The closed method for the treatment of compound fractures of the limbs emerged and popularised during the interwar period. The historiography on this procedure sustains an essentially Anglo-Saxon narrative focusing on contributions by the American surgeon Winnett H. Orr during the First World War and the Spanish Josep Trueta during the Spanish Civil War and his exile in Britain. This paper aims to 'open' this story by reconstructing the early work of another Spanish surgeon: Manuel Bastos. Although originally an army medical officer, Bastos specialised in the treatment of limb fractures in a dual military-civilian context. On the one hand, during successive assignments to the Spanish Protectorate in Morocco, he familiarised with the management of gunshot wounds. On the other hand, he specialised in the treatment of tuberculosis humerus fractures in children at the Instituto Rubio in Madrid. The visit to Spain of the Argentinian surgeon Pedro Chutró, who had acquired a great prestige in First World War Paris for his approach to fractures and osteomyelitis, and the escalation of the Moroccan campaigns to the so-called Rif War (1921-27) gave Bastos the opportunity, the idea, and the courage to develop a closed treatment of humerus fractures in soldiers. Chutró's influence on Bastos persisted in the context of the Hispano-Americanist policy embraced in mid-twentieth-century Spain. Ultimately, this study questions the understanding of the closed method as a single, univocally traceable procedure, suggesting instead parallel versions emerging in different sites and transforming themselves and influencing each other as they circulated globally.
IntroductionMargin status after lumpectomy is crucial in determining risk of local recurrence. Current guidelines recommend "no ink on tumor" as adequate negative margins for invasive breast carcinoma. Still, up to 20% of patients may have positive margins and need re-excision. This study explored the use of a commercially available tumor marking system during specimen radiography and its effect on re-excision rates in breast conservation surgery.MethodsWith IRRB approval, a review was conducted of a prospectively collected cohort of 105 study patients and a retrospectively collected cohort of 92 control patients with invasive breast carcinoma undergoing breast conservation surgery. In the study group, lumpectomy specimens were labeled with clips from a commercial tumor marking system, followed by two-view radiography to assess the need for shave margins. The surgeon interpreted the radiograph, and, at their discretion, excised additional margins. A control group was managed by the same surgeons without the tumor marking system. Categorical variables were compared using Chi-Squared or Fisher's exact tests and continuous variables were compared using t-tests or Wilcoxon Rank Sum tests depending on their distribution.ResultsA total of 197 patients were divided into a study group (n = 105) and a control group (n = 92). The types of margin excision rates differed significantly between groups (P ≤ 0.0105). In the study group, the rates of selective and complete margin excisions were 39% and 7%, respectively, while 53% had no margins excised, as determined using the tumor marking system. In the control group, rates of selective and complete margin excisions were 42% and 21%, respectively, and 37% had no margins excised. Final pathology showed positive margins in 24% (study) vs 21% (control), with no significant difference between the groups (P ≤ 0.0810).ConclusionsThe tumor marking system did not decrease the rate of margin positivity compared to the control group. However, the study group demonstrated a significant decrease in the number of patients requiring selective or complete margin excision.
Rectal cancer treatment has evolved over the past 4 decades. Numerous advances in surgical technique, chemotherapy, and radiation therapy have fueled the changes. The surgeon, oncologist, radiation therapist, radiologist, and pathologist work as a team toward a multidisciplinary approach. This has led to individualized care for patients. Amazingly, the use of chemoradiotherapy after diagnosis has led to total regression of rectal cancer in about a third of patients. These patients are felt to be cured and are carefully watched and typically do not require surgery. These advancements have been led by inquisitive surgeons and caregivers who have observed a problem, studied ways to improve the situation, and reported on their conclusion. These individuals are dynamic intellectuals, thinking outside the box to discover these miraculous advancements. However, we still have work to do. This discussion will outline what I feel are the advancements during my professional career over the past 4 decades. I will also outline where I feel we now need to focus our inquisitive energy.
