This document summarizes three studies related to trauma scoring and outcomes:
1. A study that found incorporating patient comorbidity (ASA-PS) into trauma scoring (ISS) improved predictive accuracy for mortality, complications, and discharge disposition over ISS alone. The best model was (AIS1)2+(AIS2)2+(Age-Modified ASA-PS)2.
2. A study that evaluated ASA-PS classification as a predictor of mortality in trauma patients. Higher ASA-PS classes were associated with higher mortality rates (2.4-13.2% between classes). ASA-PS showed moderate ability to predict outcomes.
3. A study that evaluated the Surgical
Central Adiposity and Mortality after First-Ever Acute Ischemic StrokeErwin Chiquete, MD, PhD
Erwin Chiquete a José L. Ruiz-Sandoval c Luis Murillo-Bonilla e
Carolina León-Jiménez g Bertha Ruiz-Madrigal d, f Erika Martínez-López d, f
Sonia Román d, f Arturo Panduro d, f Alma Ramos b Carlos Cantú-Brito
Background: The waist-to-height ratio (WHtR) may be a better
adiposity measure than the body mass index (BMI). We
evaluated the prognostic performance of WHtR in patients
with acute ischemic stroke (AIS). Methods: First, we compared
WHtR and BMI as adiposity measures in 712 healthy
adults by tetrapolar bioimpedance analysis. Thereafter,
baseline WHtR was analyzed as predictor of 12-month allcause
mortality in 821 Mexican mestizo adults with first-ever
AIS by a Cox proportional hazards model adjusted for baseline
predictors. Results: In healthy individuals, WHtR correlated
higher than BMI with total fat mass and showed a higher
accuracy in identifying a high percentage of body fat (p <
0.01). In AIS patients a U-shaped relationship was observed
between baseline WHtR and mortality (fatality rate 29.1%).
On multivariate analysis, baseline WHtR ≤ 0.300 or >0.800 independently
predicted 12-month all-cause mortality (h
Serum Uric Acid and Outcome after Acute Ischemic Stroke: PREMIER StudyErwin Chiquete, MD, PhD
Background: Current evidence shows that uric acid is a potent
antioxidant whose serum concentration increases rapidly
after acute ischemic stroke (AIS). Nevertheless, the relationship
between serum uric acid (SUA) levels and AIS
outcome remains debatable. We aimed to describe the
prognostic significance of SUA in AIS. Methods: We studied
463 patients (52% men, mean age 68 years, 13% with glomerular
filtration rate <60 />2) at 30 days, or with
any outcome measure at 3, 6 or 12 months poststroke. After
adjustment for age, gender, stroke type and severity (NIHSS
<9),><24 h. Conclusions: A low SUA
concentration is modestly associated with a very good
short-term outcome. Our findings support the hypothesis
that SUA is more a marker of the magnitude of the cerebral
infarction than an independent predictor of stroke outcome.
Compliance of pharmacological treatment for non-ST-elevation acute coronary syndromes with contemporary guidelines: influence on outcomes
Authors: Hélder Dores, Carlos Aguiar, Jorge Ferreira, Jorge Mimoso, Sílvia Monteiro, Filipe Seixo, José Ferreira Santos, On behalf of Portuguese Registry on Acute Coronary Syndromes (ProACS) Investigators
Central Adiposity and Mortality after First-Ever Acute Ischemic StrokeErwin Chiquete, MD, PhD
Erwin Chiquete a José L. Ruiz-Sandoval c Luis Murillo-Bonilla e
Carolina León-Jiménez g Bertha Ruiz-Madrigal d, f Erika Martínez-López d, f
Sonia Román d, f Arturo Panduro d, f Alma Ramos b Carlos Cantú-Brito
Background: The waist-to-height ratio (WHtR) may be a better
adiposity measure than the body mass index (BMI). We
evaluated the prognostic performance of WHtR in patients
with acute ischemic stroke (AIS). Methods: First, we compared
WHtR and BMI as adiposity measures in 712 healthy
adults by tetrapolar bioimpedance analysis. Thereafter,
baseline WHtR was analyzed as predictor of 12-month allcause
mortality in 821 Mexican mestizo adults with first-ever
AIS by a Cox proportional hazards model adjusted for baseline
predictors. Results: In healthy individuals, WHtR correlated
higher than BMI with total fat mass and showed a higher
accuracy in identifying a high percentage of body fat (p <
0.01). In AIS patients a U-shaped relationship was observed
between baseline WHtR and mortality (fatality rate 29.1%).
