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Eldredge RS, Moore Z, Smith J, Barnes K, Norton SP, Larsen K, Padilla BE, Swendiman RA, Fenton SJ, Russell KW. A Pediatric Teletrauma Program Pilot Project: Improves Access to Pediatric Trauma Care and Timely Assessment of Pediatric Traumas. J Trauma Acute Care Surg 2024:01586154-990000000-00613. [PMID: 38197703 DOI: 10.1097/ta.0000000000004241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
BACKGROUND Geographic location is a barrier to providing specialized care to pediatric traumas. In 2019, we instituted a pediatric teletrauma program in collaboration with the Statewide Pediatric Trauma Network at our level 1 pediatric trauma center (PTC). Triage guidelines were provided to partnering hospitals (PH) to aid in evaluation of pediatric traumas. Our pediatric trauma team was available for phone/video trauma consultation to provide recommendations on disposition and management. We hypothesized that this program would improve access and timely assessment of pediatric traumas while limiting patient transfers to our PTC. METHODS A retrospective cohort study was conducted at the PTC between January 2019 to May 2023. All pediatric trauma patients age < 18 years who had teletrauma consults (TC) were included. We also evaluated all avoidable transfers without TC defined as admission for less than 36 hours without an intervention or imaging as a comparison group. RESULTS A total of 151 TCs were identified: 62% male and median age of 8 years [IQR:4-12]. TC increased from 12 in 2019 to 100 in 2022-2023 and the number of partnering hospitals increased from 2 to 32. PH were 15-554 miles from the pediatric trauma center, with a median distance of 34 miles [IQR:28-119]. Following consultation, we recommended discharge 34%, admission 29%, or transfer to PTC 35%. Of those that were not transferred, 3% (3/97) required subsequent treatment at the PTC. Non-transferred TC had a higher percentage of TBI (61% vs 31%;p < 0.001) and were from farther, (40 miles[IQR:28-150] vs 30 miles[IQR:28-50];p < 0.001) compared to avoidable transferred patients without a TC. CONCLUSIONS TC is a safe and viable addition to a pediatric trauma program faced with providing care to a large geographical catchment area. The pediatric teletrauma program provided management recommendations to 32 partnering hospitals and avoided transfer in approximately 63% of cases. LEVEL OF EVIDENCE IV Treatment study.
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Affiliation(s)
| | | | | | - Kasey Barnes
- Intermountain Healthcare, Department of Surgery, Division of Pediatric Surgery
| | - Sidney P Norton
- Intermountain Healthcare, Department of Surgery, Division of Pediatric Surgery
| | - Kezlyn Larsen
- University of Utah, Department of Surgery, Division of Pediatric Surgery
| | | | - Robert A Swendiman
- University of Utah, Department of Surgery, Division of Pediatric Surgery
| | - Stephen J Fenton
- University of Utah, Department of Surgery, Division of Pediatric Surgery
| | - Katie W Russell
- University of Utah, Department of Surgery, Division of Pediatric Surgery
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Blakely ML, Krzyzaniak A, Dassinger MS, Pedroza C, Weitkamp JH, Gosain A, Cotten M, Hintz SR, Rice H, Courtney SE, Lally KP, Ambalavanan N, Bendel CM, Bui KCT, Calkins C, Chandler NM, Dasgupta R, Davis JM, Deans K, DeUgarte DA, Gander J, Jackson CCA, Keszler M, Kling K, Fenton SJ, Fisher KA, Hartman T, Huang EY, Islam S, Koch F, Lainwala S, Lesher A, Lopez M, Misra M, Overbey J, Poindexter B, Russell R, Stylianos S, Tamura DY, Yoder BA, Lucas D, Shaul D, Ham PB, Fitzpatrick C, Calkins K, Garrison A, de la Cruz D, Abdessalam S, Kvasnovsky C, Segura BJ, Shilyansky J, Smith LM, Tyson JE. Effect of Early vs Late Inguinal Hernia Repair on Serious Adverse Event Rates in Preterm Infants: A Randomized Clinical Trial. JAMA 2024; 331:1035-1044. [PMID: 38530261 DOI: 10.1001/jama.2024.2302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
Importance Inguinal hernia repair in preterm infants is common and is associated with considerable morbidity. Whether the inguinal hernia should be repaired prior to or after discharge from the neonatal intensive care unit is controversial. Objective To evaluate the safety of early vs late surgical repair for preterm infants with an inguinal hernia. Design, Setting, and Participants A multicenter randomized clinical trial including preterm infants with inguinal hernia diagnosed during initial hospitalization was conducted between September 2013 and April 2021 at 39 US hospitals. Follow-up was completed on January 3, 2023. Interventions In the early repair strategy, infants underwent inguinal hernia repair before neonatal intensive care unit discharge. In the late repair strategy, hernia repair was planned after discharge from the neonatal intensive care unit and when the infants were older than 55 weeks' postmenstrual age. Main Outcomes and Measures The primary outcome was occurrence of any prespecified serious adverse event during the 10-month observation period (determined by a blinded adjudication committee). The secondary outcomes included the total number of days in the hospital during the 10-month observation period. Results Among the 338 randomized infants (172 in the early repair group and 166 in the late repair group), 320 underwent operative repair (86% were male; 2% were Asian, 30% were Black, 16% were Hispanic, 59% were White, and race and ethnicity were unknown in 9% and 4%, respectively; the mean gestational age at birth was 26.6 weeks [SD, 2.8 weeks]; the mean postnatal age at enrollment was 12 weeks [SD, 5 weeks]). Among 308 infants (91%) with complete data (159 in the early repair group and 149 in the late repair group), 44 (28%) in the early repair group vs 27 (18%) in the late repair group had at least 1 serious adverse event (risk difference, -7.9% [95% credible interval, -16.9% to 0%]; 97% bayesian posterior probability of benefit with late repair). The median number of days in the hospital during the 10-month observation period was 19.0 days (IQR, 9.8 to 35.0 days) in the early repair group vs 16.0 days (IQR, 7.0 to 38.0 days) in the late repair group (82% posterior probability of benefit with late repair). In the prespecified subgroup analyses, the probability that late repair reduced the number of infants with at least 1 serious adverse event was higher in infants with a gestational age younger than 28 weeks and in those with bronchopulmonary dysplasia (99% probability of benefit in each subgroup). Conclusions and Relevance Among preterm infants with inguinal hernia, the late repair strategy resulted in fewer infants having at least 1 serious adverse event. These findings support delaying inguinal hernia repair until after initial discharge from the neonatal intensive care unit. Trial Registration ClinicalTrials.gov Identifier: NCT01678638.
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Affiliation(s)
- Martin L Blakely
- Department of Surgery, Institute for Clinical Research and Learning Healthcare and Institute for Implementation Science, University of Texas Health Science Center, Houston
| | | | - Melvin S Dassinger
- Division of Pediatric Surgery, University of Arkansas for Medical Sciences, Little Rock
| | - Claudia Pedroza
- Department of Pediatrics, Institute for Clinical Research and Learning Healthcare, University of Texas Health Science Center, Houston
| | | | - Ankush Gosain
- Division of Pediatric Surgery, University of Colorado, Aurora
| | - Michael Cotten
- Division of Neonatology, Duke University, Durham, North Carolina
| | - Susan R Hintz
- Division of Neonatology, Stanford University, Palo Alto, California
| | - Henry Rice
- Division of Pediatric Surgery, Duke University, Durham, North Carolina
| | - Sherry E Courtney
- Division of Neonatology, University of Arkansas for Medical Sciences, Little Rock
| | - Kevin P Lally
- Department of Pediatric Surgery, University of Texas Health Science Center, Houston
| | | | | | - Kim Chi T Bui
- Division of Neonatology, Kaiser Permanente, Los Angeles, California
| | - Casey Calkins
- Division of Pediatric Surgery, Medical College of Wisconsin, Milwaukee
| | - Nicole M Chandler
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St Petersburg, Florida
| | - Roshni Dasgupta
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jonathan M Davis
- Division of Neonatology, Tufts Medical Center, Boston, Massachusetts
| | - Katherine Deans
- Department of Pediatric Surgery, Nemours Children's Hospital, Wilmington, Delaware
| | - Daniel A DeUgarte
- Division of Pediatric Surgery, David Geffen School of Medicine, University of California, Los Angeles
| | - Jeffrey Gander
- Division of Pediatric Surgery, University of Virginia, Charlottesville
| | - Carl-Christian A Jackson
- Division of Pediatric Surgery, Alpert Medical School, Brown University, Providence, Rhode Island
| | - Martin Keszler
- Division of Neonatology, Alpert Medical School, Brown University, Providence, Rhode Island
| | - Karen Kling
- Rady Children's Hospital and Division of Pediatric Surgery, University of California, San Diego
| | - Stephen J Fenton
- Division of Pediatric Surgery, University of Utah, Salt Lake City
| | | | - Tyler Hartman
- Division of Neonatology, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Eunice Y Huang
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Saleem Islam
- Division of Pediatric Surgery, University of Florida, Gainesville
- Department of Surgery, Aga Khan University, Sindh, Pakistan
| | - Frances Koch
- Division of Neonatology, Medical University of South Carolina, Charleston
| | - Shabnam Lainwala
- Division of Neonatology, Connecticut Children's Medical Center, Hartford
| | - Aaron Lesher
- Division of Pediatric Surgery, Medical University of South Carolina, Charleston
| | - Monica Lopez
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Meghna Misra
- Pediatric Surgery, Elliot Hospital, Manchester, New Hampshire
| | - Jamie Overbey
- Division of Neonatology, Naval Medical Center, San Diego, California
| | - Brenda Poindexter
- Division of Neonatology, School of Medicine, Emory University, Atlanta, Georgia
| | - Robert Russell
- Division of Pediatric Surgery, University of Alabama at Birmingham
| | - Steven Stylianos
- Division of Pediatric Surgery, Columbia University Medical Center, Morgan Stanley Children's Hospital, New York, New York
| | - Douglas Y Tamura
- Division of Pediatric Surgery, Valley Children's Hospital, Madera, California
| | | | - Donald Lucas
- F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Division of Pediatric Surgery, Naval Medical Center, San Diego, California
| | - Donald Shaul
- Division of Pediatric Surgery, Kaiser Permanente, Los Angeles, California
| | - P Ben Ham
- Division of Pediatric Surgery, University at Buffalo, Buffalo, New York
| | - Colleen Fitzpatrick
- Division of Pediatric Surgery, Cohen Children's Medical Center, Northwell Health, New Hyde Park, New York
| | - Kara Calkins
- Division of Neonatology, David Geffen School of Medicine, University of California, Los Angeles
| | - Aaron Garrison
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Diomel de la Cruz
- Division of Neonatology, School of Medicine, University of Florida, Gainesville
| | - Shahab Abdessalam
- Division of Neonatology, University of Nebraska Medical Center, Omaha
| | | | - Bradley J Segura
- Division of Pediatric Surgery, M Health Fairview University of Minnesota Masonic Children's Hospital, Minneapolis
| | - Joel Shilyansky
- Department of Pediatric Surgery, University of Iowa Stead Family Children's Hospital, Iowa City
| | | | - Jon E Tyson
- Department of Pediatrics, Institute for Clinical Research and Learning Healthcare, University of Texas Health Science Center, Houston
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Russell KW, Katz MG, Phillips RC, Kelley-Quon LI, Acker SN, Shahi N, Lee JH, Fialkowski EA, Nacharaju D, Smith CA, Jensen AR, Mueller CM, Padilla BE, Ignacio RC, Ourshalimian S, Wang KS, Ostlie DJ, Fenton SJ, Kastenberg ZJ. Corrigendum to Adolescent Vaping-Associated Trauma in the Western United States [J Surg Res. 2022 Aug;276:251-255]. J Surg Res 2024; 294:247-248. [PMID: 37925952 DOI: 10.1016/j.jss.2023.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Affiliation(s)
- Katie W Russell
- Division of Pediatric Surgery, University of Utah, Primary Children's Hospital, Salt Lake City, Utah.
