The British journal of surgery
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The management of 405 patients presenting with head injury to an accident and emergency department was assessed. Sixty-nine patients were admitted, although this number should have been 127 according to current guidelines on the management of head injury. Only three attenders were admitted inappropriately according to these guidelines. ⋯ When closed, only 15 of the 51 patients (29 per cent) with these criteria were admitted. Guidelines were applied effectively to reduce the number of unnecessary admissions, but there was a significant number of patients with minor head injury who were discharged inappropriately. This number was much reduced when an observation ward was available.
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The reliable prediction of imminent limb death remains a clinical problem. The International Vascular Symposium and European working parties each produced similar definitions of 'critical ischaemia', but this is the first attempt to address the issue with prospectively collected data. Complete 3-year follow-up data were available for 213 patients. ⋯ None of the definitions reliably predicted which grafts would occlude, in which event the 3-year mortality rate was approximately 35 per cent. Critical ischaemia by any of these definitions is associated with a high mortality rate. Arterial reconstruction is associated with a reduction in both mortality and amputation rates These data do not support the hypothesis that critical ischaemia is associated with a greater graft occlusion rate than lesser degrees of severe ischaemia.