共查询到20条相似文献，搜索用时 875 毫秒
1.
Andrew Williams Morgan McWilliam James Ahlin Jacob Davidson Mackenzie A. Quantz Andreana Bütter 《Journal of pediatric surgery》2018,53(5):937-941
Background
Hypertrophic pyloric stenosis (HPS) is a common neonatal condition treated with open or laparoscopic pyloromyotomy. 3D-printed organs offer realistic simulations to practice surgical techniques. The purpose of this study was to validate a 3D HPS stomach model and assess model reliability and surgical realism.Methods
Medical students, general surgery residents, and adult and pediatric general surgeons were recruited from a single center. Participants were videotaped three times performing a laparoscopic pyloromyotomy using box trainers and 3D-printed stomachs. Attempts were graded independently by three reviewers using GOALS and Task Specific Assessments (TSA). Participants were surveyed using the Index of Agreement of Assertions on Model Accuracy (IAAMA).Results
Participants reported their experience levels as novice (22%), inexperienced (26%), intermediate (19%), and experienced (33%). Interrater reliability was similar for overall average GOALS and TSA scores. There was a significant improvement in GOALS (p < 0.0001) and TSA scores (p = 0.03) between attempts and overall. Participants felt the model accurately simulated a laparoscopic pyloromyotomy (82%) and would be a useful tool for beginners (100%).Conclusion
A 3D-printed stomach model for simulated laparoscopic pyloromyotomy is a useful training tool for learners to improve laparoscopic skills. The GOALS and TSA provide reliable technical skills assessments.Level of Evidence
II. 相似文献2.
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3.
Inna N. Lobeck Amir M. Alhajjat Phylicia Dupree John M. Racadio Mark M. Mitsnefes Rebekah Karns Greg M. Tiao Jaimie D. Nathan 《Journal of pediatric surgery》2018,53(9):1825-1831
Introduction
Renal artery occlusive disease is poorly characterized in children; treatments include medications, endovascular techniques, and surgery. We aimed to describe the course of renovascular hypertension (RVH), its treatments and outcomes.Methods
We performed literature review and retrospective review (1993–2014) of children with renovascular hypertension at our institution. Response to treatment was defined by National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents at most-recent follow-up.Results
We identified 39 patients with RVH. 54% (n = 21) were male, with mean age of 6.93 ± 5.27 years. Most underwent endovascular treatment (n = 17), with medication alone (n = 12) and surgery (n = 10) less commonly utilized. Endovascular treatment resulted in 18% cure, 65% improvement and 18% failure; surgery resulted in 30% cure, 50% improvement and 20% failure. Medication alone resulted in 0% cure, 75% improvement and 25% failure. 24% with endovascular treatment required secondary endovascular intervention; 18% required secondary surgery. 20% of patients who underwent initial surgery required reoperation for re-stenosis. Mean follow-up was 52.2 ± 58.4 months.Conclusions
RVH treatment in children includes medications, surgical or endovascular approaches, with all resulting in combined 79% improvement in or cure rates. A multidisciplinary approach and individualized patient management are critical to optimize outcomes.Type of Study
Retrospective comparative studyLevel of evidence
Level III 相似文献4.
Ruth Wragg Renuka P Dias Timothy Barrett Liam McCarthy 《Journal of pediatric surgery》2018,53(2):321-325
Aim
Wolfram syndrome is a rare genetic defect in WFS1 or WSF2(CISD2). It includes diabetes mellitus and insipidis, sensorineural deafness, optic atrophy, but not bladder dysfunction. However, this has appeared a common finding in our national referral clinic, and we sought to quantify this problem.Methods
Data were collected from a multidisciplinary team managing all Wolfram patients in the UK. The following was analyzed: age, date of non-invasive urodynamics (NIU), symptoms, bladder capacity, voided volume, post-void residual and uroflow pattern. Bladder capacity was given as percentage predicted bladder capacity (PBC). Bladders were divided into normal, overactive (OAB), and underactive (UAB). Symptoms, bladder behavior, and genotyping were correlated. Data were expressed as median (interquartile range).Main results
Forty patients with Wolfram syndrome were identified, and 38 underwent NIU. This showed normal bladder function (n = 4), OAB (n = 9), UAB (n = 25). Symptoms were present in only 11 children. The different patterns of bladder behavior (OAB vs. normal vs. UAB) were significantly associated with different %PBC (36 (29–59)% vs. 105 (93–233)% vs. 100 (77.5–337)%; p < 0.001), and percentage emptying (100 (80–100)% vs. 100 (87–100)% vs. 69 (48–93)%; p < 0.05). There was no association of genotype, symptoms and bladder behavior. Patients with megacystis were older: [13.4 (9.7–16.1) vs. 15.4 (13.9–18.7) years; p < 0.05).Conclusion
Bladder dysfunction is very common in Wolfram syndrome (~ 90%), but most children cope (symptoms ~ 30%). With time there is a significant progression to megacystis, which may represent an underlying neuropathic myogenic failure and is likely to require intervention in the future.Level of evidence
Level II (National cohort study of prognosis). 相似文献5.
