Eliminating disparity in evaluation for abuse in infants with head injury: use of a screening guideline

Purpose

Minority and disadvantaged children are evaluated for nonaccidental trauma (NAT) at higher rates than other children. At our institution, we implemented a guideline to perform skeletal surveys to screen for occult fractures in all infants with unwitnessed head injury (UHI). The goal was to determine if this guideline decreased disparities in the screening of African American (AA) and uninsured children.

Patients and Methods

For 54 months, rates of skeletal surveillance and abuse determination were compared between AA and white infants admitted with UHI before and after implementation of our guideline. Logistic regression was used to control for confounders.

Results

Before the guideline, AAs underwent skeletal surveillance more than whites (n = 208; 90.5% vs 69.3%; P = .01), with 20% of screened infants determined to be probable victims of NAT. Whites with private insurance were less likely to be screened compared to those without private insurance (50.0% vs 88.1%; P < .001). After the guideline, AA and whites were surveyed equally (n = 52; 92.3% vs 84.6%; P = 1.0), with 22% found to be probable cases of NAT.

Conclusions

This is the first report of a successful policy-based intervention to decrease disparity in care. The maintenance of a stable rate of NAT determination despite increased screening suggests more victims of abuse may be identified with guideline use, and therefore, this may be an additional benefit of the guideline.     

Disparities in child abuse mortality are not explained by injury severity

Background

Unadjusted abuse-related mortality has been demonstrated to be nearly 4-fold higher for African American (AA) children. Little is known about the etiology of this disparity. This study examines the importance of injury severity and initial presentation in explaining the observed disparity.

Method

Our trauma database was reviewed to identify all abused patients admitted over a 10-year period. Outcomes among white and AA children were compared with specific attention to injury severity scores and initial presentation. Logistic regression and Cox proportional hazard analyses were performed to evaluate the impact of race on outcome.

Results

There were 443 abused children identified. Thirty-eight percent of the group was AA. The overall mortality was 7.7%; however, the AA mortality was significantly higher than white children (14.8% vs 3.3%; P < .05). After controlling for injury severity and physiology at presentation, the odds ratio of mortality for an AA child was 9.14 (95% confidence interval, 1.97-42.43). Survival analysis confirmed the disparity after revealing a hazard ratio of dying for AA children of 6.51 (95% confidence interval, 2.74-15.47) compared with white children.

Conclusion

Despite attempts to control for the clinical presentation and injury severity of abused children, significant differences in mortality persist between AA and white children.     

Pancreaticojejunostomy of duct to mucosa anastomosis can be performed more safely without than with a stenting tube

Background

The aim of this study was to evaluate the safety of performing a pancreaticojejunostomy with a duct-to-mucosa anastomosis without a stenting tube.

Methods

One hundred twenty-one patients with pancreaticojejunostomy, classified into 2 groups of those with duct-to-mucosa anastomoses with stenting tubes (group A; n = 49) and without stenting tubes (group B; n = 72), were investigated. Outcomes, including complications and survival rates, are reported.

Results

In group A, morbidity was 32.7%, 6.7% had pancreatic fistulas, 14.3% had delayed gastric emptying, 6.1% had remnant pancreatitis, 2% had intra-abdominal abscesses, 2% had intra-abdominal bleeding, and mortality was 2%. In group B, morbidity (15.3%) and delayed gastric emptying (2.8%) showed significant differences from group A. Other results were nonsignificant. In the normal soft pancreas, pancreatic fistulas in group B (3.3%) were less frequent than in group A (12.5%).

Conclusion

Pancreaticojejunostomy of a duct-to-mucosa anastomosis could be performed more safely without than with a stenting tube to obtain a definitive anastomosis and transection of the pancreas.     

Videothoracoscopic drainage for esophageal perforation with mediastinitis in children

Background

Esophageal perforation remains a devastating event that is difficult to diagnose and manage. The overall mortality associated with esophageal perforation can approach 20%, and delay in treatment of more than 24 hours after perforation can result in a doubling of mortality. The treatment option for esophageal perforation with mediastinitis is not very clear and still controversial.

Methods

Between April 2000 and March 2004, 6 males and 2 females, with ages ranging from 2 to 6 years (mean, 3.8 years), underwent videothoracoscopic drainage for esophageal perforation with mediastinitis.

Results

The mean hospital length of stay for patients in our series was 34.1 days (range, 14-47 days). There was no perioperative mortality. All patients were discharged from hospital without major sequelae.

