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1.
Nicholas P. McKenna Donald D. Potter Katherine A. Bews Amy E. Glasgow Kellie L. Mathis Elizabeth B. Habermann 《Journal of pediatric surgery》2019,54(1):112-117
Purpose
The purpose of this study was to determine if a laparoscopic approach reduces complications and length of stay (LOS) after total proctocolectomy with ileal pouch-anal anastomosis (TPC-IPAA) in pediatric patients using a multicenter prospective database.Methods
The American College of Surgeons National Surgical Quality Improvement Project Pediatric database from 2012 to 2015 was used to identify patients with a diagnosis of chronic ulcerative colitis (CUC) or familial adenomatous polyposis (FAP) undergoing TPC-IPAA. Major complications, minor complications, and prolonged LOS were compared based on laparoscopic versus open approach.Results
195 (108 female) patients underwent TPC-IPAA at a median age of 14?years (IQR: 11–16) for CUC (N?=?99) or FAP (N?=?96). Two-thirds of cases were laparoscopic. A laparoscopic approach was not associated with major complications, but lower odds of minor complications were observed. A reduced LOS was seen in laparoscopic versus open surgery (median LOS 6 vs 8?days, p?<?0.01). Open IPAA was independently associated with prolonged LOS (> 9?days) in the FAP cohort (OR 4.0, 95% CI 1.1–14.0).Conclusion
A laparoscopic approach was not associated with increased major complications but was associated with lower odds of minor complications and shorter LOS. The laparoscopic approach should continue to be preferred for pouch procedures in pediatric patients.Type of study
Treatment; retrospective study.Level of evidence
Level III. 相似文献2.
Allison F. Linden Manish T. Raiji Jonathan E. Kohler Erica M. Carlisle J. Carlos Pelayo Kate Feinstein Jessica J. Kandel Grace Z. Mak 《Journal of pediatric surgery》2019,54(1):184-188
Background/purpose
We examined outcomes before and after implementing an enteral water-soluble contrast protocol for management of pediatric adhesive small bowel obstruction (ASBO).Methods
Medical records were reviewed retrospectively for all children admitted with ASBO between November 2010 and June 2017. Those admitted between November 2010 and October 2013 received nasogastric decompression with decision for surgery determined by surgeon judgment (preprotocol). Patients admitted after October 2013 (postprotocol) received water-soluble contrast early after admission, were monitored with serial examinations and radiographs, and underwent surgery if contrast was not visualized in the cecum by 24?h. Group outcomes were compared.Results
Twenty-six patients experienced 29 admissions preprotocol, and 11 patients experienced 12 admissions postprotocol. Thirteen (45%) patients admitted preprotocol underwent surgery, versus 2 (17%) postprotocol patients (p?=?0.04). Contrast study diagnostic sensitivity as a predictor for ASBO resolution was 100%, with 90% specificity. Median overall hospital LOS trended shorter in the postprotocol group, though was not statistically significant (6.2?days (preprotocol) vs 3.6?days (postprotocol) p?=?0.12). Pre- vs. postprotocol net operating cost per admission yielded a savings of $8885.42.Conclusions
Administration of water-soluble contrast after hospitalization for pediatric ASBO may play a dual diagnostic and therapeutic role in management with decreases in surgical intervention, LOS, and cost.Type of study
Retrospective comparative study.Level of evidence
Level III. 相似文献3.
Alexander Becker Kobi Peleg Joseph Dubose Yaakov Daskal Adi Givon Boris Kessel 《Journal of pediatric surgery》2019,54(4):780-782
Background
Penetrating stab wounds in children are relatively rare and no clear recommendations for the optimal evaluation have been devised. An acceptable traditional approach to the patient with an abdominal stab wound who does not require urgent surgery is selective nonoperative management and serial exams. The use of routine computed tomography remains an actively utilized investigation for these patients at many institutions.Purpose
We hypothesize that the approach to pediatric stab wound victims should be distinctly different than that of adult counterparts in order to minimize radiation exposure.Methods
A retrospective cohort study involving abdominal stab wounds among pediatric trauma patients (age < 14) compared with adults between the years 1997 and 2016 was conducted utilizing the Israeli National Trauma Registry.Results
A total of 92 children and 4444 adults were identified from the registry for inclusion. Among the children 20 (21.7%) patients had intraabdominal injury compared to 1730 (38.9%) among adult counterparts. Four children were hemodynamically unstable, two of them were referred directly to operating room and two others were treated without surgery. Among the remaining 88 children there was no observed mortality.Conclusions
The majority of pediatric stab wounds trauma victims have minor abdominal injuries. We do not recommend the routine utilization of abdominal CT scan in the evaluation of abdominal stab wounds. Observation with serial exams and minimization of radiation exposure from CT are warranted in this unique population.Type of study
Retrospective comparative study.Level of evidence
3. 相似文献4.
