LAC+USC Medical Center

About: LAC+USC Medical Center is a healthcare organization based out in Los Angeles, California, United States. It is known for research contribution in the topics: Population & Poison control. The organization has 1348 authors who have published 886 publications receiving 21927 citations. The organization is also known as: County/USC & Los Angeles County General.

Evaluation of Single- versus Dual-Tube Thoracostomy after Thoracotomy for Trauma.

Abstract: Draining the chest cavity with two chest tubes after thoracotomy for trauma is controversial. This article aims to determine whether using two tubes after thoracotomy for trauma is more effective than using a single tube. A 9-year retrospective review (2007-2015) was performed at our academic level I trauma center. All patients who underwent trauma thoracotomy (unilateral and bilateral) were included for analysis (n = 99). Patients with incomplete data, pediatric patients (age < 18), pregnant patients, and early deaths (<24 hours) were excluded. When analyzed by chest cavity, dual tubes have increased drainage bilaterally (P = 0.008) and require more days to clear the right chest (P = 0.002). Patients with dual tubes bilaterally are associated with increased intensive care unit length of stay (P = 0.05) and ventilator days (P = 0.04). Although dual chest tube insertion achieves greater drainage, it comes at the cost of increased time to clear the chest and is associated with worse outcomes in bilateral injuries. One chest tube may be sufficient post-trauma thoracotomy; routine placement of two chest tubes is not recommended.

Evaluation of the FilmArray Meningitis/Encephalitis Molecular Panel in a Tertiary Care Public County Hospital

Abstract: Abstract Background Rapid diagnosis and treatment of meningitis and encephalitis is critical to reduce morbidity and mortality. The Biofire FilmArray Meningitis/Encephalitis (ME) Panel is a rapid, multiplex PCR assay that targets 14 common bacterial, viral, and fungal agents of ME. To our knowledge, there are no published studies evaluating the ME Panel’s impact on clinical decision-making. Methods Retrospective chart review was performed on 100 consecutive cases from January through April 2017 who underwent testing with the ME Panel. ME Panel results were compared with conventional testing methods. Each case was categorized as either contributory (n = 51), possibly contributory (n = 13), or noncontributory (n = 36) based upon clinicians’ acknowledgement and utilization of ME Panel results. Duration of ME antimicrobial therapy (bacterial, viral, and/or fungal) was determined for each case. Results The average patient age was 41.1 years, with 37% of cases having either a new or established HIV diagnosis at the time of testing. The average turnaround time to reporting was 3.7 hours. The ME panel was positive in seven cases and demonstrated 100% sensitivity and 100% clinical specificity. During the study period, ME Panel detected infections with varicella-zoster virus, Cryptococcus neoformans in three different patients, Listeria monocytogenes, enterovirus, and Streptococcus pneumoniae. The ME panel detected L. monocytogenes and S. pneumoniae despite antibiotic therapy prior to lumbar puncture. The CSF cultures were subsequently negative but blood cultures were positive. Duration of antibacterial therapy was significantly decreased in the contributory and possibly contributory cases compared with noncontributory cases (28.38 hours vs. 76.69 hours, P = 0.04). Although not statistically significant, similar reductions were observed in duration of antiviral therapy (P = 0.4). Conclusion The FilmArray ME Panel demonstrated high sensitivity and specificity during the study period and was capable of detecting infections that would only have been diagnosed by blood culture. Duration of therapy was reduced in patients where the ME panel was contributory to clinical medical decision-making. Disclosures S. M. Butler-Wu, Biofire Diagnostics: Consultant, Consulting fee and Research support

Challenges in the re-irradiation of locally advanced head and neck cancers: outcomes and toxicities

Abstract: To retrospectively review outcomes and toxicities for patients with recurrent head and neck cancer (HNC) undergoing re-irradiation (re-RT). Retrospective review of oncologic outcomes and toxicity data from patients who received head and neck (HN) re-RT with curative intent using intensity-modulated radiation therapy (IMRT) from 2011 to 2016. Common toxicities were scored using Common Terminology Criteria for Adverse Events (CTCAE) V4. Treatment outcomes included progression-free survival (PFS), locoregional control (LRC), and overall survival (OS). Twenty-one patients with HNC were re-irradiated with curative intent. The median follow-up after re-RT was 27.8 months. The median retreatment dose was 66 Gy (range, 60–70), and the median retreatment volume was 194.1 cm3 (range, 52.4–1375.6). The median LRC, PFS, and OS were 10 months, 8.4 months, and 18.1 months, respectively. Patients treated with surgery as a component of primary HN cancer treatment had significantly worse PFS and OS when retreated compared with those initially treated with chemoradiation alone (p = 0.026 and p = 0.005, respectively). Those with stage IVA/B recurrent disease had worse LRC, PFS, and OS compared with stage II/III disease (p = 0.029, p = 0.049, and p = 0.020 respectively). Acute grade ≥ 3 toxicity and late grade ≥ 3 toxicity were 38% and 38%, respectively, with dysphagia being most common (24% acute and 14% late). Re-irradiation with IMRT for locally advanced HN recurrences either definitively or after salvage surgery is feasible, but treatment-related toxicity remains significant. Patients who received surgery as a component of their initial treatment and those with more advanced stage disease may be more difficult to salvage with re-irradiation.