678 Can patients have their old life back? Using PM:L3 ratio to predict discharge destination of emergency laparotomy survivors

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
J Y Ming ◽  
M Holmes ◽  
J Gani ◽  
P Pockney
Keyword(s):  
Assessment Tool ◽  
Care Facility ◽  
Psoas Muscle ◽  
Emergency Laparotomy ◽  
Ct Image ◽  
Discharge Destination ◽  
Skeletal Muscle Index ◽  
Psoas Muscles ◽  
Discrete Area ◽  
Axial Ct

Abstract Aim Psoas muscle:L3 vertebra (PM:L3) ratio is a relatively new risk assessment tool for emergency laparotomy(1,2) based upon the proven concept that sarcopenia – as diagnosed by low skeletal muscle index(3–6), psoas muscle density(7–9) or total psoas area(10–13) in a single axial slice CT image – correlates with increasing risks of bad outcomes in surgery. This study looks into the association between PM:L3 ratio of emergency laparotomy patients from home and their discharge destination. Method We performed an analysis on patients in the Hunter Emergency Laparotomy Audit (HELA) database, from January 2016 to December 2017. HELA is a retrospective review of all emergency laparotomy undertaken in a discrete area in NSW, Australia. All patients admitted from home, survived to be discharged from hospital and had an available CT abdomen were included (N = 433/562). A single slice axial CT image at the L3 endplate level was analysed using ImageJ® software to measure the area of L3 and bilateral psoas muscles. Results PM:L3 ratio is significantly lower in the group of patient discharged to a care facility than the group discharging back to their previous home residence (mean 0.951 vs. mean 1.128, p < 0.001). Upon further analysis, the PM:L3s are divided into quartiles and stratified by sex. There is an association between lower PM:L3 and risk of discharging into a care facility (Q1 22.45%, Q2 19.59%, Q3 19.10%, Q4 5.71%). Conclusions PM:L3 ratio can predict the discharge destination of patients undergoing emergency laparotomy.

677 Quick, Simple and just as Effective – Comparing PM:L3 Ratio to NELA, P-POSSUM and NSQIP Scores for Emergency Laparotomy

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
J Y Ming ◽  
M Holmes ◽  
P Pockney ◽  
J Gani
Keyword(s):  
Risk Assessment ◽  
Assessment Tool ◽  
Emergency Laparotomy ◽  
Routine Practice ◽  
Mortality Risks ◽  
Risk Assessment Models ◽  
Psoas Muscles ◽  
Discrete Area ◽  
Risk Patients ◽  
Axial Ct

Abstract Aim Multiple tools (NELA, P-POSSUM, ACS-NSQIP) are available to assess mortality risks in patients requiring emergency laparotomy(1–3), but they are time-consuming to perform and have had limited uptake in routine clinical practice in many countries(4). Simpler measures, including psoas muscle:L3 vertebrae (PM:L3) ratio(5,6), may be useful alternates. This measure is quick to perform, requiring no special skills or equipment apart from basic CT viewing software. Method We performed an analysis on all patients in the Hunter Emergency Laparotomy Audit (HELA) database, from January 2016 to December 2017. HELA is a retrospective review of all emergency laparotomy undertaken in a discrete area in NSW, Australia. Patients with an available CT abdomen were included (N = 500/562). A single slice axial CT image at the L3 endplate level was analysed using ImageJ® software to measure the area of L3 and bilateral psoas muscles. This can be done using normal PACS software in routine practice. Results PM:L3 ratios in this cohort have a mean of 1.082 (95%CI 1.042-1.122; range 0.141-3.934). PM:L3 ratio is significantly lower (p < 0.00001) in those patients who did not survive beyond 30 days (mean 0.865 [95% CI 0.746-0.984 ]) and 90 days (mean 0.888 [95%CI 0.768-1.008]) compared to patients that survived these periods (30 day mean 1.106 [95% vs. 1.033-1.179], 90 day mean 1.112 [95% CI 1.070-1.154]) . These associations are similar to those calculated by established risk assessment models. Conclusions PM:L3 ratio is a reliable, quick and easy risk assessment tool to identify high risk patients undergoing emergency laparotomy.

