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2.
Artigo em Inglês | MEDLINE | ID: mdl-32023168

RESUMO

Background: Acute appendicitis is one of the most common surgical emergencies globally. Its incidence is increasing in low- and middle-Human Development Index countries (LMHDICs). Although a proportion of patients can be treated successfully with non-operative management consisting of antibiotics, supportive therapy, and close observation, current diagnostic algorithms lack the granularity to identify these patients accurately. Methods: We reviewed published literature describing practice patterns and clinical outcomes for appendicitis in LMHDICs and compared them with studies from high-Human Development Index countries, as well as guidelines published by international surgical societies. Results: We identified shortcomings in current diagnostic and therapeutic strategies used in LMHDICs. Delays in obtaining surgical care inherent in many LMHDIC healthcare systems make prompt surgical care the mainstay for the treatment of acute appendicitis. Laparoscopic appendectomy leads to better outcomes than open appendectomy in resource-constrained settings and when available should be the surgical technique of choice. Conclusions: Acute appendicitis is common in LMHDICs, and if possible, laparoscopic appendectomy should be the procedure of choice.

3.
Surg Infect (Larchmt) ; 21(2): 94-100, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31464571

RESUMO

Background: Tuberculosis can cause acute abdominal pathology requiring operation. While most cases of tuberculosis resolve with appropriate anti-mycobacterial therapy, a surgical procedure still may be required. We sought to describe the modern epidemiology of acute abdominal pathology associated with tuberculosis in the United States. Methods: We retrospectively analyzed the 2010-2014 National Inpatient Sample for admissions associated with International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes for both tuberculosis and acute abdominal pain. Cases of acute abdominal tuberculosis were defined as inpatient admissions with a diagnosis of tuberculosis and a diagnosis of acute abdominal pain. Outcomes of interest included need for abdominal operation and death after operation. Adjusted analyses accounting for survey methodology were performed. Results: There were 66,034 inpatient admissions associated with tuberculosis of which 3638 (6%) included a diagnosis of acute abdominal pain. Among cases, 1578 (43%) were 45-64 years old and 2344 (64%) were male. Most patients were Hispanic (n = 1090, 30%) or black (n = 924, 25%) and were in the lowest quartile of income by zip code (n = 1367, 38%). A total of 347 (0.5% of total) patients underwent an operation. Procedures included peritoneal biopsy (n = 136, 39%), repair or resection of a hollow viscus (n = 122, 35%), and abdominal exploration (n = 111, 32%). In adjusted analysis, undergoing a surgical procedure was found to depend on the type of tuberculosis infection (odds ratio [OR] = 1.17 for intestinal, peritoneal, or genitourinary tuberculosis versus other types, 95% confidence interval [CI] = [1.12-1.22]) and whether the patient was white or Asian race versus black and Hispanic (OR = 1.11, 95% CI [1.02-1.21]). Thirty-nine (11%) of the 347 patients who underwent a surgical procedure died during hospitalization. Conclusions: An operation still may be required for patients with tuberculosis presenting with acute abdominal pain. Black and Hispanic patients are less likely to receive surgical intervention than whites or Asians. The inhospital deaths from acute abdominal pain necessitating operation among patients with tuberculosis are high.

4.
Trauma Surg Acute Care Open ; 4(1): e000374, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31803846

RESUMO

Background: Venomous snakebites can result in serious morbidity and mortality. In the USA, the "T's of snakebites" (testosterone, teasing, touching, trucks, tattoos & toothless (poverTy), Texas, tequila, teenagers, and tanks) originate from anecdotes used to colloquially highlight venomous snakebite risk factors. We performed an epidemiologic assessment of venomous snakebites in the USA with the objective of evaluating the validity of the "T's of snakebites" at a national level. Methods: We performed a retrospective analysis of the National Emergency Department Sample. Data from January 1, 2016 to December 31, 2016 were obtained. All emergency department (ED) encounters corresponding to a venomous snakebite injury were identified using the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes. Primary outcomes were mortality and inpatient admission. Demographic, injury, and hospital characteristics were assessed. Data were analyzed according to survey methodology. Weighted values are reported. Results: In 2016, 11 138 patients presented to an ED with a venomous snakebite. There were 4173 (37%) persons aged 18 to 44, and 7213 (65%) were male. Most snakebites were reported from the South (n=9079; 82%), although snakebites were reported from every region in the USA. Only 3792 (34%) snakebites occurred in rural counties. Persons in the lowest income quartile by zip code were the most heavily represented (n=4337; 39%). The most common site of injury was the distal upper extremity (n=4884; 44%). Multivariate analysis revealed that species of snake (OR=0.81; 95% CI 0.73 to 0.88) and older age (OR=1.42; 95% CI 1.08 to 1.87) were associated with hospital admission. There were <10 inpatient deaths identified, and no variables were predictive of death. Discussion: Some of the "T's of snakebites" may be valid colloquial predictors of the risk for venomous snakebites. Based on national data, common demographics of venomous snakebite victims include lower income, Caucasian, and adult men in the South who are bit on the upper extremity. Understanding common demographics of venomous snakebite victims can effectuate targeted public health prevention messaging. Level of evidence: IV.

