Journal of pediatric surgery
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Comparative Study
Assessment of pain after injury in the pediatric patient: child and parent perceptions.
Pain is an inevitable consequence of injury. Accurate assessment and treatment of a child's pain after injury is essential. This study sought to describe children's pain with injury and to elucidate the concordance of parental and self-reported pain in a pediatric traffic-injured population. ⋯ This study shows the feasibility of pain assessment for pediatric injury using 2 validated scales and the appropriateness of parental report when the child is not able to provide self-report. Because pain was not correlated with injury severity, pain assessment and intervention for all children with traumatic injuries is strongly recommended.
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Declining interest in the field of surgery is attributed to lifestyle issues, more women per class, high debt, and long residency. To maintain surgery as a premier career choice, female students must find surgery to be professionally and personally rewarding. ⋯ WPS express career satisfaction but share the concerns of their female colleagues in other surgical disciplines. Quality of life is viewed as central to career choice for the current generation of medical students; female role models are key to recruiting women into pediatric surgery.
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Review Comparative Study
Management of suspected common bile duct stones in children: role of selective intraoperative cholangiogram and endoscopic retrograde cholangiopancreatography.
Evidence for diagnostic accuracy and clinical efficacy of intraoperative cholangiogram (IOC) and endoscopic retrograde cholangiopancreatography (ERCP) in the management of common bile duct (CBD) stones in children is sparse and unclear. ⋯ Selective IOC with LC is an acceptable and safe initial approach in suspected CBD. Most CBD stones in children pass spontaneously. Endoscopic sphincterotomy appears to be safe with no long-term sequelae.
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The presence of a contrast blush on computed tomography (CT) in adult splenic trauma is a risk factor for failure of nonoperative management. Arterial embolization is believed to reduce this failure rate. The significance of a blush in pediatric trauma is unknown. The authors evaluated the outcome of children with blunt splenic trauma and contrast extravasation. ⋯ Contrast blush in children with blunt splenic trauma is rare, and its presence alone does not appear to predict delayed rupture or failure of nonoperative treatment. Based on this limited series, splenic artery embolization does not have a place in the management of splenic injuries in children.
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Previous studies have found that the Injury Prevention Priority Score (IPPS) provides a reliable and valid method to gauge the relative importance of different injury causal mechanisms at individual trauma centers. This study examines its applicability to prioritizing injury mechanisms on a national level and within defined pediatric age groups. ⋯ IPPS provides an objective, quantitative method for determining injury prevention priorities based on both frequency and severity at the national level. It also is sensitive to age-related changes in different mechanisms of injury.