Journal of the American College of Surgeons
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Cirrhosis as an independent predictor of poor outcomes in trauma patients was identified in 1990. We hypothesized that the degree of preinjury hepatic dysfunction is, by itself, an independent predictor of mortality. ⋯ The mortality rate for class C cirrhotic patients posttrauma continues to be higher than that predicted by TRISS, although patients with less severe hepatic dysfunction do not appear to have significantly lower than predicted survival. The degree of hepatic dysfunction remains an independent predictor of mortality and CTP C criteria must be considered when determining outcomes for patients posttrauma.
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Sixteen-slice CT angiography in patients with suspected blunt carotid and vertebral artery injuries.
We sought to determine whether 16-slice multidetector CT angiography (CTA) has sufficient negative predictive value for use as the initial imaging examination for patients with suspected blunt carotid and vertebral artery injury (BCVI) and to estimate the positive predictive value of different screening criteria in assessing BCVI. ⋯ Multidetector CTA misses relatively few injuries and adequately supplants DSA as a screening study in patients with risk factors for BCVI. Radiologists should maintain a high degree of suspicion in patients who meet screening criteria. Optimal imaging strategies should focus on the most predictive criteria.
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Because higher hospital procedure volume is associated with better outcomes for many high-risk procedures, regionalization to higher-volume hospitals has been proposed as a way to improve quality of surgical care. The potential impact of such policies on small rural hospital volume and revenue is unknown. ⋯ If all aortic aneurysm repairs, major cardiothoracic procedures, carotid endarterectomies, cystectomies, and pancreatectomies in New York State were regionalized to higher-volume hospitals, no small rural hospitals would experience substantial impact in terms of rural hospital procedure volume and revenue. Even regionalization of colectomy would have a small impact on inpatient volume and revenue.