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1.
Ademola Olusegun Talabi Oludayo Adedapo Sowande Anthony Taiwo Adenekan Olusanya Adejuyigbe Collins Chijioke Adumah Arua Obasi Igwe 《Journal of pediatric surgery》2018,53(10):2072-2076
Background/Purpose
The analysis of perioperative mortality as well as surgery- and anesthesia-related death in pediatric patients may serve as a potential tool to improve outcome. The aim of this study is to report the 24-h and 30-day overall, and surgery and anesthesia-related, mortality in a tertiary hospital.Methods
This is a retrospective review of perioperative mortality in children ≤ 15 years at a general pediatric surgery unit. All pediatric general surgery cases operated under general anesthesia between January 2007 and December 2016 were included in the study and data analyzed.Results
A total of 4108 surgical procedures were performed in 4040 patients. The age was 1 day to 15 years with a median age of 2 years. The all cause 24-h mortality was 34 per 10,000 procedures and the all cause 30-day mortality was 156 per 10,000 procedures. Septicemia was the most common cause of death. The determinants of mortality were neonatal age group (Adjusted Odd Ratio (AOR) = 0.033, 95% CI = 0.015–0.070, p = 0.001), emergency surgery (AOR = 90.91, 95% CI = 27.78–333.33, p = 0.001), higher ASA status (AOR = 0.014, 95% CI = 0.005–0.041, p = 0.001) and multiple operative procedures (AOR = 38.46, 95% CI = 10.64–142.85, p = 0.001).Conclusions
Neonatal age group, children with poorer ASA status, emergency and multiple surgeries were predictors of perioperative mortality.Level of evidence
Retrospective study. 相似文献2.
Sonya L. Heltshe Emily M. Godfrey Tatiana Josephy Moira L. Aitken Jennifer L. Taylor-Cousar 《Journal of cystic fibrosis》2017,16(6):687-694
Background
Little is known about how new therapies that partially correct the basic cystic fibrosis (CF) defect (ivacaftor and lumacaftor) might alter hormonal contraceptive effectiveness, impact pregnancy outcomes, or affect pregnancy timing. Examination of pregnancy rates among CF women during periods of CFTR modulator therapy initiation will provide foundation for further research in this area.Methods
The Cystic Fibrosis Foundation Patient Registry was used to examine pregnancy rates and outcomes by genotype class before, during, and after the introduction of CFTR modulator therapies between 2005 and 2014.Results
Among women with CF, ages 15–44 years, there was a slight downward trend in annual pregnancy rates from 2005 to 2014 (2% reduction per year, p = 0.041). Among women with G551D, pregnancy rates during phase 3 ivacaftor trial years was 14.4/1000 women-years compared to 34.0/1000 prior to the trial period (relative risk [RR] = 0.65; 95% CI = 0.43–0.96; p = 0.011) and 38.4/1000 after drug approval in June 2012 (RR = 1.52 post-approval compared to trial period; 95% CI = 1.26, 1.83; p < 0.001). Pregnancy outcomes did not significantly change between 2005 and 2014 for any genotype class.Conclusion
Evidence of significantly increased numbers of pregnancies among women taking approved CFTR modulators is important because of the unknown risk to pregnancy and fetal outcomes. Increases may be temporary following pregnancy prevention during controlled clinical trials, or from altered perceptions about maternal survival with new approved treatments. As more women with CF become eligible to receive modulators, the CF community must study their effect on contraceptive efficacy and safety during pregnancy. With increased health and survival due to modulation, family planning topics will become more common in CF. 相似文献3.
