The Journal of surgical research
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An appendicolith-related appendiceal obstruction leading to appendicitis is a commonly encountered surgical emergency that has clear evidence-based management plans. However, there is no consensus on management of asymptomatic patients when appendicoliths are found incidentally. The objective of this study was to determine the risk of appendicitis in patients with an incidental finding of the appendicolith. ⋯ Patients with incidentally discovered appendicolith on radiological imaging did not develop appendicitis. Hence, the risk of developing acute appendicitis for these patients does not seem higher than the general population.
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The most recent management guidelines advocate computed tomography angiography (CTA) for any suspected vascular or aero-digestive injuries in all zones and give zone II injuries special consideration. We hypothesized that physical examination can safely guide CTA use in a "no zone" approach. ⋯ Physical examination regardless of the zone of injury should be the primary guide to CTA or TNE in patients with PNT. Following traditional zone-based guidelines can result in unnecessary negative explorations in patients with soft signs and may need rethinking.
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Comparative Study
Weaker gun state laws are associated with higher rates of suicide secondary to firearms.
Firearm-related suicides comprise over two-thirds of gun-related violence in the United States, and gun laws and policies remain under scrutiny, with many advocating for revision of the regulatory map for lawful gun ownership, aiming at restricting access and distribution of these weapons. However, the quantitative relationship between how strict gun laws are and the incidence of firearm violence with their associated mortality is largely unknown. We therefore, sought to explore the impact of firearm law patterns among states on the incidence and outcomes of firearm-related suicide attempts, utilizing established objective criteria. ⋯ Trauma Outcomes study.
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Global disparities in trauma care contribute to significant morbidity and mortality (M&M) in low- and middle-income countries. Implementation of quality improvement (QI) programs has been shown to be a cost-effective strategy to improve trauma care quality. In this study, we aim to characterize the trauma QI programs in a broad range of low- to high-income countries in the Americas to assess areas for targeted improvement in global trauma QI efforts. ⋯ This survey demonstrated an encouraging pattern of widespread adoption of trauma QI programs in several countries in North and South America. However, there continue to be significant disparities in the structure and function of trauma QI efforts in low- and middle-income countries in the Americas. There are several potential areas for development and improvement of trauma care systems, including standardization of case selection and follow-up for M&M conferences and increased use of medical literature to improve evidence-based care.
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Massive transfusion (MT) is frequently required during liver transplantation. Risk stratification of transplant patients at risk for MT is an appealing concept but remains poorly developed. Thrombelastography (TEG) has recently been shown to reduce mortality when used for trauma resuscitation. We hypothesize that preoperative TEG can be used to risk stratify patients for MT. ⋯ TEG MA has a high predictability of MT during liver transplantation. The use of TEG preoperatively may help guide more cost effective blood bank preparation for this procedure as only a third of patients required a MT.