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Article ; Online: Surviving the COVID-19 Pandemic from the Pediatric Surgical Perspective: Innovations in Risk Mitigation and Scarce Resource Management.

Mak, Grace Z / Slidell, Mark B

2022 Volume 51, Issue 7, Page(s) e264–e265

MeSH term(s)	COVID-19 ; Child ; Humans ; Pandemics/prevention & control ; SARS-CoV-2
Language	English
Publishing date	2022-07-01
Publishing country	United States
Document type	Editorial
ZDB-ID	195430-1
ISSN	1938-2359 ; 0090-4481
ISSN (online)	1938-2359
ISSN	0090-4481
DOI	10.3928/19382359-20220504-04
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Article ; Online: Ethics, Social Determinants of Health, Surgical Education, and the Delivery of Pediatric Surgical Care Post-Pandemic. Will COVID-19 Leave a Surgical Scar?

Slidell, Mark B / Mak, Grace Z

Pediatric annals

2022 Volume 51, Issue 8, Page(s) e304–e305

MeSH term(s)	COVID-19 ; Child ; Cicatrix ; Humans ; Pandemics ; SARS-CoV-2 ; Social Determinants of Health
Language	English
Publishing date	2022-08-01
Publishing country	United States
Document type	Editorial
ZDB-ID	195430-1
ISSN	1938-2359 ; 0090-4481
ISSN (online)	1938-2359
ISSN	0090-4481
DOI	10.3928/19382359-20220606-02
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Article ; Online: Letter to the editor: Time to reconsider the use of Shock Index, Pediatric Adjusted in young children? Mounting evidence suggests that alternative shock indices can more accurately triage injured children.

Georgette, Nathan / Keskey, Robert C / Polcari, Ann M / Slidell, Mark B

The journal of trauma and acute care surgery

2023 Volume 96, Issue 3, Page(s) e22–e24

MeSH term(s)	Child ; Humans ; Child, Preschool ; Triage ; Trauma Centers ; Retrospective Studies ; Wounds and Injuries/diagnosis ; Wounds and Injuries/therapy ; Shock/diagnosis ; Shock/therapy ; Injury Severity Score
Language	English
Publishing date	2023-08-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	2651070-4
ISSN	2163-0763 ; 2163-0755
ISSN (online)	2163-0763
ISSN	2163-0755
DOI	10.1097/TA.0000000000003973
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Article ; Online: Improved Kasai Hepatoportoenterostomy Outcomes After Implementation of a Dedicated Biliary Atresia Team.

Jamil, Omar K / Shanmugarajah, Kumaran / Azzam, Ruba K / Slidell, Mark B

The American surgeon

2022 Volume 89, Issue 12, Page(s) 6270–6272

Abstract: ... and 2 years post HPE at 90% and 86%, respectively. Outcomes were markedly improved after the team was ...

Abstract	It can be difficult or impractical to refer all biliary atresia (BA) patients to high-volume centers. Our hypothesis was that a low volume center could improve outcomes with implementation of a dedicated multidisciplinary BA team. We conducted a retrospective study of patients with BA who underwent hepatic portoenterostomy at our institution from 2003 to 2020, before and after the development of a dedicated BA team. Ten consecutive patients with BA were identified following the establishment of a dedicated BA team. Since the establishment of the BA team, total bilirubin (TB) clearance (TB < 2 mg/dL) achieved by 3 and 6 months has been 60% and 60%, respectively, and survival of the native liver (SNL) at 1 and 2 years post HPE at 90% and 86%, respectively. Outcomes were markedly improved after the team was established. A dedicated BA team prioritizing communication and expeditious workup can improve outcomes at a low volume center.
MeSH term(s)	Humans ; Biliary Atresia/surgery ; Portoenterostomy, Hepatic ; Retrospective Studies ; Treatment Outcome ; Liver/surgery ; Bilirubin
Chemical Substances	Bilirubin (RFM9X3LJ49)
Language	English
Publishing date	2022-10-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	202465-2
ISSN	1555-9823 ; 0003-1348
ISSN (online)	1555-9823
ISSN	0003-1348
DOI	10.1177/00031348221135781
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Article ; Online: Pediatric Trauma Recidivism: A Statewide Risk Factor Analysis of the Maryland Health Services Cost Review Commission (HSCRC).