Inter-surgeon variability in robotic surgery learning curves, as well as the impact of trainee involvement and the presence or absence of a formal robotic training curriculum, remain poorly defined. Cumulative sum (CUSUM) analysis is a validated method for evaluating learning curves in robotic surgery. Our study aimed to utilize CUSUM analysis to explore whether surgical trainees affect surgical operating times. We retrospectively analyzed robotic-assisted cholecystectomies performed by 7 surgeons at a single academic institution between 2012 and 2022. A robotic surgery curriculum was implemented in 2016. Cases were ordered chronologically for each surgeon, and CUSUM learning curves were generated using operative time as the outcome. The first peak in the CUSUM curve indicated the completion of the learning phase. Trainee involvement was analyzed by postgraduate year. 707 operations were performed. Five surgeons demonstrated a distinct learning phase, with a learning phase ranging from 20 to 59 cases, whereas two surgeons exhibited baseline proficiency without an identifiable learning phase. Despite consistently high trainee participation (94.5% of cases) and similar distributions of trainee seniority, learning curve variability persisted. Implementation of an institutional robotic training curriculum was not associated with abrupt changes in learning curve trajectories among surgeons. Learning curves in robotic-assisted cholecystectomies are highly variable and surgeon-specific. Implementation of the robotic training program did not influence the overall trajectory of the surgeon's personal learning phase.
BackgroundJunior residents are not uniformly prepared for, trained in, or comfortable with their roles as teachers. There are few feasible and reproducible published curricula to address that gap and no such curriculum that targets the specific needs of junior surgical residents. We designed and implemented a course for junior residents-as-teachers with the aim of studying the impact on residents' comfort, confidence, perceptions, and behaviors as well as proving the feasibility and reproducibility of the curriculum.MethodsUsing Kern's model of curriculum development, we designed and implemented a didactic and workshop-based course. The curriculum content focused on the learning climate, expectation setting, teaching, and giving feedback. The course was offered to PGY-1 and PGY-2 general surgery residents at a university-based program over two separate years. The course was evaluated with a retrospective pre/post-survey assessing change in self-reported comfort, confidence, perceptions, and behaviors. Improvement was analyzed using a student's t-test (1-sided, P < 0.05 as significant).ResultsThe course had >90% participation (26 of 30 residents). Statistically significant increases (P < 0.01) were seen in self-reported comfort, confidence, and time spent on expectation setting, teaching, giving feedback, and role-modeling. After the curriculum, participants believed to a greater extent (P = 0.01) that being a skilled teacher as a resident is important. All respondents supported offering the course to future trainees.DiscussionThis junior residents-as-teachers course significantly improved self-reported comfort, confidence, and time spent on teaching activities. The course was feasible even within the constraints of a surgical-training program and was proven reproducible through a second pilot.
Several advances in surgery originated from observations made by medical students during their training. Although students are usually viewed primarily as learners, their position at the intersection of scientific study and patient care gave a handful a chance to have significant impact. Jean-François Calot described the hepatocystic triangle in his doctoral thesis, establishing an anatomical principle that remains central to safe cholecystectomy. Harvey Cushing and Ernest Amory Codman developed the anesthesia record, a chart that tracks vital signs during surgery and became the foundation of modern perioperative monitoring. Jay McLean identified anticoagulant substances that led to the discovery of heparin, enabling the development of vascular and cardiac surgery. After reasoning that platelets were destroyed in the spleen, Paul Kaznelson proposed splenectomy as treatment for immune thrombocytopenic purpura. Charles Best's observation that ligation of the pancreatic duct in dogs caused atrophy of the exocrine pancreas while preserving the islets led to the isolation of insulin, one of the most important therapeutic discoveries in medicine. Seeking a more efficient method of blood transfusion, Michael DeBakey designed the roller pump, a device that later became essential to cardiopulmonary bypass. As a medical student at Johns Hopkins, David C. Sabiston Jr participated in early work with Mark Ravitch exploring restorative operations for ulcerative colitis. Thomas Fogarty conceived the balloon embolectomy catheter after seeing the difficulty of removing arterial emboli. These episodes illustrate how curiosity and careful observation during medical education can produce insights that shape surgical practice for decades.