Objective
To compare treatment outcomes in children with Hirschsprung's disease who underwent treatment using the Duhamel or TERPT surgical procedures.Methods
Medline, Cochrane, EMBASE, and Google Scholar databases were searched through December 26, 2016. Search strings included Hirschsprung's disease, fecal incontinence, transanal endorectal pull-through, and Duhamel operation. Randomized controlled studies (RCTs) and retrospective studies that compared the treatment of Hirschsprung's disease in with TERPT or Duhamel surgical procedures in neonates, infants, or children were included.Results
The study included six studies with a total of 280 patients. The meta-analysis indicated that the Duhamel and TERPT interventions were similar with respect to rate of postoperative fecal incontinence (OR = 0.85, 95% CI = 0.37 to 1.92, P = 0.692) and operation time (difference in means = 46.68 min, 95% CI = ? 26.96 to 114.31, P = 0.226). The Duhamel procedure was associated with longer postoperative hospital stay (Difference in means = 3.14 days, 95% CI = 1.46 to 4.82, P < .001) and a lower rate of enterocolitis (OR = 0.21, 95% = 0.07 to 0.68, P = 0.009) compared with the TERPT procedure.Conclusions
The study found that Duhamel and TERPT procedures showed similar benefit in treating Hirschsprung's disease, although differences exist with respect to length of postoperative hospital stay and the incidence of enterocolitis.The type of study
Meta-analysis.Level of evidence
Level II. 相似文献4.
Andrea Soria Gondek Lucia Riaza Daniel Cuadras Xavier Tarrado Castellarnau Lucal Krauel 《Journal of pediatric surgery》2018,53(4):599-604
Background/purpose
To identify factors that dim the efficacy of ultrasound guided saline enema (USGSE) and to design a mathematical model for predicting the probability of success of USGSE.Methods
Retrospective review of patients admitted with the diagnosis of ileocolic intussusception from 2009 to 2014. Demographics, clinical and sonographic data were reviewed.Results
116 first episodes of ileocolic intussusceptions. 109 USGSE attempts were analyzed. Composite reduction rate was 77%. A significant relationship was found between initial location of the intussusception, free peritoneal fluid (OR = 0.329, 95% CI: 0.124–0.875), negative Doppler signal and sonographic signs of intestinal occlusion and unsuccessful USGSE. Initial location beyond the splenic angle was an independent risk factor for USGSE failure (OR = 0.053, 95% CI: 0.005–0.534). A predictive model based on onset of symptoms, free peritoneal fluid and intussusception location was a reliable tool for prediction (AUC 0.63, 95% CI: 0.53–0.817). Assuming that a patient with less than 75.3% chance of USGSE success is going to fail, we would identify more than 80.9% of the real failures.Conclusions
This predictive model could be a filter selection for the patients at risk of USGSE failure and therefore candidates to further imaging investigations or referral to a surgical unit.Level of evidence
III. 相似文献5.
Jason O. Robertson Cory N. Criss Lily B. Hsieh Niki Matsuko Josh S. Gish Rodrigo A. Mon Kevin N. Johnson Ronald B. Hirschl George B. Mychaliska Samir K. Gadepalli 《Journal of pediatric surgery》2018,53(4):629-634
Purpose
For the last seven years, our institution has repaired infants with CDH that require ECMO early after cannulation. Prior to that, we attempted to decannulate before repair, but repaired on ECMO if we were unable to wean after two weeks. This study compares those strategies.Methods
From 2002 to 2016, 65 infants with CDH required ECMO. 67.7% were repaired on ECMO, and 27.7% were repaired after decannulation. Data were compared between patients repaired ≤ 5 days after cannulation (“early protocol”, n = 30) and > 5 days after cannulation or after de-cannulation (“late protocol”, n = 35). We used Cox regression to assess differences in outcomes between groups.Results
Survival for the early and late protocol groups was 43.3% and 68.8%, respectively (p = 0.0485). For patients that were successfully decannulated before repair, survival was 94.4%. Moreover, the early repair protocol was associated with prolongation of ECMO (16.8 ± 7.4 vs. 12.6 ± 6.8 days, p = 0.0216).After multivariate regression, the early repair protocol was an independent predictor of both mortality (HR = 3.48, 95% CI = 1.28–9.45, p = 0.015) and days on ECMO (IRR = 1.39, 95% CI = 1.07–1.79, p = 0.012). All bleeding occurred in patients repaired on ECMO (29.5%, 13/44).Conclusions
Our data suggest that protocolized CDH repair early after ECMO cannulation may be associated with increased mortality and prolongation of ECMO. However, early repair is not necessarily harmful for those patients who would otherwise be unable to wean from ECMO before repair. Further work is needed to better move towards individualized patient care.Type of study
Treatment Study.Level of evidence
Level III. 相似文献6.
