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Objective: To assess the accuracy of CT angiography (CTA) in predicting resectability, degree of surgical difficulty, and individual factors that may impact resectability of isolated hepatic masses in dogs., Animals: Prospective study of 20 dogs with 21 isolated hepatic masses., Procedures: All CTAs and surgeries were performed between June 16, 2013, and November 30, 2016, at The Animal Medical Center in New York. Preoperative CTA images were evaluated by a board-certified surgeon (n = 2). A preoperative assessment was completed, documenting several predetermined factors aimed at predicting resectability of each mass and the degree of surgical difficulty. Resectability was divided into gross resectability and complete histologic excision. Following surgery, the surgeon completed a postoperative assessment documenting the intraoperative findings. Independently, a blinded board-certified radiologist analyzed the images and completed an identical preoperative assessment., Results: The radiologist was more accurate in lesion localization compared to the surgeon (P = .023). Seventeen (17/21) masses were grossly resectable in surgery. Two additional (2/21) masses that were deemed grossly resectable were incompletely excised on histopathologic analysis. Both the surgeon and radiologist were accurate in their prediction of gross resectability and complete excision. Major vascular involvement, multilobar involvement, and right-sided laterality negatively affected resectability. The surgeon was significantly more accurate in predicting the degree of surgical difficulty (κ = 0.50) when compared to the radiologist (κ = 0.38)., Clinical Relevance: Preoperative CTA of isolated hepatic masses is useful in prediction of surgical difficulty and resectability, as well as identifying several factors that impact resectability.

In children, injuries are the leading cause of death, a major source of disability, and the number one cause of death for children after the first year of life. The principles of injury prevention include surveillance, coalitions, communication, interventions, and evaluation. This article discusses a number of common pediatric injuries and their prevention strategies. This review article addresses key components of injury prevention and specifically addresses the following injuries: motor vehicle crashes (with a section on teen driver crashes, sleep-related injury, and death), poisoning, all-terrain vehicle crashes, drowning, and firearm injuries. Injuries are preventable occurrences that can result in devastating sequelae or death. We present an overview of the more common pediatric injuries along with injury-prevention strategies.

Examining a child's tympanic membrane (TM) is challenging, but crucial for proper management of acute otitis media (AOM). CellScope Oto (CSO) is an attachment that turns a smartphone into an otoscope. We aimed to assess pediatric resident comfort level with ear exams using CSO to see whether comfort level and accuracy of diagnosis of AOM improved. A pre-post study of pediatric residents in a freestanding Pediatric Emergency Department was conducted to assess their comfort level of traditional otoscope and CSO via a Likert scale. Ear exams were recorded and rated by 2 faculty for accuracy of AOM diagnosis. A total of 18 pediatric residents participated, and 308 exams were collected, with 2% diagnosed as AOM. The median change in comfort level increased by +1.0 for interns and third years but remained unchanged for second years. There was substantial agreement by faculty raters of video ear exams. Overall, comfort level increased with accuracy of diagnosis of AOM.

Objectives: The purpose of this study is to describe an advocacy effort to implement a food insecurity (FI) screening during hospital admission and describe characteristics of hospitalized patients with household FI., Methods: This is a descriptive study after the implementation of FI screening at a quaternary-care children's hospital in the Southeastern United States between August 2020 and April 2021. The Hunger Vital Sign, a 2-question screening tool for FI, was added to the intake questionnaire performed on inpatient admissions. A positive screen triggered a social work consult to connect patients with resources. Chart review and statistical analyses were performed on patients with household FI., Results: There were 7751 hospital admissions during the study period, of which 4777 (61.6%) had an FI screen completed. Among those with a completed screen, 233 patients (4.9%) were positive for household FI. Patients with household FI were more likely to be Black (P <.001) and have Medicaid (P <.001). Social work documented care specific to FI in 125 of the 233 (56%) FI patients, of which 39 (31%) were not enrolled in the Women, Infants, and Children Program/Supplemental Nutrition Assistance Program., Conclusions: This initiative highlights hospitalization as an opportunity to screen for FI using a multidisciplinary approach. Our findings underscore the importance of identifying FI with the goal of reducing FI and mitigating the adverse effects of FI on child health outcomes., (Copyright © 2022 by the American Academy of Pediatrics.)