5.
JAMA Surg ; 2019 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-31722004

RESUMO

Importance: Armed conflict in the 21st century poses new challenges to a humanitarian surgical response, including changing security requirements, access to patients, and communities in need, limited deployable surgical assets, resource constraints, and the requirement to address both traumatic injuries as well as emergency surgical needs of the population. At the same time, recent improvements in trauma care and systems have reduced injury-related mortality. This combination of new challenges and medical capabilities warrants reconsideration of long-standing humanitarian surgery protocols. Objective: To describe a consensus framework for surgical care designed to respond to this emerging need. Design, Setting, and Participants: An international group of 35 representatives from humanitarian agencies, US military, and academic trauma programs was invited to the Stanford Humanitarian Surgical Response in Conflict Working Group to engage in a structured process to review extant trauma protocols and make recommendations for revision. Main Outcomes and Measures: The working group's method adapted core elements of a modified Delphi process combined with consensus development conference from August 3 to August 5, 2018. Results: Lessons from civilian and military trauma systems as well as recent battlefield experiences in humanitarian settings were integrated into a tiered continuum of response from point of injury through rehabilitation. The framework addresses the security and medical requirements as well as ethical and legal principles that guide humanitarian action. The consensus framework includes trained, lay first responders; far-forward resuscitation/stabilization centers; rapid damage control surgical access; and definitive care facilities. The system also includes nontrauma surgical care, injury prevention, quality improvement, data collection, and predeployment training requirements. Conclusions and Relevance: Evidence suggests that modern trauma systems save lives. However, the requirements of providing this standard of care in insecure conflict settings places new burdens on humanitarian systems that must provide both emergency and trauma surgical care. This consensus framework integrates advances in trauma care and surgical systems in response to a changing security environment. It is possible to reduce disparities and improve the standard of care in these settings.

7.
Trauma Surg Acute Care Open ; 4(1): e000334, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31321313

RESUMO

Case Presentation: A 38-year-old man was brought in by ambulance as a trauma activation after sustaining a self-inflicted stab wound in the left upper quadrant with a kitchen knife. His primary survey was unremarkable and his vital signs were normal. Secondary survey revealed a 2 cm transverse stab wound inferior and medial to the left nipple. Extended focused assessment with sonography for trauma (FAST) did not show intra-abdominal or pericardial fluid and chest X-ray did not show a definite pneumothorax or hemothorax. What would you do?: Wound exploration at bedside.Admit for observation and serial examinations.Exploratory laparotomy and open repair of traumatic diaphragmatic injury (TDI).Thoracotomy and open repair of TDI.Diagnostic laparoscopy and laparoscopic repair of TDI.

8.
Disaster Med Public Health Prep ; 13(5-6): 1074-1082, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31203832

RESUMO

INTRODUCTION: The term "golden hour" describes the first 60 minutes after patients sustain injury. In resource-available settings, rapid transport to trauma centers within this time period is standard-of-care. We compared transport times of injured civilians in modern conflict zones to assess the degree to which injured civilians are transported within the golden hour in these environments. METHODS: We evaluated PubMed, Ovid, and Web of Science databases for manuscripts describing transport time after trauma among civilian victims of trauma from January 1990 to November 2017. RESULTS: The initial database search identified 2704 abstracts. Twenty-nine studies met inclusion and exclusion criteria. Conflicts in Yugoslavia/Bosnia/Herzegovina, Syria, Afghanistan, Iraq, Israel, Cambodia, Somalia, Georgia, Lebanon, Nigeria, Democratic Republic of Congo, and Turkey were represented, describing 47 273 patients. Only 7 (24%) manuscripts described transport times under 1 hour. Transport typically required several hours to days. CONCLUSION: Anticipated transport times have important implications for field triage of injured persons in civilian conflict settings because existing overburdened civilian health care systems may become further overwhelmed if in-hospital health capacity is unable to keep pace with inflow of the severely wounded.