On multivariate analysis, baseline WHtR ≤ 0.300 or >0.800 independently
predicted 12-month all-cause mortality (h
Serum Uric Acid and Outcome after Acute Ischemic Stroke: PREMIER StudyErwin Chiquete, MD, PhD
Background: Current evidence shows that uric acid is a potent
antioxidant whose serum concentration increases rapidly
after acute ischemic stroke (AIS). Nevertheless, the relationship
between serum uric acid (SUA) levels and AIS
outcome remains debatable. We aimed to describe the
prognostic significance of SUA in AIS. Methods: We studied
463 patients (52% men, mean age 68 years, 13% with glomerular
filtration rate <60 />2) at 30 days, or with
any outcome measure at 3, 6 or 12 months poststroke. After
adjustment for age, gender, stroke type and severity (NIHSS
<9),><24 h. Conclusions: A low SUA
concentration is modestly associated with a very good
short-term outcome. Our findings support the hypothesis
that SUA is more a marker of the magnitude of the cerebral
infarction than an independent predictor of stroke outcome.
Compliance of pharmacological treatment for non-ST-elevation acute coronary syndromes with contemporary guidelines: influence on outcomes
Authors: Hélder Dores, Carlos Aguiar, Jorge Ferreira, Jorge Mimoso, Sílvia Monteiro, Filipe Seixo, José Ferreira Santos, On behalf of Portuguese Registry on Acute Coronary Syndromes (ProACS) Investigators
MANAGEMENT OF COMPLICATIONS AFTER LRP: HOW TO IMPROVE EARLY CONTINENCE AND MA...Eduard Garcia Cruz
Mi presentación en las jornadas "MINIMALLY INVASIVE PROSTATE SURGERY" en Oporto del 24 y 25 de enero del 2014 - "Gestión de las complicaciones después de la prostatectomía radical laparoscópica (PRL): Cómo mejorar la incontinencia temprana y gestionar la disfunción eréctil".
Mean platelet volume and other platelet volume indices in patients with acute...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Does homeopathic Arnica Montana reduce bruising after blepharoplastyBrett Kotlus
Dr. Brett Kotlus and co-authors evaluated the efficacy of homeopathic arnica montana for ecchymosis (bruising) in conjunction with upper eyelid surgery.
Background: There is a global resolve among Clinicians towards adoption of imaging modalities in the evaluation of appendicitis because clinical algorithms have been disappointing. We sought to determine the authenticity of interobserver variability in ultrasound scan interpretation in a resourceconstrained mission hospital settings, northwestern region of Cameroon. Methods: In this study, we reviewed the standardized diagnostic approach in acute appendicitis and also performed prospective cross observational qualitative testing using sensitivity, specifi city, positive predictive value, negative predictive value, and accuracy to determine the interobserver variability of ultrasonography using the medical database of the two Mission Hospitals, northwestern region of Cameroon from January 2012 to December 2016. A sequential non-randomized convenient sampling was used and data was analyzed using the Statistical Package for the Social Sciences version 22.
How to Get More Local Traffic to Your Website. This presentation reveals effective ways to increase website visitors. Topics are, Local SEO, local directory listings, reputation management, social media, online videos, blog content, content marketing, classified ad sites, mobile marketing, email marketing, PPC, inforgraphics, tagging images, and much more!
