Medicine and Health Sciences Commons^™

Magnetic Resonance Image-Based Estimates Of Hepatic Blood Flow In Children With And Without Obesity; Implications For Physiologically-Based Pharmacokinetic Models, Yoon Cho, Sherwin S. Chan, Chance S. Friesen, Valentina Shakhnovich

Research Days

Background: Physiologically based pharmacokinetic models for simulating drug pharmacokinetics are useful to guide drug dosing for pediatric patients. Hepatic blood flow could be a useful variable to use in these models.

Objectives/Goal: In this study, we explored 2-D phase contrast non-invasive magnetic resonance imaging (MRI) to measure hepatic blood flow in children with and without obesity.

Methods/Design: In this IRB-approved study, we imaged pediatric patients with abdominal MRI with 2D phase contrast imaging of the descending aorta (AO) at the diaphragm, the inferior vena cava (IVC) at the right atrium, and inferior to hepatic drainage above the renal vein confluence …

A Case Of Dock8 Deficiency Treated With Dupilumab, Melissa Anderson, Brandon D. Newell, Hugo Escobar, Erin Stahl, Nikita Raje

Research Days

Background: Dedicator of cytokinesis 8 gene (DOCK8) deficiency is an immune disorder associated with autosomal recessive hyper-IgE syndrome, characterized by elevated IgE levels, atopic dermatitis, and predisposition to recurrent skin and lung infections.

Objectives/Goal: A 12-year-old male presented to Immunology clinic for DOCK8 deficiency. He was diagnosed in infancy due to diffuse papulopustular eruption positive for candidiasis and known family history. Past medical history included severe eczematous dermatitis, asthma, interstitial lung disease, food allergies, and poor growth, with cutaneous HSV and fungal infections, HSV keratitis, and MRSA bacteremia. Family history was notable for two siblings with DOCK8 deficiency, both deceased. …

Improvement On The Slopes: The Impact Of An Adaptive Snow Sports Program On Children And Young Adults With Disabilities, Stephanie Green, Mark T. Fisher, J Eichner, Matthew J. Mclaughlin

Research Days

Background: Adaptive downhill skiing has been described as a fun, safe, engaging recreational activity for those with disabilities (Sterba, 2006). There are numerous ways the alpine skiing can be modified to meet these athletes’ needs. For instance, athletes can use tethered skis, horizontal poles held by their instructors, or modified walkers. For those that have poor standing balance, or are non-ambulatory, sit-skis are an option, with or without outriggers to add additional support and balance for athletes with poor trunk stability or core strength. These options provide equal and accessible alternatives for those with disabilities to get out and enjoy …

Persistent Pediatric Breast Abscesses Following Initial Treatment At Tertiary And Community Centers, Derek Marlor, Kayla Briggs-Groves, Shai Stewart Md, Nelimar Cruz-Centeno, Charlene Dekonenko, Jason D. Fraser

Research Days

Introduction: Little data exist on the management of pediatric breast abscesses that fail initial treatment. Therefore, this study aimed to evaluate and report outcomes in these patients.

Methods: All patients <18-years-old treated for a breast abscess between January 2008 and December 2018 were included. Patients were divided into 2 groups: initial treatment at our institution (Group 1) and initial treatment at referring centers (Group 2). The primary outcome was disease persistence following treatment at our institution. Secondary outcomes included treatment modalities and patient characteristics.

Results: In total, 145 patients were identified: 111 in Group 1 and 34 in Group 2. Antibiotics alone were the initial treatment in 52.3% (n=58) of Group 1 patients and 64.7% (n=22) of Group 2 patients. Invasive treatment was more common in Group 1 (45.9% vs 5.8%; p<0.00001). Patients with persistent disease in Group 1 were treated with aspiration (n=7, 50%), I&D (n=5, 35.7%), antibiotics (n=1, 7.14%), and manual expression (n=1, 7.14%.), while Group 2 patients were treated with antibiotics (50%, n=17), aspiration (26.47%, n=9), I&D (17.65%, n=6), and manual expression (5.88%, n=2). Group 2 patients with persistent disease were more likely to be treated with antibiotics or a change in antibiotics (50% vs 7.14%; p=0.005). Following treatment at our institution, the rate of persistent disease was similar between groups (12.6% vs 11.8%).

