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  1. Article ; Online: Effect of Routine Child Physical Abuse Screening Tool on Emergency Department Efficiency.

    Shahi, Niti / Meier, Maxene / Reppucci, Marina L / Pickett, Kaci L / Phillips, Ryan / McLean, Marissa / Moulton, Steven L / Lindberg, Daniel M

    Pediatric emergency care

    2024  

    Abstract: Objectives: Physical abuse is a significant cause of morbidity and mortality for children. Routine screening by emergency nurses has been proposed to improve recognition, but the effect on emergency department (ED) workflow has not yet been assessed. We ...

    Abstract Objectives: Physical abuse is a significant cause of morbidity and mortality for children. Routine screening by emergency nurses has been proposed to improve recognition, but the effect on emergency department (ED) workflow has not yet been assessed. We sought to evaluate the feasibility of routine screening and its effect on length of stay in a network of general EDs.
    Methods: A 2-question child physical abuse screening tool was deployed for children <6 years old who presented for care in a system of 27 general EDs. Data were compared for the 6 months before and after screening was deployed (4/1/2019-10/2/2019 vs 10/3/2019-3/31/2020). The main outcome was ED length of stay in minutes.
    Results: There were 14,133 eligible visits in the prescreening period and 16,993 in the screening period. Screening was completed for 13,404 visits (78.9%), with 116 (0.7%) screening positive. The mean ED length of stay was not significantly different in the prescreening (95.9 minutes) and screening periods (95.2 minutes; difference, 0.7 minutes; 95% CI, -1.5, 2.8). Among those who screened positive, 29% were reported to child protective services. On multivariable analysis, implementation of the screening tool did not impact overall ED length of stay. There were no significant differences in resource utilization between the prescreening and screening periods.
    Conclusions: Routine screening identifies children at high risk of physical abuse without increasing ED length of stay or resource utilization. Next steps will include determining rates of subsequent serious physical abuse in children with or without routine screening.
    Language English
    Publishing date 2024-04-19
    Publishing country United States
    Document type Journal Article
    ZDB-ID 632588-9
    ISSN 1535-1815 ; 0749-5161
    ISSN (online) 1535-1815
    ISSN 0749-5161
    DOI 10.1097/PEC.0000000000003205
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  2. Article ; Online: Adult urological outcomes for patients with anorectal malformation.

    Reppucci, Marina L / Harris, Kelly T / Wilcox, Duncan T / Peycelon, Matthieu / Bischoff, Andrea

    Journal of pediatric urology

    2023  Volume 20, Issue 2, Page(s) 193–199

    Abstract: Anorectal malformations (ARM) are rare congenital anomalies characterized by a spectrum of defects resulting in the absence of a normal anal opening with or without fistula. Urogenital involvement is common, and the fistulous tract may terminate in the ... ...

    Abstract Anorectal malformations (ARM) are rare congenital anomalies characterized by a spectrum of defects resulting in the absence of a normal anal opening with or without fistula. Urogenital involvement is common, and the fistulous tract may terminate in the genitourinary system in males or within gynecological structures in females. Surgical reconstruction occurs early in life and survival of these patients to adulthood is the norm. There has, therefore, been increased focus on their long-term outcomes to better anticipate and treat the sequelae that may impact their health and well-being as this population ages. For urologists, urinary health, sexual function, and fertility outcomes are of particular interest among this population. This article aims to provide a review of urological, sexual, and fertility outcomes for individuals born with ARM with a focus on key issues that may occur later in life to ensure adequate counseling, screening, and treatment.
    MeSH term(s) Male ; Adult ; Female ; Humans ; Anorectal Malformations/complications ; Anorectal Malformations/surgery ; Anal Canal/surgery ; Urogenital System
    Language English
    Publishing date 2023-12-22
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2237683-5
    ISSN 1873-4898 ; 1477-5131
    ISSN (online) 1873-4898
    ISSN 1477-5131
    DOI 10.1016/j.jpurol.2023.12.015
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  3. Article ; Online: Reply to Letter to the Editor: Pediatric massive transfusion protocols applied to intraoperative complications of common pediatric surgeries.

