Eliminating Use of Home Oral Antibiotics in Pediatric Complicated Appendicitis.

Background: Postoperative oral antibiotic management at discharge for perforated appendicitis varies by institution. A prior study at our institution led to a decrease in antibiotic therapy in patients without leukocytosis. A subsequent protocol change eliminated the white blood cell count check and oral antibiotics if discharge criteria were met by postoperative day seven.

Timing of enterostomy closure for neonatal isolated intestinal perforation.

Purpose: No consensus guidelines exist for timing of enterostomy closure in neonatal isolated intestinal perforation (IIP). This study evaluated neonates with IIP closed during the initial admission (A1) versus a separate admission (A2) comparing total length of stay and total hospital cost.

Methods: Using 2012 to 2017 Pediatric Health information System (PHIS) data, 359 neonates with IIP were identified who underwent enterostomy creation and enterostomy closure.

Container Surfaces Control Initiation of Cavitation and Resulting Particle Formation in Protein Formulations After Application of Mechanical Shock.

Mechanical shock may cause cavitation in vials containing liquid formulations of therapeutic proteins and generate protein aggregates and other particulates. To test whether common formulation components such as protein molecules, air bubbles, or polysorbate 20 (PS20) micelles might nucleate cavitation, a high-speed video camera was used to detect cavitation in vials containing antibody formulations after application of controlled mechanical shock using a shock test. Higher concentrations of subvisible particles were found in formulations where cavitation had occurred.

Suspected appendicitis pathway continues to lower CT rates in children two years after implementation.

Background: We implemented a protocol to evaluate pediatric patients with suspected appendicitis using ultrasound as the initial imaging modality. CT utilization rates and diagnostic accuracy were evaluated two years after pathway implementation.

Methods: This was a retrospective observational study of patients <18 years evaluated for suspected appendicitis.

Evaluation of white blood cell count at time of discharge is associated with limited oral antibiotic therapy in children with complicated appendicitis.

Background: Variation exists for postoperative antibiotics in children with complicated appendicitis. We investigated the impact of white blood count (WBC) at discharge on oral antibiotic therapy, abscess rate, and readmission rate.

Material/methods: We conducted a two year review of children with complicated appendicitis.

24-hour and 30-day perioperative mortality in pediatric surgery.

Purpose: The low perioperative mortality rate in pediatric surgery precludes effective analysis of mortality at individual institutions. Therefore, analysis of multi-institutional data is essential to determine any patterns of perioperative death in children. The aim of this study was to determine diagnoses associated with 24-hour and 30-day perioperative mortality.

Review of bedside surgeon-performed ultrasound in pediatric patients.

Purpose: Pediatric surgeon performed bedside ultrasound (PSPBUS) is a targeted examination that is diagnostic or therapeutic. The aim of this paper is to review literature involving PSPBUS.

Methods: PSPBUS practices reviewed in this paper include central venous catheter placement, physiologic assessment (volume status and echocardiography), hypertrophic pyloric stenosis diagnosis, appendicitis diagnosis, the Focused Assessment with Sonography for Trauma (FAST), thoracic evaluation, and soft tissue infection evaluation.

Optimizing peripheral venous pressure waveforms in an awake pediatric patient by decreasing signal interference.

The purpose of this technological notes paper is to describe our institution's experience collecting peripheral venous pressure (PVP) waveforms using a standard peripheral intravenous catheter in an awake pediatric patient. PVP waveforms were collected from patients with hypertrophic pyloric stenosis. PVP measurements were obtained prospectively at two time points during the hospitalization: admission to emergency department and after bolus in emergency department.

Pediatric vascular trauma practice patterns and resource availability: A survey of American College of Surgeon-designated pediatric trauma centers.

Background: Variation exists in pediatric vascular trauma management. We aim to determine practice patterns for vascular trauma management at American College of Surgeons verified pediatric trauma centers and evaluate the resources available for management of vascular trauma at both freestanding children's hospitals (FSCH) and pediatric hospitals within general adult hospitals.

Methods: Pediatric surgeons and trauma medical directors at American College of Surgeons designated pediatric surgery trauma centers completed a survey designed to evaluate anticipated management of traumatic arterial injuries and resource availability.

Sternocostal slipping rib syndrome.

Purpose: Classical slipping rib syndrome (SRS) can be subclassified based on anatomical location. We describe our experience with three patients suffering from symptomatic sternocostal slipping rib syndrome (SCSRS), a much less common variant of SRS.

Methods: This was a retrospective review of patients with SRS from 1988 to 2016.

Does timing of gastroschisis repair matter? A comparison using the ACS NSQIP pediatric database.

Background: There is no consensus on optimal timing of gastroschisis repair. The 2012-2014 ACS NSQIP Pediatric Participant Use Data File was used to compare outcomes of primary versus staged gastroschisis repair.

Methods: Cases were divided into primary repair (0-1day) and staged repair (4-14days).

Pediatric vascular injuries: Are we preparing trainees appropriately to meet our needs?

Background: There is no required competency for pediatric vascular injury in surgical training. We sought to describe changes over time for surgical specialists operating on pediatric vascular trauma injuries at a pediatric trauma center.

Methods: Charts were retrospectively reviewed for vascular trauma injuries at a freestanding children's hospital between 1993 and 2015.

Use of bedside abdominal ultrasound to confirm intestinal motility in neonates with gastroschisis: A feasibility study.

