Journal of pediatric surgery
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On January 12, 2010, Haiti experienced the western hemisphere's worst-ever natural disaster. Within 24 hours, the United States Naval Ship Comfort received orders to respond, and a group of more than 500 physicians, nurses, and staff undertook the largest and most rapid triage and treatment since the inception of hospital ships. ⋯ This represents the largest cohort of pediatric surgical patients in an earthquake response. Our analysis provides a model for anticipating surgical caseload, injury patterns, and duration of surgical course in preparing for future disaster response missions. Moreover, we propose a 3-phased response to disaster medicine that has not been previously described.
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Trauma is the leading cause of death in children, accounting for half of all deaths in patients between birth and 18 years of age, and is the cause of a significant number of hospital admissions. We reviewed our experience at a Level I pediatric trauma center with a 2-level trauma activation (TA) system for mobilization of personnel over a 3-year period. The aim was to assess severity of injury of the trauma patients, resource use, and outcome. ⋯ Our Level I pediatric trauma center manages a large volume of patients with significant acuity and, evidenced by a TA in 29% of the patients, a severe or very severe ISS in 16% of the patients, 16% of the patients requiring ICU admission, and 47% requiring operative intervention. The TA patients had markedly higher rates of ICU admission, ISS, and mortality. Deaths in the study were lower by almost an order of magnitude comparing TA STATs with TA ALERTs and TA ALERT patients with patients without TA. The TA criteria are in many ways very helpful and is integral to a Level I trauma center. However, opportunities were identified for improvement because of areas of "overutilization" and discordance between TA and ISS.
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The readmission rate after pediatric appendectomy is frequently reported in clinical outcomes studies and quality improvement initiatives without proper description. Our aim was to delineate the context and significance of these encounters. ⋯ Emergency department visits and inpatient readmissions after pediatric appendectomy are frequent but not uniformly indicative of surgical complications or suboptimal care. Opportunities exist to reduce avoidable ED visits related to minor postoperative concerns.
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Comparative Study
Comparison of bipolar electrosurgical devices with ligatures and endoclips in the rat appendicitis model.
The aim of this study is to compare bipolar radiofrequency-driven vessel sealer, bipolar electrocautery, polyglactin 910 sutures, and endoclips in appendiceal stump closure with respect to operative time, appendiceal stump strength, and inflammation in a rat appendiceal model. ⋯ Bipolar radiofrequency-driven vessel sealer and bipolar electrocautery achieve safe stump closure with satisfactory bursting pressure values in an experimental rat appendicitis model. Decreased operative time and unimpaired healing are encouraging.
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Comparative Study Clinical Trial
A comparison of traditional incision and drainage versus catheter drainage of soft tissue abscesses in children.
Soft tissue infections are increasingly being seen for surgical management, which is associated with painful dressing changes, lost days at school, time away from family, and scarring, which can have a great impact on both child and caretaker. We postulated that a drainage technique using a modified Pezzar catheter would be associated with shorter hospital stays and less wound care. ⋯ We conclude that catheter drainage of soft tissue abscesses in children is safe and effective. Catheter drainage is associated with a decreased hospital stay. Other factors related to shorter hospital stays include age of the patient and the site of soft tissue abscess.