Emergency general surgery in pregnancy

It is often that the acute care surgeon will be called on to evaluate the pregnant patient with abdominal pain. Most of the diagnostic and management decisions regarding pregnant patients will follow the usual tenets of surgery; however, there are important differences in the pregnant patient to be aware of to avoid pitfalls which can lead to complications for both mother and fetus. This review hopes to describe the most common emergencies facing the surgeon caring for the pregnant patient and the latest management options

Self-inflicted Injuries Racial-Based Differences in Substance Abuse and in Potential Years of Life Lost

Background and Methods: Suicide is a leading cause of death in the US. Substance abuse is a known risk factor for suicide. The exact correlation between substance abuse and suicide is unknown. In addition, the potential years of life lost due to suicide is unknown. A 10-year review (2007-2016) of self-inflicted injury individuals in the National Trauma Data Bank (NTDB) is performed. Pearson Chi-square statistical test is utilized for the analysis. Results: Our results also indicate that those tested positive for substance abuse have a higher Hospital Discharge Disposition death rate compared to those who were tested negative, 56.79\% who died were tested positive. We also found that Years of Potential Life Lost (YPLL) from suicide is 224603 for Whites, 31156 for Blacks, 3054 for Native Americans, 5474 for Asians, 38758 for Hispanics, 106806 for ‘Unknown’, and 6594 for others. The most common methods of suicide are Cut/Pierce (40.56%), Firearm (31.26%), and Fall (10.50%), and the remaining percentage for other means of suicide; this is strongly associated with substance abuse (p-value\u3c .001). Those who committed suicide by Cut/Pierce 61.81% of them were drug tested positive, by Firearm 61.24%, and by Fall 60.44%. Our results also indicate that death rate related to illicit drug is slightly higher than prescription drug. Among the self-inflicted injury in the sample of size 44683, 52.64% percentage of them are tested positive of illicit substance usage and the remaining are tested negative. And also, those with severe traumatic brain injury, 51.98% are tested positive of illicit substance use. By race group, the distribution of illegal use of drug is as follow: 59.06\% of self-inflicted injuries Blacks are tested positive for illicit drug, 50.22% for self-inflicted injuries Whites and 55.24% for self-inflicted injuries Hispanics. Conclusions: This paper provides a succinct overview of substance abuse (illicit and prescribed) and by race groups using trauma database. The paper also highlights some potential years of life loss due to self-inflicted injuries. In addition, the paper points out the distribution of methods of suicide

Outcomes After Rib Fracture in Elderly Patient Due To Blunt Trauma At Doctors Renaissance Hospital

Background: Blunt trauma remains the most common traumatic reason for presentation at a hospital. Despite their frequency, there remains high morbidity and mortality. This is particularly true amongst the elderly. About 16.5 percent of the American population was 65 years old or over in 2019. This number is projected to reach 22 percent in 2050. Some clinical guidelines requiring admission to an intensive care setting in trauma centers for elderly patients with two or more rib fractures have been adopted by some trauma centers. Usage of these guidelines may lead to significant decreases in hospital stats, ICU stats, and use of mechanical ventilation. However, the effectiveness of these guidelines has not been validated across different institutions. Hence, in our study we sought to determine the mortality rate of elderly patients with ribs fracture compared to patients \u3c 65 years of age at Doctor Renaissance Hospital (Level I trauma center). We also investigated the relationship between the side of injury, the need for mechanical ventilation, ICU length of stay, and overall length of hospital stay. Methods: We performed a retrospective cohort study involving all blunt trauma patients between 18 – 100 years with rib fractures, excluding those with major vascular injuries or those needing emergent surgery due to other injuries. Patients admitted to Doctor renaissance Hospital (Level I trauma) between 2017 – 2020 were divided into two groups. The experimental group consisted of 58 patients aged 65 years or older. The control group was made of 75 patients aged \u3c 65 years old admitted during the same time. (table 1) Outcomes parameters included pulmonary complications (such as pneumonia or respiratory failure), number of ventilator days, intensive care unit length and hospital stay, disposition, and mortality. Results: In the experimental group, 58 patients were identified. These patients were divided into four groups: those with right-sided rib fractures, left-sided rib fractures, and unspecified and bilateral rib fractures. The overall mortality was 1.72 % compared to 4 % in the control group (p \u3c 0.05). Patients with right-sided rib fractures had a median hospital length of stay of 4 days vs. 6 days in the control group (p \u3c 0.05) (figure 2). We found no difference in the number of days spent in ICU between the control and experimental group with right-sided rib fractures. Patients with left-sided rib fractures had a similar median hospital length of stay compared to the control group. We noted no difference between the number of days spent in the ICU or ventilator days between these patients (figure 2). Furthermore, patients with bilateral rib fractures had a median hospital stay of 8 days compared to 13 days in the control group (p \u3c 0.05) (figure 2). Also, patients in the control group with bilateral rib fractures had a median ICU stay of 3 days and median ventilator use of 2 days compared to 0 days (p \u3c 0.05) in the experimental group (table 2). Lastly, patients 65 and older with unspecified multiple rib fractures had a median length of stay of 3.5 days compared to 1.5 days in the control group (p \u3c 0.05). The median length of stay in ICU and ventilator use was 1 day longer in the control group than the experimental group. Conclusion: Elderly patients with more than 2 rib fractures admitted at Doctor hospital renaissance between 2017-2020 had better outcomes than patients younger than 65 admitted during the same period