Price, Matthew D / McDermott, Katherine M / An, Daniel / Aslam, Usman / Slidell, Mark B / Nasr, Isam W

Journal of pediatric surgery

2024

Abstract: Background: National estimates suggest pediatric trauma recidivism is uncommon but are limited by short follow up and narrow ascertainment. We aimed to quantify the long-term frequency of trauma recidivism in a statewide pediatric population and ... ...

Abstract	Background: National estimates suggest pediatric trauma recidivism is uncommon but are limited by short follow up and narrow ascertainment. We aimed to quantify the long-term frequency of trauma recidivism in a statewide pediatric population and identify risk factors for re-injury. Methods: The Maryland Health Services Cost Review Commission Dataset was queried for 0-19-year-old patients with emergency department or inpatient encounters for traumatic injuries between 2013 and 2019. We measured trauma recidivism by identifying patients with any subsequent presentation for a new traumatic injury. Univariate and multivariable regressions were used to estimate associations of patient and injury characteristics with any recidivism and inpatient recidivism. Results: Of 574,472 patients with at least one injury encounter, 29.6% experienced trauma recidivism. Age ≤2 years, public insurance, and self-inflicted injuries were associated with recidivism regardless of index treatment setting. Of those with index emergency department presentations 0.06% represented with an injury requiring inpatient admission; unique risk factors for ED-to-inpatient recidivism were age >10 years (aOR 1.61), cyclist (aOR 1.31) or burn (aOR 1.39) mechanisms, child abuse (aOR 1.27), and assault (aOR 1.43). Among patients with at least one inpatient encounter, 6.3% experienced another inpatient trauma admission, 3.4% of which were fatal. Unique risk factors for inpatient-to-inpatient recidivism were firearm (aOR 2.48) and motor vehicle/transportation (aOR 1.62) mechanisms of injury (all p < 0.05). Conclusions: Pediatric trauma recidivism is more common and morbid than previously estimated, and risk factors for repeat injury differ by treatment setting. Demographic and injury characteristics may help develop and target setting-specific interventions. Level of evidence: III (Retrospective Comparative Study).
Language	English
Publishing date	2024-04-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	80165-3
ISSN	1531-5037 ; 0022-3468
ISSN (online)	1531-5037
ISSN	0022-3468
DOI	10.1016/j.jpedsurg.2024.04.002
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Article ; Online: Patient age must be incorporated into future paediatric injury severity scoring systems.

Keskey, Robert C / Hampton, David A / Wilson, Kenneth L / Slidell, Mark B

The Lancet. Child & adolescent health

2021 Volume 5, Issue 10, Page(s) e39

MeSH term(s)	Child ; Forecasting ; Humans ; Injury Severity Score
Language	English
Publishing date	2021-08-13
Publishing country	England
Document type	Letter ; Comment
ISSN	2352-4650
ISSN (online)	2352-4650
DOI	10.1016/S2352-4642(21)00246-7
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Article ; Online: Using rapid cycle deliberate practice to improve primary and secondary survey in pediatric trauma.

Yan, Diana Hou / Slidell, Mark B / McQueen, Alisa

BMC medical education

2020 Volume 20, Issue 1, Page(s) 131

Abstract: Background: Optimal performance of the primary and secondary survey is the foundation of Advance Trauma Life Support care. Despite its importance, not all primary surveys completed at level 1 pediatric trauma centers are performed according to ... ...

Abstract	Background: Optimal performance of the primary and secondary survey is the foundation of Advance Trauma Life Support care. Despite its importance, not all primary surveys completed at level 1 pediatric trauma centers are performed according to established guidelines (Gala et al., Pediatr Emerg Care 32:756-762, 2016, Carter et al., Resuscitation 84:66-71, 2013). We hypothesize that rapid cycle deliberate practice (RCDP) will improve surgical residents' confidence in performing the primary and secondary survey. Methods: We developed a curriculum to teach surgical interns the principles of performing the primary and secondary survey using RCDP. Surveys distributed after each session assessed the impact of the curriculum on learner confidence and perception that this curriculum would benefit patient care. Questions were scored on a 5-point Likert scale. Sixteen surgical interns participated during intern orientation and 100% of the participants completed the post curriculum survey. Results: Thirteen (81%) of participants agreed or strongly agreed that the simulation would impact future performance in the pediatric trauma bay. The curriculum also significantly improved the confidence of our learners to perform trauma surveys (p < 0.001). Conclusion: This curriculum improves the confidence of junior surgical residents in learning the primary and secondary survey. Most learners enjoyed the session and felt that the curriculum would positively impact their performance.
MeSH term(s)	Child ; Clinical Competence ; Computer Simulation/standards ; Computer-Assisted Instruction/methods ; Critical Illness/therapy ; Curriculum ; Education, Medical, Graduate/methods ; Humans ; Internship and Residency/methods ; Pediatric Emergency Medicine/education ; Pediatric Emergency Medicine/standards ; Problem-Based Learning/methods ; Resuscitation/education ; Resuscitation/standards ; Simulation Training/methods
Language	English
Publishing date	2020-04-28
Publishing country	England
Document type	Journal Article
ZDB-ID	2044473-4
ISSN	1472-6920 ; 1472-6920
ISSN (online)	1472-6920
ISSN	1472-6920
DOI	10.1186/s12909-020-02038-z
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Article ; Online: Rapid Cycle Deliberate Practice Simulation Curriculum Improves Pediatric Trauma Performance: A Prospective Cohort Study.

