Rosemary Nabaweesi

Splenectomy in hereditary spherocytosis: Review of 1,657 patients and application of the pediatric quality indicators

The objective of the present study is to profile the outcome and safety of pediatric patients undergoing splenectomy with hereditary spherocytosis (HS) using a nationwide sample and the Agency for Healthcare Research and Quality (AHRQ) Pediatric Quality Indicators (PDIs).

Diagnostic radiation exposure in pediatric trauma patients.

BACKGROUND The amount of imaging studies performed for disease diagnosis has been rapidly increasing. We examined the amount of radiation exposure that pediatric trauma patients receive because they are an at-risk population. Our hypothesis was that pediatric trauma patients are exposed to high levels of radiation during a single hospital visit. METHODS Retrospective review of children who presented to Johns Hopkins Pediatric Trauma Center from July 1, 2004, to June 30, 2005. Radiographic studies were recorded for each patient and doses were calculated to give a total effective dose of radiation. All radiographic studies that each child received during evaluation, including any associated hospital admission, were included. RESULTS A total of 945 children were evaluated during the study year. A total of 719 children were included in the analysis. Mean age was 7.8 (±4.6) years. Four thousand six hundred three radiographic studies were performed; 1,457 were computed tomography (CT) studies (31.7%). Average radiation dose was 12.8 (±12) mSv. We found that while CT accounted for only 31.7% of the radiologic studies performed, it accounted for 91% of the total radiation dose. Mean dose for admitted children was 17.9 (±13.8) mSv. Mean dose for discharged children was 8.4 (±7.8) mSv (p<0.0001). Burn injuries had the lowest radiation dose [1.2 (±2.6) mSv], whereas motor vehicle collision victims had the highest dose [18.8 (±14.7) mSv]. CONCLUSION When the use of radiologic imaging is considered essential, cumulative radiation exposure can be high. In young children with relatively long life spans, the benefit of each imaging study and the cumulative radiation dose should be weighed against the long-term risks of increased exposure.

Lorenz Bar Repair of Pectus Excavatum in the Adult Population: Should it be Done?

BACKGROUND Although extensive literature exists on the Lorenz bar repair of pectus excavatum (PE) in pediatric patients, few data examine this repair in adults or compare long-term outcomes in adults with the pediatric population. We identified the preoperative characteristics, postoperative complications, and outcomes of adult patients undergoing Lorenz bar repair of PE who had bar removal and compared these outcomes with a pediatric population undergoing the same procedure. METHODS A retrospective review (1997 to 2006) of patients undergoing primary repair of PE with a Lorenz bar identified 107 individuals aged older than 18 and 137 patients aged 6 to 14, of whom 52 and 80 had their bar(s) removed, respectively. These latter patients were the focus of analysis. Data collected included demographics, preoperative symptoms, operative characteristics, and postoperative outcomes. RESULTS The median (interquartile range, IQR) age and pectus index of adult patients (81% men) at the time of repair was 23 (18 to 30) years and 3.8 (3.5 to 4.3), respectively. In 2 adults (3.9%), PE recurred after bar removal, and 6 (11.6%) required surgical revision for bar displacement or upper sternal depression. These rates of complications were similar to those found in children undergoing Lorenz bar repair of PE at our institution. CONCLUSIONS Lorenz bar placement to correct PE in adults can be performed safely and effectively, with rates of bar displacement, sternal depression, recurrence, and reoperation that are not statistically different than those found in a younger pediatric population.

Pectus bar repair of pectus excavatum in patients with connective tissue disease

PURPOSE Few studies address the surgical correction of pectus excavatum (PE) in patients with connective tissue disease (CTD). We have identified the preoperative characteristics, postoperative complications, and outcomes of patients with CTD undergoing bar repair of PE and compared these outcomes to a control group without CTD. METHODS A retrospective review of patients undergoing primary repair of PE with a bar procedure from 1997 to 2006 identified 22 patients with CTD. Of those, 20 (90.9%) had their bars removed. We identified 223 patients of similar age without CTD whose bars were removed. Data collected included demographics, preoperative symptoms, operative characteristics, and postoperative outcomes. RESULTS Among those with CTD, the median age at repair was 15.5 years, with a mean pectus index of 4.0 +/- 1.4. Three patients (13.6%) experienced bar displacement or upper sternal depression requiring surgical revision. Only 1 patient recurred after bar removal. Rates of bar displacement, upper sternal depression, and recurrence were not statistically different than those in the comparison group. CONCLUSIONS Patients with CTD benefit from primary bar repair of PE and experience excellent operative outcomes after repair, with complication rates being no different than those found in similarly aged control patients.

