BACKGROUND:Complicated appendicitis remains a leading cause of post-operative morbidity in children, but the relationship between specific microbial resistance profiles and clinical outcomes is poorly defined. METHODS:We conducted a retrospective cohort study of pediatric patients (<18 y) who underwent appendectomy for complicated appendicitis at a tertiary children's hospital (2019-2024). Demographic, operative, and outcome data were abstracted from the National Surgical Quality Improvement Program Pediatric database and electronic health records. Intra-operative cultures were analyzed for bacterial species, gram stain morphology, and antibiotic agent resistance. Hierarchical clustering of weighted resistance scores identified resistance-based microbial groupings. The primary outcome was post-operative organ-space infection (OSI), and secondary outcomes included length of stay (LOS) and 30-day re-admission. RESULTS:Among 194 children (median age = 10.2 y; 56.2% male), 26 (13.4%) developed OSI. Culture analysis (n = 176 with samples) demonstrated that polymicrobial infections with ≥3 bacterial species isolated and the presence of Bacteroides fragilis increased the odds of OSI by 3.04× (95% confidence interval [CI] = 1.18-7.80, p = 0.010) and 2.40× (95% CI = 1.01-5.35; p = 0.021), respectively. Cluster analysis revealed three groups reflecting resistance burden and clinical phenotype. The Enterobacteriaceae group and a hard-to-treat cluster were associated with longer hospital stays (both p < 0.02), and the hard-to-treat cluster with increased 30-day re-admissions (5.6% vs. 1.5%; p = 0.040). CONCLUSIONS:Children with OSI exhibited distinct microbiologic features, including polymicrobial cultures and B. fragilis. Resistance-weighted clusters were linked to longer LOS and re-admission, highlighting that intra-operative cultures, traditionally considered low yield, may provide prognostic information with implications for post-operative management and antibiotic agent stewardship in pediatric complicated appendicitis.

BACKGROUND:Neighborhood socioeconomic disadvantage, measured by Area Deprivation Index (ADI), is associated with disparities in health care and child welfare responses following evaluation for suspected child physical abuse. We sought to determine whether historical redlining and contemporary spatial social polarization strengthen associations between neighborhood disadvantage and caregiver exclusion at discharge, a system-level outcome reflecting child welfare involvement. METHODS:This multicenter retrospective cohort study included children (age <18 y) admitted with suspected/ confirmed physical abuse at 7 New York pediatric trauma centers (2011-2023). Home addresses were linked to neighborhood disadvantage measures, including ADI, Social Vulnerability Index, Child Opportunity Index, Index of Concentration at the Extremes for race, income, and racialized economic segregation, and a Historic Redlining Score (HRS). The primary outcome was caregiver exclusion at discharge (legal removal from the home environment). Univariable and multivariable mixed-effects models adjusted for age, Injury Severity Score, and admission year. RESULTS:Of 1,242 patients, 517 (41.6%) experienced caregiver exclusion. These children were more often Black (29.6% vs. 20.0%, p < 0.001) and lived in neighborhoods with greater disadvantage [median (interquartile range); ADI: 78.0 (52.3 to 93.0) vs 52.5 (18.0 to 84.0); Child Opportunity Index: 26.0 (5.0 to 51.0) vs 31.0 (8.0 to 62.5), p < 0.001], compared with those without caregiver exclusion. Compared with ADI Quartile 1, children in the most disadvantaged neighborhoods (ADI: Q4) had 4.93-fold higher odds of caregiver exclusion (95% CI: 2.75 to 8.85). Inclusion of HRS improved model performance (area under the curve: 0.825 → 0.833); each unit increase in HRS increased the odds of caregiver exclusion by 38% (p = 0.045). CONCLUSIONS:Neighborhood deprivation is strongly associated with caregiver exclusion following hospitalization for suspected child physical abuse. This relationship is strengthened by incorporating historical redlining measures. These findings highlight the intersection of structural neighborhood disadvantage and system-level responses to child safety concerns, suggesting that historic patterns of disinvestment may continue to shape child welfare involvement. (J Trauma Acute Care Surg 2026;00:000-000. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.). LEVEL OF EVIDENCE:Prognostic/Epidemiological; Level III. STUDY TYPE:Multicenter Retrospective Cohort Study.

