Subacute haemorrhagic acalculous cholecystitis after blunt trauma in a patient on anticoagulant therapy.

Haemorrhagic cholecystitis is an uncommon cause of abdominal pain that can lead to significant morbidity and mortality if not promptly identified and treated. Known risk factors include trauma, anticoagulation use and cholelithiasis. In a patient with right upper quadrant pain after blunt trauma on anticoagulation without cholelithiasis, haemorrhagic acalculous cholecystitis should be considered in the differential diagnosis, as appeared to be the case in the patient we present here.

Potassium Chloride-Induced Phlebitis via a Malpositioned Central Venous Catheter.

We present a case of potassium chloride-induced phlebitis with severe, burning, left-sided chest pain when infused via a malpositioned central venous catheter. Using a malpositioned central venous catheter requires careful consideration, but this novel case prompts the need for additional review before its use for the infusion of potentially irritating medications.

Quality improvement methodology can reduce hospitalisation for abscess management.

Background: Abscesses are a common reason for ED visits. While many are drained in the ED, some require drainage in the operating room (OR). We observed that a higher percentage of patients at our institution in Columbus, Ohio, were admitted to the hospital with abscesses for incision and drainage (I&D) in the OR than other institutions, including paediatric institutions.

Improving care through standardized treatment of spontaneous pneumothorax.

Purpose: The objective of this quality improvement (QI) initiative was to implement a standardized clinical treatment protocol for patients presenting with primary spontaneous pneumothorax (PSP) in order to decrease hospital length of stay (LOS), diagnostic radiation exposure, and related cost.

Methods: Baseline data from patients admitted with PSP from January 1, 2016 to July 31, 2018 were compared to data from patients managed using a newly developed evidence-based treatment pathway from August 1, 2018 to December 31, 2019. Standard QI methodology was used to track results.

The pediatric surgery match by the numbers: Defining the successful application.

Background: Pediatric surgery remains the most competitive general surgery subspecialty. The authors suspected significant inflation in academic metrics since the last published paper. This study aimed to identify factors associated with applicant success in the match.

Pediatric blunt cerebrovascular injuries: A national trauma database study.

Background: The incidence of blunt cerebrovascular injuries (BCVIs) in children is unknown. We aimed to determine the rate and consequences of BCVIs in pediatric blunt trauma patients.

Methods: We queried the National Trauma Data Bank (NTDB) for all blunt trauma patients between 2007 and 2014.

Volume of Irrigation Does Not Affect Rate of Abscess in Perforated Appendicitis.

Although previous studies have evaluated whether use of irrigation decreases postoperative intraabdominal abscess (PO-IAA) formation, these studies treated irrigation as a dichotomous variable and concluded that no irrigation resulted in a decreased incidence of PO-IAA formation. However, a recent study found decreased incidence with small aliquots to a total volume of 6 L. We hypothesized that higher volumes of irrigation would result in a lower incidence of PO-IAA.

Use of a Gastroschisis Feeding Guideline to Improve Standardization of Care and Patient Outcomes at an Urban Children's Hospital.

Background: This study examined clinical outcomes associated with the use of a gastroschisis-specific (GS) feeding advancement guideline.

Methods: We performed a retrospective study of all simple gastroschisis babies (N = 65) treated between June 2009June 2015. We compared patients treated on a postintestinal surgery guideline using either a 1-day (1D) or 3-day (3D) feeding advancement from August 2009-August 2013 with infants treated on a GS guideline from September 2013-June 2015.

The utility of presacral drainage in penetrating rectal injuries in adult and pediatric patients.

Background: With changing weaponry associated with injuries in civilian trauma, there is no clinical census on the utility of presacral drainage (PSD) in penetrating rectal injuries (PRIs), particularly in pediatric patients.

Methods: Patients with PRI from July 2004-June 2014 treated at two free-standing children's hospitals and two adult level 1 trauma centers were compared by age (pediatric patients ≤16 years) and PSD. A stratified analysis was performed based on age.

Acute procedural interventions after pediatric blunt abdominal trauma: A prospective multicenter evaluation.

Background: Pediatric intra-abdominal injuries (IAI) from blunt abdominal trauma (BAT) rarely require emergent intervention. For those children undergoing procedural intervention, our aim was to understand the timing and indications for operation and angiographic embolization.

Methods: We prospectively enrolled children younger than 16 years after BAT at 14 Level I Pediatric Trauma Centers over a 1-year period.

Focused assessment with sonography for trauma in children after blunt abdominal trauma: A multi-institutional analysis.

Introduction: The utility of focused assessment with sonography for trauma (FAST) in children is poorly defined with considerable practice variation. Our purpose was to investigate the role of FAST for intra-abdominal injury (IAI) and IAI requiring acute intervention (IAI-I) in children after blunt abdominal trauma (BAT).

Methods: We prospectively enrolled children younger than 16 years after BAT at 14 Level I pediatric trauma centers over a 1-year period.

Health Disparities in the Appropriate Management of Cryptorchidism.

Objective: To assess regional practices in management of cryptorchidism with regard to timely fixation by the current recommended age of 18 months.

Study Design: A retrospective study was performed. Charts of all patients who underwent surgical correction for cryptorchidism by a pediatric general surgeon or urologist within a tertiary pediatric hospital in an urban setting were systematically reviewed.

Age at presentation and management of pediatric intussusception: A Pediatric Health Information System database study.

Background: Intussusception is uncommon in children older than 3 years, and use of enema reduction in older children is controversial. We sought to determine whether older children are at greater risk of requiring operative intervention and/or having pathology causing lead points, such that enema reduction should not be attempted.

Methods: The Pediatric Health Information System database was reviewed from January 1, 2009-June 30, 2014.

Health disparities in infants with hypertrophic pyloric stenosis.

Background: This study investigates whether health disparities exist in infants with hypertrophic pyloric stenosis (HPS), to identify factors affecting definitive treatment, and if more morbidity occurs.

Methods: A 6-year retrospective analysis was performed on infants with HPS. Analysis of variance was used to evaluate the impact of socioeconomic factors on disease severity and hospitalization.

Real-time ultrasonography for placement of central venous catheters in children: A multi-institutional study.

Background: Recommendations for the use of real-time ultrasonography for placement of central venous catheters in children are based on studies involving adults treated by nonsurgeons. Our purpose was to determine the frequency of use of real-time ultrasonography use by pediatric surgeons during central venous catheter placement, patient and procedure factors associated with real-time ultrasonography use, and adverse event rates.

Methods: Using data gathered from 14 institutions, we performed a retrospective cohort study of patients <18 years old who underwent central venous catheter placement.

Standardization of Feeding Advancement After Neonatal Gastrointestinal Surgery: Does It Improve Outcomes?

Background: Postabdominal intestinal surgery (PAIS) infants pose many complex management issues. Utilization of feeding guidelines has been shown to improve outcomes in preterm and low-birth-weight infants. We propose that standardization of feeding for PAIS infants is safe.

Improving gastroschisis outcomes: does birth place matter?

Purpose: Babies born in the hospital where they obtain definitive surgical care do not require transportation between institutions and may have shorter time to surgical intervention. Whether these differences result in meaningful improvement in outcomes has been debated. A multi-institutional retrospective study was performed comparing outcomes based on birthplace.