RESUMO
This article deals with heparin-induced thrombocytopenia. It discusses the pathophysiology of the disease, as well as the diagnostic challenges and therapeutic management. The incidence of the disease and screening recommendations are reviewed. The article also emphasizes the importance of correct diagnosis and treatment options. This article is intended for surgeons in all specialties and levels of training.
Assuntos
Anticoagulantes/efeitos adversos , Heparina/efeitos adversos , Trombocitopenia , Humanos , Trombocitopenia/induzido quimicamente , Trombocitopenia/diagnóstico , Trombocitopenia/fisiopatologia , Trombocitopenia/terapiaRESUMO
Trauma is a financial burden. For the 2634 trauma patients seen in 1999, the percentage of their hospital bill reimbursed and cost coverage (CC), whether that reimbursement covered their hospital costs, were analyzed. Student t tests to compare the mean percentage reimbursements (mPR) and logistic regression with CC (yes/no) as dependent variable with results as odds ratio (OR) were done. The overall mPR was 36 per cent. Among the 947 patients admitted (36%), there was no association between injury severity and mPR. For penetrating trauma, the mPR (25%) was lower than for blunt trauma (37%, P = 0.05). The assault mPR (21%) was lower than for motor vehicle crash (39%, P < 0.001). The mPR for patients transferred in (26%) was lower than for all others (37%, P < 0.001). Male sex (OR = 0.76), Hispanic ethnicity (OR = 0.46), admission (OR = 0.69), severe brain injury (OR = 0.58), abdominal injury (OR = 0.65), and extremity injury (OR = 0.69) were significant predictors for no CC. Reimbursement is better for blunt trauma. That transfers had a significantly lower mPR may represent "dumping" of patients. There is an association between anatomic regions injured and CC. No reimbursement was obtained for 26 per cent of the patients, and in 56 per cent the reimbursement did not cover costs. A change in financing for trauma is needed.
