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Jonathan I Groner

Publications and source records attributed to Jonathan I Groner.

12 recordsLinked to original sources
PubMed2006

A leap in faith: the impact of removing the surgeon from the level II trauma response.

BACKGROUND: Limitation of resident work hours has created the need to explore alternatives to surgeon presence during initial assessment and resuscitation for selected life-threatening injuries in children. We recently eliminated the requirement for surgeon presence during Level II alerts. The purpose of this study was to evaluate the impact of this change on patient care. METHODS: A retrospective analysis of trauma alert activity was performed using data from our trauma registry. In March 2003, responsibility for level II alerts was transferred from the pediatric surgeons (PSs) to the Emergency Department (ED) physicians. We compared the activity in the 18-month period before this change (period 1; n = 627) to that afterward (period 2; n = 587). Outcome measures included injury severity score, emergency department length of stay, missed injuries, abdominal computed tomography use, and mortality. Data were analyzed using log-rank statistic, chi2, or t test, where appropriate, with significance level at P < .05. RESULTS: During the entire study period, 1499 patients met the trauma alert activation criteria of which 1214 (81%) were level II alerts. The mean injury severity score for period 1 (8.5 +/- 7.3 SD) was similar to period 2 (9.0 +/- 7.1 SD). When ED physicians replaced PS for Level II alerts, ED length of stay increased from 135 minutes to 165 minutes (P < .001). In addition, the use of abdominal computed tomography was significantly decreased (53.6% vs 42.6%; P < .001). However, there were no missed injuries and no significant differences in the rate of mortality. CONCLUSIONS: When ED physicians replaced PS for Level II alerts, trauma room length of stay was increased, but use of abdominal imaging was decreased with no differences in rate of missed injury or mortality. Emergency Department physicians can safely replace PS during Level II alerts. These findings may be useful to institutions experiencing surgical workforce limitations for trauma alerts.

Adolescent↗
PubMed2006

Pediatric all-terrain vehicle-related injuries in Ohio from 1995 to 2001: using the injury severity score to determine whether helmets are a solution.

OBJECTIVE: The goal was to identify regions in Ohio with severe pediatric all-terrain vehicle-related injuries and to determine whether helmet usage was associated with lower injury severity scores. METHODS: We performed a retrospective review of data for all patients entered into the registries of Ohio's major pediatric trauma centers for the period of January 1, 1995, to December 31, 2001. RESULTS: Seven hospitals participated. A total of 285 children were admitted; 2 patients died, and 13 required rehabilitation. The mean age was 11.1 years, with 76.1% of patients being male and 88.1% white. Most patients came from the central and southwestern regions of Ohio. An average of 30 admissions per year occurred from 1995 to 1998, but the number increased to 55 admissions per year from 1999 to 2001. Among the 285 injured children, 869 injuries were sustained; 57% of patients sustained multiple injuries. The most commonly injured body parts were the head (22.3%) and lower extremities (12.6%). The most common injuries sustained were fractures (31.4%) and contusions/abrasions (22.2%). Of patients for whom documentation was available, 72.2% (171 of 237 patients) were not helmeted. There was no significant difference in mean injury severity scores between helmeted and nonhelmeted riders (9.58 vs 9.12). Helmet usage was not associated with a reduction in head/facial injuries. CONCLUSIONS: All-terrain vehicle-related injuries to children nearly doubled between 1995 to 1998 and 1999 to 2001. Fewer than 30% of injured children were wearing helmets at the time of injury. With the injury severity score as an indicator, helmets provided no significant protection for all-terrain vehicle riders in this pediatric population.

Accidents↗
PubMed2005

The risk of child abuse in infants and toddlers with lower extremity injuries.