Conclusions: Persistent breast abscesses may be treated with antibiotics in appropriate cases. Damage to the developing breast bud should be minimized. Disease …

Stewardship Opportunities For Cervical Lymphadenitis And Deep Neck Space Abscesses, Aaron Shaw, Brian R. Lee, Lauren Kazmaier, Emily Baker, Tina Dao, Sandra Arnold, Angela Myers

Research Days

Background: Cervical lymphadenitis (LAD) and deep neck space abscesses (DNSA) are common pediatric infections caused by similar bacteria. We sought to determine differences in presentation, diagnosis, and treatment between LAD and DNSA to identify antimicrobial and diagnostic stewardship opportunities.

Methods: Charts were obtained using ICD9/10 codes for retropharyngeal and parapharyngeal abscessed (DNSA), and LAD between 1/1/10-12/31/20 from two pediatric centers. 1981 charts were identified. Charts were excluded if the diagnosis was not a bacterial infection (e.g. Kawasaki disease), if the LAD was not in the neck, or if caused by less common bacteria (e.g. tuberculosis). Data on presenting signs, symptoms, …

Two Ais Cases, Two Surgeons, One Operating Room, One Day. The Results Of A Quality Improvement Initiative, Jonathan Warren, Robert C. Link, Sean Bonanni, John T. Anderson, Richard M. Schwend

Research Days

Background: To lessen surgical times for AIS patients undergoing posterior spinal instrumentation and fusion (PSIF), our department developed a quality improvement initiative where two AIS cases were completed in one day by a specialized team with two surgeons operating together in the same operating room (OR).

Objectives/Goal: We describe the results of this initiative and compare operative times and blood loss between cases to determine if operative time improves as experience with this structure increases.

Methods/Design: From 2017-2023, patients aged 10-18 years with AIS were prospectively scheduled to undergo primary PSIF on the dedicated “Two Spine Tuesday” at our institution. …

Respiratory Pathogen Panel Use In Hospitalized Infants <2 Months Of Age And Impact On Patient Management., Edward Lyon

Research Days

Background: Respiratory pathogen panels (RPP) are multiplex PCR platforms able to simultaneously detect several respiratory viruses. RPP utilization is not well described in infants < 2 months of age, who frequently require hospitalization for management of acute respiratory illness (ARI) and/or fever. Detection of a viral pathogen in this age group could impact the clinician’s decision to perform additional evaluation and administer antimicrobials.

Objectives/Goal: We sought to understand predictive features and clinical management impact of RPP use in infants < 2 months of age.

Methods/Design: Between October 2017 to September 2021, participants, aged < 18 years, hospitalized with an acute respiratory infection (ARI) were enrolled in Kansas City’s New Vaccine Surveillance Network (NVSN). Eligible patients were residents of Jackson County, had symptoms consistent with ARI (e.g., cough, fever, nasal congestion) lasting < 14 days, and enrolled within 48 hours of admission. For this study, only participants < 2 months of age were included. All participants had a research RPP, but results were not available to the clinician. Per provider discretion, some infants also received a clinical RPP (cRPP). Demographic characteristics, laboratory evaluations, and antimicrobial management were compared between infants with and without a cRPP.

Results: Of the 139 participants < 2 months of age, 57 (41%) had a cRPP (table 1). A cRPP was more frequently obtained in infants < 1 month of age (n=34 [47%]) compared with infants 1-2 months of age (n=23 [35%]; p=0.17). 35 (61%) participants with a cRPP had a parental report of fever while 41 (50%) of those without a cRPP had one reported. Only 20 (35.1%) of White, non-hispanic participants had a cRPP compared to 42 (51.2%) p=0.082 who did not have a cRPP. Participants who had blood or CSF culture collected were more likely to have a cRPP obtained, 47 (82.5%) p=

Conclusions: Overall, < 50% of infants < 2 months of age hospitalized with ARI received cRPP testing. Obtaining a blood or CSF culture was associated with increased cRPP usage. The length of stay was not different between the two groups. 35 viral infections went undetected in participants without a cRPP even with accounting for positive rapid NAAT testing, further investigation is needed to understand how this may influence clinical care.

