The American surgeon
-
The American surgeon · Jun 2014
Patients with blunt head trauma on anticoagulation and antiplatelet medications: can they be safely discharged after a normal initial cranial computed tomography scan?
The literature reports delayed intracranial hemorrhage (ICH) after blunt trauma in patients taking preinjury anticoagulant and antiplatelet (AC/AP) medications. We sought to evaluate the incidence of delayed ICH at our institution and hypothesize that patients taking AC/AP medications who are found to have a negative first computed tomography (CT) scan will not require a second CT scan. A total of 303 patients were retrospectively reviewed. ⋯ The protocol requiring a second CT scan for all patients on AC/AP medications after a negative first CT scan should be questioned. For patients with blunt head trauma taking warfarin or a warfarin-aspirin combination, a repeat cranial CT scan after a negative initial CT is acceptable. For patients taking clopidogrel, a period of observation may be warranted.
-
The American surgeon · Jun 2014
Current screening guidelines overlook a significant number of patients treated for colorectal cancer.
The U. S. Preventive Services Task Force (USPSTF) recommends screening for colorectal cancer (CRC) in adults, beginning at age 50 years and continuing until age 75 years. ⋯ Two hundred eight of the 708 patients (29.3%) were diagnosed on screening colonoscopy, whereas 500 patients (70.7%) were found to have CRC on diagnostic colonoscopy or at the time of operation for related complications. There are a significant number of patients who are ultimately treated for CRC that would fall outside the recommended screening parameters at our institution. Re-evaluation of the current CRC screening guidelines and risk factor assessment is needed to account for the changing trends.