BackgroundThe adoption of robotic surgery has increased in foregut procedures, but its comparative value to laparoscopy in Heller myotomy remains unclear. We sought to evaluate the short-term perioperative outcomes of the robotic vs laparoscopic approach for Heller myotomy.MethodsThe American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2022 to 2023 was queried for patients undergoing Heller myotomy, in which the "robotic" variable was included. Outcomes were evaluated using univariable analysis and multivariable logistic and linear regression.ResultsA total of 712 patients underwent a Heller myotomy; laparoscopy accounted for 63.6% of cases (n = 453) and robotic 36.3% (n = 259). The cohorts were matched aside from higher rates of HTN in the robotic group (42.9% vs 34.7%, P < 0.05). Robotic Heller myotomy had significantly (P < 0.05) greater use of intraoperative EGD (22.8% vs 16.8%) and balloon distension studies (5.4% vs 1.5%). The robotic approach was associated with a longer median operative time (167 min vs 119.5 min) and independently associated with longer operative time on linear regression (β 35.39 min, CI 26.19-45.96 min). There were no significant differences in short-term complications including reoperation, readmission, and mortality.DiscussionThese data suggest no significant differences in the short-term outcomes between robotic and laparoscopic Heller myotomy. Robotic surgery was associated with longer operative times and utilization of more EGD and balloon distension studies. Further research is required to evaluate the clinical benefit of robotic surgery in achalasia.
IntroductionVisceral aneurysms pose diagnostic and therapeutic challenges in vascular surgery. Large language models (LLMs) may assist in clinical decision-making, but their application requires rigorous validation. Traditional validation methods are labor-intensive and difficult to scale.ObjectiveWe examined the capability of an LLM in managing visceral aneurysms and explored an automated framework for validating AI-generated clinical responses.MethodsUsing Python with the Pandas library and OpenAI API, we probed the Society for Vascular Surgery (SVS) clinical practice guidelines on visceral aneurysm management. ChatGPT-4o-mini was instructed to review guideline recommendations, generate clinical scenarios, propose management strategies, and evaluate its own responses using a four-tier rubric (1 = completely correct; 2 = partially correct; 3 = partially incorrect; 4 = no correct information). Human evaluators independently assessed the same responses and graded questions as good, fair, or poor and whether they were leading.ResultsEighty visceral aneurysm scenarios were generated and evaluated. ChatGPT-4o-mini self-assessed 89% of responses as correct (scores 1-2), compared to 67% by human evaluators (chi-square, P < 0.0001), with the greatest discrepancy in the partially correct category. Most AI-generated questions were of good quality (56%), though 44% were considered leading questions.ConclusionAn automated validation framework for AI-generated clinical responses is feasible. However, the 67% correctness rate and systematic AI self-overestimation indicate that current LLMs remain unsuitable for independent clinical use, reinforcing the need for expert oversight. The integration of Python-driven automation, structured AI inference, and expert review holds promise for increasing the efficiency of evaluating LLMs at-scale across clinical domains.
Esophageal function tests (esophageal manometry and 24-hour pH monitoring) are essential to diagnose benign esophageal disorders such as gastroesophageal reflux disease and achalasia. Unfortunately, these tests are rarely taught during medical school or surgical training, so that surgeons who treat these diseases must rely on the interpretation and conclusions made by other physicians, mostly gastroenterologists, just reading the report without looking at the tracings themselves. Potentially, this approach may lead to poor outcomes or even malpractice.