| | - Micah G Katz
- Division of Pediatric Surgery, University of Utah, Primary Children's Hospital, Salt Lake City, Utah
| | - Ryan C Phillips
- Department of Pediatric Surgery, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
| | | | - Shannon N Acker
- Department of Pediatric Surgery, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
| | - Niti Shahi
- Department of Pediatric Surgery, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
| | - Justin H Lee
- Division of Pediatric Surgery, Phoenix Children's Hospital
| | | | - Deepthi Nacharaju
- Division of Trauma, General Surgery, Surgical Critical Care, University of Washington, Harborview Medical Center, Seattle, Washington
| | - Caitlin A Smith
- Department of General and Thoracic Surgery, Seattle Children's Hospital, Seattle, Washington
| | - Aaron R Jensen
- Division of Pediatric Surgery, UCSF Benioff Children's Hospitals, San Francisco, California
| | - Claudia M Mueller
- Department of Pediatric Surgery, Stanford University, Lucile Packard Children's Hospital, Palo Alto, California
| | | | - Romeo C Ignacio
- Division of Pediatric Surgery, University of California San Diego School of Medicine, San Diego, California
| | | | - Kasper S Wang
- Department of Surgery, Children's Hospital Los Angeles, Los Angeles, California
| | | | - Stephen J Fenton
- Division of Pediatric Surgery, University of Utah, Primary Children's Hospital, Salt Lake City, Utah
| | - Zachary J Kastenberg
- Division of Pediatric Surgery, University of Utah, Primary Children's Hospital, Salt Lake City, Utah
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Swendiman RA, Russell KW, Larsen K, Eyre M, Fenton SJ. USE OF A STATEWIDE SOLID ORGAN INJURY PROCOTCOL TO OPTIMIZE TRIAGE, TREATMENT, AND TRANSFER FOR PEDIATRIC ABDOMINAL TRAUMA. J Trauma Acute Care Surg 2024:01586154-990000000-00624. [PMID: 38273452 DOI: 10.1097/ta.0000000000004261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
BACKGROUND The Utah Pediatric Trauma Network (UPTN) is a non-competitive collaboration of all 51 hospitals in the state of Utah with the purpose of improving pediatric trauma care. Created in 2019, UPTN has implemented evidence-based guidelines based on hospital resources and capabilities with quarterly review of data collected in a network-specific database. A blunt solid organ injury (SOI) protocol was developed to optimize treatment of these injuries statewide. The purpose of this study was to review the effectiveness of the SOI guideline. METHODS The UPTN REDCap® database was retrospectively reviewed from 2021 through 2022. We compared admissions from the Level 1 pediatric trauma center (PED1) to non-pediatric hospitals (non-PED1) of children with low grade (I-II) and high grade (III-V) SOIs. RESULTS In 2 years, 172 patients were treated for blunt SOI, with or without concomitant injuries. There were 48 (28%) low grade and 124 (72%) high grade SOIs. 33 (69%) patients were triaged with low grade SOI injuries at a non-PED1 center, and 17 (35%) were transferred to the PED1 hospital. Most had multiple injuries, but 7 (44%) were isolated, and none required a transfusion or any procedure/operation at either hospital. Of the 124 patients with high grade injuries, 41 (33%) primarily presented to the PED1 center, and 44 (35%) were transferred there. Of these, 2 required a splenectomy and none required angiography. 39 children were treated at non-PED1 centers without transfer, and 4 required splenectomy and 6 underwent angiography/embolization procedures. No patient with an isolated SOI died. CONCLUSIONS Implementation of SOI guidelines across UPTN successfully allowed non-pediatric hospitals to safely admit children with low grade isolated SOI, keeping families closer to home, while standardizing pediatric triage for blunt abdominal trauma in the state. LEVEL OF EVIDENCE III - Retrospective study.
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Affiliation(s)
- Robert A Swendiman
- Author Affiliations: Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Katie W Russell
- Author Affiliations: Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Kezlyn Larsen
- Author Affiliations: Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Matthew Eyre
- Utah Pediatric Trauma Network, Utah Department of Health, Salt Lake City, UT
| | - Stephen J Fenton
- Author Affiliations: Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
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Fenton SJ, Swendiman RA, Eyre M, Larsen K, Russell KW. The Utah Pediatric Trauma Network, a statewide pediatric trauma collaborative can safely help nonpediatric hospitals admit children with mild traumatic brain injury. J Trauma Acute Care Surg 2023; 95:376-382. [PMID: 36728128 DOI: 10.1097/ta.0000000000003871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Created in 2019, the Utah Pediatric Trauma Network (UPTN) is a transparent noncompetitive collaboration of all hospitals in Utah with the purpose of improving pediatric trauma care. The UPTN implements evidence-based guidelines based on hospital resources and capabilities with quarterly review of data collected in a network-specific database. The first initiative was to help triage the care of traumatic brain injury (TBI) to prevent unnecessary transfers while ensuring appropriate care. The purpose of this study was to review the effectiveness of this network wide guideline. METHODS The UPTN REDCap database was retrospectively reviewed between January 2019 and December 2021. Comparisons were made between the pediatric trauma center (PED1) and nonpediatric hospitals (non-PED1) in admissions of children with very mild, mild, or complicated mild TBI. RESULTS Of the total 3,315 cases reviewed, 294 were admitted to a non-PED1 hospital and 1,061 to the PED1 hospital with very mild/mild/complicated mild TBI. Overall, kids treated at non-PED1 were older (mean, 14.9 vs. 7.7 years; p = 0.00001) and more likely to be 14 years or older (37% vs. 24%, p < 0.00001) compared with those at PED1. Increased admissions occurred post-UPTN at non-PED1 hospitals compared with pre-UPTN (43% vs. 14%, p < 0.00001). Children admitted to non-PED1 hospitals post-UPTN were younger (9.1 vs. 15.7 years, p = 0.002) with more kids younger than 14 years (67% vs. 38%, p = 0.014) compared with pre-UPTN. Two kids required next-day transfer to a higher-level center (1 to PED1), and none required surgery or neurosurgical evaluation. The mean length of stay was 21.8 hours (interquartile range, 11.9-25.4). Concomitantly, less children with very mild TBI were admitted to PED1 post-UPTN (6% vs. 27%, p < 0.00001) and more with complicated mild TBI (63% vs. 50%, p = 0.00003) than 2019. CONCLUSION Implementation of TBI guidelines across the UPTN successfully allowed nonpediatric hospitals to safely admit children with very mild, mild, or complicated mild TBI. In addition, admitted kids were more like those treated at the PED1 hospital. LEVEL OF EVIDENCE Prognostic/Epidemiological; Level IV.
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Affiliation(s)
- Stephen J Fenton
- From the Division of Pediatric Surgery, Department of Surgery (S.J.F., R.A.S., K.L., K.W.R.), University of Utah School of Medicine; and Utah Pediatric Trauma Network (M.E.), Utah Department of Health, Salt Lake City, Utah
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Russell KW, Iantorno SE, Iyer RR, Brockmeyer DL, Smith KM, Polukoff NE, Larsen KE, Barnes KL, Bell TM, Fenton SJ, Inaba K, Swendiman RA. Pediatric cervical spine clearance: A 10-year evaluation of multidetector computed tomography at a level 1 pediatric trauma center. J Trauma Acute Care Surg 2023; 95:354-360. [PMID: 37072884 DOI: 10.1097/ta.0000000000003929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
INTRODUCTION Efficient and accurate evaluation of the pediatric cervical spine (c-spine) for both injury identification and posttraumatic clearance remains a challenge. We aimed to determine the sensitivity of multidetector computed tomography (MDCT) for identification of cervical spine injuries (CSIs) in pediatric blunt trauma patients. METHODS A retrospective cohort study was conducted at a level 1 pediatric trauma center from 2012 to 2021. All pediatric trauma patients age younger than 18 years who underwent c-spine imaging (plain radiograph, MDCT, and/or magnetic resonance imaging [MRI]) were included. All patients with abnormal MRIs but normal MDCTs were reviewed by a pediatric spine surgeon to assess specific injury characteristics. RESULTS A total of 4,477 patients underwent c-spine imaging, and 60 (1.3%) were diagnosed with a clinically significant CSI that required surgery or a halo. These patients were older, more likely to be intubated, have a Glasgow Coma Scale score of <14, and more likely to be transferred in from a referring hospital. One patient with a fracture on radiography and neurologic symptoms got an MRI and no MDCT before operative repair. All other patients who underwent surgery including halo placement for a clinically significant CSI had their injury diagnosed by MDCT, representing a sensitivity of 100%. There were 17 patients with abnormal MRIs and normal MDCTs; none underwent surgery or halo placement. Imaging from these patients was reviewed by a pediatric spine surgeon, and no unstable injuries were identified. CONCLUSION Multidetector computed tomography appears to have 100% sensitivity for detecting clinically significant CSIs in pediatric trauma patients, regardless of age or mental status. Forthcoming prospective data will be useful to confirm these results and inform recommendations for whether pediatric c-spine clearance can be safely performed based on the results of a normal MDCT alone. LEVEL OF EVIDENCE Diagnostic Tests or Criteria; Level IV.
