Child physical abuse and COVID-19: Trends from nine pediatric trauma centers.

Background: Economic, social, and psychologic stressors are associated with an increased risk for abusive injuries in children. Prolonged physical proximity between adults and children under conditions of severe external stress, such as witnessed during the COVID-19 pandemic with "shelter-in-place orders", may be associated with additional increased risk for child physical abuse. We hypothesized that child physical abuse rates and associated severity of injury would increase during the early months of the pandemic as compared to the prior benchmark period.

Adrenocortical tumors in children.

Adrenocortical neoplasms are rare in childhood. Unlike their adult counterparts, they are often hormonally active and malignant. Despite being uncommon, adrenocortical neoplasms in children have significant associated morbidity and require complete surgical resection for effective management.

Report of 52nd annual meeting of the pacific association of pediatric surgeons.

This is the report of the 52nd Annual Association of Pediatric Surgeons held in Christchurch, New Zealand, March 10-March 14, 2019.

Use of ECMO support in pediatric patients with severe thoracic trauma.

Background: Extracorporeal membrane oxygenation (ECMO) has been used in the non-trauma setting for over 30 years. However, the use of ECMO in trauma remains a difficult question, as the risk of bleeding must be weighed against the benefits of cardiopulmonary support.

Methods: Retrospective review of children who sustained severe thoracic trauma (chest abbreviated injury score ≥3) and required ECMO support between 2009 and 2016.

Longboard injuries treated at a level 1 pediatric trauma center.

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.

Report of PAPS meeting.

This is a report of the Pacific Association of Pediatric Surgeons Fifty-First Scientific Meeting held in Sapporo, Japan, from May 13to May 17, 2018.

Reduction of resource utilization in children with blunt solid organ injury.

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.

Surgical outcomes of pancreaticoduodenal injuries in children.

Purpose: To examine surgical outcomes of children with pancreaticoduodenal injuries at a Quaternary Level I pediatric trauma center.

Methods: We queried a prospectively maintained trauma database of a level one pediatric trauma center for all cases of pancreatic and/or duodenal injury from 2002 to 2017. Analysis was conducted using JMP 13.

Longitudinal analysis of hospital charges following injury in a level 1 pediatric trauma system.

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.

Clearance of tunneled central venous catheter associated blood stream infections in children.

Background: The optimal time to reinsert central venous catheters (tCVC) after a documented central line associated blood stream infection (CLABSI) is unclear. The goal of this study is to identify risk factors for children who develop persistent bacteremia after tCVC removal due to CLABSI.

Methods: We performed a retrospective cohort study from a tertiary children's hospital.

Helmet under-utilization by children during equestrian events is associated with increased traumatic brain injury.

Purpose: Awareness of equestrian related injury remains limited. Studies evaluating children after equestrian injury report under-utilization of safety equipment and rates of operative intervention as high as 33%.

Methods: We hypothesized that helmets are underutilized during equestrian activity and lack of use is associated with increased traumatic brain injury.

A case of Cushing ulcer in an 8-month-old patient with medulloblastoma.

The authors present the first case of a Cushing ulcer in an infant with medulloblastoma who, despite being administered stress ulcer prophylaxis, worsened after corticosteroids were initiated. An 8-month-old boy presented with progressive vomiting, lethargy, and decreased oral intake. Imaging revealed a heterogeneous fourth ventricular mass.

The use of angiography in pediatric blunt abdominal trauma patients.

Background: Angiography is a common treatment used in adults with blunt abdominal trauma and/or severe pelvic fractures. The Committee on Trauma of the American College of Surgeons has recently advocated for this resource to be urgently available at pediatric trauma centers; however, its usefulness in the pediatric setting is unclear. The purpose of this study was to determine the incidence of angiography in the treatment of blunt abdominal trauma among injured children.

Preventable transfers in pediatric trauma: A 10-year experience at a level I pediatric trauma center.

Background: Injured children are often treated at one facility then transferred to another that specializes in pediatric trauma care. The purpose of this study was to identify and characterize potentially preventable transfers (PT) to a freestanding level-I pediatric trauma center.

Methods: Children with traumatic injuries transferred between 2003 and 2013 were retrospectively analyzed.

One hospital, one appendectomy: The cost effectiveness of a standardized doctor's preference card.

