Clinical Focus

  • Pediatric Surgery
  • Pediatric Trauma
  • Chest Wall Deformities
  • Neonatal Surgery
  • Minimal Access Surgery
  • Adolescent Weight Management and Bariatric Surgery
  • Congenital Diaphragmatic Hernia
  • Pediatric Biliary Disease
  • Anorectal Malformations

Academic Appointments

Administrative Appointments

  • Program Director, Chest Wall Program, Stanford Children's Health (2016 - Present)
  • Trauma Medical Director, Lucile Packard Children's Hospital at Stanford (2017 - Present)
  • Course Director, Division of Pediatric Surgery Continuing Medical Education (2015 - Present)
  • Surgical Representative, LPCH Operating Room Local Improvement Team (LIT) (2013 - Present)
  • Resident Representative, Stanford Graduate Medical Education Committee (2008 - 2010)

Honors & Awards

  • Presidential Leadership Scholar, George W. Bush, Bill Clinton, George H.W. Bush, Lyndon B. Johnson Presidential Centers (2024)
  • Non-Accidental Trauma Award, AAP Section on Surgery (Oct 2020)
  • Asian Pacific American Heritage Month Honoree, NBC, Asian Americans for Community Involvement (AACI) (2019)
  • Best Abstract Award, IRCAD France - Research Institute against Digestive Cancer (2019)
  • Certificate of Recognition, California State Assembly (2019)
  • Certificate of Special Congressional Recognition, Office Congresswoman Anna Eschoo, CA 18th Congressional District (2019)
  • Coolest Tricks Award, International Pediatric Endosurgery Group (IPEG) (2019)
  • Hepatitis Testing Innovation Contest Commendation Award, European Association for the Study of the Liver(EASL)/World Health Organization (2016)
  • Lloyd Nyhus Travel Scholar, US International Surgical Society (2015)
  • Hilary Sanfey Outstanding Resident (awarded to most outstanding female surgery resident in the US), Association of Women Surgeons (2012)
  • Best Poster Presentation, SNMA Annual Medical Education Conference (2011)
  • Samuel L. Kountz Humanitarian Award, Stanford University (2009)
  • Residents in Radiology Executive Council Award (Outstanding Poster), American Roentgen Ray Society (2005)
  • Research Fellowship, University of California Dean's Research Grant (2003)
  • Research Scholarship, Child Neurology Foundation (2003)
  • Aces for Campus Excellence, Doublemint (2002)
  • Phi Beta Kappa, Phi Beta Kappa Society (2002)
  • Research fellowship, Howard Hughes Medical Institute Summer Research Fellowship (2001)

Boards, Advisory Committees, Professional Organizations

  • Member, American Association for the Surgery of Trauma (AAST) (2020 - Present)
  • Member, Pediatric Trauma Society (2016 - Present)
  • Fellow, American Academy of Pediatrics (2014 - Present)
  • Member, American Pediatric Surgical Association (2014 - Present)
  • Member, Association of Women Surgeons (2013 - Present)
  • Board of Directors, National Resident Matching Program (NRMP) (2010 - 2012)
  • Invited Consultant, World Health Organization (WHO), Western Pacific Region - Laos (2010 - 2010)
  • Advisory Committee, California Viral Hepatitis Clinical Task Force (2009 - Present)
  • Advisory Committee, Immunization Action Coalition – Birth Dose Project (2009 - Present)
  • Taskforce Member, National Hepatitis B Task Force (2009 - Present)
  • Advisory Committee, Viral Hepatitis and Liver Cancer Prevention Control Act 2009 (US Congressional Bill# H.R. 3974) (2009 - 2009)
  • Fellow, American College of Surgeons (2006 - Present)

Professional Education

  • Residency: Stanford University Dept of General Surgery (2013) CA
  • Fellowship: Stanford University Pediatric Surgery (2015) CA
  • Board Certification: American Board of Surgery, Pediatric Surgery (2016)
  • Board Certification: American Board of Surgery, General Surgery (2013)
  • Medical Education: University of California San Francisco (2006) CA

Community and International Work

  • Jade Ribbon Campaign, China, Vietnam, Laos, Korea, Philippines


    Hepatitis B and liver cancer control

    Partnering Organization(s)

    Asian Liver Center



    Ongoing Project


    Opportunities for Student Involvement


  • Hep B Moms, China, Vietnam, Laos, Korea, Philippines


    Reducing perinatal hepatitis B transmission

    Partnering Organization(s)

    Populations Served

    Women and children



    Ongoing Project


    Opportunities for Student Involvement


Current Research and Scholarly Interests

Dr. Chao's research focuses on preventing surgical diseases minimizing the traumatic impact of surgery. Dr. Chao serves as the Trauma Medical Director for Stanford Children's Health. Her research and interests include preventing childhood injury, the leading cause of death among children. Dr. Chao has a particular interest in preventing child abuse and its long-term consequences.

Dr. Chao is the Director of the Stanford Chest Wall Program. She is interested in studying new ways to treat and image patients with pectus excavatum and pectus carinatum.

Dr. Chao is also works closely with pediatric anesthesiologists to find ways to minimize anxiety and discomfort associated with surgery. This includes the use of virtual reality to decrease periprocedural anxiety.

