Journal of Pediatric Surgery Article Review: May 2023, CAPS Issue
With Dr. Sonia Butterworth & Dr. Jacob Langer & Dr. Greta Bercher & Dr. Katerina Dukleska · hosted by Dr. Cecilia Gena & Dr. Tom Bash · StayCurrentMD
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Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
The Hirschsprung-associated IBD study was retrospective, looked at data from 2000 to 2021 at 17 institutions
55 patients were included in the Hirschsprung study, 50% had long segment disease
Enterocolitis was reported in 68% of Hirschsprung patients after pull-through
The most common presentation was colonic or small bowel inflammation resembling IBD
Three risk factors for Hirschsprung-associated IBD: trisomy 21, history of enterocolitis following surgery, and long segment disease
Biologic therapy is powerful and most likely to be effective for Hirschsprung-associated IBD
Hirschsprung-associated IBD is very poorly defined and presents in a number of different ways
Hirschsprung enterocolitis that persists past age 5 or is unresponsive to typical treatment under age 5 should prompt consideration of this diagnosis
The COVID-19 study assessed patients from February 2018 to June 2019 as pre-pandemic control and mid-February 2020 to June 2021 as COVID period
1100 patients total: 44% in pre-pandemic group, 56% in COVID-19 group
A larger proportion of complicated appendicitis occurred during COVID-19 compared to pre-pandemic period
Complicated appendicitis was defined as: perforated appendicitis, clear purulent peritonitis, or small bowel obstruction from appendicitis
Symptom duration at presentation and length of stay were not significantly different between pre-pandemic and COVID groups
Median symptom duration was 1 day pre-COVID and 2 days during pandemic, though not statistically significant
There was a clinically significant difference in symptom duration despite lack of statistical significance
Increased rate of perforation occurred during pandemic versus pre-pandemic
Patients during pandemic stayed in hospital longer and had increased risks of complications
Ontario government made it mandatory that all patients below 18 years of age had to be treated at a pediatric hospital during pandemic
The button battery study evaluated if implementation of a clinical algorithm shortened time from diagnosis to removal
The algorithm was based on the national database algorithm and implemented in October 2019
The institution already had a CART (critical airway response team) that activated all stakeholders except gastroenterology
Time from chest X-ray to button battery removal was shortened from 73 to 35 minutes after implementing the protocol
Even 73 minutes was a very impressive target before protocol implementation
Button battery ingestions are not common events
Anticipated decrease in major complications for button battery patients with faster removal times