The American surgeon
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The American surgeon · Aug 2001
Nonoperative management of solid abdominal organ injuries from blunt trauma: impact of neurologic impairment.
The role of nonoperative management of solid abdominal organ injury from blunt trauma in neurologically impaired patients has been questioned. A statewide trauma registry was reviewed from January 1993 through December 1995 for all adult (age >12 years) patients with blunt trauma and an abdominal solid organ injury (kidney, liver, or spleen) of Abbreviated Injury Scale score > or =2. Patients with initial hypotension (systolic blood pressure <90 mm Hg) were excluded. ⋯ There was no difference in the nonoperative failure rate between patients with normal mental status and those with mild to moderate or severe head injuries. Nonoperative management of neurologically impaired hemodynamically stable patients with blunt injuries of liver, spleen, or kidney is commonly practiced and is successful in more than 90 per cent of cases. No differences were noted in the rates of delayed laparotomy or survival between normal, mild to moderately head-injured, and severely head-injured patients.
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The American surgeon · Aug 2001
Outcome of perforated necrotizing enterocolitis in the very low-birth weight neonate may be independent of the type of surgical treatment.
Perforated necrotizing enterocolitis (NEC) in the low-birth weight infant is now one of the most common surgical problems encountered in contemporary neonatal intensive care units. However, morbidity and mortality from NEC remain high, and the optimal surgical management of these infants remains controversial. Currently few data exist comparing the factors influencing outcome in very low-birth weight infants with perforated NEC treated by either local drainage or exploration. ⋯ The mean number of comorbidities was greater for drainage than for surgery, and for the same number of comorbidities the probability of survival tended to be greater for those treated with drainage than for those undergoing surgery. Multiple logistic regression analysis identified the total number of comorbidities as affecting outcome rather than treatment choice. This suggests therefore that selection of therapeutic options for the patient requires evaluating all factors that may impact survival rather than applying a single treatment strategy for all patients.
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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.
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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.
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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.