Other research interests: pediatric surgery, neonatal surgery, congenital diaphragmatic hernia outcomes, pediatric obesity, minimal access surgery

Dr. Chao also works with the Asian Liver Center towards the global eradication of hepatitis B, the leading cause of liver cancer and liver disease globally. Dr. Chao helped launch the Jade Ribbon Campaign in 2001 to improve public and physician awareness about hepatitis B. Her work has been supported by the US Centers for Disease Control and the American Cancer Society. The Asian Liver Center also works in collaboration with the World Health Organization to improve screening and immunization strategies in Asia. For more information, visit: AND

Clinical Trials

  • Lap-assisted vs. US-Guided Visualization of TAP Blocks Not Recruiting

    Peripheral nerve blocks have been effective in decreasing post-operative pain as well as the use of narcotics for numerous years. Typically, these blocks are placed by anesthesiologist via ultrasound. In more recent years, surgeons have been placing nerve blocks laparoscopically. Since there are few studies that looks compare the two techniques we aim to perform a randomized control trial to demonstrate if a laparoscopic placed nerve block is as efficient and accurate as an ultrasound placed block.

    Stanford is currently not accepting patients for this trial. For more information, please contact Stephanie Chao, MD, (650) 723-6439.

    View full details

  • Longitudinal Virtual Reality Use in Pediatric Surgical Procedures Not Recruiting

    This study aims to investigate the use of virtual reality guided mindfulness meditation to reduce the pre and post-operative anxiety and pain of pediatric surgical patients.

    Stanford is currently not accepting patients for this trial. For more information, please contact John R Austin, MS, (949) 878-1438.

    View full details

  • Use of Virtual Reality for Pediatric Minor Surgical Procedures Not Recruiting

    This project is looking to use virtual reality for minor general surgery procedures in addition to local anesthesia instead of general anesthesia.

    Stanford is currently not accepting patients for this trial. For more information, please contact Stephanie D Chao, MD, 650-723-6439.

    View full details


  • Elucidating racial bias in the identification of child abuse


    Stanford, CA

  • Understanding the toll of pediatric firearms injuries


    Stanford, CA

  • Early screening of PTSD following injury during childhood


    Stanford, CA

  • Understanding the impact of medical comorbidities on child abuse incidence


    Stanford, CA

  • Pediatric Trauma Outcomes


    Stanford, CA

  • Chest Wall Deformities: 3D imaging


    Stanford, CA

  • Congenital Diaphragmatic Hernia - Predictors of Surgical Outcomes


    Stanford, CA

  • Evaluation of laparoscopic assisted TAP blocks


    Stanford, CA

  • The Jade Ribbon Campaign

    Global awareness campaign to end hepatitis B and liver cancer through collaboration, advocacy, research, and education


    Stanford, CA


2023-24 Courses

All Publications

  • The Sensitivity of Limited-Sequence MRI in Identifying Pediatric Cervical Spine Injury: A Western Pediatric Surgery Research Consortium Multicenter Retrospective Cohort Study. The journal of trauma and acute care surgery Melhado, C., Durand, R., Russell, K. W., Polukoff, N. E., Rampton, J., Iyer, R. R., Acker, S. N., Koehler, R., Prendergast, C., Stence, N., O'Neill, B., Padilla, B. E., Jamshidi, R., Vaughn, J. A., Ronecker, J. S., Selesner, L., Lofberg, K., Regner, M., Thiessen, J., Sayama, C., Spurrier, R. G., Ross, E. E., Liu, C. J., Chu, J., McNevin, K., Beni, C., Robinson, B. R., Linnau, K., Buckley, R. T., Chao, S. D., Sabapaty, A., Tong, E., Prolo, L. M., Ignacio, R., Floan Sachs, G., Kruk, P., Gonda, D., Ryan, M., Pandya, S., Koral, K., Braga, B. P., Auguste, K., Jensen, A. R. 2024


    Clinical clearance of a child's cervical spine after trauma is often challenging due to impaired mental status or an unreliable neurologic examination. Magnetic resonance imaging (MRI) is the gold standard for excluding ligamentous injury in children but is constrained by long image acquisition times and frequent need for anesthesia. Limited-sequence MRI (LSMRI) is used in evaluating the evolution of traumatic brain injury and may also be useful for cervical spine clearance while potentially avoiding the need for anesthesia. The purpose of this study was to assess the sensitivity and negative predictive value of LSMRI as compared to gold standard full-sequence MRI as a screening tool to rule out clinically significant ligamentous cervical spine injury.We conducted a ten-center, five-year retrospective cohort study (2017-2021) of all children (0-18y) with a cervical spine MRI after blunt trauma. MRI images were re-reviewed by a study pediatric radiologist at each site to determine if the presence of an injury could be identified on limited sequences alone. Unstable cervical spine injury was determined by study neurosurgeon review at each site.We identified 2,663 children less than 18 years of age who underwent an MRI of the cervical spine with 1,008 injuries detected on full-sequence studies. The sensitivity and negative predictive value of LSMRI were both >99% for detecting any injury and 100% for detecting any unstable injury. Young children (age < 5 years) were more likely to be electively intubated or sedated for cervical spine MRI.LSMRI is reliably detects clinically significant ligamentous injury in children after blunt trauma. To decrease anesthesia use and minimize MRI time, trauma centers should develop LSMRI screening protocols for children without a reliable neurologic exam.2 (Diagnostic Tests or Criteria).