O20 Quick, simple and just as effective—comparing pm: L3 ratio to NELA, P-POSSUM and NSQIP scores in assessing mortality risk for emergency laparotomy

2021 ◽  
Vol 108 (Supplement_5) ◽  
Author(s):  
J Y Ming ◽  
M Holmes ◽  
P Pockney ◽  
J Gani
Keyword(s):  
Risk Assessment ◽  
High Risk ◽  
Assessment Tool ◽  
Risk Assessment Tool ◽  
Emergency Laparotomy ◽  
Routine Practice ◽  
High Risk Patients ◽  
Acs Nsqip ◽  
Psoas Muscles ◽  
Risk Patients

Abstract Introduction Multiple tools (NELA, P-POSSUM, ACS-NSQIP) are available to assess mortality risks in patients requiring emergency laparotomy(1–3), but they are time-consuming to perform and have had limited uptake in routine clinical practice in many countries(4). Simpler measures, including psoas muscle: L3 vertebrae (PM: L3) ratio(5,6), may be useful alternates. This measure is quick to perform, requiring no special skills or equipment apart from basic CT viewing software. Method We performed an analysis on all patients in the Hunter Emergency Laparotomy Audit (HELA) database, from January 2016 to December 2017. HELA is a retrospective review of all emergency laparotomy undertaken in a discrete area in NSW, Australia. Patients with an available CT abdomen were included (N = 500/562). A single slice axial CT image at the L3 endplate level was analysed using ImageJ® software to measure the area of L3 and bilateral psoas muscles. This can be done using normal PACS software in routine practice. Result PM: L3 ratios in this cohort have a mean of 1.082 (95%CI 1.042–1.122; range 0.141–3.934). PM: L3 ratio is significantly lower (P < 0.00001) in those patients who did not survive beyond 30 days (mean 0.865 [95% CI 0.746–0.984]) and 90 days (mean 0.888 [95%CI 0.768–1.008]) compared to patients that survived these periods (30 day mean 1.106 [95% vs. 1.033–1.179], 90 day mean 1.112 [95% CI 1.070–1.154]). These associations are similar to those calculated by established risk assessment models. Conclusion PM: L3 ratio is a reliable, quick and easy risk assessment tool to identify high risk patients undergoing emergency laparotomy. Take-home Message PM: L3 ratio is a reliable, quick and easy risk assessment tool to identify high risk patients undergoing emergency laparotomy. It is comparable to NELA, P-POSSUM and ACS-NSQIP.

EP.FRI.204 Does Sarcopenia Increase the Risk of Needing a Stoma During Emergency Laparotomy?

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Ross Campbell ◽  
Nicholas Bradley ◽  
Michael Wilson
Keyword(s):  
Psoas Muscle ◽  
Perioperative Outcomes ◽  
Emergency Laparotomy ◽  
Patient Records ◽  
Ct Image ◽  
Body Area ◽  
Multisystem Disorder ◽  
Muscle Area ◽  
Stoma Formation

Abstract Aims Sarcopenia is a multisystem disorder which can be diagnosed clinically and radiologically. It is associated with impaired functional status and inferior perioperative outcomes, in particular increased mortality following emergency laparotomy. This study aimed to show whether sarcopenia, as defined by low psoas muscle area (PMA) on pre-operative CT, was associated with increased need for stoma formation.  Methods A retrospective analysis of consecutive emergency general surgical laparotomies over a 3-year period. PMA was measured on a single pre-operative CT image at L3 and normalized to vertebral body area to create a psoas muscle index (PMI). New stoma formation and perioperative outcomes were recorded from patient records. Cases were split by the median value into high “non-sarcopenic” and low “sarcopenic” PMI groups. Results 299 patients underwent emergency laparotomy between 01/01/2016 and 31/12/2018. 46 patients (30.67%) in the low psoas index group required a stoma compared with 37 (24.83%) in the higher group (p = 0.159). Survival was inferior in the sarcopenic group with a mean survival of 42 months compared to 48 months in the non-sarcopenic group (p = 0.032). Median follow-up was 43 months. Patients in the sarcopenic group were significantly older (Mean age 68 compared to 54 in the non-sarcopenic group, p = <0.001) but there was no difference in other baseline variables. Conclusions Sarcopenia does not significantly increase the risk of requiring a stoma during emergency laparotomy but does reduce survival.  