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6.
Cristen N. Litz Jessica B. Asuncion Paul D. Danielson Nicole M. Chandler 《Journal of pediatric surgery》2018,53(3):449-451
Purpose
Antibiotic administration within one hour prior to incision is a common quality metric; however, antibiotics are typically started at the time of diagnosis in pediatric patients with acute appendicitis. The purpose was to determine if antibiotic administration within one hour prior to incision reduces the incidence of surgical site infections (SSI) in pediatric patients with acute appendicitis started on parenteral antibiotics upon diagnosis.Methods
A retrospective review was performed of 478 patients aged 0–18 years who underwent appendectomy for acute appendicitis from 7/2013 to 4/2015. Patients were categorized based on timing of antibiotic administration; there were 198 patients in Group A (< 60 min before) and 280 in Group B (> 60 min before).Results
Demographics and operative time (A: 30.5 ± 9.9 vs B: 30.8 ± 12.2 min, p = 0.51) were similar. Procedures were performed laparoscopically and the groups had similar proportions of single-incision operations (A: 53% vs B: 55%, p = 0.64). There was no difference in the incidence of superficial SSI (A: 2.0% vs B: 2.1%, p = 1.0) or intraabdominal abscess (A: 4.0% vs B: 3.6%, p = 0.81) and this remained true when stratified by intraoperative classification.Conclusion
Antibiotic administration within one hour of appendectomy in pediatric patients with acute appendicitis who receive antibiotics at diagnosis did not change the incidence of postoperative infectious complications.Type of study
Treatment study.Level of evidence
III. 相似文献7.
Brian C. Gulack Harold J. Leraas Brian Ezekian Jina Kim Christopher Reed Obinna O. Adibe Henry E. Rice Elisabeth T. Tracy 《Journal of pediatric surgery》2018,53(1):60-66
Purpose
Resection of congenital pulmonary airway malformations (CPAMs) is often performed to reduce the risk of recurrent infection and malignant transformation. However, there is substantial variation in the timing of resection. This study was performed to determine the association of age and weight on outcomes following elective resection of CPAMs.Methods
The American College of Surgeons National Surgical Quality Improvement Program-Pediatric database from 2012 to 2014 was queried for infants undergoing elective resection of a CPAM. Infants were categorized based on age (0–3 months, 3–6 months, 6–9 months, 9–12 months, and > 12 months) and weight (0–5 kg, 5–10 kg, and > 10 kg). Groups were compared for baseline characteristics and outcomes including a morbidity composite of pneumonia, reintubation, ventilator days > 0, reoperation, readmission, hospital length of stay > 7 days, and mortality.Results
A total of 311 infants met study criteria. The morbidity composite was significantly more common among infants < 3 months of age compared to infants > 3 months of age (31.3% vs. 15.6%, p = 0.01) and among infants < 5 kg as compared to infants > 5 kg (37.5% vs. 15.8%, p < 0.01).Conclusions
Infants should be observed until three months of age and a weight of five kilograms prior to elective resection of CPAMs.Level of evidence
Level III. 相似文献8.
