Journal of pediatric surgery
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On rare occasions, endoscopic extraction of airway foreign bodies is not feasible or may be associated with large risk for the patient; in those situations, open surgery is indicated. The authors report a case of an 8-year-old boy presenting with an airway foreign body that was too large to be extracted through the subglottic region. After several attempts, extraction was accomplished through a tracheotomy with bronchoscopic control. ⋯ Since the tracheal suture was firm and without air leaks, a tracheostomy cannula was not placed. The tracheal tube was removed after 3 days. Follow-up 1 month after the procedure showed that all respiratory symptoms had disappeared.
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Randomized clinical trials (RCTs) perhaps are the best method available for the comparison of therapeutic interventions, yet these studies remain scarce in the pediatric surgery literature. The infrequency of surgical conditions, parents' refusal to participate, and difficulty with standardizing operative technique are potential obstacles to conducting multicenter randomized trials. Novel applications of information technology can potentially overcome these obstacles and facilitate randomized trials in pediatric surgery. ⋯ Internet-based protocols may facilitate trials in pediatric surgery by reducing administrative costs, improving standardization of surgical technique, and potentially increasing enrollment success rates. Future investigation will examine the impact of this protocol on the education, knowledge base, and attitudes of parents, as well as determine the efficiency and overall cost effectiveness of this data management strategy.
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Comparative Study
Development of a model for prediction of survival in pediatric trauma patients: comparison of artificial neural networks and logistic regression.
There is a paucity of outcome prediction models for injured children. Using the National Pediatric Trauma Registry (NPTR), the authors developed an artificial neural network (ANN) to predict pediatric trauma death and compared it with logistic regression (LR). ⋯ The authors were able to develop an ANN model for the prediction of pediatric trauma death, which yielded excellent discrimination and calibration exceeding that of logistic regression. This model can be used by trauma centers to benchmark their performance in treating the pediatric trauma population.
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An increasing number of pediatric surgeons are using the laparoscopic approach to treat pyloric stenosis. The advantage of laparoscopic pyloromyotomy is uncertain and has not been evaluated in the setting of a pediatric surgery fellowship program. ⋯ Laparoscopic pyloromyotomy has progressively become the dominant surgical approach to pyloromyotomy at our institution. The LAP and OPEN approaches have similar outcomes. However, the Lap approach may be associated with increased complication rates, a reduction in general surgery resident operative experience, and higher hospital charges.
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Comparative Study Clinical Trial Controlled Clinical Trial
Prospective evaluation of nonsurgical versus surgical management of appendiceal mass.
Prospective evaluation was undertaken of surgical findings, complications, morbidity, and hospital stay between initial nonsurgical management versus early surgical intervention of an appendicular mass. ⋯ Early surgical intervention was beneficial over nonoperative management in this cohort of patients. Interval appendectomy is recommended after nonsurgical management of an appendicular mass.