    View details for DOI 10.1097/TA.0000000000004271

    View details for PubMedID 38523120

  • Decision-Making in Pleural Drainage Following Lung Resection in Children: A Western Pediatric Surgery Research Consortium Survey. Journal of pediatric surgery Schnuck, J. K., Acker, S. N., Kelley-Quon, L. I., Lee, J. H., Shew, S. B., Fialkowski, E., Ignacio, R. C., Melhado, C., Qureshi, F. G., Russell, K. W., Rothstein, D. H., Western Pediatric Surgery Research Consortium, Cairo, S., Chao, S. D., Fenton, S. J., Gollin, G., Jensen, A., Keane, O. A., Nicassio, L., Ochoa, B., Pandya, S., Patwardhan, U. M. 2024


    INTRODUCTION: Studies of adults undergoing lung resection indicated that selective omission of pleural drains is safe and advantageous. Significant practice variation exists for pleural drainage practices for children undergoing lung resection. We surveyed pediatric surgeons in a 10-hospital research consortium to understand decision-making for placement of pleural drains following lung resection in children.METHODS: Faculty surgeons at the 10 member institutions of the Western Pediatric Surgery Research Consortium completed questionnaires using a REDCap survey platform. Descriptive statistics and bivariate analyses were used to characterize responses regarding indications and management of pleural drains following lung resection in pediatric patients.RESULTS: We received 96 responses from 109 surgeons (88%). Most surgeons agreed that use of a pleural drain after lung resection contributes to post-operative pain, increases narcotic use, and prolongs hospitalization. Opinions varied around the immediate use of suction compared to water seal, and half routinely completed a water seal trial prior to drain removal. Surgeons who completed fellowship within the past 10 years left a pleural drain after wedge resection in 45% of cases versus 78% in those who completed fellowship more than 10 years ago (p=0.001). The mean acceptable rate of unplanned post-operative pleural drain placement when pleural drainage was omitted at index operation was 6.3% (±4.6%).CONCLUSIONS: Most pediatric surgeons use pleural drainage following lung resection, with recent fellowship graduates more often omitting it. Future studies of pleural drain omission demonstrating low rates of unplanned postoperative pleural drain placement may motivate practice changes for children undergoing lung resection.LEVEL OF EVIDENCE: V.

    View details for DOI 10.1016/j.jpedsurg.2024.01.006

    View details for PubMedID 38355336

  • Let Kids Play: Using Virtual Reality as a Substitute for General Anesthesia for Minor Procedures in Pediatric Population. Journal of pediatric surgery Salimi-Jazi, F., Sabapaty, A., Santos Dalusag, K., Abrajano, C., Nguyen, J., Robinson, B., Caruso, T. J., Rodriguez, S., Hartman, G., Chao, S. D. 2024


    In the pediatric population, virtual reality (VR) has been used as an adjunct to augment analgesia and reduce the need for opioids. In this study, we review our experience using VR in lieu of anesthesia or sedation to enable minor procedures in children.A retrospective chart review study was performed on patients who presented to our institution from 2019 to 2022 for hormone implant placement, exchange, or removal with VR distraction. Demographic and procedure information was recorded. The primary outcome was successful procedure completion without requiring pharmacologic sedation or analgesia.A total of 111 patients underwent the following minor procedures with VR and without anesthesia or sedation. Fourteen patients had multiple encounters resulting in a total of 126 encounters. The median age was 11 [6] years. 43 patients were female, 23 were female to male, 6 were non-binary, 7 were male, and 32 were male to female. 58 % had private insurance. Most common diagnosis was precocious puberty (54 %) followed by gender dysphoria (46 %). Most common procedure was implant placement (72 %). 69 % of procedures were performed in the clinic and 31 % in the OR. All procedures were completed without requiring the administration of additional sedation or anesthesia. None of the patients required intravenous catheter placement for the procedure. No intra-procedural complications were recorded.VR is a feasible option that can spare children from sedation or general anesthesia for minor procedures. VR may enable minor procedures in children to be successfully performed in clinic setting.

    View details for DOI 10.1016/j.jpedsurg.2024.01.002

    View details for PubMedID 38307749

  • A multicenter evaluation of pediatric emergency department injury visits during the COVID-19 pandemic. Injury epidemiology Hanson, H. R., Formica, M., Laraque-Arena, D., Zonfrillo, M. R., Desai, P., O'Neil, J. O., Unni, P., Johnson, E. L., Cobb, P., Agarwal, M., Beckworth, K., Schroter, S., Strotmeyer, S., Donnelly, K. A., Middelberg, L. K., Morse, A. M., Dodington, J., Latuska, R. F., Anderson, B., Lawson, K. A., Valente, M., Levas, M. N., Kiragu, A. W., Monroe, K., Ruest, S. M., Lee, L. K., Charyk Stewart, T., Attridge, M. M., Haasz, M., Jafri, M., McIntire, A., Rogers, S. C., Uspal, N. G., Blanchard, A., Hazeltine, M. D., Riech, T., Jennissen, C., Model, L., Fu, Q., Clukies, L. D., Juang, D., Ruda, M. T., Prince, J. M., Chao, S., Yorkgitis, B. K., Pomerantz, W. J. 2023; 10 (1): 66