Elizabeth J. Renaud Stig Sømme Saleem Islam Danielle B. Cameron Robert L. Gates Regan F Williams Tim Jancelewicz Tolulope A Oyetunji Julia Grabowski Karen A. Diefenbach Robert Baird Meghan A. Arnold Dave R. Lal Julia Shelton Yigit S. Guner Ankush Gosain Akemi L Kawaguchi Robert L. Ricca Roshni Dasgupta 《Journal of pediatric surgery》2019,54(3):369-377
Background
The treatment of ovarian masses in pediatric patients should balance appropriate surgical management with the preservation of future reproductive capability. Preoperative estimation of malignant potential is essential to planning an optimal surgical strategy.Methods
The American Pediatric Surgical Association Outcomes and Evidence-Based Practice Committee drafted three consensus-based questions regarding the evaluation and treatment of ovarian masses in pediatric patients. A search of PubMed, the Cochrane Library, and Web of Science was performed and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to identify articles for review.Results
Preoperative tumor markers, ultrasound malignancy indices, and the presence or absence of the ovarian crescent sign on imaging can help estimate malignant potential prior to surgical resection. Frozen section also plays a role in operative strategy. Surgical staging is useful for directing chemotherapy and for prognostication. Both unilateral oophorectomy and cystectomy have been used successfully for germ cell and borderline ovarian tumors, although cystectomy may be associated with higher rates of local recurrence.Conclusions
Malignant potential of ovarian masses can be estimated preoperatively, and fertility-sparing techniques may be appropriate depending on the type of tumor. This review provides recommendations based on a critical evaluation of recent literature.Type of study
Systematic review of level 1–4 studies.Level of evidence
Level 1–4 (mainly 3–4). 相似文献5.
Virginie Bussières Shreyas Roy Johnny Deladoey Élisabeth Rousseau Dickens St-Vil Nelson Piché 《Journal of pediatric surgery》2019,54(3):527-530
Aim of the study
Recent publications suggest pediatric surgeons may not be well suited to perform thyroid surgeries unless considered high volume. We sought to assess the outcome of thyroidectomies performed by pediatric surgeons in an academic setting.Methods
We reviewed charts of patients younger than 18?years who underwent thyroid surgeries at a free standing children's hospital between April 2006 and October 2015.Main results
The analysis included 118 surgeries in 98 patients (mean age 11.8?years). Most surgeries were performed by a single pediatric surgeon (average 10 thyroidectomies per year). The commonest indication for resection was thyroid nodule (64%). 80% of patients had a single surgery; the remainder had two, including 13 completion hemithyroidectomies. Cancer was found in 37% of specimens, with papillary subtype being most common (72%). Seven patients had locoregional metastases and one had pulmonary metastases. Among the 17 malignant cases that had a second intervention, 6 had malignancy in the resected specimen. There were no deaths in the follow up period (mean 2.7?years). Two patients had permanent hypocalcemia, and three had persistent unilateral recurrent laryngeal nerve injuries causing dysphonia for a total permanent complication rate of 4.2%.Conclusions
We conclude that pediatric thyroidectomy is a safe procedure when performed by pediatric surgeons. Our rate of complications is comparable to those reported in the literature. Our data highlight the need for a vigilant and multidisciplinary approach for children with thyroid pathology.Type of study
