The American surgeon
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The American surgeon · Dec 2002
Clinical TrialOral antibiotics in the management of perforated appendicitis in children.
After appendectomy for perforated appendicitis children have traditionally been managed with intravenous broad-spectrum antibiotics for 5 to 10 days and then until fever and leukocytosis have resolved. We prospectively evaluated a protocol of hospital discharge on oral antibiotics when oral intake is tolerated-regardless of fever or leukocytosis-in a consecutive series of 80 children between one and 15 years of age who underwent appendectomy (38 open and 42 laparoscopic) for perforated appendicitis. At discharge subjects began a 7-day course of oral trimethoprim/sulfamethoxazole and metronidazole. ⋯ Among the 66 children who were discharged on oral antibiotics without having had an inpatient infectious complication there were three wound infections (4.4%). None of these patients had a fever or leukocytosis at discharge. We conclude that after appendectomy for perforated appendicitis children may be safely discharged home on oral antibiotics when enteral intake is tolerated regardless of fever or leukocytosis.
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The American surgeon · Dec 2002
Comparative StudyDay for night: should we staff a trauma center like a nightclub?
Most trauma services throughout the country are staffed on a fixed-call rotational basis. Staff is deployed in a linear fashion when trauma often occurs in a skewed sporadic fashion resulting in large fluctuations in volume, injury severity, and mechanism of injury. Medical error and increased mortality have been associated with certain admission times. ⋯ Six comparisons were performed: 1) morning versus night admission; 2) weekday versus weekend admission; 3) least busy day (Tuesday) versus busiest day (Sunday) admission; 4) weeknight versus weekend night admission; 5) in cases of penetrating trauma, morning versus night admission; and 6) in cases of blunt trauma, morning versus night admission. None of the six comparisons showed a significant difference in mortality. There was no significant difference in ISS-matched mortality related to fixed trauma call staffing.
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The American surgeon · Dec 2002
Wireless clinical alerts and patient outcomes in the surgical intensive care unit.
Errors in medicine have gained public interest since the Institute of Medicine published its 1999 report on this subject. Although errors of commission are frequently cited, errors of omission can be equally serious. A computerized surgical intensive care unit (SICU) information system when coupled to an event-driven alerting engine has the potential to reduce errors of omission for critical intensive care unit events. ⋯ Patients triggering the alert paging system were 49.4 times more likely to die in the SICU compared with patients who did not generate an alert. Even after transfer to floor care the patients who triggered the alerting system were 5.7 times more likely to die in the hospital. An alert page identifies patients who will stay in the SICU longer and have a significantly higher chance of death compared with patients who do not trigger the alerting system.
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The American surgeon · Dec 2002
Carotid endarterectomy using regional anesthesia: a benchmark for stenting.
Regional block (RB) anesthesia for carotid surgery offers the advantage of continuously monitoring the awake patient's neurologic status during carotid cross-clamping. We retrospectively studied our experience with RB for carotid endarterectomy (CEA) procedures performed during the period January 1, 1995 through December 31, 2001. A total of 388 consecutive CEA procedures were performed; RB was used in 314 and general anesthesia (GA) in 74. ⋯ RB allows 90 per cent of procedures to be performed without shunting, thus facilitating endarterectomy and patch angioplasty. CEA performed under RB is similar to carotid stenting because both procedures allow monitoring of the awake patient's neurologic status. The very low procedural complication rate in this study warrants the consideration of carotid surgery under regional block as a benchmark for future carotid angioplasty and stenting studies.
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The American surgeon · Dec 2002
Intensive care unit outcome of vehicle-related injury in elderly trauma patients.
Vehicle-related trauma is a common mechanism of injury in elderly (age > or = 65 years) trauma patients. Several hospital-based studies have shown that patients with pedestrian injury have a higher mortality compared with those with motor vehicle collision (MVC) injury partially because of older patients found in the former group. In addition the injury patterns also differ significantly between these two mechanisms of vehicle-related trauma. ⋯ There was no difference in the mean age and gender between the two groups. Injury Severity Score, admission Simplified Acute Physiology Score, and mortality were significantly higher in the pedestrian group compared with the MVC group. Using logistic regression analysis three factors were found to be independently predictive of mortality: Simplified Acute Physiology Score, intracranial hemorrhage with mass effect on CT scan, and cardiac complications.