BackgroundLarge language models (LLMs) have demonstrated strong performance on general medical knowledge assessments; however, their accuracy within high-acuity, guideline-driven surgical environments such as the trauma bay remains incompletely characterized.ObjectiveTo compare the accuracy of a contemporary LLM, Google Gemini, with junior general surgery residents on trauma knowledge questions derived from national practice management guidelines.MethodsThirty multiple-choice questions were developed from current trauma guidelines issued by nationally recognized professional organizations and independently validated by faculty trauma surgeons. Six junior general surgery residents (PGY-1-2) completed the assessment, generating 180 total responses. The LLM was tested on the same questions under standardized conditions. Accuracy was calculated with 95% confidence intervals and compared using a two-proportion z-test.ResultsResidents answered 157 of 180 questions correctly (87.2%, 95% CI 81.6-91.3). The LLM answered 27 of 30 questions correctly (90.0%, 95% CI 74.4-96.5). There was no statistically significant difference in accuracy between groups (P = .67).ConclusionIn this pilot study, a LLM demonstrated accuracy comparable to junior surgical residents when evaluated on trauma guideline-based questions. Although no significant difference was found, the findings of our exploratory study support cautious exploration of guideline-grounded artificial intelligence as an adjunct in surgical education while underscoring the need for broader validation. Further power studies are required to confirm these preliminary findings.
BackgroundMicrosatellites are an adverse prognostic feature in melanoma that upstages node-negative disease to N1c in the AJCC 8th edition staging system. While Breslow thickness and microsatellites are established prognostic markers, their relationship in primary cutaneous melanoma has not been well examined.Materials and MethodsWe conducted a single-institution retrospective review of an IRB-approved prospective database of patients with primary cutaneous melanoma (January 2016-January 2026), excluding those with metastatic disease at diagnosis. Microsatellites are microscopic foci of melanoma cells discontinuous from the primary tumor and located in the dermis, subcutis, separated from the main tumor by normal tissue with no fibrosis or inflammation. Breslow thickness was measured from the granular layer (or the base of ulceration) to the deepest invasive melanoma cell. Patients were grouped by Breslow-based T-stage, and microsatellite frequency was calculated for each group. Fisher's exact test evaluated the association between T-stage and microsatellite presence.ResultsAmong 1,904 patients, 87 (4.6%) had microsatellites, with one patient having two separate microsatellite-positive tumors. Microsatellite frequency increased progressively with T-stage: 0.1% of T1 tumors (1/924), 2.4% of T2 tumors (14/579), 9.1% of T3 tumors (28/309), and 17.8% of T4 tumors (45/253) (Fisher's exact p<0.0001). Within the microsatellite-positive cohort, T-stage distribution was 1.1% for T1, 15.9% for T2, 31.8% for T3, and 51.1% for T4.DiscussionWe found that microsatellite frequency increases with Breslow thickness. Since microsatellites upstage tumors to N1c with implications for immunotherapy decisions, surgeons and dermatopathologists must be diligent in performing and assessing oncology wide excision specimens.
BackgroundDelays in postoperative documentation can disrupt operating room (OR) efficiency and continuity of care. Surgeons frequently leave the OR to access computers, creating workflow interruptions.ObjectiveTo evaluate whether adding an additional surgeon-dedicated workstation within the OR improves postoperative documentation and order completion times. Secondary outcomes included adverse events and resident and attending feedback.MethodsA prospective controlled clinical trial was conducted from July 1-31, 2025, comparing ORs equipped with additional surgeon workstations to control ORs with standard computer complement. Consecutive elective and urgent general surgery cases with resident involvement were included. Median time from procedure end to postoperative note (PN) and postoperative order (PO) completion were compared. Multivariable linear regression identified independent predictors of documentation efficiency. Surveys were distributed anonymously to all residents and attendings assessing workstation usage.ResultsA total of 182 cases were analyzed, 101 (56%) with the experimental additional workstation. Median PN (7 vs 10 minutes, P = 0.02) and PO (9 vs 14 minutes, P < 0.001) completion times were shorter favoring the surgeon-dedicated workstation. On multivariable regression, the workstation independently reduced PN and PO completion times by 4.9 minutes (95% CI 1.4-8.5, P = 0.006) and 9.1 minutes (95% CI 2.7-15.5, P = 0.005), representing 54% and 83% relative improvement, respectively. No adverse postoperative events occurred. Resident surveys indicated 100% agreement that the workstation improved workflow and patient care.ConclusionImplementation of surgeon-dedicated OR workstations significantly reduced postoperative documentation times and improved OR workflow without adverse events. This strategy may represent a cost-effective, scalable intervention to enhance surgical efficiency.
