Journal of pediatric surgery最新文献

{"title":"Gender Differences in Electronic Health Record Inbox Message Volumes Among Pediatric Surgeon Specialists","authors":"Darren Ha ,&nbsp;Nicole Russell ,&nbsp;Kaitlin E. Olson ,&nbsp;Gina M. Whitney ,&nbsp;Ann M. Kulungowski ,&nbsp;Emily McCourt ,&nbsp;Kyle O. Rove","doi":"10.1016/j.jpedsurg.2025.162191","DOIUrl":"10.1016/j.jpedsurg.2025.162191","url":null,"abstract":"<div><h3>Background</h3><div>Prior studies examined the relationship between physician sex and electronic health records (EHR) utilization patterns to assess for provider gender equity, although this has not been explored among pediatric surgical subspecialists. We hypothesized that female surgeons received more inbox messages and had longer message lengths compared to male surgeons.</div></div><div><h3>Methods</h3><div>Surgeons who performed at least five surgical procedures at a free-standing children's hospital between January 2021 and December 2022 were stratified based on sex. EHR utilization data were retrospectively extracted. Message types were restricted to those from patients, health care team members, or results, opting to omit other automated messages from the EHR that were not initiated by a person. Primary outcomes were number of inbox messages received adjusting for the volume of surgical cases performed and message length. Univariate and multivariate analyses were performed to identify outcome predictors.</div></div><div><h3>Results</h3><div>41 female and 79 male surgeons were included in the final analysis. There was a median of 693 messages received by surgeons over the study period (median of 1.8 messages per surgeon per case). Male surgeons tended to be further out from training but there were no significant differences in terms of surgical case count or characteristics. Surgeon sex was a significant predictor of inbox message count in univariate analysis (incidence rate ratio 1.58 favoring female surgeons, p = 0.03), but not in multivariate analysis, after correcting for case complexity. Surgeon sex was not a significant predictor of message length in either univariate or multivariate analysis.</div></div><div><h3>Conclusion</h3><div>Surgeon sex was not a significant predictor of inbox message count or message length among a cohort of pediatric surgical subspecialists. Ensuring gender equity with respect to EHR activities reaffirms our commitment to avoiding bias.</div></div><div><h3>Level of evidence</h3><div>III.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 4","pages":"Article 162191"},"PeriodicalIF":2.4,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143154291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laser Hair Removal May Be a Primary Treatment of Pilonidal Disease: A Pilot Study","authors":"Kevin C. Janek ,&nbsp;Meaghan Kenfield ,&nbsp;Linda C. Stafford ,&nbsp;Lily Stalter ,&nbsp;Evie Carchman ,&nbsp;Charles M. Leys ,&nbsp;Peter Nichol ,&nbsp;Adam Brinkman ,&nbsp;Lisa M. Arkin ,&nbsp;Hau D. Le","doi":"10.1016/j.jpedsurg.2025.162182","DOIUrl":"10.1016/j.jpedsurg.2025.162182","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Pilonidal disease is a chronic skin disorder of the gluteal cleft in adolescents and young adults. No treatment is universally effective, and the heterogeneity of the disease and variability in treatment response frustrates patients and clinicians alike. Surgical treatment strategies focus on the removal of the sinus tracts. Post-operative laser hair removal (LHR) has demonstrated promise to reduce disease recurrence following surgery. LHR has yet to be investigated as a primary treatment strategy and may offer additional benefits.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A single-center prospective pilot study investigated laser hair removal as the primary treatment for moderate to severe pilonidal disease. Patients ages 13–35 with moderate to severe disease who were referred for surgical excision were recruited. Participants underwent 3–8 treatment sessions with the long-pulsed--Alexandrite (755 nm) laser by a dermatologist until hair removal endpoints were met. Patients with persistent symptoms after LHR underwent subsequent excision. Patients were subsequently followed in the pediatric surgery clinic at 6, 9, 12 and 18 months following LHR to evaluate for disease recurrence. Primary outcomes included resolution rates without surgical intervention and recurrence rates following surgical resection. Secondary outcomes included the number of episodes of infection and impact on quality of life, as assessed by the Dermatology Life Quality Index (DLQI) in patients ≥16 years of age, and the Children's Dermatology Life Quality Index (CDLQI) in patients &lt;16 years of age.