9.
Wilderness Environ Med ; 30(3): 244-250, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31248816

RESUMO

INTRODUCTION: Human encounters with the cougar (Puma concolor) are rare in the United States but may be fatal. METHODS: We performed a retrospective analysis of cougar attacks in the United States. We asked Fish and Wildlife Department officials from the 16 states in which cougars are known to live to identify all verified cougar attacks recorded in state history. Variables describing the human victim, cougar, and conditions surrounding the attack were recorded. The Fisher exact test was used for comparison. RESULTS: Ten states reported 74 cougar attacks from 1924 to 2018. Persons less than 18 y of age were heavily represented among victims; 48% were <18 y old, and 35% were less than 10 y old. Attacks were more common in the summer and fall months. Most attacks occurred during daylight hours. The head, neck, and chest were the most common anatomic sites of injury. Sixteen (46%) victims were hospitalized after being attacked, among the 35 victims with these data available. Eleven (15%) attacks were fatal among 71 reports with this information. None of the hospitalized victims died (P=0.02). No victim variables were predictive of death. CONCLUSIONS: Cougar attacks are uncommon but can be fatal. Attacks commonly affect children and young adults, although all age groups are at risk of attack and death. Most attacks occur during the daytime in the summer and fall. As development and recreational activities put humans in closer contact with cougars, establishing validated public health messaging is critical to minimize injurious encounters.


Assuntos
Mordeduras e Picadas/epidemiologia , Puma , Adolescente , Adulto , Idoso , Animais , Mordeduras e Picadas/etiologia , Mordeduras e Picadas/mortalidade , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos/epidemiologia , Adulto Jovem
10.
Wilderness Environ Med ; 30(2): 150-154, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31003883

RESUMO

BACKGROUND: BASE (building, antenna, span, earth) jumping involves jumping from fixed objects with specialized parachutes. BASE jumping is associated with less aerodynamic control and flight stability than skydiving because of the lower altitude of jumps. Injuries and fatalities are often attributed to bad landings and object collision. METHODS: We performed a retrospective analysis of the 2010-2014 National Emergency Department Sample database, a nationally representative sample of all visits to US emergency departments (EDs). BASE jumping-associated injuries were identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes [E004.0]. Outcomes evaluated included morbidity, mortality, inpatient admission, and costs. Adjusted analyses accounting for survey methodology were performed. RESULTS: After weighting, 1790 BASE-associated ED presentations were identified with 358±28 injuries annually. A total of 1313 patients (73%) were aged 18 to 44 y, and 1277 (71%) were male. Nine hundred seventy-six (55%) multiple body system injuries and 677 (38%) isolated extremity injuries were reported. There were 1588 (89%) patients discharged home from the ED; only 144 (7%) were admitted as inpatients. On multivariate logistic regression, only anatomic site of injury was associated with inpatient admission (odds ratio=0.6, P<0.001, 95% CI 0.5-0.8). Including ED and inpatient costs, BASE injuries cost the US healthcare system approximately $1.7 million annually. No deaths were identified within the limitations of the survey design. CONCLUSIONS: Although deemed one of the most dangerous extreme sports, many patients with BASE injuries surviving to arrival at definitive medical care do not require inpatient admission.


Assuntos
Traumatismos em Atletas/epidemiologia , Aviação/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Traumatismos em Atletas/economia , Serviço Hospitalar de Emergência/economia , Feminino , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos/epidemiologia
11.
World J Emerg Surg ; 14: 8, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30858872

RESUMO

In the last three decades, Clostridium difficile infection (CDI) has increased in incidence and severity in many countries worldwide. The increase in CDI incidence has been particularly apparent among surgical patients. Therefore, prevention of CDI and optimization of management in the surgical patient are paramount. An international multidisciplinary panel of experts from the World Society of Emergency Surgery (WSES) updated its guidelines for management of CDI in surgical patients according to the most recent available literature. The update includes recent changes introduced in the management of this infection.


