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  1. Article ; Online: Changing Patterns of Pediatric Trauma During the COVID-19 Pandemic.

    Wieck, Minna M / Silva, Taylor / Kohler, Jonathan E

    Pediatric annals

    2022  Volume 51, Issue 7, Page(s) e286–e290

    Abstract: The implementation of lockdown and social distancing policies at the beginning of the coronavirus disease 2019 (COVID-19) pandemic changed both the nature of pediatric traumatic injuries and how those injuries were managed by pediatric trauma centers. At ...

    Abstract The implementation of lockdown and social distancing policies at the beginning of the coronavirus disease 2019 (COVID-19) pandemic changed both the nature of pediatric traumatic injuries and how those injuries were managed by pediatric trauma centers. At the start of the pandemic, the number of injured children evaluated at trauma centers decreased. Trauma volumes have since rebounded, and a concerning increase in abuse-related injuries has been seen. Pediatric trauma systems responded to the pandemic with new approaches to protect health care providers, conserve critical resources, and assist adult trauma systems overburdened by patients with COVID-19. The widespread effect of COVID-19 continues to have significant repercussions on children's health, but the lessons learned and gaps exposed by the pandemic may be an opportunity to positively transform injury prevention and health care delivery.
    MeSH term(s) Adult ; COVID-19/epidemiology ; Child ; Communicable Disease Control ; Humans ; Pandemics/prevention & control ; Retrospective Studies ; SARS-CoV-2 ; Trauma Centers
    Language English
    Publishing date 2022-07-01
    Publishing country United States
    Document type Journal Article
    ZDB-ID 195430-1
    ISSN 1938-2359 ; 0090-4481
    ISSN (online) 1938-2359
    ISSN 0090-4481
    DOI 10.3928/19382359-20220504-07
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  2. Article ; Online: It's the message not the medium: Ethics in pediatric surgery communication.

    Kohler, Jonathan E / Riggle, Kevin M / Fallat, Mary E

    Seminars in pediatric surgery

    2021  Volume 30, Issue 5, Page(s) 151099

    Abstract: New communication technologies and generational differences in communication techniques create ethical challenges for pediatric surgeons. Using two hypothetical cases we explore the ethics of modern communication in pediatric surgery. The first case ... ...

    Abstract New communication technologies and generational differences in communication techniques create ethical challenges for pediatric surgeons. Using two hypothetical cases we explore the ethics of modern communication in pediatric surgery. The first case explores the ethics of text messaging with patients and families and of social media posts, both of which have useful ethical analogues in older communication technologies. The second case explores ways that generational experiential differences in learning can foster misunderstandings between team members at different levels of training and potentially impact important medical care decisions. The ethical rules that govern the delivery of patient care also apply to what we say and how we say it. Effective, ethical and compassionate communication will often be the aspect of therapy most appreciated by the patient and family.
    MeSH term(s) Aged ; Child ; Communication ; Empathy ; Humans
    Language English
    Publishing date 2021-09-04
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1133381-9
    ISSN 1532-9453 ; 1055-8586
    ISSN (online) 1532-9453
    ISSN 1055-8586
    DOI 10.1016/j.sempedsurg.2021.151099
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  3. Article ; Online: Characteristics of operative pediatric trauma transfer patients.

    Lee, Su Yeon / Jackson, Jordan E / Vukcevich, Olivia / Stokes, Sarah C / Leshikar, Holly / Rinderknecht, Tanya / Kohler, Jonathan E / Brown, Erin G

    American journal of surgery

    2023  Volume 227, Page(s) 224–228

    Abstract: Background: Pediatric patients treated at trauma centers demonstrate improved outcomes, but investigation of optimal resource utilization surrounding the transfer is ongoing. We evaluated characteristics of operative pediatric trauma transfer patients ... ...

