Search PubMed⌕ Search

Biomedical subjects

C G Cayten

Publications and source records attributed to C G Cayten.

At least 37 records · Page 2Linked to original sources
PubMed1991

Analyses of preventable deaths by mechanism of injury among 13,500 trauma admissions.

Preventable deaths (PD) were evaluated by mechanism of injury for 13,500 trauma admissions to eight hospitals over 2 years. There were 42 (3.3%) hospital deaths. Preventable deaths were analyzed by time of death, anatomic site of injury, and mechanism; penetrating (PEN) and blunt with low fall (LF) injuries were considered separately. Preventability of death for patients with probability of survival of less than 0.5, "unexpected deaths," after penetrating and blunt injuries, was determined by consensus of three trauma surgeons. Twelve per cent of deaths were found to be possibly preventable. The incidence of preventable deaths did not differ significantly across groups. Factors in preventable deaths varied by injury cause; delays in operation, PEN (50%), and blunt injury patients (48%); management errors, blunt (52%) and LF (84%); and technical errors, PEN (37.5%). Median times to death were significantly different by cause of injury: PEN, 3 hours; blunt, 13 hours; and LF, 3975 hours. Problems were identified in the hospital care of patients, especially those with LF, leading to sepsis and multiple organ failure.

Accidental Falls↗
PubMed1991

Limitations of the TRISS method for interhospital comparisons: a multihospital study.

The value of the TRISS method for interhospital comparisons of trauma care was studied using data for 5,616 consecutive patients from three trauma centers and five community hospitals. Z-scores were used to compare mortality rates. Three limitations of the method were documented: 1) the lack of homogeneity within the patient subcategory of penetrating injuries, specifically between patients with gunshot versus stab wounds; 2) the inability of the TRISS method to predict the survival rate of patients suffering low falls; and 3) the inability of the TRISS method to account for multiple severe injuries to a single body part. Remedies to the first two of these limitations can be addressed within the present TRISS method. A remedy for the third requires a new method.

Abbreviated Injury Scale↗
PubMed1990

Controlling for the severity of injuries in emergency medicine research.

The injury severity score (ISS) and age have been used retrospectively to control for trauma severity. Other control variables such as the revised trauma score (RTS) and the TRISS method (which estimates the probability of survival for each patient) additionally require that values of blood pressure, Glasgow coma scale, and respiratory rate, be recorded in the emergency department. The authors question when the RTS, ISS, the ISS and age, or the probability of survival calculated using the TRISS method should be used to control for severity of injuries in trauma research. Relations between predictor variables and (1) survival to hospital discharge, (2) hospital length of stay for survivors, and (3) length of ICU stay were compared by cause of injury: penetrating, motor vehicle accident, low fall, or other blunt. Data were collected over 12 months for 2,914 consecutive adult patients who died or stayed in five nontrauma and three trauma centers for 48 hours or more. For survival, the false-negative rates of probability of survival calculated using the TRISS method were approximately half that of the ISS and age; no variable adequately explained survival among those with low falls. Combinations of ISS, RTS, and age explained the most variation in lengths of hospital stay among survivors, while ISS explained the most variation in lengths of intensive care unit (ICU) stay. Researchers should consider the ISS with RTS and age to control for severity when lengths of hospital or ICU stay are studied. The TRISS method should be used in studies of survival. In both cases, the RTS which requires data collection in the emergency department must be calculated.

Adolescent↗
PubMed1990

Surgical emergencies of the abdomen.

Abdominal emergencies in the elderly requiring emergent surgery pose a significant challenge to the emergency physician. Because of concomitant illness, these patients generally have a substantial operative risk. Further, the symptoms and signs in these patients are frequently milder and less specific than in younger adults with the same conditions. Therefore, the emergency physician must develop a high index of suspicion for these conditions and must seek early surgical consultation, even if a definitive diagnosis has not been established. In other words, in many cases consultation must be sought on the basis of the emergency physician's clinical suspicion rather than on "hard" data. Emergency physicians must pay particular attention to associated extra-abdominal disease, which must be diagnosed and stabilized to minimize the risk of emergent surgery. Only aggressive assessment, expeditious resuscitation, and team work with the surgical consultants can minimize the high mortality rate associated with these acute abdominal surgical emergencies.

Abdomen, Acute↗
PubMed1990

Outcomes of surgery for colorectal cancer in patients age 80 years and older.