    Reppucci, Marina L / Stevens, Jenny / Pickett, Kaci / Moulton, Steven L

    Journal of pediatric surgery

    2022  Volume 57, Issue 6, Page(s) 1173

    MeSH term(s) Blood Transfusion ; Child ; Humans ; Intraoperative Complications/etiology ; Intraoperative Complications/prevention & control
    Language English
    Publishing date 2022-02-04
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 80165-3
    ISSN 1531-5037 ; 0022-3468
    ISSN (online) 1531-5037
    ISSN 0022-3468
    DOI 10.1016/j.jpedsurg.2022.01.045
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  4. Article ; Online: Individual and neighborhood level characteristics of pediatric firearm injuries presenting at trauma centers in Colorado.

    Stevens, Jenny / Leonard, Jan / Reppucci, Marina L / Schroeppel, Thomas / Bensard, Denis / Haasz, Maya

    The journal of trauma and acute care surgery

    2022  Volume 93, Issue 3, Page(s) 385–393

    Abstract: Background: Firearm injuries are the second leading cause of death among children and adolescents in the United States. In Colorado, firearm injuries have surpassed motor vehicle accidents as the leading cause of death in youth. Local research is ... ...

    Abstract Background: Firearm injuries are the second leading cause of death among children and adolescents in the United States. In Colorado, firearm injuries have surpassed motor vehicle accidents as the leading cause of death in youth. Local research is necessary to characterize risk factors associated with pediatric firearm injuries. We sought to categorize demographics, neighborhood characteristics, and trends in pediatric firearm injuries in Colorado.
    Methods: A review of pediatric firearm-injured patients (18 years or younger) evaluated at four trauma centers in Colorado from 2008 to 2019 was conducted. Clinical information, injury intent, and demographics were collected. Patient addresses were geocoded to census tracts to obtain neighborhood-level characteristics. Annual trends in firearm injury incidence per trauma evaluation were analyzed using regression modeling.
    Results: There were 446 firearm injuries during the study period. The median age was 16 years, and 87.0% were male. Assault was the most common injury intent (64.6%), and 92.0% of patients were from metropolitan (rural-urban continuum code 1-3) areas. Neighborhoods associated with firearm injuries were characterized by lower median household income ($47,112 vs. $63,443, p < 0.001) and higher levels of poverty (19.1% vs. 9.4%, p < 0.001) compared with median state levels. There was a 14.0% increase in firearm injuries compared with overall trauma evaluations for each year in the study period (incidence rate ratio, 1.14; 95% confidence interval, 1.08-1.20; p < 0.001).
    Conclusion: The incidence of pediatric firearm injuries increased significantly from 2008 to 2019 compared with overall trauma evaluations in Colorado. Children and adolescents who live in more socially vulnerable neighborhoods are disproportionately impacted, and injury prevention resources should be focused on these communities.
    Level of evidence: Prognostic and Epidemiolgic; Level III.
    MeSH term(s) Adolescent ; Child ; Colorado/epidemiology ; Female ; Firearms ; Humans ; Male ; Retrospective Studies ; Trauma Centers ; United States ; Wounds, Gunshot/epidemiology
    Language English
    Publishing date 2022-01-25
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2651070-4
    ISSN 2163-0763 ; 2163-0755
    ISSN (online) 2163-0763
    ISSN 2163-0755
    DOI 10.1097/TA.0000000000003520
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    Zs.A 127: Show issues Location:
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  5. Article ; Online: Outcomes in Pediatric Trauma Patients Who Receive Blood Transfusion.

    Reppucci, Marina L / Pickett, Kaci / Stevens, Jenny / Nolan, Margo M / Moulton, Steven L

    The Journal of surgical research

    2022  Volume 282, Page(s) 232–238

    Abstract: Introduction: Increased blood volumes, due to massive transfusion (MT), are known to be associated with both infectious and noninfectious adverse outcomes. The aim of this study was to assess the association between MT and outcomes in pediatric trauma ... ...