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Twenty-two patients were enrolled, of which 18 were initiated and 15 completed the LHR sessions in the study, designed to the endpoint of the absence of terminal hair in the gluteal cleft. One patient withdrew prior to completion of the LHR sessions, and two withdrew from the study due to the COVID-19 pandemic. Of the 15 patients who completed the LHR sessions, all demonstrated significant improvement in hair follicle density in the treatment area, with no adverse events. Median number of laser treatments was 6. Six of 15 (40 %) who completed laser treatments had resolution without surgical intervention. Nine patients underwent surgery, of which 6 (67 %) resolved after one surgery, with 18 months of follow up to evaluate for recurrence. Quality of life scores improved after laser treatments (DLQI mean change −4.6, and Children's DLQI mean change −6.0)&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;Laser hair removal was well tolerated, without adverse events and with improved quality of life, in a patient population with moderate to severe pilonidal disease. Nearly half of patients had disease resolution without the need for surgical intervention. These findings underscore the potential for laser hair removal to improve disease outcomes in pilonidal disease, reducing the need for surgical intervention. Based on these results, ","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 4","pages":"Article 162182"},"PeriodicalIF":2.4,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful Treatment of Early Presenting Intussusception With a Single Dose of Corticosteroid: A Prospective Randomized Controlled Trial","authors":"Tuğba Acer-Demir ,&nbsp;Ayşe Gültekingil ,&nbsp;Ender Fakıoğlu ,&nbsp;Lütfi Hakan Güney ,&nbsp;Rahime Sezer","doi":"10.1016/j.jpedsurg.2025.162198","DOIUrl":"10.1016/j.jpedsurg.2025.162198","url":null,"abstract":"<div><h3>Introduction</h3><div>To evaluate and compare the success rates of follow-up versus a single dose of corticosteroid (methylprednisolone) treatment in early-diagnosed intussusception cases to achieve resolution without the need for hydrostatic or pneumatic reduction and surgery.</div></div><div><h3>Methods</h3><div>This study was conducted as a prospective randomized controlled trial. Patients aged 0–4 years, admitted to the Pediatric Emergency Department with a history of symptoms less than 24 h diagnosed with intussusception by ultrasound were randomly assigned to two groups. The treatment group received a single intravenous dose of 1 mg/kg methylprednisolone, while the control group was followed without medication. Follow-up ultrasound was performed at a median of 4 h.</div></div><div><h3>Results</h3><div>The study included 60 patients in the steroid treatment group and 32 patients in the control group, with male-to-female ratio of 47:45 and a mean age of 28.3 ± 12.0 months. Ileoileal intussusceptions were more common in the control group (19/32, 59.4 %), while ileocolic intussusceptions were more frequent in the treatment group (22/60, 36.7 %) (<em>p</em> = 0.023). Steroid treatment was successful in 49 of 60 cases (81.7 %), whereas follow-up was successful in 18 of 32 cases (56.3 %). Overall, steroid treatment was significantly more successful (<em>p</em> = 0.009). For ileocolic intussusceptions, steroid treatment was successful in 17 of 22 cases (77.3 %), compared to 2 of 9 cases (22.2 %) in the control group (<em>p</em> = 0.012).</div></div><div><h3>Conclusions</h3><div>Single-dose steroid treatment is particularly effective for ileocolic intussusceptions presenting within 24 h. Steroid treatment may also be considered for unresolved ileoileal intussusception cases after initial follow-up.</div><div>The clinical trial registration number is NCT05640375 (<span><span>clinicaltrials.gov</span><svg><path></path></svg></span>).