BackgroundNo systematic review and meta-analysis to date has examined multiple child and parent-reported social and physical quality of life (QoL) in pediatric populations affected by Hirschsprung’s disease (HD) and anorectal malformations (ARM). The objective of this systematic review is to quantitatively summarize the parent-reported and child-reported psychosocial and physical functioning scores of such children.MethodsRecords were sourced from the CENTRAL, EMBASE, and MEDLINE databases. Studies that reported child and parent reported QoL in children with HD and ARM, regardless of surgery intervention, versus children without HD and ARM, were included. The primary outcome was the psychosocial functioning scores, and the secondary outcomes were the presence of postoperative constipation, postoperative obstruction symptoms, fecal incontinence, and enterocolitis. A random effects meta-analysis was used.ResultsTwenty-three studies were included in the systematic review, with 11 studies included in the meta-analysis. Totally, 1678 total pediatric patients with HD and ARM underwent surgery vs 392 healthy controls. Pooled parent-reported standardized mean (SM) scores showed better social functioning after surgery (SM 91.79, 95% CI (80.3 to 103.3), I2=0). The pooled standardized mean difference (SMD) showed evidence for parent-reported incontinence but not for constipation in children with HD and ARM after surgery that had a lower mean QoL score compared with the normal population (SMD −1.24 (-1.79 to –0.69), I2=76% and SMD −0.45, 95% CI (−1.12 to 0.21), I2=75%). The pooled prevalence of child-reported constipation was 22% (95% CI (16% to 28%), I2=0%). The pooled prevalence of parent-reported postoperative obstruction symptoms was 61% (95% CI (41% to 81%), I2=41%).ConclusionThe results demonstrate better social functioning after surgery, lower QoL scores for incontinence versus controls, and remaining constipation and postoperative obstruction symptoms after surgery in children with HD and ARM.

ObjectiveOne option for the treatment of perforated appendicitis in pediatric patients is interval appendectomy (IA). A patient decision aid (PDA) can be useful in the decision-making process regarding IA. The purpose of this study was to evaluate parents’ decisional conflict before and after engaging with a developed PDA.MethodsParticipants included (a) parents who are considering IA surgery for their child, (b) have not yet had their follow-up appointment postdischarge, and (c) were fluent in either the official languages of English or French. This study used a pretest and post-test design to measure participants’ decisional conflict and treatment option choice. Perceptions and acceptability of the PDA were also assessed.ResultsA total of 18 participants completed the study (16 mothers). Major findings include significant decreases in all Decisional Conflict Scale items from pre-PDA to post-PDA engagement, except for one item. The majority of participants perceived the PDA to be useful, easy to find information regarding risks and provided enough information to help them make a decision regarding their child’s treatment.ConclusionsThis is the first study to develop and evaluate a PDA among parents who are making a decision regarding IA surgery. The results showed a significant decrease in decisional conflict after using the PDA. The results also showed that the PDA was generally accepted among parents and had positive perceptions regarding length, content, and balance. The use of PDA for this population can help ease feelings of decisional conflict and equip parents with the information to make informed decisions.

The value for ordering laboratory tests like CRP for appendicitis in children is debatable. The objective of this study was to determine the diagnostic utility of CRP, WBC, and NP to differentiate acute and perforated appendicitis. A retrospective cohort study of pediatric patients referred for appendicitis at CHEO from January 2016 to January 2019 was conducted. Comparisons of laboratory test results were made using the Wilcoxon rank sum test. ROC curves were used to examine diagnostic utility. One hundred and eighty (101 male) of 899 children with appendicitis had CRP, WBC, and NP levels available with a median age of 11.1 (8.1, 13.7) years. There were 93 (51.7%) patients with acute appendicitis and 87 (48.3%) were perforated. The median CRP level for patients with acute appendicitis was 20.3 (6.9, 38.3) versus 65.3 (48.7, 180.8) for perforated appendicitis (p <0.001). The area under the ROC curve for CRP was 85.1 % (95% C.I. 79.5-90.7), higher than that of WBC’s 68.1 % (95% C.I. 60.1- 76.1). Our study demonstrates that CRP can achieve good sensitivity without compromising specificity. These findings suggest that CRP performs better than WBC and NP in terms of discriminating between acute versus perforated appendicitis.