J Trauma
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One hundred hemodynamically stable patients with penetrating abdominal trauma (65, stab wounds, 35, gunshot wounds) were evaluated with laparoscopy. Sixty percent of the patients had wounds in the thoracoabdominal area or the upper abdominal quadrants and 25% had injuries located in the lower abdomen and flanks. Fifteen percent had epigastric wounds. ⋯ The major role of laparoscopy in penetrating abdominal trauma is in avoiding unnecessary laparotomy in tangential SWs and GSWs. It is excellent for evaluating the diaphragm in thoracoabdominal wounds. Caution is urged in excluding hollow viscus injuries based on laparoscopy.
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Since the development of surgical critical care (SCC) as a discrete body of knowledge and its recognition by the American Board of Surgery (ABS), it has been beset by several controversies. One controversy is that the Residency Review Committee (RRC) for Surgery mandated that approved SCC training be 1 year long with no operative experience. A survey was conducted to determine the opinions and experiences on this controversy and others of 498 surgeons who regularly practice SCC. ⋯ Two thirds disagreed with the RRC's ban on operative experience during SCC fellowships and 71% believed that this prohibition limited the pool of surgical applicants to SCC programs. There were no significant differences in the responses between any of the major subgroups. Interestingly, 50% of the respondents who had completed RRC-approved SCC fellowships stated that their fellowship included operative experience.(ABSTRACT TRUNCATED AT 250 WORDS)
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Recent papers from established trauma centers reported average elapsed times from emergency department (ED) admission to the operating room (OR) of greater than 100 minutes for patients judged to be in immediate need of surgery. This study was undertaken to determine whether patients treated at an institution desiring level II trauma center designation in a geographic area with a low incidence of penetrating trauma suffered any adverse effects because of lack of a 24-hour in-house OR staff. Trauma registry data at The Stamford Hospital, a suburban community teaching hospital without OR nursing staff in-house at night, were reviewed and compared with data from three affiliated level I trauma centers and with established national standards using TRISS methodology. ⋯ No unexpected adverse outcomes could be ascribed to the lack of 24-hour OR staffing in this setting. The estimated cost of providing additional OR staffing is $145,000 per year. Since times to the OR and outcomes were similar to those at level I centers, this expense may not be warranted.
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This study examined the application of an artificial intelligence technique, the neural network (NET), in predicting probability of survival (Ps) for patients with penetrating trauma. A NET is a computer construct that can detect complex patterns within a data set. A NET must be "trained" by supplying a series of input patterns and the corresponding expected output (e.g., survival). ⋯ The increased sensitivity was statistically significant by Chi-square analysis. The NET for penetrating trauma provided a more sensitive but less specific technique for calculating Ps than did either TRISS or ASCOT. This translated into a 40% reduction in the number of deaths requiring review, and the potential for more efficient use of quality assurance resources.