</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 4","pages":"Article 162198"},"PeriodicalIF":2.4,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143153479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Educational Outcomes in School-Aged Children With a History of Simple and Complex Gastroschisis are Poor Compared to Controls","authors":"Osamuyi Asemota ,&nbsp;Gabrielle Derraugh ,&nbsp;Matthew Levesque ,&nbsp;Anna C. Shawyer ,&nbsp;Suyin A. Lum Min ,&nbsp;Richard Keijzer","doi":"10.1016/j.jpedsurg.2025.162193","DOIUrl":"10.1016/j.jpedsurg.2025.162193","url":null,"abstract":"<div><h3>Background</h3><div>Research on long-term cognitive outcomes of children with gastroschisis is limited and inconsistent. This study aimed to compare the educational outcomes of children with gastroschisis to age-matched controls using a population-based repository of educational data.</div></div><div><h3>Methods</h3><div>We performed a retrospective study of all children born with gastroschisis between 1991 and 2022. We compared the educational outcomes of children with simple and complex gastroschisis to date-of-birth matched controls using the: Early Development Instrument (EDI) and Grades 3, 7, and 8 assessments. We used odds ratio (OR) to compare the likelihood of children with gastroschisis failing an assessment compared to controls. We did subgroup analyses for simple and complex gastroschisis cases.</div></div><div><h3>Results</h3><div>A total of 208 gastroschisis cases and 2075 controls were included. There were 136 children with simple gastroschisis and 72 children with complex gastroschisis. Children with gastroschisis were more likely to fail a middle school assessment than controls (OR = 2.93, 95%CI = 1.73, 5.09). Even children with simple gastroschisis were more likely to fail a middle school assessment (OR = 2.66, 95%CI = 1.42, 5.13). Moreover, children with severe gastroschisis were at even greater odds of failing a middle school assessment than controls (OR = 4.57, 95%CI = 1.71, 13.60).</div></div><div><h3>Conclusion</h3><div>The academic performance of children born with gastroschisis, both simple and complex, is inferior to age-matched controls in middle school. Caregivers should be aware of the ongoing challenges that children born with gastroschisis face and seek early support.</div></div><div><h3>Level of evidence</h3><div>Prognostic, level III.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 4","pages":"Article 162193"},"PeriodicalIF":2.4,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143153478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Versus Late Enteral Nutrition in the Pediatric Critically-Ill Trauma Patient: A Retrospective Cohort Study","authors":"Eduardo Fastag ,&nbsp;Jhoanne Cana ,&nbsp;Salem Dehom ,&nbsp;Donald C. Moores ,&nbsp;Mona S. Guglielmo ,&nbsp;Cynthia H. Tinsley ,&nbsp;Harsha K. Chandnani","doi":"10.1016/j.jpedsurg.2025.162189","DOIUrl":"10.1016/j.jpedsurg.2025.162189","url":null,"abstract":"<div><h3>Objectives</h3><div>To determine the effect of early (within 48 h of admission) enteral nutrition on length of stay (LOS) and number of ventilator days in the pediatric intensive care unit (PICU) and identify associated barriers to initiation of enteral nutrition.</div></div><div><h3>Methods</h3><div>A retrospective cohort study at a level 1 pediatric trauma center with a tertiary care PICU including all patients &lt;18 years of age admitted with traumatic injuries, classified into an early enteral nutrition group vs. late enteral nutrition (&gt;48 h from admission). Primary outcomes of PICU and Hospital LOS and days on mechanical ventilation were compared between groups using multivariable negative binomial regression analysis to correct for confounding factors.</div></div><div><h3>Results</h3><div>A total of 238 subjects were included in our study and then classified as either the early enteral nutrition (EEN) group (n = 116) or the late enteral nutrition (LEN) group (n = 122). Compared to the LEN group, the EEN group had a shorter PICU LOS (adjusted incidence rate ratio (aIRR) 1.26, 95 % CI 1.02–1.56, p = 0.030) and hospital LOS (aIRR 1.36, 95 % CI 1.10–1.69, p = 0.005), with no difference in number of days on mechanical ventilation.</div></div><div><h3>Conclusions</h3><div>Initiation of EEN after admission to the PICU is associated with decreased PICU and hospital LOS with no effect on mechanical ventilation days after controlling for severity of illness, opioid total daily dose, use of vasoactive medications, number of regions injured and number of surgical procedures performed.