BackgroundHistorically, women in surgery have faced systemic barriers to becoming physicians, including cultural expectations that discourage leadership roles. This study provides a descriptive analysis of the educational, professional, and academic profiles of women serving as surgical chairs in the United States, with the goal of offering insight to support current and future surgical trainees.MethodsSupplementary data, including educational history, professional achievements, and publication metrics, were collected from public resources such as institutional websites, LinkedIn, and Doximity.ResultsOn average, women surgical chairs reached their positions 18.5 years after completing residency. Most (96%, 22/23) pursued fellowship training across 13 specialties, with surgical oncology being the most common (26.1%, 6/23). Nearly half (47%, 11/23) earned an additional advanced degree, including MS, MBA, or MPH qualifications. Before their appointment as Chair of the Department of Surgery, these women spent an average of 8.1 years at their institution. Their academic contributions were notable, with a mean of 208 publications, 11,428 citations, an H-index of 56.7, and an i-10 index of 151.6.DiscussionDespite ongoing strides toward gender equity in surgery, significant barriers to leadership for women remain. This study aims to illuminate the pathways taken by current women leaders, providing a framework to inspire and guide future generations of women surgeons toward leadership roles.
The morbidity and mortality (M&M) conference is a foundational tradition in surgery, serving as a forum for education, accountability, and patient safety for more than a century. Originally rooted in early efforts to track outcomes and improve hospital efficiency, M&M has evolved alongside major developments in surgical education, quality improvement, and patient safety science. This review traces the historical evolution of the M&M conference from Ernest Codman's end-result system to its institutionalization by the American College of Surgeons and formalization in graduate medical education. It examines the cultural shift from individual blame toward systems-based learning, highlights the influence of the patient safety movement, educational theory, and human factors science, and reviews contemporary approaches incorporating data analytics, multidisciplinary participation, and technology. Persistent challenges including variability in structure, underreporting, and medicolegal concerns along with future opportunities to strengthen M&M as a driver of continuous improvement are discussed. Despite ongoing evolution, the core purpose of honest reflection in service of safer and higher-quality surgical care in M&M remains unchanged.
IntroductionAppendiceal adenocarcinoma is a rare and heterogeneous malignancy with management strategies historically mirroring those of colorectal cancer. The role of adjuvant chemotherapy (AC) in stage II disease remains poorly studied, particularly in stage IIB/IIC. We evaluated the impact of AC on overall survival (OS) in stage IIB/IIC appendiceal adenocarcinoma using the National Cancer Database (NCDB).MethodsThe NCDB was queried to identify adults diagnosed with stage IIB/IIC appendiceal adenocarcinoma from 2010 to 2021. Patients with carcinoid, goblet cell, or neuroendocrine histologies were excluded. Patients were stratified into surgery alone (S) or surgery plus adjuvant chemotherapy (S+). Kaplan-Meier and log-rank tests estimated survival distributions, and multivariable Cox proportional hazards regression with Firth's correction assessed independent predictors of OS.Results2082 patients met inclusion criteria. Adequate lymph node evaluation (≥12 nodes) was independently associated with improved survival (aHR: 0.62, P < .0001). Adjuvant chemotherapy conferred a significant survival benefit, with a 26% reduction in risk of death (aHR: 0.74, 95% CI: 0.62-0.89, P = .0016). Five-year OS was 78.9% for S+ vs 68.7% for S (P < .001). Patients receiving both AC and adequate nodal harvest demonstrated the greatest survival benefit. Non-mucinous histology was associated with superior outcomes compared to mucinous disease (aHR: 0.62, P < .0001).ConclusionAdjuvant chemotherapy is independently associated with improved survival in patients with stage IIB/IIC appendiceal adenocarcinoma, particularly when combined with adequate lymph node evaluation. These findings challenge current treatment paradigms that extrapolate from colorectal cancer and support consideration of AC as standard therapy in this high-risk patient subset.