Heather L. Short Kurt F. Heiss Katelyn Burch Curtis Travers John Edney Claudia Venable Mehul V. Raval 《Journal of pediatric surgery》2018,53(4):688-692
Purpose
Enhanced recovery protocols (ERPs) have been shown to improve outcomes in adult surgical populations. Our purpose was to compare outcomes before and after implementation of an ERP in children undergoing elective colorectal surgery.Methods
A pediatric-specific colorectal ERP was developed and implemented at a single center starting in January 2015. A retrospective review was performed including 43 patients in the pre-ERP period (2012–2014) and 36 patients in the post-ERP period (2015–2016).Outcomes of interest included number of ERP interventions received, length of stay (LOS), complications, and readmissions.Results
The median number of ERP interventions received per patient increased from 5 to 11 from 2012 to 2016. The median LOS decreased from 5 days to 3 days in the post-ERP period (p = 0.01). We observed a simultaneous decrease in median time to regular diet, mean dose of narcotics, and mean volume of intraoperative fluids (p < 0.001). The complication rate (21% vs. 17%, p = 0.85) and 30-day readmission rate (23% vs. 11%, p = 0.63) were not significantly different in the pre- and post-ERP periods.Conclusions
Implementation of a pediatric-specific ERP in children undergoing colorectal surgery is feasible, safe and may lead to improved outcomes. Further experience may highlight other opportunities for increased compliance and improved care.Level of evidence
Treatment Study. Level III. 相似文献9.
Cristen N. Litz Laurie Stone Roberta Alessi Nebbie E. Walford Paul D. Danielson Nicole M. Chandler 《Journal of pediatric surgery》2018,53(4):625-628
Background
In 2012, a same-day discharge protocol following appendectomy for acute appendicitis was initiated. Our objective was to determine the success of the protocol by reviewing the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) outcomes following protocol development.Methods
The 2015 NSQIP-P Participant Use Data File was queried to identify patients with acute appendicitis who underwent appendectomy. Outcomes were compared to institutional outcomes.Results
There were 154 institutional patients and 4973 from NSQIP-P centers. Institutional rate of outpatient management was higher compared to NSQIP-P (84% vs 48%, p < 0.0001). Surgical length of stay was shorter compared to national rates (0.3 ± 0.7 vs 1.1 ± 1.9 days, p < 0.0001). There was no significant difference in the incidence of superficial (1.9% vs 1.0%, p = 0.2), deep (0.6% vs 0.1%, p = 0.17) or organ/space surgical site infections (1.3% vs 0.7%, p = 0.31). The incidences of other complications (1.3% vs 0.6%, p = 0.26) and 30-day readmissions (3.2% vs 2.6%, p = 0.61) were similar.Conclusion
Outpatient management following appendectomy in children is possible with low morbidity and readmission rates. Comparison with other NSQIP-Pediatric centers suggests an opportunity to generalize this practice with considerable savings to the health care system.Level of evidence
Prognosis study, level II. 相似文献10.
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11.
12.
Joana Barbosa Sequeira Ana Coelho Ana Sofia Marinho Berta Bonet Fátima Carvalho João Moreira-Pinto 《Journal of pediatric surgery》2018,53(10):2003-2007
Purpose
To evaluate the effectiveness and safety of Endoscopic Pilonidal Sinus Treatment (EPSiT) in the pediatric population and compare it with excision followed by primary closure (EPC) regarding intra- and postoperative outcomes.Methods
A retrospective analysis of all patients with chronic sacrococcygeal pilonidal sinus submitted to EPSiT and EPC during a 12-month period in our institution was performed. Data concerning patients' demographics and surgical outcomes were collected and compared between the two groups.Results
We analyzed a total of 21 cases that underwent EPSiT and 63 cases of EPC, both groups with similar demographic characteristics. Operative time was similar for both groups (30 vs. 38 min; p > 0.05). No major intraoperative complications were reported. Wound infection rate was lower for EPSiT ((5.2% [n = 1] vs. 20.0% [n = 12]); p > 0.05). Healing time was similar for both groups (28 vs. 37.5 days). Recurrence occurred in 18,9% (n = 15), with 2 cases (10.5%) reported in the EPSiT group versus 13 (21.6%) in EPC. There were no differences between groups regarding postoperative complications, complete wound healing and recurrence rates or healing time (p > 0.05).Conclusions
Our results suggest that EPSiT is as viable as excision followed by primary closure in the management of sacrococcygeal pilonidal sinus in the pediatric population.Level of evidence
Therapeutic study – level III. 相似文献13.