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Affiliation(s)
- Katie W Russell
- From the Division of Pediatric Surgery, Department of Surgery (K.W.R., S.E.I., K.M.S., N.E.P., K.E.L., T.M.B., S.J.F., R.A.S.) and Department of Neurosurgery (R.R.I., D.L.B.), University of Utah, Salt Lake City, Utah; Primary Children's Hospital, Salt Lake City, UT (K.L.B.); and Division of Trauma and Surgical Critical Care, Department of Surgery (K.I.), University of Southern California, Los Angles, CA
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Cox KJ, Yang MJ, Fenton SJ, Russell KW, Yost CC, Yoder BA. Operative repair in congenital diaphragmatic hernia: How long do we really need to wait? J Pediatr Surg 2022; 57:17-23. [PMID: 35216800 DOI: 10.1016/j.jpedsurg.2022.01.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 12/13/2021] [Accepted: 01/20/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To analyze preoperative cardiopulmonary support and define preoperative stability relative to timing of surgical repair for CDH neonates not on ECMO. STUDY DESIGN We retrospectively analyzed repeated measures of oxygenation index (OI; Paw*FiO2×100/PaO2) among 158 neonates for temporal preoperative trends. We defined physiologic stability using OI and characterized ventilator days and discharge age relative to delay in repair beyond physiologic stability. RESULTS The OI in the first 24 h of life was temporally reliable and representative of the preoperative mean (ICC 0.70, 95% CI 0.61-0.77). A pre-operative OI of ≤ 9.4 (AUC 0.95) was predictive of survival. Surgical delay after an OI ≤ 9.4 resulted in increased ventilator days (1.4, 95% CI 1.1-1.9) and discharge age (1.5, 95% CI 1.2-2.0). When prospectively applied to a subsequent cohort, an OI ≤ 9.4 was again reflective of physiologic stability prior to repair. CONCLUSION OI values are temporally reliable and change minimally after 24 h age. Delay in surgical repair of CDH beyond initial stability increases ventilator days and discharge age without a survival benefit. LEVEL OF EVIDENCE Prognosis study, Level III.
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Affiliation(s)
- Kyley J Cox
- Department of Pediatrics, University of Utah School of Medicine and Primary Children's Hospital, Intermountain Healthcare, Salt Lake City, UT, United States
| | - Michelle J Yang
- Divisions of Neonatology, University of Utah School of Medicine and Primary Children's Hospital, Intermountain Healthcare, P.O. Box 581289, Salt Lake City, UT 84158-1289, United States.
| | - Stephen J Fenton
- Pediatric Surgery, University of Utah School of Medicine and Primary Children's Hospital, Intermountain Healthcare, Salt Lake City, UT, United States
| | - Katie W Russell
- Pediatric Surgery, University of Utah School of Medicine and Primary Children's Hospital, Intermountain Healthcare, Salt Lake City, UT, United States
| | - Christian C Yost
- Divisions of Neonatology, University of Utah School of Medicine and Primary Children's Hospital, Intermountain Healthcare, P.O. Box 581289, Salt Lake City, UT 84158-1289, United States; Molecular Medicine Program, University of Utah School of Medicine and Primary Children's Hospital, Intermountain Healthcare, Salt Lake City, UT, United States
| | - Bradley A Yoder
- Divisions of Neonatology, University of Utah School of Medicine and Primary Children's Hospital, Intermountain Healthcare, P.O. Box 581289, Salt Lake City, UT 84158-1289, United States
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Ryan S, Fenton SJ, Hansen K, Hewes HA. Sledding Accidents at a Level 1 Pediatric Trauma Center Between 2006 and 2016. Pediatr Emerg Care 2022; 38:e1291-e1293. [PMID: 35436765 DOI: 10.1097/pec.0000000000002728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Sledding is not a risk-free winter sport. According to the US Consumer Product Safety Commission, there were an estimated 13,954 sledding accidents requiring medical care in 2010. However, specific information concerning pediatric injuries related to sledding is not well defined. OBJECTIVES This study aimed to identify the most common types of injuries associated with sledding accidents and demographic factors related to risk of injury in pediatric patients, and to compare injuries associated with 2 different age groups and sexes. METHODS This is a retrospective descriptive study of pediatric patients (<18 years of age) presenting to a regional level I pediatric trauma center secondary to a sledding injury between 2006 and 2016. Demographic information including sex, age, mechanism of injury, and injury severity score was captured and analyzed using descriptive statistics. RESULTS There were 209 patients identified for 10 years. There were no mortalities. There were 85 patients with primary head injury, of which 82 (96.5%) were hospitalized and 33 (38.8%) required an intensive care unit (ICU) stay. Seventy-five patients primarily suffered from extremity injuries, of which 56 (74.6%) had lower extremity fractures requiring operative intervention. There was no difference in ICU or length of stay between younger children (0-11 years) and adolescents (12-18 years) or between male and female patients. CONCLUSIONS Childhood sledding can result in a variety of significant injuries requiring surgical intervention and hospitalization. Children pulled on sleds behind motorized vehicles are at higher risk for more severe injuries resulting in a higher rate of ICU admission.
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Affiliation(s)
- Sydney Ryan
- From the Division of Pediatric Emergency Medicine, Department of Pediatrics
| | - Stephen J Fenton
- Division of Pediatric Surgery, Department of Surgery, University of Utah
| | - Kris Hansen
- Primary Children's Hospital, Salt Lake City, UT
| | - Hilary A Hewes
- From the Division of Pediatric Emergency Medicine, Department of Pediatrics
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Russell KW, Katz MG, Phillips RC, Kelley-Quon LI, Acker SN, Shahi N, Lee JH, Fialkowski EA, Nacharaju D, Smith CA, Jensen AR, Mueller CM, Padilla BE, Ignacio RC, Ourshalimian S, Wang KS, Ostlie DJ, Fenton SJ, Kastenberg ZJ. Adolescent Vaping-Associated Trauma in the Western United States. J Surg Res 2022; 276:251-255. [PMID: 35395565 DOI: 10.1016/j.jss.2022.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 02/01/2022] [Accepted: 02/14/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Electronic cigarettes (e-cigarettes) are handheld, battery-powered vaporizing devices. It is estimated that more than 25% of youth have used these devices recreationally. While vaping-associated lung injury is an increasingly recognized risk, little is known about the risk of traumatic injuries associated with e-cigarette malfunction. METHODS A multi-institutional retrospective study was performed by querying the electronic health records at nine children's hospitals. Patients who sustained traumatic injuries while vaping from January 2016 through December 2019 were identified. Patient demographics, injury characteristics, and the details of trauma management were reviewed. RESULTS 15 children sustained traumatic injuries due to e-cigarette explosion. The median age was 17 y (range 13-18). The median injury severity score was 2 (range 1-5). Three patients reported that their injury coincided with their first vaping experience. Ten patients required hospital admission, three of whom required intensive care unit admission. Admitted patients had a median length of stay of 3 d (range 1-6). The injuries sustained were: facial burns (6), loss of multiple teeth (5), thigh and groin burns (5), hand burns (4), ocular burns (4), a radial nerve injury, a facial laceration, and a mandible fracture. Six children required operative intervention, one of whom required multiple operations for a severe hand injury. CONCLUSIONS In addition to vaping-associated lung injury, vaping-associated traumatic injuries are an emerging and worrisome injury pattern sustained by adolescents in the United States. This report highlights another means by which e-cigarettes pose an increasing risk to a vulnerable youth population.
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Affiliation(s)
- Katie W Russell
- Division of Pediatric Surgery, University of Utah, Primary Children's Hospital, Salt Lake City, Utah.
| | - Micah G Katz
- Division of Pediatric Surgery, University of Utah, Primary Children's Hospital, Salt Lake City, Utah
| | - Ryan C Phillips
- Department of Pediatric Surgery, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
| | | | - Shannon N Acker
- Department of Pediatric Surgery, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
| | - Niti Shahi
- Department of Pediatric Surgery, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
| | - Justin H Lee
- Division of Pediatric Surgery, Phoenix Children's Hospital
| | | | - Deepthi Nacharaju
- Division of Trauma, General Surgery, Surgical Critical Care, University of Washington, Harborview Medical Center, Seattle, Washington
| | - Caitlin A Smith
- Department of General and Thoracic Surgery, Seattle Children's Hospital, Seattle, Washington
| | - Aaron R Jensen
- Division of Pediatric Surgery, UCSF Benioff Children's Hospitals, San Francisco, California
| | - Claudia M Mueller
- Department of Pediatric Surgery, Stanford University, Lucile Packard Children's Hospital, Palo Alto, California
| | | | - Romeo C Ignacio
- Division of Pediatric Surgery, University of California San Diego School of Medicine, San Diego, California
| | | | - Kasper S Wang
- Department of Surgery, Children's Hospital Los Angeles, Los Angeles, California
| | | | - Stephen J Fenton
- Division of Pediatric Surgery, University of Utah, Primary Children's Hospital, Salt Lake City, Utah
| | - Zachary J Kastenberg
- Division of Pediatric Surgery, University of Utah, Primary Children's Hospital, Salt Lake City, Utah
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Taylor MA, Lewis AE, Swendiman RA, Fenton SJ, Russell KW. Interest in Improving Access to Pediatric Trauma Care Through Telemedicine. J Med Syst 2021; 45:108. [PMID: 34755231 DOI: 10.1007/s10916-021-01789-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 11/01/2021] [Indexed: 11/25/2022]
Abstract
Despite improved outcomes at pediatric trauma centers (PTC), 90% of injured children are not treated at PTCs. Telemedicine may play a role in ensuring patients are transferred to the appropriate level of care. We aimed to determine the level of interest in trauma telemedicine with our PTC among referring facilities. A survey was conducted with the trauma program directors of 45 hospitals in Utah, which consisted of four multiple choice questions designed to determine interest in pediatric trauma telemedicine support, projected frequency of use, anticipated uses of telemedicine, and perceived barriers to implementation. Forty-one directors (91%) responded. 88% of directors were interested in developing a pediatric trauma telemedicine network. 20% estimated their center would use telemedicine more than once a week, 17% once a week, 24% once a month, and 37% a few times a year. The most frequently cited uses of a telemedicine program were triage/transfer decisions and provider support. Inadequate volume and insufficient funding were the most common perceived barriers. These data show there is a strong interest amongst hospitals in our state in pediatric trauma telemedicine. Inadequate volume to warrant a program and insufficient facility funding remain concerns for development of a program.