    BACKGROUND: Injuries, the leading cause of death in children 1-17years old, are often preventable. Injury patterns are impacted by changes in the child's environment, shifts in supervision, and caregiver stressors. The objective of this study was to evaluate the incidence and proportion of injuries, mechanisms, and severity seen in Pediatric Emergency Departments (PEDs) during the COVID-19 pandemic.METHODS: This multicenter, cross-sectional study from January 2019 through December 2020 examined visits to 40 PEDs for children<18years old. Injury was defined by at least one International Classification of Disease-10th revision (ICD-10) code for bodily injury (S00-T78). The main study outcomes were total and proportion of PED injury-related visits compared to all visits in March through December 2020 and to the same months in 2019. Weekly injury visits as a percentage of total PED visits were calculated for all weeks between January 2019 and December 2020.RESULTS: The study included 741,418 PED visits for injuries pre-COVID-19 pandemic (2019) and during the COVID-19 pandemic (2020). Overall PED visits from all causes decreased 27.4% in March to December 2020 compared to the same time frame in 2019; however, the proportion of injury-related PED visits in 2020 increased by 37.7%. In 2020, injured children were younger (median age 6.31years vs 7.31 in 2019), more commonly White (54% vs 50%, p<0.001), non-Hispanic (72% vs 69%, p<0.001) and had private insurance (35% vs 32%, p<0.001). Injury hospitalizations increased 2.2% (p<0.001) and deaths increased 0.03% (p<0.001) in 2020 compared to 2019. Mean injury severity score increased (2.2 to 2.4, p<0.001) between 2019 and 2020. Injuries declined for struck by/against (-4.9%) and overexertion (-1.2%) mechanisms. Injuries proportionally increased for pedal cycles (2.8%), cut/pierce (1.5%), motor vehicle occupant (0.9%), other transportation (0.6%), fire/burn (0.5%) and firearms (0.3%) compared to all injuries in 2020 versus 2019.CONCLUSIONS: The proportion of PED injury-related visits in March through December 2020 increased compared to the same months in 2019. Racial and payor differences were noted. Mechanisms of injury seen in the PED during 2020 changed compared to 2019, and this can inform injury prevention initiatives.

    View details for DOI 10.1186/s40621-023-00476-z

    View details for PubMedID 38093383

  • Structural Sequelae of the COVID Pandemic: The Youth Mental Health Crisis. Pediatrics Narayan, A., Chao, S. D. 2023


    A year ago, 17-year-old "Alex" was brought into the emergency department after a self-inflicted gunshot wound. Neither his primary care doctor nor his psychologist were aware of his first attempt 6 months previously. Unfortunately, this attempt was successful. It occurred in front of his home, and in front of his mother who was just seconds too late to stop him. In the aftermath, we wondered why the medical system that he had access to could not intervene in time.

    View details for DOI 10.1542/peds.2023-062963

    View details for PubMedID 38050425

  • Cervical Collar-Associated Pressure Injury in Pediatric Trauma Patients: A Western Pediatric Surgery Research Consortium Study. Journal of pediatric surgery Melhado, C., Russell, K. W., Acker, S. N., Padilla, B. E., Lofberg, K., Spurrier, R. G., Robinson, B., Chao, S., Ignacio, R. C., Ryan, M., Jensen, A. R. 2023


    Healthcare-associated pressure injuries (HAPI) are known to be associated with medical devices and are preventable. Cervical spine immobilization is commonly utilized in injured children prior to clinical clearance or for treatment of an unstable cervical spinal injury. The frequency of HAPI has been quantified in adults with cervical spine immobilization but has not been well-described in children. The aim of this study was to describe characteristics of children who developed HAPI associated with cervical immobilization.We analyzed a retrospective cohort of children (0-18 years) who developed a stage two or greater cervical HAPI. This cohort was drawn from an overall sample of 49,218 registry patients treated over a five-year period (2017-2021) at ten pediatric trauma centers. Patient demographics, injury characteristics, and cervical immobilization were tabulated to describe the population.The cohort included 32 children with stage two or greater cervical HAPI. The median age was 5 years (IQR 2-13) and 78% (n = 25) were admitted to the intensive care unit. The median (IQR) time to diagnosis of HAPI was 11 (7-21) days post-injury. The majority of cervical HAPI (78%, 25/32) occurred in children requiring immobilization for cervical injuries, with only four children developing HAPI after wearing a prophylactic cervical collar in the absence of a cervical spine injury.Advanced-stage HAPI associated with cervical collar use in pediatric trauma patients is rare and usually occurs in patients with cervical spine injuries requiring immobilization for treatment. More expedient cervical spine clearance with MRI is unlikely to substantially reduce cervical HAPI in injured children.Level III (Epidemiologic and Prognostic).

    View details for DOI 10.1016/j.jpedsurg.2023.10.021

    View details for PubMedID 38030530

  • SCAN for Abuse: Electronic Health Record-Based Universal Child Abuse Screening. Journal of pediatric surgery Martin, N. R., Claypool, A. L., Diyaolu, M., Chan, K. S., A'Neals, E., Iyer, K., Stewart, C. C., Egge, M., Bernacki, K., Hallinan, M., Zuo, L., Gupta, U., Naru, N., Scheinker, D., Morris, A. M., Brandeau, M. L., Chao, S. 2023


    Identification of physical abuse at the point of care without a systematic approach remains inherently subjective and prone to judgement error. This study examines the implementation of an electronic health record (EHR)-based universal child injury screen (CIS) to improve detection rates of child abuse.CIS was implemented in the EHR admission documentation for all patients age 5 or younger at a single medical center, with the following questions. 1) "Is this patient an injured/trauma patient?" 2) "If this is a trauma/injured patient, where did the injury occur?" A "Yes" response to Question 1 would alert a team of child abuse pediatricians and social workers to determine if a patient required formal child abuse clinical evaluation. Patients who received positive CIS responses, formal child abuse work-up, and/or reports to Child Protective Services (CPS) were reviewed for analysis. CPS rates from historical controls (2017-2018) were compared to post-implementation rates (2019-2021).Between 2019 and 2021, 14,150 patients were screened with CIS. 286 (2.0 %) patients screened received positive CIS responses. 166 (58.0 %) of these patients with positive CIS responses would not have otherwise been identified for child abuse evaluation by their treating teams. 18 (10.8 %) of the patients identified by the CIS and not by the treating team were later reported to CPS. Facility CPS reporting rates for physical abuse were 1.2 per 1000 admitted children age 5 or younger (pre-intervention) versus 4.2 per 1000 (post-intervention).Introduction of CIS led to increased detection suspected child abuse among children age 5 or younger.Level II.Study of Diagnostic Test.

