviewed for patient demographics, mechanism of injury, total body surface area (TBSA) burned, medical comorbidities, use of Swan-Ganz catheters, evidence of inhalation injury, level of support, and patient outcome. ⋯ Underlying medical problems--specifically chronic obstructive pulmonary disease--do play a role in increased patient morbidity and mortality. This study shows that age greater than 80 years in combination with burns greater than 40 per cent TBSA are uniformly fatal despite aggressive therapy. We believe that delaying the start of comfort-only measures in this situation only prolongs the pain and suffering for the patient, the family, and the physician.