Pediatric trauma mortality in India and the United States: A comparison and risk-adjusted analysis.

Background: There is a paucity of research comparing pediatric risk-adjusted trauma mortality between high-income and low- and middle-income countries. This limits identification of populations and injury patterns for targeted interventions. We aim to compare independent predictors of pediatric trauma mortality between India and the United States (US).

Delayed Presentation of Meconium Ileus in an Infant With Cystic Fibrosis.

Although infants with meconium ileus usually present with apparent symptoms shortly after birth, the diagnosis of meconium ileus and cystic fibrosis (CF) may be delayed, awaiting newborn screening (NBS) results. We present the case of an 11-day-old term girl with delayed passage of meconium at 48 hours who had 2 subsequent small meconium stools over the following week. There was a normal feeding history and no signs of abdominal distension or distress.

Management of Isolated Skull Fractures in Pediatric Patients: A Systematic Review.

Objectives: Isolated skull fractures (ISFs) in children are one of the most common emergency department injuries. Recent studies suggest these children may be safely discharged following ED evaluation with little risk of delayed neurological compromise. The aim of this study was to propose an evidence-based protocol for the management of ISF in children in an effort to reduce medically unnecessary hospital admissions.

The certifying examination of the american board of surgery: the effect of improving communication and professional competency: twenty-year results.

Purpose: In 1985, a small research group identified variables affecting applicant success on the oral Certifying Examination (CE) of the American Board of Surgery (ABS). This led to the design of an oral examination course first taught in 1991. The success of and need for this program led to its continuation.

Angiographic embolization is safe and effective therapy for blunt abdominal solid organ injury in children.

Background: : Angiographic embolization (AE) is used to control hemorrhage in adult blunt liver, spleen, and kidney (ASO) injuries. Pediatric experience with AE for blunt ASO injuries is limited. We reviewed our use of AE to control bleeding pediatric blunt ASO injuries for efficacy and safety.

Implementation of resident work hour restrictions is associated with a reduction in mortality and provider-related complications on the surgical service: a concurrent analysis of 14,610 patients.

Objective: To determine the effect of implementation of work hour restrictions on the rates of morbidity, mortality, and provider-related complications in surgical patients and to determine the incremental personnel costs associated with implementation.

Summary Background Data: In 2003, the Accreditation Council for Graduate Medical Education enacted resident work hour restrictions (RWHR) to improve patient safety by decreasing errors attributed to resident fatigue. There are no quantitative data on surgical patients to validate whether this objective has been achieved and, if so, at what cost.

Blunt pancreatoduodenal injury: a multicenter study of the Research Consortium of New England Centers for Trauma (ReCONECT).

Objectives: To evaluate the safety of nonoperative management (NOM), to examine the diagnostic sensitivity of computed tomography (CT), and to identify missed diagnoses and related outcomes in patients with blunt pancreatoduodenal injury (BPDI).

Design: Retrospective multicenter study.

Setting: Eleven New England trauma centers (7 academic and 4 nonacademic).

Initial resection of potentially viable tissue is not optimal treatment for grades II-IV pancreatic injuries.

Purpose: This study was designed to ascertain the optimal therapy and diagnostics for children with pancreatic injury.

Methods: From January 1, 2001 to January 1, 2007, all children (newborn to 17 years) who presented to this Level I trauma center with demonstrated pancreatic injury were prospectively entered into the TRACS IV system and reviewed for injury type, diagnostics, therapy, demographics, and outcome.

Results: Fourteen children sustained grade II or higher pancreatic injury during this period.

Effects of differences in percent total body surface area estimation on fluid resuscitation of transferred burn patients.

We sought to analyze the effect that differences in estimation of burn size and burn resuscitation had on complications and death among our transferred burn patients, in comparison with outcomes for burn patients directly admitted to our rural Level 1 trauma center. A retrospective chart review was performed for all patients suffering thermal injuries who were treated at a rural Level I trauma center and regional burn center. Percent TBSA burn estimates at referring hospitals were compared to burn center estimates.

Use of vena cava filters in pediatric trauma patients: data from the National Trauma Data Bank.

Background: Placement of vena cava filters (VCFs) in high-risk adult trauma patients is a well-described intervention for prophylaxis against pulmonary embolism (PE). Few data exist regarding the use of VCFs in pediatric trauma.

Methods: We performed a cross-sectional study using the National Trauma Data Bank of the American College of Surgeons.

The safety and efficacy of spinal anesthesia for surgery in infants: the Vermont Infant Spinal Registry.

Studies with modest numbers of patients have suggested that spinal anesthesia in infants is associated with a very infrequent incidence of complications, such as hypoxemia, bradycardia, and postoperative apnea. Although spinal anesthesia would seem to be a logical alternative to general anesthesia for many surgical procedures, it remains an underutilized technique. Since 1978, clinical data concerning all infants undergoing spinal anesthesia at the University of Vermont have been prospectively recorded.

Workload redistribution: a new approach to the 80-hour workweek.

Background: The new Accreditation Council for Graduate Medical Education-mandated 80-hour resident work week has resulted in busy trauma services struggling to meet these strict guidelines, or face loss of accreditation.

Methods: Beginning in July 2003, our Level I trauma service began a policy of direct admission of isolated neurosurgical or orthopedic injuries to the specific subspecialty service after complete evaluation by the trauma service in the emergency department for associated injuries. Complications, missed injuries, delayed diagnoses, and admission rates were compared in two 6-month periods: PRE, before the policy change; and POST, after the new policy had been instituted.

The diagnosis and management of children with blunt injury of the chest.

Thoracic trauma remains a major source of morbidity and mortality in injured children, and is second only to brain injuries as a cause of death. The presence of a chest injury increases an injured child's mortality by 20-fold. Greater than 80% of chest injuries in children are secondary to blunt trauma.

Functional outcome of nonoperatively managed renal injuries in children.

Background: This study aimed to define better the functional outcome of nonoperatively managed renal injuries in children.

Methods: All children who had blunt renal trauma managed nonoperatively were reviewed for injury grade, blood urea nitrogen (BUN), creatinine, blood pressure, and percentage of function according to technetium-99m-dimercaptosuccinic acid renal scan after complete healing.

Results: Over a 2-year period, 17 children (mean age, 10.