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Jordan A Weinberg

Publications and source records attributed to Jordan A Weinberg.

6 recordsLinked to original sources
PubMed2006

"Awake" laparoscopy for the evaluation of equivocal penetrating abdominal wounds.

BACKGROUND: Diagnostic laparoscopy is useful for the assessment of equivocal penetrating abdominal wounds, and has become the modality of choice for the evaluation of such wounds at our institution. We hypothesised that, in appropriate patients, diagnostic "awake" laparoscopy (AL) could be performed under local anaesthesia in the emergency department (ED), allowing for expedited discharge and potential cost savings. METHODS: Selected haemodynamically stable patients with penetrating abdominal injury underwent AL. Suitability for AL was at the discretion of the attending surgeon. Identification of peritoneal penetration by AL led to exploratory laparotomy in the operating room. Patients with no evidence of peritoneal penetration were discharged from the ED (ALneg). These patients were matched to a cohort of 24 patients who underwent diagnostic laparoscopy in the OR which was negative for peritoneal penetration (DLneg). Length of stay and hospital charges were compared. RESULTS: Over a 30-month period, 15 patients underwent AL without complication. No peritoneal penetration was found in 11 patients. The remaining four patients underwent exploratory laparotomy, of which two were positive for intra-abdominal injury. Mean time to discharge was 7h in the ALneg group versus 18 h in the DLneg group (p=0.0003). Cost savings on hospital charges averaged 2227 US dollars per patient in the ALneg group compared with the DLneg group. CONCLUSIONS: AL may be safely performed in the ED, allowing for expedited patient discharge. Cost savings are achieved by the avoidance of charges inherent to diagnostic laparoscopy performed in the operating room.

Abdominal Injuries↗
PubMed2006

The real predictors of disposition in patients with spinal cord injuries.

OBJECTIVES: A primary goal of health care providers for managing patients with spinal cord injury (SCI) is to discharge them to a rehabilitation facility (RF) to allow for maximal functional recovery. This study was undertaken to analyze hospital mortality and disposition of patients with SCI with a specific focus on evaluating the effect of payor source on discharge to a RF. Our hypothesis was that commercial insurance (CI) would be the greatest influence of hospital disposition. METHODS: All patients under 60 years of age with SCI over a 7-year period were identified from the trauma registry; and grouped according to payor source: No insurance (NI), Government insurance (GI), No Commercial insurance (NCI) (NCI = NI + GI), and CI. RESULTS: A total of 492 patients with SCI were identified with a mean age of 33, an ISS of 29, and a hospital mortality of 7.7%. Independent predictors of mortality were cervical SCI and blood transfusions. Patients who were discharged to a RF had higher ISS and %CI with lower functional independent measurement scores compared with patients who were not discharged to a RF. Logistic regression analysis demonstrated that the predictors of disposition to a RF were CI (p < 0.001) and ISS (p = 0.002). CONCLUSION: The presence of CI was an independent predictor of disposition to a RF for patients with SCI. Lack of commercial insurance clearly compromises recovery and rehabilitation of patients with SCI and predicts outcome more clearly than any other parameter. Additional funding for patients without CI is necessary to afford all with an equal opportunity for maximal functional recovery.

Adult↗
PubMed2006

The futility of the clinical pulmonary infection score in trauma patients.

