Pan computed tomography versus selective computed tomography in stable, young adults after blunt trauma with moderate mechanism: a cost-utility analysis.

Background: Pan computed tomography (PCT) of the head, cervical spine, chest, abdomen, and pelvis is a valuable approach for rapid evaluation of severely injured blunt trauma patients. A PCT strategy has also been applied for the evaluation of patients with lower injury severity; however, the cost-utility of this approach is undetermined. The advantage of rapidly identifying all injuries via PCT must be weighed against the risk of radiation-induced cancer (RIC).

Routine prophylactic central neck dissection for low-risk papillary thyroid cancer is not cost-effective.

Background: The role of routine prophylactic central neck dissection (CND) in papillary thyroid cancer (PTC) remains controversial. The aim of this study was to evaluate the cost utility of the addition of routine CND in patients with low-risk PTC compared with total thyroidectomy (TT) alone.

Methods: A Markov model for low-risk PTC was constructed with a treatment algorithm based on the American Thyroid Association guidelines for well-differentiated thyroid carcinoma.

Impact of location on outcome after penetrating colon injuries.

Background: Most studies examining suture line failure after penetrating colon injuries have focused on right- versus left-sided injuries. In our institution, operative decisions (resection plus anastomosis vs. diversion) are based on a defined management algorithm regardless of injury location.

Routine screening for methicillin-resistant Staphylococcus aureus.

Background: The prevalence of asymptomatic carriers of methicillin-resistant Staphylococcus aureus (MRSA) in the general population is increasing and now is estimated to be 5%-10%. Although the overall prevalence of MRSA infections in hospitals may be decreasing, it remains important, as asymptomatic carriers are at risk for infections of the skin and soft tissues, including surgical site infections (SSIs). Given the morbidity and cost of such infections, it has been hypothesized that identification of the carrier state, and subsequent eradication, will decrease the risk of MRSA infection.

Use of computed tomography in the emergency room to evaluate blunt cerebrovascular injury.

BCVI remains a potentially devastating consequence of blunt-force trauma. However, over the past decades significant advances have been made in understanding the pathophysiology, risk factors, and natural history of BCVI. Given the initial asymptomatic period, there is time to diagnose and treat these lesions before the onset of neurologic insult.

Use of the clinical pulmonary infection score to guide therapy for ventilator-associated pneumonia risks antibiotic overexposure in patients with trauma.

Background: The clinical pulmonary infection score (CPIS) has been advocated to guide both the diagnosis and duration of therapy in ventilator-associated pneumonia (VAP). However, the clinical, physiologic, and radiologic components of the CPIS may be difficult to differentiate from the systemic effects of injury and inflammation, unnecessarily prolonging VAP therapy. This study evaluates the use of CPIS in determining the appropriate duration of antimicrobial therapy for VAP in patients with critical illness and trauma.

Adherence to a simplified management algorithm reduces morbidity and mortality after penetrating colon injuries: a 15-year experience.

Background: Our previous experience with colon injuries suggested that operative decisions based on a defined algorithm improve outcomes. The purpose of this study was to evaluate the validity of this algorithm in the face of an increased incidence of destructive injuries observed in recent years.

Study Design: Consecutive patients with full-thickness penetrating colon injuries over an 8-year period were evaluated.

Observation for nonoperative management of blunt liver injuries: how long is long enough?

Background: Nonoperative management (NOM) of blunt liver injury is the standard of care in hemodynamically stable patients. However, there are no data regarding the optimum length of inpatient observation. The purpose of this study is to review NOM guidelines for patient safety and optimal length of stay (LOS).

Update on imaging for acute appendicitis.

Acute appendicitis is a common surgical emergency and the diagnosis can often be made clinically; however, many patients present with atypical findings. For these patients, there are multiple imaging modalities available to aid in the diagnosis of suspected appendicitis in an effort to avoid a negative appendectomy. Computed tomography is the test of choice in most patients in whom the diagnosis is not certain.