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Affiliation(s)
- Mark A Taylor
- Primary Children's Hospital, University of Utah, Salt Lake City, UT, USA.
| | - Aislinn E Lewis
- Primary Children's Hospital, University of Utah, Salt Lake City, UT, USA
| | | | - Stephen J Fenton
- Primary Children's Hospital, University of Utah, Salt Lake City, UT, USA
| | - Katie W Russell
- Primary Children's Hospital, University of Utah, Salt Lake City, UT, USA
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11
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Swendiman RA, Abramov A, Fenton SJ, Russell KW, Nance ML, Nace GW, Iii MA. Use of angioembolization in pediatric polytrauma patients: WITH BLUNT SPLENIC INJURYAngioembolization in Pediatric Blunt Splenic Injury. J Pediatr Surg 2021; 56:2045-2051. [PMID: 34034882 DOI: 10.1016/j.jpedsurg.2021.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 04/07/2021] [Accepted: 04/18/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND/PURPOSE We sought to analyze the use of angioembolization (AE) after pediatric splenic injuries at adult and pediatric trauma centers (ATCs/PTCs). METHODS The National Trauma Data Bank (2010-2015) was queried for patients (<18 years) who experienced blunt splenic trauma. Multivariate logistic regression was used to determine the association of AE with splenectomy. Propensity score matching was used to explore the relationship between trauma center designation and AE utilization. RESULTS 14,027 encounters met inclusion criteria. 514 (3.7%) patients underwent AE. When compared to PTCs, patients were older, had a higher ISS, and more often presented in shock at ATCs (p<0.001 for all). Regression models demonstrated no difference in mortality between cohorts. Odds of splenectomy were lower for patients undergoing AE (OR 0.16 [CI: 0.08-0.31]), however this effect was mostly driven by utilization at ATCs. Using a 1:1 propensity score matching model, patients treated at ATCs were 4 times more likely to undergo AE and 7 times more likely to require a splenectomy compared to PTCs (p<0.001). Over 6 years, PTCs performed only 27 splenectomies and 23 AEs (1.1% and 0.9%, respectively). CONCLUSIONS AE was associated with improved splenic salvage at ATCs in select patients but appeared overutilized when compared to outcomes at PTCs. PTCs accomplished a higher splenic salvage rate with a lower AE utilization. LEVEL OF EVIDENCE III - Retrospective cohort study.
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Affiliation(s)
- Robert A Swendiman
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States.
| | - Alexey Abramov
- Division of Pediatric General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Stephen J Fenton
- Division of Pediatric Surgery, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Katie W Russell
- Division of Pediatric Surgery, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Michael L Nance
- Division of Pediatric General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Gary W Nace
- Division of Pediatric General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Myron Allukian Iii
- Division of Pediatric General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, United States
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12
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Abstract
The consequences of most hernias can be immediately corrected by surgical repair. However, this isn't always the case for children born with a congenital diaphragmatic hernia. The derangements in physiology encountered immediately after birth result from pulmonary hypoplasia and hypertension caused by herniation of abdominal contents into the chest early in lung development. This degree of physiologic compromise can vary from mild to severe. Postnatal management of these children remains controversial. Although heavily studied, multi-institutional randomized controlled trials are lacking to help determine what constitutes best practice. Additionally, the results of the many studies currently within the literature that have investigated differing aspect of care (i.e., inhaled nitric oxide, ventilator type, timing of repair, role of extracorporeal membrane oxygenation, etc.) are difficult to interpret due to the small numbers investigated, the varying degree of physiologic compromise, and the contrasting care that exists between institutions. The aim of this paper is to review areas of controversy in the care of these complex kids, mainly: the use of fraction of inspired oxygen, surfactant therapy, gentle ventilation, mode of ventilation, medical management of pulmonary hypertension (inhaled nitric oxide, sildenafil, milrinone, bosentan, prostaglandins), the utilization of extracorporeal membrane oxygenation, and the timing of surgical repair.
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Affiliation(s)
- Michelle J Yang
- Division of Neonatology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Katie W Russell
- Division of Pediatric Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Bradley A Yoder
- Division of Neonatology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Stephen J Fenton
- Division of Pediatric Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
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13
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Pruitt LCC, Kastenberg ZJ, Fenton SJ, Short SS. Early use of autologous blood patch pleurodesis in children is successful in resolving persistent air leaks. J Pediatr Surg 2021; 56:629-631. [PMID: 33189301 DOI: 10.1016/j.jpedsurg.2020.10.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/16/2020] [Accepted: 10/28/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE Experience with autologous blood patch (ABP) pleurodesis for persistent air leak in the pediatric population is limited. The purpose of this series was to describe the experience with ABP at a single tertiary children's hospital. METHODS A retrospective study was performed of all thoracic procedures done by the pediatric surgery service over three years. RESULTS Ten patients underwent a total of 17 ABPs. The median age of patients was 12 years (IQR 6-16). The most common underlying reasons for a thoracic procedure included: blebectomy for spontaneous pneumothorax (2), need for lung biopsy (2), resection of known malignant tumor (2), and empyema (2). The median number of days of persistent air leak before first ABP was 7.5 days (IQR 7-10). A second ABP was performed in 6 cases with a third procedure performed in one case. None of the patients developed respiratory compromise during ABP and no infectious complications were identified following ABP. CONCLUSIONS Our cohort demonstrates that ABP for persistent air leak following thoracic surgery is effective with minimal morbidity in children. We believe ABP can be used early and in patients with a broad range of underlying lung pathology.
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Affiliation(s)
- Liese C C Pruitt
- University of Utah, Department of Surgery, Division of Pediatric Surgery, Salt Lake City, UT, 84112, USA.
| | - Zachary J Kastenberg
- University of Utah, Department of Surgery, Division of Pediatric Surgery, Salt Lake City, UT, 84112, USA
| | - Stephen J Fenton
- University of Utah, Department of Surgery, Division of Pediatric Surgery, Salt Lake City, UT, 84112, USA
| | - Scott S Short
- University of Utah, Department of Surgery, Division of Pediatric Surgery, Salt Lake City, UT, 84112, USA
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14
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Taylor MA, Knochel ML, Proctor SJ, Brockmeyer DL, Runyon LA, Fenton SJ, Russell KW. Pediatric trauma telemedicine in a rural state: Lessons learned from a 1-year experience. J Pediatr Surg 2021; 56:385-389. [PMID: 33228973 DOI: 10.1016/j.jpedsurg.2020.10.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 10/20/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Previous research from our center has shown that 27% of the pediatric trauma transfers from referring facilities are potentially preventable. Our hospital is the only level 1 pediatric trauma center (PTC) in our state, and we are developing a pediatric trauma telehealth network to help keep certain injured children closer to home. We instituted a pediatric trauma telehealth program with a partnering community-based hospital in our state and aim to report our experience over the first year. METHODS All pediatric trauma patients that presented to our partnering hospital from January 2019 to February 2020 were reviewed. Disposition was: a) telehealth consultation, b) admission to the children's unit without a telehealth consultation per our head trauma protocol, or c) transfer without telehealth consultation. Data on demographics, hospital course, and disposition were collected via chart review. RESULTS Eight patients underwent telehealth consults and another 8 patients were admitted to the partnering hospital's children's unit based on the head trauma protocol without a telehealth consult. Patient's ages ranged from 7 months to 15 years. Of the patients that underwent telehealth consult, 7 presented with a head injury and 1 presented with a rib fracture/small pneumothorax. The patient with a pneumothorax was observed for 6 h and discharged home after a repeat chest x-ray was stable. All 15 patients with head injuries were observed and discharged from either the emergency department or children's unit after passing concussion testing. No patients required transfer to our PTC after observation, and none were readmitted. Fifty-six patients were transferred without telehealth consultation, and 3 of these patients could potentially have avoided transfer with a telehealth consultation. CONCLUSIONS Telehealth in pediatric trauma can be a safe mechanism for preventing the transfer of patients that can be safely observed at a partnering hospital. From a facility that transfers an average of 30 trauma patients per year to our hospital, this program prevented 16 such transfers. Development of a head trauma protocol in collaboration with a pediatric neurosurgeon leads to an unexpected number of patients being admitted to the partnering hospital for observation without utilization of a telehealth consultation. TYPE OF STUDY Retrospective study. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Mark A Taylor
- University of Utah, Department of Surgery, Salt Lake City, UT.
| | - Miguel L Knochel
- University of Utah, Department of Pediatrics, Salt Lake City, UT
| | | | | | - Lisa A Runyon
- Primary Children's Hospital, Department of Pediatric Surgery, Salt Lake City, UT
| | | | - Katie W Russell
- University of Utah, Department of Surgery, Salt Lake City, UT
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15
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Abstract
Introduction Our institution uses video review as a quality improvement tool. Starting in March 2018, we specifically focused on meeting certain time goals during trauma resuscitation aimed at decreasing time to final disposition. The purpose of this study was to evaluate the effect of establishing strict time goals on total time spent in the trauma bay by pediatric trauma patients. Materials and methods A retrospective review of all level I trauma activations at a level I pediatric trauma center between November 2017 and December 2018 was performed via manual review of the recorded trauma activations. Data on key time points such as time from arrival to transfer to gurney, to completion of primary survey, to chest x-ray, to Emergency Medical Services (EMS) report, to CT scan, and to disposition (CT or admission/operating room [OR] if no CT scan was performed) were analyzed and compared between the cohort of patients prior to implementation of the time goals with that after. The cohort of patients who presented between March 2018 and May 2018 were excluded to allow for time for the intervention to take effect. Results There were 13 level I trauma activations before implementation of the time goals and 41 after. There was a significant decrease in time to transfer to gurney (1.8 minutes vs. 1.0 minutes; p=0.02), to CT scan (18.8 minutes vs. 14.2 minutes; p=0.01), and to disposition (18.3 minutes vs. 14.9 minutes; p=0.047). There was no decrease in time to completion of primary survey, EMS report, or chest x-ray. Conclusions Utilizing video review in pediatric trauma as a quality improvement initiative with a focus on meeting specific time goals for key elements of the activation led to decreased total time in our trauma bay with critically ill patients.
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Affiliation(s)
- Mark A Taylor
- Department of Surgery, University of Utah Health, Salt Lake City, USA
| | - Hilary A Hewes
- Department of Emergency Medicine, Primary Children's Hospital, Salt Lake City, USA
| | - Carol D Bolinger
- Department of Pediatric Surgery, Primary Children's Hospital, Salt Lake City, USA
| | - Stephen J Fenton
- Department of Surgery, University of Utah Health, Salt Lake City, USA
| | - Katie W Russell
- Department of Surgery, University of Utah Health, Salt Lake City, USA
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Neumayer KE, Sweney J, Fenton SJ, Keenan HT, Flaherty BF. Validation of the "CHIIDA" and application for PICU triage in children with complicated mild traumatic brain injury. J Pediatr Surg 2020; 55:1255-1259. [PMID: 31685269 DOI: 10.1016/j.jpedsurg.2019.09.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 08/27/2019] [Accepted: 09/25/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Children's Intracranial Injury Decision Aid (CHIIDA) was developed to predict which patients with complicated mild traumatic brain injury (cmTBI; GCS ≥13 with depressed skull fracture or intracranial injury) would achieve the composite outcome of neurosurgical intervention, intubation >24 h, or death. The study also explored the CHIIDA as a triage tool to determine need for PICU care. The purpose of this study is to externally validate the CHIIDA and assess its effects on PICU triage. METHODS Retrospective cohort study (January 2016 to December 2017) to validate the CHIIDA to predict the composite outcome and assess its effects as a PICU triage tool at a level 1 pediatric trauma center. RESULTS Of 345 patients with cmTBI, the composite outcome occurred in 16 patients (4.6%). At a cutoff score of 2, the CHIIDA predicted the composite outcome with a sensitivity of 94% (95% CI 67-99%) and specificity of 69% (95% CI 64-74%), similar to the original study. Using the same cutoff score for PICU triage resulted in 48 (71%) more patients admitted to PICU. CONCLUSIONS In our cohort, the CHIIDA predicted the composite outcome well. If applied as a triage tool, it would have resulted in increased unnecessary PICU admissions. LEVEL OF EVIDENCE Level III, prognosis.