scholarly journals Myosteatosis as a novel prognostic biomarker after radical cystectomy for bladder cancer

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Shimpei Yamashita ◽  
Yuya Iwahashi ◽  
Haruka Miyai ◽  
Takashi Iguchi ◽  
Hiroyuki Koike ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Cox Regression ◽  
Group Performance ◽  
Performance Status ◽  
Eastern Cooperative Oncology Group ◽  
Psoas Muscle ◽  
Hounsfield Units ◽  
Computed Tomography Images ◽  
Psoas Muscles

AbstractThis study aims to evaluate the influence of myosteatosis on survival of patients after radical cystectomy (RC) for bladder cancer. We retrospectively identified 230 patients who underwent RC for bladder cancer at our three institutions between 2009 and 2018. Digitized free-hand outlines of the left and right psoas muscles were made on axial non-contrast computed tomography images at level L3. To assess myosteatosis, average total psoas density (ATPD) in Hounsfield Units (HU) was also calculated as an average of bilateral psoas muscle density. We compared cancer-specific survival (CSS) between high ATPD and low ATPD groups and performed cox regression hazard analyses to identify the predictors of CSS. Median ATPD was 44 HU (quartile: 39–47 Hounsfield Units). Two-year CSS rate in overall patients was 76.6%. Patients with low ATPD (< 44 HU) had significantly lower CSS rate (P = 0.01) than patients with high ATPD (≥ 44 HU). According to multivariate analysis, significant independent predictors of poor CSS were: Eastern Cooperative Oncology Group performance status ≥ 1 (P = 0.03), decreasing ATPD (P = 0.03), non-urothelial carcinoma (P = 0.01), pT ≥ 3 (P < 0.01), and pN positive (P < 0.01). In conclusion, myosteatosis (low ATPD) could be a novel predictor of prognosis after RC for bladder cancer.

scholarly journals A study to assess the clean hospital initiative and quality of health services using kayakalp tool in a first referral unit, of Khordha district of Odisha, India

2018 ◽  
Vol 5 (12) ◽  
pp. 5397 ◽  
Author(s):  
Mayadhar Panda ◽  
Sikata Nanda
Keyword(s):  
Health Care ◽  
Waste Management ◽  
Health Care Providers ◽  
Assessment Tool ◽  
Care Facility ◽  
Health Care Facility ◽  
Family Welfare ◽  
Situational Analysis ◽  
Care Providers

Background: As a part of “Swachh Bharat Abhiyaan” campaign, the Ministry of Health and Family welfare, Govt. of India had launched “Kayakalp” in 2015, an initiative to promote cleanliness and enhance the quality of public health facilities. Our aim was to study the situational analysis of the health institution using Kayakalp tool; to assess the level of cleanliness, hygiene and infection control practices in the facility and to assess the status of Bio-medical waste management in the health care facility and to suggest remedial measures based on the study finding.Methods: It is a hospital based snapshot study done during a period of one year from April 2016 to March 2017. Kayakalp assessment tool was used for analysis.Results: The total scores for upkeep maintenance obtained in 2016-17 was 69 and for the year 2017-18 was 81. There was an increase of total score in the year 2017-18 and it was found to be statistically significant. On assessment in the year 2016-17, for BMW the total score obtained was 58 and in the year 2017-18 it was 81. There was a statistically significant increase in the scores (p=0.001) obtained in the year (2017-18).Conclusions: Improvements in Biomedical waste management can be made by increasing the knowledge, awareness and practices of the health care providers as well as the beneficiaries with regular periodic monitoring. 

