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Hidalgo Perea S, Loyst RA, Botros D, Barsi JM. Outcomes in Early Versus Delayed Management of Pediatric Femoral Shaft Fractures. J Pediatr Orthop 2024; 44:e238-e241. [PMID: 38115603 DOI: 10.1097/bpo.0000000000002598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
OBJECTIVE There is a paucity of literature regarding the timing of treatment for pediatric femur fractures. The purpose of this study was to analyze whether early versus delayed management of pediatric femoral shaft fractures would impact outcomes regarding time to union and return to baseline function. METHODS Pediatric patients presenting with femoral shaft fractures, from January 1, 2010 to January 1, 2021, were identified using the Pediatric Trauma Database at a single Level One Trauma Center and retrospectively reviewed. Demographic information, surgical details, associated injuries, length of follow-up, time to union, and return to baseline function were collected. Patients were then divided into 2 groups; the early intervention group underwent treatment within 24 hours of admission versus the delayed group, which underwent treatment after 24 hours. Patients with neuromuscular disease, pathologic fracture, slipped capital femoral epiphysis, nonambulatory, younger than 6 months old, or had follow-up of <8 weeks posttreatment were excluded. χ 2 and unpaired Student t tests were used to compare outcomes. A P value ≤0.05 was used as the threshold of statistical significance. RESULTS Of the 169 cases reviewed, 137 met the inclusion criteria. The mean age was 8.0 ± 5.0 (6 mo to 16 y). The average follow-up time was 1.4 ± 1.4 years. Thirty-two (19%) patients did not meet the inclusion criteria and were excluded from the study. One hundred twenty-two (89%) patients were in the early intervention group versus 15 (11%) in the delayed intervention group. There were no statistically significant differences between the early and the delayed arms in regard to time to union, quality of final reduction, and return to baseline function. CONCLUSION The findings of this study support that the timing of surgical intervention of femoral shaft fractures in the pediatric population is not correlated to time to union and final function. Clinically, prompt treatment of pediatric femoral shaft fractures should not supersede medical methods of resuscitation and likely has no bearing on the final outcome. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Sofia Hidalgo Perea
- Department of Orthopaedic Surgery, Stony Brook University Hospital, Stony Brook, NY
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A Comprehensive Assessment of The Eight Vital Signs. THE EUROBIOTECH JOURNAL 2022. [DOI: 10.2478/ebtj-2022-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
The term “vital sign” has been assigned to various phenomena with the presumptive intent to emphasize their importance in health care resulting in the emergence of eight vital signs with multiple designations and overlapping terms. This review developed a case definition for vital signs and identified and described the fifth through eighth vital signs. PubMed/Medline, Google and biographical databases were searched using the individual Medical Subject Headings (MeSH) terms, vital sign and fifth, vital sign and sixth, vital sign and seventh, and vital sign eighth. The search was limited to human clinical studies written in English literature from 1957 up until November 30, 2021. Excluded were articles containing the term vital sign if used alone without the qualifier fifth, sixth, seventh, or eighth or about temperature, blood pressure, pulse, and respiratory rate. One hundred ninety-six articles (122 for the fifth vital sign, 71 for the sixth vital sign, two for the seventh vital sign, and one for the eighth vital sign) constituted the final dataset. The vital signs consisted of 35 terms, classified into 17 categories compromising 186 unique papers for each primary authored article with redundant numbered vital signs for glucose, weight, body mass index, and medication compliance. Eleven terms have been named the fifth vital sign, 25 the sixth vital sign, three the seventh, and one as the eighth vital sign. There are four time-honored vital signs based on the case definition, and they represent an objective bedside measurement obtained noninvasively that is essential for life. Based on this case definition, pulse oximetry qualifies as the fifth while end-tidal CO2 and cardiac output as the sixth. Thus, these terms have been misappropriated 31 times. Although important to emphasize in patient care, the remainder are not vital signs and should not be construed in this manner.