Cardiac Biomarkers Differentiate Kawasaki Disease From Multisystem Inflammatory Syndrome In Children Associated With Covid-19, Mollie Walton

Research Days

Background: Kawasaki disease (KD) and Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19 show considerable clinical overlap. The goal of this study was to determine if cardiac biomarkers can differentiate KD from MIS-C.

Objectives/Goal: The goal of this study was to determine if cardiac biomarkers differentiate KD from MIS-C.

Methods/Design: The International Kawasaki Disease Registry enrolled (n=2903) contemporaneous KD and MIS-C patients1st, 2020, through June 30th, 2022. The study population was confined to KD patients meeting American Heart Association KD criteria with no prior COVID-19 infection and MIS-C patients meeting Centers for Disease Control and Prevention criteria with confirmed …

Association Between Remote Monitoring And Interstage Morbidity And Mortality In Single Ventricle Patients Across Socioeconomic Groups, Bianca Cherestal

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Background: Despite improvements in outcomes over time, morbidity and mortality for infants with single ventricle (SV) heart disease remains high. Among other risk factors for mortality, infants of low socioeconomic status (SES) are known to be particularly vulnerable following stage 1 palliation.

Objectives/Goal: We sought to determine whether use of a novel remote monitoring program, CHAMP (Cardiac High Acuity Monitoring Program), mitigates differences in outcomes by SES for infants with SV during the interstage period.

Methods/Design: Using the CHAMP database, we identified 610 infants across 11 institutions enrolled in the program between 2014–2021. All enrolled patients’ families were provided with …

Preoperative Srs-22 Scores Predict Postoperative Achievement Of Distribution-Based Mcid In Ais Patients Treated With Posterior Spinal Instrumentation And Fusion, Jonathan Warren, Cyrus Etebari, Morgan Whitmire, Kenneth Furlough, Brant Ansley, John T. Anderson, Richard M. Schwend

Research Days

Background: There is a growing body of literature assessing the role of preoperative patientreported outcome measures in predicting postoperative achievement of the minimal clinically important difference (MCID). To the best of our knowledge, there are no studies assessing whether preoperative SRS-22 scores are predictive of postoperative achievement of MCID in patient with adolescent idiopathic scoliosis (AIS).

Objectives/Goal: Our purpose is to determine if preoperative SRS-22 scores in patients with AIS who undergo posterior spinal instrumentation and fusion can predict postoperative achievement of MCID.

Methods/Design: SRS-22 forms were provided to all patients scheduled to undergo posterior spinal instrumentation and fusion. MCID …

Drug Metabolizing Enzymes And Transporters May Help Determineeffective Budesonide Dosing In Eoe, Laurie Mccann, Lisa Harvey, Norah Almahbub, Wendy Y. Wang, Erin C. Boone, Janelle R. Noel-Macdonnell Phd, Rachel Chevalier

Research Days

Background: Eosinophilic esophagitis (EoE) is a chronic inflammatory disorder diagnosed in children with painful or difficult swallowing, vomiting, or poor weight gain. Current treatment models adopt a trial-and-error approach in regard EoE treatment, including restrictive elimination diets, proton pump inhibitors, and topical budesonide. This approach can delay effective treatment which increases risk of disease progression and increases medical costs to families for frequent clinic visits and endoscopy.

Objectives/Goal: The objective of this study is to determine the CYP3A5 genotype and expression of patients with eosinophilic esophagitis to discover which patients will respond to standard dosing of topical budesonide treatment (1, …

Pilot Study Using Sideline Hand-Grip Dynamometry To Assess Strength Changes In A High School Baseball Season: A Feasibility Study, Thomas Munro, Jason D. Yoderq, Brian R. Lee, Brian S. Harvey

Research Days

Background: Upper extremity injuries are common in baseball players. Objective measurements could assist in determining early signs of fatigue before injury occurs. Using HGD to measure strength changes may help identify early signs in the injury process. To our knowledge, HGD has not been tested on high school baseball players in the sideline setting. It is feasible to perform hand-grip dynamometry on-site at the high school level and HGD measurements will change throughout the season in varsity baseball athletes. Secondary aim: Asses HGD measurement in the context of injury/pain/fatigue/pitching.