MANAGEMENT OF COMPLICATIONS AFTER LRP: HOW TO IMPROVE EARLY CONTINENCE AND MA...Eduard Garcia Cruz
Mi presentación en las jornadas "MINIMALLY INVASIVE PROSTATE SURGERY" en Oporto del 24 y 25 de enero del 2014 - "Gestión de las complicaciones después de la prostatectomía radical laparoscópica (PRL): Cómo mejorar la incontinencia temprana y gestionar la disfunción eréctil".
Mean platelet volume and other platelet volume indices in patients with acute...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Does homeopathic Arnica Montana reduce bruising after blepharoplastyBrett Kotlus
Dr. Brett Kotlus and co-authors evaluated the efficacy of homeopathic arnica montana for ecchymosis (bruising) in conjunction with upper eyelid surgery.
Background: There is a global resolve among Clinicians towards adoption of imaging modalities in the evaluation of appendicitis because clinical algorithms have been disappointing. We sought to determine the authenticity of interobserver variability in ultrasound scan interpretation in a resourceconstrained mission hospital settings, northwestern region of Cameroon. Methods: In this study, we reviewed the standardized diagnostic approach in acute appendicitis and also performed prospective cross observational qualitative testing using sensitivity, specifi city, positive predictive value, negative predictive value, and accuracy to determine the interobserver variability of ultrasonography using the medical database of the two Mission Hospitals, northwestern region of Cameroon from January 2012 to December 2016. A sequential non-randomized convenient sampling was used and data was analyzed using the Statistical Package for the Social Sciences version 22.
How to Get More Local Traffic to Your Website. This presentation reveals effective ways to increase website visitors. Topics are, Local SEO, local directory listings, reputation management, social media, online videos, blog content, content marketing, classified ad sites, mobile marketing, email marketing, PPC, inforgraphics, tagging images, and much more!
Ever considered a career in recruitment? Our Perks at Work campaign highlights just some of the benefits you will enjoy as part of the Cox Purtell Recruitment family.
Predictive value of exercise myocardial perfusion imaging in the Medicare population: the impact of the ability to exercise
Authors: Deborah H. Kwon, Venu Menon, Penny Houghtaling, Elizabeth Lieber, Richard C. Brunken, Manuel D. Cerqueira, Wael A. Jaber
The Impact of Lymph Node Dissection on Survival in Intermediate- and High-Ris...semualkaira
Aimed to evaluate the therapeutic effect of pelvic lymph node dissection (PLND) on survival and determine the predictors of lymph node involvement (LNI) in patients with intermediate- or high-risk prostate cancer (PCa) treated with Radical Prostatectomy
The Impact of Lymph Node Dissection on Survival in Intermediate- and High-Ris...semualkaira
Aimed to evaluate the therapeutic effect of pelvic lymph node dissection (PLND) on survival and determine the
predictors of lymph node involvement (LNI) in patients with intermediate- or high-risk prostate cancer (PCa) treated with Radical
Prostatectomy
Increased risk of ischemic stroke associated with new onset atrial fibrillation complicating acute coronary syndrome- a systematic review and meta-analysis
The Meta-Analysis about the Expression and Prognosis of anti-Ro-52, anti-CENP...eshaasini
We constructed the Meta-analysis to evaluate the existing experimental data and obtain the advantages of the three antinuclear antibodies compared with traditional test items using specific data processing methods and evaluated their value in the diagnosis as well as the differential diagnosis of Sjogren's syndrome and systemic sclerosis. During the process of paper collection, we strictly followed the principle of PICOS to screen the literature, trying to include the literature with a large sample size, controversial and influential results which would make the results of this Meta-analysis more valuable. In this study, Revman and Stata software was used for data processing, and the forest map was drawn to analyze the difference in antibody-positive rate, age, and gender distribution, and other factors. At the same time, a funnel plot was used to evaluate the bias of literature results.