Treatment study.Level of evidence
IV. 相似文献6.
Jan Goedeke Alexandra Ertl Daniela Zöller Stephan Rohleder Oliver J. Muensterer 《Journal of pediatric surgery》2019,54(1):200-207
Background and purpose
Telemedicine is gaining popularity for a variety of indications. We performed a randomized controlled trial comparing telemedical versus conventional clinic follow-up in terms of feasibility and quality.Methods
Patients discharged from pediatric surgery were randomized to telemedical or onsite follow-up. In the telemedical group, video telephony was used to obtain interim history and physical findings. Onsite patients were personally seen in the outpatient clinic. Caregivers completed a postvisit survey on satisfaction and efficiency. Providers scored data transmission quality and clinical interpretability.Results
From March 2015 until January 2017, 224 patients were randomized equally to the study groups. Telemedicine was highly accepted by caregivers, and data transmission quality was sufficient for comprehensive follow-up. No important clinical findings were missed. Quality of interaction scored higher in the telemedical versus the onsite group (77.8% vs. 48%, p?<?0.001) as did caregiver satisfaction (5.4 vs. 5.1, p?<?0.03). Travel investment, time required, loss of earnings, and days off from work/school were all significantly lower in the telemedical group (p?<?0.001).Conclusions
Telemedical posthospitalization follow-up in pediatric surgery provides a cost-effective, time-saving alternative for patients and caregivers that is well received and accepted. The quality of clinical data transmission is sufficient to provide safe care and uncompromised clinical judgment.Type of study
Prospective and randomized controlled study.Level of evidence
Level 1b. 相似文献7.
Lisa T VanHouwelingen Laura V Veras Martin Lu Lynn Wynn John Wu Hasmukh J Prajapati Robert E Gold Andrew J Murphy Israel Fernandez-Pineda Ankush Gosain Ching-Hon Pui Andrew M Davidoff 《Journal of pediatric surgery》2019,54(1):145-149
Background
The risk of infection associated with subcutaneous port (SQP) placement in patients with neutropenia remains unclear. We reviewed the rate of early infectious complications (< 30?days) following SQP placement in pediatric oncology patients with or without neutropenia [absolute neutrophil count (ANC) < 500/mm3].Methods
Baseline characteristics and infectious complications were compared between groups using univariate and multivariate analyses.Results
A total of 614 SQP were placed in 542 patients. Compared to nonneutropenic patients, those with neutropenia were more likely to have leukemia (n?=?74, 94% vs n?=?268, 50%), preoperative fever (n?=?17, 22% vs n?=?25, 5%), recent documented infection (n?=?15, 19% vs n?=?47, 9%), and were younger (81 vs 109?months) (p values < 0.01). After adjusting for fever and underlying-disease, there was a nonsignificant association between neutropenia and early postoperative infection (OR 2.42, 95% CI 0.82–7.18, p?=?0.11). Only preoperative fever was a predictor of infection (OR 6.09, 95% CI 2.08–17.81, p?=?0.001).Conclusion
SQP placement appears safe in most neutropenic patients.Type of study
Retrospective comparative study.Level of evidence
Level III. 相似文献8.
Harold J. Leraas Laura H. Rosenberger Yi Ren Brian Ezekian Uttara P. Nag Christopher R. Reed Samantha M. Thomas Eun-Sil Shelley Hwang Elisabeth T. Tracy 《Journal of pediatric surgery》2018,53(6):1123-1128
Background
Phyllodes tumors are fibroepithelial breast lesions that are uncommon in women and rare among children. Due to scarcity, few large pediatric phyllodes tumor series exist. Current guidelines do not differentiate treatment recommendations between children and adults. We examined national guideline adherence for children and adults.Methods
We queried the NCDB (2004–2014) for female patients with phyllodes tumor histology, excluding patients with missing age or survival data. Patients were stratified by age (pediatric < 21, adult ≥ 21), and compared based on patient characteristics, treatment patterns, and survival.Results
We identified 2787 cases of phyllodes tumor (2725 adult, 62 pediatric). Median age was 17 years in children and 52 years in adults. Margin positivity rates and median tumor size were similar between adults and children. Treatment was discordant with NCCN guidelines in 28.6% of adults and 14.5% of children through use of axillary staging, chemotherapy, adjuvant endocrine therapy, and radiotherapy. Five-year and ten-year survival were comparable between both groups.Conclusion
Children and adults present with similarly sized phyllodes tumors. Trends reveal high margin positivity rates, and overtreatment with regional axillary staging and systemic adjuvant therapies. Particularly in children, treatment decisions must consider risks of adjuvant therapy including radiation-related second primary cancers, given uncertain benefit.Type of Study
Retrospective Comparative Study.Level of Evidence
Level III. 相似文献9.
