JAMA Pediatrics: Surgery Topic Collection

Suctioning and Length of Stay in Infants Hospitalized With Bronchiolitis Suctioning in Bronchiolitis

Mussman GM, Parker MW, Statile A, et al. — Wed, 01 May 2013 00:00:00 GMT

Importance

Hospitalizations of infants for bronchiolitis are common and costly. Despite the high incidence and resource burden of bronchiolitis, the mainstay of treatment remains supportive care, which frequently includes nasal suctioning.

Objective

To examine the association between suctioning device type and suctioning lapses greater than 4 hours within the first 24 hours after hospital admission on length of stay (LOS) in infants with bronchiolitis.

Design

Retrospective cohort study. Data were extracted from the electronic health record.

Setting

Main hospital and satellite facility of a large quaternary care children's hospital from January 10, 2010, through April 30, 2011.

Participants

A total of 740 infants aged 2 to 12 months and hospitalized with bronchiolitis.

Main Outcome Measure

Hospital LOS.

Results

In the multivariable model adjusted for inverse weighting for propensity to receive deep suctioning, increased deep suction as a percentage of suction events was associated with increased LOS with a geometric mean of 1.75 days (95% CI, 1.56-1.95 days) in patients with no deep suction and 2.35 days (2.10-2.62 days) in patients with more than 60% deep suction. An increased number of suctioning lapses was also associated with increased LOS in a dose-dependent manner with a geometric mean of 1.62 days (95% CI, 1.43-1.83 days) in patients with no lapses and 2.64 days (2.30-3.04 days) in patients with 3 or 4 lapses.

Conclusions and Relevance

For patients admitted with bronchiolitis, the use of deep suctioning in the first 24 hours after admission and lapses greater than 4 hours between suctioning events were associated with longer LOS.

Association Between Parental Preference and Head Computed Tomography in Children With Minor Blunt Head Trauma

Ishida Y, Manabe A, Oizumi A, et al. — Wed, 01 May 2013 00:00:00 GMT

Natale et al recently reported that race/ethnicity is independently associated with head computed tomography (CT) use among children with minor blunt head trauma. They showed parental anxiety as an important factor influencing head CT orders in non-Hispanic white children regardless of brain injury risk. In a Japanese pediatric cohort of patients with minor blunt head trauma, we conducted a study with similar objectives attempting to identify factors that influence a physician's decision to order a head CT in children.

Influence of Surgeon Experience, Hospital Volume, and Specialty Designation on Outcomes in Pediatric Surgery A Systematic Review Factors Affecting Outcomes in Pediatric Surgery

McAteer JP, LaRiviere CA, Drugas GT, et al. — Wed, 01 May 2013 00:00:00 GMT

Importance

Analyses of volume-outcome relationships in adult surgery have found that hospital and physician characteristics affect patient outcomes, such as length of stay, hospital charges, complications, and mortality. Similar investigations in children's surgical specialties are fewer in number, and their conclusions are less clear.

Objective

To review the evidence regarding surgeon or hospital experience and their influence on outcomes in children's surgery.

Evidence Review

A MEDLINE and EMBASE search was conducted for English-language studies published from January 1, 1980, through April 13, 2012. Titles and abstracts were screened in a standardized manner by 2 reviewers. Studies selected for inclusion had to use a measure of hospital or surgeon experience as a predictor variable and had to report postoperative outcomes as dependent response variables. Included studies were reviewed with regard to methodologic quality, and study results were extracted.

Findings

Sixty-three studies were reviewed. Significant heterogeneity was detected in exposure definitions, outcome measures, and risk adjustment, with the greatest heterogeneity seen in appendectomy studies. Various exposure levels were examined: hospital level in 48 (68%) studies, surgeon level in 11 (17%), and both in 9 (14%). Nineteen percent of studies did not adjust for confounding, and 57% did not adjust for sample clustering. The most consistent methods and reproducible results were seen in the pediatric cardiac surgical literature. Forty-nine studies (78%) showed positive correlation between experience and most primary outcomes, but differences in outcomes and exposure definitions made comparisons between studies difficult. In general, hospital-level factors tended to correlate with outcomes for high-complexity procedures, whereas surgeon-level factors tended to correlate with outcomes for more common procedures.

Conclusions and Relevance

Data on experience-related outcomes in children's surgery are limited in number and vary widely in methodologic quality. Future studies should seek both to standardize definitions, making results more applicable, and to differentiate procedures affected by surgeon experience from those more affected by hospital resources and system-level variables.

Picture of the Month—Diagnosis

Wed, 01 May 2013 00:00:00 GMT