Conclusions

Minimally invasive videothoracoscopic drainage is a feasible and effective method for esophageal perforation with mediastinitis in children.     

Racial disparities in motorcycle-related mortality: an analysis of the National Trauma Data Bank

Background

Studies have shown racial disparities in outcomes after motor vehicle crashes; however, it is currently unknown if race impacts the likelihood of mortality after a motorcycle crash (MCC). The primary objective of this study was to determine if race is associated with MCC mortality.

Methods

We performed a retrospective cross-sectional analysis of MCCs included in the National Trauma Data Bank between 2002 and 2006. Multiple logistic regression was used to adjust for age, sex, insurance status, year, helmet use, and injury severity characteristics.

Results

Black patients had a 1.58 (95% confidence interval, 1.28-1.97) increased odds of mortality after a MCC, but were more likely to use a helmet (1.30; 95% confidence interval, 1.19-1.43) compared with their white counterparts (n = 62,840).

Conclusions

Black motorcyclists appear more likely to die after a MCC compared with whites. Although the reasons for this disparity are unclear, these data suggest that resources beyond encouraging helmet use are necessary to reduce fatalities among black motorcyclists.     

Alarming trends in the improper use of motor vehicle restraints in children: implications for public policy and the development of race-based strategies for improving compliance

Purpose

Little is known regarding the patterns of appropriate restraint use among minority children involved in motor vehicle collisions. The purpose of this study was to characterize patterns of restraint use among children hospitalized after motor vehicle collision and to examine the effects of race and socioeconomic status on compliance.

Methods

All children admitted to our level I trauma center over a 10-year period were identified. Patterns of appropriate restraint use were compared between African American (AA) and white children. Compliance was also compared between children insured with Medicaid (as a surrogate for socioeconomic status) and those with private insurance coverage.

Results

One thousand two hundred sixty-eight patients were included with an overall restraint use of 44.8% with only 20.3% restrained properly. Compared with white children, AAs were significantly less likely to be properly restrained (12.7% vs 22.2%, P < .001) or to be restrained by any means (28.8% vs 48.7%, P < .001). The greatest disparity between groups was observed in the use of car seats (16.0% vs 47.4%, P < .001). Medicaid patients were less likely to be restrained compared with those with commercial insurance (40.6% vs 48.3%, P = .022); however, race remained a significant predictor of noncompliance after controlling for the effect of insurance status.

Conclusions

These data demonstrate an alarming trend because nearly 80% of all children in our study were improperly restrained. Marked disparities in compliance were observed in the AA population even after controlling for insurance coverage. Future studies will need to further characterize the complex interplay between race and socioeconomic status with proper restraint use.     

The role of the altruistic unbalanced chain in exchange living donor renal transplantation: single-center experience

Background

The exchange donor program in renal transplantation is an efficient solution for recipients with a blood type or crossmatch-incompatible donor. However, this program has some difficulties to define unacceptable human leukocyte antigen matches, deteriorating clinical potential recipient condition, and withdrawal of donor consent. We analyzed the outcomes of exchange donor renal transplantation through the altruistic unbalanced chain.

Methods

Among 152 cases of exchange donor renal transplantation from 1991 to 2010 in our hospital, we performed 58 procedures through altruistic unbalanced chains. We compared their outcomes with the direct and balanced chain group. We analyzed retrospectively whether this program expanded the donor pool, seeking better immunologic, size, and age matching.

Results

The graft survival and acute rejection rates did not differ significantly in the two groups. Of 152 cases, 58 (38.2%) renal transplantations were performed through an unbalanced chain. Seventeen waiting list recipients were transplanted through an altruistic unbalanced chain. In blood type O recipients (n = 32), the causes of registration in the exchange program were ABO incompatibility (93.3%), and positive crossmatch (6.7%). Nine altruistic blood type O donors and 9 (28.1%) type O recipients underwent transplantations through this chain.

Conclusions

We suggest the altruistic unbalanced chain may expand the donor pool with advantages for difficult-to-match pairs. The disadvantages of type O recipients may be overcome through the use of an unbalanced chain. The altruistic unbalanced exchange transplantation program can help easy-to-match subjects, shortening the waiting periods.     

Despite overall low pediatric head injury mortality, disparities exist between races

Background

To continually improve quality of care, it is important for centers caring for children with head injury to evaluate their overall outcome and that among diverse patient groups.