Yan, Diana Hou / Slidell, Mark B / McQueen, Alisa

Simulation in healthcare : journal of the Society for Simulation in Healthcare

2020 Volume 16, Issue 6, Page(s) e94–e99

Abstract: Introduction: Simulation-based medical education allows learners to refine and maintain clinical skills especially for high-stake situations such as trauma resuscitation. Despite the primary and secondary survey being its foundation, literature shows ... ...

Abstract	Introduction: Simulation-based medical education allows learners to refine and maintain clinical skills especially for high-stake situations such as trauma resuscitation. Despite the primary and secondary survey being its foundation, literature shows poor adherence with overall rates as low as 13%. This study evaluates the impact of rapid cycle deliberate practice (RCDP) on primary and secondary survey skill retention. We hypothesized that RCDP-trained surgery residents will have real-world clinical improvement in their survey completion in pediatric trauma resuscitations. Methods: We developed an RCDP trauma resuscitation curriculum. Videos of trauma resuscitations before and after curriculum implementation were scored by 2 blinded reviewers using a modified Pediatric Trauma Assessment Scoring Tool. Actual trauma care by residents who had received the curriculum (study group) was compared with care provided by residents who had not received the curriculum (precurriculum historical control group and a concurrent control group who provided care without receiving the curriculum). Results: One hundred eighty-eight videos were scored with 98 in study group, 33 in concurrent control group, and 57 in historical control group. There was a significant improvement in primary survey performance between study group and historical control group (P < 0.001), but no difference between study group and concurrent control group. There was a significant improvement between study group and 2 control groups in secondary survey performance (both P < 0.001). Conclusions: The RCDP curriculum led to significant improvement in surgical residents' trauma survey performance and had clinical impact on actual patients, which is rare in pediatric trauma simulation literature.
MeSH term(s)	Child ; Clinical Competence ; Curriculum ; Humans ; Internship and Residency ; Prospective Studies ; Resuscitation
Language	English
Publishing date	2020-11-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	2223429-9
ISSN	1559-713X ; 1559-2332
ISSN (online)	1559-713X
ISSN	1559-2332
DOI	10.1097/SIH.0000000000000524
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Article ; Online: Use of shear wave elastography for the diagnosis and follow-up of biliary atresia: A meta-analysis.

Wagner, Ellen S / Abdelgawad, Hussien Ahmed H / Landry, Meghan / Asfour, Belal / Slidell, Mark B / Azzam, Ruba

World journal of gastroenterology

2022 Volume 28, Issue 32, Page(s) 4726–4740

Abstract: Background: Timely differentiation of biliary atresia (BA) from other infantile cholestatic diseases can impact patient outcomes. Additionally, non-invasive staging of fibrosis after Kasai hepatoportoenterostomy has not been widely standardized. Shear ... ...