OBJECTIVES:Perforated appendicitis commonly results in intra-abdominal infection requiring prolonged antibiotic therapy. Intraoperative antimicrobial adjuncts are limited, and photodynamic therapy (PDT) may provide a targeted, resistance-independent approach. This study evaluated the feasibility, safety, and preliminary antimicrobial effects of laparoscopic methylene blue photodynamic therapy (MB-PDT) for intra-abdominal disinfection in a rabbit model of perforated appendicitis. MATERIALS AND METHODS:New Zealand White rabbits (n = 19) underwent surgically induced perforated appendicitis via appendiceal ligation and electrocautery perforation. Animals subsequently received laparoscopic MB-PDT (n = 9) or control treatment (methylene blue lavage without laser illumination; n = 10) 24-40 h after perforation. MB-PDT consisted of peritoneal lavage with methylene blue (300 µg/mL) followed by 665-nm laser illumination at 20 mW/cm2 to a fluence of 25 J/cm2. Peritoneal aspirates were obtained before and 24 h after intervention to quantify bacterial burden. In vitro PDT was evaluated in isolated organisms. Intraperitoneal organs were assessed histologically for off-target effects. Primary outcomes were feasibility, safety, and in vivo change in bacterial burden. Secondary outcomes included clinical parameter changes and in vitro efficacy. RESULTS:Fourteen rabbits developed peritonitis, and 10 animals completed follow-up (PDT n = 7, control n = 3). Laparoscopic MB-PDT delivery was technically feasible and no histologic evidence of off-target photodynamic injury to abdominal organs was identified. Changes in bacterial burden were not significantly different between MB-PDT and control animals (p = 0.18). Body temperature showed a non-significant trend toward reduction following MB-PDT (-0.37°C ± 1.32°C) compared with controls (0.26°C ± 0.76°C; p = 0.27). In vitro MB-PDT produced significant reductions in bacterial burden across all isolated species (p < 0.001), with the most resistant Gram-positive isolate, Enterococcus faecalis, demonstrating greater susceptibility than Gram-negative species. CONCLUSION:Laparoscopic MB-PDT was technically feasible and safe in a rabbit model of perforated appendicitis. Although a reduction in bacterial burden was not observed in vivo, MB-PDT produced strong antimicrobial activity in vitro against all bacterial species isolated from infected animals. These findings establish a preclinical technical platform for intra-abdominal MB-PDT and highlight the importance of optimized light-delivery strategies for future translational studies.

INTRODUCTION:To better understand the relationships between social drivers of health (SDoH) and pediatric surgical outcomes, we examined neighborhood-based SDoH and surgical outcomes in a national cohort of children with low baseline surgical risk. METHODS:Multicenter, retrospective cohort study of healthy (American Society of Anesthesiologists Class I and II) children <18 years old undergoing surgery at 8 National Surgical Quality Improvement Program-Pediatric hospitals (1/1/2016-12/31/2021). We investigated associations between three validated SDoH indices [Social Vulnerability Index (SVI), Area Deprivation Index (ADI), and Child Opportunity Index (COI)] and serious postoperative complication; presentation to the emergency department (ED) for surgical care; hospital length of stay (LOS); and surgical site infection (SSI). All indices were re-scaled to present decile change for analysis. Multivariable regression models controlled for age, sex, racialization, pre-operative comorbidities, and hospital proximity (fixed effects) and hospital site (random effect). RESULTS:38,514 healthy children underwent surgical procedures during the study period. We found significant associations between increasing deciles of both COI and SVI and odds of ED admission (COI: OR 1.018, 95% CI 1.008-1.027, p < 0.001; SVI: OR 1.022, 95% CI 1.013-1.031, p < 0.001). While no significant associations were found between any SDoH index and SSI or serious complications, increased LOS was associated with both ADI (IRR 1.011, 95% CI 1.004-1.017, p < 0.001) and COI (IRR 1.009, 95% CI 1.004-1.015, p < 0.001). CONCLUSION:Children from more disadvantaged neighborhoods more frequently present through the ED preoperatively and experience longer LOS. Future work should investigate the potential drivers of these disparities in access and healthcare utilization.