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Affiliation(s)
- Katie E Neumayer
- Division of Critical Care, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA.
| | - Jill Sweney
- Division of Critical Care, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA.
| | - Stephen J Fenton
- Division of Pediatric of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA.
| | - Heather T Keenan
- Division of Critical Care, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA.
| | - Brian F Flaherty
- Division of Critical Care, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA.
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Taylor MA, Spanos SP, Fenton SJ, Russell KW. Ball Magnets Clicked Together on the Epiglottis. Cureus 2020; 12:e8181. [PMID: 32566422 PMCID: PMC7301421 DOI: 10.7759/cureus.8181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Neodymium ball magnets are commonly ingested by children and are a risk of causing significant morbidity if not addressed appropriately. While most ingested magnets are located distal to the epiglottis in the gastrointestinal tract, they can rarely get lodged across tissues in the mouth and throat such as the epiglottis. Though rare, this represents an impending airway emergency and requires urgent treatment once identified. We present the case of a two-year-old, asymptomatic male who presented after ingesting two neodymium ball magnets that were found to be clicked together across his epiglottis, which were ultimately retrieved by bronchoscopy without complications.
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Affiliation(s)
- Mark A Taylor
- Department of Surgery, University of Utah, Salt Lake City, USA
| | - Stephen P Spanos
- Department of Anesthesiology, Primary Children's Hospital, Salt Lake City, USA
| | | | - Katie W Russell
- Department of Surgery, University of Utah, Salt Lake City, USA
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18
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Sekhon MK, Fenton SJ, Yoder BA. Comparison of early postnatal prediction models for survival in congenital diaphragmatic hernia. J Perinatol 2019; 39:654-660. [PMID: 30770879 DOI: 10.1038/s41372-019-0335-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 01/02/2019] [Accepted: 01/14/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To compare the PF-PCO2 equation-partial pressure of arterial oxygen (PaO2)/fraction of inspired oxygen (FiO2) minus partial pressure of carbon dioxide (PCO2)-to three other tools for postnatal prediction of survival in infants with congenital diaphragmatic hernia (CDH). STUDY DESIGN A retrospective analysis of 203 infants with CDH from 1 January 2003 to 30 June 2018. Area under the curve (AUC) analysis was performed for survival and secondary outcomes of survival without extracorporeal membrane oxygenation support (ECMO) and death despite ECMO. Predictive scores were calculated to determine cutoff for PF-PCO2 score. RESULTS The PF-PCO2 tool had the highest AUC (0.84 for survival, 0.92 for survival without ECMO, and 0.83 for death despite ECMO). PF-PCO2 best predicted survival when >-60 and survival without ECMO when >+80. There was no optimal cutoff score for death despite ECMO. CONCLUSION The PF-PCO2 tool best predicted postnatal survival in infants with CDH.
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Affiliation(s)
- Mehtab K Sekhon
- Division of Neonatology, University of Utah School of Medicine, Salt Lake City, UT, USA.
| | - Stephen J Fenton
- Division of Pediatric Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Bradley A Yoder
- Division of Neonatology, University of Utah School of Medicine, Salt Lake City, UT, USA
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Russell KW, Katz MG, Short SS, Scaife ER, Fenton SJ. Longboard injuries treated at a level 1 pediatric trauma center. J Pediatr Surg 2019; 54:569-571. [PMID: 30593338 DOI: 10.1016/j.jpedsurg.2018.10.098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 09/09/2018] [Accepted: 10/28/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Recreation on longboards is gaining in popularity. The purpose of this study is to detail the injury patterns, treatment and management of children with longboarding injuries seen at a level 1 pediatric trauma center. METHODS A retrospective review using our trauma registry from 2006 to 2016 of pediatric patients who sustained injuries while riding a longboard. RESULTS Of 12,920 injured children, 64 (0.5%) were treated for injuries that occurred while riding a longboard. Median age was 14.5 years (IQR 13.6, 15.4) and 84% were male. Fifty-one (80%) suffered a traumatic brain injury (TBI) including 32 intracranial hemorrhages (ICH), 17 concussions, and 31 skull fractures. Seven (11%) were wearing helmets. Three patients required neurosurgical intervention. Extremity fractures were the most common reason for surgery. Ninety-six percent of patients were admitted to the hospital with a median length of stay of 1 day (IQR 1, 3). All children survived to discharge. Compared with skateboard injuries during the same period, TBI, ICH, concussion, and skull fractures were all greater. CONCLUSIONS TBI ranging from concussion to ICH requiring craniotomy is common in children injured while riding a longboard, and greater than rates after skateboarding injuries. Extremity fracture was the most common reason for operative intervention. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Katie W Russell
- Division of Pediatric Surgery, University of Utah School of Medicine, Salt Lake City, UT.
| | - Micah G Katz
- Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Scott S Short
- Division of Pediatric Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Eric R Scaife
- Division of Pediatric Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Stephen J Fenton
- Division of Pediatric Surgery, University of Utah School of Medicine, Salt Lake City, UT
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20
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Katz MG, Kastenberg ZJ, Taylor MA, Bolinger CD, Scaife ER, Fenton SJ, Russell KW. Reduction of resource utilization in children with blunt solid organ injury. J Pediatr Surg 2019; 54:354-357. [PMID: 30471878 DOI: 10.1016/j.jpedsurg.2018.10.066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 10/25/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND/PURPOSE Nonoperative management of blunt solid organ injuries continues to progress and improve cost-effective utilization of resources while maximizing patient safety. The purpose of this study is to compare resource utilization and patient outcomes after changing admission criteria from a grade-based protocol to one based on hemodynamic stability. METHODS A retrospective review of isolated liver and spleen injuries was done using prospectively collected trauma registry data from 2013 to 2017. The 2 years preceding the change were compared to the 2 years after protocol change. All analyses were performed using SAS 9.4. RESULTS There were 121 patients in the preprotocol cohort and 125 patients in the postprotocol cohort. Baseline demographics were similar along with injury mechanisms and severity. The ICU admission rate decreased from 40% to 22% (p = 0.002). There were no adverse events on the floor and no patient needed to be transferred to the ICU. CONCLUSIONS A protocol for ICU admission based on physiologic derangement versus solely on radiologic grade significantly reduced admission rates to the ICU in children with solid organ injury. The protocol was safe and effectively reduced resource utilization. LEVEL OF EVIDENCE Level II, prospective comparison study.
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Affiliation(s)
- Micah G Katz
- Department of Surgery, University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT 84132.
| | - Zachary J Kastenberg
- Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, 100 North Mario Capecchi Drive, Suite 3800, Salt Lake City, UT 84113.
| | - Mark A Taylor
- Department of Surgery, University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT 84132.
| | - Carol D Bolinger
- Primary Children's Hospital, 100 North Mario Capecchi Drive, Suite 3800, Salt Lake City, UT 84113.
| | - Eric R Scaife
- Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, 100 North Mario Capecchi Drive, Suite 3800, Salt Lake City, UT 84113.
| | - Stephen J Fenton
- Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, 100 North Mario Capecchi Drive, Suite 3800, Salt Lake City, UT 84113.
| | - Katie W Russell
- Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, 100 North Mario Capecchi Drive, Suite 3800, Salt Lake City, UT 84113.
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Stokes SM, Scaife ER, Stevens AM, Fenton SJ. Longitudinal analysis of hospital charges following injury in a level 1 pediatric trauma system. J Pediatr Surg 2018; 53:2189-2194. [PMID: 29576401 DOI: 10.1016/j.jpedsurg.2018.02.054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 01/12/2018] [Accepted: 02/14/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND The treatment of injured children contributes substantially to the financial burden of a health care system. The purpose of this study was to characterize these charges at a level-1 pediatric trauma center. METHODS Financial data for children (<14 years) admitted for traumatic injury from 1/2009 to 12/2014 were analyzed. The charges of the index admission and first two years following discharge were evaluated. RESULTS 5853 trauma patients were included with average annual charges of $11,128,730. The most common mechanisms of injury were fall (44%), sports (12%), and bike (9%). The median ISS was 6 (IQR 4-10) with a mortality rate of 1.8% and Z-score of 13.04 (p<0.001). The overall total charges per patient during the index admission were $9513. Spinal cord and major abdominal injuries had the greatest charges per patient ($55,560 and $23,618 respectively) primarily owing to hospital LOS. During the first year after discharge, the total charges per patient were $1733, of which spinal cord injury resulted in highest overall ($19,426), owing to inpatient rehabilitation. For all other injury patterns, mean total charges per patient were $2376 (range $791-$3573). CONCLUSIONS The value proposition in health care requires us to define outcomes relative to costs. Injury severity, major injury location, and hospital length of stay are the highest contributors for the financial burden of pediatric traumatic injury, while inpatient readmissions and inpatient rehabilitation drove higher charges in the years following discharge. TYPE OF STUDY Clinical Research Paper. LEVEL OF EVIDENCE II - Cohort Study.
