Most patients who present with stage IV colorectal cancer undergo resection of the primary tumor. The proportion of patients undergoing resection depends on patient age and race and the anatomical location of the primary tumor. The degree to which case selection explains the treatment and survival differences observed is not known. Further investigation of the role of surgery in the management of incurable stage IV colorectal cancer is warranted.

The incidence of VAP is greatest among trauma patients at our institution. The increased use of bronchoalveolar lavage, the earlier onset of VAP, and the higher incidence of gram-negative pneumonias suggest that both patient and provider factors may influence this phenomenon. VAP was associated with increased mortality in the nontrauma group only. These factors should be considered before VAP is applied as a quality indicator.

OBJECTIVES: To prospectively investigate associations of sarcopenia, obesity, and sarcopenic obesity with the incidence of falls in a racially and ethnically diverse cohort of healthy postmenopausal women from the Women’s Health Initiative (WHI). DESIGN: Prospective cohort study. SETTING: Three WHI clinical centers (Tucson-Phoenix, AZ; Pittsburgh, PA; Birmingham, AL). PARTICIPANTS: Postmenopausal women aged 50–79 years enrolled in the WHI who received bone and body composition scans by Dual-Energy X-ray Absorptiometry (DXA) at baseline (n=11,020). MEASUREMENTS: Sarcopenia was defined as the lowest 20th percentile of appendicular lean mass, correcting for height and body fat. Obesity was defined as a body fat percentage above 42%. Sarcopenic obesity was defined as the co-occurrence of sarcopenia and obesity. Fall outcome was defined as participants who reported falling 2 or more times in any year during 7 years of follow-up. The relative risk (RR) and 95% confidence interval (95% CI) for falls associated with sarcopenic obesity status were analyzed with log binomial regression models stratified by age and race/ethnicity. RESULTS: Sarcopenic obesity was associated with an increased risk of falls among women aged 50 – 64 years (RR=1.35, 95% CI: 1.17, 1.56), and those aged 65–79 years (RR=1.21, 95% CI: 1.05, 1.39). Sarcopenic obesity related fall risk among Hispanic/Latina women was higher than Non-Hispanic White women (RR=2.40, 95% CI: 1.56, 3.67 and RR=1.24, 95% CI: 1.11, 1.39, respectively). CONCLUSION: In a multiethnic cohort of postmenopausal women, sarcopenic obesity related fall risk was elevated among women aged less than 65 years and women 65 years and over. Sarcopenic obesity posed the highest risk for falls in Hispanic/Latina women. The findings support identification of causal factors and health disparities in sarcopenic obesity to better tailor fall prevention strategies and ameliorate this significant public health burden.

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BACKGROUND Outcome prediction models allow risk adjustment required for trauma research and the evaluation of outcomes. The advent of ICD-10-CM has rendered risk adjustment based on ICD-9-CM codes moot, but as yet no risk adjustment model based on ICD-10-CM codes has been described. METHODS The National Trauma Data Bank provided data from 773,388 injured patients who presented to one of 747 trauma centers in 2016 with traumatic injuries ICD-10-CM codes and Injury Severity Score (ISS). We constructed an outcome prediction model using only ICD-10-CM acute injury codes and compared its performance with that of the ISS. RESULTS Compared with ISS, the TMPM-ICD-10 discriminated survivors from non-survivors better (ROC TMPM-ICD-10 = 0.861 [0.860–0.872], ROC [reviever operating curve] ISS = 0.830 [0.823–0.836]), was better calibrated (HL [Hosmer-Lemeshow statistic] TMPM-ICD-10 = 49.01, HL ISS = 788.79), and had a lower Akaike information criteria (AIC TMPM-ICD10 = 30579.49; AIC ISS = 31802.18). CONCLUSIONS Because TMPM-ICD10 provides better discrimination and calibration than the ISS and can be computed without recourse to Abbreviated Injury Scale coding, the TMPM-ICD10 should replace the ISS as the standard measure of overall injury severity for data coded in the ICD-10-CM lexicon. LEVEL OF EVIDENCE Prognostic/Epidemiologic, level II.