Assuntos
Infecções por Clostridium/terapia , Clostridium difficile/patogenicidade , Complicações Pós-Operatórias/terapia , Antibacterianos/uso terapêutico , Gestão de Antimicrobianos , Infecções por Clostridium/diagnóstico , Enterocolite Pseudomembranosa/etiologia , Enterocolite Pseudomembranosa/prevenção & controle , Transplante de Microbiota Fecal/métodos , Transplante de Microbiota Fecal/tendências , Guias como Assunto , Humanos , Incidência , Controle de Infecções/métodos , Controle de Infecções/tendências , Fatores de Risco
12.
Surg Infect (Larchmt) ; 20(2): 139-145, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30628859

RESUMO

BACKGROUND: Abdominal infections following surgery have many severe consequences. Several effective, well-evaluated infection prevention and control processes exist to avoid these infections. METHODS: This manuscript reviews and provides supporting evidence for common management strategies useful to avoid postoperative abdominal infection. RESULTS: Prevention of abdominal infection begins with preparation of the environment using standard infection control practices. Peri-operative use of systemic antibiotics, an antibiotic bowel preparation in colorectal surgery, and effective antiseptic preparation of the surgical site all reduce infection rates. Peri-operative supplemental oxygenation, maintenance of core body temperature, and physiologic euglycemia will reduce both incisional and organ-space infections in the abdominal surgery patient. Strategic use of irrigation and drain placement may be useful in some circumstances. CONCLUSION: Specific methods of prevention are documented to reduce intra-abdominal infections. Prevention requires a multi-disciplinary team including the surgeon, anesthesiologist, and all operating room personnel.


Assuntos
Cirurgia Geral/métodos , Controle de Infecções/métodos , Infecções Intra-Abdominais/prevenção & controle , Infecção da Ferida Cirúrgica/prevenção & controle , Humanos
13.
Surg Infect (Larchmt) ; 20(1): 95-99, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30359547

RESUMO

BACKGROUND: Intussusception is the process by which one segment of intestine "telescopes" into another segment. Escherichia coli O157:H7 is a rare cause of intussusception that uncommonly requires a surgical procedure. METHODS: Case report and literature review. RESULTS: We reviewed 25 cases of infection with E. coli O157:H7 that resulted in intussusception, all of which involved minors. Our case identifies the first reported adult with intussusception secondary to E. coli infection necessitating surgical intervention. In total, two (8%) required operation. Hemolytic uremic syndrome did not develop in any patient, and there were no deaths. CONCLUSIONS: E. coli O157:H7-associated intussusception is rare and does not commonly require operation. If conservative management fails, a surgical procedure may be necessary to resect the pathologic lead point.


Assuntos
Infecções por Escherichia coli/complicações , Infecções por Escherichia coli/microbiologia , Escherichia coli O157/isolamento & purificação , Intussuscepção/etiologia , Intussuscepção/microbiologia , Adolescente , Criança , Pré-Escolar , Infecções por Escherichia coli/patologia , Feminino , Humanos , Lactente , Intussuscepção/patologia , Masculino , Radiografia Abdominal , Tomografia Computadorizada por Raios X
14.
J Thorac Dis ; 10(Suppl 26): S3218-S3219, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30370117
15.
Wilderness Environ Med ; 29(4): 425-430, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30241931

