Gastrostomy Tube Use in Pediatrics: A Systematic Review.

CONTEXT: Despite frequency of gastrostomy placement procedures in children, there remains considerable variability in preoperative work-up and procedural technique of gastrostomy placement and a paucity of literature regarding patient-centric outcomes. OBJECTIVES: This review summarizes existing literature and provides consensus-driven guidelines for patients throughout the enteral access decision-making process. DATA SOURCES: PubMed, Google Scholar, Medline, and Scopus. STUDY SELECTION: Included studies were identified through a combination of the search terms "gastrostomy," "g-tube," and "tube feeding" in children. DATA EXTRACTION: Relevant data, level of evidence, and risk of bias were extracted from included articles to guide formulation of consensus summaries of the evidence. Meta-analysis was conducted when data afforded a quantitative analysis. EVIDENCE REVIEW: Four themes were explored: preoperative nasogastric feeding tube trials, decision-making surrounding enteral access, the role of preoperative imaging, and gastrostomy insertion techniques. Guidelines were generated after evidence review with multidisciplinary stakeholder involvement adhering to GRADE methodology. RESULTS: Nearly 900 publications were reviewed, with 58 influencing final recommendations. In total, 17 recommendations are provided, including: (1) tTrial of home nasogastric feeding is safe and should be strongly considered before gastrostomy placement, especially for patients who are likely to learn to eat by mouth; (2) rRoutine contrast studies are not indicated before gastrostomy placement; and (3) lLaparoscopic placement is associated with the best safety profile. LIMITATIONS: Recommendations were generated almost exclusively from observational studies and expert opinion, with few studies describing direct comparisons between GT placement and prolonged nasogastric feeding tube trial. CONCLUSIONS: Additional patient- and family-centric evidence is needed to understand critical aspects of decision-making surrounding surgically placed enteral access devices for children.

Implementation of a standardized screening program for risk of posttraumatic stress disorder among youth hospitalized with injury.

Children with pediatric injury and their parents are at risk for developing posttraumatic stress disorder (PTSD). Although challenging to implement, standardized screening for risk of developing PTSD can identify families most at risk. The current retrospective, chart review study evaluated the implementation of a clinical program that integrated screening for risk of PTSD into standard care for youth admitted to a Level I pediatric trauma center due to injury. Advanced practice nurses administered the Screening Tool for Early Predictors of PTSD (STEPP), a brief screen that evaluates risk of developing PTSD for injured children (ages 8-17 years) and their parents. Positive parent or child STEPPs prompted a referral to psychology for an inpatient consultation. Data were collected via review of electronic medical records and trauma program registry, including demographic, injury, and admission information, completion of and result on the STEPP, and completion of a psychology consultation. During the 2.5 year study period, 1,153 youth (birth-17 years) were admitted due to injury. Among those eligible for the STEPP (i.e., ≥8 years; N = 562), 67% completed the STEPP. Among those who completed the STEPP, 25% had positive parent or child screens and 68% of these completed an inpatient psychology consultation. Standardized screening was related to significantly higher use of inpatient psychology services compared with a control sample not eligible for screening (i.e., <8 years). STEPP scores varied by demographic, admission and injury factors. Results suggest standardized screening is feasible and improves reach of trauma-informed care. Barriers and facilitators of this screening program are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).