The British journal of surgery
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Multicenter Study Clinical Trial
Diagnostic accuracy of surgeons and trainees in assessment of patients with acute abdominal pain.
Diagnostic accuracy in the assessment of patients with acute abdominal pain in the emergency ward is not adequate. It has been argued that this is because the investigations are carried out predominantly by a trainee. Resource utilization could be lowered if surgeons had a higher initial diagnostic accuracy. ⋯ The diagnostic accuracy of the initial clinical assessment is not improved when a surgeon rather than a surgical trainee assesses a patient with abdominal pain in the emergency department.
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Comparative Study
Comparison of a national early warning score in non-elective medical and surgical patients.
The National Early Warning Score (NEWS) is used to identify deteriorating patients in hospital. NEWS is a better discriminator of outcomes than other early warning scores in acute medical admissions, but it has not been evaluated in a surgical population. The study aims were to evaluate the ability of NEWS to discriminate cardiac arrest, death and unanticipated ICU admission in patients admitted to surgical specialties, and to compare the performance of NEWS in admissions to medical and surgical specialties. ⋯ NEWS discriminated deterioration in non-elective surgical patients at least as well as in non-elective medical patients.
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Chronic kidney disease is an important preoperative risk factor. However, the association between renal dysfunction and risk of death has not been well explored in non-cardiac surgery. ⋯ Renal dysfunction is an important risk factor for death after non-cardiac surgery and the risk increases steeply for patients with moderate to severe kidney dysfunction.
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Observational Study
Causes of excessive late death after trauma compared with a matched control cohort.
Studies on mortality following trauma have been restricted mainly to in-hospital or 30-day death. Mortality risk may be sustained several years after trauma, but the causes of late death have not been elucidated. The aim was to investigate mortality and analyse causes of late death after trauma. ⋯ Postinjury mortality is increased for several years after trauma. Excess mortality is largely attributed to recurrent trauma and other external causes of death.
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Alcohol and substance abuse, depression and suicide attempts after Roux-en-Y gastric bypass surgery.
Small studies suggest that subjects who have undergone bariatric surgery are at increased risk of suicide, alcohol and substance use disorders. This population-based cohort study aimed to assess the incidence of treatment for alcohol and substance use disorders, depression and attempted suicide after primary Roux-en-Y gastric bypass (RYGB). ⋯ Patients who have undergone RYGB are at an increased risk of being diagnosed with alcohol and substance use, with an increased rate of attempted suicide compared with a non-obese general population cohort.