</div></div><div><h3>Type of Study</h3><div>Retrospective Cohort Study.</div></div><div><h3>Level of Evidence</h3><div>3.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 4","pages":"Article 162189"},"PeriodicalIF":2.4,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dictation Precision: Evaluating Paediatric Oncology Operative Reports as an Impetus for Synoptic Reports","authors":"Alisiya Petrushkevich ,&nbsp;Eliza Livingston ,&nbsp;Jacob Davidson ,&nbsp;Claire A. Wilson ,&nbsp;Jennifer Y. Lam ,&nbsp;Marta Wilejto ,&nbsp;Natashia M. Seemann","doi":"10.1016/j.jpedsurg.2025.162186","DOIUrl":"10.1016/j.jpedsurg.2025.162186","url":null,"abstract":"<div><h3>Purpose</h3><div>The purpose of this study was to audit paediatric surgical oncology dictations to evaluate completeness and ease of data collection and provide a baseline measurement for the implementation of synoptic operative reports (SORs) in a tertiary care setting.</div></div><div><h3>Methods</h3><div>An audit tool based on Children's Oncology Group (COG) protocols was created to assess the completeness of surgical and tumour-specific data within operative reports. Audited cases included four paediatric tumours of interest (Germ Cell, Wilms, Neuroblastoma, and Hepatoblastoma) between 2010 and 2023.</div></div><div><h3>Results</h3><div>Overall, 71 audits were performed, the majority being Wilms Tumour cases (45.1 %), followed by Neuroblastoma (29.6 %), Germ Cell (18.3 %), and Hepatoblastoma (7.0 %). The average percentage of complete data for operative reports was low; the mean completeness of general oncological information for all tumour types was 66.0 %, and tumour-specific details were 42.0 %. Ovarian Germ Cell Tumour had the highest average percentage of complete data (65.9 %), followed by Wilms Tumour (58.7 %), Testicular Germ Cell Tumour (43.0 %), Neuroblastoma (15.0 %), and Hepatoblastoma (9.5 %). The median data collection time was 6.0 min per audit. The median time from the operation to the transcription of the report was 1.0 days (interquartile range (IQR): 1.0–7.0).</div></div><div><h3>Conclusion</h3><div>Narrative operative reports have inadequate completeness, especially concerning tumour-specific factors, which are often essential in accurate diagnosis, and in guiding treatment for children with cancer. SORs could be a solution and aid in the completeness and accessibility of data use.</div></div><div><h3>Type of study</h3><div>Retrospective review.</div></div><div><h3>Level of evidence (I–V)</h3><div>IV.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 4","pages":"Article 162186"},"PeriodicalIF":2.4,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Simulation Models for Training in Pediatric General, Thoracic, Plastic, and Urologic Surgery in Low-resource Settings: A Scoping Review.","authors":"Lyndon Rebello, Rachel Livergant, Parsa Khanbadr, Olga Bednarek, Shahrzad Joharifard","doi":"10.1016/j.jpedsurg.2025.162183","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2025.162183","url":null,"abstract":"<p><strong>Background: </strong>Simulation is an educational tool that can be used to augment surgical training. We sought to provide an overview of existing pediatric surgical simulation models, with a focus on low-cost models amenable for use in low-resource settings.</p><p><strong>Methods: </strong>PubMed and Google Patents were searched for studies describing simulation models for pediatric surgery. Studies were included if cost, construct validity, face validity, or reproducibility were described, and if the model was either already utilized in low-resource settings or amenable for use in low-resource settings.</p><p><strong>Results: </strong>A total of 18 studies and 7 patents were included. Over half (58.3 %) of the models were created in the last five years. Only four models were created in an upper-middle income country, and none were created in a low or lower-income middle income country (LMIC) (16.7 %). Most models were designed for general pediatric surgical procedures, with esophageal atresia repair being the most common procedure (20.8 %). The cost of models ranged between $0.61 USD to $301.44 USD, and cost per simulation episode ranged from $0.61 to $38 USD. Seven models (41.1 %) were 3D printed. Thirteen models (54.2 %) were simulators for minimally-invasive procedures. Sixteen models (66.7 %) were deemed to be reproducible based on their descriptions in published manuscripts or available patents.