Journal of the American College of Surgeons
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Randomized Controlled Trial Comparative Study
An Apgar score for surgery.
Surgical teams have not had a routine, reliable measure of patient condition at the end of an operation. We aimed to develop an Apgar score for the field of surgery, an outcomes score that teams could calculate at the end of any general or vascular surgical procedure to accurately grade a patient's condition and chances of major complications or death. ⋯ A simple score based on blood loss, heart rate, and blood pressure can be useful in rating the condition of patients after general or vascular operations.
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Comparative Study
Statewide assessment of injury and death rates among riders of off-road vehicles treated at trauma centers.
Injuries and deaths among riders of off-road motorized all-terrain vehicles are increasing in the US. We hypothesized that serious injuries in Oregon have increased among riders of both four-wheel and two-wheel vehicles. ⋯ There has been an alarming increase in the number of both ATV and ORMC riders requiring treatment in Oregon's trauma centers. Surgeons need to join a coalition of health care providers, citizens and public officials to implement a comprehensive injury-prevention response to this epidemic.
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Wrong-site surgery can be a catastrophic event for a patient, caregiver, and institution. Although communication breakdowns have been identified as the leading cause of wrong-site surgery, the efficacy of preventive strategies remains unknown. This study evaluated the impact of operating room briefings on coordination of care and risk for wrong-site surgery. ⋯ OR briefings significantly reduce perceived risk for wrong-site surgery and improve perceived collaboration among OR personnel.
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There are few reproducible models of blast injury, so it is difficult to evaluate new or existing therapies. We developed a clinically relevant polytrauma model to test the hypothesis that cerebrovascular resuscitation is optimized when intravenous fluid is restricted. ⋯ After polytrauma and resuscitation to standard MAP and CPP targets with mannitol and pressor therapy, we concluded that intracranial hypertension was attenuated and brain oxygenation was maintained with intravenous fluid restriction; cerebrovascular resuscitation was optimized with Hextend versus NS; and longer term studies are needed to determine neuropathologic consequences.
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Randomized Controlled Trial
Preliminary report of a prospective, randomized trial of underwater seal for spontaneous and iatrogenic pneumothorax.
Management of pneumothorax has traditionally been tube thoracostomy and -20 cm H2O suction. The purpose of our study was to determine if underwater seal in iatrogenic and spontaneous pneumothoraces is safe and efficacious and if small-caliber chest tubes are appropriate for routine use in pneumothorax. ⋯ Early underwater seal appears to be safe for treating iatrogenic and spontaneous pneumothoraces. It can achieve comparable frequencies of early chest tube removal and avoidance of operation compared with traditional management. A larger, multi-institutional study should be performed to demonstrate that pneumothorax treatment can effectively incorporate small-caliber tubes and underwater seal.