    Abstract Background: Pediatric patients treated at trauma centers demonstrate improved outcomes, but investigation of optimal resource utilization surrounding the transfer is ongoing. We evaluated characteristics of operative pediatric trauma transfer patients for resource optimization.
    Methods: A retrospective review of pediatric trauma patients transferred to a level 1 pediatric trauma center from 2009 to 2019 was performed. Patients were categorized by initial operative subspecialty.
    Results: Of 4164 transferred patients, 33.9 ​% required operative intervention. 65 ​% of operations were performed on orthopedic patients, who were significantly less injured compared to other patients. General surgery patients were more likely to undergo surgery on day of transfer compared to orthopedic patients (39.4%vs 56.3 ​%, OR 2.0, CI 1.4-2.8).
    Conclusions: One-third of pediatric trauma transfer patients required operative intervention. The majority of surgeries were on orthopedic patients, who were less likely to undergo surgery on day of transfer. Critical evaluation of this patient population is required to safely utilize a less resource-intensive transfer process.
    MeSH term(s) Humans ; Child ; Trauma Centers ; Retrospective Studies ; Surgical Wound ; Orthopedics ; Patient Transfer
    Language English
    Publishing date 2023-11-02
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2953-1
    ISSN 1879-1883 ; 0002-9610
    ISSN (online) 1879-1883
    ISSN 0002-9610
    DOI 10.1016/j.amjsurg.2023.09.030
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  4. Article ; Online: Development and Feasibility Testing of a Decision Aid for Acute Appendicitis.

    Rosen, Joshua E / Yang, Frank F / Liao, Joshua M / Flum, David R / Kohler, Jonathan E / Agrawal, Nidhi A / Davidson, Giana H

    The Journal of surgical research

    2023  Volume 289, Page(s) 82–89

    Abstract: Introduction: Patients with acute uncomplicated appendicitis will be increasingly asked to choose between surgery and antibiotic management. We developed a novel decision aid for patients in the emergency department (ED) with acute appendicitis who are ... ...

    Abstract Introduction: Patients with acute uncomplicated appendicitis will be increasingly asked to choose between surgery and antibiotic management. We developed a novel decision aid for patients in the emergency department (ED) with acute appendicitis who are facing this choice. We describe the development of the decision aid and an initial feasibility study of its implementation in a busy tertiary care ED.
    Materials and methods: We conducted a prepost survey analysis comparing patients before and after standardized implementation of the decision aid. Patients were surveyed about their experience making treatment decisions after discharge from the hospital. The primary outcome measure was the total score on the decisional conflict scale (; 0-100; lower scores better).
    Results: The study included 24 participants (12 in the predecision aid period; 12 in the post period). Only 33% of participants in each group knew antibiotics were a treatment option prior to arriving at the ED. Prior to implementing the use of decision aid, only 75% of patients reported being told antibiotics were a treatment option, while this increased to 100% after implementation of the decision aid. The mean total decisional conflict scalescores were similar in the pre and post periods (mean difference = 0.13, 95% CI: -13 - 13, P > 0.9).
    Conclusions: This novel appendicitis decision aid was effectively integrated into clinical practice and helped toinform patients about multiple treatment options. These data support further large-scale testing of the decision aid as part of standardized pathways for the management of patients with acute appendicitis.
    MeSH term(s) Humans ; Decision Support Techniques ; Appendicitis/diagnosis ; Appendicitis/surgery ; Appendicitis/drug therapy ; Feasibility Studies ; Patient Participation ; Acute Disease ; Anti-Bacterial Agents/therapeutic use
    Chemical Substances Anti-Bacterial Agents
    Language English
    Publishing date 2023-04-20
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 80170-7
    ISSN 1095-8673 ; 0022-4804
    ISSN (online) 1095-8673
    ISSN 0022-4804
    DOI 10.1016/j.jss.2023.03.028
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  5. Article ; Online: Rural health, telemedicine and access for pediatric surgery.

    Kohler, Jonathan E / Falcone, Richard A / Fallat, Mary E

    Current opinion in pediatrics

    2019  Volume 31, Issue 3, Page(s) 391–398

    Abstract: Purpose of review: Access to care for children requiring pediatric general or specialty surgery or trauma care who live in rural areas remains a challenge in the United States.: Recent findings: The expertise of specialists in tertiary centers can be ...