Hearing hoofbeats? Think head and neck trauma: a 10-year NTDB analysis of equestrian-related trauma in the USA

Objective There is a paucity of evidence about traumatic injuries and their sequelae sustained due to equestrian injuries nationally. Methods Retrospective study analyzing National Trauma Data Bank data from 2007 to 2016. Variables collected included age, sex, race, payer status, Injury Severity Score (ISS), hospital length of stay, Glasgow Coma Scale, systolic blood pressure (SBP) at presentation, discharge disposition, and mortality. Patient data were analyzed by anatomic region. Results The most frequent type of injury was in the thorax, but head and neck injuries produced the highest mortality. Increased ISS and an SBP of less than 90 mm Hg were also significant predictors of mortality. Conclusions The risk of hospital admission from equestrian injuries is higher than football, motor vehicle racing, and skiing. Preventive measures and campaigns should be instituted to highlight safety practices and the use of personal protective equipment while on horseback either for sports, leisure, or work

Detecting Invasive Fungal Disease in Surgical Patients: Utility of the (1 3)- b-d-Glucan Assay

Background: The specificity and sensitivity of the (1 3)-b-d-glucan (BDG) assay in surgical patients needs further investigation. We hypothesized that the BDG assay would have lower sensitivity/specificity compared with that of medical patients. Methods: We reviewed patients who had undergone laparotomy, gastrectomy, hepatectomy, or colectomy and had a BDG assay post-operatively. Results: A total of 71 patients met study criteria. There were 29 (40.8%) who had proven/probable invasive fungal infection. Sensitivity for BDG level ‡80 diagnosed within one week of the assay draw was 77.3% (95% confidence interval [CI], 54.6–92.2%), and specificity was 44.9% (95% CI, 30.7–59.8). The positive predictive value was 38.6% (95% CI, 31.0–46.9%), and negative predictive value was 82.5% (95% CI, 65.7–91.0%). A BDG assay result of 149 pg/mL had a classification rate of 63.4%. Therefore, a BDG assay result ‡150 pg/mL has a sensitivity of 78.6% and a specificity of 41.4%. Conclusion: A BDG assay can be useful for ruling out invasive fungemia in post-operative patients

Association of Insurance Status with Health Outcomes Following Traumatic Injury: Statewide Multicenter Analysis

Introduction: Recognizing disparities in definitive care for traumatic injuries created by insurance status may help reduce the higher risk of trauma-related mortality in this population. Our objective was to understand the relationship between patients\u27 insurance status and trauma outcomes. Methods: We collected data on all patients involved in traumatic injury from eight Level I and 15 Level IV trauma centers, and four non-designated hospitals through Arizona State Trauma Registry between January 1, 2008 and December 31, 2011. Of 109,497 records queried, we excluded 29,062 (26.5%) due to missing data on primary payer, sex, race, zip code of residence, injury severity score (ISS), and alcohol or drug use. Of the 80,435 cases analyzed, 13.3% were self-pay, 38.8% were Medicaid, 13% were Medicare, and 35% were private insurance. We evaluated the association between survival and insurance status (private insurance, Medicare, Medicaid, and self-pay) using multiple logistic regression analyses after adjusting for race/ethnicity (White, Black/African American, Hispanic, and American Indian/Alaska Native), age, gender, income, ISS and injury type (penetrating or blunt). Results: The self-pay group was more likely to suffer from penetrating trauma (18.2%) than the privately insured group (6.0%), p\u3c0.0001. There were more non-White (53%) self-pay patients compared to the private insurance group (28.3%), p\u3c0.0001. Additionally, the self-pay group had significantly higher mortality (4.3%) as compared to private insurance (1.9%), p\u3c0.0001. A simple logistic regression revealed higher mortality for self-pay patients (crude OR= 2.32, 95% CI [2.07-2.67]) as well as Medicare patients (crude OR= 2.35, 95% CI [2.54-3.24]) as compared to private insurance. After adjusting for confounding, a multiple logistic regression revealed that mortality was highest for self-pay patients as compared to private insurance (adjusted OR= 2.76, 95% CI [2.30-3.32]). Conclusion: These results demonstrate that after controlling for confounding variables, self-pay patients had a significantly higher risk of mortality following a traumatic injury as compared to any other insurance-type groups. Further research is warranted to understand this finding and possibly decrease the mortality rate in this population

Search for dark matter produced in association with bottom or top quarks in √s = 13 TeV pp collisions with the ATLAS detector

A search for weakly interacting massive particle dark matter produced in association with bottom or top quarks is presented. Final states containing third-generation quarks and miss- ing transverse momentum are considered. The analysis uses 36.1 fb−1 of proton–proton collision data recorded by the ATLAS experiment at √s = 13 TeV in 2015 and 2016. No significant excess of events above the estimated backgrounds is observed. The results are in- terpreted in the framework of simplified models of spin-0 dark-matter mediators. For colour- neutral spin-0 mediators produced in association with top quarks and decaying into a pair of dark-matter particles, mediator masses below 50 GeV are excluded assuming a dark-matter candidate mass of 1 GeV and unitary couplings. For scalar and pseudoscalar mediators produced in association with bottom quarks, the search sets limits on the production cross- section of 300 times the predicted rate for mediators with masses between 10 and 50 GeV and assuming a dark-matter mass of 1 GeV and unitary coupling. Constraints on colour- charged scalar simplified models are also presented. Assuming a dark-matter particle mass of 35 GeV, mediator particles with mass below 1.1 TeV are excluded for couplings yielding a dark-matter relic density consistent with measurements