Journal of pediatric surgery
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The provision of clinical care in the United Kingdom now requires the acquisition of a licence to practise from the regulatory authority. A review process-revalidation has been put in place to ensure that standards of care are maintained by the medical workforce, and that all doctors remain up-to-date and fit for purpose so that this licence can be retained. This article outlines how this new statutory requirement pertains to paediatric surgery and highlights those areas where adjudication of competence remains imprecise and where progress in this process of revalidation needs to be made.
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Comparative Study
Laparoscopic versus open appendicectomy in children: a UK District General Hospital experience.
The aim of this study was to evaluate the potential role of laparoscopic appendicectomy in reducing morbidity and length of stay in children compared to open procedures in a UK District General Hospital setting. ⋯ Laparoscopic appendicectomy in children in a UK District General Hospital is safe and was associated with significantly less post-operative morbidity than the open technique.
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To determine the incidence of catheter-associated venous thromboembolic events (VTE) in long gap esophageal atresia (LGEA) patients treated at Boston Children's Hospital (BCH) and to identify possible risk factors associated with their development. ⋯ The incidence of symptomatic VTE was 34%, significantly higher than the VTE incidence of 4.5% reported for our other hospitalized children. These data have led to multidisciplinary discussions regarding thromboprophylaxis and development of a consensus-driven protocol. Since the initiation of this protocol, no VTEs have been identified.
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Multicenter Study
Head injury and unclear mechanism of injury: initial hematocrit less than 30 is predictive of abusive head trauma in young children.
Head injury secondary to abusive head trauma (AHT) is a major cause of morbidity and mortality in susceptible young infants and children. Diagnosing AHT remains challenging and is often complicated by a questionable mechanism of injury. Concern of ionizing radiation risk to children undergoing head CT imaging warrants a selective approach. We aimed to evaluate initial findings that could direct further investigation of AHT. ⋯ In the setting of head injury and unclear history of trauma, a hematocrit of ≤ 30% on presentation increases the likelihood of abusive head trauma in children up to the age of 5 years.
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Guidelines for evaluating the cervical spine in pediatric trauma patients recommend cervical spine CT (CSCT) when plain radiographs suggest an injury. Our objective was to compare usage of CSCT between a pediatric trauma center (PTC) and referral general emergency departments (GEDs). ⋯ Despite a stable rate of CSI, rate of CSCT increased significantly over time, especially among patients initially evaluated at a GED.