Abstract：
BACKGROUND:Despite the development of several prediction rules to guide head CT imaging, determining whom to screen for head trauma in the geriatric population after a ground level fall remains controversial. The purpose of this study was to assess the impact of head CT on the management of older adult patients who present with a normal GCS after a ground level fall, and to identify factors that could predict the need for neurosurgical intervention. METHODS:A retrospective study was conducted on hemodynamically stable patients >55 years of age with GCS of 15, who presented to a level 1 trauma center after a ground level fall. Radiological reads of head CT scans were reviewed for new findings and clinical documentation was analyzed for evidence of a change in management. Univariate analysis of key demographic and clinical factors was performed to probe for statistically significant differences between patients receiving medical management versus surgical management. RESULTS:Of 437 patients receiving head CTs, 146 (33.4%) had a positive finding. 95 (21.7%) patients had a change in management; 76 (17.4%) were medication changes and 19 (4.3%) required neurosurgical intervention. Age 85 years and older, and having a neurologic deficit on initial physical examination were found to be significantly associated with the need for neurosurgery. CONCLUSION:The results of this study confirm that head CT findings often alter clinical management of elderly patients presenting with a GCS of 15 after ground level falls, and should be a part of standard evaluation.
journal_name
Am J Surgjournal_title
American journal of surgeryauthors
Sartin R,Kim C,Dissanaike Sdoi
10.1016/j.amjsurg.2017.07.038subject
Has Abstractpub_date
2017-12-01 00:00:00pages
1055-1058issue
6eissn
0002-9610issn
1879-1883pii
S0002-9610(17)30474-9journal_volume
214pub_type
杂志文章abstract：:The lower esophageal high pressure zone (HPZ) was characterized manometrically and reflux status determined in eight male rhesus monkeys. The studies were repeated six weeks and six months after 50 per cent distal small bowel resection. At the same time fasting serum gastrin and gastric inhibitory polypeptide values w...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(77)90002-2
更新日期：1977-05-01 00:00:00
abstract：:Patients with cirrhosis and esophagogastric varices have a 25% to 33% risk of initial variceal bleeding, a risk of up to 70% for recurrent variceal bleeding, and an associated mortality of up to 50%. Based on a review of prospective randomized trials, control of acute variceal bleeding should involve vasopressin plus ...
journal_title：American journal of surgery
pub_type： 杂志文章,评审
doi：10.1016/s0002-9610(05)80864-5
更新日期：1990-07-01 00:00:00
abstract：:Eighty-two femoropopliteal reconstructions were performed on sixty-six consecutive patients. Of seventeen late failures, thirteen were secondarily reconstructed. Clinical and angiographic studies demonstrated the reasons for failure in all patients except one. Seven patients were improved and six unimproved by reopera...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(78)90107-1
更新日期：1978-02-01 00:00:00
abstract：:A new surgical approach is proposed for patients with coarctation of the aorta associated with severe aortic valvular insufficiency. The valvular lesion should be repaired first and the coarctation corrected during a second operation; both interventions should be done during the same hospital stay. We base our approac...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(77)90424-x
更新日期：1977-09-01 00:00:00
abstract：BACKGROUND:Tracheostomal recurrence after total laryngectomy for laryngeal carcinoma has a poor prognosis. The independent risk factors of tracheostomal recurrence are, however, not well documented. METHODS:This is a multivariate analysis of the risk factors of tracheostomal recurrence after total laryngectomy for 322...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/S0002-9610(96)00162-6
更新日期：1996-09-01 00:00:00
abstract：:Mesenteric vascular disease continues to be associated with an extremely high mortality. It is not necessarily a disease of old age: 20 of the 75 patients in our series were less than 60 years of age. In retrospect, earlier diagnosis and a more aggressive approach could have improved the survival rate of 17.3 percent....
