Arch Surg Chicago
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To explore the risk of bleeding complications during percutaneous central venous catheterization in patients with coagulopathy, 40 liver transplant recipients underwent 259 percutaneous central venous catheterizations. Two hundred two catheterizations were performed in patients with coagulopathy, as evidenced by their prothrombin times, activated partial thromboplastin times, and/or platelet counts. Furthermore, no attempt was made to correct these episodes of coagulopathy with medications or infusion of blood products. No serious bleeding complications occurred during the 259 catheterizations, which suggests that experienced clinicians using appropriate techniques may safely perform central venous catheterization in patients with abnormal prothrombin times, activated partial thromboplastin times, and platelet counts.
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Historical Article
History and current status of scoring systems for critical care.
Scoring systems for quantifying critical illness and predicting outcome are being used increasingly for resource utilization analysis and quality assurance purposes. The history of the development of these systems, the rationale for their use, and the data elements and statistical methods involved in these systems were reviewed. ⋯ At the same time, there are limitations of such systems in the treatment of individual patients. While improvement and refinement of existing scoring systems is likely to occur with time, these limitations must be kept in mind.