ABSTRACT
BACKGROUND: There are safety concerns about the use of radiation-based imaging (computed tomography [CT]) to diagnose appendicitis in children. Factors associated with CT use remain to be determined. METHODS: For patients ≤18 years old undergoing appendectomy, we evaluated diagnostic imaging performed, patient characteristics, hospital type, and imaging/pathology concordance (2008-2012) using data from Washington State's Surgical Care and Outcomes Assessment Program. RESULTS: Among 2538 children, 99.7% underwent pre-operative imaging. 52.7% had a CT scan as their first study. After adjustment, age >10 years (OR 2.9 (95% CI 2.2-4.0), Hispanic ethnicity (OR 1.7, 95% CI 1.5-1.9), and being obese (OR 1.7, 95% CI 1.4-2.1) were associated with CT use first. Evaluation at a non-children's hospital was associated with higher odds of CT use (OR 7.9, 95% CI 7.5-8.4). Ultrasound concordance with pathology was higher for males (72.3 vs. 66.4%, p=.03), in perforated appendicitis (75.9 vs. 67.5%, p=.009), and at children's hospitals compared to general adult hospitals (77.3 vs. 62.2%, p<.001). CT use has decreased yearly statewide. CONCLUSIONS: Over 50% of children with appendicitis had radiation-based imaging. Understanding factors associated with CT use should allow for more specific QI interventions to reduce radiation exposure. Site of care remains a significant factor in radiation exposure for children.
Subject(s)
Appendectomy , Appendicitis/diagnosis , Diagnostic Imaging/statistics & numerical data , Quality Improvement , Acute Disease , Adolescent , Adult , Appendicitis/surgery , Child , Child, Preschool , Diagnostic Imaging/standards , Female , Humans , Male , Reproducibility of Results , Tomography, X-Ray Computed/standards , Tomography, X-Ray Computed/statistics & numerical data , WashingtonABSTRACT
Extralobar pulmonary sequestrations have been occasionally described in the abdomen but rarely in the diaphragm. We present the case of a 10 month old girl with an intradiaphragmatic pulmonary sequestration. The minimally invasive operative technique is outlined in detail, including the combine use of laparoscopy and thoracoscopy. The case is discussed and the literature is reviewed.
Subject(s)
Bronchopulmonary Sequestration/surgery , Diaphragm , Laparoscopy , Thoracic Surgery, Video-Assisted , Bronchopulmonary Sequestration/diagnosis , Diaphragm/pathology , Diaphragm/surgery , Female , Humans , InfantABSTRACT
Congenital cervical anomalies are important to consider in the differential of head and neck masses in children and adults. These lesions can present as palpable cystic masses, infected masses, draining sinuses, or fistulae. Thyroglossal duct cysts are most common, followed by branchial cleft anomalies, dermoid cysts, and more rarely median cervical clefts. Other topics discussed include median ectopic thyroid, cervical teratomas, and branchiootorenal syndrome. Appropriate diagnosis and management of these lesions requires a complete understanding of their embryology and anatomy. Correct diagnosis, resolution of infectious issues before definitive therapy, and complete surgical excision are essential to prevent recurrence.
Subject(s)
Branchial Region/abnormalities , Branchioma/diagnosis , Thyroglossal Cyst/diagnosis , Branchio-Oto-Renal Syndrome/diagnosis , Dermoid Cyst/diagnosis , Head and Neck Neoplasms/diagnosis , Humans , Magnetic Resonance Imaging , Radiography , Thyroglossal Cyst/diagnostic imagingABSTRACT
BACKGROUND: Nonoperative management of many pediatric injuries has generated debate as to whether surgeons must be routinely involved in the early assessment and management of pediatric trauma. This study examines the frequency of operative intervention among injured children and evaluates potential predictors of emergent intervention. METHODS: Pediatric (age < 18 years) patients were identified from the National Trauma Data Bank. Primary outcome measures were surgical intervention by specialty, time to intervention, and mortality. Prehospital factors were evaluated as predictors of emergent surgical intervention. RESULTS: Thirty percent of trauma admissions underwent operative intervention, with 57% of these requiring emergent surgery. Patients needing emergent general or neurosurgical intervention were at increased risk of death. Requiring one type of emergent surgical intervention was predictive of needing a second type of emergent procedure. Predictors of emergent general surgical intervention were penetrating mechanism, increasing age, and the presence of shock or coma. CONCLUSION: These data support the continued routine involvement of surgeons in the initial assessment and management of the injured child.