Alexander Howes , Sanjeev Khurana , Jennie Louise , Isabella Watts , Rebecca Linke , Amit Kochar
{"title":"Validation of the paediatric appendicitis risk calculator (pARC) in an Australian emergency department setting","authors":"Alexander Howes , Sanjeev Khurana , Jennie Louise , Isabella Watts , Rebecca Linke , Amit Kochar","doi":"10.1016/j.yjpso.2025.100192","DOIUrl":"10.1016/j.yjpso.2025.100192","url":null,"abstract":"<div><h3>Study objective</h3><div>Our objective is to assess the performance of the Paediatric Appendicitis risk calculator (pARC) in quantifying the risk of appendicitis, in an Australian tertiary emergency department (ED) and to compare its performance with that of the Paediatric Appendicitis Score (PAS) and Alvarado score in predicting risk of appendicitis.</div></div><div><h3>Methods</h3><div>We conducted this prospective, observational cohort study from July 2021 to October 2022 in the Women's and Children's Hospital (WCH) ED in Adelaide, South Australia. Patients aged 5 to 18 presenting with abdominal pain ≤120 h, where appendicitis was a differential diagnosis, were eligible for enrolment. Our primary outcome was the histopathological diagnosis of appendicitis within 14 days of initial presentation. We reported performance characteristics and secondary outcomes by pARC risk strata and compared the receiver operator characteristic (ROC) curves of the PAS, Alvarado and pARC.</div></div><div><h3>Results</h3><div>We enrolled 675 patients with a mean age of 11.93 years, 51 % were female. Appendicitis was histologically diagnosed in 29.33 % of patients, with 13.6 % having perforated appendicitis. 51 % of patients had very low (<5 %) or low (5 % to 14 %) predicted risk, 40.3 % had intermediate risk (15 % to 84 %), and 6.5 % had high risk (>85 %). In the very-low- and low-risk groups, 6.4 % and 11 % of patients had appendicitis, respectively. The AUROC was 0.852 (95 % confidence interval (CI) 0.820 to 0.885) for the pARC compared with 0.80 (95 % CI 0.77 to 0.84) for the PAS, and 0.73 (95 % CI 0.69, 0.78) for Alvarado.</div></div><div><h3>Conclusion</h3><div>The pARC score has been validated as an appendicitis risk calculator which is as reliable as previous studies, in the study population, whilst outperforming the PAS and Alvarado scores.</div></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"10 ","pages":"Article 100192"},"PeriodicalIF":0.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143132080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Volume-outcome relationship in pediatric blunt liver and spleen injuries: A multicenter retrospective cohort study","authors":"Susumu Matsushime , Akira Kuriyama , Morihiro Katsura","doi":"10.1016/j.yjpso.2025.100194","DOIUrl":"10.1016/j.yjpso.2025.100194","url":null,"abstract":"<div><h3>Background</h3><div>The relationship between the number of patients treated in a hospital and patient outcomes (“volume-outcome relationship”) has been reported. We aimed to examine the relationship between hospital case volume and complications, in-hospital mortality, and non-operative management (NOM) failure in pediatric blunt liver and/or spleen injuries (BLSIs).</div></div><div><h3>Methods</h3><div>This was a post-hoc analysis of a multicenter retrospective study that enrolled patients aged ≤16 years admitted for BLSIs with Abbreviated Injury Scale grade of at least ≥1 between January 2008 and December 2019. Participating hospitals were categorized into three groups of 33 % each, according to the annual pediatric trauma case volume. We used the Cochrane-Armitage test to determine a linear trend between the hospital case volume and each outcome.</div></div><div><h3>Results</h3><div>We identified 1406 patients with BLSIs who were treated at 83 hospitals; 44 (3.1 %) and 12 (0.9 %) patients experienced complications and NOM failure, respectively, with 21 cases (1.5 %) of in-hospital mortality. Hospitals were categorized into high- (28 hospitals), medium- (26 hospitals), and low-volume (29 hospitals) groups. No significant linear trend was observed between hospital volumes and complications (P <em>trend</em>=0.07), in-hospital mortality (P <em>trend</em>=0.67), or NOM failure (P <em>trend</em>=0.57). Sensitivity analyses using different group categorizations provided similar findings.</div></div><div><h3>Conclusions</h3><div>This study failed to confirm a volume-outcome relationship between annual pediatric trauma case volume and complications, in-hospital mortality, or NOM failure in pediatric BLSIs in Japan. The limited exposure of Japanese hospitals to pediatric trauma, lack of a system to certify pediatric trauma centers, and practice variations across hospital types potentially underlie these findings.</div></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"10 ","pages":"Article 100194"},"PeriodicalIF":0.0,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143132081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jean Dai , Jesse York , Baylor Schexnayder , Frankie Fike