Yangyang R. Yu Jennifer L. Carpenter Annalyn S. DeMello Sundeep G. Keswani Darrell L. Cass Oluyinka O. Olutoye Adam M. Vogel James A. Thomas Cole Burgman Caraciolo J. Fernandes Timothy C. Lee 《Journal of pediatric surgery》2018,53(5):1060-1064
Purpose
This study assesses the impact of extracorporeal membrane oxygenation (ECMO) associated morbidities on long-term quality of life (QOL) outcomes.Methods
A single center, retrospective review of neonatal and pediatric non-cardiac ECMO survivors from 1/2005–7/2016 was performed. The 2012 Pediatric Quality of Life Inventory? (PedsQL?) survey was administered. Clinical outcomes and QOL scores between groups were compared.Results
Of 74 patients eligible, 64% (35 NICU, 12 PICU) completed the survey. Mean time since ECMO was 5.5 ± 3 years. ECMO duration for venoarterial (VA) and venovenous (VV) were similar (median 9 vs. 7.5 days, p = 0.09). VA ECMO had higher overall complication rate (64% vs. 36%, p = 0.06) and higher neurologic complication rate (52% vs. 9%, p = 0.002). ECMO mode and ICU type did not impact QOL. However, patients with neurologic complications (n = 15) showed a trend towards lower overall QOL (63/100 ± 20 vs. 74/100 ± 18, p = 0.06) compared to patients without neurologic complications. A subset analysis of patients with ischemic or hemorrhagic intracranial injuries (n = 13) had significantly lower overall QOL (59/100 ± 19 vs. 75/100 ± 18, p = 0.01) compared to patients without intracranial injuries.Conclusion
Neurologic complication following ECMO is common, associated with VA mode, and negatively impacts long-term QOL. Given these associations, when clinically feasible, VV ECMO may be considered as first line ECMO therapy.Type of study
Retrospective review.Level of evidence
II 相似文献14.
Yangyang R. Yu Carolyn M. Smith Kimberly K. Ceyanes Bindi J. Naik-Mathuria Sohail R. Shah Adam M. Vogel Kathleen E. Carberry Jed G. Nuchtern Monica E. Lopez 《Journal of pediatric surgery》2018,53(1):36-41
Purpose
Standardized clinical pathways for simple appendicitis decrease length of stay and result in cost savings. We performed a prospective cohort study to assess a same day discharge (SDD) protocol for children with simple appendicitis.Methods
All children undergoing laparoscopic appendectomy for simple appendicitis after protocol implementation (February 2016 to January 2017) were assessed. Length of stay (LOS), 30-day resource utilization (ED visits and hospital readmissions), patient satisfaction, and hospital accounting costs for SDD were compared to non-SDD patients.Results
Of 602 children treated at our institution, 185 (31%) were successfully discharged per protocol. SDD patients had longer median PACU duration (3.0 vs. 1.0 h, p < 0.001), but postoperative LOS (4.4 vs. 17.4 h, p < 0.001) and overall LOS (17.1 vs. 31.2 h, p < 0.001) were significantly shorter. Complication rates (1.6% vs. 3.1%), ED visits (4.3% vs. 6.0%), and readmissions (0.5% vs. 2.4%) were not significantly different for SDD compared to non-SDD patients. However, SDD decreases total cost of an appendectomy episode ($8073 vs $8424, p = 0.002), and patients report high satisfaction with their hospital experience (mean 9.4 out of 10).Conclusions
Safe and satisfactory outpatient management of pediatric simple appendicitis is achievable with appropriate patient selection. An SDD protocol can lead to significant generation of value to the healthcare system.Level of Evidence
Prognosis study, Level II. 相似文献15.
