Incidence of Delayed Intracranial Hemorrhage in Older Patients After Blunt Head Trauma – JAMA Surgery (link to abstract – $ for full-text)
Related: Infographic: ATLS Trauma Update 2018
Rapid Recommendations: Antibiotics after incision and drainage for uncomplicated skin abscesses: a clinical practice guideline – The BMJ (free text and infographics)
Original article: Effect of treatment delay on the effectiveness and safety of antifibrinolytics in acute severe haemorrhage: a meta-analysis of individual patient-level data from 40 138 bleeding patients – The Lancet (free) AND Invited Commentary: Tranexamic acid: is it about time? (free)
“It is now clearer that every 15-minute delay after the first hour can reduce survival by about 10%”.
“The odds of postoperative mortality were 27 percent higher for patients admitted to the hospital on Saturday or Sunday, compared to those hospitalized on a weekday” (from NewsWise).
Chemical venous thromboembolism prophylaxis in neurosurgical patients: an updated systematic review and meta-analysis – Journal of Neurosurgery (link to abstract – $ for full-text)
Chemical venous thromboembolism prophylaxis seems to be effective and safe in neurosurgical patients.
Report: The High Toll of Traffic Injuries : Unacceptable and Preventable – The World Bank (free PDF) (via @equitylist)
Press release: Road Deaths and Injuries Hold Back Economic Growth in Developing Countries (free)
Key Findings: The High Toll of Traffic Injuries : Unacceptable and Preventable – The World Bank (free)
Author Interview: Work-Related Musculoskeletal Disorders Among Surgeons and Interventionalists (free)
Commentary: Work-Related Musculoskeletal Injury Common in Surgeons, Interventionalists – Medscape (free registration required)
Association Between Wait Time and 30-Day Mortality in Adults Undergoing Hip Fracture Surgery – JAMA (link to abstract – $ for full-text)
Commentaries: Delaying Surgery for Hip Fracture for More Than One Day Associated with Small Increased Risk of Death – The JAMA Network (free) AND Delaying Hip Fracture Surgery for 1 Day Tied to Higher Mortality Risk – Physician’s First Watch (free) AND Emergency Hip Surgery Best Done Within 24 Hours – Medscape (free registration required)
Commentaries: Motorcycle crashes cause 5 times as many deaths as car accidents, 6 times the health costs – CMAJ, via EurekAlert (free) AND Motorcycle crashes are alarmingly common — and incredibly costly – STAT (free)
European guidelines on perioperative venous thromboembolism prophylaxis (free PDF articles):
Effect of treatment delay on the effectiveness and safety of antifibrinolytics in acute severe haemorrhage: a meta-analysis of individual patient-level data from 40 138 bleeding patients – The Lancet (free)
Commentaries: Tranexamic acid: is it about time? – The Lancet (free) Rapid use of blood drug could save thousands of lives, study finds – The Guardian (free) AND Severely bleeding patients must receive lifesaving drug within minutes, not hours – London School of Hygiene & Tropical Medicine, via EurekAlert (free)
Percutaneous cholecystostomy in the management of high-risk patients presenting with acute cholecystitis: Timing and outcome at a single institution – American Journal of Surgery (link to abstract – $ for full-text)
Commentary: Percutaneous Cholecystostomy: An Alternative to Urgent Surgery for Cholecystitis? – Medscape (free registration required)
Stair-related injuries treated in United States emergency departments – The American Journal of Emergency Medicine (link to abstract – $ for full-text)
Commentary: Injuries on stairs occur in all age groups and abilities – Reuters (free)
Original article: Keeping Children Safe: a multicentre programme of research to increase the evidence base for preventing unintentional injuries in the home in the under-fives – Programme Grants for Applied Research (free)
Managing Head Trauma in Children – The New York Times (10 articles per month are free)
Related Articles: Reducing Head CT Use for Children With Head Injuries in a Community Emergency Department – Pediatrics (link to abstract – $ for full-text) AND Development and Internal Validation of a Clinical Risk Score for Treating Children With Mild Head Trauma and Intracranial Injury – JAMA Pediatrics (free PDF) AND Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort stud – The Lancet (free PDF)
Randomized clinical trial of antibiotic therapy for uncomplicated appendicitis – British Journal of Surgery (link to abstract – $ for full-text)
See also a related meta-analysis suggesting the safety of nonoperative treatment for uncomplicated cases (free) and a recent guideline that incorporates the possibility of non-operative treatment for uncomplicated disease (free)
Low-dose CT for the diagnosis of appendicitis in adolescents and young adults (LOCAT): a pragmatic, multicentre, randomised controlled non-inferiority trial – Lancet Gastroenterology &Hepatology (link to abstract – $ for full-text)
Related: Enhanced recovery pathway for colorectal surgical patients improves outcomes, reduces cost – ACS, via EurekAlert (free) AND Clinical Practice Guidelines for Enhanced Recovery After Colon and Rectal Surgery From the American Society of Colon and Rectal Surgeons and Society of American Gastrointestinal and Endoscopic Surgeons (free) AND Enhanced Recovery After Surgery (ERAS) Guidelines and Reviews in our collection (free) AND ERAS Society Website (free).