{"title":"Open versus thoracoscopic approach in the surgical treatment of congenital pulmonary airway malformations: A retrospective cross-sectional analysis and review","authors":"Jean Dai , Jesse York , Baylor Schexnayder , Frankie Fike","doi":"10.1016/j.yjpso.2025.100193","DOIUrl":"10.1016/j.yjpso.2025.100193","url":null,"abstract":"<div><h3>Introduction</h3><div>Congenital pulmonary airway malformations (CPAMs) are rare developmental lung abnormalities that often require surgical intervention. This study aimed to compare resource utilization and in-hospital outcomes between open thoracotomy and thoracoscopic approaches for CPAM treatment.</div></div><div><h3>Methods</h3><div>We used the Kids' Inpatient Database (KID), the largest publicly available all-payer pediatric inpatient care registry, to identify patients under 20 years old who were treated with elective surgery for CPAM in 2016 and 2019. Patients were categorized into open thoracotomy or thoracoscopic groups based on International Classification of Disease, Tenth Revision (ICD-10) procedure codes. We analyzed differences in demographic characteristics, complications, total cost of stay, and length of hospital stay between the two groups.</div></div><div><h3>Results</h3><div>The study included 749 patients (436 thoracoscopic, 313 open). Demographic analysis revealed significant differences in sex distribution (<em>p</em> = 0.028) and race (<em>p</em> < 0.001) between groups. The mean age was similar (thoracoscopic: 1.2 years, open: 1.7 years; <em>p</em> = 0.059). Complications were not significantly different between approaches. The thoracoscopic approach was associated with lower mean total cost of stay ($74,719 vs. $82,146; <em>p</em> = 0.037) and shorter mean length of stay (3.1 vs. 4.5 days; <em>p</em> < 0.001) compared to the open approach (Table 1).</div></div><div><h3>Conclusion</h3><div>This study suggests that the thoracoscopic approach for CPAM treatment may offer advantages in terms of reduced hospital costs and shorter length of stay without significantly increasing complication rates. These findings could inform clinical decision-making and resource allocation in pediatric surgical care. Further research is needed to assess long-term outcomes and patient-reported measures between these approaches.</div><div>Type of study: retrospective cross-sectional analysis</div><div>Level of evidence: 4</div></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"10 ","pages":"Article 100193"},"PeriodicalIF":0.0,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143132147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Emily Byrd , M. Jake Petersen , Minna M. Wieck , Frank Ing , Shinjiro Hirose
{"title":"Combined surgical and interventional cardiology approach for central venous access salvage in children with intestinal failure: A case series","authors":"Emily Byrd , M. Jake Petersen , Minna M. Wieck , Frank Ing , Shinjiro Hirose","doi":"10.1016/j.yjpso.2024.100186","DOIUrl":"10.1016/j.yjpso.2024.100186","url":null,"abstract":"<div><h3>Background</h3><div>Pediatric patients with intestinal failure are critically dependent on central venous access for nutrition and fluids. Long-term central venous access can be complicated by recurrent infections, catheter malfunction, and venous stricture and thrombosis. Prior studies have discussed hybrid procedures to salvage suboptimal central venous access sites; however, data is very limited.</div></div><div><h3>Methods</h3><div>This is a retrospective review of six pediatric patients with intestinal failure (IF) and long-term total parenteral nutrition (TPN) dependence who underwent one or more hybrid procedures for achieving complex vascular access, vascular mapping, and/or salvage of vascular access sites.</div></div><div><h3>Results</h3><div>Median age at the time of intervention was 1.4 years (range 2.5 weeks – 2.6 years) with a median weight of 10 kg (range 3.3–13.8 kg). The median number of lifetime central lines was 4 (range 2–6). Indications for hybrid intervention included line fractures, occlusions, dislodgement, recurrent infections, and refractory central line infection. The most common procedures included vascular access, vein mapping, and balloon angioplasty of occluded central veins. The median procedure time was 4.6 h (range 1.3–5.9 h) with a median procedural radiation dose of 2.2 Gycm<sup>2</sup> (range 0.1–6.7 Gycm<sup>2</sup>). All patients who underwent hybrid procedures had successful exchange and/or rehabilitation of the at-risk access site.</div></div><div><h3>Conclusions</h3><div>These cases highlight the importance of vascular mapping for identifying potential access sites, as well as techniques for successful vascular rehabilitation for maintenance or salvage of existing central venous access. A multidisciplinary hybrid approach is a feasible and effective means of maintaining central venous access.</div></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"9 ","pages":"Article 100186"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143102546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shachi Srivatsa , Jennifer H. Aldrink , Dana Schwartz , Grant Heydinger , Andrew Davidoff , Andrew J. Murphy , Kyle O. Rove , Sara A. Mansfield
