European journal of pediatric surgery : official journal of Austrian Association of Pediatric Surgery ... [et al] = Zeitschrift für Kinderchirurgie
-
Review Comparative Study
Thoracoscopic procedures in pediatric surgery: what is the evidence?
Video-assisted thoracoscopic surgery (VATS) has gained enormous acceptance among pediatric surgeons. However, most studies on advantages of VATS do not reach a high level of evidence. According to a recent classification of the Oxford Centre for Evidence-Based Medicine (CEBM), studies can be classified into Levels 1 to 5 in order of descending quality. We aimed to identify comparative studies investigating VATS versus open procedures in pediatric surgery and to classify publications according to the CEBM criteria. ⋯ Only RCS on pediatric VATS are available. Therefore, the best available evidence is Level 3. Randomized controlled trials comparing VATS and the corresponding open procedure are mandatory to obtain the highest possible evidence.
-
A regionalized trauma system must be tailored to the trauma epidemiology and the trauma care resources of the population it serves. Pediatric trauma system in Singapore differs from others because of its geographic compactness and relatively low incidence of severe trauma. The scarcity of polytrauma highlights the need of a reliable screening system to identify injured children who necessitate urgent transport to emergency department (ED) with pediatric resuscitation capacity as well as activation of trauma team upon their arrival. In this study, the validity of Pediatric Trauma Score (PTS), Glasgow Come Scale (GCS), and respiratory rate (RR) in identifying pediatric patients with major trauma and receipt of resuscitation is evaluated. ⋯ The parameters of PTS need to be further refined to improve its accuracy and minimize the undertriage rate. If a combined physiologic and anatomic scoring system such as PTS is used, other physiologic parameters such as GCS and RR may become redundant. The evaluation of the validity of PTS, GCS, and RR in predicting pediatric major trauma indicated poor reliability.