The Meta-Analysis about the Expression and Prognosis of anti-Ro-52, anti-CENP...semualkaira
We constructed the Meta-analysis to evaluate the existing experimental data and obtain the advantages of the three antinuclear antibodies compared with traditional test items using specific data processing methods and evaluated their value in the diagnosis as well as the differential diagnosis of Sjogren's syndrome and systemic sclerosis. During the process of paper collection, we strictly followed the principle of PICOS to screen the literature, trying to include the literature with a large sample size, controversial and influential results which would make the results of this Meta-analysis more valuable. In this study, Revman and Stata software was used for data processing, and the forest map was drawn to analyze the difference in antibody-positive rate, age, and gender distribution, and other factors. At the same time, a funnel plot was used to evaluate the bias of literature results.
The Meta-Analysis about the Expression and Prognosis of anti-Ro-52, anti-CENP...semualkaira
We constructed the Meta-analysis to evaluate the existing experimental data and obtain the advantages of the three antinuclear antibodies compared with traditional test items using specific data processing methods and evaluated their value in the diagnosis as well as the differential diagnosis of Sjogren's syndrome and systemic sclerosis. During the process of paper collection, we strictly followed the principle of PICOS to screen the literature, trying to include the literature with a large sample size, controversial and influential results which would make the results of this Meta-analysis more valuable. In this study, Revman and Stata software was used for data processing, and the forest map was drawn to analyze the difference in antibody-positive rate, age, and gender distribution, and other factors. At the same time, a funnel plot was used to evaluate the bias of literature result
Evaluation of POSSUM scoring system in patients with perforation peritonitis ...Kundan Singh
Background: Continuous audit of clinical practice is an essential part of making improvements in medicine and
enhancing patient care. Recently, physiological and operative severity score for the enumeration of mortality and
morbidity (POSSUM) scores has been developed, which would help to identify those patients who are at increased
risk of developing complications and deaths. This scoring system is based on 12 physiological characteristics of
patient and 6 characteristics of the surgery performed.
Methods: This study was done in Department of surgery at Patna medical college, Patna, Bihar, India from April
2014 to October 2015 on 100 patients. Physiological variables were collected prior to induction of anesthesia and
operative variable collected during operation chi-square test was used for expected and actual mortality differences.
Results: In present study 100 patients of peritonitis due to different cause of intestinal perforation were studied.
Comparison of observed and POSSUM predicted mortality and morbidity rates were done. Observed to expect
mortality and morbidity ratio was 1.005 and 1.001 respectively and there was no statistically significant difference
between the predicted and observed values.
Conclusions: This study confirms and validates the findings of previous work that POSSUM is an accurate and
reliable tool for estimating in-hospital mortality.
The Impact Visceral Abdominal Fat and Muscle Mass Using CT on Patients with S...semualkaira
The association between abdominal visceral
fatty area (VFA) and muscle mass and mortality is not fully understood despite the fact that being overweight is an established
risk factor for the onset and severity of acute pancreatitis (AP). We
assessed the effect of VFA on severe AP (SAP) mortality
The aim of this study was to investigate the association of adipose
and muscle parameters with the severity grade of AP
Comparison of clinical, radiological and outcome characteristics of ischemic ...MIMS Hospital
Here is the latest publication from the department of Neurology in the Journal of Neurology Research, titled, ’Comparison of Clinical, Radiological and Outcome Characteristics of Ischemic Strokes in Different Vascular Territories’ authored by Ashraf V Valappila, c, Dhanya T Janardhanana, Praveenkumar Raghunatha, Abdulla Cherayakkatb, Girija ASa
1. asc-abstracts.org http://www.asc-abstracts.org/
ASC 2015 Searchable Abstracts
9.01 Improving Predictive Value of Trauma Scoring Through Integration of ASA-PS with ISS
D. Stewart1, C. Janowak1, H. Jung1, A. Liepert1, A. O’Rourke1, S. Agarwal1 1University Of
Wisconsin,Surgery,Madison, WI, USA
Introduction: Many methods exist for predicting mortality among adult trauma patients; however, most systems
ignore patient co-morbidity, a significant predictor of outcome, in their calculations. The American Society of
Anesthesiologists Physical Status (ASA-PS), a well-validated and easy-to-use scale, is an assessment of pre-
operative status that has been shown to accurately predict post-operative mortality. Using the ASA-PS as a marker of
cumulative patient comorbidity severity we sought to test whether we would be able to improve the predictive power
of the Injury Severity Score (ISS), the most commonly utilized trauma grading system, with respect to mortality, major
complication, and discharge disposition.