Methods

Data on children with head injuries were extracted from the National Trauma Data Bank of the American College of Surgeons and our local trauma registry. Unadjusted mortality, as well as stratified analysis and logistic regression modeling, was used to evaluate overall and race-specific mortality.

Results

There were 13,363 children in the National Trauma Data Base and 3111 in our database included. Our overall mortality rate compared favorably with the national data (3.2% vs 6.8%, P < .05). Our local data, however, showed a significant difference in mortality between white and African American (AA) children (2.2% vs 5.3%, P < .05), which was not identified in the national data. After stratification, the disparities by race persisted. Finally, multivariate regression modeling revealed that AA race was an independent predictor of mortality among our patient population, with an odds ratio of 3.1 (95% confidence interval, 1.2-7.8).

Conclusion

Despite excellent outcomes for children with head injuries, we have uncovered unsettling inequities between AA and white children. These findings support the need to evaluate outcomes among specific groups to identify disparities that require further careful investigation.     

Promotion to professor: a career development resource

Background

Patients with penetrating injuries are known to have worse outcomes than those with blunt trauma. We hypothesize that within each injury mechanism there should be no outcome difference between insured and uninsured patients.

Methods

The National Trauma Data Bank version 7 was analyzed. Patients aged 65 years and older and burn patients were excluded. The insurance status was categorized as insured (private, government/military, or Medicaid) and uninsured. Multivariate analysis adjusted for insurance status, mechanism of injury, age, race, sex, injury severity score, shock, head injury, extremity injury, teaching hospital status, and year.

Results

A total of 1,203,243 patients were analyzed, with a mortality rate of 3.7%. The death rate was significantly higher in penetrating trauma patients versus blunt trauma patients (7.9% vs 3.0%; P < .001), and higher in the uninsured (5.3% vs 3.2%; P < .001). On multivariate analysis, uninsured patients had an increased odds of death than insured patients, in both penetrating and blunt trauma patients. Penetrating trauma patients with insurance still had a greater risk of death than blunt trauma patients without insurance.

Conclusions

Insurance status is a potent predictor of outcome in both penetrating and blunt trauma.     

A contemporary evaluation of surgical outcome in neonates and infants undergoing lung resection

Background/Purpose

The timing and need of resection of asymptomatic congenital lung lesions are controversial. The morbidity of such surgery needs to be considered in the decision analysis. We analyzed the contemporary outcome of infants and neonates undergoing lung resection.

Methods

With institutional review board approval, all patients 12 months or younger undergoing lung resection between 1995 and 2004 in 2 hospitals were reviewed. Demographic data, indications for surgery, operative procedure, complications, use of regional anesthesia, length of stay (LOS), and follow-up were assessed.

Results

Forty-five patients (28 male, 17 female) with a median age of 4 months (2 days-12 months) were evaluated. Congenital lesions (42) were the most frequent indication for surgery. Twenty-two (48.9%) patients had cardiorespiratory symptoms or infection preoperatively. Lobectomy was the most common operation (40/45). Three patients had intraoperative difficulty (bleeding, hypotension, desaturation). Significant postoperative complications occurred in 7 patients: prolonged air leak or chest tube drainage (4), anemia or bleeding (2), respiratory distress requiring reintubation (1). Fewer complications occurred in asymptomatic vs symptomatic patients (1/23 vs 6/22). Of 12 patients, 7 (58%) requiring 24 hours of ventilation or longer were 3 months or younger. Increasing age did significantly influence the chance of successful extubation (P = .01; odds ratio, 1.5; 95% confidence interval, 1.0-2.0), as did the use of epidural anesthesia (P < .001). Median LOS was 6 days (2-89 days). Asymptomatic patients had shorter LOS (median, 4 days; range, 2-20 days; P = .024) vs symptomatic patients (median, 8 days; range, 4-89 days). The only death occurred from underlying heart disease. Mean follow-up at 35 months (12-132 months) revealed no subjective reduction in cardiopulmonary function.

Conclusions

Lung resection is safe and well tolerated in infancy. Surgery should be scheduled before the development of symptoms but likely after 3 months of age to improve the chances of postoperative extubation. The use of regional anesthesia may facilitate this.     

Severe and acute pancreatitis admitted in intensive care: a prospective epidemiological multiple centre study using CClin network database

Objectives

To describe the demographic characteristics, incidence of extra-abdominal hospital-acquired infections and outcome of patients admitted to intensive care unit (ICU) with severe acute pancreatitis.