Purpose: Appendicitis in children provides a unique opportunity to explore changes that reduce variation, reduce cost, and improve value. In this study we sought to evaluate the effectiveness of standardization of surgical technique and intraoperative disposable device utilization for laparoscopic appendectomy among all surgeons at a tertiary children's hospital.

Methods: All 6 surgeons at our tertiary children's hospital agreed to standardize to a single technique of performing a laparoscopic appendectomy.

Cervical spine imaging in hospitalized children with traumatic brain injury.

Objectives: The purposes of this study, in children with traumatic brain injury (TBI), to describe cervical spine imaging practice, to assess for recent changes in imaging practice, and to determine whether cervical spine computed tomography (CT) is being used in children at low risk for cervical spine injury.

Methods: The setting was children's hospitals participating in the Pediatric Health Information System database, from January 2001 to June 2011. Participants were children (younger than 18 y) with TBI who were evaluated in the emergency department, admitted to the hospital, and received a head CT scan on the day of admission.

Effectiveness of an organized bowel management program in the management of severe chronic constipation in children.

Background: Chronic constipation is a common problem in children. The cause of constipation is often idiopathic, when no anatomic or physiologic etiology can be identified. In severe cases, low dose laxatives, stool softeners and small volume enemas are ineffective.

Helicopter versus ground emergency medical services for the transportation of traumatically injured children.

Background: Helicopter emergency medical services (HEMS) are a common mode of transportation for pediatric trauma patients. We hypothesized that HEMS improve outcomes for traumatically injured children compared to ground emergency medical services (GEMS).

Methods: We queried trauma registries of two level 1 pediatric trauma centers for children 0-17 years, treated from 2003 to 2013, transported by HEMS or GEMS, with known transport starting location and outcome.

A dynamic postoperative protocol provides efficient care for pediatric patients with non-ruptured appendicitis.

Purpose: Postoperative management of pediatric patients with non-ruptured appendicitis is highly variable and often includes an overnight stay in the hospital. We implemented a criteria-based postoperative protocol designed to eliminate postoperative antibiotics and facilitate timely discharge by utilizing the bedside nurse to evaluate for readiness for discharge.

Methods: We collected data on all patients with non-ruptured appendicitis at our institution following protocol implementation (May 1, 2012 to April 30, 2013) and compared them to a control group.

Impact of newly adopted guidelines for management of children with isolated skull fracture.

Purpose: In an effort to standardize practices and reduce unnecessary hospital resource utilization, we implemented guidelines for management of patients with isolated skull fractures (ISF). We sought to examine the impact of these guidelines.

Methods: Patients with nondisplaced/depressed fracture of the skull vault without intracranial hemorrhage were prospectively enrolled from February 2010 to February 2014.

The role of screening and prophylactic surgery for malrotation in heterotaxy patients.

Purpose: There are no standardized guidelines for screening or management of malrotation in Heterotaxy Syndrome (HS). We sought to review our experience to determine if evidenced based guidelines could be drafted.

Methods: A retrospective chart review was performed at our freestanding children's hospital on all patients under one year of age undergoing a Ladd procedure between 2000 and 2011.

Response-based therapy for ruptured appendicitis reduces resource utilization.

Purpose: We examined the effectiveness of a postoperative ruptured appendicitis protocol that eliminated Pseudomonas coverage and based the duration of IV antibiotic treatment and length of hospital stay on the patient's clinical response.

Methods: In our new protocol, IV antibiotics were administered until the patient met discharge criteria: adequate oral intake, pain control with oral medications, and afebrile for 24h. We collected data on all patients with ruptured appendicitis at our institution following protocol implementation (May 1, 2012, to April 30, 2013) and compared them to a control group.

Charge Awareness Affects Treatment Choice: Prospective Randomized Trial in Pediatric Appendectomy.

Objective: To determine whether charge awareness affects patient decisions.

Background: Pediatric uncomplicated appendicitis can be treated with open or laparoscopic techniques. These 2 operations are considered to have clinical equipoise.

Magnamosis: a novel technique for the management of rectal atresia.

We report a case of rectal atresia treated using magnets to create a rectal anastomosis. This minimally invasive technique is straightforward and effective for the treatment of rectal atresia in children.