PURPOSE: The aim of this study was to assess the risk of child abuse in children younger than 18 months admitted to a pediatric trauma service with lower extremity injuries. METHODS: An Institutional Review Board-approved retrospective case series of children admitted to a regional pediatric trauma center with lower extremity injuries from 1998 to 2002 (n = 5497) was performed. Factors analyzed included age, injuries, and injury mechanism. RESULTS: Among 5497 trauma patients, the incidence of abuse was 104 (2%) of 4942 children 18 months or older and 175(32%) of 555 children younger than 18 months (odds ratio [OR], 21.4 +/- 2.9, P < .001). There were 1252 (23%) patients with lower extremity injuries in the entire sample, and 66 of these were younger than 18 months. In the extremity trauma group, for patients 18 months or older, 16 (1%) of 1186 were abused compared with 44 (67%) of 66 patients younger than 18 months (OR, 146 +/- 53, P < .001). Among all trauma patients younger than 18 months, 41 of 55 lower extremity fractures were linked to abuse, whereas 134 of 500 other injuries were caused by abuse (OR, 8.0 +/- 2.6, P < .001). Among the 41 abuse-related fractures, femur fracture was the most common (22), followed by tibia fracture (14). CONCLUSIONS: Among children 18 months or older, abuse is an uncommon cause of lower extremity trauma. In children younger than 18 months, lower extremity injuries, particularly fractures, are highly associated with child abuse. Clinicians must thoroughly investigate lower extremity injuries in this age group.

Child Abuse↗
PubMed2005

Use of cholecystokinin-octapeptide for the prevention of parenteral nutrition-associated cholestasis.

OBJECTIVE: To determine whether cholecystokinin-octapeptide (CCK-OP) would prevent or ameliorate parenteral nutrition-associated cholestasis (PNAC) among high-risk neonates treated with total parenteral nutrition. STUDY DESIGN: This was a multicenter, double-blind, randomized, controlled trial conducted between 1996 and 2001. PATIENTS: Neonates at risk for the development of PNAC included very low birth weight neonates and those with major surgical conditions involving the gastrointestinal tract. SETTING: Tertiary care hospitals. INTERVENTION: Patients were randomized to receive CCK-OP (0.04 mug/kg per dose, twice daily) or placebo. Eligible infants were all <30 days of age. Patients were enrolled within 2 weeks after birth or within 7 days after surgery. OUTCOME MEASURES: The primary outcome measure was conjugated bilirubin (CB) levels, which were measured weekly. Secondary outcome measures included incidence of sepsis, times to achieve 50% and 100% of energy intake through the enteral route, number of ICU and hospital days, mortality rate, and incidences of biliary sludge and cholelithiasis. RESULTS: A total of 243 neonates were enrolled in the study. CCK-OP administration did not significantly affect CB levels (1.76 +/- 3.14 and 1.93 +/- 3.31 mg/dL for CCK-OP and placebo groups, respectively; mean +/- SD). Secondary outcome measures also were not significantly affected by the study drug. CONCLUSIONS: Use of CCK-OP failed to reduce significantly the incidence of PNAC or levels of CB. CCK-OP had no effect on other secondary measures and should not be recommended for the prevention of PNAC.

Bilirubin↗
PubMed2005

Minority status and the risk of serious childhood injury and death.

OBJECTIVE: Minority populations have an increased risk for trauma, but little is known about injury rates for minority children. This study compares the causes, rates and outcomes of traumatic injuries between minority and white children in a statewide population sample. METHODS: A cohort study of 5,973 children (age <16) receiving inpatient care for treatment of acute injuries at the pediatric trauma centers in Ohio from 1999--2001. Case records were analyzed for race, injury type, injury severity, length of stay and demographic information. Supplemental data sources included the 2000 U.S. census and Ohio Vital Statistics death certificates 1996--2001. MAIN OUTCOME MEASURES: Hospital admission rate, mortality rate, length of stay, rate of admission to rehabilitation service. RESULTS: African-American children, who composed the vast majority of the minority population sample, were 7.7 more times likely to sustain a burn or gunshot wound, seven times more likely to be struck by a car, six times more likely to be intentionally injured and over twice as likely to killed by an injury than white children. However, after adjusting for injury severity, they have the same mortality, hospital length of stay and referral rate to rehabilitation as white children. CONCLUSION: Trauma has a far greater impact on minority children than on white children. Research and development of injury prevention initiatives that specifically target minority children are urgently needed.

Adolescent↗
PubMed2004

Management of penetrating colon and rectal injuries in the pediatric patient.