Kristina H. Berg Lene Ryom Daniel Faurholt-Jepsen Tania Pressler Terese L. Katzenstein 《Journal of cystic fibrosis》2018,17(4):478-483
Background
With improved prognosis of CF, comorbidities including chronic kidney disease (CKD) are becoming increasingly important. Identification of those at highest CKD risk is hence a priority.Methods
In this cross-sectional study, adults with CF attending the Copenhagen CF Centre at Rigshospitalet with ≥ 2 measurements of serum creatinine from 2013 to 2015 were included. Data was obtained from an electronic CF database, which contains anonymised clinical and laboratory data on all individuals attending the clinic. CKD was defined as a confirmed (≥ 3 months apart) estimated glomerular filtration rate ≤ 60 mL/min/1.73m2.Results
Of 181 individuals, the CKD prevalence was 2.7% and increased to 11% after inclusion of lung transplanted patients. Individuals with CKD were generally older (median 39 (IQR, 36–45) vs. 31 (IQR, 24–39) years; p < 0.001), diabetic (86% vs. 41%, p < 0.001), with longer median duration of chronic pulmonary infection (28.3 (20.0–35.8) vs. 20.0 (9.9–34.7) years; p = 0.008) and with longer intravenous aminoglycosides use (606 (IQR, 455–917) vs. 273 (IQR, 91–826) days, p = 0.005).Conclusions
The CKD prevalence is high and related to age, diabetes, chronic infection, transplantation and aminoglycosides use. These observations call for longitudinal studies investigating CKD predictors in adults with CF. 相似文献16.
Stephanie F. Polites Shennen A. Mao Amy E. Glasgow Christopher R. Moir Elizabeth B. Habermann 《Journal of pediatric surgery》2018,53(5):1024-1027
Purpose
Skiing and snowboarding are popular winter sports. The purpose of this study was to determine differences in injury patterns and severity between children participating in these sports treated at trauma centers in the United States.Methods
Ski and snowboard injuries in children < 15 identified from the 2011–2015 National Trauma Data Bank were compared using t tests, chi squared tests, and multivariable analyses. Time trends were evaluated using the Cochran Armitage trend test.Results
We identified 1613 injured snowboarders and 1655 skiers. Snowboarders were older (12 vs. 11 years, p < .001) and more likely to be male (84 vs. 68%, p < .001). The proportion of ski to snowboard injuries increased over time (p < .001). Skiers had greater median ISS than snowboarders (5 vs. 4, p < .001) but similar severe injuries ISS ≥ 16 (9 vs. 8%, p = .31). Head injuries were more frequent among snowboarders (26 vs. 23%, p = .013). Helmet use was greater in skiers (46 vs. 34%, p < .001). Skiers were more likely to sustain face, chest, and lower extremity injuries. Snowboarders had more abdominal and upper extremity injuries (p < .05). Snowboarders were more likely to undergo CT (20 vs. 16%, p = .008), and skiers were more likely to undergo surgery (25 vs. 22% p = .021). Need for intensive care (12 vs. 13%, p = .43) and mortality (0.3 vs. 0.3%, p = .75) were similar. Median length of stay was greater for skiers (2 days vs. 1 day, p < .001).Conclusion
Many children are treated at United States trauma centers for ski and snowboard injuries. One in 10 is severely injured. Different injury patterns between sports can be used to tailor prevention efforts. However, avoiding head injury and improving helmet use should be a priority for all children on the slopes.Level of Evidence
IIIType of study
Prognostic 相似文献17.
Scott S. Short Stephen J. Fenton Eric R. Scaife Brian T. Bucher 《Journal of pediatric surgery》2018,53(3):545-547
Purpose
Awareness of equestrian related injury remains limited. Studies evaluating children after equestrian injury report under-utilization of safety equipment and rates of operative intervention as high as 33%.Methods
We hypothesized that helmets are underutilized during equestrian activity and lack of use is associated with increased traumatic brain injury. We queried the trauma database of a level one pediatric trauma center for all cases of equestrian and rodeo related injury from 2005 to 2015. Analysis was conducted using SAS 9.4.Results
Of 312 children identified, 142 were assessed for use of a helmet. Only 28 children (19.7%) had documented use of a helmet. Most injuries occurred while riding a horse (83%) or bull (13%) with traumatic brain injury being the most common injury (51%). Helmet use was associated with decreased ISS (7.1 vs. 11.3, p < 0.01), TBI (32.4% vs. 55.3%, p = 0.03), and ICU admission (10.7% vs. 29%, p = 0.05). Multivariable analysis reveals lack of helmet use to be an independent predictor of TBI (OR 2.5, 95% CI 1.1–6.3).Conclusion
Helmets are underutilized by children during equestrian related activity. Increased awareness of TBI and education encouraging helmet use may decrease morbidity associated with equestrian activities.Level of Evidence
Retrospective comparative study, Level III. 相似文献18.
