BACKGROUND Post-colonoscopy diverticulitis is increasingly recognized as a potential complication.However,the evidence is sparse in the literature.AIM To systematically review all available evidence to describe the in...BACKGROUND Post-colonoscopy diverticulitis is increasingly recognized as a potential complication.However,the evidence is sparse in the literature.AIM To systematically review all available evidence to describe the incidence,clinical course with management and propose a definition.METHODS The databases PubMed,EMBASE and Cochrane databases were searched using with the keywords up to June 2020.Additional manual search was performed and cross-checked for additional references.Data collected included demographics,reason for colonoscopy,time to diagnosis,method of diagnosis(clinical vs imaging)and management outcomes.RESULTS A total of nine studies were included in the final systematic review with a total of 339 cases.The time to diagnosis post-colonoscopy ranged from 2 h to 30 d.Clinical presentation for these patients were non-specific including abdominal pain,nausea/vomiting,per rectal bleeding and chills/fever.Majority of the cases were diagnosed based on computed tomography scan.The management for these patients were similar to the usual patients presenting with diverticulitis where most resolve with non-operative intervention(i.e.,antibiotics and bowel rest).CONCLUSION The entity of post-colonoscopy diverticulitis remains contentious where there is a wide duration post-procedure included.Regardless of whether this is a true complication post-colonoscopy or a de novo event,early diagnosis is vital to guide appropriate treatment.Further prospective studies especially registries should include this as a complication to try to capture the true incidence.展开更多
Background:Well-known trauma mortality prediction scores such as New Injury Severity Score (NISS), Revised Trauma Score (RTS), and Trauma and Injury Severity Score (TRISS) have been externally validated from high-inco...Background:Well-known trauma mortality prediction scores such as New Injury Severity Score (NISS), Revised Trauma Score (RTS), and Trauma and Injury Severity Score (TRISS) have been externally validated from high-income countries with established trauma databases. However, these scores were never used in Malaysian population. In this current study, we attempted to validate these scoring systems using our regional trauma surgery database. Methods:A retrospective analysis of the regional Malaysian Trauma Surgery Database was performed over a period of 3 years from May 2011 to April 2014. NISS, RTS, Major Trauma Outcome Study (MTOS)-TRISS, and National Trauma Database (NTrD)-TRISS scores were recorded and calculated. Individual scoring system's performance in predicting trauma mortality was compared by calculating the area under the receiver operating characteristic (AUC) curve. Youden index and associated optimal cutoff values for each scoring system was calculated to predict mortality. The corresponding positive predictive value, negative predictive value, and accuracy of the cutoff values were calculated. Results:A total of 2208 trauma patients (2004 blunt and 204 penetrating injuries) with mean age of 36 (SD=16) years were included. There were 239 deaths with a corresponding mortality rate of 10.8%. The AUC calculated for the NISS, RTS, MTOS-TRISS, and NTrD-TRISS were 0.878, 0.802, 0.812, and 0.848, respectively. The NISS score with a cutoff value of 24, sensitivity of 86.6%and specificity of 74.3%, outperformed the rest (p<0.001). Mortality was predicted by NISS with an overall accuracy of 75.6%;its positive predictive value was at 29.02%and negative predictive value at 97.86%. Conclusion:Amongst the four scores, the NISS score is the best trauma mortality prediction model suited for a local Malaysian trauma population. Further validation with multicentre data in the country may require to ascertain the finding.展开更多
文摘BACKGROUND Post-colonoscopy diverticulitis is increasingly recognized as a potential complication.However,the evidence is sparse in the literature.AIM To systematically review all available evidence to describe the incidence,clinical course with management and propose a definition.METHODS The databases PubMed,EMBASE and Cochrane databases were searched using with the keywords up to June 2020.Additional manual search was performed and cross-checked for additional references.Data collected included demographics,reason for colonoscopy,time to diagnosis,method of diagnosis(clinical vs imaging)and management outcomes.RESULTS A total of nine studies were included in the final systematic review with a total of 339 cases.The time to diagnosis post-colonoscopy ranged from 2 h to 30 d.Clinical presentation for these patients were non-specific including abdominal pain,nausea/vomiting,per rectal bleeding and chills/fever.Majority of the cases were diagnosed based on computed tomography scan.The management for these patients were similar to the usual patients presenting with diverticulitis where most resolve with non-operative intervention(i.e.,antibiotics and bowel rest).CONCLUSION The entity of post-colonoscopy diverticulitis remains contentious where there is a wide duration post-procedure included.Regardless of whether this is a true complication post-colonoscopy or a de novo event,early diagnosis is vital to guide appropriate treatment.Further prospective studies especially registries should include this as a complication to try to capture the true incidence.
文摘Background:Well-known trauma mortality prediction scores such as New Injury Severity Score (NISS), Revised Trauma Score (RTS), and Trauma and Injury Severity Score (TRISS) have been externally validated from high-income countries with established trauma databases. However, these scores were never used in Malaysian population. In this current study, we attempted to validate these scoring systems using our regional trauma surgery database. Methods:A retrospective analysis of the regional Malaysian Trauma Surgery Database was performed over a period of 3 years from May 2011 to April 2014. NISS, RTS, Major Trauma Outcome Study (MTOS)-TRISS, and National Trauma Database (NTrD)-TRISS scores were recorded and calculated. Individual scoring system's performance in predicting trauma mortality was compared by calculating the area under the receiver operating characteristic (AUC) curve. Youden index and associated optimal cutoff values for each scoring system was calculated to predict mortality. The corresponding positive predictive value, negative predictive value, and accuracy of the cutoff values were calculated. Results:A total of 2208 trauma patients (2004 blunt and 204 penetrating injuries) with mean age of 36 (SD=16) years were included. There were 239 deaths with a corresponding mortality rate of 10.8%. The AUC calculated for the NISS, RTS, MTOS-TRISS, and NTrD-TRISS were 0.878, 0.802, 0.812, and 0.848, respectively. The NISS score with a cutoff value of 24, sensitivity of 86.6%and specificity of 74.3%, outperformed the rest (p<0.001). Mortality was predicted by NISS with an overall accuracy of 75.6%;its positive predictive value was at 29.02%and negative predictive value at 97.86%. Conclusion:Amongst the four scores, the NISS score is the best trauma mortality prediction model suited for a local Malaysian trauma population. Further validation with multicentre data in the country may require to ascertain the finding.
