In patients with acute appendicitis, the presence of an in-house acute care surgeon significantly decreased the time to operation, rupture rate, complication rate, and hospital length of stay. The ACS model appears to improve outcomes of acute appendicitis compared with a TRAD home-call model. This study supports the efficacy and efficiency of the ACS model in the management of surgical emergencies.

Forty-two patients with abdominal masses caused by appendicitis underwent immediate surgery. A clear separation between a phlegmon and abscess could not be made before operation. In most patients, it was possible to perform an appendectomy and, thus, obviate the need for appendectomy at a subsequent admission. There were no deaths in this series of patients. The complication rate of 35.7% could have been reduced by leaving the skin wounds open.

Introduction Hospital readmission rates will soon impact Medicare reimbursements. While risk factors for readmission have been described for medical and elective surgical patients, little is known about their predictive value specifically in trauma patients. Patients and methods We retrospectively identified all admissions after trauma resuscitation to our urban level 1 trauma centre from 1/1/2004 to 8/31/2010. All patients discharged alive were included. Data collected included demographics, Injury Severity Score (ISS), and length of stay (LOS). We analyzed these index admissions for the development of complications that have previously been shown to be associated with readmission. Readmissions that occurred within 30 days of index admission were identified. Univariable and multivariable analyses were performed. p < 0.05 was considered significant. Results We identified 10,306 index admissions, with 447 (4.3%) early (within 30 days) readmissions. Mean ISS was 11.1 (SD 10.4). On multivariable analysis, African-American race (OR 1.3, p = 0.009), preexisting chronic obstructive pulmonary disease (COPD) (OR 1.5, p = 0.02), and diabetes mellitus (OR 1.8, p < 0.001) were associated with readmission, along with higher ISS (OR 1.01, p < 0.001), ICU admission (OR 2.1, p < 0.001), and increased LOS (OR 1.01, p < 0.001). Among many in-hospital complications examined, only the development of surgical site infection (SSI) (OR 1.9, p = 0.02) was associated with increased risk of readmission. Conclusions Trauma patients have a low risk of readmission. In contrast to elective surgical patients, the only modifiable risk factor for readmission in our trauma population was SSI. Other risk factors may present clinicians with opportunities for targeted interventions, such as proactive follow up or early phone contact. With future changes to health care policy, clinicians may have even greater motivation to prevent readmission.

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Our CT + S protocol (axial CT images plus AP and lateral scanograms) outperformed screening CLSRs in the detection of fractures of the lower spine (TLJ + LS) after blunt trauma. In addition, scanogram imaging is less dependent on body habitus and adds no additional cost or time to abdominal and pelvic CT scanning. Further study is required to determine whether CT + S can routinely replace conventional radiographs of the lower spine after blunt trauma.

In this matched case-control retrospective study, after controlling for gender and age, we identified the typical profile of elderly patients at risk of readmission. These patients had an unplanned admission at the index hospitalization and prescribed nervous system drugs at discharge from the index admission; they have a history of unplanned readmission within 30 days and return home after discharge.

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