Trauma Surgery

Enhanced recovery with high adherence shortens LOS and lowers complications in pediatric GI surgery

In this stepped-wedge trial of 597 patients (age 10–18) across 18 US sites, overall LOS did not differ by study phase. Patients receiving ≥13 of the 21 ERP elements had shorter median LOS (−1.14 days) and fewer complications (aOR 0.48). Patient-level adherence increased with implementation, and integration into order sets correlated with fidelity. When implementing pediatric ERPs, aim for high element-level fidelity and use toolkits and feedback to sustain adherence. 1

Self-pay status independently predicts higher in-hospital mortality after pediatric traumatic injury

In 148,019 pediatric trauma patients (ISS >9), overall mortality was 4.4%, higher in Non-Hispanic Black children (6.6%) and self-pay patients (7.5%). Adjusted models found self-pay status associated with increased mortality versus Medicaid (OR 1.23), with Non-Hispanic Black race also showing a smaller adjusted effect. Firearm-related injury carried the highest mortality risk (OR 4.18). Consider insurance status when risk-stratifying and target system-level interventions to reduce access-related mortality differences. 2

AUA and EAU urologic trauma guidelines largely align but differ in specificity and follow-up

Both guidelines favor nonoperative management for hemodynamically stable urologic trauma and recommend contrast-enhanced imaging for renal injury. AUA allows intervention based on hematoma size, whereas EAU emphasizes angioembolization and structured follow-up including blood pressure monitoring. EAU provides more detail on iatrogenic injuries and post-treatment imaging; AUA gives more diagnostic protocols for ureteral trauma. Apply guideline differences to local resources and patient needs, and recognise recommendations often rest on low-quality evidence. 3