In-hospital Pediatric Endoscopic Retrograde Cholangiopancreatography Is Associated With Shorter Hospitalization for Children With Choledocholithiasis.

OBJECTIVES: Children with choledocholithiasis are frequently managed at tertiary children's hospitals that do not have available endoscopic retrograde cholangiopancreatography (ERCP) proceduralists. We hypothesized that patients treated at hospitals without ERCP proceduralists would have a longer hospital length of stay (LOS) than those with ERCP proceduralists. METHODS: Charts were reviewed for patients who underwent cholecystectomy and ERCP at 3 tertiary children's hospitals over 10 years. Trauma and complicated pancreatitis patients were excluded. Comparisons between patients requiring and not requiring transfer for ERCP were made using Wilcoxon rank-sum tests for continuous variables and Fisher's exact tests for categorical variables. RESULTS: One hundred and sixty-four children underwent ERCP for suspected choledocholithiasis: 79 (48%) in the transfer group and 85 (52%) in the no transfer group.Median LOS was longer for patients requiring transfer (7 vs 5 days, P < 0.0001). One-third (34%) of the transfer patients had magnetic resonance cholangiopancreatography compared to only 7% that did not require transfer (P < 0.0001). Among the 123 patients who underwent ERCP before cholecystectomy, 53% required (66/123) transfer and 47% (57/123) did not. Transfer group patients had longer median hospital LOS (P < 0.0001), more days between admission and ERCP (P < 0.0001), and more days between ERCP and surgery (P = 0.0004). CONCLUSIONS: Overall median LOS was significantly shorter for patients who underwent ERCP at the admitting facility. Patients who underwent ERCP before cholecystectomy at hospitals without available ERCP proceduralists incurred longer LOS. There is a need for more pediatric proceduralists appropriately trained to perform ERCP in children.

Pediatric vascular trauma practice patterns and resource availability: A survey of American College of Surgeon-designated pediatric trauma centers.

BACKGROUND: Variation exists in pediatric vascular trauma management. We aim to determine practice patterns for vascular trauma management at American College of Surgeons verified pediatric trauma centers and evaluate the resources available for management of vascular trauma at both freestanding children's hospitals (FSCH) and pediatric hospitals within general adult hospitals. METHODS: Pediatric surgeons and trauma medical directors at American College of Surgeons designated pediatric surgery trauma centers completed a survey designed to evaluate anticipated management of traumatic arterial injuries and resource availability. Hospital setting comparisons were made using Fisher exact tests and t tests. Binomial tests were used to compare pediatric and vascular surgeons' responses to clinical vignettes. p Values of 0.05 or less were significant. RESULTS: One hundred seventy-six (42%) of 414 pediatric surgeons participated. Vascular surgeons are more likely to operatively manage vascular trauma at all anatomic sites except subclavian artery when compared to pediatric surgeons, regardless of hospital setting (p <0.001). Forty-eight percent of the pediatric trauma medical directors completed their portion of the survey. At FSCHs, 36% did not have a fellowship-trained vascular surgeon on-call schedule, 27% did not have endovascular capabilities, and 18% did not have a radiology technologist always available. CONCLUSION: Vascular surgeons are more likely to manage pediatric vascular trauma regardless of hospital setting. However, FSCH have fewer resources available to provide optimal care. LEVEL OF EVIDENCE: Care management, level IV.