Background
Hirschsprung-associated enterocolitis (HAEC) represents the primary cause of high morbidity and mortality in Hirschsprung disease (HSCR) patients. The most common surgical methods for HSCR are the Soave and Duhamel procedures. Therefore, we aimed to compare the HAEC frequency following the Soave and Duhamel procedures.Methods
Medical records were retrospectively analyzed for patients who underwent the Soave and Duhamel pull-through at Dr. Sardjito Hospital, Indonesia from 2010 to 2015. The diagnosis of HAEC was determined using a HAEC scoring system.Results
One hundred patients were involved (Soave: 52 males and 19 females vs. Duhamel: 23 males and 6 females, p = 0.62). There was significant difference in mean age at pull-through (Soave: 29.9 ± 45.2 vs. Duhamel: 50.8 ± 47.5 months, p = 0.04), whereas mean age of HSCR diagnosis and pre-operative enterocolitis frequency did not differ significantly between groups (Soave: 25.4 ± 41.0 vs. Duhamel: 43.7 ± 48.1 months, p = 0.06, and Soave: 7% vs. Duhamel: 14%, p = 0.44, respectively). The HAEC frequency after pull-through was significantly higher in the Duhamel than the Soave group (28% vs. 10%, respectively, p = 0.03). Furthermore, pre-operative enterocolitis showed a significant association with HAEC following pull-through (p = 2.0 × 10–4) and the risk of HAEC after Soave pull-through was increased in long-segment aganglionosis compared to short-segment HSCR (p = 0.015).Conclusions
The frequency of HAEC was significantly higher after the Duhamel than the Soave procedure. Moreover, patients with pre-operative enterocolitis are prone to have HAEC following pull-through.Level of evidence
III 相似文献19.
Katherine J. Baxter Lauren M. Baxter April M. Landry Mark L. Wulkan Amina M. Bhatia 《Journal of pediatric surgery》2018,53(9):1655-1659
Background
Long-term dysphagia occurs in up to 50% of repaired esophageal atresia and tracheoesophageal fistula (EA/TEF) patients. The underlying factors are unclear and may include stricture, esophageal dysmotility, or associated anomalies. Our purpose was to determine whether structural airway abnormalities (SAA) are associated with dysphagia in EA/TEF.Methods
We conducted a retrospective chart review of children who underwent EA/TEF repair in our hospital system from 2007 to 2016. Children with identified SAA (oropharyngeal abnormalities, laryngeal clefts, laryngomalacia, vocal cord paralysis, and tracheomalacia) were compared to those without airway abnormalities. Dysphagia outcomes were determined by the need for tube feeding and the modified pediatric Functional Oral Intake Scale (FOIS) at 1 year.Results
SAA was diagnosed in 55/145 (37.9%) patients with EA/TEF. Oropharyngeal aspiration was more common in children with SAA (58.3% vs. 36.4%, p = 0.028). Children with SAA were more likely to require tube feeding both at discharge (79.6% vs. 48.3%, p < 0.001) and at 1 year (52.7% vs. 13.6%, p < 0.001) and had lower mean FOIS (4.18 vs. 6.21, p < 0.001). In the logistic regression model adjusting for gestational age, long gap EA, and esophageal stricture, the presence of SAA remained a significant risk factor for dysphagia (OR 4.17 (95% CI 1.58–11.03)).Conclusion
SAA are common in children with EA/TEF and are associated with dysphagia, even after accounting for gestational age, esophageal gap and stricture. This study highlights the need for a multidisciplinary approach, including early laryngoscopy and bronchoscopy, in the evaluation of the EA/TEF child with dysphagia.Level of evidence
Level II retrospective prognostic study 相似文献20.
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