RESUMO

INTRODUCTION: Rock climbing and mountaineering are popular outdoor recreational activities. More recently, indoor climbing has become popular, which has increased the number of persons at risk for climbing-related injuries. The purpose of this study was to assess the morbidity, mortality, and healthcare cost due to climbing-related injury among persons presenting to US emergency departments (ED). METHODS: We performed a retrospective analysis of the 2010 to 2014 National Emergency Department Sample database, a nationally representative sample of all visits to US EDs. Rock climbing, mountain climbing, and wall climbing injuries were identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes (E004.0). Outcomes evaluated included morbidity, mortality, inpatient admission, and costs. Adjusted analyses accounting for survey methodology were performed. RESULTS: A weighted-estimate 15,116 adult ED visits were associated with climbing-related injury. Patient age was 32.8±14.7 (mean±SD) (95% CI: 32.1-33.5) y, and 62% of patients were male. The majority of the injuries occurred in the Western census region (9593; 63%). Less than 1% of all climbing-related visits resulted in death. Only of injury severity score >15 was associated with death (P = 0.005). A total of 1610 (11%) of patients were admitted as inpatients. Accounting for ED and inpatient costs, climbing-related injuries cost the US healthcare system approximately $102 (95% CI: $75-130) million USD for the 5-y period, averaging $20±9.5 million USD per y. CONCLUSIONS: Most persons with climbing-related injuries presenting to EDs do not require inpatient admission. Although death is rare among patients with climbing-related injuries, the costs of injuries in survivors remain high.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Traumatismos em Atletas/epidemiologia , Montanhismo/lesões , Acidentes por Quedas/economia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Traumatismos em Atletas/economia , Traumatismos em Atletas/mortalidade , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Vigilância da População , Estudos Retrospectivos , Índice de Gravidade de Doença , Estados Unidos/epidemiologia , Adulto Jovem
16.
Surg Infect (Larchmt) ; 19(6): 593-602, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30156997

RESUMO

BACKGROUND: Surgical infections are a major cause of morbidity and mortality in low- and middle-income countries (LMICs). Inadequately reprocessed surgical instruments can be a vector for pathogens. Little has been published on the current state of surgical instrument reprocessing in LMICs. METHODS: We performed a scoping review of English-language articles in PubMed, Web of Science, and Google Scholar databases describing current methods, policies, and barriers to surgical instrument reprocessing in LMICs. We conducted qualitative analysis of all studies to categorize existing practices and barriers to successful surgical instrument reprocessing. Barriers were non-exclusively categorized by theme: training/education, resource availability, environment, and policies/procedures. Studies associating surgical infections with existing practices were separately evaluated to assess this relationship. RESULTS: Nine hundred seventy-two abstracts were identified. Forty studies met criteria for qualitative analysis and three studies associated patient outcomes with surgical instrument reprocessing. Most studies (n = 28, 70%) discussed institution-specific policies/procedures; half discussed shortcomings in staff training. Sterilization (n = 38, 95%), verification of sterilization (n = 19, 48%), and instrument cleaning and decontamination (n = 16, 40%) were the most common instrument reprocessing practices examined. Poor resource availability and the lack of effective education/training and appropriate policies/procedures were cited as the common barriers. Of the case series investigating surgical instrument reprocessing with patient outcomes, improperly cleaned and sterilized neurosurgical instruments and contaminated rinse water were linked to Pseudomonas aeruginosa ventriculitis and Mycobacterium port site infections, respectively. CONCLUSIONS: Large gaps exist between instrument reprocessing practices in LMICs and recommended policies/procedures. Identified areas for improvement include instrument cleaning and decontamination, sterilization aspects of instrument reprocessing, and verification of sterilization. Education and training of staff responsible for reprocessing instruments and realistic, defined policies and procedures are critical, and lend themselves to improvement interventions.


Assuntos
Países em Desenvolvimento , Desinfecção/métodos , Política Organizacional , Instrumentos Cirúrgicos/efeitos adversos , Contaminação de Equipamentos/prevenção & controle , Humanos , Instrumentos Cirúrgicos/normas , Infecção da Ferida Cirúrgica/prevenção & controle
18.
Surg Infect (Larchmt) ; 19(3): 254-263, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29341840

RESUMO

BACKGROUND: Musculoskeletal trauma represents a large source of morbidity in low and middle human development index countries (LMHDICs). Open reduction and internal fixation (ORIF) of traumatic long bone fractures definitively manages these injuries and restores function when conducted safely and effectively. Surgical site infections (SSIs) are a common complication of operative fracture fixation, although the risks of infection are ill-defined in LMHDIC. PATIENTS AND METHODS: This study reviewed systematically all studies describing SSI after ORIF in LMDHICs. Studies were reviewed based on their qualitative characteristics, after which a quantitative synthesis of weighted pooled infection rates based on available patient-level data was performed to estimate published incidence of SSI. RESULTS: Forty-two studies met criteria for qualitative review and 32 studies comprising 3,084 operations were included in the quantitative analysis. Among 3,084 operations, the weighted pooled SSI rate was 6.4 infections per 100 procedures (95% confidence interval [CI] 4.6-8.2 infections per 100 procedures). Higher rates of infection were noted among the sub-group of open fractures (95% CI 13.9-23.0 infections per 100 procedures). Lower extremity injuries and procedures utilizing intra-medullary nails also had slightly higher rates of infection versus upper extremity procedures and other fixation devices. CONCLUSIONS: Reported rates of SSI after ORIF are higher in LMHDICs, and may be driven by high rates of infection in the sub-group of open fractures. This study provides a baseline SSI rate obtained from literature produced from LMHDICs. Infection rates are highly dependent on fracture sub-types.