Background: Failure to perform ovarian conservation surgery (OCS) for patients who present with adnexal torsion was recognized as a practice gap by the American Pediatric Surgical Association (APSA) in 2017. A targeted educational campaign was conducted to promote detorsion and ovarian conservation surgery as the standard of care for ovarian torsion. We evaluated the practice change that has occurred for pediatric and adolescent patients with ovarian torsion from 2012 to 2022. Methods: Using the American College of Surgeons (ACS) National Safety and Quality Improvement Project-Pediatrics (NSQIP-P) Participant Use Files from 2012 to 2022, we compared surgical treatment types during the time periods that encompassed the targeted educational period. Results: A total of 2249 patients (70 %) underwent OCS surgery and 980 (30 %) patients underwent salpingectomy and/or oophorectomy (SO). Patients who were treated with OCS were older (12.4 [SD 3.6] vs. 11.4 [SD 4.8] years, p < 0.01). Patients were more likely to be treated with SO if they were Black (11 vs. 15 %, p < 0.01) or obese (28 vs. 33 %, p < 0.01). From 2012 to 2017, 42 % of patients underwent OCS, compared to 76 % in 2018-2022 (p < 0.01). A mixed effect analysis comparing year-over-year rates of SO across pediatric surgeons and gynecologic surgeons showed a statistically significant difference in rates across specialty and time (p < 0.01), with pediatric surgeons performing fewer SOs. Conclusion: In the treatment of ovarian torsion in pediatric and adolescent patients, we demonstrated successful adoption and sustained implementation of practice improvement coincident with the introduction of a comprehensive educational initiative. Type of Study: Retrospective cohort. Level of Evidence: IV. (c) 2024 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Background Disparities in emergency department (ED) utilization after gastrostomy (G-) tube placement were previously demonstrated at our children's hospital. We aimed to reduce postoperative G-tube dislodgements and ED visits with a particular focus on socially vulnerable children. Methods Our improvement team implemented a G-tube care bundle (6/2018-9/2019) targeting caregiver preparedness and standardizing care in the pre-, intra-, and post-operative periods. Patients who had G tubes placed between 1/2011-8/2022 were categorized to either pre- or post-intervention groups. Primary outcomes were tracked prospectively. National area deprivation index (ADI) was assigned retrospectively and employed to evaluate social risk. Univariate comparisons were made between pre- and post-intervention groups, and between High ADI (>= 80) and Low ADI (<80) subgroups in both pre- and post- intervention periods. We used statistical process control methods to further analyze change over time. Results 396 children were included (188 pre-intervention, 208 post-intervention). The post-intervention cohort demonstrated a lower rate of outpatient dislodgement at 90 days following G-tube placement (21.3 % vs 10.1 %, p = 0.002) and fewer G-tube-related ED visits per G-tube placed within one year of placement (mean 0.8 visits vs 0.6 visits, p = 0.012). Pre-intervention, children from high ADI neighborhoods had significantly greater healthcare utilization compared to those from lower ADI neighborhoods. Post-intervention, previously statistically significant disparities were no longer present. Outpatient G-tube dislodgements within 90 days were particularly mitigated. Conclusions A longstanding quality improvement initiative has led to sustained reductions in overall G-tube-related health care utilization. Care standardization and improvement may mitigate outcome disparities related to socioeconomic advantage.