Adenocarcinoma of Unknown Primary Site (Acups) Presenting as a Psoas Abscess

1989 ◽  
Vol 34 (3) ◽  
pp. 470-470 ◽  
Author(s):  
I.C. Stewart ◽  
K.J. Blaikie ◽  
H.M. MacLeod
Keyword(s):  
Psoas Abscess ◽  
Psoas Muscle ◽  
Primary Site ◽  
Unknown Primary ◽  
Unknown Primary Site ◽  
Tumour Type ◽  
Psoas Muscles

The presentation of a psoas abscess is commonly seen in conjunction with infection, especially tuberculous. Involvement of the psoas muscles with tumour, however, is extremely rare. We present a case in which adenocarcinoma of unknown primary site infiltrated the psoas muscle, thus mimicking a psoas abscess. A review of this unusual tumour type is discussed.

A long-term care facility pandemic influenza preparedness planning assessment tool

2011 ◽  
Vol 6 (4) ◽  
pp. 219-230 ◽  
Author(s):  
Philip W. Smith, MD ◽  
Keith Hansen, BS ◽  
Harlan Sayles, MS ◽  
Brendan Brodersen ◽  
Sharon Medcalf, RN, Med
Keyword(s):  
Pandemic Influenza ◽  
Long Term Care ◽  
Assessment Tool ◽  
Care Facility ◽  
Term Care ◽  
Term Care Facility ◽  
Long Term Care Facility ◽  
Preparedness Planning

scholarly journals Diagnostic and prognostic value of psoas muscle thickness and area in patients with liver cirrhosis and sarcopenia

2021 ◽  
Vol 25 (4) ◽  
pp. 551-558
Author(s):  
V. M. Motsiuk ◽  
N. O. Pentiuk
Keyword(s):  
Skeletal Muscle ◽  
Liver Cirrhosis ◽  
Prognostic Value ◽  
Psoas Muscle ◽  
Muscle Thickness ◽  
Diagnostic Value ◽  
Reference Ranges ◽  
Skeletal Muscle Index ◽  
Male And Female ◽  
Diagnostic And Prognostic Value

Annotation. Sarcopenia is a typical complication of liver cirrhosis (LC) and is associated with a poor prognosis. The skeletal muscle index is the most studied radiological marker of sarcopenia, but it’s using requires the qualification of a radiologist, specialized software, time reserve. The aim of the study: to investigate the relationship between different radiological markers of skeletal muscle mass, to determine their reference ranges for Ukrainian population and to assess their diagnostic and prognostic value in patients with LC. The study involved 216 healthy people and 147 patients with LC. During 18 months of follow-up 45 patients died from LC complications. Skeletal muscles were assessed by computed tomography. Skeletal muscle index (SMI), psoas muscle index (PMI), and transverse psoas muscle thickness (TPMT) at L3 were determined. Statistical data processing was performed in SPSS22. Diagnostic and prognostic value of SMI, PMI, TPMT were studied in ROC analysis. It was found that in Ukrainian population the reference ranges of SMI are >52.2 / 39.3 cm2/m2, PMI>6. 44 / 3.49 cm2/m2, TPMT>11.1 / 7.42 mm/m, in men / women, respectively. Sarcopenia was diagnosed in 54.9% and 86.3% of LC class B and C patients. PMI and TPMT had a high diagnostic value in sarcopenia detection (SMI≤52.2 and ≤39.3 cm2/m2) in male and female LC patients (AUC PMI 0.899 and 0.955, p˂0.001, AUC TPMT 0.884 and 0.942, p˂0.001). SMI, PMI and TPMT predicted one-and-a-half-year mortality in male and female LC patients (AUC SMI 0.815 and 0.786, p<0.001; AUC PMI 0.745 and 0.804, p<0.001; AUC TPMT 0.752 and 0.871, p<0.001). The optimal cut-off values for predicting death in male and female are: SMI≤49.1 and ≤38.4 cm2/m2; PMI≤5.99 and ≤3.30 cm2/m2; TPMT≤11.0 and ≤6.70 mm/m. Thus, routine assessment of PMI and TPMT in LC can identify patients with sarcopenia and high risk of complications.

