scholarly journals Utility of World Society of Emergency Surgery Sepsis Severity Score in Predicting Outcomes of Intra-abdominal Infections

2020 ◽  
Vol 17 (2) ◽  
pp. 65-68
Author(s):  
Kinyua Isaiah Mwenda ◽  
Daniel Ojuka ◽  
Mark Awori
Keyword(s):  
Emergency Surgery ◽  
Severity Score ◽  
Adult Population ◽  
Abdominal Sepsis ◽  
World Society ◽  
Adverse Outcomes ◽  
Source Control ◽  
Sepsis Severity ◽  
Unit Increase ◽  
Abdominal Infections

Background: Intra-abdominal infections are classified as simple or complicated. Many tools have been studied to predict risk factors and outcomes of patients with intra-abdominal infections. None of these tools has been adopted for patient care at the Kenyatta National Hospital (KNH), Kenya. Objective: To determine the utility of the World Society of Emergency Surgery (WSES) Sepsis Severity Score in predicting short-term outcomes of patients managed for complicated intra-abdominal infections. Methods: We conducted a hospital-based prospective cohort study. Patients aged 18 years and above with complicated intra-abdominal infections were recruited. Data were obtained on demographics, condition at admission, time to source control, origin of infection, immune suppressants and complications. IBM SPSS version 21.0 was used to obtain means and standard deviations while logistic regression was used for associations. Results: A sepsis severity score of 6.5, best predicted mortality having a sensitivity of 80% and a specificity of 20.9% were obtained. For each unit increase in the WSES scores, the odds of mortality were 2.1, organ dysfunction 2.2, CCU admission 2.1. Conclusion: Our sepsis severity score has demonstrated good performance in our adult population, and also ability to predict adverse outcomes other than mortality in patients managed for intra-abdominal sepsis. Keywords: WSES, Sepsis, Sepsis severity score, Intra-abdominal infections

scholarly journals Management of intra-abdominal-infections: 2017 World Society of Emergency Surgery guidelines summary focused on remote areas and low-income nations

2020 ◽  
Vol 99 ◽  
pp. 140-148
Author(s):  
Gennaro Perrone ◽  
Massimo Sartelli ◽  
Giuffrida Mario ◽  
Alain Chichom-Mefire ◽  
Francesco Maria Labricciosa ◽  
...  
Keyword(s):  
Low Income ◽  
Emergency Surgery ◽  
World Society ◽  
Remote Areas ◽  
Abdominal Infections

Intra-abdominal sepsis in the critically ill

2016 ◽  
Author(s):  
Jeffrey D. Doyle ◽  
John C. Marshall
Keyword(s):  
Critically Ill ◽  
Anaerobic Bacteria ◽  
Abdominal Sepsis ◽  
Source Control ◽  
Successful Management ◽  
Abdominal Infection ◽  
Infectious Disease Specialists ◽  
Intra Abdominal Infection ◽  
Abdominal Infections ◽  
Prompt Diagnosis

Intra-abdominal infection encompasses a broad group of infections arising both within the peritoneal cavity and the retroperitoneum. The probable bacteriology reflects patterns of normal and pathological colonization of the gastrointestinal tract. Anaerobic bacteria are found in the distal small bowel and colon. The abdomen is the second most common site of infection leading to sepsis in critically-ill patients. Intra-abdominal infections can be complex to manage and require excellent collaboration between intensivists, diagnostic and interventional radiologists, surgeons, and sometimes gastroenterologists and infectious disease specialists. Prompt diagnosis, appropriate antimicrobial coverage and timely source control are the cornerstones of successful management. The spectrum of pathologic conditions responsible for intra-abdominal infection is broad, although some common biological features facilitate an understanding of their diagnosis and management.

