Journal of Pediatric Surgery Article Review: May 2022, CAPS Issue

Published: 2022-08-23

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Inside this episode

Kai, the Library's AI content creator, listened to this episode and mapped who's speaking, the chapters, key claims, and cases. Every item links to the exact moment in the recording.

AI-enriched

Who's speaking

Richard Kaiser — host
Richard Kaiser — host
Richard Kaiser — guest
Richard Kaiser — guest
Richard Kaiser — guest
Richard Kaiser — guest
Richard Kaiser — guest
Gareth Gilna — host
Chad Thorson — guest
Gareth Gilna — guest

Chapters

0:07Introduction and Overview — Introduction to the Journal of Pediatric Surgery article review series covering the May 2022 CAPS issue, with three articles on pediatric firearm injuries, Hirschsprung disease outcomes, and bicycle injuries.
1:17Pediatric Firearm Violence Mortality — Review of UC Davis study comparing firearm injuries to motor vehicle collisions, examining mortality rates, case fatality rates, temporal trends, and self-inflicted injuries in pediatric patients.
6:35Educational Outcomes in Hirschsprung Disease — Discussion of University of Manitoba study examining long-term educational performance and neurodevelopmental outcomes in children with Hirschsprung disease compared to matched controls.
11:13Pediatric Bicycle Injuries and Geodemographic Analysis — Review of University of Miami study analyzing bicycle injuries using geographic and demographic data, examining helmet use, injury locations, and socioeconomic factors.
15:39Closing and Upcoming Events — Closing remarks and information about upcoming virtual events and content availability.

Key claims

1:31Motor vehicle collisions and firearm violence represent the leading causes of morbidity and mortality in the pediatric age group — Richard Kaiser
1:54Mortality for pediatric patients with gunshot wounds was 7.5% compared to 1% for motor vehicle collisions — Richard Kaiser
2:04After adjusting for confounding factors, children who were shot were 7.8 times more likely to die than those injured in motor vehicle collisions — Richard Kaiser
2:27The statewide case fatality rate for pediatric firearm injuries was almost 15% overall, twice as high as institutional mortality rate — Richard Kaiser
2:37The statewide case fatality rate for pediatric firearm injuries was 49 times higher than the case fatality rate for motor vehicle collisions — Richard Kaiser
2:51The case fatality rate for motor vehicle related injuries decreased over time across the state — Richard Kaiser
3:03The case fatality rate for children injured by firearms rose from 13% to almost 17% over the study period — Richard Kaiser
3:13The rate of self-inflicted pediatric gunshot wounds doubled over the study period from 2% to 4.4% of all pediatric firearm injuries — Richard Kaiser
3:28Self-inflicted pediatric gunshot wounds had a case fatality rate of 77% — Richard Kaiser
4:13A 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, suggesting guns became more dangerous — Richard Kaiser
5:49Local interventions like community violence intervention programs can help reduce violence in the community — Richard Kaiser
6:09Policy level changes are needed around the country to reduce access to firearms and increase safety — Richard Kaiser
6:09Clinicians can make an individual difference by talking to families about firearm safety and safe storage every time they see an injured child — Richard Kaiser
7:48The University of Manitoba study examined 75 patients with Hirschsprung disease — Richard Kaiser
7:52A 10 to 1 matched control cohort was identified using the Manitoba Center for Health Policy provincial data repository — Richard Kaiser
8:54Hirschsprung patients performed just as well as the control cohort from grade 3 onwards until grade 12 graduation — Richard Kaiser
9:05In preschool age, much closer to their treatment timeline, differences in neurodevelopmental performance can be seen in Hirschsprung patients — Richard Kaiser
9:16The early developmental index is one of the more subjective examinations used in the Hirschsprung outcomes study — Richard Kaiser
9:52Children with Hirschsprung disease going into school may still have challenges around potty training, bowels, and abdominal discomfort — Richard Kaiser
10:25Most children with isolated Hirschsprung disease do not have developmental delay down the road based on the study data — Richard Kaiser
12:12The Miami bicycle injury study identified 77 cases over an eight year period from October 2013 to March 2020 — Gareth Gilna
12:55The average age of bicycle injury patients was 13 years old — Gareth Gilna
11:32Only one of 77 bicycle injury patients was wearing a helmet — Gareth Gilna
13:02The majority of bicycle injuries were happening in low income neighborhoods — Gareth Gilna
13:10Bicycle injuries were happening at high speed areas like interstate on-ramps and off-ramps — Gareth Gilna
13:10About half of the bicycle injuries happened within 1 mile from home — Gareth Gilna
13:51Free helmet programs going through a pediatrician's office is useful but needs to be sustained — Gareth Gilna
13:58Cities that have been successful with helmet programs implemented multidisciplinary approaches including free helmet programs, changing laws, and public education sustained over several years — Gareth Gilna

