Hi everyone. Welcome back. We're back with another Journal of Pediatric Surgery article review. I'm Ellen and Cisco and I'm Ealmesh, Brittany Levy, and we're research fellows with the state current team and Cincinnati Children's Hospital Medical Center. As a reminder, in this series, we review articles from the Journal of Pediatric Surgery. This is from the May issue. We got a little bit behind in the months, but we're catching up. As usual, we got help from the editorial board in picking the articles that we're featuring here. The main issue was the CAPS issue. Alan, what is CAAPS? So CAPS is the Canadian Association of Pediatric Surgeons, and these publications are from the presentations at the last CAPS conference. So Doctor Sonia Butterworth helped us choose these articles. She is the chair of the CAPS publication Committee and a pediatric surgeon. At BC Children's Hospital. And if you want to read along to any of these articles, be sure to check out below the Media Player. We have all of the links to all the articles discussed today. OK, so we have 3 articles coming up for you. One about pediatric firearm injuries, one about long-term outcomes in Hirschsprung disease, and one about pediatric bicycle injuries. OK, the first article we're going to review is called The Hidden Mortality of Pediatric Firearm Violence. It's out of UC Davis in California. So this was a retrospective review. The authors looked at institutional data and statewide data. So in this study, we compared the impact of motor vehicle collisions and firearm violence in pediatric trauma patients, and we chose these two mechanisms of injury as they represent the leading causes of morbidity and mortality in this age group. That is Dr. Christina Theodoro. I'm a general surgery resident. UC Davis Medical Center. They looked at the mortality of those patients, finding that the mortality was higher for the patients with gunshot wounds. Despite lower absolute numbers of children sustaining firearm injuries, the mortality was significantly higher at 7.5%. And that's compared to 1% for motor vehicle collisions. And after adjusting for confounding factors, children who were shot were 7.8 times more likely to die than those injured in MPCs. They also calculated the case fatality rate. So case fatality rate, meaning The number of fatal cases divided by the total number of cases. And so the unfortunate truth is that we can only save children who survive their injuries long enough to make it to the hospital. Uh, and as expected, the mortality or the case fatality rate statewide was almost 15% overall, which is twice as high as our institutional mortality rate. And 49 times higher than the case fatality rate statewide for NBCs, which is astounding. Here's Doctor Todd Pansky. Right, so that just means that guns got worse, more guns got more uh damaging. Although we saw that the case fatality rate across the state decreased over time for motor vehicle related injuries, the case fatality rate for children injured by firearms rose from 13% to almost 17% over time. Which is just another sad reminder of the progress that hasn't been made. Other concerning findings came when the authors looked at some of the mechanisms behind the injuries. The rate of self-inflicted pediatric gunshot wounds doubled over the study period from 2% to 4.4% of all pediatric firearm injuries, and these injuries had a case fatality rate of 77%, which is Hard to believe. Um, these data, in conjunction with what everyone knows of their own institutional data, highlight the multiple areas that are in critical need of intervention. The, the authors I felt were, were very diligent in not only really carefully looking at their own uh database, but going and looking at multiple statewide databases. That was Doctor Sonia Butterworth, the editor that helped us choose these articles. To gather the information on, um, what was happening to, to patients in the field, if you will, uh, that never made it to hospital and, and, um, and really understand the impact as a population. Um, and I think that more authors and, and more groups, um, uh, would benefit, uh, from that kind of thorough approach. Look, this is an interesting article. Yes, it showed that gun violence went up, we all know that, but more interestingly, it showed that case by case, A child getting shot by a gun 10 years ago had less of a chance of dying than a child getting shot by a gun now, which suggests maybe that that's because our guns became more dangerous. Yes, I think one of the interesting things about this paper being published in May 2022 is that every so often when we have these big nationwide tragedies, we have this resurgence of people that are up in arms about pediatric gun violence and And gun violence in schools, and how can we change it, and how can we help. But when you see papers like this published, you know that they didn't just start researching it, you know, in April or in January when we've had kind of this nationwide outcry. Research has been going on for a long time. So there is Groups of people across the nation who are working on this all the time, they just don't always have a national spotlight on them. And I think that bringing these papers up is so important frequently so that we, we recognize those people exist and figure out how we can help when there isn't this, this nationwide tragedy. Yeah, that's a