Explore the vast range of titles available.

The role of mandatory exploration and repair of low-grade penetrating carotid injuries is unclear. We aim to compare outcomes of those managed non-operatively and operatively. A single-center retrospective (1/2012–12/2023) review of penetrating common carotid (CCA) and internal carotid arteries (ICA) was performed. Low-grade injuries were defined as intimal dissections and intramural hematomas. Patients with low-grade injuries managed non-operatively and operatively were compared. There were 54 patients with 62 low-grade injuries. Ten patients underwent operative management, of which 90 ​% had non-therapeutic vascular explorations. One patient expired due to neurologic decline and herniation. Of the 44 patients managed non-operatively, none expired due to a decline in their neurologic exam. There was no difference in stroke rates between the groups. Stroke rates were similar between non-operatively and operatively managed low-grade penetrating CCA and ICA injuries. CT imaging should be considered in stable patients with penetrating neck trauma to characterize their vascular injury, as low-grade injuries may be managed non-operatively without significant sequelae. •There was no difference in stroke rate between operative vs non-operative management of low-grade ICA and CCA injuries.•If low-grade injury on CT and no aerodigestive injury, management can proceed without vascular neck exploration.•Low-grade penetrating ICA and CCA injuries can be safely managed non-operatively.

BackgroundSuspicion of cancer in the Emergency Department (ED) may lead to potentially avoidable and prolonged admissions. We aimed to examine the reasons for potentially avoidable and prolonged hospitalizations after admissions from the ED for new colon cancer diagnoses (ED-dx).MethodsA retrospective, single-institution analysis was conducted of patients with ED-dx between 2017 and 2018. Defined criteria were used to identify potentially avoidable admissions. Patients without avoidable admissions were examined for ideal length of stay (iLOS), using separate defined criteria. Prolonged length of stay (pLOS) was defined as actual length of stay (aLOS) being greater than 1 day longer than iLOS.ResultsOf 97 patients with ED-dx, 12% had potentially avoidable admissions, most often (58%) for cancer workup. Very little difference in demographic, tumor characteristics, or symptoms were found, except patients with potentially avoidable admissions were more functional (Eastern Cooperative Oncology Group [ECOG] score 0–1: 83% vs. 46%; p = 0.049) and had longer symptom duration prior to ED presentation {24 days (interquartile range [IQR] 7–75) vs. 7 days (IQR 2–21)}. Among the 60 patients who had necessary admissions but did not require urgent intervention, 78% had pLOS, most often for non-urgent surgery (60%) and further oncologic workup. The median difference between iLOS and aLOS was 12 days (IQR 8–16) for pLOS.ConclusionsPotentially avoidable admissions following Ed-dx were uncommon but were mostly for oncologic workup. Once admitted, the majority of patients had pLOS, most often for definitive surgery and further oncologic workup. This suggests a lack of systems to safely transition to outpatient cancer management.