Objectives/Goal: It is feasible to perform hand-grip dynamometry on-site at the …

Common Misperceptions Of Child Abuse In Toddler Femur Fractures, Olivia Pruss, Jonathan Warren, Vincent Staggs, Grace Tideman, Collin Erickson, William L. Hennrikus, Richard M. Schwend

Research Days

Background: Current AAOS guidelines recommend that all children younger than thirty-six months with a femur fracture be evaluated for child abuse. However, the chance for abuse in walking-age children is highly unlikely at less than 20%.

Objectives/Goal: The purpose of this study is to identify how a patient’s age and femur fracture morphology impact the likelihood that providers assess a fracture as non-accidental and their decision to pursue further investigation of possible child abuse.

Methods/Design: This was a questionnaire study completed by clinicians from multiple specialties. There were 5 subgroup populations (6, 12, 18, 24, 35 months old) combined with …

Genes Predictive Of Aggressive Infant Acute Lymphoblastic Leukemia, Meghana Bhumireddy

Research Days

Background: Acute Lymphoblastic Leukemia (ALL) is a rapidly progressive cancer in which the bone marrow makes too many immature leukocytes that divide uncontrollably. KMT2A, or MLL, is a methyltransferase found in many types of leukemia, whose rearrangement (KMT2A-r) is present in approximately 2/3 of infants with ALL. KMT2A-r is associated with a very poor prognosis: roughly ⅔ of patients relapse within 1 year of diagnosis, and the relapsed KMT2A-r ALL is resistant to treatment (having nearly 100% morality). We explored gene expression in patient samples from three groups at diagnosis: KMT2A-r patients who relapsed, KMT2A-r patients who did not relapse, …

Degree Of Uncertainty In Reporting Imaging Findings For Necrotizing Enterocolitis: A Secondary Analysis From A Pilot Randomized Diagnostic Trial, Disa Rathore, Kira Bourrett, Sherwin S. Chan, Erin Opfer, Alain Cuna

Research Days

Background: Uncertainty in reporting of imaging findings for necrotizing enterocolitis (NEC) can be challenging for clinicians and result in ambiguity, miscommunication, and potential diagnostic errors. The degree to which uncertainty complicates diagnostic imaging for NEC has not been characterized.

Objective: To determine the degree of uncertainty in diagnostic imaging for NEC.

Methods: We conducted a retrospective study using data from a previously completed pilot diagnostic randomized clinical trial (RCT). The study population comprised of preterm infants with suspected NEC who were randomized to either standard imaging with abdominal radiographs (AXR) alone or experimental imaging with AXR + add-on bowel ultrasound …

Increased Injury Rate After Covid-19 Infection In Elite Us Youth Soccer Players, Kyle Brougham, Jonathan Warren, Shannon Margherio, James Roberson, Brian Harvey

Research Days

Background: COVID changed the sporting world over the past several years. As the pandemic winds down, it is important to study what effects the virus has on the athletes we serve. As we learn to live and participate in sport with the virus, it is inevitable that athletes will continue to be impacted by COVID. To the best of our knowledge, there is no data on the effects that COVID infection has on elite youth soccer athletes in the United States.

Objectives/Goal: Our purpose is to determine the risk of injury after a COVID infection in youth soccer athletes at …

Indications For Early Surgical Intervention In Adolescents With Salter-Harris Ii Distal Radius Fractures, Cyrus Etebari, Jonathan R. Warren, Olivia Pruss, Sricharan Yadali, Vincent Staggs, Micah K. Sinclair

Research Days

Introduction: Currently, there is little information regarding risk factors for failure of nonoperative treatment in Salter-Harris II distal radius fractures (SHII-DRF). Our purpose is to identify predictors of which patients will require acute surgery and which will develop late malunion based on degree of deformity and skeletal maturity.