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(80)90251-2
更新日期：1980-02-01 00:00:00
abstract：OBJECTIVE:The purpose of this study was to determine if the distance from the skin to the seroma cavity, as measured with ultrasound (US) before catheter placement, correlated with the distance from skin to MammoSite balloon catheter as measured on computerized axial tomography (CAT) after catheter placement. METHODS:...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2007.11.012
更新日期：2008-08-01 00:00:00
abstract：:This study prospectively compared the following tests for their accuracy in amputation level selection: transcutaneous oxygen, transcutaneous carbon dioxide, transcutaneous oxygen-to-transcutaneous carbon dioxide, foot-to-chest transcutaneous oxygen, intradermal xenon-133, ankle-brachial index, and absolute popliteal ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(87)90174-7
更新日期：1987-08-01 00:00:00
abstract：:Information illustrating the benefits of fracture stabilization after multiple trauma has been gathering for almost a century. At the turn of the last century, the introduction of the Thomas splint clearly demonstrated the importance of skeletal stabilization in the management of these patients. The introduction of st...
journal_title：American journal of surgery
pub_type： 历史文章,杂志文章,评审
doi：10.1016/s0002-9610(02)00865-6
更新日期：2002-06-01 00:00:00
abstract：BACKGROUND:There is a paucity of literature concerning general anesthesia and surgery in patients with amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease). This report summarizes the largest series of surgical cases in ALS during multicenter prospective trials of the laparoscopic diaphragm pacing system (DPS) t...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2008.11.008
更新日期：2009-03-01 00:00:00
abstract：BACKGROUND:Women are disproportionately underrepresented in American academic surgery and surgical society leadership; we investigated the proportion of speaking roles held by women across a wide variety of surgical society meetings. METHODS:Publicly-available data on invited speakers, panelists, and moderators at 23 ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2020.12.019
更新日期：2020-12-09 00:00:00
abstract：:A prospective study of 390 indwelling central venous catheters placed by way of the subclavian route identified bacteremia and tracheostomy as the only significant variables associated with the colonization of the catheters by pathogenic microorganisms. Catheter-related sepsis was likely in only 3 of 33 episodes of pr...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(79)90085-0
更新日期：1979-06-01 00:00:00
abstract：:A small bore feeding tube may be readily introduced into the stomach by splinting it internally, before insertion, with a flexible arteriographic guide wire, which is removed when the tube is in place. Gentle placement of the tube is recommended. ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(80)90374-8
更新日期：1980-05-01 00:00:00
abstract：:Between 1982 and 1985, 83 patients with hypopharyngeal or extensive laryngeal cancers underwent pharyngoesophagectomy (48 patients), circumferential pharyngectomy (8 patients), and partial pharyngectomy (27 patients), depending on the site and extent of tumor involvement. The resultant hypopharyngeal defects were reco...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(89)90007-x
更新日期：1987-10-01 00:00:00
abstract：BACKGROUND:Base Deficit (BD) and lactate have been used as indicators of shock and resuscitation. This study was done to determine the association of BD and lactate and to determine if one is superior. METHODS:A retrospective review from 3/2014-12/2016 was performed. Data included demographics, systolic BP, ISS, BD, l...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2018.01.025
更新日期：2018-04-01 00:00:00
abstract：:From 1972 to 1987, 403 patients underwent a composite resection consisting of segmental mandibulectomy and neck dissection for the treatment of bucco-pharynx squamous cell carcinoma (303 patients had postoperative radiotherapy [XRT], 29 patients had preoperative XRT, and 100 patients had tissue salvage performed after...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(05)80350-2
更新日期：1993-10-01 00:00:00
abstract：BACKGROUND:Two decades since the advent of laparoscopic cholecystectomy, the rate of bile duct injuries still remains higher than in the open cholecystectomy era. METHODS:The rate and complexity of bile duct injuries was evaluated in 83,449 patients who underwent laparoscopic cholecystectomy between 1995 and 2008 in t...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2011.08.018
更新日期：2012-04-01 00:00:00
abstract：BACKGROUND:In view of the indolent nature of most cancers of the thyroid, particularly of the papillary and follicular variety, the decision to remove a segment of the upper aerodigestive tract when the cancer is either close to or invading this area is a difficult one. It was felt relevant to review the experience at ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(05)80136-9
更新日期：1994-12-01 00:00:00
abstract：:Herein, we have described the surgical management of 23 patients with chronic intestinal ischemia. The patients presented most commonly with postprandial pain and weight loss. Diagnosis was confirmed by angiography, including lateral aortography. Surgery included bypass with Dacron being the most common graft material...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(84)90301-5
更新日期：1984-07-01 00:00:00
abstract：BACKGROUND:Predicting length of stay (LOS) is difficult for trauma and emergency general surgery (TEGS) patients. Our aim was to determine the accuracy of LOS predictions by TEGS team members and the NSQIP Risk Calculator and the patient factors associated with inaccurate predictions. METHODS:LOS for 200 TEGS patients...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2020.01.055
更新日期：2020-09-01 00:00:00
abstract：BACKGROUND:Teaching professionalism effectively to fully engaged residents is a significant challenge. A key question is whether the integration of professionalism into residency education leads to a change in resident culture. METHODS:The goal of this study was to assess whether professionalism has taken root in the ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2011.05.007
更新日期：2012-01-01 00:00:00
abstract：:Primary prevention is defined as the prevention of gallstone formation; secondary prevention is defined as the prevention of clinical manifestations of gallstones--symptoms or more severe complications. For primary prevention, general "wellness" measures can be recommended from a theoretic standpoint. These include el...