great point, Brittany. This research isn't new and has been ongoing. I, I suspect we'll, we'll be hearing more on this, um, but I think it shines a really Uh, a really important light, um, on something that, uh, I think we should all care very deeply about. Well, there's a lot of, a lot more work to be done in terms of trying to figure out how we can reduce the risk to children. Um, I think that's gonna be a multi-pronged approach, so. Again, that's Doctor Christina Theodoro, the first author in the paper, and she says that there should be local interventions like community violence interventions programs. And so that can kind of help reduce violence in the community, but I think obviously there's a lot of policy level changes that need to be made around the country to reduce access to firearms and increase the safety. And then as, you know, residents and surgeons, I think it's important to know that you can make an individual difference. Every time you see a kid who's injured, you can talk to the family about firearm safety, safe storage, and things like that. That's a really great point. That's something we can all do on a daily basis is talk to trauma patients about gun safety. OK, let's move on to the next article on long-term outcomes in Hirschsprung disease. My question for you, Todd would be, for amongst Hirschrung kids, isolated Hirschrung, how do you think they do in terms of school assessments and, you know, neurodevelopmental outcomes compared to their peers? Um, maybe slightly delayed. I think that we underestimate the impact of childhood ailments and childhood procedures, no matter what it is. And here's Brittany to tell us about this article. Next up, we're gonna be talking about educational outcomes in school-age children with history of Hi Spring's disease. And for anyone that tuned in to the best of the best, this was one of the CAPS presentations. So this was brought to us by um the University of Manitoba all the way in Canada, and really looking at what are the long-term outcomes cognitively of children that go through treatment and The hospitalization experience for Hirschprung's disease, um, as children. We did a retrospective kind of cohort study of all the Hirshsprung patients born in Winnipeg, Canada. That's Doctor Michael Co op, the first author on this paper. I'm a resident at the University of Manitoba in Canada. So, in their study, they looked at 75 patients with Spring's disease. Um, and then we used a provincial data repository that we had available to us called the Manitoba Center for Health Policy, and using that, we found a 10 to 1, uh, match control cohort. They looked at, as they entered elementary school, were they on par with their classmates in terms of standardized testing and Even further than that in graduation rates from high school. In general, we're trying to study, uh, uh, uh, in Winnipeg, if when you're born with a congenital surgical anomaly, how is that gonna affect the rest of your life? That's Doctor Richard Kaiser, the senior author. Our study is unique in the sense that we are able to uh uh go backwards in time and uh do almost like a retrospective. Uh, long-term follow-up study because you have access to these databases and administrative databases that have been collecting information on these patients while they were growing up. And so basically, they found that really, it's the same. It was interesting to see um that the Hirshprung patients performed. Um, just as well as the control cohort, basically from grade 3 or grade school onwards until grade 12 graduation. But early on in school, in the preschool age, much closer to their treatment timeline for most kids with Hirschsprung's disease, you can see some differences in neurodevelopmental performance. And whether that was, you know, just a product of the early developmental index index and what it actually measures, it's one of the more subjective ones of the Examinations that we looked at. Here's what Todd had to say. Fantastic news. I mean, that, because Hirschsprung's is is not like a one and done. That's like a a pretty involved thing to have. And so, I would have expected that there would have been lasting impact. So, I would be curious to see what happens in even longer follow-up. What happens in adolescence or or on. But I think that's actually a pretty impressive, uh, Result. And here's Doctor Butterworth again. Very encouraging, uh, I think for all of us as, um, as pediatric surgeons to, to see that, that, that was happening, but also to recognize that going into school, as I think many of us, um, expect and counsel our families, that they may well Um, still have some challenges, um, around, um, potty training and bowels and abdominal discomfort, those kind of things. Um, so I think it's, uh, an important piece of information that I think we, uh, we can benefit from, uh, from this study. I would say overall the findings are helpful for educating parents of kids with Hirschprung disease. You know, maybe some of them are worried coming in that their kids might have a developmental delay down the road, but based on this data, most of them don't, especially for isolated Hirschprung disease, and that's something we can let the parents know. We have done previous studies with a parent. Of a child with Hirsprung disease and um uh she's, she's high up in the organization of REACH, research, education and