Introduction:Our goal was to validate a new method of intraoperative blood loss measurement in pediatric patients who undergo orthopaedic surgery.Methods:We prospectively collected surgical sponges from 55 patients who underwent pediatric posterior spinal fusion, single-event multilevel surgery, or hip reconstruction for measurement of intraoperative blood loss. We enrolled patients if expected estimated blood loss (EBL) was >200 mL. The methods used for blood loss assessment included the Triton sponge scanning system, visual method, gravimetric method, and measured assay (reference) method.Results:The Triton system calculation of cumulative EBL per patient against the reference method yielded a strong positive linear correlation (R2 = 0.88). A weaker correlation was noted between the gravimetric method and reference EBL (R2 = 0.49). The Triton system had a low bias and narrow limits of agreement relative to the reference method (49 mL; 95% CI, 30 to 68). The gravimetric method had a higher bias and wider limits of agreement (101 mL; 95% CI, 67 to 135). The comparison of visual total EBL against the reference method yielded a notable discrepancy.Discussion:Estimated blood loss measured using the Triton system correlated better with the reference method than with the gravimetric method. The visual estimation method was found to be inaccurate. Intraoperative use of the Triton system is convenient and precise for monitoring intraoperative blood loss.
Pediatric obesity has become a worldwide epidemic and leads to notable effects on the developing skeleton that can have lifelong implications. Obesity in the pediatric population alters bone metabolism, increasing the risk for fracture. It can alter the presentation of common pediatric orthopaedic conditions such as scoliosis. Obesity also leads to changes in the patterns and severity of pediatric fractures as well as alters conservative fracture treatment due to increased displacement risk. Obese pediatric trauma patients place a high burden on the nationwide hospital system in a variety of ways including the increased risk of perioperative complications. Obesity is modifiable, and addressing the issue can improve the orthopaedic and overall health of children.
Maintenance of certification (MOC) within a medical society requires continuing medical education that demonstrates life-long learning, cognitive expertise, and practice-based self-assessment. This prospective study sought to evaluate whether a self-directed Practice Improvement Module (PIM) would improve pediatric orthopedic patient outcomes, thus demonstrating evidence of life-long learning (Part II MOC credit) in treating supracondylar humerus fractures. Six surgeons and 113 patients were included. There was no significant difference in actual fracture outcome before or after PIM at any level of surgeon experience regarding radiographic appearance or need for reoperation (p > 0.10). Junior staff demonstrated a statistically significant improvement in the percentage of time that marking the operative site was documented in the chart by the surgeon before (38%) and after (65%) PIM (p = 0.02). The self-directed education portion of the supracondylar fracture PIM led to modest improvement in documentation habits among junior staff, without impact on overall patient outcomes. Therefore, the PIM appears to be less useful in providing evidence for life-long learning as it relates to surgical outcomes (Part II MOC/CME), yet, it may directly benefit practice-based self-assessment (Part IV MOC), and the self-assessment and Personal Improvement Plan may be the most important portion of the PIM to improve outcomes.
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