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Affiliation(s)
- Sean M Stokes
- University of Utah School of Medicine, Department of Surgery, Division of General Surgery, 30 N 1900 E, Salt Lake City, Utah 84132.
| | - Eric R Scaife
- University of Utah School of Medicine, Department of Surgery, Division of Pediatric Surgery, 100 North Medical Drive, Suite 3800, Salt Lake City, Utah 84113
| | - Austin M Stevens
- University of Utah School of Medicine, Department of Surgery, Division of General Surgery, 30 N 1900 E, Salt Lake City, Utah 84132
| | - Stephen J Fenton
- University of Utah School of Medicine, Department of Surgery, Division of Pediatric Surgery, 100 North Medical Drive, Suite 3800, Salt Lake City, Utah 84113
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Yu PT, Fenton SJ, Delaplain PT, Vrecenak J, Adzick NS, Nance ML, Guner YS. Management of choledocholithiasis in an infant. Journal of Pediatric Surgery Case Reports 2018. [DOI: 10.1016/j.epsc.2017.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Hunt MM, Stevens AM, Hansen KW, Fenton SJ. The utility of a "trauma 1 OP" activation at a level 1 pediatric trauma center. J Pediatr Surg 2017; 52:322-326. [PMID: 27692626 DOI: 10.1016/j.jpedsurg.2016.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 09/06/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To expedite flow of injured children suspected to require operative intervention, a "trauma 1 OP" (T1OP) activation classification was created. The purpose of this study was to review this strategy at a level 1 pediatric trauma center. METHODS A retrospective review of T1OP activations between 2003 and 2015 was performed. Children suspected of requiring neurosurgical intervention were classified as trauma 1 OP neuro (T1OP(N)). Comparisons were made to trauma 1 (T1) patients who required emergent operative intervention, excluding orthopedic injuries. RESULTS Overall, 461 T1OP activations occurred (72% T1OP(N)) compared to 129 T1 activations requiring emergent surgery. Demographics were not significantly different between groups, although T1OP patients were slightly younger and more often experienced falls or were victims of abuse. Compared to T1 activations, T1OP activations had a significantly higher mortality rate (21% vs. 7%, p<0.001). Repeat head imaging was more common in the T1OP(N) group compared to imaged children in the T1 group (20% vs. 37%, p=0.05). T1OP(N) patients more often went directly to the OR (45% vs. 33%, p=0.02) and did so in a significantly faster period of time (32min vs. 53min, p<0.001). CONCLUSIONS Use of the T1OP activations appropriately triaged surgical patients, resulting in significantly faster transport times to the OR. LEVEL OF EVIDENCE II, prognosis study.
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Affiliation(s)
| | | | | | - Stephen J Fenton
- Division of Pediatric Surgery, University of Utah School of Medicine.
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Abstract
Blunt cerebrovascular injury in children is an uncommon occurrence that if missed and left untreated can result in devastating long-term neurologic consequences. Diagnosis can be readily obtained by a computed tomographic angiogram of the head and neck. If confirmed, treatment with antithrombotic therapy dramatically reduces the risk of a cerebrovascular accident. The difficulty lies in determining which child should be screened for such an injury. Several institutions have come up with criteria for screening. In this article, we review the nuances of the cerebrovascular system and its resulting injury. We present recent literature on the subject in an attempt to add clarity to this challenging situation.
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Affiliation(s)
- Stephen J Fenton
- Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, 100 North Mario Capecchi Dr, Suite 3800, Salt Lake City, Utah 84113.
| | - Robert J Bollo
- Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, Utah
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Tyner RP, Clifton GT, Fenton SJ. Hand-sewn gastrojejunostomy using knotless unidirectional barbed absorbable suture during laparoscopic gastric bypass. Surg Endosc 2012; 27:1360-6. [PMID: 23093243 DOI: 10.1007/s00464-012-2616-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 09/19/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND This report describes the authors' institutional experience using knotless unidirectional barbed absorbable suture to close the common enterotomy of the jejunojejunostomy (JJ) and to create a hand-sewn gastrojejunostomy (GJ) during laparoscopic Roux-en-Y gastric bypass. METHODS A retrospective review of morbidly obese patients who underwent laparoscopic gastric bypass with a hand-sewn GJ between April 2011 and 2012 was performed. The authors' traditional technique (TT) consisted of using standard monofilament absorbable suture to close the common JJ enterotomy in a single running layer and to create the GJ with a two-layer anastomosis. A novel technique (NT) was introduced using knotless unidirectional barbed monofilament absorbable suture to perform both tasks. A comparison between these two techniques was performed. RESULTS In this study, 84 patients with a mean body mass index of 41.7 ± 4.7 kg/m(2) underwent laparoscopic gastric bypass using a hand-sewn technique. For the 84 patients, 75 primary procedures (89.3 %) and 9 revisional procedures (10.7 %) were performed. In 38 procedures (45.2 %), the TT was used, whereas 46 cases (54.8 %) were managed using the NT. For the primary procedures, the average operating room times were slightly faster in the NT group (178.9 ± 44.4 vs 154.2 ± 74.7 min; p = 0.08). The average hospital length of stay was comparable between the two groups (2.3 ± 0.7 vs 2.6 ± 1.4 days; p = 0.25). A 30-day follow-up assessment was obtained for all 84 patients, without a significant difference in the overall complication rate between the two groups (TT 18.4 % vs NT 13 %; p = 0.77). No complications were secondary to the JJ closure or gastrojejunostomy. The complications included bleeding (n = 1), small bowel obstruction (n = 1), dehydration (n = 2), esophagitis (n = 1), and subarachnoid hemorrhage (n = 1). No anastomotic leak or stenosis occurred in either group. The mean percentage of excess weight loss at 1 month was 21.3 % ± 5.4 %, without a significant difference between the two groups. CONCLUSION In the study cohort, the use of knotless unidirectional barbed suture instead of traditional monofilament absorbable suture had similar 30-day outcomes and appears to be a feasible option for laparoscopic bowel closure and anastomosis creation.
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Affiliation(s)
- Ryan P Tyner
- Department of Surgery, San Antonio Military Medical Center, 3851 Roger Brooke Drive, Fort Sam Houston, TX 78234, USA
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Alley JB, Fenton SJ, Harnisch MC, Angeletti MN, Peterson RM. Integrated bioabsorbable tissue reinforcement in laparoscopic sleeve gastrectomy. Obes Surg 2012; 21:1311-5. [PMID: 21088926 DOI: 10.1007/s11695-010-0313-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Division of the stomach in laparoscopic sleeve gastrectomy may be performed using bare stapler cartridges or cartridges fitted with tissue reinforcement strips, with or without oversewing. Many tissue reinforcement strips are after-market add-on products that must be fitted onto a stapler during surgery. A retrospective review was conducted of 85 consecutive patients undergoing laparoscopic sleeve gastrectomy using a novel integrated bioabsorbable polymer buttress pre-mounted on a single-use loading unit stapler. Mean preoperative body mass index (BMI) was 41.7 ± 5.2 kg/m(2). Morbidity and short-term outcomes were documented. Mean follow-up was 8.1 ± 3.6 months (range, 1.0-16.2 months). There were no mortalities or staple line leaks noted in this series with short-term follow up. The major complication rate (grade III and above) was 7.1% and included: reoperation for staple line bleeding (2.4%, n = 2), gastric sleeve stenosis requiring balloon dilation (2.4%, n = 2), choledocholithiasis 2 weeks after surgery (1.2%, n = 1), and reoperation without abnormality for suspected perioperative obstruction (1.2%, n = 1). Mean percent excess BMI loss at 3 (44.6 ± 11.3), 6 (57.9 ± 17.2), and 12 months (72.4 ± 27.5) was comparable to other published series. The use of an integrated absorbable synthetic polymer for stapled tissue reinforcement in laparoscopic sleeve gastrectomy appears to be feasible and safe, and yields results consistent with other published techniques.
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Affiliation(s)
- Joshua B Alley
- Department of Surgery, San Antonio Military Medical Center, 59th SSS/SGO2G, Lackland AFB/Fort Sam Houston, San Antonio, TX, USA.
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Alley JB, Fenton SJ, Harnisch MC, Tapper DN, Pfluke JM, Peterson RM. Quality of life after sleeve gastrectomy and adjustable gastric banding. Surg Obes Relat Dis 2012; 8:31-40. [DOI: 10.1016/j.soard.2011.03.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Revised: 03/10/2011] [Accepted: 03/15/2011] [Indexed: 01/07/2023]
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Parikh A, Alley JB, Peterson RM, Harnisch MC, Pfluke JM, Tapper DM, Fenton SJ. Management options for symptomatic stenosis after laparoscopic vertical sleeve gastrectomy in the morbidly obese. Surg Endosc 2011; 26:738-46. [PMID: 22044967 DOI: 10.1007/s00464-011-1945-1] [Citation(s) in RCA: 120] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Accepted: 08/31/2011] [Indexed: 12/11/2022]
Abstract
BACKGROUND This study aimed to determine the incidence, etiology, and management options for symptomatic stenosis (SS) after laparoscopic sleeve gastrectomy (LSG). METHODS A retrospective study reviewed morbidly obese patients who underwent LSG between October 2008 and December 2010 to identify patients treated for SS. RESULTS In this study, 230 patients (83% female) with a mean age of 49.5 years and a mean body mass index (BMI) of 43 kg/m(2) underwent LSG. In 3.5% of these patients (100% female; mean age, 42 years; mean BMI, 42.6 kg/m(2)), SS developed. The LSG procedure was performed using a 36-Fr. bougie and tissue-reinforced staplers. Four patients had segmental staple-line imbrication, and seven patients underwent contrast study, with 71.4% demonstrating a fixed narrowing. Endoscopy confirmed short-segment stenoses: seven located at mid-body and one located near the gastroesophageal junction. Endoscopic management was 100% successful. The mean number of dilations was 1.6, and the median balloon size was 15 mm. The mean time from surgery to initial endoscopic intervention was 48.8 days, and the mean time from the first dilation to toleration of a solid diet was 49.6 days. Two patients were referred to our institution after undergoing LSG at another facility. The mean time to the transfer was 28.5 days. The two patients had a mean age of 35 years and a mean BMI of 42.3 kg/m(2). Both patients experienced immediate SS after perioperative complications comprising one staple-line hematoma and one leak. Contrast studies demonstrated minimal passage of contrast through a long-segment stenosis. Both patients underwent multiple endoscopic dilation procedures and endoluminal stenting, ultimately requiring laparoscopic conversion to Roux-en-Y gastric bypass. The mean time from the initial surgery to the surgical revision was 77 days, and the mean time after the first intervention to tolerance of a solid diet was 82 days. CONCLUSION Symptomatic short-segment stenoses after LSG may be treated successfully with endoscopic balloon dilation. Long-segment stenoses that do not respond to endoscopic techniques may ultimately require conversion to Roux-en-Y gastric bypass.
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Affiliation(s)
- Amit Parikh
- Department of Surgery, University of Texas Health Sciences Center at San Antonio, Mail Code 7842, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900, USA
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Alley JB, Fenton SJ, Harnisch MC, Tapper DN, Peterson RM. P-122: Laparoscopic sleeve gastrectomy and adjustable gastric banding: Patient choice and postoperative quality of life. Surg Obes Relat Dis 2010. [DOI: 10.1016/j.soard.2010.03.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Scaife ER, Fenton SJ, Hansen KW, Metzger RR. Use of focused abdominal sonography for trauma at pediatric and adult trauma centers: a survey. J Pediatr Surg 2009; 44:1746-9. [PMID: 19735819 DOI: 10.1016/j.jpedsurg.2009.01.018] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2008] [Revised: 01/16/2009] [Accepted: 01/18/2009] [Indexed: 12/01/2022]
Abstract
PURPOSE Focused abdominal sonography for trauma (FAST) has been popularized for the initial evaluation of trauma patients. We sought to understand the scope of practice on a national level with specific attention to its use in the pediatric age group. METHODS An electronic survey was sent to all American College of Surgeons level I trauma centers and the National Association of Children's Hospitals and Related Institutions that were freestanding children's hospitals. RESULTS The survey was emailed to 124 centers, and 98 (79%) completed the survey. Of the surveyed centers, 23% cared for adults only, 28% were freestanding children's hospitals, and 49% managed both. At adults-only institutions, 96% use FAST and at children's hospitals, only 15%; it is used at 85% of centers that care for both. For the centers that use FAST on children, 88% have no age limit. Of all the institutions that typically use FAST, the individual performing the examination could be a surgeon (73%), an emergency department doctor (48%), or a radiologist (3%). Of the centers that perform FAST, 51% bill for the FAST examination. CONCLUSIONS Adult hospitals are much more likely to perform FAST examinations in the trauma patient, and many adult centers routinely use FAST to examine pediatric patients.