Methods: This was a review of SHII-DRFs in patients 9 to 18 years of age, from 2017-2020. Demographics, initial displacement, displacement post-reduction, and displacement after cast removal were evaluated. Skeletal maturity was determined using Sander’s classification. These values were compared between patients who underwent casting alone, underwent acute surgery, or required late …

Therapeutic Plasma Exchange To Alleviate Ventricular Tachycardia After Diphenhydramine Ingestion, Kaushal Dosani, Lejla Music Aplenc, Stephen Pfeiffer

Research Days

Background: The Covid-19 pandemic has adversely affected the mental health of children causing an increased incidence of suicide attempts. Diphenhydramine is a common household medication and is frequently ingested by children. Toxic doses of diphenhydramine can affect the cardiovascular and central nervous system. In the heart, diphenhydramine blocks fast sodium channels and potassium channels which can result in conduction abnormalities including sinus tachycardia, widening of QRS duration, ventricular tachycardia and torsades de pointes. Massive ingestion can cause severe cardiovascular collapse which may require ECMO support

Objectives/Goal: To describe a novel method of clearing highly protein-bound diphenhydramine molecules from circulation after …

Functional Evaluation Of A Novel Rpl30 Mutation And Its Role In Diamond Blackfan Anemia (Dba), Alexandra Prosser, Alexandria Cockrell, Danny Miller, Chris Seidel, Tamara Potapova, John M. Perry, Midhat Farooqi, Erin M. Guest, Jennifer Gerton

Research Days

Background: Bone marrow failure is life-threatening and requires prompt, intensive treatment, which is dependent upon identification of genetic drivers. Although there has been investigation into associated genetic mutations, especially in Diamond Blackfan anemia (DBA), the relationship between genotype and phenotype remains unclear.DBA has been identified as a ribosomopathy, also known as a disease associated with defects in ribosome biogenesis. We identified a novel heterozygous variant (c.167+769C >T) in the noncoding region of RPL30 in a patient with clinical diagnosis of DBA. Clinical RNA sequencing (RNA-seq) suggests the variant generates a novel splice acceptor site resulting in truncated RPL30 transcripts. Elucidation …

Tracheostomy Dependance Patterns In Children With 22q11 Deletion Syndrome, Elie Khalifee, Meghan Tracy, Jill M. Arganbright

Research Days

Background: 22q11.2 deletion syndrome (22q11DS) is the most common chromosomal microdeletion syndrome and presentation often includes congenital heart disease (CHD), palate anomalies, and developmental delay. Due to the medical complexity of this syndrome, some patients require tracheostomy. To date, there is little in the literature regarding tracheostomy for these patients.

Objectives/Goal: our aim is to better delineate patients with 22q11DS who require tracheostomy, assess outcomes including decannulation and complications.

Methods/Design: This is a retrospective chart review of patients in our 22q Center’s repository. Inclusion criteria were a diagnosis of 22q11DS with a current or previous history of tracheostomy. Data collected …

Management Of Primary Spontaneous Pneumothorax In Children: A Single Institution Protocol Analysis, Shai Stewart Md, James Fraser, Nelimar Cruz-Centeno, Derek Marlor, Rebecca M. Rentea, Pablo Aguayo, David Juang, Jason D. Fraser, Charles L. Snyder, Richard J. Hendrickson, Tolulope A. Oyetunji, Shawn D. St.Peter

Research Days

Background: Primary spontaneous pneumothorax (PSP) affects 3.4 per 100,000 children in the United States. Regardless of the initial management, additional procedures, and prolonged hospital length of stay (LOS) may occur. There is currently no consensus in the pediatric surgical community on the optimal management of these patients, which has resulted in marked variability in management. The Midwest Pediatric Surgery Consortium (MWPSC), of which our site is a participant, suggested a management algorithm to include simple aspiration upon presentation, and if this fails, VATS should be considered.