Background: Optimal timing to begin feeds in neonates with gastroschisis remains unclear. We examined if bedside abdominal ultrasound for intestinal motility is a feasible tool to detect return of bowel function in neonates with gastroschisis.

Methods: Neonates born with uncomplicated gastroschisis who underwent closure received daily ultrasound exams.

Optimal timing of appendectomy in the pediatric population.

Background: No consensus has been reached on optimal timing for performing appendectomies. We compared immediate and delayed appendectomies in pediatric patients presenting with suspected acute appendicitis to determine differences in postsurgical complications and perforation rates.

Methods: A retrospective cohort study was performed of all children who underwent appendectomy during a 4-y period.

A stitch in time saves nine: suture technique does not affect intestinal growth in a young, growing animal model.

Background: Although this issue remains unexamined, pediatric surgeons commonly use simple interrupted suture for bowel anastomosis, as it is thought to improve intestinal growth postoperatively compared to continuous running suture. However, effects on intestinal growth are unclear. We compared intestinal growth using different anastomotic techniques during the postoperative period in young rats.

Are Surgeons Being Paid Fairly by Medicaid? A National Comparison of Typical Payments for General Surgeons.

Background: Both the Medicare (MCR) and Medicaid (MCD) programs turn 50 this year. Medicare has developed a national resource-based payment methodology for physicians' services, with broad input by specialty societies, and MCD payments are set by individual states by various means.

Study Design: We have conducted the first national comparison of payment methodology of MCD vs MCR for procedures commonly delivered by general surgeons.

Implementation of the World Health Organization checklist and debriefing improves accuracy of surgical wound class documentation.

Background: Surgical wound classification (SWC) is a component of surgical site infection risk stratification. Studies have demonstrated that SWC is often incorrectly documented. This study examines the accuracy of SWC after implementation of a multifaceted plan targeted at accurate documentation.

Surgeon-performed bedside ultrasound to assess volume status: a feasibility study.

Purpose: Rapid assessment of volume status in children is often difficult. The purpose of this study was to evaluate the feasibility of surgeon-performed ultrasound to assess volume status in patients with hypertrophic pyloric stenosis.

Methods: Ultrasounds were performed on admission and before operation.

Surgeon-performed ultrasound: accurate, reproducible, and more efficient.

Purpose: A study previously performed at our institution demonstrated that surgeon-performed ultrasound (SPUS) was accurate compared to radiology department ultrasound (RDUS) when evaluating children with suspected appendicitis. The purpose of this study was to determine if these results were reproducible and if SPUS decreased time to definitive diagnosis.

Methods: A surgery resident performed examinations and ultrasounds on children with suspected appendicitis.

Surgeon as educator: bedside ultrasound in hypertrophic pyloric stenosis.

Objective: Our institution has demonstrated the diagnostic accuracy of surgeon-performed ultrasound (US) in the diagnosis of hypertrophic pyloric stenosis (HPS). Moreover, we have also shown this modality to be accurate and reproducible through surgeon-to-surgeon instruction. The purpose of this study was to determine whether a surgical resident with experience in diagnosing HPS can teach pediatric emergency medicine (PEM) fellows, with little experience in sonography, to accurately measure the pyloric channel with bedside US.

Persistent gastrocutaneous fistula: factors affecting the need for closure.

Purpose: The occurrence of gastrocutaneous fistula (GCF) is a well-known complication after gastrostomy tube placement. We explore multiple factors to ascertain their impact on the rate of persistent GCF formation.

Methods: We retrospectively reviewed patient records for all gastrostomies (GT) constructed at our institution from 2007 to 2011.

Traumatic carotid-cavernous fistula presenting as massive epistaxis.

Carotid-cavernous sinus fistulae (CCF) are a rare complication with the potential for great morbidity including intracranial hemorrhage, blindness, cranial nerve palsy and stroke. Traumatic CCF are the most common type of CCF. Here we discuss a patient who sustained blunt head trauma and had substantial epistaxis, requiring massive transfusion, intraoperatively due to unrecognized CCF.

Restraint status improves the predictive value of motor vehicle crash criteria for pediatric trauma team activation.

Background: Most trauma centers incorporate mechanistic criteria (MC) into their algorithm for trauma team activation (TTA). We hypothesized that characteristics of the crash are less reliable than restraint status in predicting significant injury and the need for TTA.

Methods: We identified 271 patients (age, <15 y) admitted with a diagnosis of motor vehicle crash.

An animal model of necrotizing enterocolitis (NEC) in preterm rabbits.

Creation of an animal model of necrotizing enterocolitis (NEC) allowing adjustment of severity and potential recoverability is needed to study effectiveness of prevention and treatment strategies. This study describes a novel model in preterm rabbits capable of adjusting severity of NEC-like histologic changes. Rabbit pups (n = 151) were delivered by cesarean section 2 days preterm.

Repair of esophageal atresia with tracheoesophageal fistula via thoracotomy: a contemporary series.

Background: A recent series detailing thoracoscopic repair of esophageal atresia with tracheoesophageal fistula (EA/TEF) reported lower complication rates compared with historic controls. This study provides a contemporary cohort of patients repaired via thoracotomy for comparison with the recent large multi-institutional thoracoscopic series.

Methods: Records of patients with EA/TEF between 1993 and 2008 were reviewed.