    Abstract Introduction: Increased blood volumes, due to massive transfusion (MT), are known to be associated with both infectious and noninfectious adverse outcomes. The aim of this study was to assess the association between MT and outcomes in pediatric trauma patients, and, secondarily, determine if these outcomes are differential by age once MT is reached.
    Methods: Pediatric patients (ages 1-18 y old) in the ACS pediatric Trauma Quality Improvement Program (TQIP) database (2015-2018) who received blood were included. Patients were stratified by MT status, which was defined as blood product volume of 40 mL/kg within 24 h of admission (MT+) and compared to children who received blood products but did not meet the MT threshold (MT-). Defined MT + patients were matched 1:1 to MT-patients via propensity score matching of characteristics before comparisons. Adjusted logistic regression was performed on univariably significant outcomes of interest.
    Results: There were 2318 patients in the analytic cohort. Patients who received MT had higher rates of deep venous thrombosis (DVT) (2.5% versus 1.0%, P < 0.001), acute kidney injury (AKI) (1.5% versus 0.0%, P = 0.022), CLABSI (4.0% versus 2.0% P = 0.008), and severe sepsis (2.3% versus. 1.1%, P = 0.02). On logistic regression MT was an independent risk factor for these outcomes. There was no differential effect of MT on these outcomes based on age.
    Conclusions: Outcomes associated with blood transfusion in pediatric trauma patients are low overall, but rates of DVT, AKI, CLABSI, and sepsis are higher in those who receive MT+ with no differences based on age.
    MeSH term(s) Child ; Humans ; Infant ; Child, Preschool ; Adolescent ; Blood Transfusion ; Databases, Factual ; Propensity Score ; Logistic Models ; Acute Kidney Injury ; Wounds and Injuries/complications ; Wounds and Injuries/therapy ; Retrospective Studies ; Injury Severity Score ; Trauma Centers
    Language English
    Publishing date 2022-10-31
    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.2022.10.007
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    Zs.A 178: Show issues Location:
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  6. Article ; Online: A precision-designed gastrostomy button securement device.

    Stevens, Jenny / Reppucci, Marina L / Mironuck, Tyler / Nolan, Margo M / Choi, Young Mee / Moulton, Steven L

    Journal of pediatric surgery

    2022  

    Abstract: Background: Gastrostomy buttons (g-buttons) are commonly placed in children to facilitate weight gain, correct nutritional deficiencies, and provide hydration and/or medication delivery. At our institution, parents are taught to place a gauze sponge ... ...

    Abstract Background: Gastrostomy buttons (g-buttons) are commonly placed in children to facilitate weight gain, correct nutritional deficiencies, and provide hydration and/or medication delivery. At our institution, parents are taught to place a gauze sponge under their child's g-button and secure it with strips of tape; however, the g-button still moves in the tract, which delays wound healing and leads to a variety of tract-related complications. We viewed this universal problem as a challenge and a prime opportunity for innovation.
    Methods: In 2016, a pediatric surgeon and a team of graduate engineering students outlined the problem, created a list of design requirements, and began to iterate on a variety of device designs.
    Results: Over 400 design ideas were iterated upon to various degrees. The first prototype was studied in a small clinical trial, in which 80% of caregivers reported satisfaction with the design, but 90% noted difficulty connecting the extension feeding tube. A second-generation prototype was developed, which included a reusable lid and disposable base layer. Third- generation prototypes added "edge-grippers" to facilitate attaching the extension tubing, plus pre-cut absorbent, sterile gauze pads to fit around the stem of the g-button. Finally, in 2020, the design was finalized with the addition of a childproof hinge between the lid and base layer.
    Conclusions: An intuitive g-button securement device was created to simplify daily gauze replacement, reduce tract-related complications, and lower the cost of care. A randomized controlled trial comparing the securement device to the "tic-tac-toe" dressing will begin in early 2022 with results available later this year.
    Language English
    Publishing date 2022-09-26
    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.2022.09.025
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  7. Article ; Online: National trends in pediatric firearm and automobile fatalities.

