Journal of pediatric surgery
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Computed tomographic (CT) scanning has mostly replaced x-rays as an imaging modality, but concerns exist because of excess radiation, missed injuries, and whether it is the definitive procedure for intubated patients. The purpose of this study was to characterize missed cervical spine injuries (CSIs). ⋯ Our data suggest that CT scans should be the primary modality to image a CSI. Flexion/extension views did not add to the decision making for C-spine clearance after CT evaluation.
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The emerging "pay for performance" national initiative mandates the development of valid metrics for risk stratification and performance assessment. The International Classification Injury Severity Score (ICISS) predicts survival from injury and is calculated as the product of survival risk ratios (SRRs) for a patient's 3 worst injuries. Survival risk ratios are derived as the proportion of fatalities for every International Classification of Diseases, Ninth Edition, Clinical Modification, diagnosis in a "benchmark" population. We hypothesized that the ICISS prediction model derived from the National Pediatric Trauma Registry (NPTR) would accurately predict mortality in an independent sample from a single pediatric trauma center (PTC) and could be applied to the NSQIP methodology to analyze performance. ⋯ These data validate the application of injury diagnosis derived survival probabilities as objective metrics for determining performance using the NSQIP methodology. Incorporation of these objective predictors of expected outcome to calculation of the risk adjusted O/E ratio enables trend analysis of program performance over time. The lack of significant correlation between O/E and mean Ps demonstrates that NSQIP does indeed reflect process of care while adjusting for severity of patient pathologic condition.
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Complete contrast enema reduction of intussusception is traditionally considered confirmed when contrast is seen refluxing into the terminal ileum. Operative intervention is typically indicated when the intussusception is not completely reduced. This study reviews the outcomes after symptomatic reduction of intussusception without requiring reflux of contrast into the terminal ileum. ⋯ Nonoperative management may be used in patients with reduced intussusception despite lack of contrast refluxing into the terminal ileum if symptoms resolve.
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After a successful course of extracorporeal membrane oxygenation (ECMO), patients can deteriorate and a second ECMO course may be contemplated. When a second ECMO course becomes necessary in pediatric patients, survival rates comparable to the first ECMO course are possible. The perceived difficulties involved in recannulation after an initial ECMO course can prevent clinicians from reliably offering a second ECMO run to an eligible pediatric patient. We hypothesized that national ECMO registry data could provide cannulation templates for pediatric patients requiring a second ECMO course. ⋯ Second ECMO courses in pediatric patients can achieve survival comparable to the first course, but more often require central cannulation. Reusing cannulation sites for a second ECMO course is associated with fewer total complications than cannulating at new sites. These data provide guidance when considering cannulation strategies for second ECMO courses in pediatric patients.