    View details for DOI 10.1016/j.jpedsurg.2023.10.025

    View details for PubMedID 37953157

  • Outcomes of Extracorporeal Life Support Utilization for Pediatric Patients With COVID-19 Infections. ASAIO journal (American Society for Artificial Internal Organs : 1992) Jacobson, J. C., Ryan, M. L., Vogel, A. M., Mehl, S. C., Acker, S. N., Prendergast, C., Padilla, B. E., Lee, J., Chao, S. D., Martin, N. R., Russell, K. W., Larsen, K., Harting, M. T., Linden, A. F., Ignacio, R. C., Slater, B. J., Juang, D., Jensen, A. R., Melhado, C. G., Pelayo, J. C., Zhong, A., Spencer, B. L., Gadepalli, S. K., Maamari, M., Jimenez Valencia, M., Qureshi, F. G., Pandya, S. R. 2023


    Outcomes of pediatric patients who received extracorporeal life support (ECLS) for COVID-19 remain poorly described. The aim of this multi-institutional retrospective observational study was to evaluate these outcomes and assess for prognostic factors associated with in-hospital mortality. Seventy-nine patients at 14 pediatric centers across the United States who received ECLS support for COVID-19 infections between January 2020 and July 2022 were included for analysis. Data were extracted from the electronic medical record. The median age was 14.5 years (interquartile range [IQR]: 2-17 years). Most patients were female (54.4%) and had at least one pre-existing comorbidity (84.8%), such as obesity (44.3%, median body mass index percentile: 97% [IQR: 67.5-99.0%]). Venovenous (VV) ECLS was initiated in 50.6% of patients. Median duration of ECLS was 12 days (IQR: 6.0-22.5 days) with a mean duration from admission to ECLS initiation of 5.2±6.3 days. Survival to hospital discharge was 54.4%. Neurological deficits were reported in 16.3% of survivors. Nonsurvivors were of older age (13.3±6.2 years vs. 9.3±7.7 years, p=0.012), more likely to receive renal replacement therapy (63.9% vs. 30.2%, p=0.003), demonstrated longer durations from admission to ECLS initiation (7.0±8.1 days vs. 3.7±3.8 days, p=0.030), and had higher rates of ECLS-related complications (91.7% vs. 69.8%, p=0.016) than survivors. Pediatric patients with COVID-19 who received ECLS demonstrated substantial morbidity and further investigation is warranted to optimize management strategies.

    View details for DOI 10.1097/MAT.0000000000002059

    View details for PubMedID 37816012

  • Complications Associated with Subsequent Vascular Access in Pediatric ECMO Patients. Journal of pediatric surgery Chan, K. S., Martin, N., Rafeeqi, T., Salimi-Jazi, F., Chao, S. 2023


    Following ECMO decannulation, intensivists and surgeons must consider whether to reuse the cannulation site for central venous catheters (CVC) or seek remote access. This study investigates the risk of infectious complication associated with the reuse of peripheral ECMO cannulation sites for subsequent central venous access.A retrospective review was conducted for patients aged 0-18 years, who underwent peripheral ECMO cannulation between 2009 and 2021 at a single children's hospital.Of the 227 charts reviewed, after ECMO decannulation, 53 patients received a CVC at the same location, 25 received a CVC at a different location, 62 received a peripherally inserted central catheter (PICC), and 87 had no subsequent vascular access placed within 30 days of decannulation. Patients with secondary access placed at the same site experienced 1 CLABSI, or 0.94 CLABSIs per 1000 line days. Patients with PICC lines after ECMO decannulation had 1 CLABSI, or 0.43 CLABSIs per 1000 line days. In comparison, the institution's hospital-wide CLABSI rate was 1.46 per 1000 line days during this same period. Although the rate of CLABSI among patients with secondary access at the site of decannulation was higher than the rate among patients with PICC lines (p = 0.79) it was lower than the institutional rate (p = 0.54), these differences did not rise to the level of statistical significance.Compared with ECMO patients with subsequent CVCs placed at an alternative access site or via PICC after decannulation, patients with contemporaneous CVC placement at the site of decannulation do not experience a significantly higher rate of CLABSIs.Level III.Retrospective comparative study.

    View details for DOI 10.1016/j.jpedsurg.2023.07.013

    View details for PubMedID 37599195

  • Parental Health Mindset is Related to Preoperative Perceptions of Chest Wall Anomalies. The Journal of surgical research Chao, S., Mu, Q. S., Austin, J., Mueller, C. M. 2023; 284: 318-321