BackgroundLarge cell lung cancer (LCLC) is an aggressive, undifferentiated subtype of non-small cell lung cancer (N-SCLC) and is now a rare subtype in clinical practice.MethodsData were retrieved from the SEER database, with two analytical cohorts established. Joinpoint regression quantified LCLC incidence trends. Propensity score matching (PSM) balanced baseline characteristics of the survival cohort. Cox regression determined independent overall survival (OS) predictors, restricted cubic spline (RCS) explored non-linear associations between continuous factors and outcomes, and Kaplan-Meier curves with Log-rank tests compared survival differences.ResultsFrom 1992 to 2022, the incidence of LCLC exhibited a significant downward trend (annual percent change [APC] = -12.690%, 95% CI: -13.788 to -11.577, P < 0.001). The most rapid decline was observed during 2005-2015, with an APC of -19.624% (95% CI: -21.955 to -17.224, P < 0.001). Finally, a significant decreasing trend persisted from 2015 to 2022, albeit with a slightly slowed rate (APC = -13.995%, 95% CI: -21.303 to -6.008, P = 0.002). Multivariate analysis identified advanced age, male sex and advanced AJCC stage as independent predictors. Lobectomy and extended lobectomy were associated with improved OS, while no chemotherapy was a risk factor.Conclusions1992-2022 US LCLC incidence decline is attributable to diagnostic drift rather than reduced actual disease burden; our study identified sex, age, AJCC stage, surgical resection extent and chemotherapy as OS predictors for LCLC patients. Notably, SEER lacks modern systemic therapy data, precluding unrigorous extrapolation of its chemoradiotherapy findings to current regimens.
Malignant left-sided large-bowel obstruction remains a high-risk presentation that often requires urgent decompression. Self-expanding metal stents (SEMS) can convert an emergency to an elective operation and may create a window for staging, multidisciplinary planning, and (in selected patients) neoadjuvant systemic therapy. Photodynamic therapy (PDT) is a light-activated, locally delivered ablative modality that has been used historically for palliation or local control of colorectal and pelvic recurrences, but its role in contemporary management of obstructing colon cancer remains investigational. We present an anchoring case of obstructive rectosigmoid adenocarcinoma managed with endoscopic SEMS placement, interval endoluminal PDT, followed by systemic neoadjuvant therapy and curative resection with a pathologic complete response. Using this case as a framework, we review established management pathways for obstructing left-sided colon cancer (emergency surgery, diversion, and SEMS as a bridge to surgery), summarize evidence and guideline positions on SEMS and neoadjuvant therapy for resectable colon cancer, and synthesize the limited clinical literature describing PDT in colorectal malignancy. We emphasize that, given the multimodal sequence and existing evidence base, PDT should be viewed as a potential adjunct to-rather than a replacement for-SEMS, systemic therapy, or standard oncologic surgery. This case illustrates technical feasibility and conceptual integration, but does not establish efficacy; prospective study is needed to define patient selection, timing, and safety.
