Journal of pediatric surgery
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The American Academy of Pediatrics provided a home for pediatric surgery when organized surgery did not recognize the specialty. They have continued to support surgical specialties in their pursuit of quality in education, training and practice. ⋯ The fact that it does not have a PAC, and that it always puts the child first, has given it great credibility. Much of the AAP infrastructure is already used by surgeons to advocate for their patients, but still more opportunities for collaboration are available.
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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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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.
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Comparative Study
Repair of congenital diaphragmatic hernias on Extracorporeal Membrane Oxygenation (ECMO): does early repair improve patient survival?
The optimal timing of repair for congenital diaphragmatic hernia (CDH) patients that require ECMO is controversial. Early repair on ECMO theoretically allows for restoration of normal thoracic anatomy but entails significant bleeding risks. The purpose of this study was to examine the institutional outcomes of early CDH repair on ECMO. ⋯ In conclusion, early repair on ECMO was associated with decreased ECMO duration, decreased circuit complications, and a trend towards improved survival.