Objectives: Children with unintentional poisonings (UPs) are frequently admitted to monitored beds (MBs), though most require minimal interventions. We aimed to (1) describe clinical factors and outcomes for children admitted for UPs and (2) identify clinical factors associated with MB placement., Methods: In this single-center retrospective cohort study, we studied patients younger than 6 years admitted from the emergency department (ED) for UPs over a 5-year period to a quaternary-care children's hospital. Primary outcome was disposition (MB vs non-MB). Secondary outcomes included length of stay, escalation of inpatient care, 7-day readmission, and death. Covariates included age, certainty of ingestion, altered mental status, and ED provider training level. Subanalysis of drug class effect on disposition was also studied. Associations of clinical factors with MB placement were tested with multivariable logistic regression., Results: Of 401 patients screened, 345 subjects met inclusion criteria. Most subjects (308 of 345 [89%]) were admitted to MBs. Children with high certainty of ingestion (adjusted odds ratio [aOR], 4.2; 95% confidence interval [CI], 1.52-11.58), altered mental status (aOR, 5.82; 95% CI, 2.45-13.79), and a fellow (vs faculty) ED provider (aOR, 2.34; 95% CI, 1.04-5.24) were more likely to be admitted to MBs. No escalations of care, readmissions, or deaths occurred. Exposures to cardiac drugs had increased MB placement (aOR, 6.74; 95% CI, 1.93-23.59)., Conclusions: The majority of children admitted for UPs were placed in MBs. Regardless of inpatient placement, no adverse events were observed, suggesting opportunities for optimized resource utilization. Future research may focus on direct costs, inpatient interventions, or prospective outcomes to validate these findings., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Pierre Robin sequence (PRS) is a triad of congenital facial abnormalities that can present as a syndrome (syndromic PRS [sPRS]) or an isolated entity (isolated PRS [iPRS]). Patients with PRS can develop airway and feeding problems that may result in failure to thrive. Mandibular distraction osteogenesis (MDO) is a method for improving the functional issues associated with breathing and feeding. There is a Paucity of literature evaluating the outcomes of MDO between sPRS and iPRS patients., Methods: An institutional review board-approved retrospective review of PRS patients managed by a single surgeon and treated with MDO between January 2015 and December 2019 at a tertiary referral hospital was performed. The patients were stratified into iPRS or sPRS based on gene testing. Airway outcome measures included avoidance of tracheostomy, relief of sleep apnea, and oxygen saturation improvement. Primary feeding measures included achievement of full oral feeds and growth/weight gain. Statistical analysis included t tests and χ2 tests where appropriate using SPSS., Results: Over the study period, of the 29 infants with PRS, 55% identified as iPRS and 45% as sPRS. There were no significant differences in the patient characteristics, apnea-hypoxia index (22.27 ± 12.27) and laryngeal view (3 ± 0.79) pre-MDO. After MDO, 83% of the subjects achieved a positive feeding outcome and 86% achieved a positive airway outcome with no statistical significance between sPRS and iPRS (P = 0.4369). There was a statistically significant change post-MDO in apnea-hypoxia index (5.24 ± 4.50, P = 0.02) and laryngeal view (1.59 ± 1.00, P = 0.01)., Conclusions: Our recent experience would lead us to believe that sPRS patients have greater morbidities and challenging clinical developments that, when properly evaluated, can be managed by MDO. There is a potential role for MDO in reducing the need for traditional surgical interventions for respiratory and feeding problems in both iPRS and sPRS patients., Competing Interests: Conflicts of interest and sources of funding: This article was funded in part by the National Center for Advancing Translational Sciences of the National Institutes of Health under award number UL1TR003096., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: Voting is one of our civic duties, yet many Americans do not vote, and physician voter participation is even lower than that of the general public. We aimed to explore pediatric residents' attitudes and behaviors in regard to voting and assess the impact of interventions aimed at increasing resident participation., Methods: Pediatric residents were given preelection surveys regarding interest in voting, plans to vote in the November 2016 national election, and barriers to participation. Voting registration, election dates, and registration deadlines were disseminated before the election. Postelection surveys were distributed after the 2016 national election to pediatric residents regarding their voter participation, barriers to voting, and the effectiveness of our interventions., Results: Fifty-one residents completed the presurvey and 49 completed the postsurvey (61% and 59% of total residents, respectively). Eighty-nine percent of residents surveyed planned to vote and 83% were registered to vote. The postsurveys indicated that only 69% of responding residents voted in the national election, far fewer than the 89% who planned to vote (z = 2.5, P < 0.05). The most common reasons for not voting were "no time off," "didn't get absentee ballot," and "not registered in state of residence." In total, 19 of 33 (58%) respondents indicated that interventions encouraged them to vote., Conclusions: Intention to vote among participants was higher than voting participation; however, participants in this study voted at higher rates (69%) than the average citizen rates (61.4%). More than half of the residents who did vote indicated that the study interventions encouraged them to vote.