Study design

A retrospective, observational multiple center (65 centers) analysis of prospectively acquired data.

Patients and methods

During 2 years, all consecutive admitted patients to ICU for severe acute pancreatitis in the centers participating in the nosocomial infections surveillance network CClin Sud-Est were included. Patients whose ICU stay was less than 48 hours were not included. Demographic characteristics, extra-abdominal hospital-acquired infections and clinical course were described.

Results

During the study period, 510 patients were included which represented 2 % of patients with a length of stay longer than 48 hours in the 65 participating ICUs. The global attack rate of extra-abdominal hospital-acquired infections (pneumonia, bacteremia, urinary tract or central venous catheter infection) was 23 % in overall patients and it was 33 % in the 294 mechanically ventilated patients. ICU mortality was 20 % in overall patients and it was 34 % in mechanically ventilated patients.

Conclusion

Severe acute pancreatitis represents 2 % of ICU stay longer than 48 hours. Its clinical course is frequently complicated by hospital-acquired infections and is associated with an high ICU mortality rate. This epidemiological observational study may be used for calculating sample size for future multicenter interventional therapeutic studies.     

High incidence of postoperative bowel obstruction in newborns and infants

Background

Postoperative bowel obstruction (PBO) plagues patients of all ages after intraabdominal surgery. We examined the incidence, risk factors, and the need for operative intervention of PBO.

Methods

We reviewed all children who underwent a laparotomy or laparoscopy. Parameters included age, diagnosis, type and number of procedures, complications, time interval to PBO, treatment of PBO, morbidity, and mortality.

Results

From 2001 to 2005, 2187 abdominal operations were performed. Overall, 61 patients (2.8%) developed a PBO; 43 (70.5%) required reoperation. Postoperative bowel obstruction was more common in patients younger than 1 year (28/601, 4.7%) compared with older children (33/1586, 2.1%; P = .01, β = .80). In infants, PBO was not influenced by initial diagnosis (P = .26) or whether the initial operation was clean/clean-contaminated or contaminated/dirty (P = .12). In children older than 1 year, nonoperative treatment was more likely to be successful if PBO occurred within 12 weeks of initial operation (12/16 vs 3/14; P = .01). In contrast, all but one infant (16/17) with early PBO required reoperation.

Conclusion

The incidence of PBO is significantly higher in newborns and infants than in older children (who have rates comparable to those reported in adults). Infants are significantly more likely to require operative intervention, particularly if PBO occurs early after the initial operation.     

Avoiding futile damage control laparotomy

Background

The age of a patient, lowest pre-operative pH and lowest core temperature are significant predictors of mortality in patients undergoing damage control surgery (DCS). An equation had previously been devised based on these three variables, which could predict which patients would die despite undergoing DCS (100% positive predictive value, 25% sensitivity). The aim of this study was to validate this equation by testing it on a different cohort of patients undergoing DCS.

Patients and methods

A retrospective validation study of patients who underwent DCS over a four-year period (1998-2001) was undertaken. The lowest pre-operative pH, lowest pre-operative core temperature and age were recorded and the equation was used to predict which patients were “unsalvageable”. This was then compared to the true outcomes of these patients.

Results

A total of 73 case notes were analysed for the period 1998-2001. The equation predicted that eight patients were unsalvageable. All eight patients died (100% positive predictive value), despite DCS being utilised. A further 25 of the rest of the “potentially salvageable” patients also died (24% sensitivity). When data of the original study (2002-2004) was combined with the current study data, the cohort totalled 145 patients, of whom 53 died (37%). Thirteen of these would have been predicted as unsalvageable with a 100% positive predictive value, had the equation been used during this time.

Conclusion

Both the positive predictive value and sensitivity of the equation remain consistent. When resources are overwhelmed by multiple casualties, this equation could prove useful in identifying patients in whom surgery may be futile, allowing surgical triage to be directed in a more efficient manner.     

Stapled intestinal anastomoses in infants

Background

We reviewed our experience with stapled intestinal anastomoses in infants younger than 1 year and compared operative data and outcome to that of infants who underwent hand-sewn anastomoses.

Methods

Infants younger than 1 year who underwent an intestinal anastomosis over an 8-year period were identified. Stapled anastomoses were constructed in a side-to-side fashion using standard or endoscopic linear cutters. Outcome variables including operative time, anastomotic failure, and death were recorded.