OBJECTIVES Impostor phenomenon (IP) is defined as feeling inadequacy, self-doubt, and the tendency to attribute achievement to external causes. We sought to examine IP rates among pediatric surgeons and to identify IP-associated factors, based on the hypothesis that pediatric surgeons experience imposterism, especially in the first few years of practice. DESIGN Anonymous survey, including the validated Clance IP Scale (CIPS), distributed to pediatric surgeons. CIPS scores indicated degree of IP characteristics: 21-40= “few,” 41-60=“moderate,” 61-80=“frequent,” 81-100=“intense.” Demographic, training, and practice-based characteristics were collected. Univariate statistics were used to compare differences between groups and logistic regression to further understand associations. SETTING Survey study distributed via email to the American Pediatric Surgical Association (January 2023-February 2023). PARTICIPANTS 1129 surveys were sent. We received 337 responses (29.8%) and analyzed data from 319 respondents, after exclusion of incomplete responses and fellows. RESULTS The median CIPS score for analyzed respondents was 52 (IQR 40-65), moderate imposterism. Female respondents were more likely to have IP compared to males (OR 3.52 [CI 2.13-5.73], p < 0.01). Junior attendings (<5y practice) had increased odds of IP (OR 2.88, CI 1.71-4.93) compared to midcareer and senior attendings (p < 0.001). Using multiple logistic regression, the addition of junior attending status plus female gender was even more predictive of imposterism [AUC 0.722; CI 0.661-0.782; p < 0.0001]. There was no relationship between IP and fellowship or practice-based characteristics. CONCLUSIONS IP is prevalent among pediatric surgeons, particularly junior surgeons, and females. We did not find a relationship with IP and fellowship or practice-based characteristics but did find higher IP in respondents who did not feel they had support in practice. We underscore both intrapersonal and interpersonal characteristics impact IP in the pediatric surgeon. We suggest interventions that foster inclusion and mentorship be employed to help mitigate possible negative outcomes of IP.

Perforated appendicitis (PA) is the most common cause of intra-abdominal abscess in children and is associated with higher costs, extended hospitalizations, and worse postoperative outcomes compared to uncomplicated appendicitis. Photodynamic therapy (PDT) utilizes a photosensitizer and light to generate cytotoxic reactive species that are efficacious against bacteria. We sought to determine whether PDT could effectively eliminate bacteria isolated from the peritoneal cavities of pediatric patients with perforated appendicitis. After IRB approval, bacterial subcultures from 30 pediatric surgical patients with PA were developed as planktonic monocultures. Samples were derived from standard clinical collection of peritoneal fluid in patients undergoing surgery for PA. Cultures were incubated with the photosensitizer methylene blue (MB) and exposed to a 665 nm laser to perform PDT. Control conditions were MB alone, laser alone, or no MB and no laser. Log reductions in bacterial growth between groups were compared using two-way ANOVA. Bacteria were isolated from 28 (93.3%) specimens, and 26 (86.7%) were polymicrobial. The most prevalent organisms included Escherichia coli (76.7%), the Streptococcus anginosus group (56.7%), Bacteroides fragilis (46.6%), and Pseudomonas aeruginosa (26.7%), with antibiotic resistance common among E. coli isolates. For E. coli, MB-PDT caused a 5.86 ± 0.39 log10 reduction compared to the no-treatment control (p < 0.001). For S. anginosus and P. aeruginosa, MB-PDT resulted in reductions of 5.91 ± 0.88 log10 and 2.23 ± 0.64 log10, respectively (all p < 0.001). PDT showed comparable efficacy in isolates with multiple antibiotic resistance relative to those that were antibiotic pan-susceptible for E. coli (p = 0.760), S. anginosus group (p > 0.999), and P. aeruginosa (p = 0.991). PDT application to bacterial isolates from patients with perforated appendicitis achieved > 99.9% bacterial kill in all isolated strains other than P. aeruginosa, regardless of antibiotic susceptibility, suggesting that PDT may be a viable adjunct to in vivo antimicrobial therapy.