Background: The leading cause of death in children less than 19 years old is motor vehicle crashes (MVC). Non-use or improper use of motor vehicle car seats significantly adds to the morbidity and mortality. Emergency department (ED) encounters provide an opportunity for caregiver education. Our objective was to determine the effect of an educational intervention on knowledge and counseling behaviors of pediatric ED nurses regarding child passenger safety (CPS)., Methods: A pre/post educational intervention study was conducted with nursing staff in an urban ED. Responses to CPS related knowledge and counseling behaviors were collected using surveys administered before and after the intervention. The ED nurse education intervention was a one-hour lecture based on the American Academy of Pediatrics (AAP) CPS guidelines and Alabama state law regarding ages for each car seat type and teen driving risky behaviors. Individual data from pre and post surveys were matched, and nominal variables in pre-post matched pairs were analyzed using McNemar's test. To compare categorical variables within pre or post test data, we used the Chi-square test., Results: Pretests were administered to 83/110 ED nurses; 64 nurses received the educational intervention and posttest. On the pretests, nurses reported "never" or "occasionally" counseling about CPS for the following: 56% car seats, 62% booster seat, 56% teen driving, 32% seat belts. When comparing the pretest CPS knowledge between nurses working 0-1 year vs. ≥ 2 years there was no statistically significant difference. Two CPS knowledge questions did not show significance due to a high correct baseline knowledge rate (> 98%), including baseline knowledge of MVC being the leading cause of death. Of the remaining 7 knowledge questions, 5 questions showed statistically significant improvement in knowledge: age when children can sit in front seat, state GDL law details, seat belt state law for back seat riders, age for booster seat, and rear facing car seat age. All four counseling behavior questions showed increases in intent to counsel families; however, only intent to counsel regarding teen driving reached statistical significance., Conclusions: Educational efforts improved pediatric ED nursing knowledge regarding CPS. Intent to counsel was also improved following the education.

Objectives: We evaluated and defined the analytical performance of the Beckman Coulter DxC 700 AU analyzer compared to the Siemens Dimension Vista 500 analyzer., Design: and Methods: Performance characteristics included intra and inter-run precision, linearity/analytical measurement range, method correlation, and reference range verification. A total of 53 assays including 11 critical care, 19 general chemistries, 11 proteins, 10 urines, and 2 CSF analytes were tested. We also evaluated similarities and differences in assay methodologies between the 2 systems., Results: The DxC 700 AU demonstrated excellent precision, comparable analytical measurement ranges and strong method correlation with the Dimension Vista 500 for most serum/plasma assays. 95% of the intra-run and 95% of the inter-run precision QC levels showed <3.0%CV and <6.0%CV, respectively. None of the deviations were clinically significant. The AMRs for all analytes except 5 met the manufacturer's stated range. ALP, Lactate, U-glucose and CSF-glucose all recovered above the stated upper limit range, while prealbumin showed a smaller range. All analytes, except 14, showed slopes between 0.9 and 1.1 and/or biases <10%. Only ammonia, ferritin and lipase required significant reference range changes. The urine and CSF assays correlated very well with no adjustments in reference ranges required., Conclusions: The analytical performance of the DxC 700 AU analyzer was acceptable with only a small number of analytes requiring significant reference range changes., (© 2019 The Authors.)