Adesoji Ademuyiwa Felix Alakaloko Olumide Elebute Christopher Bode Ifeoma Udenze 《Journal of pediatric surgery》2018,53(2):335-338
Background/purpose
Serum Intestinal Fatty-Acid Binding Protein (I-FABP) is a useful marker of bowel necrosis in pediatric intussusception. The aim of this study is to determine the sensitivity of this marker and correlate it with length of necrosed small bowel.Methods
A single-centre prospective study of 50 children presenting to Lagos University Teaching Hospital, Nigeria, in whom a diagnosis of intussusception was made over 1 year was completed. Additionally, 25 age- and sex-matched controls (day case surgery) were recruited. They were grouped into three: 25 children with necrotic bowel, 25 without bowel necrosis, and 25 controls. The serum IFABP levels were compared between the cohorts with confirmed bowel necrosis at surgery and those with no necrosis, as well as controls. The cut-off values for the diagnosis of bowel necrosis were calculated using a receiver operating characteristic curve (ROC). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated.Results
Twenty-five children were diagnosed with necrotic intussusception whose serum IFABP immunoassay has significantly higher median compared with those without necrosis and controls (2056.0 ng/ml vs. 943.0 ng/ml and 478.0 ng/ml P = 0.0002). Using a cut-off value of 1538 ng/ml, the sensitivity, specificity, PPV, and NPV were 64%, 88%, 84%, and 71%, respectively. I-FABP titer greater than 1538 ng/ml was found to have higher likelihood of necrotic bowel (p = 0.002; odds ratio 13.04; 95% confidence interval; 0.618–0.891).Conclusion
Serum I-FABP is moderately sensitive for discriminating between bowel necrosis, and it predicts increased likelihood of bowel resectability in intussusception.Level of evidence
Level II – Development of diagnostic criteria in a consecutive series of patients and a universally applied “gold standard”. 相似文献7.
Nick Lansdale Nadeem Al-Khafaji Patrick Green Simon E Kenny 《Journal of pediatric surgery》2018,53(3):540-544
Objectives
Determine national outcomes for pyloromyotomy; how these are affected by: (i) surgical approach (open/laparoscopic), or (ii) centre type/volume and establish potential benchmarks of quality.Methods
Hospital Episode Statistics data were analysed for admissions 2002–2011. Data presented as median (IQR).Results
9686 infants underwent pyloromyotomy (83% male). Surgery was performed in 22 specialist (SpCen) and 39 nonspecialist centres (NonSpCen). The proportion treated in SpCen increased linearly by 0.4%/year (r = 0.76, p = 0.01). Annual case volume in SpCen vs. NonSpCen was 40 (24–53) vs. 1 (0–3). Time to surgery was shorter in SpCen (1 day [1, 2] vs. 2 [1–3]), but total stay equal (4 days [3–6]). 137 (1.4%) had complications requiring reoperation (wound problem 0.6%; repeat pyloromyotomy 0.5% and perforation, bleeding or obstruction 0.2%): pooled rates were similar between SpCen and NonSpCen (1.4% vs. 1.6%, p = 0.52). Three NonSpCen had > 5% reoperations (within 99.8% C.I. as small denominators). There was no relationship between reoperation and centre volume. Laparoscopic pyloromyotomy had increased risk of repeat pyloromyotomy (OR 2.28 [1.14–4.57], p = 0.029).Conclusions
Pyloric stenosis surgery shifted from centres local to patients, but outcomes were unaffected by centre type/volume. Modest reported benefits of laparoscopy appear offset by increased reoperations. Quality benchmarks could be set for reoperation < 4%.Type of study
Treatment Study.Level of evidence
Level III. 相似文献8.