Exploring the Association between Multimorbidity and Cognitive Impairment in Older Adults Living in the Community: A Review of the Literature

2021 ◽  
pp. 108482232110304
Author(s):  
Grace F. Wittenberg ◽  
Michelle A. McKay ◽  
Melissa O’Connor
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Assessment Tool ◽  
Adult Population ◽  
Home Health ◽  
Adverse Outcomes ◽  
Community Dwelling ◽  
Cognitive Screening ◽  
Review Of The Literature ◽  
Increased Risk

Two-thirds of older adults have multimorbidity (MM), or co-occurrence of two or more medical conditions. Mild cognitive impairment (CI) is found in almost 20% of older adults and can lead to further cognitive decline and increased mortality. Older adults with MM are the primary users of home health care services and are at high risk for CI development; however, there is no validated cognitive screening tool used to assess the level of CI in home health users. Given the prevalence of MM and CI in the home health setting, we conducted a review of the literature to understand this association. Due to the absence of literature on CI in home health users, the review focused on the association of MM and CI in community-dwelling older adults. Search terms included home health, older adults, cognitive impairment, and multimorbidity and were applied to the databases PubMed, CINAHL, and PsychInfo leading to eight studies eligible for review. Results show CI is associated with MM in older adults of increasing age, among minorities, and in older adults with lower levels of education. Heart disease was the most prevalent disease associated with increased CI. Sleep disorders, hypertension, arthritis, and hyperlipidemia were also significantly associated with increased CI. The presence of MM and CI was associated with increased risk for death among older adults. Further research and attention are needed regarding the use and development of a validated cognitive assessment tool for home health users to decrease adverse outcomes in the older adult population.

scholarly journals WSES-AAST guidelines: management of inflammatory bowel disease in the emergency setting

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Belinda De Simone ◽  
Justin Davies ◽  
Elie Chouillard ◽  
Salomone Di Saverio ◽  
Frank Hoentjen ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Emergency Surgery ◽  
Steering Committee ◽  
Consensus Conference ◽  
World Society ◽  
Emergency Setting ◽  
Disease Spectrum ◽  
Precise Analysis ◽  
Inflammatory Bowel

Abstract Background Despite the current therapeutic options for the treatment of inflammatory bowel disease, surgery is still frequently required in the emergency setting, although the number of cases performed seems to have decreased in recent years. The World Society of Emergency Surgery decided to debate in a consensus conference of experts, the main pertinent issues around the management of inflammatory bowel disease in the emergent situation, with the need to provide focused guidelines for acute care and emergency surgeons. Method A group of experienced surgeons and gastroenterologists were nominated to develop the topics assigned and answer the questions addressed by the Steering Committee of the project. Each expert followed a precise analysis and grading of the studies selected for review. Statements and recommendations were discussed and voted at the Consensus Conference of the 6th World Society of Emergency Surgery held in Nijmegen (The Netherlands) in June 2019. Conclusions Complicated inflammatory bowel disease requires a multidisciplinary approach because of the complexity of this patient group and disease spectrum in the emergency setting, with the aim of obtaining safe surgery with good functional outcomes and a decreasing stoma rate where appropriate.

Epidemiology and outcomes of obese critically ill patients in Australia and New Zealand

2020 ◽  
Vol 22 (1) ◽  
pp. 35-44
Author(s):  
Paul Secombe ◽  
◽  
Richard Woodman ◽  
Sean Chan ◽  
David Pilcher ◽  
...  
Keyword(s):  
New Zealand ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Adult Population ◽  
Diagnostic Category ◽  
Class Ii ◽  
Adverse Outcomes ◽  
Class I ◽  
Class I Obesity

OBJECTIVE: The apparent survival benefit of being overweight or obese in critically ill patients (the obesity paradox) remains controversial. Our aim is to report on the epidemiology and outcomes of obesity within a large heterogenous critically ill adult population. DESIGN: Retrospective observational cohort study. SETTING: Intensive care units (ICUs) in Australia and New Zealand. PARTICIPANTS: Critically ill patients who had both height and weight recorded between 2010 and 2018. OUTCOME MEASURES: Hospital mortality in each of five body mass index (BMI) strata. Subgroups analysed included diagnostic category, gender, age, ventilation status and length of stay. RESULTS: Data were available for 381 855 patients, 68% of whom were overweight or obese. Increasing level of obesity was associated with lower unadjusted hospital mortality: underweight (11.9%), normal weight (7.7%), overweight (6.4%), class I obesity (5.4%), and class II obesity (5.3%). After adjustment, mortality was lowest for patients with class I obesity (adjusted odds ratio, 0.78; 95% CI, 0.74– 0.82). Adverse outcomes with class II obesity were only seen in patients with cardiovascular and cardiac surgery ICU admission diagnoses, where mortality risk rose with progressively higher BMIs. CONCLUSION: We describe the epidemiology of obesity within a critically ill Australian and New Zealand population and confirm that some level of obesity is associated with lower mortality, both overall and across a range of diagnostic categories and important subgroups. Further research should focus on potential confounders such as nutritional status and the appropriateness of BMI in isolation as an anthropometric measure in critically ill patients.