{"title":"Early removal of indwelling urinary catheters in children undergoing abdominal tumor resection with epidural analgesia","authors":"Shachi Srivatsa , Jennifer H. Aldrink , Dana Schwartz , Grant Heydinger , Andrew Davidoff , Andrew J. Murphy , Kyle O. Rove , Sara A. Mansfield","doi":"10.1016/j.yjpso.2024.100191","DOIUrl":"10.1016/j.yjpso.2024.100191","url":null,"abstract":"<div><h3>Purpose</h3><div>Epidural analgesia (EA) is commonly employed for postoperative pain management in children undergoing abdominal tumor resection. Indwelling urinary catheters (IUCs) often remain for the duration of EA administration due to concern for associated urinary retention. This study focuses on children undergoing abdominal tumor resection with appropriate EA coverage, to assess whether IUC can be removed early with minimal risk of reinsertion for urinary retention.</div></div><div><h3>Methods</h3><div>A retrospective review of children who underwent abdominal tumor resections with EA between 2015 and 2023 at two institutions was conducted. Data were summarized, and rates of postoperative urinary retention requiring catheter reinsertion and catheter-associated urinary tract infections (CAUTIs) were compared between patients with early and late IUC removal groups using Fisher's exact testing. “Early” was defined as IUC removal with EA in place and “late” as IUC removal after or concurrent with EA discontinuation.</div></div><div><h3>Results</h3><div>A total of 228 children underwent abdominal tumor resections with EA. Of these, 104 had early, and 124 had late IUC removal. The average postoperative day (POD) of IUC removal in the early group was 1.1±0.5 days and 2.9±1.1 days in the late group. EA was at T12 level or higher in 101 patients (97.1 %) in the early group, and 68 (54.8 %) in the late group (p<0.001). EA contained opioids in 27 (26.0 %) in the early group and 54 (43.5 %) in the late group (p=0.005). There were 6 (5.8 %) children in the early group and 1 (0.8 %) in the late group requiring re-catheterization (p = 0.049). For those requiring re-catheterization, the EA level was T7-8 in 5 patients, T10-11 in 1 patient, and T4 in 1 patient (late). There was 1 (1.0 %) patient with a CAUTI in the early group, and 3 (2.4 %) patients in the late group (p = 0.63).</div></div><div><h3>Conclusions</h3><div>Early removal of indwelling urinary catheters in the setting of thoracic epidural analgesia is associated with a small risk of urinary retention necessitating catheter re-insertion. Balancing the need for IUCs with this possibility, patient comfort, and infectious risk should inform decision-making to best align with enhanced recovery efforts.</div></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"9 ","pages":"Article 100191"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143102543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Functional outcomes following injury in pediatric patients without traumatic brain injury","authors":"Ryo Yamamoto , Lillian Liao , Keitaro Yajima , Akira Endo , Kazuma Yamakawa , Junichi Sasaki","doi":"10.1016/j.yjpso.2024.100183","DOIUrl":"10.1016/j.yjpso.2024.100183","url":null,"abstract":"<div><h3>Background</h3><div>Pediatric trauma patients often have disability after successful resuscitation for hemorrhage. Clinical characteristics related to dependency on living following injury were elucidated among pediatric patients without traumatic brain injury.</div></div><div><h3>Methods</h3><div>This retrospective cohort study used the 2019–2021 Japan Trauma Data Bank and included pediatric patients aged ≤16 years without head injury (Abbreviated Injury Scale [AIS] ≥ 2). The unfavorable function was defined as dependency in daily life at discharge (Glasgow Outcome Scale ≤ 3), and predictors for unfavorable functional outcomes were examined using a generalized estimating equations (GEE) model, including age, sex, physical disability before injury, injury mechanism, transportation time, prehospital procedures, vital signs on arrival, surgery in each body region, transfusion, AIS in each region, and institutions. Furthermore, these factors were analyzed separately in toddler/preschool (≤5 years), school age (6–11 years), and adolescence (12–16 years).</div></div><div><h3>Results</h3><div>Among 1,412 patients eligible for the study, 137 had an unfavorable physical function at discharge. The GEE model revealed that female sex, physical disability before injury, prehospital transfusion, lower Glasgow Coma Score (GCS) score on arrival, neck surgery, and higher AIS in the neck and extremity/pelvis were independently associated with unfavorable function at discharge. In age-specific analyses, physical disability before injury strongly predicted worse functional outcomes in toddlers/preschoolers, whereas higher AIS in the chest and lower systolic blood pressure on arrival were additional predictors of dependent living among adolescents.</div></div><div><h3>Conclusions</h3><div>Severe neck/extremity/pelvis injury and lower GCS on arrival are associated with unfavorable functional outcomes in patients with pediatric trauma.</div></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"9 ","pages":"Article 100183"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143102596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Y. Doruk Bilgili , Duygu Tatli Uçarci , B. Haluk Güvenç
