Are We Overusing Coagulation Studies in the Emergency Department?

Methods: This retrospective observational study, conducted in the ED of King Saud University Medical City (KSUMC) in Riyadh, Saudi Arabia, during July and August of 2021(2 months) examined coagulation profile requests. Patients' demographic data (age and gender), medical and clinical history (presenting complaint, comorbidities, and diagnosis), the use of antiplatelets or anticoagulant agents and laboratory values for PT, APTT, and INR were collected. We calculated the total cost of unnecessary coagulation profile testing based on the independent assessment of two ED consultants. Results: Of 1,754 patients included in the study, 811 (46.2%) were males and 943 (53.8%) were females, with a mean age of 42.1 ± 18.5 years. There were 29 (1.7%) patients with liver disease and 21 (1.2%) patients had thromboembolic disease. The majority of the patients' results were within normal levels of PT (n = 1,409, 80.3%), APTT (n = 1,262, 71.9%), and INR (n = 1,711, 97.4%). Evidence of active bleeding was detected in 29 patients (1.7%). Among patients with bleeding only one had an abnormal INR (3.01) and was on warfarin. Forty-six (2.6%) patients had elevated INR level. Cohen's kappa between the two consultants was recorded at 0.681 (substantial agreement) in their assessment of the appropriateness of coagulation tests requests and both consultants believed that 1,051 tests (59.9%) were not indicated and were unnecessary. The expected annual cost saving if the unnecessary tests were removed would be around SAR 1,897,200 (approximately US$ 503,232) which is about SAR 180000 (US$ 48000)/1000 patients. Conclusion: This study showed that coagulation tests are overused in the ED. More than half of coagulation profile tests in our study population were deemed unnecessary and associated with significant cost. Targeted testing based on specific patient presentation and medical history can guide physicians in wisely choosing who needs coagulation studies.

Oncological outcomes of elective versus emergency surgery for colon cancer: A tertiary academic center experience.

Background: In this study, we aimed to identify the oncological outcomes in colon cancer patients who underwent elective versus emergency curative resection. Methods: All patients who underwent curative resection for colon cancer between July 2015 and December 2019 were retrospectively reviewed and analyzed. Patients were divided into two groups based on the presentation into elective and emergency groups. Results: A total of 215 patients with colon cancer were admitted and underwent curative surgical resection. Of those, 145 patients (67.4%) were elective cases, and 70 (32.5%) were emergency cases. Family history of malignancy was positive in 44 patients (20.5%) and significantly more common in the emergency group (P = 0.016). The emergency group had higher T and TNM stages (P = 0.001). The 3-year survival rate was 60.9% and significantly less in the emergency group (P = 0.026). The mean duration from surgery to recurrence, 3-year disease-free survival, and overall survival were 1.19, 2.81, and 3.11, respectively. Conclusion: Elective group was associated with better 3-year survival, longer overall, and 3-year disease-free survival compared to the emergency group. The disease recurrence rate was comparable in both groups, mainly in the first two years after curative resection.

The burden of viral infections in pediatric intensive care unit between endemic and pandemic coronavirus infections: A tertiary care center experience.

OBJECTIVES: To measure the prevalence of viral infections, length of stay (LOS), and outcome in children admitted to the pediatric intensive care unit (PICU) during the period preceding the COVID-19 pandemic in a MERS-CoV endemic country. METHODS: A retrospective chart review of children 0-14 years old admitted to PICU with a viral infection. RESULTS: Of 1736 patients, 164 patients (9.45%) had a positive viral infection. The annual prevalence trended downward over a three-year period, from 11.7% to 7.3%. The median PICU LOS was 11.6 days. Viral infections were responsible for 1904.4 (21.94%) PICU patient-days. Mechanical ventilation was used in 91.5% of patients, including noninvasive and invasive modes. Comorbidities were significantly associated with intubation (P-value = 0.025). Patients infected with multiple viruses had median pediatric index of mortality 2 (PIM 2) scores of 4, as compared to 1 for patients with single virus infections (p < 0.001), and a median PICU LOS of 12 days, compared to 4 in the single-virus group (p < 0.001). Overall, mortality associated with viral infections in PICU was 7 (4.3%). Patients with viral infections having multiple organ failure were significantly more likely to die in the PICU (p = 0.001). CONCLUSION: Viral infections are responsible for one-fifth of PICU patient-days, with a high demand for mechanical ventilation. Patients with multiple viral infections had longer LOS, and higher PIM 2 scores. The downward trend in the yearly rate of PICU admissions for viral infections between the end of the MERS-CoV outbreak and the start of the COVID-19 pandemic may suggest viral interference that warrants further investigations.

The Safety of Large-Amount Liposuction: A Retrospective Analysis of 28 Cases.

Aim: Our study aims to assess the safety of large amounts of liposuction in a new light. Materials and Methods: This is a retrospective review of patients who underwent large-volume liposuction from August 2020 to April 2021. Patient demographics, liposuction areas, the amount of infiltrate and aspirate, the surface area of liposuction areas, anesthesia duration, pain score after surgery, preoperative and 4-h postoperative hemoglobin, and basic metabolic panel (sodium, potassium, creatinine, urea) were measured. Results: Out of the 28 patients, 26 (92.85%) were females. The mean age was 37.1 years old. The mean preoperative hemoglobin was 13.73 g/dL. The average anesthesia time was 220.39 min. The average amount of liposuction infiltrated was 7.55 L, and the average amount of liposuction aspirate was 6.83 L. The mean hemoglobin 4 h postoperatively was 13.7 g/dL. Conclusions: With proper patient selection and a comprehensive physical exam with preoperative blood workup performed in an accredited facility with a highly experienced plastic surgeon and anesthesiologist, mega liposuction can be safely performed as a day surgery procedure.

A 16-Year-Old Saudi Boy with a Symptomatic Large Splenic Epidermoid Cyst.

BACKGROUND Splenic epidermoid cysts rarely occur and the majority of cases are discovered incidentally. However, large cysts can present with symptoms due to mass effect. Splenectomy is the treatment indicated for most splenic cysts and definitive diagnosis can only be made after histopathological examination. CASE REPORT A 16-year-old boy was referred to the general surgery clinic from a local hospital with a history of abdominal asymmetry, distention, decreased oral intake, and early satiety. Abdominal computed tomography (CT) was performed and revealed a large splenic mass measuring 18.4×14×17.4 cm with multiple mural calcifications at the rim. The mass was displacing the stomach, jejunal loops, pancreas, left kidney, and transverse colon. Preoperative biopsy was not possible because a parasitic cyst was suspected; therefore, splenectomy was performed through midline laparotomy. The patient recovered well, with no complications except for transient reactive thrombocytosis. Histopathology was reported as benign epithelial cysts, with the most likely diagnosis being a splenic epidermoid cyst. Subsequently, the patient was followed up at the surgery clinic. During the last outpatient visit, the patient exhibited good recovery with no problems. CONCLUSIONS Large splenic epidermoid cysts are rare, particularly in the pediatric population. Nonspecific clinical and radiological findings are hurdles to an accurate diagnosis. Preoperative diagnosis is crucial to determine the type of intervention. However, a final diagnosis can only be made after histopathological examination.