This is a case of an 8-year-old, Caucasian boy with a complex prior medical history who presented with worsening, acute, left-sided abdominal pain and fever after empiric treatment for a urinary tract infection. Repeat urinalysis was negative for infection. A renal ultrasound assessing for occult perinephric abscess or nephronia revealed normal kidneys but found a tubular structure adjacent to the left kidney. A CT scan further revealed a splenic infarction secondary to torsion. He had a surgical evaluation but was treated empirically with piperacillin/tazobactam for 10 days due to concern for infectious complications following splenic infarction. He had complete resolution of his pain and symptoms. He received routine vaccines for asplenia prior to being discharged home without any further sequelae., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Tobacco use begins in adolescence for the majority of smokers. The purpose of this study was to increase screening and reporting of tobacco use in hospitalized adolescents at a tertiary care children's hospital. We completed a nursing focus group to understand challenges and completed four iterative Plan-Do-Study-Act cycles, which included: (1) in-person nursing education regarding tobacco use screening, (2) addition of an e-cigarette-specific screening question, (3) the creation and dissemination of an educational video for nursing, and (4) adding the video as a mandatory component of nursing orientation. Run charts of the percentage of patients screened who reported tobacco use were created. Absolute counts of tobacco products used were also captured. From January 2016 to September 2018, 12,999 patients ≥13 years of age were admitted to the hospital. At baseline, 90.1% of patients were screened and 4.8% reported tobacco use. While the absolute number of adolescents reporting e-cigarette use increased from zero patients per month at baseline to five, the percentage of patients screened and reporting tobacco use was unchanged; the majority of e-cigarette users reported use of other tobacco products. This study demonstrates that adding e-cigarettes to screening increases reporting and suggests systems level changes are needed to improve tobacco use reporting.

Tennis elbow or epicondylitis lateralis humeri is a commonly seen pain-syndrome. Radial tunnel syndrome is generally assumed to be a rare nerve compression syndrome. This study intents to demonstrate that tennis elbow is the most common manifestation of radial tunnel syndrome or in other words, tennis elbow is nothing else but radial tunnel syndrome. In patients with tennis elbow one will always find the ramus profundus n. radialis compressed by the arcade of Frohse. The author is convinced that following the carpal tunnel syndrome, the radial tunnel syndrome is the second most common nerve compression in upper extremity.

30 casualties who had sustained a kidney contusion (23 patients) or a kidney rupture (7 patients) were questioned about their posttraumatic possibility of action after their recovery. Essential result: Fundamental differences were detected between the two groups. The high degree of the ability to act for a longer period of time may be explained by the comparatively low acuteness of pain after kidney contusions and the impression of most casualties of not being seriously injured. In contrast to kidney contusions, kidney ruptures are generally accompanied by moderate to severe pain. Accordingly, the possibility of action in cases of kidney ruptures is restricted more frequently and to a greater extent than in cases of kidney contusions. The two groups had one thing in common: the casualties' mostly deliberate posttraumatic reaction; there were only 3 patients in a state of helplessness.

In order to extend the knowledge about posttraumatic possibility of action after blunt abdominal traumas, 34 patients mostly having sustained isolated ruptures of the liver, spleen and the intestines, were interviewed after their recovery; the results obtained were separated by the organs involved. Essential result: In general, there is a close correlation between the acuteness of pain, the patient's assessment of severity of the injury and the degree of the ability to act during the first posttraumatic minutes. In the further course of the injury, the capacity to act was limited by the extent and the developmental speed of the loss of blood into the abdominal cavity, provided that it was not limited or cancelled primarily by the acuteness of pain. No correlation could be detected between the extent of rupture and the acuteness of pain. The casualties' thoughtful, deliberate behavior was the predominant posttraumatic characteristic. There was a varying posttraumatic clinical picture ranging from freedom from pain to severe pain and non-restricted possibility of action to the inability to act.