Open questions

What happens to Hirschsprung patients in even longer follow-up during adolescence and beyond?
How can sustained community-based helmet safety programs be effectively implemented and maintained?
What specific policy changes would be most effective in reducing pediatric firearm mortality?

This episode was analyzed and enriched by Kai, the Library's AI content creator. Every item links to the moment it comes from — click a timestamp to listen in context.

Written for:

Pediatric Firearm Injury Mortality: Why Case Fatality Rates Tell a Different Story Than Hospital Data

The episode's main topic retold as a plain-language walkthrough — what it is, why it matters, and what the speakers concluded. Written by Kai from the episode transcript and reviewed before publishing.

For the care team · Explainer · AI-written, human-reviewed

The Problem That Made This Analysis Necessary

Motor vehicle collisions and firearm violence represent the leading causes of morbidity and mortality in the pediatric age group 1:31. For decades, trauma systems have tracked in-hospital mortality — the metric surgeons can directly influence 1:54. But this approach systematically undercounts the lethality of injuries where many patients die before reaching care 2:27. A UC Davis study compared institutional trauma registry data against statewide vital statistics to reveal what the authors termed "the hidden mortality" of pediatric firearm violence 2:27.

The Core Clinical Problem

At the institutional level, pediatric gunshot wounds appeared more lethal than motor vehicle collisions, but not catastrophically so: mortality was 7.5% for firearm injuries versus 1% for motor vehicle collisions 1:54. After adjusting for confounding factors, children who were shot were 7.8 times more likely to die than those injured in motor vehicle collisions 2:04. These are the numbers trauma surgeons see — the patients who survived long enough to reach the emergency department 1:54.

The statewide case fatality rate told a different story 2:27. When the authors included all pediatric firearm deaths in California — field deaths, deaths in non-trauma centers, deaths before EMS arrival — the case fatality rate was almost 15%, twice the institutional mortality rate 2:27. More striking: this statewide case fatality rate for pediatric firearm injuries was 49 times higher than the case fatality rate for motor vehicle collisions 2:37.

This gap between institutional mortality and population-level case fatality reveals the fundamental difference between these two leading causes of pediatric death 2:27 2:37. Motor vehicle collision victims who die in the field represent a small fraction of total cases 2:51. Firearm injury victims who die in the field represent the majority 2:27.

Temporal Trends: Diverging Trajectories

The case fatality rate for motor vehicle-related injuries decreased over time across California 2:51 — the expected result of decades of coordinated intervention: seatbelt laws, airbags, car seat requirements, graduated licensing, road design improvements 2:51. The case fatality rate for children injured by firearms rose from 13% to almost 17% over the study period 3:03. One of the discussants framed this finding plainly: "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" 4:13.

The rate of self-inflicted pediatric gunshot wounds doubled over the study period from 2% to 4.4% of all pediatric firearm injuries 3:13. These injuries had a case fatality rate of 77% 3:28 — a figure that reflects both anatomic targeting and the brief window between injury and death 3:28.

What This Means for Referring Clinicians

The practical implication is that trauma surgeons see a selected population 1:54 2:27. The children who reach the operating room represent the minority of pediatric firearm injury victims 2:27. The majority die before transport or in the emergency department 2:27. This selection bias makes institutional quality improvement efforts necessary but insufficient 5:49. Reducing pediatric firearm mortality requires preventing the injury or ensuring the weapon is less lethal — interventions that occur outside the hospital 5:49 6:09.