Konstantinos S. Mylonas Dimitrios Nasioudis Diamantis I. Tsilimigras Ilias P. Doulamis Peter T. Masiakos Cassandra M. Kelleher 《Journal of pediatric surgery》2018,53(4):647-652
Purpose
To examine the clinicopathological characteristics and prognosis of pediatric patients with malignant pancreatic tumors in a population-based cohort.Methods
The Surveillance, Epidemiology, and End Results (SEER) database was utilized to identify all pediatric patients with malignant pancreatic tumors, diagnosed between 1973 and 2013. Kaplan–Meier analysis was performed to determine median and five-year overall survival (OS) rates. Univariate survival analysis was executed using the log-rank test. Cox proportional hazards model was used to identify variables independently associated with mortality.Results
A total of 114 patients with pancreatic malignancies were identified. Median patient age was 16 years and the majority of patients were white (64%) females (61.4%). The most prevalent histologic subtype was neuroendocrine tumors (35.1%), whereas pancreatoblastoma was more common during the first decade of life (P < 0.001). Distant metastases were noted in 41.7% of the patients, while 33.3% and 25% had localized and regional disease respectively. Five-year OS rates were 77%, 66.4% and 64.8% for patients with pancreatoblastoma, neuroendocrine and epithelial tumors respectively. No death was observed in the solid pseudopapillary tumor group. Only history of having cancer-directed surgery (CDS) was significantly associated with lower overall mortality (HR: 5.1, 95% CI: 2.1, 12.4).Conclusion
Pancreatic malignancies are rare in children. Their prognosis is variable and only CDS was independently associated with superior survival.Evidence rating/classification
Prognosis study, Level II. 相似文献10.
Brandon A. Sherrod Samuel G. McClugage Vincent E. Mortellaro Inmaculada B. Aban Brandon G. Rocque 《Journal of pediatric surgery》2019,54(4):631-639
Purpose
To evaluate venous thromboembolism (VTE) rates and risk factors following inpatient pediatric surgery.Methods
153,220 inpatient pediatric surgical patients were selected from the 2012–2015 NSQIP-P database. Demographic and perioperative variables were documented. Primary outcome was VTE requiring treatment within 30 postoperative days. Secondary outcomes included length of stay (LOS) and 30-day mortality. Prediction models were generated using logistic regression. Mortality and time to VTE were assessed using Kaplan–Meier survival analysis.Results
305 patients (0.20%) developed 296 venous thromboses and 12 pulmonary emboli (3 cooccurrences). Median time to VTE was 9?days. Most VTEs (81%) occurred predischarge. Subspecialties with highest VTE rates were cardiothoracic (0.72%) and general surgery (0.28%). No differences were seen for elective vs. urgent/emergent procedures (p?=?0.106). All-cause mortality VTE patients was 1.2% vs. 0.2% in patients without VTE (p?<?0.001). After stratifying by American Society of Anesthesiologists (ASA) class, no mortality differences remained when ASA?<?3. Preoperative, postoperative, and total LOSs were longer for patients with VTE (p?<?0.001 for each). ASA?≥?3, preoperative sepsis, ventilator dependence, enteral/parenteral feeding, steroid use, preoperative blood transfusion, gastrointestinal disease, hematologic disorders, operative time, and age were independent predictors (C-statistic?=?0.83).Conclusions
Pediatric postsurgical patients have unique risk factors for developing VTE.Level of evidence
Level II. 相似文献11.
Cynthia M. Tom Scott Friedlander Rie Sakai-Bizmark Shant Shekherdimian Howard Jen Daniel A. DeUgarte Steven L. Lee 《Journal of pediatric surgery》2019,54(1):103-107
Background/Purpose
Despite policy efforts to support rural hospitals, little is known about the quality and safety of pediatric surgical care in geographically remote areas. Our aim was to determine the outcomes and costs of appendectomies at rural hospitals.Methods
The Kids’ Inpatient Database (2003–2012) was queried for appendectomies in children < 18 years at urban and rural hospitals. Outcomes (disease severity, laparoscopy, complications, length of stay (LOS), cost) were analyzed with bivariate and multivariable regression analysis.Results
Rural hospitals performed 13.6% of appendectomies. On multivariable analysis, rural hospitals were associated with higher negative appendectomy rates (OR 1.49, 95% CI 1.39-1.60, p < 0.001), decreased appendiceal perforation rates (OR 0.86, 95% CI 0.83-0.89, p < 0.001), less laparoscopy use (OR 0.48, 95% CI 0.47-0.50, p < 0.001), higher complication rates (OR 1.29, 95% CI 1.19-1.39, p < 0.001), shorter LOS (IRR 0.90, 95% CI 0.89-0.91, p < 0.001), and slightly increased costs (exponentiated log$ 1.02, 95% CI 1.01-1.02, p < 0.001)Conclusions
Rural hospitals care for fewer patients with advanced appendicitis but are associated with higher negative appendectomy rates, lower laparoscopy use, and higher complication rates. Additional studies are needed to identify factors that drive this disparity to improve the quality of pediatric surgical care in rural settings.Type of Study
Treatment/Cost Study (Outcomes).Level of Evidence
Level III. 相似文献12.
