American journal of surgery
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Comparative Study
Rib fractures: comparison of associated injuries between pediatric and adult population.
Rib fractures are considered a marker of exposure to significant traumatic energy. In children, because of high elasticity of the chest wall, higher energy levels are necessary for ribs to fracture. The purpose of this study was to analyze patterns of associated injuries in children as compared with adults, all of whom presented with rib fractures. ⋯ The incidence of associated head, thoracic, and abdominal solid organ injuries in children was significantly higher than in adults suffering from rib fractures. In spite of a higher Injury Severity Score and incidence of associated injuries, mortality rate was similar. Mortality of rib fracture patients was mostly affected by the presence of extrathoracic injuries.
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Current practices suggest that patients with mild traumatic brain injuries (MTBI) receive neurosurgical consultations, while less than 1% require neurosurgical intervention. We implemented a policy of selective neurosurgical consultation with the hypothesis that trauma surgeons alone may manage such patients with no impact on patient outcomes. ⋯ Implementation of a selective neurosurgical consultation policy for patients with MTBI reduced neurosurgical consultations without any impact on patient outcomes, suggesting that trauma surgeons can effectively manage these patients.
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Comparative Study
Incidence of overall complications and symptomatic tracheal stenosis is equivalent following open and percutaneous tracheostomy in the trauma patient.
While percutaneous tracheostomy (PT) is becoming the procedure of choice for elective tracheostomy, there is little late complication data. This study compared incidence of, and factors contributing to, tracheal stenosis following PT or open tracheostomy (OT). ⋯ Risk of tracheal stenosis should not impact the decision to perform an OT or PT.
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Historical Article
A historical review of classic articles in surgery field.
Surgery is one of the most rapidly developing specialties in the past century. Diagnostic methods, operation technique, and knowledge of the diseases are changing continuously. In the academic history, lots of classic papers brought advances for surgery. They were accepted and cited numerously by the medical specialists all over the world. Citation analysis reflects the recognition a work has received in the scientific community by its peers. ⋯ Totally 36 articles have been cited at least 1,000 times since their publication to the year 2011. According to their citation histories, 35 articles were further evaluated. These topmost articles covered 8 subspecialties of surgery and were published in 17 journals. The publication year varied from 1940 to 1999 and the articles provided different level of evidence, most of which are retrospective studies of case series. Six articles were research articles including animal model, histology analysis, and laboratory research. The others were clinical articles. From the results of citation analysis, the classic articles are not always in top citations. In addition, some of these articles have no citations after several years post their publication. The introduction of a commonly used classification or scoring system is a major factor in propelling citation by other authors. The most cited articles in surgery present their long academic life in spite of their level of evidence and journal impact factor in which they were published.