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Kelley-Quon LI, Ourshalimian S, Lee J, Russell KW, Kling K, Shew SB, Mueller C, Jensen AR, Vu L, Padilla B, Ostlie D, Smith C, Inge T, Roach J, Ignacio R, Lofberg K, Radu S, Rohan A, Wang KS. Multi-Institutional Quality Improvement Project to Minimize Opioid Prescribing in Children after Appendectomy Using NSQIP-Pediatric. J Am Coll Surg 2022; 234:290-298. [PMID: 35213491 DOI: 10.1097/xcs.0000000000000056] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND There is wide variation in opioid prescribing after appendectomy in children and adolescents, with recent increases noted in opioid-related pediatric deaths from prescription and illicit opioids. The goal of this project was to minimize opioid prescribing at the time of discharge for children undergoing appendectomy by using Quality Improvement (QI) methodology. STUDY DESIGN Children (18 years of age or less) who underwent appendectomy were evaluated from January to December 2019 using NSQIP-Pediatric at 10 children's hospitals within the Western Pediatric Surgery Research Consortium. Before project initiation, 5 hospitals did not routinely prescribe opioids after appendectomy (protocol). At the remaining 5 hospitals, prescribing was not standardized and varied by surgeon (no-protocol). A prospective multi-institutional QI project was used to minimize outpatient opioid prescriptions for children after appendectomy. The proportion of children at each hospital receiving an opioid prescription at discharge was compared for 6 months before and after the intervention using chi-square analysis. RESULTS Overall, 1,524 children who underwent appendectomy were evaluated from January to December 2019. After the QI intervention, overall opioid prescribing decreased from 18.2% to 4.0% (p < 0.001), with significant decreases in protocol hospitals (2.7% vs 0.8%, p = 0.038) and no-protocol hospitals (37.9% vs 8.8%, p < 0.001). The proportion of 30-day emergency room visits did not change after the QI intervention (8.9% vs 9.9%, p = 0.54) and mean postintervention pain management satisfaction scores were high. CONCLUSION Opioid prescribing can be minimized in children after appendectomy without increasing emergency room visits or decreasing patient satisfaction. Furthermore, NSQIP-Pediatric can be used as a platform for multi-institutional collaboration for successful implementation of QI projects.
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Affiliation(s)
- Lorraine I Kelley-Quon
- From the Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA; Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA (Kelley-Quon, Ourhsalimian, Wang)
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA (Kelley-Quon)
| | - Shadassa Ourshalimian
- From the Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA; Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA (Kelley-Quon, Ourhsalimian, Wang)
| | - Justin Lee
- Division of Surgery, Phoenix Children's Hospital, Phoenix, AZ (Lee, Padilla, Ostlie)
| | - Katie W Russell
- Division of Pediatric Surgery, University of Utah and Primary Children's Hospital, Salt Lake City, UT (Russell, Rohan)
| | - Karen Kling
- Division of Pediatric Surgery, Rady Children's Hospital San Diego, San Diego, CA; Department of Surgery, University of California San Diego School of Medicine, San Diego, CA (Kling, Ignacio)
| | - Stephen B Shew
- Division of Pediatric Surgery, Lucile Packard Children's Hospital, Palo Alto, CA; Department of Surgery, Stanford University School of Medicine, Palo Alto, CA (Shew, Mueller)
| | - Claudia Mueller
- Division of Pediatric Surgery, Lucile Packard Children's Hospital, Palo Alto, CA; Department of Surgery, Stanford University School of Medicine, Palo Alto, CA (Shew, Mueller)
| | - Aaron R Jensen
- Division of Pediatric Surgery, UCSF Benioff Children's Hospitals, and Department of Surgery, University of California San Francisco School of Medicine, San Francisco, CA (Jensen, Vu)
| | - Lan Vu
- Division of Pediatric Surgery, UCSF Benioff Children's Hospitals, and Department of Surgery, University of California San Francisco School of Medicine, San Francisco, CA (Jensen, Vu)
| | - Benjamin Padilla
- Division of Surgery, Phoenix Children's Hospital, Phoenix, AZ (Lee, Padilla, Ostlie)
| | - Daniel Ostlie
- Division of Surgery, Phoenix Children's Hospital, Phoenix, AZ (Lee, Padilla, Ostlie)
| | - Caitlin Smith
- Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Seattle WA; Department of Surgery, University of Washington School of Medicine, Seattle, WA (Smith)