Related meta-analysis: A meta-analysis of resuscitative endovascular balloon occlusion of the aorta (REBOA) or open aortic cross-clamping by resuscitative thoracotomy in non-compressible torso hemorrhage patients – World Journal of Emergency Surgery (free)
Source: Journal Watch ($)
“we found that the risk associated with nonobstetric surgery was relatively low, confirming that surgical procedures during pregnancy are generally safe”
Related book: Essential Surgery – Disease Control Priorities 3 (DCP3) (free)
Related report: Global Surgery 2030 (free PDF)
Related commentary on the subject: In countries with a shortage of surgeons, other health care workers can fill in the gaps – STAT (free)
A meta-analysis of resuscitative endovascular balloon occlusion of the aorta (REBOA) or open aortic cross-clamping by resuscitative thoracotomy in non-compressible torso hemorrhage patients – World Journal of Emergency Surgery (free)
This meta-analysis, mainly from observational studies and including 1276 patients, suggests a positive effect of REBOA on mortality among non-compressible torso hemorrhage patients.
American College of Surgeons (ACS) 2017 Quality and Patient Safety Conference: Enhanced recovery pathway for colorectal surgical patients improves outcomes, reduces cost – ACS, via EurekAlert (free)
Related guideline: Clinical Practice Guidelines for Enhanced Recovery After Colon and Rectal Surgery From the American Society of Colon and Rectal Surgeons and Society of American Gastrointestinal and Endoscopic Surgeons (free)
“Successful protocol shortens hospital stays, reduces patients’ risk of complications, and cuts costs up to $11,000 per procedure”
2017 ACS Quality and Safety Conference: “Strong for Surgery” Shows Promise in Reducing Smoking Rates for Patients Facing Surgery – American College of Surgeons, via NewsWise (free)
“Study suggests big drop in smoking rates when surgeons help patients quit before their operations”.
Commentary: 3 steps to restore patient trust in overlapping surgeries – FierceHealthcare (free)
This interesting viewpoint discusses the practice of scheduling overlapping surgeries, in which a qualified practitioner finishes noncritical parts of the first operation while the primary surgeon moves to the next surgery.
Related: Essential Surgery – Disease Control Priorities (DCP3) (free landmark book on the topic) AND The Lancet Commission on Global Surgery (free resources)
Source: Global Health NOW Newsletter
Association of delay of urgent or emergency surgery with mortality and use of health care resources: a propensity score–matched observational cohort study – Canadian Medical Association Journal (free)
Source: STAT News Newsletter
“Delayed operating room access for emergency surgery was associated with increased risk of inhospital mortality, longer length of stay and higher costs”.