The discussants identified three levels of intervention 5:49 6:09 6:09. Local interventions like community violence intervention programs can help reduce violence in the community 5:49. Policy-level changes are needed around the country to reduce access to firearms and increase safety 6:09. At the individual clinical encounter level, clinicians can make a difference by talking to families about firearm safety and safe storage every time they see an injured child 6:09.

Where Practice Remains Contested

The discussion did not address the contested question of whether pediatric primary care visits should include universal firearm counseling or targeted counseling based on risk factors. The discussants also did not specify which community violence intervention programs have demonstrated effectiveness in reducing pediatric firearm injuries 5:49, nor did they detail what policy changes they considered most urgent 6:09. The emphasis was on the magnitude of the problem and the inadequacy of hospital-based interventions alone 5:49 6:09.

When to Think About This

Every pediatric trauma admission is an opportunity for secondary prevention counseling 6:09. Every well-child visit in a household with firearms is an opportunity for primary prevention counseling 6:09. The data suggest that the window for intervention is narrow — once the injury occurs, the outcome is often determined before the patient reaches medical care 2:27 3:28. The case fatality rate gap between institutional data and population data is not a quality problem 2:27. It is a structural problem that requires structural solutions 5:49 6:09.

Takeaways from this story

Statewide pediatric firearm case fatality rate is 49 times higher than for motor vehicle collisions, revealing hidden pre-hospital mortality.
Pediatric firearm case fatality rate rose from 13% to 17% over the study period while motor vehicle rates declined.
Self-inflicted pediatric gunshot wounds doubled in frequency and carried 77% case fatality rate.
Trauma surgeons see a selected minority — most pediatric firearm deaths occur before hospital arrival.

Pediatric Injury Research: What Case Fatality Rates Reveal About Prevention

The episode's teaching points arranged as a structured lesson, building from the basics up to the finer points. Written by Kai from the episode transcript and reviewed before publishing.

For trainees · Teaching arc · AI-written, human-reviewed

Understanding Hidden Mortality in Trauma Research

This discussion teaches how to read beyond institutional mortality data to understand the true burden of pediatric injuries. The critical insight: when comparing mechanisms of injury, institutional mortality captures only patients who survive long enough to reach the hospital, while statewide case fatality rates include field deaths 2:27. For pediatric firearm injuries, the statewide case fatality rate was almost 15%, twice the institutional mortality rate, and 49 times higher than the motor vehicle collision case fatality rate 2:27 2:37. This gap reveals which injuries kill before medical intervention becomes possible — a pattern that fundamentally changes how you think about prevention priorities.

The temporal trend matters more than the absolute number. While motor vehicle collision case fatality rates decreased over time, firearm case fatality rates rose from 13% to almost 17% 2:51 3:03. This divergence suggests that a child shot today faces worse odds than a child shot a decade ago, independent of injury volume 4:13. When you see improving outcomes for one mechanism but worsening outcomes for another over the same period and in the same system, you are likely observing a change in the injury itself — in this case, more lethal firearms — rather than changes in care delivery.

Self-inflicted injuries represent a distinct epidemiologic pattern. The rate of self-inflicted pediatric gunshot wounds doubled from 2% to 4.4% of all pediatric firearm injuries, with a case fatality rate of 77% 3:13 3:28. This is not a subset you can address with the same prevention strategies as unintentional or assault-related injuries. The lethality reflects both intent and anatomic targeting. When counseling families about firearm safety, this subgroup demands explicit discussion of secure storage as suicide prevention, not just unintentional injury prevention.

Geodemographic Analysis Reveals Actionable Patterns

For bicycle injuries in Miami, geodemographic mapping identified three converging risk factors: low-income neighborhoods, proximity to high-speed roadways like interstate ramps, and occurrence within one mile of home 13:02 13:10 13:10. This is not simply descriptive epidemiology — it tells you where to deploy interventions. A child injured near home in a low-income area adjacent to an interstate is navigating infrastructure designed without consideration for pediatric cyclists. The injury clusters around specific geographic features, which means prevention requires environmental modification, not just behavior change.

