OK. Welcome back, everyone, to another episode of the Stay Current podcast. I'm Cecilia Gena and I'm, I'm Tom Bash. And we are research fellows at Cincinnati Children's Hospital. And along with Stay Current, we are sharing knowledge to improve child health around the globe. So, today we are with another episode of the JPS podcast. It's May. Issue for this issue of May, we have the CUPS issue. CAPS is the Canadian Association of Pediatric Surgeons. For this episode, we talked to Doctor Sonia Butterworth. Sonia Butterworth, I'm a pediatric surgeon at BC Children's Hospital, a clinical professor at UBC, and the chair of the publication committee for the Canadian Association of Pediatric Surgeons. And we have 3 articles. The first one is about Hirshprung associated inflammatory bowel disease. The second one is about pandemic policies and its consequences in appendicitis. And the last one is about the use of a critical airway response team for bottom battery ingestion. As always, you can find the articles in the description below so you can follow along with us. Great. So with nothing else to say, let's start. So the first article of today is Hirschspring associated inflammatory bowel disease, a multi-center study from the Absa Hirshspring Disease Interest Group, and it's a retrospective study that looked from 2000 to 2021 at 17 institutions, and they want to identify potential risk factors for IVD symptoms after a pull-through and the treatment response. And we talked to the senior author, Dr. Jacob Langer. I'm Jacob Langer. I'm a pediatric surgeon in Toronto. So they have 55 patients, 50% of them had lung segment disease, and enterocolitis was reported in 68% of them after the pull through. The most common presentation for these patients was the colonic or small bowel inflammation resemble IBD. The three things. That came up as risk factors, trisomy 21, a history of enterocolitis following Coulter's surgery, and long segment disease. And then the treatment with respect to what was most likely to be effective and just how powerful that biologic therapy is. And again, that was Dr. Sonia Butterworth, the editor that helped us choose these articles. So Hirschsprung's associated inflammatory. Bowel disease, like how common is that? Well, I don't know if it's really common in a normal pediatric surgery practice, but people that specialize in colorectal surgery, I think they see it pretty often. This Hirschsprung's associated IBD is very poorly defined, and it presents in a number of different ways, and we have no idea why it happens. And this paper is the first step in understanding this condition. The other really, I think important thing is it talked about the Hirschprung's enterocolitis that persists either past age 5, or that are unresponsive to typical treatment under age 5. I think many would not necessarily consider this diagnosis, so it just highlights this to the pediatric surgery population. All right, I mean, this is, this is helpful. It's really interesting. And that was tough. And the second paper of the day is unanticipated consequences of COVID-19 Pandemic policies on pediatric acute appendicitis surgery. This is a paper from Hospital for Sick Children in Toronto, Canada, and for this paper, we talked to the senior author. Hey, I'm Greta Bercher. I'm a pediatric surgeon at Sick Kids and I'm transitioning actually to go to Dartmouth Hitchcock. In New Hampshire. As we all know, we had the COVID-19 pandemic a few years ago and this limits access to specialized care, access to the hospital and healthcare providers. In this paper, authors wanted to see how the pandemic policies affected pediatric acute appendicitis surgery outcomes. They retrospectively assessed patients and they created two groups. One is from patients admitted to the hospital with acute appendicitis from February 2018 to June 2019. They call this a pre-pandemic control group. And the COVID period that we had analyzed was from Basically, mid February 2020 to June 2021. And in these two groups, they had 1100 patients in total, 44% of them in the pre-pandemic control group and 56% in the COVID-19 group and according to their study, a larger proportion of complicated appendicitis occurred during COVID-19 compared to So we had a pretty precise definition of complicated appendicitis. All the perforated appendicitis. The second one was when there was clearly pure peritonitis, and the third one was if they had a small bowel obstruction from their appendicitis. But interestingly, symptom duration at presentation and length of stay were not significantly different. Why? What's their theory on why? I think I don't know the answer to that question. I think we saw. Some increased distance, increased complication rates, but the exact biological answer to that, I don't know. Here's Doctor Butterworth. She helped us choose articles as CAP's publication committee chair. I was surprised by that, but then when I looked a little bit closer, it was interesting because although there was no statistically significant difference. The median symptom duration between onset of symptoms and presentation to emergency was 1 day pre-COVID and 2 days during the pandemic. And so, even though it wasn't statistically significant, I do think that there was a clinical significant difference. Yeah, I think that I was surprised too that the time was not significantly different cause one would expect that. But what the author told us, pediatric patients, meaning under 18 years old, were only going to be taken care of in pediatric hospitals. And so, I wonder if this more complicated appendicitis actually is a reflection of having older patients. Not surprisingly, they did have an increased rate of perforation pre-pandemic versus post-pandemic. They stayed in hospital for, for longer and had increased risks of Complications. The government of Ontario made it mandatory that all children, so all patients below 18 years of age, had to be treated at a pediatric hospital. It's interesting how some of the decision making from a policy side could affect some of the volumes at our hospitals. And I think we're ready for your papers, Cecilia. Awesome. So the last one of the day, utilizing a critical airway response team expedites esophageal bottom battery removal. And we talked to one of the authors, Doctor Katerina Dukleska. Hi everyone, I'm Katerina Dukleska. I'm an assistant professor of surgery and an attending pediatric surgeon at Connecticut Children's in Hartford, Connecticut. This is a A study made on Connecticut, it's a retrospective study, and they wanted to evaluate if the implementation of a clinical algorithm shortened the time from diagnosis to removal of the esophageal bottom battery. And so what they did is they created an algorithm based on the national database algorithm and implemented in October 2019. At our institution, we already had something called a CART team or a critical airway response team, and essentially what we decided to do because the CART team activated all of the stakeholders with the exception of the gastroenterology team, so by Doing so, we actually, the purpose of this paper was to track our time from diagnosis to the OR. So what they found is that after implementing this algorithm of the critical airway response team, they shortened the time from. The chest X-ray to the bottom battery removal from 73 to 35 minutes. By instituting a protocol, not only may it improve outcomes, it actually cuts the time in half. And that was tough. Uh, first of all, I thought that even 73 minutes was a very impressive. Target, but that they were able to get it down to less than half was certainly impressive. And again, that was Sonia Butterworth. And I think this is one of those papers that having a guideline that you can follow along and you know what to do, it's kind of helps you go to your goal in a short amount of time because everyone. Knows where the patient needs to go next and also implementing a protocol or a guideline gives this management a structure. These are not common events and even though we didn't talk about outcomes, you know, I would anticipate with time, we're gonna be able to see a decrease in at least major complications for these patients. OK. So, there we have it. This was the May issue of the JPS podcast. We first went through inflammatory bowel disease associated with Hirschsprung after pull-through, and we know now that we have some risk factors to be aware of, to check in our Hirschsprung patients. Then we talked about the pandemic policies and how they affected the appendicitis. This making people go further away and actually creating like more complicated appendicitis in that period. And lastly, we talked about implementing a critical airways response team for the esophaal baton battery ingestion and so that that was really helpful and useful as we have seen that protocols are for many things before. If you like this episode, give us a rating on wherever you listen to your podcasts. Don't forget to subscribe to our YouTube channel, follow us on social media, and download the Stay Current app for hundreds of pieces of content. I'm, I'm Tom Bash, and I'm Cecilia Jigena. And we are research fellows at Cincinnati Children's Hospital, and along with Stay Current, we are sharing knowledge to improve child health around the globe.
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