Journal of pediatric surgery
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Pediatric surgical care in developing countries is not well studied. We sought to identify the range of pediatric surgery available, the barriers to provision, and level of safety of surgery performed for the entire pediatric population in Zambia. ⋯ The primary limitation to providing pediatric surgical care in Zambia is lack of surgical skills. Minimum safety standards were met by 14% of hospitals. Efforts to improve pediatric surgery should prioritize teaching surgical skills to expand access and providing safety training, equipment and supplies to increase safety.
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The aim of this study was to review evidence-based literature addressing pertinent questions about venous thromboembolism (VTE) after traumatic injury in children. ⋯ The overall incidence of VTE is low. Older (>13years) and more severely injured patients are at higher VTE risk. Additional factors including injury type or presence of a central venous catheter also place a patient at higher VTE risk. Implementation of a risk-based clinical practice guideline for VTE prophylaxis has been associated with reduced symptomatic VTE at one institution. Randomized, prospective trials analyzing outcomes of VTE prophylaxis in pediatric trauma victims are needed.
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Non-Accidental Trauma (NAT) is a significant cause of childhood morbidity and mortality, causing 50% of trauma-related deaths at our institution. Our purpose was to evaluate the necessity of primary surgical evaluation and admission to the trauma service for children presenting with NAT. ⋯ Given the high incidence of polytrauma in NAT patients, prompt surgical evaluation is necessary to determine the scope of injury. Admission to the trauma service and a thorough tertiary survey should be considered for all patients.
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To examine the correlation between readmission rate and total hospital days as resource utilization and quality measures for comparative analysis. ⋯ There is poor correlation between unplanned readmission and total hospital days following treatment for complicated appendicitis in children. Research and reporting for this condition should incorporate both measures to provide a more comprehensive assessment of resource utilization.
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Admission rapid thrombelastography (rTEG) is a "real-time" clinical tool used to evaluate trauma-induced coagulopathy and direct hemostatic resuscitation. The relationship of rTEG to conventional coagulation tests (CCT) and early lifesaving interventions (LSI) in pediatric trauma is unknown. ⋯ Admission rTEG correlates with CCT and predicts early transfusion, early LSI, and outcome in pediatric trauma. rTEG provides valuable data for goal-directed hemostatic resuscitation of critically injured children.