    INTRODUCTION: Mindsets of health have been linked to different outcomes for patients with both surgical and medical conditions. A "growth" mindset, in which health is defined as malleable and subject to improvement, is associated with improved attitudes and outcomes when compared to a "fixed" mindset, in which health is defined as unchangeable. In pediatric surgery, parental growth mindsets of health have been correlated with better postoperative outcomes, including lower scores of anxiety and pain perceptions, for children. This was particularly notable in a study of postoperative outcomes for patients with pectus excavatum. In our current study, we extend our investigations to explore how health mindsets are associated with perceptions of chest wall anomalies before correction is undertaken.METHODS: Seventy-six patients (71 males, mean age 14y, and 43 excavatum) and 18 parents were surveyed during a routine chest wall clinic visit. Demographic and clinical information as well as the Health Mindset Scale and Pectus Excavatum Evaluation Questionnaire were administered and collected pretreatment.RESULTS: Parental mindsets of health were significantly correlated with parent assessments of their children's chest pain, physical activity, and concerns about the life-time effect of the condition. A parental growth mindset was linked to lower scores of chest pain, higher ratings of activity, and lower overall level of concern. Furthermore, parental health mindsets also significantly correlated with children's own perceptions of their chest pain, physical activity, shortness of breath, and fatigue. Growth mindsetalso was linked to more positive ratings.CONCLUSIONS: Parental growth mindset was associated with more positive assessments of children's symptoms and limitations due to pectus deformities than fixed mindsets. Health mindset has been linked to patient perceptions of, and outcomes for, diabetes, renal disease, allergies, scoliosis, and obesity. Further study into parental and patient mindset correlation may help elucidate factors for bracing compliance, and perhaps to better prepare children and parents for corrective surgical procedures.

    View details for DOI 10.1016/j.jss.2022.11.046

    View details for PubMedID 36641946

  • Disparities in detection of suspected child abuse. Journal of pediatric surgery Diyaolu, M., Ye, C., Huang, Z., Han, R., Wild, H., Tennakoon, L., Spain, D. A., Chao, S. D. 2022


    BACKGROUND: Child abuse is a significant cause of injury and death among children, but accurate identification is often challenging. This study aims to assess whether racial disparities exist in the identification of child abuse.METHODS: The 2010-2014 and 2016-2017 National Trauma Data Bank was queried for trauma patients ages 1-17. Using ICD-9CM and ICD-10CM codes, children with injuries consistent with child abuse were identified and analyzed by race.RESULTS: Between 2010-2014 and 2016-2017, 798,353 patients were included in NTDB. Suspected child abuse victims (SCA) accounted for 7903 (1%) patients. Of these, 51% were White, 33% Black, 1% Asian, 0.3% Native Hawaiian/Other Pacific Islander, 2% American Indian, and 12% other race. Black patients were disproportionately overrepresented, composing 12% of the US population, but 33% of SCA patients (p<0.001). Although White SCA patients were more severely injured (ISS 16-24: 20% vs 16%, p<0.01) and had higher in-hospital mortality (9% vs. 6%, p=0.01), Black SCA patients were hospitalized longer (7.2±31.4vs. 6.2±9.9 days, p<0.01) despite controlling for ISS (1-15: 4. 5.7±35.7vs. 4.2±6.2 days, p<0.01). In multivariate regression, Black children continued to have longer lengths of stay despite controlling for ISS and insurance type.CONCLUSIONS: Utilizing a nationally representative dataset, Black children were disproportionately identified as potential victims of abuse. They were also subjected to longer hospitalizations, despite milder injuries. Further studies are needed to better understand the etiology of the observed trends and whether they reflect potential underlying unconscious or conscious biases of mandated reporters.TYPE OF STUDY: Treatment study.LEVEL OF EVIDENCE: III.

    View details for DOI 10.1016/j.jpedsurg.2022.10.039

    View details for PubMedID 36404182

  • Trends in Adolescent Bariatric Procedures: a 15-Year Analysis of the National Inpatient Survey. Obesity surgery Salimi-Jazi, F., Chkhikvadze, T., Shi, J., Pourmehdi-Lahiji, A., Moshksar, A., Rafeeqi, T. A., Pratt, J., Bruzoni, M., Chao, S. 2022


    BACKGROUND: Adolescents with severe obesity achieve superior health outcomes following metabolic and bariatric surgery (MBS) than medical treatment alone. Surgery results in significant and sustained decrease in BMI and reduces associated comorbidity. We characterized the changing demographics of adolescents who had MBS over a 15-year time period.METHODS: Using ICD-9 and ICD-10 codes, the 2005-2019 National Inpatient Sample database was queried for patients<20years who underwent MBS. National trends, socio-demographics, and hospital resource utilization were analyzed.RESULTS: Between 2005 and 2019, there were 16,381 pediatric hospitalizations for MBS. The annual MBS procedures increased from 839 cases in 2005 to 1785 in 2019. There was a significant shift away from laparoscopic gastric bypass (LGB) to sleeve gastrectomy (SG). Initially, LGB represented 67% of cases with no SG. In 2019, SG constituted 85% of MBS procedures, while LGB comprised only 14%. Patients were predominantly female (76%) and White (56%). Over time, there were considerable increases in patients with public insurance (12 to 46%) and Hispanics (11 to 30%). There was also a shift away from urban, non-teaching hospitals to urban, teaching hospitals. The average length of stay (LOS) decreased, while mean charges remained similar.CONCLUSION: Our study demonstrates a gradual increase in the utilization of MBS among adolescents and a significant shift to SG. We observed a shift in MBS cases to teaching institutions, along with an increase in Hispanics and patients with public insurance. However, MBS remains underutilized, and effort should be made to increase early referral of adolescents for MBS evaluation.

