The American surgeon
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Ultrasound (US) has been reported as a useful aid to increase the sensitivity and specificity of the diagnosis of appendicitis. To determine the accuracy of US, we performed a prospective study of patients evaluated in the emergency department for acute appendicitis. US results of 125 consecutive patients over an 11-month period were correlated with operative and pathologic findings and clinical follow-up. ⋯ The sensitivity of US for appendicitis was 90 per cent, and the specificity was 94 per cent. Visualization of the noncompressible appendix or abnormal Doppler activity strongly suggests appendicitis. More importantly, the absence of both of these ultrasonographic findings defines a patient subset that may be safely discharged from the emergency department without admission.
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The American surgeon · Oct 1999
Comparative StudyNosocomial infections in the surgical intensive care unit: a difference between trauma and surgical patients.
In 1970, the Centers for Disease Control and Prevention (CDC) established the National Nosocomial Infection Surveillance System to assist institutions with infection surveillance, data collection, and processing. This facilitates interinstitutional comparison for nosocomial infection rates. Nosocomial infection rates in the surgical intensive care unit have been shown to be different from the medical intensive care unit. ⋯ We conclude that trauma patients are at higher risk for nosocomial infections than routine surgical patients. Because of this difference, centers should collect and report data separately for trauma and surgical patients in the intensive care unit. Specific attention should be focused on the causes and prevention of increased rates of nosocomial pneumonia in trauma patients.
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The American surgeon · Oct 1999
Abdominal computed tomography scan in pediatric blunt abdominal trauma.
The purpose of this study was to evaluate the role of abdominal CT scans in pediatric patients and correlate the findings with the clinical examination. A 2-year retrospective review of 88 patients with an abdominal CT scan after blunt trauma was performed. Seventy-two patients were identified with complete clinical examination data available. ⋯ No patient with a soft, nontender abdomen and a negative CT scan required an abdominal operation. We conclude that the CT scan alone may miss clinically significant injuries. In blunt abdominal trauma in the pediatric population, the CT scan findings should be coupled with the clinical examination to ensure that no significant abdominal injuries are missed.
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The American surgeon · Oct 1999
The utility and reliability of computed tomography scan in the diagnosis of small bowel obstruction.
Accurate diagnosis and treatment of small bowel obstruction (SBO) is critical to prevent complications and reduce costs. The purpose of the current study was to evaluate the evolving role of CT scan for patients with suspected SBO and compare its sensitivity and specificity with plain abdominal films. We identified 108 patients over a 1-year period with an admission or discharge diagnosis of SBO. ⋯ CT was able to correctly identify partial or complete SBO in 35 of 38 patients (sensitivity, 92%) and correctly identified the lack of obstruction in 8 of 13 patients (specificity, 71%). These data document that plain films are a less sensitive and less specific method of diagnosing SBO and confirm that the use of CT scan is a valuable modality. CT scan should be considered for use as the primary test for patients with suspected SBO.
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Although percutaneous dilatational tracheostomy (PDT) has been shown to be a cost-effective bedside alternative to open tracheostomy (OT), prior reports of the complications of the procedure are contradictory. Reported complications range from minor events to fatal ones, in varying percentages. This prospective study was designed to identify the type and severity of complications accompanying the introduction of PDT to a tertiary medical center. ⋯ Twenty-three major and minor complications occurred, including two perioperative deaths, in 15 patients (15.8%). A total of 37 PDT patients (38.9%) died in the hospital, indicative of the severity of illness of patients requiring tracheostomy. Based on the experience to date, Cedars-Sinai Medical Center (Los Angeles, CA) continues to require a surgeon privileged to perform OT to participate in all PDT procedures.