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Affiliation(s)
- Eric R Scaife
- Division of Pediatric Surgery, Primary Children's Medical Center, Salt Lake City, Utah 84113, USA
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Alley JB, Fenton SJ, Peterson RM. The “Tip-Stitch”: A Time-Saving Technique for Specimen Extraction in Sleeve Gastrectomy. Obes Surg 2009; 19:926-7. [DOI: 10.1007/s11695-009-9810-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2009] [Accepted: 02/05/2009] [Indexed: 01/07/2023]
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Vogler SA, Fenton SJ, Scaife ER, Book LS, Jackson D, Nichol PF, Meyers RL. Closed gastroschisis: total parenteral nutrition-free survival with aggressive attempts at bowel preservation and intestinal adaptation. J Pediatr Surg 2008; 43:1006-10. [PMID: 18558174 DOI: 10.1016/j.jpedsurg.2008.02.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2008] [Accepted: 02/08/2008] [Indexed: 11/17/2022]
Abstract
BACKGROUND In infants with gastroschisis antenatal closure of the umbilical defect results in a proximal atresia with ischemia and/or volvulus of the extracorporeal midgut. It has been described as "closed gastroschisis" or "vanishing midgut." METHODS A 10-year review of 219 gastroschisis patients identified 10 infants with this rare complication. RESULTS In these 10 infants, the extracorporeal midgut was invariably matted and fibrosed. In 3 cases, the midgut had completely "vanished." In the remaining 7 cases, the remnant midgut was surgically reduced into the abdominal cavity with care not to compromise the diminutive vascular pedicle. Abdominal exploration was performed several weeks later to reestablish bowel continuity; 4 required an ostomy and 2 underwent a serial transverse enteroplasty. Mean residual length of salvaged small bowel was 79 cm with retention of the distal half of the colon. Eight infants survived the initial hospitalization, with a mean length of stay of 121 days and mean hospital charge of $287,094. Six of the 7 long-term survivors have been completely weaned off total parenteral nutrition. CONCLUSION A nihilistic attitude toward infants with closed gastroschisis may not be uniformly supported because in the majority of these infants' long-term independence from total parenteral nutrition was achieved.
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Affiliation(s)
- Sarah A Vogler
- Department of Surgery, University of Utah, Salt Lake City, UT 84132, USA
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Rose NA, Fenton SJ, Beauchamp G, McCoy RW. Analysis of Vehicle-to-Ground Impacts During a Rollover with an Impulse-Momentum Impact Model. ACTA ACUST UNITED AC 2008. [DOI: 10.4271/2008-01-0178] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Fenton SJ, Kastenmeier A, Pysher TJ, Nichol PF. Acute appendicitis in a patient with hemolytic uremic syndrome: an unusual clinical scenario. Pediatr Surg Int 2008; 24:439-41. [PMID: 17410368 DOI: 10.1007/s00383-007-1917-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/05/2007] [Indexed: 11/28/2022]
Abstract
Gastroenteritis due to Escherichia coli O157:H7 occurs in young children and is associated with consumption of under cooked beef. Approximately 5-10% of patients will develop hemolytic uremic syndrome (HUS): renal failure, microangiopathic hemolytic anemia, and thrombocytopenia. A 6-year-old boy was admitted with abdominal pain, guaiac positive stool, decreased urine output and elevated creatinine levels. Hemodialysis was initiated upon rapid progression to anuria. On hospital day # 5 he developed acute abdominal pain, which was different from his initial assessment. Exam revealed focal tenderness in the right lower quadrant with localized guarding and rebound. Ultrasound demonstrated a dilated, fluid filled tubular structure in the RLQ concerning for appendicitis. Based on these findings the patient was taken to the operating room for a laparoscopic appendectomy. The patient had undergone dialysis the previous day and was preoperatively treated with DDAVP to minimize the risk of bleeding. The procedure occurred without complication and final pathology confirmed acute appendicitis. This case highlights the unique clinical scenario in which patients with HUS require operative intervention. Surgical procedures can be performed on these patients, however, all precautions should be taken to minimize the risk of bleeding, including the use of preoperative DDAVP.
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Affiliation(s)
- Stephen J Fenton
- Department of Surgery, University of Utah, Salt Lake City, UT 84132, USA
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Abstract
Foreign body ingestion in small children is common yet only 1% of cases require operative management of associated complications (Arana et al. in Eur J Pediatr 160:468-472, 2001). A 6-year-old boy was referred to our institution with a 12 h history of abdominal pain. This pain was diffuse and crampy in nature and associated with multiple episodes of non-bilious, non-bloody emesis. On evaluation he was stable and his abdomen demonstrated slight distention and tenderness without peritoneal signs. Plain abdominal radiographs demonstrated some distended loops of small bowel and a radio-opaque foreign object within the mid-abdomen. A small bowel obstruction secondary to foreign body ingestion was diagnosed and an emergent laparotomy performed. Upon exploration, a transition zone was noted near the ileocecal valve. Further exploration revealed the obstruction to be caused secondary to the apposition of two small (8 mm) magnets, one in the proximal ileum and the other near the ileocecal valve, resulting in an internal hernia. The magnets were easily separated relieving the obstruction and both were removed via two small bowel enterotomies. After being presented with the magnets, his parents suspected that they came from the clothes of a Polly Pocket (Mattel, Inc., El Segundo, CA) doll. The patient had an uneventful post-operative course and was discharged to home on the second post-operative day. This case demonstrates the complications that may occur with multiple magnet ingestion. It highlights the need for close observation and early surgical intervention in children with a suspected history of foreign body ingestion, a clinical picture of gastrointestinal distress, and radiographic evidence of a radio-opaque foreign object.
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Affiliation(s)
- Stephen J Fenton
- Department of Surgery, University of Utah, Salt Lake City, UT 84132, USA.
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Brant-Zawadzki PB, Fenton SJ, Nichol PF, Matlak ME, Scaife ER. The split abdominal wall muscle flap repair for large congenital diaphragmatic hernias on extracorporeal membrane oxygenation. J Pediatr Surg 2007; 42:1047-50; discussion 1051. [PMID: 17560218 DOI: 10.1016/j.jpedsurg.2007.01.041] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Numerous techniques exist for repairing large congenital diaphragmatic hernias (CDHs) including prosthetic patches, tissue-engineered grafts, and various muscle flaps. A split abdominal wall muscle flap is a simple, durable way to repair a large diaphragmatic hernia. This technique has not gained widespread use, and some have suggested that it would be inappropriate in the setting of extracorporeal membrane oxygenation (ECMO) because of bleeding risk. We present our series of diaphragmatic hernias with a focus on those repaired with the split abdominal wall technique while on ECMO. METHODS A retrospective, single-institution chart review was performed on all patients who underwent surgical repair for CDH over 6 years beginning in August 2000. RESULTS Seventy-five patients underwent repair. Sixteen were performed with patients on ECMO. Of these, 4 were closed primarily, 7 used a prosthetic patch, and 5 used a split abdominal wall muscle flap. Two patients in the prosthetic group developed a recurrent hernia, and 2 required reoperation for bleeding while on ECMO. No reoperations for bleeding were required in the abdominal muscle flap group. CONCLUSIONS The split abdominal wall muscle flap can be safely performed on anticoagulated patients. We believe it is a practical option for repairing large CDHs.
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Abstract
BACKGROUND Temporary abdominal vacuum-packing (vac-pac) closure is well known in adult literature, yet has not been reported in infants. METHODS A review of children in the neonatal intensive care unit who underwent vac-pac closure from 2000 to 2006 was performed. RESULTS During this time, 7 infants underwent vac-pac closure after abdominal surgery. Median age was 39 days, with a median weight of 3.2 kg. Reasons for vac-pac included abdominal compartment syndrome (3), ongoing intraabdominal sepsis (1), anticipated second-look procedures (2), and abdominal observation after repair of congenital diaphragmatic hernia on extracorporeal membrane oxygenation (1). PaCO2 revealed a drop from a median preoperative level of 50.3 to 44.0 mm Hg postoperatively. Median preoperative urine output was 3.9 and 3.1 mL/(kg h) postoperatively. One patient died with an open abdomen from overwhelming Escherichia coli sepsis, and all surviving patients (85.7%) proceeded to definitive abdominal closure with the median time of vac-pac use being 4 days. CONCLUSION Vac-pac closure in infants is a safe and effective method of temporary abdominal closure. The detrimental effects of intraabdominal hypertension as well as risk of hemorrhage after repair of congenital diaphragmatic hernia while on extracorporeal membrane oxygenation also make this an important technique for abdominal observation.
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Affiliation(s)
- Stephen J Fenton
- Department of Surgery, University of Utah, Salt Lake City, UT 84132, USA
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Abstract
OBJECT Currently, no diagnostic or procedural standards exist for clearing the cervical spine in children after trauma. The establishment of protocols has been shown to reduce the time required to accomplish clearance and reduce the number of missed injuries. The purpose of this study was to determine if reeducation and initiation of a new protocol based on the National Emergency X-Radiography Utilization Study criteria could safely increase the number of pediatric cervical spines cleared by nonneurosurgical personnel. METHODS The authors collected and reviewed data regarding cervical spine clearance in children (age range 0-18 years) who presented to the emergency department at Primary Children's Medical Center in Salt Lake City, Utah, between 2001 and 2006 after sustaining significant trauma. Radiographic and clinical methods of clearing the cervical spine, as well as the type and management of injuries, were determined for two periods: Period I (January 2001-December 2003) and Period II (January 2004-February 2006). Between 2001 and 2003, 95% of 936 cervical spines were cleared by the neurosurgical service. Twenty-one ligamentous injuries (2.2%) and 12 fracture/dislocations (1.3%) were detected, and five patients (0.5%) required operative stabilization. Since January 2004, 585 (62.4%) of 937 cervical spines have been cleared by nonneurosurgical personnel. Twelve ligamentous injuries (1.3%) and 14 fracture/dislocations (1.5%) were identified, and four patients (0.4%) required operative stabilization. No late injuries were detected in either time period. CONCLUSIONS The protocol outlined in the paper has been effective in detecting cervical spine injuries in children after trauma and has increased the number of cervical spines cleared by nonneurosurgical personnel by nearly 60%. Reeducation with the establishment of protocols can safely facilitate clearance of the cervical spine after trauma by nonneurosurgical personnel.
