The American surgeon
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The American surgeon · Feb 2018
eFAST for Pneumothorax: Real-Life Application in an Urban Level 1 Center by Trauma Team Members.
The focused assessment with sonography for trauma (FAST) examination has become the standard of care for rapid evaluation of trauma patients. Extended FAST (eFAST) is the use of ultrasonography for the detection of pneumothorax (PTX). The exact sensitivity and specificity of eFAST detecting traumatic PTX during practical "real-life" application is yet to be investigated. ⋯ The literature on the utility of eFAST for PTX in trauma is variable. Our data show that although specific for clinically significant traumatic PTX, it has poor sensitivity when performed by clinicians with variable levels of ultrasound training. We conclude that CT is still the gold standard in detecting PTX, and clinicians performing eFAST should have adequate training.
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The rate of ulcerative colitis (UC), an inflammatory bowel disease, has been on the rise in the United States for the last several decades. Colectomy can be performed when other treatment options cannot provide a reasonable quality of life to patients with UC. Frailty has been shown to be a strong tool for evaluating preoperative risk factors for poor postoperative outcomes. ⋯ As the mFI increased from 0 (nonfrail) to 0.18 and above, the overall morbidity increased from 25.40 to 52.1 per cent (P < 0.05), serious morbidity increased from 14.9 to 42.1 per cent (P < 0.05), septic complications increased from 9.87 to 21.49 per cent (P < 0.05), cardiopulmonary complications increased from 2.98 to 23.14 per cent (P < 0.05), Clavien class IV complications increased from 3.5 to 26.5 per cent (P < 0.05), and Clavien V complications increased from 0.16 to 6.61 per cent (P < 0.05). On multivariate analysis, mFI was an independent predictor of septic complications [Adjusted Odds Ratio (AOR): 31.26; P = 0.006], cardiopulmonary complications (AOR: 216.3; P ≤ 0.001), serious morbidity(AOR: 66.8; P ≤ 0.001), overall morbidity (AOR: 25.5; P ≤ 0.001), Clavien class IV (AOR: 204.9; P ≤ 0.001) complications, and return to the operating room (AOR: 14.29; P = 0.048). Frailty is associated with an increase in morbidity and mortality after colectomy in patients with UC. mFI is an easy-to-use tool and can play an important role in the risk stratification of these patients.
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The American surgeon · Feb 2018
Helmets Matter: Kentucky All-Terrain Vehicle Crashes Seen at a Tennessee Trauma Center.
All-terrain vehicle (ATV) safety laws, including helmet use, vary by state and are sporadically enforced. Kentucky state laws require safety helmets only for younger riders. We hypothesized that ATV riders injured in Kentucky and seen at a Tennessee trauma center would more likely be unhelmeted, have more severe head injuries, and have higher mortality rates than those injured in Virginia or Tennessee. ⋯ ATV riders injured in the state of Kentucky were twice as numerous. In addition, they were more likely than ATV riders injured in Tennessee or Virginia to be unhelmeted, to have severe head injuries, and to sustain fatal injuries (all P < 0.001). This single trauma center study lends support for maintaining and enforcing current universal helmet laws for ATV riders of all ages in states where they are in effect and highlights the need to upgrade helmet laws that apply only to some riders.