| | - Thomas Inge
- Children's Hospital Colorado, University of Colorado, Aurora, CO (Inge, Roach)
| | - Jonathan Roach
- Children's Hospital Colorado, University of Colorado, Aurora, CO (Inge, Roach)
| | - Romeo Ignacio
- Division of Pediatric Surgery, Rady Children's Hospital San Diego, San Diego, CA; Department of Surgery, University of California San Diego School of Medicine, San Diego, CA (Kling, Ignacio)
| | - Katrine Lofberg
- the Division of Pediatric Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR (Lofberg, Radu)
| | - Stephanie Radu
- the Division of Pediatric Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR (Lofberg, Radu)
| | - Autumn Rohan
- Division of Pediatric Surgery, University of Utah and Primary Children's Hospital, Salt Lake City, UT (Russell, Rohan)
| | - Kasper S Wang
- From the Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA; Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA (Kelley-Quon, Ourhsalimian, Wang)
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Adams AJ, Paladino J, Townsend C, Ilyas AM. Preoperative Opioid Use Results in Greater Postoperative Opioid Consumption After Thumb Basal Joint Arthroplasty. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2022; 4:78-83. [PMID: 35434573 PMCID: PMC9005379 DOI: 10.1016/j.jhsg.2021.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 12/15/2021] [Indexed: 11/27/2022] Open
Abstract
Purpose Thumb basal joint arthroplasty surgery is a common hand surgery after which patients often require opioids. To better understand safe opioid consumption patterns, this study sought to identify risk factors for filling a second prescription and/or prolonged opioid use (prescription over 6 months after the surgery). Preoperative opioid use was hypothesized to show an association with greater postoperative opioid use. Methods A retrospective review of consecutive patients who underwent primary thumb basal joint arthroplasty was conducted, yielding 110 patients for analysis. Demographic and clinical data were collected. Opioid prescription data were extracted from 6 months before the surgery to 9 months after the surgery using a state prescription drug monitoring program. Bivariate and multivariate analyses were performed for filling a second opioid prescription or filling an opioid prescription over 6 months after the surgery. Results All the patients filled their initial postoperative prescription. Of the 110 patients, 26.4% filled an opioid prescription before the surgery, 42% filled a second postoperative prescription, and 14.5% were still consuming opioids over 6 months after the surgery. Patients using preoperative opioids had 7-fold higher odds of filling a second opioid prescription and 37-fold higher odds of prolonged use. No other demographic or clinical factors, including the type of procedure or number of initial opioids prescribed, were associated with increased use of postoperative opioids. Of all the opioid prescriptions filled after the initial postoperative prescription, only 9.3% were prescribed by a surgeon’s office. Conclusions Patients who undergo thumb basal joint arthroplasty with preoperative opioid use have much greater odds of filling a second opioid prescription and prolonged use after the surgery. Low initial surgeon-provided opioid dosages did not correlate to filling a second prescription, indicating that lower initial doses are feasible. Finally, nearly all opioid-naïve patients who filled a second opioid prescription received them from providers other than a surgeon, indicating the need for greater communication with nonsurgical providers simultaneously caring for patients in the perioperative period. Type of study/level of evidence Therapeutic III.
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Affiliation(s)
- Alexander J. Adams
- Department of Orthopedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, PA
- Corresponding author: Alexander J. Adams, MD, Rothman Institute at Thomas Jefferson University, 925 Chestnut Street, Philadelphia, PA 19107.
| | - Joseph Paladino
- Department of Orthopedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, PA
| | - Clay Townsend
- Department of Orthopedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, PA
| | - Asif M. Ilyas
- Department of Orthopedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, PA
- Rothman Opioid Foundation, Philadelphia, PA
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