Journal of pediatric surgery
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Children requiring prehospital cardiopulmonary resuscitation (CPR) after traumatic injury have been shown to have poor survival. However, outcome of children still receiving CPR on-arrival by emergency medical service to the emergency department (ED) has not been demonstrated in a published clinical series. ⋯ Although mortality was extremely high for children requiring CPR in the field After traumatic injury, it was absolute for those arriving at the ED still undergoing CPR.
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The rising prevalence of community-acquired, methicillin-resistant Staphylococcus aureus (MRSA) has correlated with an escalating number of complex, subcutaneous abscesses in pediatric patients. The purpose of this study was to present a novel technique and early outcome results for the minimally invasive drainage of complex, subcutaneous abscesses. ⋯ We present a successful technique for the drainage and treatment of complex abscesses in children with limited, postoperative wound care and no morbidity or recurrence.
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Case Reports
Use of a massive transfusion protocol with hemostatic resuscitation for severe intraoperative bleeding in a child.
Use of a defined massive transfusion (MT) protocol for severe intraoperative bleeding in a pediatric patient has never been described. Herein we present a case whereby use of hemostatic resuscitation delineated in an MT protocol optimally treated hemorrhage resulting from a large tumor during right hepatectomy. The MT protocol principles, benefits, and postoperative course of the patient are described.
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Comparative Study
Analysis of adverse events in pediatric surgery using criteria validated from the adult population: justifying the need for pediatric-focused outcome measures.
Little is known regarding the incidence and financial impact of adverse events associated with the surgical care of children. The purpose of this study was to characterize the epidemiology and resource utilization associated with these events using definitions validated from the adult population. ⋯ A relatively small number of pediatric surgical procedures contribute to a disproportionate share of adverse events. Although the National Surgical Quality Improvement Project and Agency for Healthcare Research and Quality criteria can identify pediatric procedures associated with a significant risk of morbidity, the relatively high 30-day event rates captured for some procedures may be heavily influenced by underlying co-morbidity profiles not related to the surgical disease or intervention. Furthermore, the validity of applying adult-focused "adverse" event definitions for the pediatric population should be further explored. Collaborative efforts will be needed to develop more clinically meaningful outcome measures for the purpose of quality improvement end points.
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Comparative Study
Physiologically focused triage criteria improve utilization of pediatric surgeon-directed trauma teams and reduce costs.
Pediatric surgeon-directed trauma teams (STTs) provide lifesaving treatment but at a high cost. We used physiologically based criteria to improve STT utilization. ⋯ Physiologic STT activation criteria would have saved 25 activations, $20,000 in costs, and $120,000 in charges annually without compromising patient safety.