The combination of ECG and cTnI identifies reliably the presence or absence of Sig-BCT. Patients with an abnormal ECG and cTnI need close monitoring for at least 24 hours. Patients with a normal admission ECG and cTnI can be safely discharged in the absence of other injuries.

Hypothesis: For critically injured patients, a limited course of antibiotics is as effective as a prolonged course in preventing sepsis and organ failures.

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BackgroundThere is currently conflicting evidence surrounding the effects of obesity on postoperative outcomes. Previous studies have found obesity to be associated with adverse events, but others have found no association. The aim of this study was to determine whether increasing body mass index (BMI) is an independent risk factor for development of major postoperative complications.MethodsThis was a multicentre prospective cohort study across the UK and Republic of Ireland. Consecutive patients undergoing elective or emergency gastrointestinal surgery over a 4‐month interval (October–December 2014) were eligible for inclusion. The primary outcome was the 30‐day major complication rate (Clavien–Dindo grade III–V). BMI was grouped according to the World Health Organization classification. Multilevel logistic regression models were used to adjust for patient, operative and hospital‐level effects, creating odds ratios (ORs) and 95 per cent confidence intervals (c.i.).ResultsOf 7965 patients, 2545 (32·0 per cent) were of normal weight, 2673 (33·6 per cent) were overweight and 2747 (34·5 per cent) were obese. Overall, 4925 (61·8 per cent) underwent elective and 3038 (38·1 per cent) emergency operations. The 30‐day major complication rate was 11·4 per cent (908 of 7965). In adjusted models, a significant interaction was found between BMI and diagnosis, with an association seen between BMI and major complications for patients with malignancy (overweight: OR 1·59, 95 per cent c.i. 1·12 to 2·29, P = 0·008; obese: OR 1·91, 1·31 to 2·83, P = 0·002; compared with normal weight) but not benign disease (overweight: OR 0·89, 0·71 to 1·12, P = 0·329; obese: OR 0·84, 0·66 to 1·06, P = 0·147).ConclusionOverweight and obese patients undergoing surgery for gastrointestinal malignancy are at increased risk of major postoperative complications compared with those of normal weight.

Computed tomography (CT) is used liberally in the evaluation of pediatric trauma, even of low or moderate severity, because clinical examination of pediatric patients is considered unreliable. Appropriate utilization of valuable resources is essential in a cost-conscious medical era. The objective of this study is to determine if children with mild to moderate trauma are evaluated by more CT scans than adults with injuries of similar severity. Altogether, 108 pediatric patients less than 7 years old were matched according to mechanism of injury, Injury Severity Score (ISS), and the six individual body-region Abbreviated Injury Scores with adult patients admitted over the same 2-year period. All these patients had mild or moderate injuries (mean ISS 3.3 +/- 3.4). Pediatric patients had significantly more CT scans than adults, mostly because of a more liberal use of abdominal CT. CT scans of multiple body areas on the same patient were used more frequently in children but failed to identify more injuries compared to adults. None of the pediatric patients required an operation for abnormalities identified by CT. No differences were observed in morbidity, mortality, length of hospital stay, or length of intensive care unit stay for the two groups. It was concluded that a liberal policy of CT scanning for pediatric patients with a low ISS leads to increased resource consumption with no obvious diagnostic or treatment benefit.

The Sequential Compression Device (SCD) is frequently the sole measure used to prevent deep venous thrombosis (DVT) in trauma patients. The purpose of this study was to evaluate the compliance with physician orders for the application of SCD prophylaxis among nonambulatory trauma patients at risk for DVT. We conducted a prospective observational study at two Level I university-affiliated trauma centers. Nonambulatory trauma patients were observed during their early postadmission period in a non-critical care setting. Six observations were made as to proper SCD applications during a 24-hour period (two times in the morning shift, two in the evening shift, and two overnight). “Full compliance” was defined as SCD on and functioning properly in all six observations. In a total of 1343 observations in 227 patients only 42 patients (19%) were fully compliant. The devices were on and functioning in 712 (53%) observations. Among the 185 patients who were not fully compliant DVT risk factors were common (83%) and adjunctive heparin prophylaxis was infrequent (27%). The most common times for “noncompliant” observations were early afternoon and midmorning. On multivariate analysis only spinal column injury correlated with increased compliance. In nearly half of the observations trauma patients at risk for DVT were not receiving their SCD prophylaxis as per physician orders. Fewer than 20 per cent of patients had the devices on and functioning during each of the six observations during a 24-hour period. These data point to the need for education of hospital staff and for additional prophylactic measures in at-risk patients.

Gastrointestinal hemorrhage is a rare complication of pancreatitis and can involve any of the peripancreatic vessels. The three cases reported herein illustrate the involvement of the splenic artery in diverse forms of pancreatitis: chronic pancreatitis, a pancreatic pseudocyst, and necrotizing pancreatitis. Bleeding was controlled in all cases by a bipolar ligation of the bleeding vessel at surgery.

Background: Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery. Methods: This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and intercentre variation in critical care admission after emergency laparotomy. Results: Of 4529 patients included, 37.8% (n¼1713) underwent planned critical care admissions from theatre. Some 3.1% (n¼86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n¼133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51e19.97) than planned admissions (OR: 2.32, 95% CI: 1.43e3.85). Some 26.7% of patients (n¼1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8e51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n¼10/145) of centres outside the 95% CI. Conclusions: After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.