The objective of this study was to describe a population of children admitted to a tertiary care pediatric hospital with severe trauma to identify key areas for injury prevention research, and programming.
Retrospective chart review conducted on all children 0-17 years admitted to the Children's Hospital of Eastern Ontario (CHEO) between April 1, 1996, and March 31, 2000, following acute trauma. Each record was reviewed and assigned an ISS using the AIS 1990 revision. All cases with an ISS > 11 were included in the study.
There were 2610 trauma cases admitted to CHEO over the study period. Of these, 237 (9.1%) had severe trauma (ISS > 11). Sixty-two percent were male. Twenty-nine percent were between the ages of 10 and 14 years, 27% between 5 and 9 years, 16% between 15 and 17 years, 15% between 1 and 4 years, and 13% less than 1 year old. The most common mechanisms of injury were due to motor vehicle traffic (39%), falls (24%), child abuse (8%), and sports (5%). Of those resulting from motor vehicle traffic, 53 (57%) were occupants, 22 (24%) were pedestrians, and 18 (19%) were cyclists. When combining traffic and nontraffic mechanisms, 26 (11% of all severe trauma cases) occurred as a result of cycling incidents. The most severe injury in 65% of patients was to the head and neck body region.
Research efforts and activities to prevent severe pediatric trauma in our region should focus on road safety, protection from head injuries, avoidance of falls, and prevention of child abuse.
The first children's hospital in Sweden (Kronprinsessan Lovisa's Children's Hospital) was established in Stockholm in 1854. In 1885 it was divided into a medical and a surgical department. This constituted the birth of pediatric surgery in Sweden. Pediatric surgery has been included in undergraduate teaching programs since 1945. A personal Associate Professorate in Pediatric Urology was instituted at the Karolinska Medical School in Stockholm for N. O. Ericsson in the late fifties. Upon his retirement in 1976 this personal chair was converted into an established Professorship in Pediatric Surgery. Pediatric surgery has been recognized as a specialty by our Medical Association since 1947. A survey of the Annual Reports from the Lovisa Hospital from 1885 to 1969 shows three phases in the development of our specialty in Sweden. The first stage extends from 1885 to 1932. During this period the disease pattern was dominated by septic and tuberculous infections, by empyemas, and by ENT diseases. Few cases of congenital malformations were reported. The bulk of general surgery in childhood was performed in the departments of general surgery. The second stage (1932-1945) was characterized by a decreasing incidence of tuberculous infections, by a successive transfer of orthopedic and ENT patients to the Departments of Orthopedic and ENT surgery respectively. During this period, a marked increase occurred in the volume of malformation surgery. This was due to the centralized treatment of congenital anomalies. The third stage started in 1945. The war had ended and we became acquainted with the dramatic development of pediatric surgery in other countries, in particular in the USA. The main advance was the possibility of opening the chest for repair of congenital anomalies of the heart and the great vessels, of the esophagus, and of the diaphragm. Soon afterwards, rectosigmoidectomy was introduced for the treatment of Hirschsprung's disease. In 1952, a second department of pediatric surgery was opened in Stockholm as a part of a new Children's Clinic at the Karolinska University Hospital. The major part of general surgery from the Stockholm area and all of the cardiovascular surgery stayed with the "Lovisa Hospital", while the major part of neonatal surgery and specific abdominal surgery was performed at the Karolinska Hospital. In order to improve the rather underdeveloped situation of pediatric urology, N. O. Ericsson was appointed to the post of Associate Head of the Karolinska Department, soon bringing this field to the frontlines of international standards. This historical review ends with some of the author's personal memories from the last 50 years.
The aim of this study is to determine if there has been a true, absolute, or apparent relative increase in congenital diaphragmatic hernia (CDH) survival for the last 2 decades.
All neonatal Bochdalek CDH patients admitted to an Ontario pediatric surgical hospital during the period when significant improvements in CDH survival was reported (from January 1, 1992, to December 31, 1999) were analyzed. Patient characteristics were assessed for CDH population homogeneity and differences between institutional and vital statistics-based population survival outcomes. SAS 9.1 (SAS Institute, Cary, NC) was used for analysis.
Of 198 cohorts, demographic parameters including birth weight, gestational age, Apgar scores, sex, and associated congenital anomalies did not change significantly. Preoperative survival was 149 (75.2%) of 198, whereas postoperative survival was 133 (89.3%) of 149, and overall institutional survival was 133 (67.2%) of 198. Comparison of institution and population-based mortality (n = 65 vs 96) during the period yielded 32% of CDH deaths unaccounted for by institutions. Yearly analysis of hidden mortality consistently showed a significantly lower mortality in institution-based reporting than population.
A hidden mortality exists for institutionally reported CDH survival rates. Careful interpretation of research findings and more comprehensive population-based tools are needed for reliable counseling and evaluation of current and future treatments.
We evaluated the effectiveness of a pet visitation program in helping children and their families adjust to hospitalization on a pediatric cardiology ward. Thirty-one pet visits were observed and followed by interviews with patients and parents. Analysis of data suggested that pet visits relieved stress, normalized the hospital milieu, and improved patient and parent morale. The benefit received by the subjects correlated with the amount of physical contact and rapport developed with the visiting animal.