Helmet distribution alone does not sustain behavior change. Only one of 77 bicycle injury patients was wearing a helmet 11:32. Free helmet programs through pediatricians' offices have utility but require sustained effort 13:51. Cities with successful helmet programs implemented multidisciplinary approaches: free distribution, legal changes, public education, and sustained effort over several years 13:58. The teaching point: when you see near-zero adoption of a known protective behavior, the problem is not knowledge deficit. It is access, social norms, enforcement, and infrastructure. Single-intervention programs fail because they address only one barrier.

Long-Term Outcomes Inform Preoperative Counseling

For Hirschsprung disease, a matched cohort study using provincial data found that patients performed equivalently to controls from grade 3 through high school graduation 8:54. However, differences in neurodevelopmental performance appeared in preschool age, closer to the treatment timeline 9:05. This teaches you how to counsel families: most children with isolated Hirschsprung disease will not have developmental delay long-term 10:25, but early school years may present challenges around toileting, bowel function, and abdominal discomfort 9:52. The reassurance you offer is specific and evidence-based, not generic. You acknowledge the near-term difficulty without overstating the long-term risk.

Takeaways from this story

Statewide case fatality rates reveal field deaths that institutional mortality data miss — essential for understanding true injury burden.
Rising firearm case fatality rates over time suggest weapons became more lethal, independent of care quality or injury volume.
Self-inflicted pediatric gunshot wounds carry 77% case fatality — secure storage counseling is suicide prevention, not just safety.
Geodemographic clustering of bicycle injuries near interstates and within one mile of home identifies where infrastructure fails children.
Most children with isolated Hirschsprung disease show no developmental delay by grade school, but early years may present bowel-related challenges.

Pediatric Firearm Mortality, Hirschsprung Outcomes, and Bicycle Injury Prevention

The episode's teaching points arranged as a structured lesson, building from the basics up to the finer points. Written by Kai from the episode transcript and reviewed before publishing.

For specialists · Teaching arc · AI-written, human-reviewed

Statewide case fatality reveals hidden mortality that institutional data miss

Institutional mortality captures only patients who survive long enough to reach the hospital. The UC Davis group calculated both: their trauma center mortality for pediatric firearm injuries was 7.5%, but the statewide case fatality rate was nearly 15% — twice as high 2:27. For motor vehicle collisions, the statewide rate was 49 times lower 2:37. Case fatality rate is total deaths divided by total cases, including field deaths. When you compare only the children who made it to your trauma bay, you are looking at a pre-selected cohort. The children who died at the scene or en route never appear in your registry. For gunshot wounds, that hidden mortality is enormous. For motor vehicle collisions, it is comparatively small. This gap — between what you see in your trauma bay and what is happening in your community — is the number that matters for public health intervention.

Rising case fatality over time suggests increasing weapon lethality

The statewide case fatality rate for motor vehicle collisions decreased over the study period, as expected given improvements in vehicle safety and trauma systems 2:51. The case fatality rate for pediatric firearm injuries rose from 13% to 17% 3:03. Same population, same trauma system, worsening outcomes. The implication is that the weapons themselves became more lethal — higher-caliber firearms, more devastating wound patterns, or both 4:13. A child shot early in the study period had a better chance of survival than a child shot later, independent of the quality of trauma care. This is not a phenomenon you can address with faster transport or better resuscitation. The injury severity at the moment of impact is increasing.

Self-inflicted pediatric gunshot wounds doubled and carry 77% case fatality

Self-inflicted injuries rose from 2% to 4.4% of all pediatric firearm injuries over the study period 3:13. The case fatality rate for these injuries was 77% 3:28. Most of these children die before reaching the hospital. The mechanism is typically a contact wound to the head. There is no meaningful opportunity for intervention once the injury occurs. The only leverage point is primary prevention: safe storage, means restriction, and screening for suicidal ideation in households with firearms. This is not a trauma surgery problem — it is a public health and primary care problem that happens to produce the occasional survivor in your ICU.