Results

Two hundred ninety-five subjects were identified. Hand-sewn anastomoses were performed in 189 cases and stapled anastomoses in 106. Patients who had a stapled anastomosis were older (105 vs 44 days) and larger (5.2 vs 3.1 kg), although 25 stapled anastomoses were performed in infants between 600 and 1000 g. When a stapled anastomosis was used operative time was significantly reduced overall (102 vs 128 minutes) and for individual procedures including resection for necrotizing enterocolitis (85 vs 132 minutes) and colostomy closure (104 vs 141 minutes). There was no difference between hand-sewn and stapled anastomoses in the incidence of adhesive obstruction, stricture, or leak.

Conclusions

When permitted by intestinal size in infants younger than 1 year, stapled anastomoses were safe and effective and significantly reduced operative time.     

Hyperglycemia is associated with increased morbidity and mortality rates in neonates with necrotizing enterocolitis

Background purpose

An association between hyperglycaemia and poor outcome has been reported in critically ill adults and children. The authors investigated the incidence of hyperglycemia in infants with necrotizing enterocolitis (NEC) and the relationship between glucose levels and outcome in these infants.

Methods

All glucose measurements (n = 6508) in 95 neonates with confirmed NEC admitted to the surgical intensive care unit (ICU) were reviewed. Maximum glucose concentration during admission (G_max) was determined for each infant and correlated with outcome. Eleven infants in whom treatment was withdrawn within 24 hours owing to unsalvageable panintestinal NEC were excluded from the analysis.

Results

Glucose levels ranged from 0.5 to 35.0 mmol/L and 69% of infants became hyperglycemic (>8 mmol/L) during their admission. Thirty-two infants died. Mortality rate tended to be higher in infants with G_max greater than 11.9 mmol/L compared with those with G_max less than 11.9 mmol/L, and late (>10 days admission) mortality rate was significantly higher in these infants (29% v, 2%; P = .0009). Median length of stay was 9.3 days. Linear regression analysis indicated that G_max was significantly related to length of stay (P < .0001).

Conclusions

Hyperglycemia is common in infants with NEC admitted to the ICU and is associated with an increase in late mortality and longer intensive care stay. Aggressive glycemic control may improve outcome in this group of infants.     

The role of abiraterone acetate in the management of prostate cancer: a critical analysis of the literature

Context

The development of agents targeting androgen signalling holds promise for men with castration-resistant prostate cancer (CRPC).

Objective

The emerging role of abiraterone acetate (AA), a novel, orally administered androgen synthesis inhibitor, is critically analysed.

Evidence acquisition

Data were acquired from critically important original research published in peer-reviewed literature or presented at conferences conducted by the American Society of Clinical Oncology and the European Society of Medical Oncology.

Evidence synthesis

The major findings are addressed in an evidence-based, objective, and balanced fashion.

Conclusions

AA specifically inhibits CYP17 and substantially reduces serum androgen levels without inducing significant adrenal insufficiency. A phase 3 trial reported a significant extension of survival in metastatic CRPC with AA plus prednisone compared to prednisone alone following docetaxel. The primary toxicity of mineralocorticoid excess is manageable. The addition of low-dose corticosteroids to AA may be necessary for controlling symptoms of mineralocorticoid excess.     

Outcomes of multigestational pregnancies affected by congenital diaphragmatic hernia

Background/purpose

The prognosis for multiple vs singleton pregnancies affected by congenital diaphragmatic hernia (CDH) is not known. To improve the counseling of families with multiple gestation pregnancies complicated by CDH, we examined outcomes of a consecutive series of CDH cases occurring in multiple gestation pregnancy referrals.

Methods

Clinical characteristics and morbidity and mortality data were gathered for a consecutive series of infants with CDH from 16 multiple gestation pregnancies. Outcomes were compared to a cohort of 91 patients with CDH from singleton pregnancies. Multivariate regression was also used in an attempt to determine whether multiple gestation pregnancy was independently predictive of subsequent long-term adverse outcomes.

Results

Four pregnancies were lost to follow-up, and 1 underwent selective reduction. Overall mortality for live-born multiple gestation fetuses affected by CDH was 30% and was 8% for unaffected siblings. No pregnancy was concordant. Clinical features were not different between the case series and control infants, except median gestational age at delivery, which was significantly lower for the multigestational infants (34 [range, 32-36] vs 38 [range, 28-41] weeks) (P = .02). Long-term morbidity was comparable between cases and controls.