scholarly journals WSES SM (World Society of Emergency Surgery Summer Meeting) highlights: emergency surgery around the world (Brazil, Finland, USA)

2009 ◽  
Vol 4 (1) ◽  
pp. 11 ◽  
Author(s):  
Renato Poggetti ◽  
Ari Leppanemi ◽  
Paula Ferrada ◽  
Juan Puyana ◽  
Andrew B Peitzman ◽  
...  
Keyword(s):  
Emergency Surgery ◽  
World Society ◽  
The World

scholarly journals The Incidence of Bleeding and the Factors That Influence Its Development among Patients Admitted With Dengue Fever

2017 ◽  
Vol 9 (2) ◽  
pp. 23-28
Author(s):  
Krishna Bahadur Thapa ◽  
Namrata KC ◽  
T Koirala ◽  
A Bhatttarai
Keyword(s):  
Platelet Count ◽  
Dengue Fever ◽  
Medical Center ◽  
Adult Population ◽  
World Health ◽  
Chi Square ◽  
Factors Affecting ◽  
Female Sex ◽  
Unit Increase ◽  
Health Organization

Background: Dengue virus is now classified as a major global health threat by the World Health Organization. Bleeding is a common complication and is one of the most feared. There is an increase incidence in the adult population, hence, the focus of this study.Objectives: To determine the incidence of bleeding and the factors that influence its development among patients admitted with dengue fever at Fatima Medical Center, Phillipines from January 2009 to December 2011.Methods: This is a case control study using chart review. The incidence of bleeding is calculated using risk ratio. Factors affecting bleeding are determined using chi square for qualitative variables and T-test or ANOVA for quantitative variables. Simultaneous determination of factors association with bleeding will be analyzed using multiple logistic regression. Level of significance will be set at alpha = 0.05.Results: The female sex is significantly more prone to develop bleeding (p=0.044). There is no significant increase in bleeding in patients who have co-morbidities (p=0.447). In every one unit increase in WBC (1 x 109) the odds of bleeding decrease by 15%. For every one unit increase in hematocrit the odds of bleeding decreases by 6.8%. For every one unit increase in platelet count the odds of bleeding decreases by 3% that is every 10 unit increase in platelet count the odds of bleeding decrease by 22.9%.Conclusions: Female sex, a low initial WBC and platelet count will increase a patient’s propensity to develop bleeding.Journal of Gandaki Medical College Volume, 09, Number 2, July December  2016, page: 23-28

Pulmonary Contusion in the Pediatric Population

2010 ◽  
Vol 76 (7) ◽  
pp. 721-724 ◽  
Author(s):  
Miller Carlton Hamrick ◽  
Ryan Donsworth Duhn ◽  
David Edward Carney ◽  
William Carson Boswell ◽  
Mims Gage Ochsner
Keyword(s):  
Respiratory Failure ◽  
Injury Severity Score ◽  
Lung Volume ◽  
Severity Score ◽  
Injury Severity ◽  
Adult Population ◽  
Pulmonary Contusion ◽  
Total Lung Volume ◽  
Arterial Blood ◽  
Increased Risk

Pulmonary contusion in the adult population is an independent risk factor for respiratory failure, ventilator associated pneumonia, and acute respiratory distress syndrome. Pilot studies in adults note an increased risk when volume of pulmonary contusion exceeds 20 per cent of total lung volume. The purpose of this study was to determine if children with pulmonary contusion suffer the same morbidity as adults. From January 2005 to May 2007, all trauma patients ages 3 to 18-years-old were assessed for CT evidence of pulmonary contusion. Children were excluded if injury included confounding variables, which could result in respiratory failure independent of contusion status. CT images were reviewed and pulmonary contusion was calculated as a percentage of total lung volume. Outcomes including need for invasive ventilation, pneumonia, and development of oxygenation problems were recorded. Data collected included patient age, Injury Severity Score, arterial blood gas findings, and number of rib fractures. Twenty-six patients met criteria for the study with a mean age of 13.35 years and mean Injury Severity Score of 24. The mean percentage of pulmonary contusion was 19.81 per cent. No patients required intubation. Pediatric pulmonary contusion does not carry the same morbidity as noted in the adult population. Invasive airway management is rarely required.

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