</p><p><strong>Conclusion: </strong>The utilization of simulation models in pediatric surgery is growing. Unfortunately, there are few validated models that can be used for training in low-resource settings. Significant work remains to be done on developing educational simulation tools for pediatric surgery in low-resource settings.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162183"},"PeriodicalIF":2.4,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beneath the Surface: A Retrospective Analysis of Pediatric Drowning Trends & Risk Factors in Quebec","authors":"Alexandra Dimmer ,&nbsp;Kacylia Roy Proulx ,&nbsp;Elena Guadagno ,&nbsp;Mathieu Gagné ,&nbsp;Paul-André Perron ,&nbsp;Hussein Wissanji","doi":"10.1016/j.jpedsurg.2025.162184","DOIUrl":"10.1016/j.jpedsurg.2025.162184","url":null,"abstract":"<div><h3>Purpose</h3><div>Despite the known importance of water safety, and recent efforts to enact pool safety legislation, drowning remains a leading cause of unintentional injury death in Canada. To date, little is known about the rates of pediatric drownings in Québec, the severity of these drownings, and the trends associated with the adoption of provincial regulations of pool enclosures – legislation which has been delayed twice, and remains to be fully enacted. This study aims to assess these knowledge gaps.</div></div><div><h3>Methods</h3><div>Retrospective observational study of all provincial pediatric drownings from January 1, 2017 to December 31, 2021. Three databases were accessed and subsequently analysed using descriptive statistics to identify trends and risk factors in the data, categorized by drowning severity (emergency room visits, hospitalizations, deaths).</div></div><div><h3>Results</h3><div>Throughout the study period, 655 drowning events were identified (an average of 92 ER visits, 29 hospitalizations, and 10 deaths, per year). Drownings were most prevalent in pools, and among children aged 1–4 (<strong>Table 1</strong>). The highest number of drownings occurred in 2020, possibly linked to the COVID-19 pandemic. Drowning events peaked in summer months, averaging 1 per day. The presence of safety features such as enclosures, or the presence of an accompanying individual was uncommon among drowning deaths.</div></div><div><h3>Conclusion</h3><div>Our results illustrate that younger children, particularly those aged 1–4, are at greatest risk of drowning events. Drowning deaths occurred most commonly in the absence of safety features, indicating an opportunity for improved drowning prevention education, and enforcement of evolving enclosure legislature to improve water safety.</div></div><div><h3>Level of Evidence</h3><div>Level 2 (prospectively collected data, retrospective analysis).</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 4","pages":"Article 162184"},"PeriodicalIF":2.4,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of Preventable Transfers of Pediatric Trauma Patients From Montana to an out of State Tertiary Level I Pediatric Trauma Center","authors":"Abigail J. Alexander ,&nbsp;Stephanie E. Iantorno ,&nbsp;Madison McLaughlin ,&nbsp;Barry A. McKenzie ,&nbsp;Lisa Foley ,&nbsp;Phoebe McNeally ,&nbsp;Stephen J. Fenton ,&nbsp;Robert A. Swendiman ,&nbsp;Katie W. Russell","doi":"10.1016/j.jpedsurg.2025.162188","DOIUrl":"10.1016/j.jpedsurg.2025.162188","url":null,"abstract":"<div><h3>Background</h3><div>The process of transferring pediatric trauma patients to specialized centers is essential for providing high-level trauma care to critically injured children. However, preventing unnecessary transfers is also a crucial component of optimizing healthcare utilization. The aim of this study was to identify and describe patients who underwent preventable transfers from hospitals in Montana to a single out-of-state Level I Pediatric Trauma Center (PTC).</div></div><div><h3>Methods</h3><div>We performed a retrospective review of pediatric trauma patients who underwent transfer from hospitals in Montana to an out-of-state Level I PTC from 2013 to 2022. Our primary outcome, preventable transfer, was defined as discharge within 48 h without advanced imaging (CT or MRI) or surgical intervention. We performed a secondary analysis to identify possibly preventable transfers (i.e. patients that could have been safely managed at an in-state Level II Adult Trauma Center).