Are we doing too many non-therapeutic laparotomies in trauma? An analysis of the National Trauma Data Bank

AbstractBackgroundExploratory laparotomy (EL) has been the definitive diagnostic and therapeutic modality for operative abdominal trauma in the US. Recently, many trauma centers have started using diagnostic laparoscopy (DL) in stable trauma patients in an effort to reduce the incidence of non-therapeutic laparotomy (NL). We aim to evaluate the incidence of NL in the trauma population in the US and compare the outcomes between DL and NL.MethodsUsing ICD-9 codes, the National Trauma Data Bank (2010 –2015) was queried for patients undergoing any abdominal surgical intervention. Patients were divided into two groups: diagnostic laparoscopy (DL) and exploratory laparotomy (EL). Hemodynamically unstable patients on arrival and patients with abbreviated injury score (AIS) >  3 were excluded. Patients in EL group without any codes for gastrointestinal, diaphragmatic, hepatic, splenic, vascular, or urological procedures were considered to have undergone NL. After excluding patients who were converted to open from the DL group, multivariate regression models were used t o analyze the outcomes of DL vs NL group with respect to mortality, length of stay, and complications.ResultsA total of 3197 patients underwent NL vs 1323 patients who underwent DL. Compared to DL group, the NL group were older (mean age: 35 vs. 31,P 
Source: Surgical Endoscopy - Category: Surgery Source Type: research

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Authors: Tosoni A, Paratore M, Piscitelli P, Addolorato G, De Cosmo S, Mirijello A, Internal Medicine Sepsis Study Group Abstract Procalcitonin (PCT) is a circulating polypeptide produced in response to bacterial infections. Studies conducted in the Intensive Care Unit (ICU) setting have demonstrated its utility as a biomarker of bacterial infection and sepsis. Thus, PCT is widely used to distinguish between sepsis and SIRS, and to guide antibiotic therapy. At present sepsis represents a frequent diagnosis among patients admitted to Internal Medicine (IM) departments. Basing on the knowledge derived from ICU studie...
Source: Panminerva Medica - Category: General Medicine Tags: Panminerva Med Source Type: research
ConclusionOur study indicates RA-ILD among Blacks is predominantly a disease of elderly females with higher rates of GERD and CVD risk factors. Further studies are needed to identify the pathogenetic differences accounting for the gender distribution of RA-ILD among Black and White populations.Key Points•First study to assess ILD among predominantly Black RA patients.•The prevalence of RA-associated ILD was 6.36%, affecting mostly women in their sixth decade with seropositive disease.•COPD was the most common airway disease among non-RA-ILD Black population.•GERD was found in approximately one-third of ...
Source: Clinical Rheumatology - Category: Rheumatology Source Type: research
Publication date: Available online 16 November 2019Source: The Brazilian Journal of Infectious DiseasesAuthor(s): Renan Barros Domingues, Márcio Vega dos Santos, Fernando Brunale Vilela de Moura Leite, Carlos SenneAbstractThe precise diagnosis of bacterial meningitis is essential. Cytological and biochemical examination of cerebrospinal fluid (CSF) are not specific. Conventional methods for bacterial meningitis lack sensitivity or take too long for a final result. Therefore, other methods for rapid and accurate diagnosis of central nervous system infections are required. FilmArray meningitis/encephalitis (ME) panel ...
Source: The Brazilian Journal of Infectious Diseases - Category: Infectious Diseases Source Type: research
Conclusions: A low preoperative TFdi,max can help to identify patients at increased risk of postoperative pulmonary complications after cardiac surgery.
Source: Critical Care Medicine - Category: Emergency Medicine Tags: Online Clinical Investigations Source Type: research
Publication date: Available online 14 November 2019Source: The LancetAuthor(s): Michel Attal, Paul G Richardson, S Vincent Rajkumar, Jesus San-Miguel, Meral Beksac, Ivan Spicka, Xavier Leleu, Fredrik Schjesvold, Philippe Moreau, Meletios A Dimopoulos, Jeffrey Shang-Yi Huang, Jiri Minarik, Michele Cavo, H Miles Prince, Sandrine Macé, Kathryn P Corzo, Frank Campana, Solenn Le-Guennec, Franck Dubin, Kenneth C AndersonSummaryBackgroundIsatuximab is a monoclonal antibody that binds a specific epitope on the human CD38 receptor and has antitumour activity via multiple mechanisms of action. In a previous phase 1b study, ar...
Source: The Lancet - Category: General Medicine Source Type: research
ConclusionBoth neurologic and medical complications were common in majority of stroke patients. But the management protocol for stroke patients was sub-optimal and lagging behind the recommended guidelines due to lack of skilled personnel, appropriate treatment and diagnostic agents. The clinical team involved in the care of stroke patients should make preparations to take preventive measures that will save a lot of lives.
Source: Annals of Medicine and Surgery - Category: General Medicine Source Type: research
ConclusionsSingle administration or multiple administration does not affect SC and CLCVVH. Owing to therapeutic vancomycin levels is difficult to maintain in severe pneumonia patients who are receiving IV vancomycin therapy while on CVVH, close monitoring of serum trough concentrations is required.
Source: European Journal of Clinical Pharmacology - Category: Drugs & Pharmacology Source Type: research
AbstractNo studies evaluating the association between statins and outcomes of patients with seasonal influenza have been performed since the 2007 –2008 and the 2009 pandemic H1N1 influenza seasons. All consecutive hospitalized patients between October 2017 and April 2018, diagnosed with laboratory-confirmed influenza A and B virus, were included. Patients were divided into two groups: statin and non-statin users. Outcomes were 30- and 90-da y mortality, complications (pneumonia, myocarditis, encephalitis, intensive care unit (ICU) transfer, mechanical ventilation, vasopressor support), length of hospital stay, and re...
Source: European Journal of Clinical Microbiology and Infectious Diseases - Category: Microbiology Source Type: research
Proton-pump inhibitor (PPI) use is not associated with an increased risk of dementia, pneumonia or intestinal infections, and an association with chronic kidney disease (CKD) was likely due to residual confounding, new research suggests.Reuters Health Information
Source: Medscape Critical Care Headlines - Category: Intensive Care Tags: Gastroenterology News Source Type: news
To evaluate clinical outcomes after either immediate or deferred initiation of antiretroviral therapy in HIV-1-infected patients, presenting late with pneumocystis pneumonia (PCP) or toxoplasma encephalitis (TE).
Source: AIDS Research and Therapy - Category: Infectious Diseases Authors: Tags: Research Source Type: research
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