Diverting Ostomy in Adult Patients with Perineal Burns
Bibliographic record
Abstract
Deep thermal injury to the perineal area poses unique challenges for successful wound healing and skin graft taking due to the nature of the contours in the area as well as the inevitability of fecal soilage. Surgical diversion of the fecal stream has the potential to enhance wound healing and skin graft take. This study reviews one burn center's experience with diverting ostomy in patients with perineal burns. A retrospective review of patients with perineal burns discharged from an adult regional burn center between January 1, 1999 and December 31, 2003 was performed. Outcomes of patients with diverting ostomy (O+) were compared with controls without diverting ostomy (O-) and matched by age, burn size, and presence of inhalation injury. Statistical analysis using t-test or Chi-square where appropriate were performed, with a p<0.05 considered significant. Of 131 patients admitted with perineal burns, 12 (9.2%) had perineal burns severe enough and close enough to the anal verge that a diverting ostomy was felt to be indicated. These 12 patients had diversion performed by an average of day 9 days (range 1–21 days) post-burn. 11 patients received colostomy and one an ileostomy. Most of the ostomies (75%) were made by laparotomy, the remaining (25%) by laparoscopy. Attending surgeons felt the ostomy improved wound care and graft take. Three patients died (25%) due to multiple organ failure, unrelated to the ostomy. The ostomy was surgically reversed in 5 (62.5%) of the 8 survivors, 4–5 months post-ostomy. One patient (8.3%) had surgical wound infection and superficial dehiscence following ostomy reversal. Comparing O+ and O- patients there was no statistical differences in their demographic characteristics or their outcomes (Table).
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".