{"title":"Perceptions and decision making regarding circumcision amongst parents and medical personnel","authors":"Y. Doruk Bilgili , Duygu Tatli Uçarci , B. Haluk Güvenç","doi":"10.1016/j.yjpso.2024.100181","DOIUrl":"10.1016/j.yjpso.2024.100181","url":null,"abstract":"<div><h3>Aim of the study</h3><div>Despite the fact that male circumcision being one of the most common procedures, there is a lack of awareness amongst parents and doctors. In this study, a questionnaire was applied to find answers covering topics, which include best timing of operation and type of anaesthesia, indications, expected complications, and contraindications, as well as effect on sexual performance.</div></div><div><h3>Methods</h3><div>A total of 146 test subjects (48 parents, 48 local pediatricians, and 50 general practitioners (GP)) were requested to fill out a questionnaire concerning the mentioned topics.</div></div><div><h3>Main results</h3><div>GP mostly preferred (46 %) circumcision under age of two when compared to parents (18.8 %) (<em>p</em> = 0.001). However, 18.8 % of pediatricians and 30 % of GP preferred circumcision during phallic stage. Parents (47.9 % vs 16.7 %-10 %) believed that newborns did not require any type of anaesthesia (<em>p</em> < 0.001). From a religious point of view, the act of circumcision is regarded mandatory according to 10.4 % of parents, 8.3 % pediatricians, and 4 % GP. Doctors regarded circumcision as compulsory (pediatricians 60 % - GP 68.8 %) in preventing venereal diseases compared to parents (37.5 %) (<em>p</em> < 0.001). Need for circumcision in the presence of hydronephrosis was regarded unnecessary by parents (10.4 %) when compared to doctors (<em>p</em> < 0.001). However, this point of view was interestingly shared by 35.4 % of the pediatricians and 40 % GP. According to 37.5 % of the parents, circumcision did not correlate with good reproductive ability (<em>p</em> < 0.001).</div></div><div><h3>Conclusions</h3><div>Results showed that enhanced medical education and awareness are required amongst medical personnel with regards to a widely known subject as circumcision. Public information is also needed to achieve a better state of knowledge.</div></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"9 ","pages":"Article 100181"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143102547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Factors associated with biloma formation in biliary atresia patients after Kasai operation and outcomes of percutaneous transhepatic biliary drainage","authors":"Niramol Tantemsapya, Rattakan Jutiyon, Mongkol Laohapensang","doi":"10.1016/j.yjpso.2024.100189","DOIUrl":"10.1016/j.yjpso.2024.100189","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aims to investigate factors associated with the development of biloma after Kasai operation, and to study the outcomes of treatment.</div></div><div><h3>Methods</h3><div>A retrospective chart review was conducted on biliary atresia patients who underwent Kasai operation at Siriraj Hospital from 2006 to 2021. The eligible 79 patients were divided into groups with biloma (n=13) and without biloma. Clinical and laboratory data at diagnosis and postoperation were compared. The treatment outcome of biloma was studied. Finally, the overall outcomes of portoenterostomy between both groups were analyzed.</div></div><div><h3>Results</h3><div>Patients with biloma demonstrated a longer time to jaundice clearance (p=0.004), more frequent episodes of postoperative cholangitis (p=0.006), and higher levels of alkaline phosphatase (ALP) at 5 months post-operation (p=0.037). There was a significant decrease in bilirubin levels (p=0.028) and gamma-glutamyltransferase (GGT) (p=0.021) after biloma treatment. However, there was no significant difference in the overall outcomes of Kasai operation between the two groups.</div></div><div><h3>Conclusion</h3><div>Biloma formation should be suspected in biliary atresia patients requiring longer duration to clear jaundice, having persistent ALP level and frequent episodes of cholangitis after the Kasai operation. Treatment of biloma improves liver function but it did not show a significant difference in the overall outcome of portoenterostomy.</div></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"9 ","pages":"Article 100189"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143102544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Editorial Board Page","authors":"","doi":"10.1016/S2949-7116(25)00004-8","DOIUrl":"10.1016/S2949-7116(25)00004-8","url":null,"abstract":"","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"9 ","pages":"Article 100195"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143102597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}