Assuntos
Fixação Interna de Fraturas , Fraturas Ósseas , Redução Aberta , Infecção da Ferida Cirúrgica/epidemiologia , Feminino , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/estatística & dados numéricos , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/cirurgia , Humanos , Masculino , Redução Aberta/efeitos adversos , Redução Aberta/estatística & dados numéricos
19.
Wilderness Environ Med ; 29(1): 36-44, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29373216

RESUMO

INTRODUCTION: To review recent (2008-2015) United States mortality data from deaths caused by nonvenomous and venomous animals and compare with historical data. METHODS: The Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database was queried to return all animal-related fatalities between 2008 and 2015. Mortality frequencies for animal-related fatalities were calculated using the estimated 2011 United States population. Inclusion criteria included all mortalities that were a consequence of bite, contact, attack, or envenomation (International Classification of Diseases 10th revision codes W53-W59 and X20-X29). RESULTS: There were 1610 animal-related fatalities, with the majority from nonvenomous animals (4.8 deaths per 10 million persons annually). The largest proportion of animal-related fatalities was due to "other mammals," largely composed of horses and cattle. Deaths attributable to Hymenoptera (hornets, wasps, and bees) account for 29.7% of the overall animal-related fatalities and have been steady over the last 20 years. Dog-related fatality frequencies are stable, although the fatality frequency of 4.6 deaths per 10 million persons among children 4 years of age or younger was nearly 4-fold greater than in the other age groups. CONCLUSIONS: Appropriate education and prevention measures aimed at decreasing injury from animals should be directed at the high-risk groups of agricultural workers and young children with dogs. Public policy and treatment pricing should align to ensure adequate available medication for those at risk of anaphylaxis from stings from Hymenoptera.


Assuntos
Animais Domésticos , Mordeduras e Picadas/mortalidade , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Animais , Mordeduras e Picadas/etiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos/epidemiologia , Adulto Jovem
20.
Surg Infect (Larchmt) ; 19(3): 237-244, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29058569

RESUMO

BACKGROUND: Acute appendicitis is a common surgical emergency worldwide. Early intervention is associated with better outcomes. In low and middle Human Development-Index Countries (LMHDICs), late presentation and poor access to healthcare facilities can contribute to greater illness severity and higher complication rates, such as post-operative surgical site infections (SSIs). The current rate of SSIs post-appendectomy in low- and middle-index settings has yet to be described. METHODS: We performed a systemic review of the literature describing the incidence and management of SSIs after appendectomy in LMHDICs. We conducted qualitative and quantitative analysis of the data in manuscripts describing patients undergoing appendectomy to establish a baseline SSI rate for this procedure in these settings. RESULTS: Four hundred twenty-three abstracts were initially identified. Of these, 35 studies met the criteria for qualitative and quantitative analysis. The overall weighted, pooled SSI rated were 17.9 infections/100 open appendectomies (95% confidence interval [CI] 10.4-25.3 infections/100 open appendectomies) and 8.8 infections/100 laparoscopic appendectomies (95% CI 4.5-13.2 infections/100 laparoscopic appendectomies). The SSI rates were higher in complicated appendicitis and when pre-operative antibiotic use was not specified. CONCLUSIONS: Observed SSI rates after appendectomy in LMHDICs are dramatically higher than rates in high Human Development-Index Countries. This is particularly true in cases of open appendectomy, which remains the most common surgical approach in LMHDICs. These findings highlight the need for SSI prevention in LMHDICs, including prompt access to medical and surgical care, routine pre-operative antibiotic use, and implementation of bundled care packages and checklists.


Assuntos
Apendicectomia/efeitos adversos , Apendicectomia/estatística & dados numéricos , Infecção da Ferida Cirúrgica/epidemiologia , Apendicectomia/métodos , Países Desenvolvidos , Feminino , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/estatística & dados numéricos , Masculino
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