Katerina Dukleska Loren Berman Allison A. Aka Charles D. Vinocur Erin A. Teeple 《Journal of pediatric surgery》2018,53(6):1154-1159
Introduction
Patients with familial adenomatous polyposis (FAP) and ulcerative colitis (UC) commonly undergo restorative proctocolectomy with ileal-pouch anal anastomosis (RP-IPAA). We sought to describe patient characteristics and postoperative outcomes in this patient population.Methods
Using the National Surgical Quality Improvement Program-Pediatric Participant Use Files from 2012 to 2015, children who were 6–18 years old who underwent RP-IPAA for FAP or UC were identified. Postoperative morbidity, including reoperation and readmission were quantified. Associations between preoperative characteristics and postoperative outcomes were analyzed.Results
A total of 260 children met the inclusion criteria, of which 56.2% had UC. Most cases were performed laparoscopically (58.1%), and the operative time was longer with a laparoscopic versus open approach (326 [257–408] versus 281 [216–391] minutes, p = 0.02). The overall morbidity was 11.5%, and there were high reoperation and readmission rates (12.7% and 21.5%, respectively). On bivariate analysis, preoperative steroid use was associated with reoperation (22.5% versus 10.9%, p = 0.04). On multivariable regression analysis, obesity was independently associated with reoperation (odds ratio: 3.34 [95% confidence intervals: 1.08–10.38], p = 0.04).Conclusions
Children who undergo RP-IPAA have high rates of overall morbidity, reoperation, and readmission. Obesity was independently associated with reoperation. This data can be used by practitioners in the preoperative setting to better counsel families and establish expectations for the postoperative setting.Type of Study
Retrospective Comparative Study.Level of Evidence
Level III. 相似文献9.
Priya H. Dedhia Yasmine White Jonathan R. Dillman Jeremy Adler Marcus D. Jarboe Daniel H. Teitelbaum Ronald B. Hirschl Samir K. Gadepalli 《Journal of pediatric surgery》2018,53(3):477-482
Background and objectives
Sarcopenia, defined as reduced muscle mass, is typically assessed by CT scans, which are infrequently performed in children. Using MRI to measure sarcopenia, we determined the association with postoperative complications after colectomy for ulcerative colitis (UC).Methods
Clinical and preoperative MRI data for 13–18-year-old UC patients who underwent colectomy were retrospectively reviewed. Bilateral paraspinous muscle area (PSMA) and psoas muscle area (PMA) at L3 vertebra were measured and averaged. Composite complications were infection, wound dehiscence, postoperative leak/abscess, prolonged ileus, pulmonary embolism, venous thromboembolism, or readmission.Results
Twenty-nine patients with average age 15.9 ± 1.36 years and weight 61.5 ± 19.8 kg had a preoperative MRI. The 18/29(62%) with complications had significantly reduced PSMA (4.71 ± 1.44 vs 5.64 ± 1.38 cm2, p = 0.04) and PMA (7.16 ± 2.60 vs 8.93 ± 2.44, p = 0.04). When stratified and compared to highest PSMA, patients with lowest PSMA had increased complication rates (88% vs 29%, p = 0.04). There were no differences in age, BMI, albumin, CRP, ESR, or preoperative steroid or anti-TNFα use. Odds of complication in the lowest tertile were 25.0-fold higher than the highest tertile (p = 0.04, 95% CI = 1.2–520.73).Conclusion
This is the first study to show low PSMA on MRI is associated with complications and increased hospital stay after colectomy in children with UC.Levels of evidence
Level III retrospective comparative study. 相似文献10.