awareness for children with Hirsprung disease. And through that, so I, I just wanna do a little shout out for them. Uh, they, they distribute these types of educational resources and, and information and share it with parents. OK, time for our last article. Here's M. And the last article called Analyzing Pediatric Bicycle Injuries Using Geodemographic Data. This is a study about pediatric bicycle accidents. This is a retrospective study about bicycle accidents in Miami. They found 77 cases. Todd, how many of them do you think wearing helmets? I would guess that 20% were wearing helmets. Just one of them wearing a helmets. Wow, OK. This is a study from University of Miami Miller School of Medicine. We talked with the senior author. I'm Chad Thorson. I'm a pediatric surgeon at the University of Miami, associate professor and associate program director there. And the first author. My name is Gareth Gilna. I'm a rising PGY 5, general surgery resident at the University of Miami, um, just finishing my two years of research fellowship and about to go back into my clinical years as a PGY 3. This study took all bicycle injuries at the Level One trauma centers for patients younger than 18 years old from October 2013 to March 2020. Yeah, so, um, I mean, we just did a retrospective chart review from our, uh, just in institution, uh, trauma database that we have, um, and parsed all the bicycle injuries out. They also use geodemographic data. Looking at. The zip codes and the associated income statuses with those zip codes and then looking at home addresses, um, and then we're able to kind of see, you know, distance from home, what, um, if they're near interstates and try to see if there's high clusters in certain, uh, cross sections and stuff like that. And over the eight year time period, they identified 77 cases, an average of 13 years old. I think probably the three main points that we saw was that one, the majority of the injuries were happening in low income neighborhoods. Secondly, the injuries were happening at a high. Speed areas, kind of like interstate on-ramps and off-ramps, and then it was about half of the injuries happened within 1 mile from home. I found it really powerful to take a look at their figure one, which basically has the SES, so the median household income. The bicycle injuries per 10,000 and then the mean injury severity score, and they've got the, the roads and the highways um on the map, uh, and you can see quite clearly that there's, there's things that line up. We've been looking into, uh, you know, ways to interact with the community to increase helmet usage. And the research shown that free helmet programs going through a pediatricians office is useful but needs to be sustained. Cities that have been successful have implemented multidisciplinary ways of doing it, like free helmet programs, changing the laws, uh, public education, so hitting the issue from multi, multifaceted areas and then sustaining that over several years has been the way that it's successfully been maintained. Yeah, so, um, I'm the director of the injury-free Coalition for Kids, and we do have an injury-free bus that, um, goes around to the community. With COVID, we've been kind of obviously squashed, but it gave us time to upgrade our bus. So we do have a new tour bus that, um, has been fully renovated, has fire safety, helmet safety, um, skateboard, car seats, all, all you can imagine, uh, firearm safety as well, that we're going to the communities and, and providing that education in the field. I think in all of these studies about injury and trauma and bicycle accidents and gunshot wounds, this is a really a call to action for a lot of public health initiatives and for policy reform, both on a large scale of gun reform, but also even within our own communities where we see that kids aren't putting on helmets and they get hurt. I mean, there's a lot that we can do that doesn't require a huge sweeping bipartisan change, which is difficult but important, and there's things that we can do in our own communities. Yeah, I think all, all three of them in some ways really help put our patients in context, looking at supports, looking at, you know, bigger picture strategies that we as surgeons can be aware of, potentially, you know, even instigate or, or lead change, um, particularly in, in the trauma literature, um, because I think our voice is an, an important one. OK, great summaries. Stay tuned to the next podcast for the JPS article reviews. The next podcast will cover the June issue. And we have another virtual event coming up soon. We've got the update course coming up, and so tune in virtually, um, or you'll have our update course rewinds coming out a few months after. And the update course is happening on August 30th. We're gonna have some people in person in Cleveland, Ohio, but anyone is welcome to join virtually. Find the link below. Until then, don't forget to subscribe to our YouTube channel. Don't forget to leave us a comment and a review on either Apple Podcasts or Spotify, depending on where you're listening. And don't forget, as always, to download the Stay Current and pediatric surgery app where you can hear all of our podcasts, watch our videos, and see other content. Until next time, I'm Ellen. I'm Em. I'm Brittany. And remember, knowledge should be free.
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