    Abstract Purpose of review: Access to care for children requiring pediatric general or specialty surgery or trauma care who live in rural areas remains a challenge in the United States.
    Recent findings: The expertise of specialists in tertiary centers can be extended to rural and underserved areas using telemedicine. There are challenges to making these resources available that need to be methodically approached to facilitate appropriate relationships between hospitals and providers. Programs, such as the National Pediatric Readiness Project and the HRSA Emergency Medical Services for Children Program enhance the capability of the emergency care system to function optimally, keep children at the home hospital if resources are available, facilitate transfer of patients and relationship building, and develop necessary transfer protocols and guidelines between hospitals.
    Summary: Telehealth services have the potential to enhance the reach of tertiary care for children in rural and underserved areas where surgical and trauma specialty care is not readily available, particularly when used to augment the objectives of national programs.
    MeSH term(s) Child ; Health Services Accessibility ; Humans ; Rural Health ; Rural Health Services ; Rural Population ; Specialties, Surgical ; Telemedicine ; United States
    Language English
    Publishing date 2019-07-08
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1049374-8
    ISSN 1531-698X ; 1040-8703
    ISSN (online) 1531-698X
    ISSN 1040-8703
    DOI 10.1097/MOP.0000000000000763
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    Zs.A 3049: Show issues Location:
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  6. Article ; Online: Need for Consensus Guidelines in Pediatric Umbilical Hernia Repair.

    Kohler, Jonathan E / Nichol, Peter F / Cartmill, Randi S

    JAMA pediatrics

    2019  Volume 173, Issue 11, Page(s) 1109–1110

    Language English
    Publishing date 2019-09-28
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2701223-2
    ISSN 2168-6211 ; 2168-6203
    ISSN (online) 2168-6211
    ISSN 2168-6203
    DOI 10.1001/jamapediatrics.2019.3414
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  7. Article ; Online: Continued Prescribing of Periprocedural Codeine and Tramadol to Children after a Black Box Warning.

    Kohler, Jonathan E / Cartmill, Randi S / Kalbfell, Elle / Schumacher, Jessica

    The Journal of surgical research

    2020  Volume 256, Page(s) 131–135

    Abstract: Background: Codeine and tramadol are commonly used analgesics in surgery. In 2013, the Food and Drug Administration (FDA) issued a contraindication to the use of codeine in tonsillectomy and adenoidectomy patients aged below 18 y. This warning was ... ...

    Abstract Background: Codeine and tramadol are commonly used analgesics in surgery. In 2013, the Food and Drug Administration (FDA) issued a contraindication to the use of codeine in tonsillectomy and adenoidectomy patients aged below 18 y. This warning was expanded in April 2017 to include tramadol and all children aged below 12 y. We sought to describe the prescribing of codeine and tramadol to contraindicated populations in Wisconsin before and after the release of the expanded FDA warning.
    Materials and methods: Using a statewide Wisconsin claims database, we identified common pediatric ambulatory surgical procedures across the specialties of otolaryngology, urology, general surgery, orthopedics, and ophthalmology. For these procedures, we examined the rates of perioperative codeine and tramadol prescription fills and change in prescribing after the FDA contraindication.
    Results: Surgeons in all of the specialties studied continued to prescribe codeine to pediatric patients after the contraindication, but tramadol was rarely prescribed. Procedures with relatively high rates of codeine fills were strabismus repair (65% of opioid fills), circumcision >1 yo (22%), and laparoscopic appendectomy (15%). Codeine fills significantly declined after the contraindication to 6% for circumcision >1 yo and 5% for orchiopexy and inguinal hernia repair. Otolaryngology, which was subject to the 2013 codeine contraindication, has low rates of codeine fills (under 2.5%) for the whole period studied. Codeine prescribing for strabismus repair showed no significant decline.
    Conclusions: Codeine, and to a lesser extent tramadol, continue to be prescribed to contraindicated populations of children. This represents a target for future de-implementation interventions.
    MeSH term(s) Administrative Claims, Healthcare/statistics & numerical data ; Adolescent ; Ambulatory Surgical Procedures/adverse effects ; Child ; Child, Preschool ; Codeine/therapeutic use ; Drug Labeling ; Drug Prescriptions/standards ; Drug Prescriptions/statistics & numerical data ; Female ; Humans ; Inappropriate Prescribing/prevention & control ; Inappropriate Prescribing/statistics & numerical data ; Infant ; Male ; Pain, Postoperative/drug therapy ; Pain, Postoperative/etiology ; Perioperative Care/standards ; Perioperative Care/statistics & numerical data ; Practice Patterns, Physicians'/standards ; Practice Patterns, Physicians'/statistics & numerical data ; Retrospective Studies ; Tramadol/therapeutic use ; Wisconsin
    Chemical Substances Tramadol (39J1LGJ30J) ; Codeine (UX6OWY2V7J)
    Language English
    Publishing date 2020-07-18
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 80170-7
    ISSN 1095-8673 ; 0022-4804
    ISSN (online) 1095-8673
    ISSN 0022-4804
    DOI 10.1016/j.jss.2020.06.023
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  8. Article ; Online: Management of Abdominal Solid Organ Injury After Blunt Trauma.