</div></div><div><h3>Results</h3><div>Out of 132 total patients, 22 patients (16 %) met criteria for preventable transfer and 31 patients (23 %) met criteria for possibly preventable transfer.</div><div>The majority of preventable transfers involved head trauma (68 %), followed by isolated orthopedic injuries (18 %), and burns (9 %). The majority of the possibly preventable transfers involved head trauma (48 %), followed by orthopedic injuries (16 %).</div><div>The average distance travelled was 466 miles (SD: 110 miles) for preventable transfers and 458 miles (SD: 81 miles) for possibly preventable transfers.</div></div><div><h3>Conclusions</h3><div>A significant proportion of pediatric trauma patients in Montana who underwent long-distance transfer to an out-of-state Level I PTC likely could have received appropriate care at facilities closer to home.</div></div><div><h3>Level of evidence</h3><div>IV, Prognostic and Epidemiological.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 4","pages":"Article 162188"},"PeriodicalIF":2.4,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional Outcomes of Anterior Sagittal Anorectoplasty Repair for Rectovestibular Fistula: An Integrated Clinical and MRI-based Assessment: Initial Findings","authors":"Nezar Abo-Halawa ,&nbsp;Ahmed Abdelrasheed ,&nbsp;AbdAlraheem Husein ,&nbsp;Akram Elbatarny ,&nbsp;Usama Ghieda ,&nbsp;Mohamed Abohalawa ,&nbsp;Mahitab Younes ,&nbsp;Mohamed Ahmed Negm","doi":"10.1016/j.jpedsurg.2025.162156","DOIUrl":"10.1016/j.jpedsurg.2025.162156","url":null,"abstract":"<div><h3>Background/Purpose</h3><div>This study aimed to assess the functional outcomes of anterior sagittal anorectoplasty for rectovestibular fistula using an integrated Rintala clinical continence score and MRI-based assessment.</div></div><div><h3>Methods</h3><div>Between October 2022 and April 2024, female patients with rectovestibular fistula who underwent anterior sagittal anorectoplasty were investigated. The patients were at least 4 years old, and cases with spinal cord anomalies or sacral dysplasia were excluded. MRI was performed and linked to the Rintala clinical continence score. The MRI parameters assessed were anorectal angle, striated muscle surrounding the neorectum, centrality of the neorectum, pubococcygeal (PC) distance, and pelvic hiatal distance.</div></div><div><h3>Results</h3><div>Twelve patients (mean age 68.6 months, range 54–108) were enrolled in this study. The findings revealed that the anorectal angle was strongly correlated with the total Rintala score (Spearman rank = −0.831, p &lt; 0.001), social problems (Spearman rank = −0.879, p &lt; 0.001), and accidents (Spearman rank = −0.790, p = 0.002). Additionally, the hiatal/pubococcygeal ratio was correlated with the total Rintala score (Spearman rank = −0.627, p = 0.029), the ability to hold back defecation (Spearman rank = −0.725, p = 0.008), soiling (Spearman rank = −0.733, p = 0.007), and accidents (Spearman rank = −0.778, p = 0.002). Furthermore, deficient striated muscle significantly correlated with the total Rintala score (Spearman rank = −0.652, p = 0.022) and accidents (Spearman rank = −0.827, p &lt; 0.001). Non-centralized neorectum correlated with the urge to defecate (Spearman rank = −0.674, p = 0.016) and soiling (Spearman rank = −0.548, p = 0.065). Additionally, the presence of fat tissue between the anorectum and the muscle was correlated with constipation (Spearman rank = −0.529, p = 0.077).</div></div><div><h3>Conclusions</h3><div>The anatomical findings following anterior sagittal anorectoplasty for repairing the rectovestibular fistula are crucial in determining the functional outcome. To enhance functional outcomes, meticulous surgical techniques are essential to achieve a more acute anorectal angle, maintain the integrity of the striated muscle sphincter, align the neorectum centrally, and ensure an appropriate size of the pelvic hiatus.</div></div><div><h3>Level of Evidence</h3><div>Level IV.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 4","pages":"Article 162156"},"PeriodicalIF":2.4,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}