Three hundred patients treated for colorectal cancer during the period 1975-1980 were divided into two groups (less than 80 yr, 236; greater than or equal to 80 yr, 64). No statistically significant differences were seen between the two groups for American Joint Committee on Cancer (AJCC) stage, site, and length of stay. Operative mortality (30 days) was associated with type of treatment (p less than 0.01), stage (p less than 0.05), and age (p less than 0.01) but not with site of cancer. Five-year survival curves excluding 30-day mortalities showed no significant difference between the two age groups. Proportional hazards linear model (multivariate) analysis showed that, whereas 5-yr survival was related to stage (p less than 0.001) and type of operation, patients greater than or equal to 80 did not have a significantly greater risk of death than patients less than 80 yr. Since the age of the patient influences operative morality, but not 5-yr survival, increasing attention needs to be paid to minimizing operative risk by careful preoperative assessment, optimization of underlying cardiac, pulmonary, and nutritional deficiencies, and monitoring numerous physiologic variables during the intraoperative and postoperative period. Resection of cancer should not be limited or denied on the basis of age alone.

Adenocarcinoma↗
PubMed1988

Predictive ability of various nutritional variables for mortality in elderly people.

Nutritional indices (percentage ideal body weight [IBW], serum albumin, serum transferrin, total lymphocyte count [TLC] and delayed cutaneous hypersensitivity [DH] response) were assessed in 80 consecutive patients (aged 85-100 y) within 24 h of admission to determine their predictive value for mortality. Nine patients died. Pearson correlation analysis demonstrated that death was significantly (p less than 0.05 to less than 0.01) associated with sepsis, serum albumin less than 30 g/L, TLC less than or equal to 1500 cells/mm3, and percentage IBW less than or equal to 90%. However, when serum albumin was controlled for, logit regression analyses demonstrated that the impact of other nutritional indices on death was insignificant. The effect of serum albumin remained significant (p less than 0.05 to less than 0.01) even when age and physician's diagnosis were held constant. With the logit model, serum albumin greater than or equal to 30 g/L had a sensitivity of 0.33, specificity of 0.99, and overall predictive power of 0.91. Serum albumin is thus the simplest and best single predictor of mortality and can provide early identification of elderly people at increased risk of death.

Aged↗
PubMed1986

Energy expenditure in chronic alcoholics with and without liver disease.

Chronic alcoholism activates metabolic pathways, resulting in wasteful expenditure of energy (Pirola and Lieber, J Nutr 1975;105:1544-8). To study this hypothesis, we measured oxygen consumption (VO2), carbon dioxide production (VCO2), and resting energy expenditure (MREE) utilizing indirect calorimetry in 8 chronic alcoholics with (group I) and 11 chronic alcoholics without (group II) clinical or biochemical evidence of alcoholic liver disease. Seven healthy volunteers served as controls. A statistically increased MREE was observed in group II subjects (p less than 0.05, MREE 999.7 +/- 111.4 kcal X day X m2) as compared to normals (MREE 842.3 +/- 42.1 kcal X day X m2) and group I subjects (MREE 813.4 +/- 101.4 kcal X day X m2). VO2 and VCO2 were also significantly higher (p less than 0.05) in group II than in group I and normals. The predicted resting energy expenditure as calculated by the Harris-Benedict equation was similar in both groups and normals. Theories to explain the increased MREE in group II subjects are presented.

Adult↗
PubMed1986

Increased risk of colorectal cancer following breast cancer.

Identification of population groups at increased risk for colorectal cancer is important for deriving maximum benefit from screening procedures. A retrospective analysis of 7605 patients with cancer treated between 1958 to 1982 revealed that the colorectum was the site of metachronous primary in 38 patients (15 males and 23 females). The risk factor of developing the metachronous multiple primary cancer was determined by comparing the observed number of second primary malignancy with the expected number based on person years of observation, age, sex, and site specific incidence rates. Incidence of metachronous colonic cancer was twice the expected number and was the highest following a primary in the breast. This increased risk (2.0) is of equal magnitude as noted following primary colon cancer (1.7). Advanced metachronous colonic lesions were seen more often following breast cancer than following colon cancer. Since carcinoma of the breast is the leading cancer in women, it is urged that the follow-up management of such patients include the same aggressive screening program as that recommended for those with colorectal cancer.

Breast Neoplasms↗
PubMed1986

Factors influencing DRG 210 (hip fracture) reimbursement.