The purpose of this study was to use factor analysis to explore potential underlying dimensions that explain associations between social determinants of health (SDoH), operationalized as Social Deprivation Index (SDI) and Area Deprivation Index (ADI) scores and other neighborhood characteristics, and postoperative outcomes in pediatric patients with simple appendicitis. We retrospectively reviewed all children (age < 18 years) who underwent an appendectomy for simple appendicitis at our institution (January 2015–December 2021). Patients were identified and patient demographics, clinicopathologic factors, and postoperative outcomes were abstracted from the American College of Surgeons National Surgical Quality Improvement Program Pediatric (NSQIP-P) institutional dataset. Supplemental patient-level data were obtained via the electronic medical record. Population-level variables, including SDI and ADI as well as other neighborhood characteristics were obtained after geocoding patient home addresses. Patient-level postoperative outcomes included length of stay, percutaneous drain insertion, peripherally inserted central catheter (PICC) placement, emergency department (ED) visit within 30 days of discharge, as well as any postoperative fever, antibiotics, imaging, and parenteral nutrition usage. A multivariable model predictive of outcomes was created using feature selection and exploratory factor analysis. Factor analysis revealed two uncorrelated multivariable factors: factor 1 included SDI score and ADI score, and factor 2 included percentages of Black, Hispanic, high-needs, and linguistically isolated residents. Lower factor 1 scores were associated with increased length of stay and increased frequency of postoperative imaging, while low factor 2 scores were associated with increased postoperative antibiotic usage. Two latent factors were identified encompassing broad socioeconomic advantage (factor 1: SDI and ADI) and specific neighborhood characteristics (factor 2: the proportion of minoritized, high-needs, and linguistically isolated residents). Dividing the population using these factors demonstrated that patients with more socioeconomic advantage (low factor 1 scores) had increased lengths of stay and more postoperative imaging. Similarly, patients from neighborhoods with lower proportions of minoritized, high-needs, and linguistically isolated residents had less postoperative antibiotic usage. These results suggest that postoperative outcomes in children with appendicitis extend beyond socioeconomic status in a broad sense and are also impacted by specific neighborhood characteristics. The ability to isolate individual drivers of outcomes that are associated with SDoH may help to develop more tailored interventions aimed at attenuating disparities for vulnerable populations.

BACKGROUND:Adhesions form as a response to peritoneal tissue trauma. Myofibroblast collagen production is key to adhesion formation and ogerin can prevent myofibroblast differentiation in tissue-resident fibroblast populations. In this two-part study, we sought to evaluate ogerin's potential to prevent myofibroblast differentiation, in vitro, and adhesion formation in vivo. METHODS:We performed a two-part study. (1) In vitro: Human peritoneal fibroblasts were cultured from four pediatric surgical patients. We tested myofibroblast differentiation using alpha smooth muscle actin (α-SMA) and collagen (Col1A1) expression in response to transforming growth factor beta (TGF-β), ogerin, and TGF-β+ogerin versus control. (2) In vivo: Randomized, blinded trial of intraperitoneal ogerin versus control using a murine model. Adhesions were quantified using clinical adhesion scores, histologic measurements, and α-SMA/FAP expression. RESULTS:In vitro: TGF-β induced differentiation of human peritoneal fibroblasts into pro-fibrotic myofibroblasts increased α-SMA (TGF-β: 2.7 ± 1.2 vs. control: 1.0 ± 0.27, p < 0.01) and Col1A1 expression (TGF-β: 1.2 ± 0.18 vs. control: 1.0 ± 0.12, p = 0.03); a response that was blunted with ogerin treatment (α-SMA: ogerin + TGF-β: 1.2 ± 0.58 vs. TGF-β: 2.7 ± 1.2, p < 0.01; Col1A1: TGF-β+ogerin: 0.79 ± 0.21 vs. TGF-β: 1.2 ± 0.18, p < 0.01). In vivo: Ogerin-treated mice had lower adhesion scores (ogerin: 1.85 ± 1.01; control: 2.95 ± 0.95; p = 0.03) and decreased histologic adhesion area (ogerin: 1.16 ± 1.82 mm2; control: 3.31 ± 3.20 mm2; p = 0.04) compared to controls. CONCLUSION:Ogerin inhibits TGF-β-induced myofibroblast differentiation in vitro and, blunts adhesion formation in an in vivo murine model. While the complete mechanism of action is not fully elucidated, these results suggest that ogerin may be a translational tool for preventing adhesion formation in patients undergoing abdominopelvic surgery. TYPE OF STUDY:Laboratory Investigation. LEVEL OF EVIDENCE:N/A.