Robert J. Obermeyer Nina S. Cohen Sheema Gaffar Robert E. Kelly M. Ann Kuhn Frazier W. Frantz Margaret M. McGuire James F. Paulson 《Journal of pediatric surgery》2018,53(6):1226-1229
Background/Purpose
Our previously published data suggested several risk factors for infection after the Nuss procedure. We aimed to further elucidate these findings.Methods
An IRB-approved (14–03-WC-0034), single institution, retrospective review was performed to evaluate the incidence of postoperative Nuss bar infections associated with seven variables. These were subjected to bivariate and multivariable analyses. A broad definition of infection was used including cellulitis, superficial infection with drainage, or deep infection occurring at any time postoperatively.Results
Over 7 years (4/1/2009–7/31/2016), 25 (3.2%) of 781 patients developed a postoperative infection after primary Nuss repair. Multivariable analyses demonstrated an increased risk of infection with perioperative clindamycin versus cefazolin for all infections (AOR 3.72, p = .017), and specifically deep infections (AOR 5.72, p = .004). The risk of a superficial infection was increased when antibiotic infusion completed > 60 min prior to incision (AOR 10.4, p = .044) and with the use of peri-incisional subcutaneous catheters (OR 8.98, p = .008).Conclusion
Following primary Nuss repair, the rate of deep bar infection increased with the use of perioperative clindamycin rather than cefazolin. The rate of superficial infection increased when perioperative antibiotic infusion was completed more than 60 min prior to incision and with the use of peri-incisional subcutaneous catheters. Further studies are needed to better understand these findings.Type of study
Retrospective chart review.Level of evidence
Level III treatment study. 相似文献11.
Background
Recently, perioperative transfusions were demonstrated to be associated with higher rate of surgical site infections (SSIs) in neonates. We sought to examine whether a similar relationship exists between perioperative blood transfusions and SSI among non-neonatal pediatric general surgical patients.Methods
We conducted an IRB-approved retrospective study reviewing non-neonatal patients (age greater than 28 days and less than 18 years) who underwent a general or thoracic surgical procedure in 2012, 2013, 2014, in the American College of Surgeons National Safety and Quality Improvement Project-Pediatric (ACS-NSQIP-P) Participant User Files. We used Chi-square analyses to perform a bivariate analysis comparing proportions of SSI's between patients who received blood transfusion to those who did not. Multiple logistic regression analyses compared the odds of SSIs in transfused versus nontransfused patients controlling for organ failure, steroid use, nutritional status, current infection, American Society of Anesthesiologists (ASA) Physical Status classification, and wound classification.Results
There were 55,133 patients with 1779 patients who received blood transfusion (≥ 25 ml/kg body weight) during or within 72 h of surgery. Bivariate analysis showed at least twice the rate of infection in transfused patients compared to nontransfused patients (p < 0.01): superficial SSI 3.5% vs 1.5%; deep SSI 0.8% vs 0.2%, organ space SSI 3.8% vs 1.6%; deep dehiscence 2% vs 0.3%. Total wound infections and dehiscence for transfused patients were 10.5% vs 3.8% in nontransfused patients (p < 0.01). Multiple regression analysis showed that nutritional issue, current infection, and wounds not classified as “clean” have statistically significant correlation with SSI. Although there was significant interaction between ASA and transfusion (p < 0.0001), we found statistically significant associations between transfusions and SSI for ASA class 1–2 (OR = 5.51, 95% CI 3.47–7.52), ASA class 3 (OR = 2.06, 95% CI 1.63–2.61), and ASA class 4–5 (OR = 1.67, 95% CI 1.15–2.42).Conclusion
In non-newborn pediatric general and thoracic surgery patients, transfusions were associated with higher risk of SSI or wound dehiscence. Although there was a significant interaction between ASA and transfusion, OR for SSI was stronger for lower ASA classes.Type of Study
Retrospective Review.Level of Evidence
II 相似文献12.
13.
