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      Epidemiological features and outcomes of patients with psoas abscess: A retrospective cohort study


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          Psoas abscess (PA) is an uncommon disease. Although PA is associated with significant morbidity and mortality, its epidemiology and clinical characteristics remain unknown. This study aimed to evaluate the epidemiological and clinical features and outcomes of patients with PA in a prefectural-wide study.

          Materials and methods

          This was a multicenter retrospective cohort study conducted between 2010 and 2012 in the Miyagi prefecture with a population of 2,344,062 in 2011. Adult patients with PA were enrolled from 71 secondary and tertiary care hospitals.


          There were 57 patients with adult PA in the Miyagi prefecture. The median age of the patients was 72 years, and 67% patients were male. Fever and flank pain were the primary symptoms in 82% and 74% of patients, respectively. Ten patients (18%) had septic shock, and the hospital mortality rate was 12%. Secondary PA was present in 72% of cases, and the most common origin was pyogenic spondylitis. Of the patients with secondary PA, 44% had an epidural abscess. The most common pathogens were Staphylococcus aureus, and 11% (6 cases) of the cases were caused by methicillin-resistant S. aureus.


          In the Miyagi prefecture of Japan, the estimated prevalence of PA was 1.21/100,000 population years and hospital mortality was 12%. Secondary PA accounted for more than 70% of the cases, and S. aureus was the most common causative pathogen.


          • The hospital mortality rate of psoas abscess (PA) was 12% in Japan.

          • Estimated prevalence of PA was 1.21/10,000 population years between 2010 and 2012.

          • Secondary PA: >70% of cases with the most common origin as pyogenic spondylitis.

          • Epidural abscess formed in 44% of patients.

          • The most common pathogen was Staphylococcus aureus.

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          Most cited references27

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          A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation

          The objective of this study was to develop a prospectively applicable method for classifying comorbid conditions which might alter the risk of mortality for use in longitudinal studies. A weighted index that takes into account the number and the seriousness of comorbid disease was developed in a cohort of 559 medical patients. The 1-yr mortality rates for the different scores were: "0", 12% (181); "1-2", 26% (225); "3-4", 52% (71); and "greater than or equal to 5", 85% (82). The index was tested for its ability to predict risk of death from comorbid disease in the second cohort of 685 patients during a 10-yr follow-up. The percent of patients who died of comorbid disease for the different scores were: "0", 8% (588); "1", 25% (54); "2", 48% (25); "greater than or equal to 3", 59% (18). With each increased level of the comorbidity index, there were stepwise increases in the cumulative mortality attributable to comorbid disease (log rank chi 2 = 165; p less than 0.0001). In this longer follow-up, age was also a predictor of mortality (p less than 0.001). The new index performed similarly to a previous system devised by Kaplan and Feinstein. The method of classifying comorbidity provides a simple, readily applicable and valid method of estimating risk of death from comorbid disease for use in longitudinal studies. Further work in larger populations is still required to refine the approach because the number of patients with any given condition in this study was relatively small.
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            STROCSS 2019 Guideline: Strengthening the reporting of cohort studies in surgery

            The STROCSS guideline was developed in 2017 to improve the reporting quality of observational studies in surgery. Building on its impact and usefulness, we sought to update the guidelines two years after its publication.
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              2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference.

              In 1991, the American College of Chest Physicians (ACCP) and the Society of Critical Care Medicine (SCCM) convened a "Consensus Conference," the goals of which were to "provide a conceptual and a practical framework to define the systemic inflammatory response to infection, which is a progressive injurious process that falls under the generalized term 'sepsis' and includes sepsis-associated organ dysfunction as well. The general definitions introduced as a result of that conference have been widely used in practice, and have served as the foundation for inclusion criteria for numerous clinical trials of therapeutic interventions. Nevertheless, there has been an impetus from experts in the field to modify these definitions to reflect our current understanding of the pathophysiology of these syndromes. Several North American and European intensive care societies agreed to revisit the definitions for sepsis and related conditions. This conference was sponsored by the Society of Critical Care Medicine (SCCM), The European Society of Intensive Care Medicine (ESICM), The American College of Chest Physicians (ACCP), the American Thoracic Society (ATS), and the Surgical Infection Society (SIS). 29 participants attended the conference from Europe and North America. In advance of the conference, subgroups were formed to evaluate the following areas: signs and symptoms of sepsis, cell markers, cytokines, microbiologic data, and coagulation parameters. The present manuscript serves as the final report of the 2001 International Sepsis Definitions Conference. 1. Current concepts of sepsis, severe sepsis and septic shock remain useful to clinicians and researchers. 2. These definitions do not allow precise staging or prognostication of the host response to infection. 3. While SIRS remains a useful concept, the diagnostic criteria for SIRS published in 1992 are overly sensitive and non-specific. 4. An expanded list of signs and symptoms of sepsis may better reflect the clinical response to infection. 6. PIRO, a hypothetical model for staging sepsis is presented, which, in the future, may better characterize the syndrome on the basis of predisposing factors and premorbid conditions, the nature of the underlying infection, the characteristics of the host response, and the extent of the resultant organ dysfunction.

                Author and article information

                Ann Med Surg (Lond)
                Ann Med Surg (Lond)
                Annals of Medicine and Surgery
                18 January 2021
                February 2021
                18 January 2021
                : 62
                : 114-118
                [1]Department of Emergency and Critical Care Medicine, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
                Author notes
                []Corresponding author. Department of Emergency and Critical Care Medicine Tohoku University Hospital, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan. takesato@ 123456hkg.odn.ne.jp
                © 2021 Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

                : 11 January 2021
                : 12 January 2021
                Cohort Study

                psoas abscess,secondary abscess,pyogenic spondylitis,staphylococcus aureus,epidemiology


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