David M. Notrica Bethany L. Sussman Nilda M. Garcia Charles M. Leys R. Todd Maxson Amina Bhatia Robert W. Letton Todd Ponsky Karla A. Lawson James W. Eubanks Adam C. Alder Cynthia Greenwell Daniel J. Ostlie David W. Tuggle Shawn D. St. Peter 《Journal of pediatric surgery》2019,54(2):340-344
Background
APSA guidelines do not recommend routine reimaging for pediatric blunt liver or spleen injury (BLSI). This study characterizes the symptoms, reimaging, and outcomes associated with a selective reimaging strategy for pediatric BLSI patients.Methods
A planned secondary analysis of reimaging in a 3-year multi-site prospective study of BLSI patients was completed. Inclusion required successful nonoperative management of CT confirmed BLSI without pancreas or kidney injury and follow up at 14 or 60?days. Patients with re-injury after discharge were excluded.Results
Of 1007 patients with BLSI, 534 (55%) met inclusion criteria (median age: 10.18 [IQR: 6, 14]; 62% male). Abdominal reimaging was performed on 27/534 (6%) patients; 3 of 27 studies prompting hospitalization and/or intervention. Abdominal pain was associated with reimaging, but decreased appetite predicted imaging findings associated with readmission and intervention.Conclusion
Selective abdominal reimaging for BLSI was done in 6% of patients, and 11% of studies identified radiologic findings associated with intervention or re-hospitalization. A selective reimaging strategy appears safe, and even reimaging symptomatic patients rarely results in intervention. Reimaging after 14?days did not prompt intervention in any of the 534 patients managed nonoperatively.Level of evidence
Level II, Prognosis. 相似文献13.
Daniel K. Noland Nadja Apelt Cynthia Greenwell Jefferson Tweed David M. Notrica Nilda M. Garcia R. Todd Maxson James W. Eubanks Adam C. Alder 《Journal of pediatric surgery》2019,54(2):345-349
Background/Purpose
Massive transfusion protocols (MTPs) are considered valuable in pediatric trauma. Important questions regarding the survival benefit and optimal blood component ratio remain unknown.Methods
The study time frame was January 2007 through December 2013 five Level I Pediatric Trauma Centers reviewed all trauma activations involving children ≤ 18?years of age. Included were patients who either had the institutional MTP or received > 20?mL/kg or?>?2?units packed red blood cells (PRBCs).Results
110/202 qualified for inclusion. Median age was 5.9?years (3.0–11.4). 73% survived to discharge; median hospitalization was 10 (3.1–22.8) days. Survival did not vary by arrival hemoglobin (Hgb), gender or age. Partial prothrombin time (PTT), INR, GCS and injury severity score (ISS) significantly differed for nonsurvivors (all p?<?0.05). Logistic regression found increased mortality (OR 3.08 (1.10–8.57), 95% CI; p?=?0.031) per unit increase over a 1:1 ratio of pRBC:FFP.Conclusion
In pediatric trauma pRBC:FFP ratio of 1:1 was associated with the highest survival of severely injured children receiving massive transfusion. Ratios 2:1 or ≥ 3:1 were associated with significantly increased risk of death. These data support a higher proportion of plasma products for pediatric trauma patients requiring massive transfusion.Level of evidence
Level IV. 相似文献14.