Tiffany J. Zens Andrew P. Rogers Erica L. Riedesel Charles M. Leys Daniel J. Ostlie Michael A. Woods Kara G. Gill 《Journal of pediatric surgery》2018,53(6):1168-1174
Introduction
Contrast-enhanced CT remains the first-line imaging for evaluating postoperative abscess (POA) after appendicitis. Given concerns of ionizing radiation use in children, we began utilizing quick MRI to evaluate POA and summarize our findings in this study.Materials and Methods
Children imaged with quick MRI from 2015 to 2017 were compared to children evaluated with CT from 2012 to 2014 using an age and weight matched case–control model. Radiation exposure, size and number of abscesses, length of exam, drain placement, and patient outcomes were compared.Results
There was no difference in age or weight (p > 0.60) between children evaluated with quick MRI (n = 16) and CT (n = 16). Mean imaging time was longer (18.2 ± 8.5 min) for MRI (p < 0.001), but there was no difference in time from imaging order to drain placement (p = 0.969). No children required sedation or had non-diagnostic imaging. There were no differences in abscess volume (p = 0.346) or drain placement (p = 0.332). Thirty-day follow-up showed no difference in readmissions (p = 0.551) and no missed abscesses. Quick MRI reduced imaging charges to $1871 from $5650 with CT.Conclusion
Quick MRI demonstrated equivalent outcomes to CT in terms of POA detection, drain placement, and 30-day complications suggesting that MRI provides an equally effective, less expensive, and non-radiation modality for the identification of POA.Type of Study
Retrospective Case–Control Study.Level of Evidence
Level III. 相似文献14.
Yangyang R. Yu Annalyn S. DeMello Christopher S. Greeley Charles S. Cox Bindi J. Naik-Mathuria David E. Wesson 《Journal of pediatric surgery》2018,53(5):1028-1032
Purpose
This study examines non-accidental trauma (NAT) fatalities as a percentage of all injury fatalities and identifies injury patterns in NAT admissions to two level 1 pediatric trauma centers.Methods
We reviewed all children (< 5 years old) treated for NAT from 2011 to 2015. Patient demographics, injury sites, and survival were obtained from both institutional trauma registries.Results
Of 4623 trauma admissions, 557 (12%) were due to NAT. However, 43 (46%) of 93 overall trauma fatalities were due to NAT. Head injuries were the most common injuries sustained (60%) and led to the greatest increased risk of death (RR 5.1, 95% CI 2.0–12.7). Less common injuries that increased the risk of death were facial injuries (14%, RR 2.9, 95% CI 1.6–5.3), abdominal injuries (8%, RR 2.8, 95% CI 1.4–5.6), and spinal injuries (3%, RR 3.9, 95% CI 1.8–8.8). Although 76% of head injuries occurred in infants < 1 year, children ages 1–4 years old with head injuries had a significantly higher case fatality rate (27% vs. 6%, p < 0.001).Conclusion
Child abuse accounts for a large proportion of trauma fatalities in children under 5 years of age. Intracranial injuries are common in child abuse and increase the risk of death substantially. Preventing NAT in infants and young children should be a public health priority.Type of study
Retrospective Review.Level of evidence
II 相似文献15.
Sona Sehgal Anthony D. Sandler A Alfred Chahine Parvati Mohan Clarivet Torres 《Journal of pediatric surgery》2018,53(10):1989-1995
Introduction
Despite medical and surgical management, a subset of children with short bowel syndrome (SBS) who have discrepancy between proximal small bowel and distal colon have persistent feeding intolerance. We propose the use of an Ostomy in Continuity (OIC) (Bishop-Koop or Santulli) as a salvage procedure to decompress the proximal bowel while still maintaining maximal intestinal length, in these patients.Methods
A retrospective chart review of 104 SBS patients identified sixteen patients who underwent an OIC. Measures of reliance on parenteral nutrition (PN), growth, intestinal failure associated liver disease, the rate of central venous catheter infections and enterocolitis were collected. These parameters were compared before and after the placement of OIC in the same patients at a median follow-up period of 24 months (range 3–52 months). Outcome measures include intestinal autonomy and survival without intestinal and liver transplant.Results
All 16 patients showed significant improvement in their enteral tolerance after OIC. The mean PN caloric requirement decreased from 95% to 21% (p = 0.0001). The median weight Z score improved from ? 1.18 to 0.20 (p = 0.0006) and the median height Z score improved from ? 2.74 to ? 1 (p = 0.0001). The mean conjugated bilirubin decreased from 10.3 mg/dl to 0.3 mg/dl (p = 0.0001) in nine patients with hyperbilirubinemia. There was no decrease in central venous catheter infections (CVCI) but there was a decrease in the rate of enterocolitis. None of the patients required intestinal or liver transplant. There was one minor skin excoriation complication in one patient with a Bishop-Koop stoma.Conclusions
The application of an ostomy in continuity within a comprehensive intestinal rehabilitation program is a novel approach in the treatment of refractory short bowel syndrome that improves intestinal autonomy and decreases the rate of enterocolitis.Type of Study
Case Series.Level of evidence
IV (Cohort Study). 相似文献16.