Abstract	Background: Timely differentiation of biliary atresia (BA) from other infantile cholestatic diseases can impact patient outcomes. Additionally, non-invasive staging of fibrosis after Kasai hepatoportoenterostomy has not been widely standardized. Shear wave elastography is an ultrasound modality that detects changes in tissue stiffness. The authors propose that the utility of elastography in BA can be elucidated through meta-analysis of existing studies. Aim: To assess the utility of elastography in: (1) BA diagnosis, and (2) post-Kasai fibrosis surveillance. Methods: A literature search identified articles that evaluated elastography for BA diagnosis and for post-Kasai follow-up. Twenty studies met criteria for meta-analysis: Eleven for diagnosis and nine for follow-up post-Kasai. Estimated diagnostic odds ratio (DOR), sensitivity, and specificity of elastography were calculated through a random-effects model using Meta-DiSc software. Results: Mean liver stiffness in BA infants at diagnosis was significantly higher than in non-BA, with overall DOR 24.61, sensitivity 83%, and specificity 79%. Post-Kasai, mean liver stiffness was significantly higher in BA patients with varices than in patients without, with DOR 16.36, sensitivity 85%, and specificity 76%. Elastography differentiated stage F4 fibrosis from F0-F3 with DOR of 70.03, sensitivity 96%, and specificity 89%. Elastography also differentiated F3-F4 fibrosis from F0-F2 with DOR of 24.68, sensitivity 85%, and specificity 81%. Conclusion: Elastography has potential as a non-invasive modality for BA diagnosis and surveillance post-Kasai. This paper's limitations include inter-study method heterogeneity and small sample sizes. Future, standardized, multi-center studies are recommended.
MeSH term(s)	Biliary Atresia/diagnostic imaging ; Biliary Atresia/pathology ; Biliary Atresia/surgery ; Elasticity Imaging Techniques/methods ; Fibrosis ; Follow-Up Studies ; Humans ; Infant ; Liver/diagnostic imaging ; Liver/pathology ; Liver Cirrhosis/pathology ; Portoenterostomy, Hepatic
Language	English
Publishing date	2022-09-19
Publishing country	United States
Document type	Journal Article ; Meta-Analysis
ZDB-ID	2185929-2
ISSN	2219-2840 ; 1007-9327
ISSN (online)	2219-2840
ISSN	1007-9327
DOI	10.3748/wjg.v28.i32.4726
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Article ; Online: Determinants of electrocardiographic abnormalities in patients with pectus excavatum.

Kohli, Utkarsh / Kaur, Tripat / Donington, Jessica S / Slidell, Mark B

Journal of electrocardiology

2021 Volume 65, Page(s) 91–95

Abstract: Background: Electrocardiographic abnormalities such as cardiac axis deviation, conduction abnormalities and ST-segment, and T &P wave abnormalities have been reported in patients with pectus excavatum. The precise determinants of these ... ...

Abstract	Background: Electrocardiographic abnormalities such as cardiac axis deviation, conduction abnormalities and ST-segment, and T &P wave abnormalities have been reported in patients with pectus excavatum. The precise determinants of these electrocardiographic abnormalities have however not been systematically evaluated. We therefore carried out this exploratory study to assess the electrocardiographic abnormalities and their determinants in children and young adults with pectus excavatum. Methods: Patients aged between 6 and 22 years with unrepaired pectus excavatum were eligible for enrollment in this preliminary hypothesis generating study, if they were seen at University of Chicago Medical Center between Jan 1, 2017 to Nov 30, 2020, and underwent an electrocardiogram during comprehensive evaluation for pectus excavatum. Pertinent data was collected from the medical charts. Unadjusted and adjusted logistic regression models were used to determine the effect of variables including age, BMI, inspiratory Haller's index, gender, right ventricular geometric distortion and FEV1/FVC (% predicted) on odds of electrocardiographic abnormalities (primary outcome variable). P-values of <0.05 were considered significant. Results: The study group (16.6 ± 2.9 years, 80% symptomatic) consisted of 28 patients [Caucasian, male (n = 24, 86% each)]. A high proportion (86%) of these patients had geometric distortion of the right ventricle on noninvasive imaging and these patients had a higher Haller's index (4.4 ± 0.95 vs 3.3 ± 0.2, p = 0.03). Approximately 60% of the patients had an abnormal electrocardiogram. Unadjusted and adjusted logistic regression models were utilized to study the determinants of these electrocardiographic abnormalities. Haller's index, BMI, age, gender, geometric distortion of the right ventricle and lung function parameters [FEV1/FEV (% predicted)] were not associated with increased odds of electrocardiographic abnormalities. Conclusions: Electrocardiographic abnormalities, particularly deviation of cardiac axis, are common in patients with pectus excavatum. In this exploratory hypothesis generating study, Haller's index and geometric distortion of the right ventricle were not associated with these abnormalities. However, systematic multicentric efforts are needed to better define electrocardiographic abnormalities in patients with pectus excavatum and elucidate their precise determinants.
Language	English
Publishing date	2021-02-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	410286-1
ISSN	1532-8430 ; 0022-0736
ISSN (online)	1532-8430
ISSN	0022-0736
DOI	10.1016/j.jelectrocard.2021.01.015
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