Are emergency general surgery patients more work than trauma patients? Characterizing surgeon work in an acute care surgery practice.

BACKGROUND: Many trauma surgery groups have embraced emergency general surgery (EGS) as part of their practice. This practice pattern takes advantage of the trauma surgeon's 24-hour presence in the hospital. However, differences in quantity and timing of work between EGS and trauma patients affect demands on resources and staff. METHODS: Hospital trauma, financial, pharmacy, and medical records of 100 successive trauma and 50 successive EGS patients were reviewed. Work performed by our service was quantified using relative value units, operations, complications, and laboratory tests/imaging/medications ordered, and the events organized by time intervals after contact by the acute care surgery service. RESULTS: Our estimators of surgeon work per patient, totaled over all studied time intervals, showed EGS exceeding trauma patients by 59% (laboratory tests) to 470% (operations) (all but one p < 0.01). The exception was that trauma patients required more imaging studies per patient (4.25 vs. 2.48, p < 0.01). Trauma patients had a mean time to primary diagnosis of 0.9 hours, compared to 4.3 hours in EGS patients. CONCLUSION: In this pilot effort, we found that EGS patients required more diagnostic effort initially and generated more relative value units, operations, laboratory tests, and new medication orders and had more complications during the course of their care. Addition of EGS patients to a trauma service consumes more per-patient resources than trauma patients. LEVEL OF EVIDENCE: Epidemiologic study, level III.

Sensitivity of computed tomography in detection of perirectal abscess.

Most patients with anorectal abscess are diagnosed clinically based on pain, erythema, warmth, and fluctuance. Some patients, however, present with subtle or atypical signs. CT is easily accessible and is commonly used for diagnosis and delineation of anorectal abscess. The purpose of this study is to determine the sensitivity of CT scan in detecting perirectal abscesses and to see if immune status impacts the accuracy of CT. A retrospective study was conducted to identify patients from 2000 to 2009 with International Classification of Diseases, 9th Revision code 566 (anal or rectal abscess). Patients included had a CT scan less than 48 hours before drainage. Patients with CT-positive abscess were compared with patients with CT-negative abscess. Patients were categorized as either immunocompetent or immunosuppressed based on documentation of diabetes mellitus, cancer, human immunodeficiency virus, or end-stage renal disease. One hundred thirteen patients were included in this study. Seventy-four (65.5%) were male and the average age was 47 years. Eighty-seven of 113 (77%) patients were positive on CT for anorectal abscess. Sixty of 113 (53%) patients included in this study were immunocompromised. CT missed 26 of 113 (23%) patients with confirmed perirectal abscess. Eighteen (69%) of these patients were immunocompromised compared with CT-positive patients (42 [48%], P = 0.05). The overall sensitivity of CT in identifying abscess was 77 per cent. CT lacks sensitivity in detecting perirectal abscess, particularly in the immunocompromised patient.