    Stevens, Jenny / Pickett, Kaci / Reppucci, Marina L / Nolan, Margo / Moulton, Steven L

    Journal of pediatric surgery

    2022  

    Abstract: Background: Successful public health policies and injury prevention efforts have reduced pediatric automobile fatalities across the United States. In 2019, firearm injuries exceeded motor vehicle crashes (MVC) as the leading cause of childhood death in ... ...

    Abstract Background: Successful public health policies and injury prevention efforts have reduced pediatric automobile fatalities across the United States. In 2019, firearm injuries exceeded motor vehicle crashes (MVC) as the leading cause of childhood death in Colorado. We sought to determine if similar trends exist nationally and if state gun laws impact firearm injury fatality rates.
    Methods: Annual pediatric (≤19 years-old) fatality rates for firearm injuries and MVCs were obtained from the CDC WONDER database (1999-2020). State gun law scores were based on the 2014-2020 Gifford's Annual Gun Law Scorecard and strength was categorized by letter grades A-F. Poisson generalized linear mixed models were used to model fatality rates. Rates were estimated for multiple timepoints and compared between grade levels.
    Results: In 1999, the national pediatric fatality rate for MVCs was 248% higher than firearm injuries (Incidence Rate Ratio (IRR) 95% Confidence Interval (CI): 2.25-2.73, p<0.0001). By 2020, the fatality rate for MVCs was 16% lower than that of firearm injuries (IRR 95% CI: 0.75- 0.93, p = 0.0014). For each increase in letter grade for gun law strength there was an 18% reduction in the firearm fatality rate (IRR 95%CI: 0.78-0.86, p<0.0001). States with the strongest gun laws (A) had a 55% lower firearm fatality rate compared to those with the weakest laws (F).
    Conclusion: Firearm injuries are the leading cause of death in pediatric patients across the United States. State gun law strength has a significant impact on pediatric firearm injury fatality rates. New public health policies, political action, media attention and safer guns are urgently needed to curb this national crisis.
    Level of evidence/study type: Level III, retrospective.
    Language English
    Publishing date 2022-09-26
    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.2022.09.028
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  8. Article ; Online: Reply to Letter to the Editor: Pediatric massive transfusion protocols applied to intraoperative complications of common pediatric surgeries.

    Stevens, Jenny / Reppucci, Marina L / Acker, Shannon / Bensard, Denis / Moulton, Steven L

    Journal of pediatric surgery

    2022  Volume 57, Issue 6, Page(s) 1172

    MeSH term(s) Blood Transfusion ; Child ; Humans ; Intraoperative Complications/etiology ; Intraoperative Complications/prevention & control
    Language English
    Publishing date 2022-02-04
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 80165-3
    ISSN 1531-5037 ; 0022-3468
    ISSN (online) 1531-5037
    ISSN 0022-3468
    DOI 10.1016/j.jpedsurg.2022.01.047
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  9. Article ; Online: Incidence of and risk factors for perioperative blood transfusion in infants undergoing index pediatric surgery procedures.

    Reppucci, Marina L / Meier, Maxene / Stevens, Jenny / Shirek, Gabrielle / Kulungowski, Ann M / Acker, Shannon N

    Journal of pediatric surgery

    2022  Volume 57, Issue 6, Page(s) 1067–1071

    Abstract: Background: There is a paucity of data on the frequency of transfusion during pediatric surgery index cases and guidelines for pretransfusion testing, defined as type and screen and crossmatch testing, prior to operation are not standardized. This study ...