PURPOSE: Management of civilian penetrating colon injuries in the adult has evolved from the universal use of fecal diversion to the highly selective use of colostomy. We hypothesized that a similar management approach was appropriate for the pediatric population. METHODS: A retrospective review of pediatric patients (age <17 years) with a penetrating colorectal injury was performed at six Level I trauma centers for the period January 1990 through June 2001. RESULTS: For the period of review, 53 children with a penetrating colorectal injury were identified. Firearms caused 89 percent of the injuries. The colon was injured in 83 percent (n = 44) of patients and the rectum in 17 percent (n = 9) of patients. The colorectal injury was managed without colostomy in 62 percent (n = 33) and with colostomy in 38 percent (colon = 11, rectum = 9). All rectal injuries were treated with colostomy. The hospital length of stay was longer in the colostomy group (17.6 days vs. 11.4 days). The complication rate was higher in the colostomy group (55 percent vs. 27 percent), which included two patients with stoma-related complications. There was no mortality in this series. CONCLUSIONS: Primary repair was used safely in most cases of civilian penetrating colon injuries in the pediatric population. All rectal injuries were treated with colostomy in this series. Fecal diversion was used selectively. Colostomy was performed for selected cases of colon wounds associated with shock, multiple blood transfusions, multiple other injuries, extensive contamination, and high-velocity weapons. In the absence of these associated factors, primary repair appears justified.

Adolescent↗
PubMed2004

Clinical manifestations of appendiceal pinworms in children: an institutional experience and a review of the literature.

The association of Enterobius vermicularis infestation with acute appendicitis varies from 0.2-41.8% worldwide. Our purpose was to determine the significance of Enterobius-associated appendicitis by retrospective review of appendectomies performed during a 5-year period at a major children's hospital. The Surgical Pathology database at Children's Hospital, Columbus, Ohio, was reviewed for appendiceal specimens found to have Enterobius infestation. Corresponding patient charts were evaluated for age, gender, presenting symptoms, laboratory data, operative findings, and clinical course. Of the 1,549 appendectomies performed from January 1998 through January 2003, 21 specimens (1.4%) were found to contain Enterobius vermicularis. Fifteen of the appendectomies were performed for symptoms of acute appendicitis; the remaining six were incidental appendectomies in conjunction with other operations. The mean age was 8.9 years. Ten patients were male; 11 were female. Of the 15 symptomatic children, nine presented with fever >99.0 degrees F, and 11 had a WBC count >10,000. Intra-operative appearance of the appendix ranged from normal to perforation. Pathologic evaluation showed neutrophil or eosinophil infiltration in 15 of the 21 specimens. Enterobius infestation is an uncommon cause of acute appendicitis in children in the United States. It may be associated with acute appendicitis, "chronic appendicitis," ruptured appendicitis, or with no significant clinical symptoms.

Adolescent↗
PubMedDate not supplied

Parenteral nutrition-associated cholestasis in neonates: multivariate analysis of the potential protective effect of taurine.

BACKGROUND: Neonates receiving parenteral nutrition (PN) are at risk for PN-associated cholestasis (PNAC); however, no preventive factors for PNAC have been clearly identified. Despite reports suggesting that taurine may prevent PNAC in neonates, such an effect of taurine has not yet been definitively demonstrated. We determined whether taurine supplementation reduces the incidence of PNAC in premature or critically ill neonates. METHODS: This study was part of a prospective, randomized, multi-institutional trial designed to assess cholecystokinin vs placebo as a potential preventive therapy of PNAC. Taurine supplementation of PN varied between institutions. The presence or absence of taurine in PN was analyzed by multivariate analysis, with a primary outcome measure of serum conjugated bilirubin (CB) as a measure of PNAC. RESULTS: Taurine reduced PNAC in premature infants (estimated maximum CB [95% confidence interval] 0.50 mg/dL [-0.17 to 1.18] for those receiving taurine, vs 3.45 mg/dL [1.79-5.11] for neonates not receiving taurine, approaching significance, p = .07). Taurine significantly reduced PNAC in infants with necrotizing enterocolitis (NEC; estimated maximum CB 4.04 mg/dL [2.85-5.23], NEC infants receiving taurine, vs 8.29 mg/dL [5.61-10.96], NEC infants not receiving taurine, p < .01). There were too few neonates with surgical anomalies to evaluate the effect of taurine in this group. CONCLUSIONS: Within specific subgroups of neonatal patients, taurine supplementation does offer a very significant degree of protection against PNAC. Patients with NEC or severe prematurity are most likely to benefit substantially from taurine supplementation.

Bilirubin↗