Predictors of New Findings on Repeat Head CT Scan in Blunt Trauma Patients with an Initially Negative Head CT Scan
benefit; brain-injury; follow-up; intracranial injury; management; moderate; patients; serial computed-tomography; Surgery; utility
BACKGROUND: Our goal was to determine the need for a repeat head CT scan when the initial CT was negative. STUDY DESIGN: Data were collected from January 1, 2002 to December 31, 2008. There were 281 patients admitted to the trauma center with an initial negative head CT, who had a repeat CT during the same hospitalization. Repeat CTs were categorized into negative/negative (NNG) and negative/positive (NPG) groups. RESULTS: There were 281 patients who underwent a repeat head CT for changes in neurologic status, persistent symptoms, follow-up, decreased mental status, or suspected bleed. Of these, 241 patients remained negative (NNG) and new abnormal findings were noted in 40 patients (NPG). There were no differences in sex (NNG, 63% males vs NPG, 75% females; p = 0.14) or average age (NNG, 51.6 +/- 22.5 years vs NPG, 45.2 +/- 24.6 years; p = 0.07). There was no difference in positive toxicology (NNG, 29% vs NPG, 30%; p = 0.94) or mechanism of injury (NNG, 51% motor vehicle crash [MVC] vs NPG, 62% MVC; p = 0.18). There was a significant difference in Injury Severity Score (ISS) (NNG, 10.7 +/- 8.1 vs NPG, 17.9 +/- 11.0; p = 0.0002) and initial Glasgow Coma Scale (GCS) (NNG, 12.7 +/- 3.5 vs NPG, 10.9 +/- 4.2; p = 0.006). Patients with an ISS > 15 and who were intubated were associated with an increased odds of having a positive repeat CT scan (odds ratio [OR] 2.6; 95% CI 1.2, 5.5 and OR 3.5; 95% CI, 1.7, 7.3, respectively). CONCLUSIONS: Patients with a high ISS score and/or those who are intubated have significantly higher odds of having a positive repeat head CT when repeated for follow-up or when clinically warranted. (J Am Coll Surg 2012;214:965-972. (C) 2012 by the American College of Surgeons)
Muakkassa F F; Marley R A; Paranjape C; Horattas E; Salvator A; Muakkassa K
Journal of the American College of Surgeons
2012
2012-06
Journal Article
<a href="http://doi.org/10.1016/j.jamcollsurg.2012.02.004" target="_blank" rel="noreferrer noopener">10.1016/j.jamcollsurg.2012.02.004</a>
Appendicitis in the elderly: a change in the laparoscopic era.
*Laparoscopy; 80 and over; Aged; Appendectomy/*methods; Appendicitis/diagnostic imaging/mortality/*surgery; Female; Humans; Length of Stay; Male; Middle Aged; Minimally Invasive Surgical Procedures; Retrospective Studies; Tomography; Treatment Outcome; X-Ray Computed
BACKGROUND: Appendicitis in elderly patients is associated with significant morbidity and mortality. Early and correct diagnosis together with minimally invasive surgery can lead to more favorable outcomes than occurred in the prelaparoscopic era. METHODS: A retrospective review of 116 elderly patients (age \textgreater 60) from 1999 to 2004 is compared with the authors' previously published studies from 1978 to 1988 (n = 96) and from 1988 to 1998 (n = 113), respectively. RESULTS: In our current series (1999-2004), more cases were managed laparoscopically (n = 68) than with open surgery (n = 48). Perforated appendicitis cases resulted in significantly longer hospital stays, more complications, and longer operating time than nonperforated cases. The laparoscopic cases had significantly shorter lengths of hospital stay and fewer complications than open cases, and comparable operating times. As compared with our previous studies from 1978 to 1988) and from 1988 to 1998, the current series (1999-2004) consists of patients presenting with fewer classical symptoms. Computed tomography (CT) scanning was more accurate in the current study and more routinely used. The patients in the current series had more correct preoperative diagnoses. Perforated appendicitis was encountered less frequently and associated with fewer complications. The 4% mortality rate in the previous two series decreased to less than 1% in this series. CONCLUSION: Minimally invasive surgery combined with increased use and accuracy of preoperative CT scans has changed the clinical management of acute appendicitis in elderly patients, leading to decreased lengths of stay, decreased mortality, and more favorable outcomes.
Paranjape C; Dalia S; Pan J; Horattas M
Surgical endoscopy
2007
2007-05
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<a href="http://doi.org/10.1007/s00464-006-9097-4" target="_blank" rel="noreferrer noopener">10.1007/s00464-006-9097-4</a>