Methods: A retrospective review of a prospectively collected and internally validated database at an academic Level
I trauma center was performed for consecutive adult admissions between 2009-2013. Abbreviated Injury Scale (AIS)
was measured by region (head/neck, face, thorax, abdomen, extremities, general) and severity of injury (1 to 5). ISS
was measured by summing the squares of the three most injured regions [(AIS1)2 + (AIS2)2 + (AIS3)2]. ASA-PS
scores were assigned based on patient comorbidities and then integrated with the traditional ISS in a variety of
permutations, including adjustments of ASA-PS for patient age >70 and using individual AIS components of ISS. We
assessed these various models for predictive ability with a primary outcome of mortality and secondary outcomes of
major complications as per National Trauma Data Bank (NTDB) definitions as well as discharge disposition using
receiver operating characteristic (ROC) analysis. These were compared with the ISS.
Results: All of the ISS/ASA-PS hybrid formulas outperformed ISS alone in predictive power for mortality, major
complication, and discharge disposition. The best overall permutation, (AIS1)2+(AIS2)2+(Age-Modified ASA-PS)2,
yielded an ROC of 0.888 for mortality as compared to ISS with an ROC=0.853 (p<0.001). Similar differences were
seen for discharge disposition (Hybrid ROC=0.743; ISS ROC=0.639, p<0.001) and major complication (Hybrid
ROC=0.761; ISS ROC=0.719, p<0.001).
Conclusion: Incorporating ASA-PS into calculations of trauma scoring is both simple and more predictive of mortality,
major complication, and discharge disposition than the traditional ISS metric. Replacing ISS with this new method,
which takes patient age and comorbid condition into account through adaptation of the ASA-PS improves
prognostication of outcomes and enables care providers to prioritize resources for injured patients.
2. Presentation Time: Tuesday, 7:30am - 9:30am
68.18 ASA-PS is Associated With Mortality Rate Among Adult Trauma Patients
D. Stewart1, C. Janowak1, A. Liepert1, A. O’Rourke1, H. Jung1, S. Agarwal1 1University Of
Wisconsin,Surgery,Madison, WI, USA
Introduction: American Society of Anesthesiologists-Physical Status (ASA-PS) classification assesses pre-
anesthesia surgical risk. Numerous studies correlate higher ASA-PS classification with increased perioperative
mortality. As the number of comorbidities in a traumatically injured patient is correlated to mortality rate, we evaluated
if ASA-PS was an indicator of mortality risk for adult trauma patients.
Methods: Our prospectively collected and internally validated database at an academic Level I trauma center was
retrospectively reviewed for adult patients for 2009-2013. ASA-PS scores were assigned based on patient
comorbidities. Three different methods were used to reflect a lack of concordance on the consideration of patient age
in establishing ASA-PS. In all three methods, NTDB-defined comorbidities were assigned an ASA-PS value and
summed for each risk level. Patients with no comorbidities were considered PS1, while PS2 consisted of those with a
single PS2 condition. Multiple PS2 conditions were considered multi-system disease, elevating a patient’s risk to
PS3. Presence of 3+ PS3 conditions led to a PS4 classification. We then evaluated mortality rates as a primary
outcome for each ASA-PS class using receiver operating characteristic (ROC) and Pearson Chi-Square analysis.
Discharge disposition and major complications were assessed as secondary outcomes.