    Abstract Background: There is a paucity of data on the frequency of transfusion during pediatric surgery index cases and guidelines for pretransfusion testing, defined as type and screen and crossmatch testing, prior to operation are not standardized. This study aimed to determine the incidence of perioperative blood transfusions during index neonatal operations and identify risk factors associated with perioperative blood transfusion to determine which patients benefit from pretransfusion testing.
    Methods: A retrospective review of infants who underwent index neonatal cases between 2013 and 2019 was performed. Data were collected for patients who underwent operations for Hirschsprung's disease, esophageal atresia/tracheoesophageal fistula (EA/TEF), biliary atresia, anorectal malformation, omphalocele, gastroschisis, duodenal atresia, congenital diaphragmatic hernia (non-ECMO) or pulmonary lobectomy. Infants under 6 months were included except in the case of lobectomy where infants up to 12 months were included.
    Results: Analysis was performed on 420 patients. Twenty-five (6.0%) patients received perioperative blood transfusion. Patients who received perioperative transfusion most commonly underwent EA/TEF repair. Patients who received perioperative transfusion had higher rates of structural heart disease (52.0% vs 17.7%, p<0.001), preoperative transfusion (48.0% vs 8.9%, p<0.001), and prematurity (52.0% vs 25.6%, p = 0.005). Presence of all three risk factors resulted in a 48% probability of requiring perioperative transfusion.
    Conclusions: Blood transfusion during the perioperative period of neonatal index operations is rare. Factors associated with increased risk of perioperative transfusion include prematurity, structural heart disease, and history of previous blood transfusion.
    Level of evidence: III.
    MeSH term(s) Blood Transfusion ; Child ; Congenital Abnormalities/surgery ; Congenital Abnormalities/therapy ; Esophageal Atresia/complications ; Esophageal Atresia/surgery ; Heart Diseases/congenital ; Heart Diseases/surgery ; Humans ; Incidence ; Infant ; Infant, Newborn ; Perioperative Period ; Retrospective Studies ; Risk Factors ; Tracheoesophageal Fistula/complications ; Tracheoesophageal Fistula/epidemiology ; Tracheoesophageal Fistula/surgery
    Language English
    Publishing date 2022-02-12
    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.2022.01.055
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  10. Article ; Online: Comparison of Pediatric Trauma Scoring Tools That Incorporate Neurological Status for Trauma Team Activation.

    Reppucci, Marina L / Cooper, Emily / Stevens, Jenny / Meier, Maxene / Nolan, Margo M / Moulton, Steven L / Bensard, Denis D / Acker, Shannon N

    Pediatric emergency care

    2023  Volume 39, Issue 7, Page(s) 501–506

    Abstract: Background: Two novel pediatric trauma scoring tools, SIPAB+ (defined as elevated SIPA with Glasgow Coma Scale ≤8) and rSIG (reverse Shock Index multiplied by Glasgow Coma Scale and defined as abnormal using cutoffs for early outcomes), which combine ... ...

    Abstract Background: Two novel pediatric trauma scoring tools, SIPAB+ (defined as elevated SIPA with Glasgow Coma Scale ≤8) and rSIG (reverse Shock Index multiplied by Glasgow Coma Scale and defined as abnormal using cutoffs for early outcomes), which combine neurological status with Pediatric Age-Adjusted Shock Index (SIPA), have been shown to predict early trauma outcomes better than SIPA alone. We sought to determine if one more accurately identifies children in need of trauma team activation.
    Methods: Patients 1 to 18 years old from the 2014-2018 Pediatric Trauma Quality Improvement Program database were included. Sensitivity and specificity for SIPAB+ and rSIG were calculated for components of pediatric trauma team activation, based on criteria standard definitions.
    Results: There were 11,426 patients (1.9%) classified as SIPAB+ and 235,672 (39.0%) as having an abnormal rSIG. SIPAB+ was consistently more specific, with specificities exceeding 98%, but its sensitivity was poor (<30%) for all outcomes. In comparison, rSIG was a more sensitive tool, with sensitivities exceeding 60%, and specificity values exceeded 60% for all outcomes.
    Conclusions: Trauma systems must determine their priorities to decide how best to incorporate SIPAB+ and rSIG into practice, although rSIG may be preferred as it balances both sensitivity and specificity.
    Level of evidence: Level III.
    MeSH term(s) Humans ; Child ; Infant ; Child, Preschool ; Adolescent ; Retrospective Studies ; Glasgow Coma Scale ; Blood Pressure ; Heart Rate/physiology ; Injury Severity Score
    Language English
    Publishing date 2023-06-05
    Publishing country United States
    Document type Journal Article
    ZDB-ID 632588-9
    ISSN 1535-1815 ; 0749-5161
    ISSN (online) 1535-1815
    ISSN 0749-5161
    DOI 10.1097/PEC.0000000000002985
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