Conclusions

In terms of mortality, outcomes of multigestational pregnancies affected by CDH are no worse than for CDH pregnancies in general. Long-term risk may depend more on CDH severity rather than the presence of multiple fetuses.     

Hepatic parenchymal transection with vascular staplers: a comparative analysis with the crush-clamp technique

Background

This retrospective study compares the safety and efficacy of hepatic parenchymal transection using vascular staplers (VS) and the crush-clamp (CC) technique.

Methods

Demographics, clinicopathologic data, treatments, and postoperative outcomes from patients who underwent VS or CC hepatic parenchymal transection were compared.

Results

From 1996-2006, 99 and 112 patients underwent hepatic transection with VS and CC, respectively. Compared to CC, VS transection was associated with less operative time (median 210 vs 275 minutes), blood loss (median 250 vs 500 mL), and postoperative red blood cell (RBC) transfusion (29% vs 44%), all P < .05. VS transection was not associated with RBC transfusion on multivariate analysis. There were no differences in rates of positive resection margins (9% vs 13%), postoperative mortality (2% vs 4%), overall morbidity (32% vs 29%), and severe morbidity (20% vs. 23%), all P > .05.

Conclusion

Hepatic parenchymal transection with VS can be accomplished with similar safety and efficacy as CC transection.     

The frequency of apneas in premature infants after inguinal hernia repair: do they need overnight monitoring in the intensive care unit?

Background

Postoperative apneas are reported in up to 49% of premature infants undergoing anesthesia for inguinal hernia repair. Our current practice is to monitor all of these babies in the intensive care unit (ICU) overnight after surgery. In addition to the considerable expense to the health care system, these cases are cancelled if no ICU bed is available.

Methods

A retrospective chart review of all premature infants undergoing inguinal hernia repairs over the past 5 years was undertaken. All postoperative apneas were identified. Potential risk factors were evaluated.

Results

Five (4.7%) of 126 premature infants had apneas after inguinal hernia repair. All of these babies had a previous history of apneas. They also had lower weights both at birth (1.08 vs 1.73 kg) and at the time of surgery (3.37 vs 4.4 kg) as well as lower gestational ages (29 vs 32.3 weeks). They were much more likely to have a complicated past medical history. Markers for this included intraventricular hemorrhage, patent ductus arteriosus, bronchopulmonary dysplasia, and requirement for mechanical ventilation and supplemental oxygen after birth. The use of sevoflurane was the only anesthetic factor which had significance.

Conclusion

Postoperative apnea in premature infants after inguinal hernia repair using current anesthetic techniques is much less common than previously reported. Infants with prior history of apneas are at highest risk. Other risk factors appear to include gestational age, birth weight, weight at time of surgery, and a complicated neonatal course. Selective use of postoperative ICU monitoring for high-risk patients could result in significant resource and cost savings to the health care system.     

Survival disparities in newborns with congenital diaphragmatic hernia: a national perspective

Purpose

The aim of the study was to examine national outcomes for congenital diaphragmatic hernia (CDH).

Methods

We analyzed the Kids' Inpatient Database for patients admitted at less than 8 days of age.

Results

Overall, 2774 hospitalizations were identified. Most patients were white and had private insurance. Most patients were treated at urban (96%), teaching (75%), and not identified as children's hospital (NIACH) (50%). Birth was the most common admission source at NIACH (91%) and children's unit in general hospital (CUGH) (59%), compared to hospital transfer at children's general hospital (CGH) (81%). Most CDH were repaired through the abdomen (81%), and 25% required extracorporeal membrane oxygenation (ECMO). Most NIACH patients were transferred to another hospital, whereas most at CGH and CUGH were discharged home. Survival to discharge was 66% after excluding hospital transfers. Univariate analysis revealed higher survival for males, birth weight (BW) of 3 kg or more, whites, patients with private insurance, and those in the highest median household income quartile. Survival was 86% after CDH repair but 46% for ECMO. Multivariate analysis identified black race (hazard ratio [HR], 1.536; P = .03) and other race (HR, 1.515; P = .03) as independent predictors of mortality.

Conclusions

Hospital survival for CDH is related to sex, BW, race, and socioeconomic status. Blacks and other non-Hispanic minorities have higher mortality rates.