BackgroundDiabetic foot (DF) complications, including diabetic foot ulcers (DFUs), lead to significant morbidity, disability, and economic burden. Hemoglobin (Hb) levels may influence the prognosis of DF patients, but their relationship with adverse clinical outcomes remains unclear. This systematic review and meta-analysis aimed to assess the association between hemoglobin concentration and the risk of adverse outcomes in diabetic foot patients, including amputation and mortality.MethodsWe followed PRISMA guidelines to conduct a systematic literature review. A meta-analysis was performed on observational studies assessing the impact of hemoglobin levels on amputation, mortality, and ulcer incidence. A random-effects model was applied, and risk bias was evaluated using the Newcastle-Ottawa Scale.ResultsA total of 22 observational studies involving 10,984 patients were included. Our meta-analysis revealed that lower hemoglobin levels were significantly associated with a higher risk of amputation (OR = 0.97, 95% CI: 0.94-0.99, P < .001), and lower hemoglobin concentrations were found in amputation cases compared to non-amputation cases (SMD = -0.14, 95% CI: -0.24 to -0.04, P < .01). However, no significant association was found between hemoglobin levels and mortality (OR = 0.99, 95% CI: 0.33-2.89, P > .05). Sensitivity and publication bias analyses indicated robust results.ConclusionLower hemoglobin levels were associated with higher odds of amputation in patients with diabetic foot. However, pooled effects were small and heterogeneity was substantial across studies; therefore, hemoglobin likely functions primarily as a marker of overall disease burden and perioperative risk rather than a proven modifiable target. Prospective interventional studies are needed to determine whether correcting anemia improves limb outcomes and survival.
Intrapericardial diaphragmatic hernia (IPDH) is a rare condition that commonly occurs after trauma, in which abdominal contents herniate through the central tendon of the diaphragm into the pericardial sac. Diagnosis is frequently delayed due to nonspecific cardiopulmonary symptoms and subtle imaging findings. We performed a narrative review of cases of traumatic IPDH to identify diagnostic challenges and operative strategies and present a case of a 71-year-old woman who developed IPDH following a motor vehicle collision. Initial imaging demonstrated rib, liver, and pelvic fractures without evidence of diaphragmatic injury. After orthopedic surgery, the patient developed chest pain and dyspnea, prompting repeat imaging suggesting IPDH. Robotic-assisted repair revealed a 9-cm anterior diaphragmatic defect containing stomach and omentum, which was repaired with mesh. Postoperatively, the patient developed pericarditis confirmed by cardiac evaluation. This review highlights the diagnostic challenges of IPDH, limitations of imaging, and the importance of multimodal evaluation and timely surgical intervention.
BackgroundMotor vehicle collisions (MVCs) are the second leading cause of childhood mortality in the US, and child restraint systems (CRS) remain underutilized. We examine differences in demographics and clinical characteristics in pediatric patients presenting to the emergency department (ED) after MVCs with or without CRS.MethodsWe identified MVC trauma patients reported within the National Trauma Data Bank (NTDB) < 8 years of age and height/weight CRS-eligible. Bivariate descriptive analyses, interquartile range for continuous variables and a chi-square test of proportions tested differences of categorical variables of CRS strata. Sensitivity analysis was used in patients that were age appropriate for car and booster seats.ResultsIn all patients, median age for those without CRS was older (6 years, IQR 4-7) than those with CRS (4 years, IQR 2-5, P < 0.0001). A lower proportion of Black patients had CRS compared to White (24.0% vs 32.6%, P < 0.0001). For those with CRS, the highest proportion were boosters (38.7%). Injury severity score (ISS) was higher in the non-CRS group (8, IQR 4-14) than CRS (5, IQR 2-11, P < 0.0001). A larger proportion of CRS patients were discharged home from ED (26.8% vs 18.5%). Racial disparities persisted in older patients, with fewer booster-eligible Black children in CRS (30.0% vs 17.9%, P < 0.001).ConclusionsThis study demonstrates that older and Black children were less likely to be in a CRS, and that those who were not in CRS were more severely injured. Our study serves as the foundation for research to mitigate disparities, and outreach related to CRS improvements.