    View details for DOI 10.1007/s11695-022-06265-9

    View details for PubMedID 36103080

  • Burden of pilonidal disease and improvement in quality of life after treatment in adolescents. Pediatric surgery international Salimi-Jazi, F., Abrajano, C., Garza, D., Rafeeqi, T., Yousefi, R., Hartman, E., Hah, K., Wilcox, M., Diyaolu, M., Chao, S., Su, W., Hui, T., Mueller, C., Fuchs, J., Chiu, B. 2022


    PURPOSE: Pilonidal Disease (PD) affects adolescents in different aspects. We hypothesized that patients with different gender, ethnicity, and age have different quality of life (QOL) measurements which could improve with minimally invasive treatment (MIT).METHODS: 131 PD patients underwent MIT (laser epilation±trephination) from 2019 to 2021. Patients' demographics were recorded. Before and after MIT, patients received QOL questionnaire consisting of four categories: daily activities, sports participation, school/work attendance, and socializing. Data were analyzed using Student and multivariate t test. P<0.05 was considered statistically significant.RESULTS: 101 (51 male, 50 female) patients were included. 30 patients with incomplete data were excluded. 54% of patients were<18years old. 47.5% were Hispanic. Median symptom duration prior to presentation was 5.4 (1.3-15) months. Prior to MIT, patients' ability to perform daily activities, participate in sports, attend school/work, and socialize was moderately or severely impacted in 66%, 57%, 45%, and 23% of respondents, respectively; after MIT, only 7%, 8%, 2%, and 4% were affected (p<0.01). Recurrence rate was 6%. Pre-MIT, older patients and non-Hispanics reported worse impact on their QOL. Symptom duration or PD recurrence did not correlate with patient's pre- or post-MIT QOL.CONCLUSION: Patients' ethnicity and age impacted QOL in PD. All patients' QOL significantly improved with MIT. Considering the importance of socializing, playing sports, and school/work attendance in adolescents, our study highlights importance of early treatment of PD.

    View details for DOI 10.1007/s00383-022-05175-2

    View details for PubMedID 35842877

  • Adoption of a standardized treatment protocol for pilonidal disease leads to low recurrence. Journal of pediatric surgery Rafeeqi, T., Abrajano, C., Salimi-Jazi, F., Garza, D., Hartman, E., Hah, K., Wilcox, M., Diyaolu, M., Chao, S., Su, W., Hui, T., Mueller, C., Fuchs, J., Chiu, B. 2022


    BACKGROUND: Pilonidal disease may present as acute abscesses or chronic draining sinuses. There is no standardized treatment and recurrence rates can be as high as 30%. Within our five-hospital network we have established a standardized treatment protocol including minimally invasive surgical trephination and aggressive epilation. We hypothesize that such a treatment protocol can be established across different hospital settings and lead to low overall recurrence.METHODS: Patients with pilonidal disease were enrolled in the study on presentation to our hospital network. Those that underwent initial surgery outside our hospital system or were noncompliant with our treatment protocol were excluded. Patients were grouped based on surgeon and treating facility. Frequency of recurrence per surgeon and per hospital was calculated and compared.RESULTS: Out of 132 patients, 80 patients were included (45 female, 35 male) while 52 were excluded because of initial surgery at a non-network hospital or for protocol noncompliance. Median age was 17 (16-19) years and median length of follow-up was 352 (261-496) days. There were 6 patients who experienced at least one recurrence. There was an overall 8% recurrence rate with no significant difference noted between surgeons or hospitals (p=0.15, p=0.64, respectively).CONCLUSIONS: We have successfully implemented a standardized treatment protocol for pilonidal disease across different hospital settings and by different surgeons, with an overall low recurrence rate. Our findings suggest that adoption of a standardized protocol for treatment of pilonidal disease can lead to low recurrence.LEVEL OF EVIDENCE: Level IV.

    View details for DOI 10.1016/j.jpedsurg.2022.06.014

    View details for PubMedID 35868880

  • Unintended Consequences of COVID-19 on Pediatric Falls From Windows: A Multicenter Study. The Journal of surgical research Theodorou, C. M., Brown, E. G., Jackson, J. E., Castle, S. L., Chao, S. D., Beres, A. L. 2022; 279: 187-192


    INTRODUCTION: In attempts to quell the spread of COVID-19, shelter-in-place orders were employed in most states. Increased time at home, in combination with parents potentially balancing childcare and work-from-home duties, may have had unintended consequences on pediatric falls from windows. We aimed to investigate rates of falls from windows among children during the first 6mo of the COVID-19 pandemic.METHODS: Patients <18y old admitted to three pediatric trauma centers (two - level 1, one - level 2) between 3/19/20 and 9/19/20 (COVID-era) were compared to a pre-COVID cohort (3/19/19 to 9/19/19). The primary outcome was the rate of falls from windows. Secondary outcomes included injury severity score (ISS), injuries sustained, and mortality.RESULTS: Of 1011 total COVID-era pediatric trauma patients, 36 (3.6%) sustained falls from windows compared to 23 of 1108 (2.1%) pre-COVID era patients (OR 1.7, P=0.05). The median ISS was seven pre-COVID versus four COVID-era (P=0.43). The most common injuries sustained were skull fractures (30.5%), extremity injuries (30.5%), and intracranial hemorrhage (23.7%). One-fifth of patients underwent surgery (21.7% pre-COVID versus 19.4% COVID-era, P=1.0). There was one mortality in the COVID-era cohort and none in the pre-COVID cohort (P=1.0).CONCLUSIONS: Despite overall fewer trauma admissions during the first 6mo of the COVID-19 pandemic, the rate of falls from windows nearly doubled compared to the prior year, with substantial associated morbidity. These findings suggest a potential unintended consequence of shelter-in-place orders and support increased education on home safety and increased support for parents potentially juggling multiple responsibilities in the home.