Matthew C. Hernandez Ryan M. Antiel Karthik Balakrishnan Martin D. Zielinski Denise B. Klinkner 《Journal of pediatric surgery》2018,53(2):352-356
Introduction
Supraglottic airway (SGA) use and outcomes in pediatric trauma are poorly understood. We compared outcomes between patients receiving prehospital SGA versus bag mask ventilation (BVM).Methods
We reviewed pediatric multisystem trauma patients (2005–2016), comparing SGA and BVM. Primary outcome was adequacy of oxygenation and ventilation. Additional measures included tracheostomy, mortality and abbreviated injury scores (AIS).Results
Ninety patients were included (SGA, n = 17 and BVM, n = 73). SGA patients displayed increased median head AIS (5 [4–5] vs 2 [0–4], p = 0.001) and facial AIS (1 [0–2] vs 0 [0–0], p = 0.03). SGA indications were multiple failed intubation attempts (n = 12) and multiple failed attempts with poor visualization (n = 5). Median intubation attempts were 2 [1–3] whereas BVM patients had none. Compared to BVM, SGA patients demonstrated inadequate oxygenation/ventilation (75% vs 41%), increased tracheostomy rates (31% vs 8.1%), and increased 24-h (38% vs 10.8%) and overall mortality (75% vs 14%) (all p < 0.05).Conclusions
Escalating intubation attempts and severe facial AIS were associated with tracheostomy. Inadequacy of oxygenation/ventilation was more frequent in SGA compared to BVM patients. SGA patients demonstrate poor clinical outcomes; however, SGAs may be necessary in increased craniofacial injury patterns. These factors may be incorporated into a management algorithm to improve definitive airway management after SGA. 相似文献17.
Young Mee Choi David Leopold Kristen Campbell Jane Mulligan Greg Z. Grudic Steven L. Moulton 《Journal of pediatric surgery》2018,53(2):241-246
Introduction
Physiologic compromise in children with acute appendicitis has heretofore been difficult to measure. We hypothesized that the Compensatory Reserve Index (CRI), a novel adjunctive cardiovascular status indicator, would be low for children presenting with acute appendicitis in proportion to their physiological compromise, and that CRI would rise with fluid resuscitation and surgical management of their disease.Methods
Ninety-four children diagnosed with acute appendicitis were monitored with a CipherOx CRI? M1 pulse oximeter (Flashback Technologies Inc., Boulder, CO). For clarity, CRI = 1 indicates supine normovolemia, CRI = 0 indicates hemodynamic decompensation (systolic blood pressure < 80 mmHg), and CRI values between 1 and 0 indicate the proportion of volume reserve remaining before collapse. Results are presented as counts with proportion (%), or mean with 95% confidence interval (CI).Results
Mean age was 11 years old (95% CI: 10–12), and 49 (52%) of the children were male. Fifty-four (57%) had nonperforated appendicitis and 40 (43%) had perforated appendicitis. Mean initial CRI was significantly higher in those with nonperforated appendicitis compared to those with perforated appendicitis (0.57, 95% CI: 0.52–0.63 vs. 0.36, 95% CI: 0.29–0.43; P < 0.001). The significant differences in mean CRI values between the two groups remained throughout the course of treatment, but lost its significance at 2 h after surgery (0.63, 95% CI: 0.57–0.70 vs. 0.53, 95% CI: 0.46–0.61; P = 0.05).Conclusion
Low CRI values in children with perforated appendicitis are indicative of their lower reserve capacity owing to peritonitis and hypovolemia. CRI offers a real-time, noninvasive adjunctive tool to monitor tolerance to volume loss in children.Level of evidence
Study of diagnostic test; Level of evidence: Level III. 相似文献18.