The effect of prospective payment system (PPS) on reducing cost and quality of care is still unknown. Fifty-two patients (mean +/- SD, 82.0 +/- 6.5 years) with hip fracture classified as DRG 210 (hip and femur procedures except major joint, age greater than 69 years and/or complication and/or comorbidity), treated by compression nail were separated into four groups: Group I--no comorbidity, no complications; Group II--no comorbidity but had complications; Group III--with comorbidity but no complications; and Group IV--with both comorbidity and complications. Compared to length of stay (LOS) in Groups I, II and III (mean 26 days), Group IV had significantly increased LOS (mean, 61.5 days) and 81% of the 16 who were day outliers (L.O.S. greater than 40 days). Patients without comorbidity (I & II) even if they did develop complications were not financial losers. Those with comorbidity appear to be high-cost patients as they invariably end up with complications (78%), and reimbursement for Group IV was significantly less, resulting in net loss of this DRG. Our finding demonstrates the importance of preventing complications in patients with comorbidity. Present DRG reimbursement guidelines do not provide sufficient attention to LOS implications of both comorbidity and complications. Ideally, they should be considered as separate factors within the DRG category.

Aged↗
PubMed1985

The effect of telemetry on urban prehospital cardiac care.

A three-year, controlled trial of the use of telemetry in the prehospital care of cardiac patients was conducted in a major metropolitan area. Five of the ten paramedic squads in the city used telemetry; the other five squads did not. We studied the effect of telemetry on the following: paramedics' abilities to recognize ECGs in a written test; paramedics' abilities to identify ECG arrhythmias in the field; length of time spent by paramedics in the field; survival rates of patients with ventricular fibrillation (VF) cared for by paramedics; abilities of base station physicians to interpret telemetered ECGs; and attitudes of paramedics toward using telemetry. Telemetry was not found to affect the abilities of paramedics to read ECGs in either test or field situations. Paramedics who used telemetry spent more time in the field with their patients than did paramedics who did not use telemetry (P less than .02). We found no statistically significant effect of telemetry on survival rates of VF patients. Using matched ECGs, readings by base station physicians were found to be more accurate than were those by paramedics (P less than .01). Paramedics overwhelmingly reported that telemetry did not help them to save patients' lives, but that it did help them to treat patients with certain arrhythmias. The results suggest that telemetry may not improve either paramedics' abilities to identify arrhythmias or prehospital care for all cardiac patients. The implications for emergency services researchers are discussed.

Allied Health Personnel↗
PubMed1984

Abdominal trauma.

The proper management of abdominal injuries is essential to maximize the chances of survival of the multiply injured patient. Although the assessment of the abdomen must take place within the framework of the primary and secondary surveys of the patient, the critical management decision focuses on the need for exploratory laparotomy. The decision criteria for laparotomy can be grouped according to the bases of the decision. The more critical the patient, the more rapid the judgment for surgery must be. Thus, the patient with hypotension that is unresponsive to fluid resuscitation is the highest priority, followed by stable patients in whom the decision for laparotomy is made by physical examination, peritoneal lavage, and further studies. Diagnostic techniques, such as peritoneal lavage, and wound exploration must be used selectively. With the exceptions of abdominal films and frequently of an intravenous pyelogram, more sophisticated x-ray procedures usually are reserved for the most stable patients. Initial laboratory tests do not contribute significantly to the early management of the patient with abdominal injuries but are necessary to provide a baseline for further care. Early administration of antibiotics is important to minimize septic complications.

Abdominal Injuries↗
PubMed1983

Clinical algorithms for prehospital cardiac care.

Algorithms for the prehospital management of cardiac arrhythmias were developed and their use by and value to paramedics evaluated. The algorithms, in booklet form, were distributed to half of the Philadelphia paramedic platoons; paramedics in the other platoons followed a narrative protocol that reflected identical contents. An arrhythmia recognition test given 18 months after the algorithm booklets were introduced showed that paramedics who received the booklets scored significantly higher in identifying life-threatening arrhythmias (p = 0.029) than did their counterparts without the booklets. Survival data for 459 patients in ventricular fibrillation treated by paramedics were collected 1 year before and 7 months after the introduction of the algorithm booklets. The paramedics using the algorithms improved their survival rate from 11.25 to 15.1 per cent, while the survival rate for patients treated by paramedics using the narrative protocols decreased from 12.4 to 7.7 per cent. The likelihood of obtaining a ratio of survival odds of this magnitude when there is no true difference is 0.092. Time-to-death was significantly different (p = 0.04) for the two groups of patients. Thus, the use of algorithm booklets as an inexpensive educational aid for paramedics is recommended.

Allied Health Personnel↗