ABSTRACT
BACKGROUND: The Warkentin 4-T scoring system for determining the pretest probability of heparin-induced thrombocytopenia (HIT) has been shown to be inaccurate in the ICU and does not take into account body mass index (BMI). METHODS: Prospectively collected data on patients in the surgical and cardiac ICU between January 2007 and February 2016 who were presumed to have HIT by clinical suspicion were reviewed. Patients were categorized into 3 BMI groups and assigned scores: Normal weight, overweight, and obese. Multivariate analyses were used to identify independent predictors of HIT. RESULTS: A total of 523 patients met inclusion criteria. Multivariate analysis showed that only BMI, Timing, and oTher variables were independently associated with HIT. This new 3-T model was better than a five-component model consisting of the entire 4-T scoring system plus BMI (AUCâ¯=â¯0.791). CONCLUSIONS: Incorporating patient 'T'hickness into a pretest probability model along with platelet 'T'iming and the exclusion of o'T'her causes of thrombocytopenia yields a simplified "3-T" scoring system that has increased predictive accuracy in the ICU.
Subject(s)
Body Mass Index , Fibrinolytic Agents/adverse effects , Heparin/adverse effects , Models, Theoretical , Thrombocytopenia/chemically induced , Adult , Aged , Female , Forecasting , Humans , Intensive Care Units , Male , Middle Aged , Retrospective StudiesABSTRACT
OBJECTIVE: The objective of the study was to characterize house staff time to response and intervention when notified of a patient care issue by pager vs. smartphone. We hypothesized that smartphones would reduce house staff time to response and intervention. DESIGN: Prospective study of all electronic communications was conducted between nurses and house staff between September 2015 and October 2015. The 4-week study period was randomly divided into two 2-week study periods where all electronic communications between intensive care unit nurses and intensive care unit house staff were exclusively by smartphone or by pager, respectively. Time of communication initiation, time of house staff response, and time from response to clinical intervention for each communication were recorded. Outcomes are time from nurse contact to house staff response and intervention. SETTING: Single-center surgical intensive care unit of Cedars-Sinai Medical Center in Los Angeles, California, an academic tertiary care and level I trauma center. PARTICIPANTS: All electronic communications occurring between nurses and house staff in the study unit during the study period were considered. During the study period, 205 nurse-house staff electronic communications occurred, 100 in the phone group and 105 in the pager group. RESULTS: House staff response to communication time was significantly shorter in the phone group (0.5 [interquartile range = 1.7] vs. 2 [3]min, p < 0.001). Time to house staff intervention after response was also significantly more rapid in the phone group (0.8 [1.7] vs. 1 [2]min, p = 0.003). CONCLUSIONS: Dedicated clinical smartphones significantly decrease time to house staff response after electronic nursing communications compared with pagers.
Subject(s)
Communication , Critical Care Nursing/methods , Intensive Care Units , Medical Staff, Hospital/organization & administration , Smartphone/statistics & numerical data , Adult , Female , Humans , Male , Middle Aged , Mobile Applications , Patient Care Team/organization & administration , Prospective Studies , Quality Control , Telecommunications/instrumentation , Time FactorsSubject(s)
Foreign Bodies/etiology , Gastrostomy/adverse effects , Hernia, Inguinal/surgery , Intestinal Obstruction/etiology , Aged, 80 and over , Emergency Service, Hospital , Female , Follow-Up Studies , Foreign Bodies/diagnosis , Foreign Bodies/surgery , Gastrostomy/instrumentation , Hernia, Inguinal/complications , Hernia, Inguinal/diagnosis , Humans , Intestinal Obstruction/surgery , Intestine, Small/surgery , Laparotomy/methods , Risk Assessment , Treatment OutcomeSubject(s)
Aortic Aneurysm, Abdominal/surgery , Arterial Occlusive Diseases/surgery , Blood Vessel Prosthesis Implantation/adverse effects , Endovascular Procedures/adverse effects , Foreign-Body Migration/surgery , Stents/adverse effects , Aged , Angiography/methods , Arterial Occlusive Diseases/diagnosis , Blood Vessel Prosthesis Implantation/methods , Elective Surgical Procedures/adverse effects , Elective Surgical Procedures/methods , Endovascular Procedures/methods , Female , Follow-Up Studies , Humans , Iliac Artery/physiopathology , Iliac Artery/surgery , Laparotomy/methods , Reoperation/methods , Risk Assessment , Tomography, X-Ray Computed/methods , Treatment OutcomeABSTRACT
The treatment of complex wounds is commonplace for plastic surgeons. Standard management is debridement of infected and devitalized tissue and systemic antibiotic therapy. In cases where vital structures are exposed within the wound, coverage is obtained with the use of vascularized tissue using both muscle and fasciocutaneous flaps. The use of nondissolving polymethylmethacrylate and absorbable antibiotic-impregnated beads has been shown to deliver high concentrations of antibiotics with low systemic levels of the same antibiotic. We present a multicenter retrospective review of all cases that used absorbable antibiotic-impregnated beads for complex wound management from 2003 to 2013. A total of 104 cases were investigated, flap coverage was used in 97 cases (93.3%). Overall, 15 patients (14.4%) required reoperation with the highest groups involving orthopedic wounds and sternal wounds. The advantages of using absorbable antibiotic-impregnated beads in complex infected wounds have been demonstrated with minimal disadvantages. The utilization of these beads is expanding to a variety of complex infectious wounds requiring high concentrations of local antibiotics.