Ilan I. Maizlin Matthew Dellinger Kenneth W. Gow Adam B. Goldin Melanie Goldfarb Jed G. Nuchtern Monica Langer Sanjeev A. Vasudevan John J. Doski Mehul V. Raval Elizabeth A. Beierle 《Journal of pediatric surgery》2018,53(9):1748-1752
Background/purpose
Pediatric testicular tumors are rare, constituting only 1% of all pediatric solid tumors. Single-institution studies addressing pediatric testicular tumors published to date have been limited in the number of patients.Methods
We utilized the National Cancer Data Base (1998–2012) to review all prepubescent patients (≤ 12 years old) with testicular neoplasms. Demographics, tumor characteristics, treatment modalities, and outcomes were abstracted.Results
A total of 479 patients were identified, with a median age of 3 years (IQR 0–4) at diagnosis. 67% of cases were diagnosed by 3 years of age. Yolk sac tumors were the most common histology (202 patients, 42.2%). Most tumors were diagnosed at a low stage. Resection was performed in 465 boys, with 75% having undergone radical orchiectomies. Chemotherapy was utilized in 28% of cases and radiotherapy in 7%. With mean follow-up of 5.6 years, mortality rate was 3%. No difference in mortality was noted based on histology or extent of surgical resection.Conclusions
This series of prepubertal testicular tumors is the largest yet reported and highlights the patient demographics, tumor characteristics, treatment modalities and outcomes for these tumors.Type of study
Prognosis studyLevel of evidence
II. 相似文献15.
Beatrix Hyemin Choi Kamalou Yaya Vinay Prabhu Nancy Fefferman Beverly Mitchell Keith A Kuenzler Howard B Ginsburg Jason C Fisher Sandra Tomita 《Journal of pediatric surgery》2019,54(1):170-173
Purpose
The purpose of this study was to reduce radiation exposure during pediatric central venous line (CVL) placement by implementing a radiation safety process including a radiation safety briefing and a job-instruction model with a preradiation time-out.Methods
We reviewed records of all patients under 21 who underwent CVL placement in the operating room covering 22?months before the intervention through 10?months after 2013–2016. The intervention consisted of a radiation safety briefing by the surgeon to the intraoperative staff before each case and a radiation safety time-out. We measured and analyzed the dose area product (DAP), total radiation time pre- and postintervention, and the use of postprocedural chest radiograph.Results
100 patients with valid DAP measurements were identified for analysis (59 preintervention, 41 postintervention). Following implementation of the radiation safety process, there was a 79% decrease in median DAP (61.4 vs 13.1?rad*cm2, P?<?0.001) and a 73% decrease in the median radiation time (28 vs 7.6?s, P?<?0.001). Additionally, there was a significant reduction in use of confirmatory CXR (95% vs 15%, P?<?0.01).Conclusion
A preoperative radiation safety briefing and a radiation safety time-out supported by a job-instruction model were effective in significantly lowering the absorbed doses of radiation in children undergoing CVL insertion.Type of study
Case–control study.Level of evidence
Level III. 相似文献16.
Punam P. Parikh Eduardo A. Perez Holly L. Neville Anthony R. Hogan Juan E. Sola 《Journal of pediatric surgery》2018,53(6):1175-1180
Introduction
There remains a paucity of literature on survival related to pediatric appendiceal tumors. The purpose of this study was to determine the incidence, surgical management, and survival outcomes of appendiceal tumors in pediatric patients.Methods
The Surveillance, Epidemiology, and End Results (SEER) Registry was analyzed for pediatric appendiceal tumors from 1973 to 2011. Parameters analyzed were: tumor type, surgical management (appendectomy vs. extensive resection), tumor size, and lymph node sampling. Chi-square analysis for categorical and Student's t test for continuous data were used.Results
Overall, 209 patients had an appendiceal tumor, including carcinoid (72%), appendiceal adenocarcinoma (16%), and lymphoma (12%). Patients undergoing appendectomy vs. extensive resection had similar 15-year survival rates (98% vs. 97%; p = 0.875). Appendectomy vs. extensive resection conferred no 15-year survival advantage when patients were stratified by tumor type, including adenocarcinoma (87% vs. 89%; p = 0.791), carcinoid (100% vs. 100%; p = 0.863), and lymphoma (94% vs. 100%; p = 0.639). There was no significant difference in 15-year survival between tumor size groups ≥ 2 and < 2 cm (both 100%) and presence or absence of lymph node sampling (96% and 97%; p = 0.833) for all patients with a carcinoid tumor.Conclusion
Appendectomy may be adequate for pediatric appendiceal tumors. Extensive resection may be of limited utility for optimizing patient survival, placing patient at greater operative risk.Type of Study
Retrospective Prognostic Study.Level of Evidence
III 相似文献17.