Andrew Nordin Alan Coleman Junxin Shi Krista Wheeler Henry Xiang Brian Kenney 《Journal of pediatric surgery》2018,53(5):1020-1023
Purpose
Firearm-related trauma represents a major source of preventable injury and death. Many firearm injuries in young children are unintentional, and the true incidence may be underestimated. We sought to characterize the morbidity of unintentional firearm injuries.Methods
National Trauma Data Bank data from 2007 to 2014 was obtained for patients aged 0–14 sustaining gunshot wounds (GSW). We analyzed demographics, injury severity score, hospital and ICU length of stay (LOS), ventilator days, discharge to rehab, and mortality. We categorized intention as assault, unintentional, self-inflicted or other, and compared unintentional firearm injuries against all others using Student's t test or chi-square analysis.Results
We identified 7487 GSW patients aged 0–14, of whom 2514 (33.6%) sustained unintentional injuries. The mortality rate for unintentionally injured patients was 9.2%, compared with 14.2% for all other intentions (p < 0.0001). Unintentionally injured children were more likely to be male (p = 0.01) and Caucasian (p < 0.0001) and had lower rates of ICU admission (p = 0.02), ventilator use (p = 0.0004), and discharge to rehab (p < 0.0001).Conclusions
Unintentional injuries comprise one-third of firearm injuries and approximately 10% of GSW-related mortality in young children. Since these injuries are entirely preventable, our findings suggest a major opportunity to reduce disease burden.Level of Evidence
IV. 相似文献19.
Robert J. Obermeyer Sheema Gaffar Robert E. Kelly M. Ann Kuhn Frazier W. Frantz Margaret M. McGuire James F. Paulson Cynthia S. Kelly 《Journal of pediatric surgery》2018,53(2):260-264
Aim of the study
The aim of the study was to determine the role of patch metal allergy testing to select bar material for the Nuss procedure.Methods
An IRB-approved (11–04-WC-0098) single institution retrospective, cohort study comparing selective versus routine patch metal allergy testing to select stainless steel or titanium bars for Nuss repair was performed. In Cohort A (9/2004–1/2011), selective patch testing was performed based on clinical risk factors. In Cohort B (2/2011–9/2014), all patients were patch tested. The cohorts were compared for incidence of bar allergy and resultant premature bar loss. Risk factors for stainless steel allergy or positive patch test were evaluated.Main results
Cohort A had 628 patients with 63 (10.0%) selected for patch testing, while all 304 patients in Cohort B were tested. Over 10 years, 15 (1.8%) of the 842 stainless steel Nuss repairs resulted in a bar allergy, and 5 had a negative preoperative patch test. The incidence of stainless steel bar allergy (1.8% vs 1.7%, p = 0.57) and resultant bar loss (0.5% vs 1.3%, p = 0.23) was not statistically different between cohorts. An allergic reaction to a stainless steel bar or a positive patch test was more common in females (OR = 2.3, p < 0.001) and patients with a personal (OR = 24.8, p < 0.001) or family history (OR = 3.1, p < 0.001) of metal sensitivity.Conclusion
Stainless steel bar allergies occur at a low incidence with either routine or selective patch metal allergy testing. If selective testing is performed, it is advisable in females and patients with a personal or family history of metal sensitivity. A negative preoperative patch metal allergy test does not preclude the possibility of a postoperative stainless steel bar allergy.Level of evidence
Level III Treatment Study and Study of Diagnostic Test. 相似文献20.
Punam P. Parikh Eduardo A. Perez Holly L. Neville Anthony R. Hogan Juan E. Sola 《Journal of pediatric surgery》2018,53(6):1175-1180