Assessment of Safe Sleep: Validation of the Parent Newborn Sleep Safety Survey

Purpose: Sudden Infant Death Syndrome (SIDS) and suffocation account for more than half of all Sudden Unexpected Infant Deaths (SUID). The American Academy of Pediatrics (AAP) recommendations describe the safest environments to protect infants. This study compared parent responses on the Newborn Sleep Safety Survey and observational assessments (N = 72) of infant sleep environments in families thought to be at high‐risk for non‐compliance with AAP recommendations. Design and Methods: A naturalistic study of participants enrolled in two home visitation support programs was used. Observed risks ranged from 36.6% (never use pacifier) to 4.3% (never use firm mattress). Results: Results comparing report to observation demonstrated acceptable concordance. Five items had fair concordance (Kappa > .4), four showed moderate concordance (Kappa > .6), and one excellent concordance (Kappa > .8). Although direct observation of safety behaviors is the gold standard in the injury prevention field, direct observation is logistically difficult, time consuming, and costly. Conclusions: Research and interventions aimed at a reduction of Sudden Infant Death Syndrome (SIDS) and suffocation require accurate assessment of the infant sleep environment. This study provides acceptable evidence for the use of the Newborn Sleep Safety Survey as an alternative to direct observation to assess parent adherence to recommendations. Limitations are discussed. Practical Implications: This study provided evidence of the usefulness of the Newborn Sleep Safety Survey, a parent survey of infant sleep environments. This tool will provide medical and research professionals a reliable, inexpensive tool to evaluation of the quality of sleep environments using a standard definition. Highlights:Sudden Infant Death Syndrome and suffocation are in the top three causes of infant mortality in the US.Infants who succumb to SIDS are unable to respond and protect themselves.A screening tool is needed to assess the risk of SIDS in the home sleeping environment.The Newborn Sleep Safety Survey is a reliable tool to identify risk of SIDS in the sleep environment.

A Cross-Sectional Study of Emergency Department Visits by Children After All-Terrain Vehicle Crashes, Motor Vehicle Crashes, and Sports Activities.

Objectives All-terrain vehicle (ATV) crashes have been responsible for significant injuries among children, despite public education efforts. Our study examined pediatric ATV injury patterns in US emergency departments (EDs) compared with injuries after motor vehicle crash (MVC) and sports activities. Methods We studied 2006 to 2011 data from the Nationwide Emergency Department Sample. Children younger than 18 years and involved in ATV crashes, MVC, or sports activities were included. The primary outcome analyzed was a constructed binary measure identifying severe trauma, defined as injury severity score greater than 15. Logistic regression models were fit to determine the association between mechanism of injury and severe trauma. Results A total of 6,004,953 ED visits were identified. Of these, ATV crashes accounted for 3.4%, MVC accounted for 44.7%, and sports activities accounted for 51.9%. Emergency department visits after ATV crashes were more likely to result in admission (8%) and incur higher median charges (

42 Emergency department visits for all-terrain vehicle (ATV) injury among U.S. children

1263) compared with visits after sports activities (1%,

Risk stratification of 4344 patients with gastroschisis into simple and complex categories

1013). Visits after sports activities were 90% less likely to result in severe trauma when compared with ATV crash visits. Emergency department visits after ATV crashes result in severe injuries similar to those sustained in MVC (odds ratio, 1.03; P = 0.626). Conclusions Pediatric ED visits after ATV crashes result in significant injuries and charges. Public health interventions such as education, legislation, and engineering are needed to reduce injuries among children and the subsequent ED visits for care. The impact of proven interventions may be greatest for children living in rural areas and among older children, 10 to 17 years old.

Gastroschisis in the United States 1988-2003: Analysis and risk categorization of 4344 patients

Statement of purpose Increasingly popular, all-terrain vehicles (ATVs) continue to injure children disproportionately. This study examines ATV injuries in children who present to emergency departments (ED) in the US. Methods/approach We studied 2009–2011 data from the HCUP Nationwide Emergency Department Sample (NEDS). The NEDS is the largest, all-payer ED database in the US and is comprised of a 20% stratified sample of hospital-based ED visits from over 950 hospitals in 30 states. NEDS can be used to generate national estimates, with weighted data representing approximately 130 million discharges annually. ATV-related injuries occurring in children <18 years of age were included. Demographics, ED disposition, and charges were examined. Results A total 94,906 ATV-related ED visits were identified, occurring at a rate of 42.5/100,000 annually in children <18 years. 79.1 percent of these were <16 years, for whom ATV use is not generally recommended with a rate of 37.9 visits/ 100,000 annually. Out of all the visits, 92.6% were treated and released, 7.3% were admitted and 0.1% died in the ED. Males were over represented with 66.3%,56.8% had private insurance, 7.4% were uninsured and 32% received Medicaid. Majority reside in urban areas (58.3%), with 41.7% living in rural communities. There was a 9% decline from a 2009 rate of 46.7/100,000 and 34,659 ED visits (Confidence Interval [CI]: 31,742, 37,576) to a 2011 rate of 38.3/100,000 and 28,636 visits (CI: 26241, 31,032). ED visits were highest among the 15–17 year olds at 83/100,000; for 10–14 year olds, rates were at 65.3/100,000. While average charges per visit were

Retinal Hemorrhages and Shaken Baby Syndrome: An Evidence-Based Review

2,421, aggregate charges were