Background Venous thromboembolism is a common cause of morbidity and mortality in hospital patients, especially that of the lower extremities. Risk factors and diagnostic elements of upper-extremity deep-vein thrombosis (UEDVT) are poorly understood compared to those of the lower extremities. The primary objectives of this study were to identify predictive risk factors of secondary UEDVT. Methods This retrospective study included all nonpregnant patients aged >18 years who had undergone upper-extremity duplex scans to check for the presence of secondary UEDVT at Richmond University Medical Center from January 2014 to March 2020. Patients were stratified by presence or absence of UEDVT. Collected data points included patient demographics, comorbidities, central-line use, platelet count at time of scan, length of stay, and overall mortality. IBM 27.0 was used for all statistical analysis, with p<0.05 considered significant. Results A total of 1,009 upper extremity venous duplex studies were included. There were no significant differences in age, sex, race, or mean platelet levels between patients diagnosed with DVT and those without ( p <0.05). After multinomial regression analysis, central venous catheter (CVC; 26.8% versus 78.5%, aOR 1.770, 95% CI 1.150–2.725; p <0.002), peripherally inserted central catheter (PICC) line (17.5% versus 82.5%, aOR3.254, 95% CI 1.997–5.304; p <0.001), hypertension (67.8% versus 28.8%, aOR 1.641, 95% CI 1.136–2.369; p <0.001), chronic kidney disease (CKD; 34.5% versus 65.5%, aOR 1.743, 95% CI 1.201–2.531; p <0.001), and malignancy (27.1% versus 74.6%, aOR 1.475, 95% CI 0.994–2.190; p <0.053) were found to be independent predictors of UEDVT. Conclusion Use of CVC or PICC line, preexisting diagnosis of hypertension, malignancy, and CKD were independent risk factors of UEDVT, while there was no significant correlation between increased platelet levels and UEDVT.

BACKGROUND: Older trauma patients present with poor preinjury functional status and more comorbidities. Advances in care have increased the chance of survival from previously fatal injuries with many left debilitated with chronic critical illness and severe disability. Palliative care (PC) is ideally suited to address the goals of care and symptom management in this critically ill population. A retrospective chart review was done to identify the impact of PC consults on hospital length of stay (LOS), ICU LOS, and surgical decisions. STUDY DESIGN: A Level 1 Trauma Center Registry was used to identify adult patients who were provided PC consultation in a selected 3-year time period. These PC patients were matched with non-PC trauma patients on the basis of age, sex, race, Glasgow Coma Scale, and Injury Severity Score. Chi-square tests and Student’s t-tests were used to analyze categorical and continuous variables, respectively. Any p value >0.05 was considered statistically significant. RESULTS: PC patients were less likely to receive a percutaneous endoscopic gastric tube or tracheostomy. PC patients spent less time on ventilator support, spent less time in the ICU, and had a shorter hospital stay. PC consultation was requested 16.48 days into the patient’s hospital stay. Approximately 82% of consults were to assist with goals of care. CONCLUSION: Specialist PC team involvement in the care of the trauma ICU patients may have a beneficial impact on hospital LOS, ICU LOS, and surgical care rendered. Earlier consultation during hospitalization may lead to higher rates of goal-directed care and improved patient satisfaction.

Vascular disease may manifest atypically in elderly patients due to presence of comorbid conditions, age related physiologic changes and frailty. Here we outline some of these uncommon clinical presentations of common vascular disease and discuss how management must change to effectively diagnose and treat these conditions specifically in an elderly population.

patients admitted to surgical services had a mean of 2 comorbidities documented per patient, not statistically different from those admitted to a medical service (p¼0.87). Patients admitted to surgical services had more subspecialty medical consultations (68.8% vs 57.9%, p¼0.005). Ground level fall is the most common mechanism of injury in the two admitting groups. CONCLUSION:The care of the elderly population can be complex and require multidisciplinary approach. This study shows that the care provided by a surgical service have similar outcomes compared to patients admitted with lesser degree of injuries to a non-surgical service.