Hirschsprung patients match controls from grade school onward

The Manitoba group used provincial administrative data to compare 75 Hirschsprung patients to a 10:1 matched control cohort 7:48 7:52. From grade 3 through high school graduation, Hirschsprung patients performed equivalently to controls on standardized testing and graduation rates 8:54. In preschool, closer to the treatment timeline, differences in neurodevelopmental performance were detectable 9:05. Whether this reflects real developmental delay or the subjectivity of early childhood assessments is unclear 9:16. The practical message for counseling families: most children with isolated Hirschsprung disease do not have long-term developmental delay 10:25. They may struggle with toileting and abdominal symptoms in early school years 9:52, but by the time standardized testing begins, they are indistinguishable from their peers.

Geodemographic analysis identifies high-risk injury clusters near home

The Miami bicycle injury study used zip code income data and home addresses to map injury locations 13:02 13:10 13:10. The majority of injuries occurred in low-income neighborhoods, at high-speed areas like interstate ramps, and within 1 mile of home. Only one of 77 patients was wearing a helmet 11:32. Mapping injury density against road infrastructure and socioeconomic status reveals where to target interventions. Free helmet distribution through a pediatrician's office is insufficient 13:51. Cities that reduced bicycle injury rates used sustained multidisciplinary approaches: free helmets, legal mandates, public education, and several years of consistent effort 13:58. Single-intervention programs fail because they are not sustained and do not address the structural determinants — road design, traffic speed, and economic barriers to helmet access.

Takeaways from this story

Statewide case fatality for pediatric firearm injuries is twice institutional mortality—field deaths are the hidden majority.
Rising firearm case fatality over time (13% to 17%) suggests increasing weapon lethality independent of trauma care quality.
Self-inflicted pediatric gunshot wounds doubled to 4.4% of cases with 77% case fatality—prevention is the only intervention.
Hirschsprung patients match controls academically from grade 3 onward; early preschool differences do not predict long-term delay.
Sustained multidisciplinary bicycle injury prevention (helmets, laws, education) works; single interventions fail without persistence.

Topic overview

A review of three articles from the May 2022 Journal of Pediatric Surgery CAPS (Canadian Association of Pediatric Surgeons) issue. The discussion covers pediatric firearm injuries showing mortality rates of 7.5% versus 1% for motor vehicle collisions, with case fatality rates rising from 13% to 17% over the study period and self-inflicted injuries having a 77% case fatality rate. Educational outcomes in Hirschsprung disease patients show performance equivalent to matched controls from grade 3 through high school graduation, though early developmental assessments showed some differences. Pediatric bicycle injuries in Miami revealed only 1 of 77 patients wore helmets, with injuries concentrated in low-income neighborhoods near high-speed roadways and approximately half occurring within 1 mile of home.

Key takeaways

Pediatric firearm injuries are 7.8× more lethal than MVCs; case fatality rose from 13% to 17%, with self-inflicted wounds at 77%. (2:04)
Counsel families on firearm safe storage at every visit; policy changes and community programs are needed to reduce access. (5:49)
Hirschsprung patients show equivalent academic performance from grade 3 onward; early preschool differences likely reflect bowel issues. (8:54)
Only 1/77 Miami pediatric cyclists wore helmets; injuries cluster in low-income areas near high-speed roads, often <1 mile from home. (11:32)
Sustained multidisciplinary helmet programs (free distribution, law changes, public education) reduce pediatric bicycle injuries. (13:51)

Keywords

Hirschsprung disease pediatric firearm injuries pediatric bicycle injuries developmental delay UC Davis University of Manitoba Manitoba Center for Health Policy Cincinnati Children's Hospital Medical Center BC Children's Hospital University of Miami Miller School of Medicine REACH (Research, Education and Awareness for Children with Hirschsprung disease)

Hashtags

#PediatricTrauma #FirearmInjury #InjuryPrevention #CAPS2022

Transcript

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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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