Archives of surgery (Chicago, Ill. : 1960)
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To systematically review the literature on quality indicators (QIs) for evaluating trauma care, identify QIs, map their definitions, and examine the evidence base in support of the QIs. ⋯ Many QIs for evaluating the quality of trauma care have been proposed, but the evidence to support these indicators is not strong. Practical recommendations to select QIs to measure the quality of trauma care will require systematic reviews of identified candidate indicators and empirical studies to fill the knowledge gaps for postacute QIs.
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Surgical and anesthetic care is increasingly recognized as a neglected but cost-effective component of primary health care in low- and middle-income countries (LMICs). Strengthening delivery can help achieve Millennium Development Goals 4, 5, and 6. Large gaps in access to essential surgical care in LMICs result in considerable morbidity and mortality. The goal of this study was to provide a baseline overview of essential surgical and anesthetic capacity at district-level health facilities in multiple LMICs. ⋯ Enormous shortfalls in infrastructure, supplies, and procedures undertaken are common at district-level health facilities in LMICs.
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To examine racial/ethnic differences in the use of high-volume hospitals and surgeons for 10 surgical procedures with documented associations between volume and mortality. ⋯ Minority patients in New York City are doubly disadvantaged in their surgical care; they are substantially less likely to use both high-volume hospitals and surgeons for procedures with an established volume-mortality association. Better information is needed about which providers minority patients have access to and how they select them.
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Review Comparative Study
Conversion of emergent cricothyrotomy to tracheotomy in trauma patients.
To review the literature to determine the rates of airway stenosis after cricothyrotomy, particularly as they compare with previously documented rates of this complication after tracheotomy, and to examine the complications associated with conversion. ⋯ Cricothyrotomy after trauma is safe for initial airway access among patients who require the establishment of an emergent airway. The prolonged use of a cricothyrotomy tube, however, remains controversial. Although no study to date has demonstrated any benefit of routine conversion to tracheostomy, considerable deficiencies in existing studies highlight the need for further investigations of this practice.