Objectives/Goal: The purpose of this study was to evaluate the outcomes of instituting a …

Sepsis-Induced Acute Lung Injury (Ali) And The Development Of Bronchopulmonary Dysplasia (Bpd) In Premature Infants., Jacob S. Ward, Hung-Wen Yeh, Megan Tucker, Venkatesh Sampath

Research Days

Background: Bronchopulmonary dysplasia (BPD) is a significant cause of morbidity and mortality in premature infants with several known risk factors. Recent literature described the harmful effect of inflammation on the developing lung. Recently, we showed that late-onset sepsis (LOS) and necrotizing enterocolitis (NEC) causes acute lung injury (ALI) in preterm infants as measured by increases in pulmonary severity scores (PSS). The aim of this study was to investigate the association between LOS-induced ALI and BPD outcomes. We hypothesized that LOS would increase the likelihood of developing BPD, and the associated LOS-induced ALI will add to the ability to predict development …

Two Adolescent Idiopathic Scoliosis (Ais) Cases, Two Surgeons, One Operating Room, One Day. Faster And Safer Than One Case In A Day., Jonathan Warren, Robert C. Link, Sean Bonanni, John T. Anderson, Richard M. Schwend

Research Days

Background: To lessen surgical times for AIS patients undergoing posterior spinal instrumentation and fusion (PSIF), our department developed a quality improvement initiative where two AIS cases were completed in one day by a specialized team with two surgeons operating together in the same operating room (OR).

Objectives/Goal: Our purpose is to describe the results of this initiative and compare operative times and outcomes to single cases completed by a single surgeon during the same period.

Methods/Design: From 2017-2023, patients aged 10-18 years with AIS were scheduled to undergo primary PSIF on the dedicated “Two Spine Tuesday” at our institution (Group …

Predicting Avascular Necrosis After Unstable Slipped Capital Femoral Epiphysis, Jonathan Warren, Alexander Metoxen, Michael Held, Brant Ansley, Berglund Lisa

Research Days

Background: There is no consensus in the literature on the risk of developing avascular necrosis (AVN) after unstable slipped capital femoral epiphysis (SCFE). In recent years, a number of studies have sought to better characterize risk factors for AVN in this population. However, to the best of our knowledge, there is no study that uses predictive modeling to assess the chance of developing AVN based on different patient-centric factors.

Objectives/Goal: Our goal is to assess whether or not previously-published risk factors for AVN in unstable SCFE such as duration of symptoms, reduction type, type of surgery, timing of surgery, and …

A Novel Approach For Laparoscopic Direct Inguinal Hernia Repair In Children, Shai Stewart Md, Charlene Dekonenko, Nelimar Cruz-Centeno, Derek Marlor, Jason D. Fraser

Research Days

Background: Inguinal hernia repair is one of the most common operations performed by pediatric surgeons, and the frequency of laparoscopy for repair is increasing. The vast majority of these are indirect hernias and therefore how to best repair a direct defect when seen during laparoscopy is still unknown. Simple high ligation of the hernia sac (as is done in an indirect hernia) does not repair the inguinal floor weakness/defect seen in a direct hernia.

Objectives/Goal: We therefore present a case of laparoscopic bilateral indirect and direct inguinal hernia repair, commonly known as pantaloon hernia, repaired without mesh and utilizing the …

Antibiotic Monotherapy Vs Dual-Drug Therapy In Perforated Appendicitis: Single Center Retrospective Review, Shai Stewart Md, Nelimar Cruz-Centeno, Derek Marlor, Dae H. Kim, Shawn D. St Peter, Tolulope A. Oyetunji Md Mph

Research Days

Background: The optimal antibiotic regimen in perforated appendicitis to reduce intraabdominal abscess (IAA) formation has not yet been agreed upon in the pediatric surgery community. We aimed to evaluate the outcomes of patients with perforated appendicitis when intravenous antibiotic monotherapy with Piperacillin-Tazobactam (PT) versus dual-drug therapy with Ceftriaxone and Metronidazole (CM) are administered. We hypothesized there is no difference in the rate of IAA formation with antibiotic monotherapy, as opposed to our once-daily dosed, institutional standard dual-drug therapy.