BACKGROUND:Our purpose was to investigate whether neighborhood deprivation is associated with outcomes in a multicenter population of children with suspected or confirmed child physical abuse. We hypothesized that community level social determinants of health are associated with worse outcomes following child physical abuse. METHODS:This multicenter retrospective review included children (18 years or younger) admitted with suspected or confirmed physical abuse at six pediatric trauma centers. A national Area Deprivation Index (ADI) score was assigned to each patient based on home address. Area Deprivation Index was divided into quartiles using the distribution of our dataset. Exclusion of a caregiver at discharge was used as a proxy for confirmed physical abuse. Descriptive statistics and stepwise logistic regression were used to identify covariates. Multiple logistic regression was used to test for associations between ADI and caregiver exclusion. RESULTS:Of 1,105 included patients, 512 had confirmed abuse. These patients were younger (median [interquartile range], 0.50 [1.50] vs. 0.83 [1.67]; p = 0.002), more likely to be Black or African American (28.3% vs. 19.5%, p < 0.001), and had higher ADI scores (81.0 [35.0] vs. 66.0 [60.0], p < 0.001). A dose-dependent relationship between ADI and caregiver exclusion was identified. Compared with those from the least vulnerable neighborhoods (ADI first quartile), patients from the most vulnerable neighborhoods (ADI fourth quartile) had 2.65 (95% confidence interval, 1.73-4.08; p < 0.001) times higher odds of confirmed abuse. Despite no differences in Injury Severity Scores (8.0 [6.0] vs. 9.0 [10.0], p = 0.163), they also had longer lengths of hospital stay (1.0 [2.0] vs. 3.0 [2.8], p = 0.002) and higher mortality (1.5% vs. 5.0%, p = 0.028). CONCLUSION:This large multicenter experience demonstrates a dose-dependent relationship between socioeconomic disadvantage and child physical abuse. We further demonstrate that disadvantage is associated with worse outcomes, including increased mortality, in child physical abuse. These findings provide objective data and lead to suggestions for interdisciplinary and multiscale approaches to primary prevention of child physical abuse. LEVEL OF EVIDENCE:Prognostic and Epidemiological; Level III.

INTRODUCTION:Disparities relating to social and economic advantage exist in pediatric surgery. To better identify specific areas of improvement, we evaluated long term gastrostomy (G-) tube outcomes at our children's hospital to assess the relationship to a child's neighborhood. METHODS:Patients with G-tubes placed between January 2011 and May 2018 were included. We gathered demographic and outcomes data retrospectively and assigned national Area Deprivation Index (ADI) and Child Opportunity Index (COI) scores to each patient. Univariate comparisons were made between groups with higher and lower index scores, as defined by the median score for our population. Kaplan-Meier survival analysis was used to evaluate time to first tube dislodgment. RESULTS:There were 183 and 185 children with accessible ADI and COI scores, respectively. The median follow-up time was 5.6-5.8 y. Children with less social advantage had significantly higher mean G-tube related emergency department (ED) visits per child, a higher proportion of very high ED utilizers (children with ≥5 ED visits), and a longer length-of-stay following G-tube placement, all of which were consistent across both ADI and COI scores. Survival curves analyzing G-tube dislodgement within 90 d demonstrate children identified as White with more advantage have the lowest risk of dislodgement. Children identified as Black or African American with any level of advantage had the highest risk of dislodgement. CONCLUSIONS:Identifying specific outcomes related to patients' environmental advantage is critical for efficient allocation of resources to target disparities; once a baseline is established, these metrics can be considered for continued outcomes tracking to evaluate for effective improvement and disparity mitigation.

Solid pseudopapillary neoplasm (SPN) is a rare low-grade malignant tumor of the pancreas that occurs predominantly in young females. This tumor is occasionally multicentric, posing a unique surgical conundrum for resection. We present a case of a 10-year-old female with a history of multicystic dysplastic left kidney and persistent urogenital sinus who was diagnosed with biopsy-proven multicentric SPN of the pancreatic head and tail and underwent middle-preserving pancreatectomy. The patient tolerated the surgery very well. Our case is one of the few reported cases of multicentric SPN in a pediatric patient, and the only case treated with middle-preserving pancreatectomy, which is a novel surgical option for protecting pediatric patients from total endocrine and exocrine pancreatic insufficiency. With the increase in the incidence of SPN, there is an increasing need for pancreas-preserving surgical options, particularly in pediatric patients.