Long-term health status and trajectories of seriously injured patients: A population-based longitudinal study – PLOS Medicine (free) (RT @karimbrohi see Tweet – “Trauma is a chronic disease”)
“The prevalence of reporting problems at 36-months postinjury was 37% for mobility, 21% for self-care, 47% for usual activities, 50% for pain/discomfort, and 41% for anxiety/depression… the prevalence of ongoing problems at 3-years postinjury is high, confirming that serious injury is frequently a chronic disorder”
A Placebo-Controlled Trial of Antibiotics for Smaller Skin Abscesses – New England Journal of Medicine (link to abstract – $ for full-text)
Commentaries: Adding Antibiotics to Incision-and-Drainage of Small Skin Abscesses Helps – Physician’s First Watch (free) AND Antibiotics Improve Short-Term Outcomes for Simple Abscesses – Medscape (free registration required) AND Study finds benefit for antibiotic treatment of simple skin wounds – CIDRAP (free)
Source: EvidenceAlerts (free resource to find articles of interest)
“Antiplatelet therapy at the time of noncardiac surgery confers minimal bleeding risk with no difference in thrombotic complications. In many cases, it is safe to continue antiplatelet therapy in patients with important indications for their use”
Surgeon-level variation in complications among surgeons was nearly twice as great for Minimally Invasive Colectomy than for Open Colectomy, implying a need for improved training in adoption of minimally invasive techniques.
Inspired by War Zones, Balloon Device May Save Civilians From Fatal Blood Loss – The New York Times (10 articles per month are free)
Antibiotics Versus Surgical Therapy for Uncomplicated Appendicitis: Systematic Review and Meta-analysis of Controlled Trials – Annals of Surgery (link to abstract – $ for full-text)
Commentary: Antibiotics Versus Surgery: Equally Effective in Treating Appendicitis? – Medscape (free registration required)
This meta-analysis and the author’s conclusions do not favor antibiotics alone for the treatment of uncomplicated appendicitis, contradiction the results of other recent meta-analysis, as well as a recent guideline on the subject, suggesting antibiotics might be an option in selected cases.
Effect of a Modified Hospital Elder Life Program on Delirium and Length of Hospital Stay in Patients Undergoing Abdominal Surgery: A Cluster Randomized Clinical Trial – JAMA Surgery (free) (RT @PreetiNMalani see Tweet)
Multicomponent nonpharmacologic interventions, including orienting communications, oral and nutritional assistance, and early mobilization reduced postoperative delirium by 56% and length of stay by 2 days.
New Advice to Move More After a Concussion – The New York Times (10 articles per month are free)
Related: Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016 – British Journal of Sports Medicine (free) AND So, Tom Brady had a concussion. What does that mean? Your guide to the latest science – STAT News (free)
Invited commentary: Surgical Site Infection Prevention – What We Know and What We Do Not Know – JAMA Surgery (free)
Commentary: ‘Long-Awaited’ CDC Guidelines on SSI Prevention Released – Medscape (free registration required)
Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial – The Lancet (free)
Editorial: WOMAN: reducing maternal deaths with tranexamic acid (free)
Mortality Trends After a Voluntary Checklist-based Surgical Safety Collaborative – Annals of Surgery (link to abstract – free PDF available)
Sources: Global Health NOW Newsletter (free) AND South Carolina Hospitals Saw Surgery Deaths Drop After Implementing WHO Checklist – AJMC News (free) AND A simple checklist prevents deaths after surgery, a large new study suggests – The Washington Post (a few articles per month are free)
See also: WHO Surgical Safety Checklist – World Health Organization (free) AND A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population – New England Journal of Medicine (free)
The wound/burn guidelines – Japanese Dermatological Association (all guidelines are free)
Wounds in general / Guidelines for the diagnosis and treatment for pressure ulcers / Guidelines for the diagnosis and treatment for diabetic ulcer/gangrene / Guidelines for the management of skin ulcers associated with connective tissue disease/vasculitis / Guidelines for the management of lower leg ulcers/varicose veins / Guidelines for the management of burns
Browse Appropriateness Criteria Topics (free)
This comprehensive guide from American College of Radiology (ACR) covers 230 topics with more than 1,100 clinical indications and has just been updated. It is a very useful resource for doctors in all specialties to guide which exam is most appropriate in each clinical situation.
Editorial: Medical Treatment of Pediatric Appendicitis: Are We There Yet? (free)
Nonoperative treatment was successful in 90% of cases. Subgroup analysis indicated an increased risk for initial fails and recurrent appendicitis in those with appendicolith.
Going Under the Knife, With Eyes and Ears Wide Open – New York Times (free access to 10 articles per month)
“More and more surgeries are being performed with the patient awake and looking on, for financial and medical reasons”.