INTRODUCTION: The Clinical Pulmonary Infection Score (CPIS) has received much attention recently. Advocates have touted its use for the diagnosis and duration of therapy in patients with ventilator-associated pneumonia (VAP). However, little has been written about its utility in trauma patients. The clinical, physiologic, and radiologic components of the CPIS may be difficult to differentiate from the systemic effects of injury. Quantitative cultures of the lower airway have been shown to be efficacious in differentiating VAP from the systemic inflammatory response syndrome (SIRS). In this study, we evaluated the potential use of CPIS as the sole means for diagnosis of VAP in critically injured patients. METHODS: Patients were identified from the VAP database maintained in our Level I trauma center. Only those who had CPIS calculated at the time of bronchoscopy with BAL were included. VAP required >or=10 colonies/mL on quantitative BAL for diagnosis. Antibiotic therapy was based on quantitative BAL results. Patients with <10 colonies/mL were diagnosed with SIRS. Sensitivity and specificity of a CPIS>6 for VAP diagnosis (confirmed by BAL) were calculated. RESULTS: In all, 158 patients underwent 285 BALs. The overall incidence for VAP was 42%. Patients with episodes of VAP and SIRS were well matched for age, Injury Severity Score, APACHE II score, and Glasgow Coma Scale score. The average CPIS was 6.8 in patients with SIRS and 6.9 for those with VAP. Using a CPIS>6 as the threshold for VAP only yielded a sensitivity of 61% and a specificity of 43%. CONCLUSIONS: CPIS cannot differentiate VAP from SIRS in critically injured patients. Using CPIS to initiate antibiotic therapy in trauma patients could be harmful. Whether CPIS is useful to determine duration of antibiotic therapy is unknown.

Adult↗
PubMed2006

Penetrating rectal trauma: management by anatomic distinction improves outcome.

BACKGROUND: Controversy persists regarding the optimal management of penetrating rectal injuries, specifically with respect to the routine application of diversion and presacral drainage. Our previous experience suggested that management decisions based on precise anatomic characterization of injury relative to retroperitoneal involvement might improve outcome. A clinical pathway was developed and implemented. Patients managed by the pathway (PATH) were compared with the previous study (PREV, n=58) to determine the impact of the clinical pathway on outcome. METHODS: Consecutive patients with full-thickness penetrating rectal injury subsequent to the development of the pathway were evaluated. Intraperitoneal rectal injuries (IP) were treated with primary repair. Injuries to the proximal two-thirds and accessible distal one-third of the extraperitoneal rectum (EP) were treated with repair and selective fecal diversion. Inaccessible distal EP injuries were treated with diversion and presacral drainage. Infectious complications (wound infection, bacteremia, intraabdominal abscess, retroperitoneal abscess) were compared between the PATH and PREV groups. RESULTS: In all, 54 patients were identified. Demographics, injury severity, and preventive antibiotics (24-hour) were similar between groups. Overall infectious complication rate was 13% in the PATH group versus 31% in the PREV group (p<0.05). There was a zero incidence of retrorectal abscess in the PATH group versus 11% of the total complications in the PREV group. CONCLUSIONS: Implementation of the pathway resulted in a significant decrease in infectious morbidity. Management by anatomic distinction allows for omission of colostomy in most IP injuries and select EP injuries, while diminishing the risk of retrorectal abscess in EP injuries with the judicious application of presacral drainage.

Abscess↗
PubMed2003

Trauma laparotomy in a rural setting before transfer to a regional center: does it save lives?

BACKGROUND: In the rural setting, long distances may necessitate that a patient undergo emergency laparotomy before transfer to a regional trauma center for definitive management. The purpose of this study was to review the experience of three regional trauma centers with such treated patients. METHODS: This study was a retrospective chart review of patients who underwent emergency laparotomy for trauma before transfer, identified from the respective databases of participating centers over a 6-year period. RESULTS: Fifty-six patients met the study criteria. Twenty-six (46%) were transferred primarily for management of the abdominal injury, and 14 of these patients (25% overall) underwent damage control procedures. Overall survival was 82%. Logistic regression demonstrated that transfer for treatment of the extra-abdominal injury was the only significant predictor of survival (odds ratio, 34.33; 95% confidence interval, 1.80-655.24). CONCLUSION: Although patients undergoing laparotomy who were subsequently transferred for management of abdominal injury have reasonable outcome, patients transferred primarily for management of extra-abdominal injury seem to have a survival advantage.

Abdominal Injuries↗