Results: Model 1 (ASA), considered patient age >70 as a PS2 comorbidity, yielded an ROC of 0.619 for predicting
mortality. Model 2, not including age as a factor in ASA-PS (ASA–w/o Age), produced an ROC of 0.615. Model 3,
Age-Modified ASA (AM-ASA), produced an ROC of 0.648 (p<0.001). Cross-tabulation revealed mortality rates of
3. 2.4%, 2.4%, 4%, and 13.2%, for PS1, PS2, PS3, and PS4, respectively. ASA–w/o Age (2.4%, 2.7%, 3.9%, and
13.2%) showed a similar trend, as did AM-ASA (2.4%, 1.9%, 2.9%, 10.2%), albeit with a dip in mortality rate for PS2.
All three ASA models had two-sided p<0.001 under Pearson Chi-Square analysis of mortality rates. For discharge
disposition (ASA ROC=0.668; ASA–w/o Age ROC=0.650; AM-ASA ROC=0.693) and major complications (ASA
ROC=0.648; ASA–w/o Age ROC=0.653; AM-ASA ROC=0.641) all three models showed moderate predictive power.
Conclusion: ASA-PS classification models show an association between higher risk status and increasing mortality
rate. ASA-PS is moderately predictive of mortality, discharge disposition, and major complications per ROC analysis.
AM-ASA performed significantly better for mortality and discharge disposition, indicating that age can serve as an
adjustment to the codified system to improve accuracy in the trauma population.
Presentation Time: Thursday, 1:30pm - 3:30pm
39.07 The Surgical Apgar Score in Major Esophageal Surgery
C. F. Janowak2, L. Taylor2, J. Blasberg1, J. Maloney1, R. Macke1 1University Of Wisconsin,Division Of
Cardiothoracic Surgery,Madison, WI, USA 2University Of Wisconsin,Department Of Surgery,Madison, WI, USA
Introduction: Most postoperative assessments and triage decisions are based on subjective evaluation of a
patient’s risk factors and overall condition. The Surgical Apgar Score (SAS) is a validated prognostic tool used to
predict postoperative morbidity and mortality in a wide variety of surgical patients. The esophagectomy population is
a unique subset of surgical patients who are high risk for post-operative complication and disposition resources. An
objective prognostic metric is an appealing and efficient way to allocate limited care resources to the sickest of
4. postoperative patients. Although other more complex risk calculators have been developed, the SAS is a simple,
bedside usable, model that has been validated in a variety of surgical populations. We evaluated the reliability of the
SAS in a major esophageal surgery population.
Methods: A retrospective review of a prospectively collected and internally validated database of cardiothoracic
operations was performed for consecutive esophagectomies from 2009 to 2013. Basic demographics, comorbidities,
post-operative complications, and intraoperative variables were collected for all patients. The primary outcomes
studied were mortality and NSQIP-defined in-hospital major complication; secondary outcomes were prolonged length
of hospital stay (LOS) greater than 10 days and post-operative disposition. We used descriptive statistics, receiver
operating characteristics (ROC) and Pearson Chi-Square analysis to analyze primary and secondary outcome
prediction efficacy of SAS. Preoperative comorbid conditions were also analyzed for association with post-operative
outcomes prognostication using odds ratio (OR) analysis.
Results: A total of 172 consecutive esophageal resections over four years were reviewed. Overall mortality was 5
deaths (2.9%) with 4 occurring within 30 days of surgery, 1 after discharge within 30 days, and 1 after 90 days of
hospitalization. Overall SAS 9-10, n=16; SAS 7-8, n=113; SAS 5-6, n= 42; and SAS ≤ 4, n=1. Of these, 34.3% had a
major complication, 27.3% had a prolonged LOS, and 12.2% were discharged to a care facility other than home. No
significant correlation was demonstrated between complication, LOS, or discharge disposition and the SAS with
respective ROC of 0.44, 0.43, and 0.44. Of the preoperative comorbid conditions analyzed, only neoadjuvant
chemoradiation significantly increased the risk of any outcome, with an OR of 3.59 (95% CI 1.38-9.37, p < 0.01) risk
of discharge to care other than home.
Conclusion: The perioperative performance measure of the SAS does not appear to have a good ability to predict
major post-operative adverse outcomes in a major esophageal surgery population.