"Blunt adrenal injury does not affect outcomes in the pediatric population with isolated abdominal injury- a National Trauma Data Bank Review®."

BACKGROUND: The incidence of blunt abdominal injury (BAI) in the adult population has been estimated to be between 0.03% and 4.95%. However, the impact of BAI on the pediatric population remains unknown. METHODS: We conducted a retrospective review of National Trauma Data Bank datasets for the years 2017-2019. We included patients under the age of 18 who experienced blunt trauma and had suffered a blunt abdominal injury with an Abbreviated Injury Scale (AIS) severity score of 2 or higher. RESULTS: Out of the 8064 pediatric patients with isolated abdominal trauma, 134 patients also suffered from BAI. We found no difference in the outcomes of patients with blunt adrenal injury in terms of mortality, length of stay in the intensive care unit (ICU) and hospital, and the number of ventilator days. Within poly-trauma patients BAI was associated with worst patient outcomes. CONCLUSIONS: This study demonstrates that BAI has minimal clinical impact on patient outcomes in isolation. However it is associated with worst outcomes in poly trauma patients suggesting correlation with increased trauma burden. LEVEL OF EVIDENCE: III.

Unusual Manifestation of a Non-inflamed Appendiceal Fistula as a Necrotizing Soft Tissue Infection in the Setting of a Gigantic Ventral Hernia.

Necrotizing soft tissue infection (NSTI) is a rapidly progressive infection of the soft tissues that necessitates early identification and emergent aggressive surgical debridement due to its high mortality. NSTI most often results from the introduction of microbes through breaks in the skin. Unique sources, like appendiceal fistulae, can be etiologies of abdominal wall NSTIs. We present the case of a 46-year-old female with a past medical history of poorly controlled type II diabetes mellitus and ventral hernia who presented in septic shock with a necrotic wound in her abdominal wall. The wound was overlying a large ventral hernia and was consistent with NSTI. She was treated urgently with fluid resuscitation, antibiotic therapy, and surgical debridement of the wound. On repeat exploration, an appendiceal fistula was found protruding from the hernial sac. Open appendectomy and primary repair of the ventral hernia were performed. Principles of immediate intervention and repeat surgical debridement allowed control of the septic insult and definitive source control upon identification of an appendiceal fistula.

Financial status and literacy among residents and medical students.

BACKGROUND: There is a wide perception of physicians as having minimal financial literacy, and this assumption is perpetuated through the community as the "Dumb Doctor" persona relating to financial management. This study examined medical student and resident financial behaviors and assessed their level of financial literacy using previously validated questions within the survey tool. METHODS: Two surveys were distributed to medical students and residents, 1 survey each, who are part of a single medical education system. After the initial email request, 2 additional email requests were sent at 2 and 6 weeks. Using the validated questions, "The Big 3" and "The Big 5," the level of financial literacy was assessed. RESULTS: Of the 461 possible respondents, 261 trainees responded with 65 residents and 196 medical students, for a response rate of 57%. Financial literacy was demonstrated to be higher than the average adult with 60% answering all 3 of "Big 3" correctly, compared to national average of 30%. Investment-based questions were the most difficult with 16% correct for bond price activity and 70% for stock risk. There is high level of interest with 93% open to education on financial topics. CONCLUSION: This study showed that this cohort of medical trainees demonstrated better financial habits and a very high level of financial literacy compared to the general population. There are areas surrounding investment principles that provide an opportunity to improve their financial literacy and would likely be well received based on the high level of interest for more education.