PTSD Risk Factors and Acute Pain Intensity Predict Length of Hospital Stay in Youth after Unintentional Injury.

Background: Many hospitals have adopted screening tools to assess risk for posttraumatic stress disorder (PTSD) after pediatric unintentional injury in accordance with American College of Surgeons recommendations. The Screening Tool for Early Predictors of PTSD (STEPP) is a measure initially developed to identify youth and parents at high risk for meeting diagnostic criteria for PTSD after injury. Acute pain during hospitalization has also been examined as a potential predictor of maladaptive outcomes after injury, including PTSD. We investigated in a retrospective cohort study whether the STEPP, as well as acute pain intensity during hospitalization, would predict maladaptive outcomes during the peri-trauma in addition to the post-trauma period, specifically length of hospitalization. Methods: A total of 1123 youths aged 8-17 (61% male) and their parents were included. Patients and parents were administered the STEPP for clinical reasons while hospitalized. Acute pain intensity and length of stay were collected through retrospective chart review. Results: Adjusting for demographics and injury severity, child but not parent STEPP total predicted length of stay. Acute pain intensity, child threat to life appraisal, and child pulse rate predicted length of stay. Conclusions: Acute pain intensity and child PTSD risk factors, most notably child threat to life appraisal, predicted hospitalization length above and beyond multiple factors, including injury severity. Pain intensity and child appraisals may not only serve as early warning signs for maladaptive outcomes after injury but also indicate a more difficult trajectory during hospitalization. Additional assessment and treatment of these factors may be critical while youth are hospitalized. Utilizing psychology services to support youth and integrating trauma-informed care practices during hospitalization may support improved outcomes for youth experiencing unintentional injury.

Mucinous adenocarcinoma of the lung in association with congenital pulmonary airway malformation.

Congenital pulmonary airway malformation (CPAM) is a rare developmental abnormality of the lung that has been associated with the presence of rhabdomyosarcoma, pleuropulmonary blastoma, and most commonly bronchioalveolar carcinoma (BAC) of the lung. Here, we report the case of an 8-year-old patient who developed KRAS mutation positive stage IV mucinous adenocarcinoma of the lung in association with CPAM. This case reflects the previously recognized progression of CPAM to malignancy and suggests that BAC arising in CPAM may take a more aggressive course than previously recognized.

Magnetic resonance imaging-guided laparoscopic-assisted anorectoplasty for imperforate anus.

PURPOSE: Magnetic resonance imaging (MRI) has been well described as a modality for evaluation of a failed anorectal pull-through procedure for imperforate anus. To the authors' knowledge, intraoperative MRI has not been previously used to guide a laparoscopic-assisted anorectoplasty (LAARP). We propose that such a procedure would assure anatomically correct placement of the pulled-through rectum. METHODS: Three male patients with imperforate anus and a prostatic urethral fistula underwent an MRI-guided LAARP in an operative MRI suite. The patients' ages ranged from 5 to 6 months at the time of their pull-through procedure. Preoperative MRIs with mineral oil within the distal colostomy were performed on all patients to document the anatomy of the rectourethral fistula and its relationship to the parasagittal and vertical muscle complex. The perineum was pierced with an MRI compatible needle at the central portion of the parasagittal muscle complex as determined by a direct muscle stimulator. Further incremental advancement of the needle within the muscle complex was guided by serial MRIs in axial, coronal, and sagittal planes until the levator floor was penetrated, and the peritoneal cavity was entered. LAARP was then completed. RESULTS: Completion MRI demonstrated placement of the pulled-through segment in a central location through the length of the muscle complex. Serial MRIs performed intraoperatively during advancement of the localization needle demonstrated a curved path of the vertical fibers. Attempts to nonincrementally advance the needle in a straight plane resulted in a breach of the vertical muscle complex or eccentric placement of the needle. CONCLUSIONS: Magnetic resonance imaging-guided LAARP results in anatomically correct placement of the rectum within the vertical muscle complex. Straight needle advancement techniques in LAARP could result in a deviation of the pulled-through rectum from the central muscular path. Further follow-up will be required to demonstrate functional advantage.