Objectives/Goal: The goal was to determine if our current management protocols for acute appendicitis were delivering the best possible results for our …

“There’S A Difference In Practice When You Have To Make The Decision”: Autonomy In Pediatric Emergency Medicine Fellowship, Katherine Dunne, Vivek Dubey, Sarkan Toy, Camryn Martinez, Kelsey Gavin, Christopher S. Kennedy

Research Days

Background: The Accreditation Council for Graduate Medical Education allows individual training programs to define appropriate supervision and autonomy commensurate with the trainees’ knowledge, clinical competence, and patient complexity and acuity. In pediatric emergency medicine (PEM), supervision is not standardized and subject to supervisor discretion, creating variability in trainee autonomy.

Objectives/Goal: To explore the concept of autonomy from the perspectives of PEM fellows and faculty.

Methods/Design: We conducted a qualitative study consisting of semi-structured interviews of PEM fellows and faculty from a large, single-center pediatric emergency medicine fellowship program. A trained interviewer conducted the interviews over an electronic interview platform. Audio …

Institutional Outcomes Of Blunt Liver & Splenic Injury In The Atomac Era, Shai Stewart Md, James Fraser, Rebecca M. Rentea, Pablo Aguayo, David Juang, Jason D. Fraser, Charles L. Snyder, Richard J. Hendrickson, Shawn D. St.Peter, Tolulope A. Oyetunji

Research Days

Background: The Arizona-Texas-Oklahoma-Memphis-Arkansas Consortium (ATOMAC) practice management guideline (PMG) was created to standardize management of blunt liver or spleen injury (BLSI) across pediatric trauma centers. Evaluations of institutional outcomes after its adoption remain scarce. We describe our outcomes since PMG adoption at our institution.

Objectives/Goal: The purpose of this study was to assess patient outcomes and resource utilization after implementation of this protocol. We hypothesized there is no difference in length of stay (LOS) or complications regardless of grade of isolated injuries to the liver or spleen. In addition, there is limited guidance on the management of concurrent injuries to …

Laparoscopic Versus Open Inguinal Hernia Repair: A Single Institution Comparison Of 1200 Patients, Shai Stewart Md, Wendy Jo Svetanoff, James Fraser, Rebecca M. Rentea, Pablo Aguayo, David Juang, Jason D. Fraser, Charles L. Snyder, Richard J. Hendrickson, Shawn D. St.Peter, Tolulope A. Oyetunji

Research Days

Background: : Laparoscopy has become the standard of care for many pediatric surgical procedures; however, there is no consensus regarding the optimal approach for inguinal hernia repair (IHR). We report our experience over an 8-year period with open and laparoscopic inguinal hernia repair (LIHR).

Objectives/Goal: We aim to describe our experience within a free-standing tertiary care pediatric institution and compare outcomes between open and laparoscopic repair of pediatric inguinal hernias.

Methods/Design: A retrospective review of patients under 18 years who underwent IHR between June 2010 and June 2017 was performed. The open technique utilizes high ligation of the internal ring, …

Institutional Use Of Ultrasound In The Evaluation Of Cryptorchidism, Shai Stewart Md, Dae H. Kim, Nelimar Cruz-Centeno, Derek Marlor, James Fraser, Tolulope A. Oyetunji Md Mph, Shawn D. St.Peter

Research Days

Background, Objectives/Goal, Methods/Design, Results, Conclusions limited to 500 words Background: In 2014, the American Urological Association guidelines recommended against the performance of ultrasound and other imaging modalities in the evaluation of patients with cryptorchidism prior to expert consultation. We hypothesized that ultrasound remains overused by referring physicians.

Objectives/Goal: We aimed to examine our institutional experience and measure adherence to currently available guidelines.

Methods/Design: An institutional review board (IRB) approved retrospective review of ultrasound utilization in the evaluation of patients with cryptorchidism was performed from June 1, 2016, to June 30, 2018, at a single tertiary level pediatric hospital.

Results: We …