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Affiliation(s)
- Richard C E Anderson
- Department of Neurosurgery, Children's Hospital of New York, Columbia University College of Physicians and Surgeons, New York, New York, USA.
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Abstract
The rare clinical scenario of an infant with group A streptococcal pancreatitis associated with toxic shock syndrome is reported. The presentation, evaluation, and management of this unusual clinical entity are discussed.
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Affiliation(s)
- Danielle Adams
- Department of Surgery, University of Utah, Salt Lake City, Utah 84132, USA
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Abstract
BACKGROUND Small children are vulnerable to serious accidents when a motor vehicle is placed in motion in a driveway. We describe a series of such accidents, consider the predisposing factors, and analyze the outcomes. METHODS We conducted a retrospective review of the trauma database of a large, level I, freestanding children's hospital with specific attention to driveway auto-pedestrian accidents. RESULTS During an 8-year period, 495 children were treated for injuries sustained in auto-pedestrian accidents, with 128 occurring in the driveway. The children's median age was 2.9 years, with 54% of the injuries sustained by boys. These often serious accidents carried an overall mortality rate of 6%. The most common injuries were abrasions, blunt head injury, and fractures. Chest trauma was associated with the highest mortality (11%), and both chest and abdominal trauma had the highest median Injury Severity Score of 13. Orthopedic injuries were the most common reason for operative intervention. Thirty-one percent of the children required intensive care unit monitoring, with their average unit stay being 3.9 days. Cars, trucks, and sports utility vehicles comprised 55%, 25%, and 12% of the accidents, respectively. Truck accidents carried the highest mortality rate (19%). Accidents were more likely to occur between 3:00 and 8:00 pm, between Thursday and Saturday, and between May and October. An increasing number of accidents occurred during the last 4 years of the study. CONCLUSIONS Driveway injuries are an underrecognized often severe form of auto-pedestrian accidents. To prevent these family tragedies, drivers of large vehicles with children younger than 12 years old should be extremely attentive and account for children outside the vehicle before moving.
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Affiliation(s)
- Stephen J Fenton
- Department of Surgery, University of Utah, Salt Lake City, UT 84132, USA
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41
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Abstract
Desmoid tumors are rare tumors accounting for only 0.03% of all neoplasms. Mainly occurring in the fourth and fifth decades of life, these tumors originate in musculoaponeurotic tissues of the limbs, neck, trunk, abdominal wall, and mesentery. We present a rare case of a chest wall desmoid tumor that was mistaken for breast cancer on both physical examination and mammography, which highlights the unique risk these tumors present for confusion with other malignant processes. Although past literature contains numerous reports of other misdiagnoses, this case is unique in reporting the potential for misdiagnosis between chest wall desmoid tumors and breast cancer. In cases where suspicious breast findings do not correlate to usual diagnostic measures, such as fine-needle aspiration or core needle biopsy, the possibility of another pathology such as a chest wall desmoid tumor mimicking breast cancer should be considered in the differential diagnosis.
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Affiliation(s)
- Alicia Privette
- Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah 84132, USA
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42
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Abstract
BACKGROUND Recent literature expresses concern for an increased risk of cancer in children exposed to low-dose radiation during computed tomography (CT). In response, children's hospitals have implemented the ALARA (as low as reasonably achievable) concept, but this is not true at most adult referring institutions. The purpose of this study was to assess the diagnostic necessity of CT in the evaluation of pediatric trauma patients. METHODS A retrospective review was conducted of the trauma database at a large, level I, freestanding children's hospital with specific attention to the pattern of CT evaluations. RESULTS From January 1999 to October 2003, 1,653 children with traumatic injuries were evaluated by the trauma team, with 1,422 patients undergoing 2,361 CT scans. Overall, 54% of obtained scans were interpreted as normal. Fifty percent of treated patients were transferred from referring hospitals. Approximately half arrived with previous CT scans with 9% of these requiring further imaging. Of the 897 patients that underwent abdominal CT imaging, only 2% were taken to the operating room for an exploratory laparotomy. In addition, of those patients who had abnormal findings on an abdominal CT scan, only 5% underwent surgical exploration. CONCLUSIONS CT scans are used with regularity in the initial evaluation of the pediatric trauma patient, and perhaps abdominal CT imaging is being used too frequently. A substantial number of these scans come from referral institutions that may not comply with ALARA. The purported risk of CT radiation questions whether a more selective approach to CT evaluation of the trauma patient should be considered.
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Affiliation(s)
- Stephen J Fenton
- Department of Pediatric Surgery, Primary Children's Medical Center, Salt Lake City, UT 84113, USA
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43
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Abstract
Health care providers must take the time to educate themselves about domestic violence, its signs and symptoms, and the proper care of victims of child, spouse, or elder abuse. It is not enough to treat the immediate injuries without offering necessary and appropriate intervention on behalf of the victim. No one deserves to be beaten, sexually abused, or emotionally mistreated. If abuse is suspected, report it to the proper authorities. By focusing attention on this major health problem, physicians can provide a leadership role in using health care response to reduce the incidence of abuse and, ultimately, to save lives.
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Affiliation(s)
- S J Fenton
- Department of Pediatric Dentistry and Community Oral Health, College of Dentistry, University of Tennessee, Memphis, USA
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Unkel JH, McKibben DH, Fenton SJ, Nazif MM, Moursi A, Schuit K. Comparison of odontogenic and nonodontogenic facial cellulitis in a pediatric hospital population. Pediatr Dent 1997; 19:476-9. [PMID: 9442541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Facial cellulitis in the pediatric hospital population can be classified as odontogenic and nonodontogenic. Emergency departments welcome timely diagnosis from consultants as cellulitis is associated with significant morbidity in children. The purpose of this retrospective study is to assist pediatric dentists in recognizing differences between odontogenic and nonodontogenic facial cellulitis and to determine whether odontogenic infections make up a major portion of facial swellings seen upon admission to the hospital. The completed medical records of 100 patients admitted to Children's Hospital of Pittsburgh from 1980-1989 with an ICD-9 diagnosis of facial cellulitis were reviewed. The types of cellulitis were differentiated using admission data. The information reviewed included age, sex, temperature, white blood cell count, location of facial infection, and season of the year. Odontogenic cellulitis comprised approximately 50% of the total hospital facial infections of the records reviewed during the 10-year period. Upon admission, patients with odontogenic and nonodontogenic facial cellulitis have similarities (season of onset during the year, febrile temperature, and location of infection) and differences (mean admission temperature, age at time of affliction, white blood cell count, and most commonly occurring microorganisms.
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Affiliation(s)
- J H Unkel
- Department of Pediatric Dentistry, University of Tennessee-Memphis, USA
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45
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Fenton SJ, Unkel JH. Viral infections of the oral mucosa in children: a clinical review. Pract Periodontics Aesthet Dent 1997; 9:683-90; quiz 692. [PMID: 9573839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The oral cavity is a microcosm of the world around us, exposed to a variety of microorganisms present in the local environment. Some of these microorganisms establish a permanent presence in the oral tissues, which serve as a suitable growth medium. These locations include soft and hard tissue, areas of high and low oxygen content, flowing secretions and dryness, and flat or grooved surfaces. Most of the normal oral flora does not cause disease; some even provide a protective benefit. However, occasionally one or more groups become pathologic, producing a disease that may have serious consequences for the host. Many of the pathologic microorganisms are viruses, and children are particularly prone to such infections, since their immune systems are still in the development stage. The learning objective of this article is to review the viral infections of the oral mucosa in children, including varicella, herpes zoster, mononucleosis, and herpangina.
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Affiliation(s)
- S J Fenton
- Department of Pediatric Dentistry, University of Tennessee/Memphis 38163, USA
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46
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Unkel JH, Nieusma GE, Todd MJ, Fenton SJ. Pediatric facial fistula. Pediatr Emerg Care 1997; 13:21-3. [PMID: 9061730 DOI: 10.1097/00006565-199702000-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- J H Unkel
- Department of Pediatric Dentistry, University of Tennessee College of Dentistry, Memphis 38263, USA
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Unkel JH, Fenton SJ, Hobbs G, Frere CL. Toothbrushing ability is related to age in children. ASDC J Dent Child 1995; 62:346-348. [PMID: 8550924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Methods to assess toothbrushing ability vary. The purpose of this study was to determine whether age could be a predictor for toothbrushing ability in children. This study evaluated the brushing patterns of 122 children utilizing the horizontal scrub technique. The results obtained suggest that a child's age is a reasonable predictor for toothbrushing ability.
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Affiliation(s)
- J H Unkel
- Department of Pediatric Dentistry, University of Tennessee, Memphis, USA
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48
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Tesini DA, Fenton SJ. Oral health needs of persons with physical or mental disabilities. Dent Clin North Am 1994; 38:483-98. [PMID: 7926199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Dentists who examine the needs of their patient population will recognize that the oral health concerns of persons with physical or mental disabilities demand more of their knowledge and skills than any other segment of their practice. To deliver quality, comprehensive care, the clinician must be updated on prevention and treatment techniques. A reference table in this article focuses on awareness of medical issues and oral conditions and the associations and interactions between them. Access to care for persons with disabilities is discussed also.
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Affiliation(s)
- D A Tesini
- Tufts University School of Dental Medicine, Boston, Massachusetts
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49
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Affiliation(s)
- S J Fenton
- Department of Pediatrics, West Virginia School of Dentistry
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50
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Abstract
Five cases of a chronic, self-limiting Candida albicans infection of the lip vermilion and juxtavermilion skin in young persons are presented. These infections typically appeared as erythematous, pruritic, yellow crusting plaques of the juxtavermilion skin, with or without desquamation of vermilion surfaces. Evidence of intraoral candidiasis, especially loss of filiform lingual papillae, was present in several cases. The disorder mimics the early stage of chronic mucocutaneous candidiasis but remains within a few millimeters of the mucocutaneous junction and affected individuals appear (with a possible exception) to be immune competent. Mild trauma apparently triggers the infection. The authors emphasize that a scientifically sound cause-and-effect relationship between this new disease and Candida albicans is not herein established and present these cases in the hope that others will thereby be identified and a firmer causal relationship be established.
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Affiliation(s)
- J E Bouquot
- Department of Oral Pathology, West Virginia University School of Dentistry, Morgantown 26506
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