Background: The assignment of trauma team activation levels can be conceptualized as a classification task. Machine learning models can be used to optimize classification predictions. Our purpose was to demonstrate proof-of-concept for a machine learning tool for predicting trauma team activation levels in pediatric patients with traumatic injuries. Methods: Following IRB approval, we retrospectively collected data from the institutional trauma registry and electronic medical record at our Pediatric Trauma Center for all patients (age 15 or positive for any of 6 NFTI criteria 1/4 full activation). Model performance was quantified and compared to emergency department (ED) staff. Results: ED staff had 75% accuracy, an area under the curve (AUC) of 0.73 +/- 0.04, and an F1 score of 0.49. The best performing of all machine learning models, the support vector machine, had 80% accuracy, AUC 0.81 +/- 4.1e5 , F1 Score 0.80, with less variance compared to other models and ED staff. Conclusions: All machine learning models outperformed ED staff in all performance metrics. These results suggest that data-driven methods can optimize trauma team activations in the ED, with potential improvements in both patient safety and hospital resource utilization. Type of study: Economic/Decision Analysis or Modeling Studies. Level of evidence: II. (c) 2023 Elsevier Inc. All rights reserved.

BACKGROUND: Assigning trauma team activation (TTA) levels for trauma patients is a classification task that machine learning models can help optimize. However, performance is dependent on the “ground-truth” labels used for training. Our purpose was to investigate 2 ground truths, the Cribari matrix and the Need for Trauma Intervention (NFTI), for labeling training data. STUDY DESIGN: Data were retrospectively collected from the institutional trauma registry and electronic medical record, including all pediatric patients (age <18 years) who triggered a TTA (January 2014 to December 2021). Three ground truths were used to label training data: (1) Cribari (Injury Severity Score >15 = full activation), (2) NFTI (positive for any of 6 criteria = full activation), and (3) the union of Cribari+NFTI (either positive = full activation). RESULTS: Of 1,366 patients triaged by trained staff, 143 (10.47%) were considered undertriaged using Cribari, 210 (15.37%) using NFTI, and 273 (19.99%) using Cribari+NFTI. NFTI and Cribari+NFTI were more sensitive to undertriage in patients with penetrating mechanisms of injury (p = 0.006), specifically stab wounds (p = 0.014), compared with Cribari, but Cribari indicated overtriage in more patients who required prehospital airway management (p < 0.001), CPR (p = 0.017), and who had mean lower Glasgow Coma Scale scores on presentation (p < 0.001). The mortality rate was higher in the Cribari overtriage group (7.14%, n = 9) compared with NFTI and Cribari+NFTI (0.00%, n = 0, p = 0.005). CONCLUSIONS: To prioritize patient safety, Cribari+NFTI appears best for training a machine learning algorithm to predict the TTA level.

INTRODUCTION:Large language models like Chat Generative Pre-Trained Transformer (ChatGPT) are increasingly used in academic writing. Faculty may consider use of artificial intelligence (AI)-generated responses a form of cheating. We sought to determine whether general surgery residency faculty could detect AI versus human-written responses to a text prompt; hypothesizing that faculty would not be able to reliably differentiate AI versus human-written responses. METHODS:Ten essays were generated using a text prompt, "Tell us in 1-2 paragraphs why you are considering the University of Rochester for General Surgery residency" (Current trainees: n = 5, ChatGPT: n = 5). Ten blinded faculty reviewers rated essays (ten-point Likert scale) on the following criteria: desire to interview, relevance to the general surgery residency, overall impression, and AI- or human-generated; with scores and identification error rates compared between the groups. RESULTS:There were no differences between groups for %total points (ChatGPT 66.0 ± 13.5%, human 70.0 ± 23.0%, P = 0.508) or identification error rates (ChatGPT 40.0 ± 35.0%, human 20.0 ± 30.0%, P = 0.175). Except for one, all essays were identified incorrectly by at least two reviewers. Essays identified as human-generated received higher overall impression scores (area under the curve: 0.82 ± 0.04, P < 0.01). CONCLUSIONS:Whether use of AI tools for academic purposes should constitute academic dishonesty is controversial. We demonstrate that human and AI-generated essays are similar in quality, but there is bias against presumed AI-generated essays. Faculty are not able to reliably differentiate human from AI-generated essays, thus bias may be misdirected. AI-tools are becoming ubiquitous and their use is not easily detected. Faculty must expect these tools to play increasing roles in medical education.