journal_title：American journal of surgery
pub_type： 杂志文章,评审
doi：10.1016/s0002-9610(05)80958-4
更新日期：1993-04-01 00:00:00
abstract：BACKGROUND:Gastric stump carcinoma (GSC) has been studied after primary gastrectomy for benign disease but few studies have evaluated its correlation with gastric cancer. PATIENTS:We assessed 541 patients submitted to subtotal gastrectomy for early gastric cancer at least 15 years ago. RESULTS:GSC was diagnosed in 16...
journal_title：American journal of surgery
pub_type： 杂志文章,多中心研究
doi：10.1016/j.amjsurg.2014.06.021
更新日期：2015-06-01 00:00:00
abstract：BACKGROUND:Leakage from esophageal anastomoses is higher than that for other gastrointestinal anastomoses. An intrathoracic anastomotic leak is a potentially catastrophic event. METHODS:Patients with and without thoracic anastomotic leakage were compared for predisposing factors. Leak-related mortality was analyzed. ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(01)00559-1
更新日期：2001-03-01 00:00:00
abstract：:Fourteen infants with intestinal stenosis as a late sequela of necrotizing enterocolitis were treated at Texas Children's and Ben Taub General Hospitals from 1972 to 1979. Barium enema studies are the keystone in making the diagnosis and should be performed in any infant with abdominal distention or poor feeding after...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(81)90320-2
更新日期：1981-12-01 00:00:00
abstract：:Examples of the use of endoscopic pancreatography in the preoperative evaluation and postoperative follow-up study of patients with pancreatic disease are presented and discussed. Six cases selected from a total experience of forty-eight patients have been summarized. The direct role of pancreatography in the manageme...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(75)90164-6
更新日期：1975-01-01 00:00:00
abstract：:Ninety carotid endarterectomies with venous patch angioplasty were performed in 83 patients between July 1980 and December 1985. The primary indication for patching was a small-caliber internal carotid artery (ICA) with a diameter less than 3.0 mm in 54 arteriotomies (60%). Patency of the endarterectomy was evaluated ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/0002-9610(91)90201-n
更新日期：1991-07-01 00:00:00
abstract：BACKGROUND:No studies to date exist regarding the attire of physicians on a surgical service. The objective of this study was to determine patient, surgeon, and nonhospitalized public (NHP) attitudes and preferences regarding surgeons' attire and mannerisms. METHODS:A questionnaire was developed to survey each group. ...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/j.amjsurg.2005.04.003
更新日期：2005-07-01 00:00:00
abstract：BACKGROUND:Metastatic colorectal carcinoma to the liver is a potentially curable disease. The purpose of this study was to determine the safety and efficacy of hepatic resection for metastatic colorectal carcinoma. METHODS:One hundred twenty-one consecutive hepatic resections in 110 patients with metastatic colorectal...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(99)00070-7
更新日期：1999-05-01 00:00:00
abstract：:Gut glutamine utilization after massive small bowel resection was studied to gain further insight into the alterations and adaptations in intestinal glutamine metabolism that occur during the development of post-resectional hyperplasia. After resection of the middle 60% of the small intestine in the rat, gut glutamine...
journal_title：American journal of surgery
pub_type： 杂志文章
doi：10.1016/s0002-9610(05)80603-8
更新日期：1990-01-01 00:00:00
