Journal of the American College of Surgeons
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Cirrhosis as an independent predictor of poor outcomes in trauma patients was identified in 1990. We hypothesized that the degree of preinjury hepatic dysfunction is, by itself, an independent predictor of mortality. ⋯ The mortality rate for class C cirrhotic patients posttrauma continues to be higher than that predicted by TRISS, although patients with less severe hepatic dysfunction do not appear to have significantly lower than predicted survival. The degree of hepatic dysfunction remains an independent predictor of mortality and CTP C criteria must be considered when determining outcomes for patients posttrauma.
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Despite our regular use of CT for suspected appendicitis, a recent study at our institution demonstrated a negative appendectomy (NA) rate similar to our rate 15 years earlier. Based on analysis of this data, a diagnostic pathway was implemented prospectively for adult patients with possible appendicitis. ⋯ Frequent appendiceal CT alone does not ensure surgical diagnostic accuracy. CT need not be used in all patients to achieve very low NA rates. An evidence-based diagnostic algorithm incorporating early surgical evaluation, objective criteria for preoperative CT, deterrence of early operation after negative CT, and use of CT to facilitate safe discharge led to substantial improvements in the care of our adult population presenting with possible appendicitis.
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Sixteen-slice CT angiography in patients with suspected blunt carotid and vertebral artery injuries.
We sought to determine whether 16-slice multidetector CT angiography (CTA) has sufficient negative predictive value for use as the initial imaging examination for patients with suspected blunt carotid and vertebral artery injury (BCVI) and to estimate the positive predictive value of different screening criteria in assessing BCVI. ⋯ Multidetector CTA misses relatively few injuries and adequately supplants DSA as a screening study in patients with risk factors for BCVI. Radiologists should maintain a high degree of suspicion in patients who meet screening criteria. Optimal imaging strategies should focus on the most predictive criteria.