Quick Literature Updates Episode 4

Hello pediatric surgery family. I'm EmTom Bash, a research fellow from Cincinnati Children's Hospital Medical Center. And along with Stay Current, we share knowledge to improve child health around the globe. Today, our team is going to deliver the articles that you should know about. We have four papers today. First three of them are from the Journal of Pediatric Surgery, and the last one is an APSA article of interest from Critical Care Medicine Journal. We don't have much time, so let's start. Our first paper titled as, "Does the mechanism matter? Comparing thrombelastography between blunt and penetrating pediatric trauma patients" by Stevens et al. And this paper summarized by Ellen and Cisco. She's a research fellow at Cincinnati Children's Hospital. In this study, they looked at two pediatric trauma centers. Specifically, they looked at the highest level trauma patients presenting with either blunt solid organ injuries or penetrating injuries. And they looked at patients who had had a teg or a thromboelastography within the first two hours of arrival. They compared the coagulopathy measured on the teg between those two groups, blunt solid organ injuries and penetrating injuries. They found that the teg abnormalities were not significantly different between the two groups. But wait. They also looked at whether or not the patients presented in shock, and they found that patients presenting in shock had significant decreases in the alpha angle and in the MA values or maximum amplitude. So hemodynamic status or shock may be more predictive of coagulopathy than injury mechanism. Great. Let's keep moving. Our second paper is "Decreased ER visits and readmissions after implementation of a standardized perioperative toolkit for children with IBD" by Short et al. This paper is summarized by Rod Gerardo. He's a general surgery resident at Wright State University and a former research fellow at Cincinnati Children's Hospital. In this retrospective review, the researchers looked at pediatric patients who underwent a surgery for their inflammatory bowel disease before and after the implementation of a multidisciplinary clinic. What did they find? After the implementation of a multidisciplinary clinic that utilized protocols such as ERAS, there was a significant decrease in the 30-day ER visits post-operatively, as well as the 30-day readmission rate. Does your institution utilize a multidisciplinary team for IBD? Let us know in the comments. You heard Rod. Leave your comments below. Next, we have our third paper of the day. Antireflux surgery in children with congenital diaphragmatic hernia. A prospective cohort study on a controversial practice by Montalva et al. This one is summarized by Dr. Todd Ponsky. He's a pediatric surgeon at Cincinnati Children's Hospital. What the authors wanted to look at was this big problem of gastroesophageal reflux disease that's commonly associated with CDH or diaphragmatic hernia. In fact, it's like 50% of patients with CDH have reflux. So, apparently, in like 30% of hospitals in France and maybe worldwide, a lot of surgeons will do a fundoplication at the time of CDH repair to prophylactically prevent reflux. So, what the authors did, they wanted to see if this worked. So, a huge number of hospitals came together in France, like 20 hospitals came together and did a 10-year prospective review of patients with CDH. They found that actually doing a prophylactic fundoplication at the time of CDH repair actually is worse. It actually leads to more failure to thrive, more oral aversion, and more need for tube feeds. And not surprisingly, they also found that patients that had a patch had worse GERD more often. And remember, don't do a fundoplication at the time of CDH repair. Great. Our last paper is an APSA article of interest from Critical Care Medicine Journal. Use of antifibrinolytics in pediatric life threatening hemorrhage, a prospective observational multicenter study by Spinella et al. This paper is summarized by Britney Levy. She's a research fellow at Cincinnati Children's Hospital as well. So the real question here is, does the administration of tranexamic acid or aminocaproic acid improve outcomes in pediatric hemorrhage? They looked at 24 different children's hospitals across North America and Italy where they found about 450 pediatric patients between the ages of 0 and 17 who had received blood, either through a massive transfusion protocol or had received more than 40 milliliters per kilogram over about six hours. Well, they found that in kids that had gotten that antifibrinolytic therapy, there was reduced mortality at both a 6 and 24-hour time point. Well, that's pretty impressive. Anytime there's a mortality benefit, we really should consider integrating that into our practice. So tell us what you think. Do you routinely administer these medications at your center? Leave it in the comments below. Check the link in the description below to read each paper. We hope you liked this episode. Please follow us on social media, give us a rating, and subscribe to our YouTube channel. And don't forget to download our Stay Current app on App Store or Play Store for more content. Thank you for listening. Cincinnati Children's Hospital and Stay Current, share knowledge to improve child health around the globe.