Matthew T. Harting Austin Wheeler Todd Ponsky Benedict Nwomeh Chuck L. Snyder Nicholas E. Bruns Aaron Lesher Samir Pandya Belinda Dickie Sohail R. Shah 《Journal of pediatric surgery》2019,54(3):587-594
Importance
Telemedicine is an emerging strategy for healthcare delivery that has the potential to expand access, optimize efficiency, minimize cost, and enhance patient satisfaction.Objective
To review the current spectrum, potential strategies, and implementation process of telemedicine in pediatric surgery.Design
Review and opinion design.Setting
n/a.Participants
n/a.Main outcomes and measures
n/a.Results
n/a.Conclusions and relevance
Telemedicine is an emerging approach with the potential to facilitate efficient, cost-effective delivery of pediatric surgical services.Brief Abstract
Telemedicine is an emerging strategy for healthcare delivery that has the potential to expand access, optimize efficiency, minimize cost, and enhance patient satisfaction. The objectives of this review are to explore common terms in telemedicine, provide an overview of current legislative and billing guidelines, review the current state of telemedicine in surgery and pediatric surgery, and provide basic themes for successful implementation of a pediatric surgical telemedicine program.Type of Study
Review.Level of Evidence
Level V. 相似文献18.
Yasmine Yousef Etienne St-Louis Robert Baird Emily R. Smith Elena Guadagno Dickens St-Vil Dan Poenaru 《Journal of pediatric surgery》2019,54(4):831-837
Background
The Lancet Commission on Global Surgery highlighted global surgical need but offered little insight into the specific surgical challenges of children in low-resource settings. Efforts to strengthen the quality of global pediatric surgical care have resulted in a proliferation of partnerships between low-and middle-income countries (LMICs) and high-income countries (HICs). Standardized tools able to reliably measure gaps in delivery and quality of care are important aids for these partnerships. We undertook a systematic review (SR) of capacity assessment tools (CATs) focused on needs assessment in pediatric surgery.Methods
A comprehensive search strategy of multiple electronic databases was conducted per PRISMA guidelines without linguistic or temporal restrictions. CATs were selected according to pre-defined inclusion criteria. Articles were assessed by two independent reviewers. Methodological quality of studies was appraised using the COSMIN checklist with 4-point scale.Results
The search strategy generated 16,641 original publications, of which three CATs were deemed eligible. Eligible tools were either excessively detailed or oversimplified. None used weighted scores to identify finer granularity between institutions. No CATs comprehensively included measures of resources, outcomes, accessibility/impact and training.Discussion
The results of this study identify the need for a CAT capable of objectively measuring key aspects of surgical capacity and performance in a weighted tool designed for pediatric surgical centers in LMICs.Type of Study
Systematic Review.Level of Evidence
II. 相似文献19.
Katie W. Russell Micah G. Katz Scott S. Short Eric R. Scaife Stephen J. Fenton 《Journal of pediatric surgery》2019,54(3):569-571
Introduction
Recreation on longboards is gaining in popularity. The purpose of this study is to detail the injury patterns, treatment and management of children with longboarding injuries seen at a level 1 pediatric trauma center.Methods
A retrospective review using our trauma registry from 2006 to 2016 of pediatric patients who sustained injuries while riding a longboard.Results
Of 12,920 injured children, 64 (0.5%) were treated for injuries that occurred while riding a longboard. Median age was 14.5 years (IQR 13.6, 15.4) and 84% were male. Fifty-one (80%) suffered a traumatic brain injury (TBI) including 32 intracranial hemorrhages (ICH), 17 concussions, and 31 skull fractures. Seven (11%) were wearing helmets. Three patients required neurosurgical intervention. Extremity fractures were the most common reason for surgery. Ninety-six percent of patients were admitted to the hospital with a median length of stay of 1 day (IQR 1, 3). All children survived to discharge. Compared with skateboard injuries during the same period, TBI, ICH, concussion, and skull fractures were all greater.Conclusions
TBI ranging from concussion to ICH requiring craniotomy is common in children injured while riding a longboard, and greater than rates after skateboarding injuries. Extremity fracture was the most common reason for operative intervention.Level of evidence
III. 相似文献20.
Amy E. Lawrence Peter C. Minneci Katherine J. Deans Lorraine I. Kelley-Quon Jennifer N. Cooper 《Journal of pediatric surgery》2019,54(1):44-49