scholarly journals Evaluation of the Patient Sitter Assessment Tool

2011 ◽  
Author(s):  
Tamara DeSousa
Keyword(s):  
Acute Care ◽  
Assessment Tool ◽  
Care Facility ◽  
Strong Relationship ◽  
Cognitive Status ◽  
Ease Of Use ◽  
Contributing Factors ◽  
Improvement Project ◽  
Patient Falls ◽  
Telemetry Unit

<p>Maintaining the safety of hospitalized patients is a top priority in healthcare. Evidence has demonstrated that most patient injuries associated with falls are preventable. Despite major, sustained national initiatives related to fall prevention, fall rates continue to be problematic in acute care settings. Patient sitters are often used to observe/and or assist those that are identified as at a high risk for falls; however evidence to support the effectiveness of this intervention in reducing fall risk is lacing. A committee charged with revising the sitter policy in an acute care facility discovered inconsistencies by nurses when assessing this patient population. A literature review revealed common contributing factors to a change in cognition and delirium, both having strong relationship to patient falls. A Patient Sitter Assessment tool was developed and pilot tested on a 27 bed medical surgical telemetry unit. The purpose of this process improvement project was to determine the ease of use,utility, and staff satisfaction of the tool. Evaluation from 12 staff nurses who participated were favorable. Overall, nurses indicated satisfaction with the tool, and provided feedback that more education on delirium and contributing factors that impact cognition was needed. It is expected that use of the tool will result in earlier detection and treatment of change in cognitive status and improved sitter use. Implications and recommendations are presented and discussed.</p>

scholarly journals TP9.2.16Peri-operative Delirium in the Emergency Laparotomy Population

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Michael McCusker ◽  
Jennifer Edwards ◽  
Margaret Clark
Keyword(s):  
Length Of Stay ◽  
Cognitive Dysfunction ◽  
Risk Score ◽  
Assessment Tool ◽  
Treatment Guidelines ◽  
Emergency Laparotomy ◽  
Care Pathways ◽  
Calendar Period ◽  
Site Survey ◽  
Baseline Characteristics

Abstract Aims To determine the incidence of peri-operative delirium in our emergency laparotomy population. Methods Utilising our local prospectively maintained Emergency Laparotomy and Laparoscopic Scottish Audit (ELLSA) database all cases over a two-month calendar period were identified. Case notes were reviewed retrospectively for all patients. The 4 A's Test (4AT) assessment tool was used to screen for the presence of delirium (a score ≥4 = delirium), performed throughout the peri-operative period. For all patients baseline characteristics were recorded including NELA risk score, 30 day survival, length of stay (LOS), ASA score, age, sex and presence of pre-morbid cognitive dysfunction. Results Thirty-two patients were identified through the ELLSA database. Incidence of peri-operative delirium as determined by 4AT was 10/32 patients (31.25%). The thirty day mortality was 4/32 (12.5%). Peri-operative delirium was identified in all non-survivors. NELA risk score for those with delirium 14% / 21% (median / mean) versus 2.5% / 2.3% (median / mean) without (p 0.0015). The LOS for those with delirium 26 / 24.6 days (median / mean) versus 11 / 13.6 (median / mean) without (p 0.0194). Conclusions Delirium is a common peri-operative event. In our population it is associated with a higher NELA score. The presence of delirium is associated with poorer outcomes, with an increased mortality and LOS. This single site survey indicates that there is a need to develop care pathways that identify those at risk of delirium and implement treatment guidelines. Our survey suggests that the NELA score could be used as a triage tool for the risk of delirium.

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