    Kohler, Jonathan E / Chokshi, Nikunj K

    Pediatric annals

    2016  Volume 45, Issue 7, Page(s) e241–6

    Abstract: Injury to the solid abdominal organs-liver, spleen, kidney, and pancreas-is one of the most common injury patterns in pediatric blunt trauma. Pediatric trauma centers are becoming increasingly successful in managing these injuries without operative ... ...

    Abstract Injury to the solid abdominal organs-liver, spleen, kidney, and pancreas-is one of the most common injury patterns in pediatric blunt trauma. Pediatric trauma centers are becoming increasingly successful in managing these injuries without operative intervention. Well-validated guidelines have been established for liver and spleen injury management, and operative intervention is reserved for patients who show evidence of active bleeding after resuscitation. No such guidelines yet exist for the management of traumatic injury of the kidney or pancreas. Exploratory laparotomy remains the treatment of choice in patients suffering hemodynamic collapse, but interventional radiologic or endoscopic procedures are increasingly used to manage all but the most devastating solid organ injuries. [Pediatr Ann. 2016;45(7):e241-e246.].
    MeSH term(s) Abdominal Injuries/etiology ; Abdominal Injuries/surgery ; Child ; Child, Preschool ; Disease Management ; Guidelines as Topic ; Humans ; Laparotomy/methods ; Male ; Pediatrics ; Wounds, Nonpenetrating/etiology ; Wounds, Nonpenetrating/surgery
    Language English
    Publishing date 2016-07-01
    Publishing country United States
    Document type Journal Article
    ZDB-ID 195430-1
    ISSN 1938-2359 ; 0090-4481
    ISSN (online) 1938-2359
    ISSN 0090-4481
    DOI 10.3928/00904481-20160518-01
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  9. Article ; Online: Reply to: Confounding factors on the analysis of opioid prescription after pediatric umbilical hernia repair.

    Cartmill, Randi / Yang, Dou-Yan / Fernandes-Taylor, Sara / Kohler, Jonathan E

    Surgery

    2019  Volume 166, Issue 2, Page(s) 232–233

    MeSH term(s) Analgesics, Opioid ; Child ; Hernia, Umbilical ; Herniorrhaphy ; Humans ; Pain, Postoperative ; Practice Patterns, Physicians'
    Chemical Substances Analgesics, Opioid
    Language English
    Publishing date 2019-04-05
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 202467-6
    ISSN 1532-7361 ; 0039-6060
    ISSN (online) 1532-7361
    ISSN 0039-6060
    DOI 10.1016/j.surg.2019.02.019
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  10. Article ; Online: Work system barriers and facilitators of a team health information technology.

    Hose, Bat-Zion / Carayon, Pascale / Hoonakker, Peter L T / Brazelton, Thomas B / Dean, Shannon M / Eithun, Benjamin L / Kelly, Michelle M / Kohler, Jonathan E / Ross, Joshua C / Rusy, Deborah A

    Applied ergonomics

    2023  Volume 113, Page(s) 104105

    Abstract: Designing health IT aimed at supporting team-based care and improving patient safety is difficult. This requires a work system (i.e., SEIPS) evaluation of the technology by care team members. This study aimed to identify work system barriers and ... ...

    Abstract Designing health IT aimed at supporting team-based care and improving patient safety is difficult. This requires a work system (i.e., SEIPS) evaluation of the technology by care team members. This study aimed to identify work system barriers and facilitators to the use of a team health IT that supports care transitions for pediatric trauma patients. We conducted an analysis on 36 interviews - representing 12 roles - collected from a scenario-based evaluation of T
    MeSH term(s) Humans ; Child ; Communication ; Patient Safety ; Medical Informatics ; Task Performance and Analysis ; Technology
    Language English
    Publishing date 2023-08-02
    Publishing country England
    Document type Journal Article
    ZDB-ID 2003513-5
    ISSN 1872-9126 ; 0003-6870
    ISSN (online) 1872-9126
    ISSN 0003-6870
    DOI 10.1016/j.apergo.2023.104105
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