Gabriel Ruiz

Hypercoagulability and venous thromboembolism in burn patients

To our knowledge, this is the first comprehensive review on the subject of venous thromboembolism (VTE) and hypercoagulability in burn patients. Specific changes in coagulability are reviewed using data from thromboelastography and other techniques. Disseminated intravascular coagulation in burn patients is discussed. The incidence and risk factors associated with VTE in burn patients are then examined, followed by the use of low-molecular-weight heparin thromboprophylaxis and monitoring techniques using antifactor Xa levels. The need for large, prospective trials in burn patients is highlighted, especially in the areas of VTE incidence and safe, effective thromboprophylaxis.

Closed (Blunt) Compared to Open (Penetrating) Pulmonary Contusion–A National Trauma Data Bank Review

Results: A total of 12,884 patients with pulmonary contusions were identified. The closed pulmonary contusion was present in 12,329 patients, open pulmonary contusion in 555 patients. Patients with closed pulmonary contusions were older with a mean age of 38.00 ± 22.23 versus 30.58 ± 12.88. Patients with closed pulmonary contusion had a higher injury severity score (ISS) 21.60 ± 0.22 versus 18.64 ± 1.08, p = 0.001. Closed pulmonary contusion was associated with increased ventilator days 3.09 ± 0.13, p = 0.052, intensive care unit (ICU) days 5.11 ± 0.15 versus 4.01 ± 0.69, p = 0.003 and hospital length of stay 0.65 ± 0.25 versus 9.37 ± 0.99, p = 0.032.

A survey of the practice and attitudes of surgeons regarding the treatment of appendicitis

BACKGROUND We surveyed surgeons to document their attitudes, practice, and risk tolerance regarding the treatment of appendicitis. METHODS A web-based survey was sent to the EAST membership. The primary composite endpoint was defined as 1-year incidence of perioperative complications, antibiotic failure, infections, ED visits, and readmissions. RESULTS A total of 563 of 1645 surveys were completed (34% response). Mean age was 47 ± 10 years and 98% were from the United States. Most (72%) were employed at academic teaching hospitals and 66% practiced in an urban setting. There were significant differences in treatment recommendations for different presentations of appendicitis. Regarding the primary composite endpoint, surgeons would tolerate a median 17% [10%-25%] excess morbidity in order to avoid an operation (i.e. non-inferiority) and would require a median 24% [10%-50% lower morbidity for the surgical approach in order to declare it a superior treatment (i.e. superiority). CONCLUSIONS To be considered non-inferior, antibiotic therapy of appendicitis cannot have >17% excess morbidity and appendectomy must have at least 24% lower morbidity to be considered superior.