    View details for DOI 10.1016/j.jss.2022.05.022

    View details for PubMedID 35779448

  • Ultrasound Verification of Laparoscopic-Assisted Transversus Abdominis Plane Blocks in Children Undergoing Laparoscopic Procedures. Journal of laparoendoscopic & advanced surgical techniques. Part A Taylor, J. S., Ramamurthi, R. J., Austin, J., Gibson, M., Diyaolu, M., Munshey, F., McFadyen, G., Tsui, B., Chao, S. D. 1800


    Purpose: Ultrasound-guided transversus abdominis plane (TAP) blocks have been demonstrated to decrease postoperative pain; however, laparoscopic-assisted TAP (L-TAP) blocks have not been well studied in children. Our study utilized intraoperative ultrasound to verify whether surgeon-administered blocks using only laparoscopic visualization were reliably delivered into the correct plane. Materials and Methods: Patients undergoing laparoscopic procedures were enrolled to receive L-TAP blocks. Preblock and postblock ultrasounds were performed to document the plane of local anesthetic delivery. Ultrasound images were reviewed by two blinded anesthesiologists to determine whether the L-TAP block was administered into the desired plane. Results: Fifty-one patients were enrolled. The average age was 5.9 years (range: 2 days to 17 years) and the mean weight was 25.4kg (range: 2.64-118.8kg). The most common procedures were inguinal hernia repair (n=19), appendectomy (n=10), and gastrostomy-tube placements (n=13). Nine surgeons performed 93L-TAP blocks (average: 10.3 blocks/surgeon). Ultrasound confirmed distribution in the correct plane in 53.5/93 blocks (57.5%; 58.0% for attending surgeons), with 77.4% concurrence between the anesthesiologist reviewers. Conclusion: L-TAP achieves delivery of local anesthetic into the correct tissue plane in over half the cases with minimal training. Further studies are needed to examine the effect of L-TAP blocks on reducing postoperative pain in pediatric patients.

    View details for DOI 10.1089/lap.2020.0994

    View details for PubMedID 34962162

  • Relationship Between Comorbidities and Child Abuse: A National Trauma Data Bank Study Diyaolu, M., Ye, C., Chao, S. D. ELSEVIER SCIENCE INC. 2021: S190
  • Child physical abuse and COVID-19: Trends from nine pediatric trauma centers. Journal of pediatric surgery Russell, K. W., Acker, S. N., Ignacio, R. C., Lofberg, K. M., Garvey, E. M., Chao, S. D., Bliss, D. W., Smith, C. A., Nehra, D., Anderson, M. L., Bunnell, B. L., Shahi, N., Perry, J. M., Evans, L. L., Kwong, J. Z., Tobias, J., Rohan, A., Pickett, K. L., Kaar, J. L., Kastenberg, Z. J., Laskey, A. L., Scaife, E. R., Jensen, A. R. 2021


    BACKGROUND: Economic, social, and psychologic stressors are associated with an increased risk for abusive injuries in children. Prolonged physical proximity between adults and children under conditions of severe external stress, such as witnessed during the COVID-19 pandemic with "shelter-in-place orders", may be associated with additional increased risk for child physical abuse. We hypothesized that child physical abuse rates and associated severity of injury would increase during the early months of the pandemic as compared to the prior benchmark period.METHODS: We conducted a nine-center retrospective review of suspected child physical abuse admissions across the Western Pediatric Surgery Research Consortium. Cases were identified for the period of April 1-June 30, 2020 (COVID-19) and compared to the identical period in 2019. We collected patient demographics, injury characteristics, and outcome data.RESULTS: There were no significant differences in child physical abuse cases between the time periods in the consortium as a whole or at individual hospitals. There were no differences between the study periods with regard to patient characteristics, injury types or severity, resource utilization, disposition, or mortality.CONCLUSIONS: Apparent rates of new injuries related to child physical abuse did not increase early in the COVID-19 pandemic. While this may suggest that pediatric physical abuse was not impacted by pandemic restrictions and stresses, it is possible that under-reporting, under-detection, or delays in presentation of abusive injuries increased during the pandemic. Long-term follow-up of subsequent rates and severity of child abuse is needed to assess for unrecognized injuries that may have occurred.

    View details for DOI 10.1016/j.jpedsurg.2021.09.050

    View details for PubMedID 34758909

  • Mental health outcomes in pediatric trauma patients: A 10 year real world analysis using a large database approach. Journal of pediatric surgery Chandler, J. M., Chan, K. S., Han, R., Chao, S. D. 2021


    INTRODUCTION: Traumatic injury is the leading cause of morbidity and mortality among children in the United States. Single institution studies suggest an increased risk of poor mental health outcomes among these patients, but there are few population-based studies assessing this risk.METHODS: The IBMⓇ MarketScanⓇ private insurance claims database was used to identify children (6-17yo) with traumatic injuries between 2007 and 2016. Time-to-event analysis was performed to compare rates of PTSD, depression, anxiety, and adjustment disorder among children admitted to the hospital compared to children treated in the emergency department (ED), urgent care (UC), or in the outpatient setting, and to children admitted with uncomplicated appendicitis.RESULTS: Among children admitted for traumatic injury, 3.3% developed a subsequent mental health diagnosis, and 1.6% developed PTSD. Children admitted for traumatic injury were at increased risk of developing a mental health condition (HR 1.34, p<0.001) compared to those admitted for appendicitis. Children treated in the ED or UC for traumatic injury and those treated in the outpatient setting were also at increased risk (HR 1.20 and 1.18, p=0.006 and p=0.012, respectively). Among those admitted to the hospital, the risk of subsequent mental health diagnosis increased by 1.5% per day; in the first 31 days of hospitalization, the risk of PTSD diagnosis increased by 13% per day.CONCLUSION: Children who sustain a traumatic injury are at increased risk of developing a mental health condition. PTSD rates found in our real world analysis are lower than those found in prospective studies, raising the possibility of under-recognition of PTSD in this population.LEVEL OF EVIDENCE: Level II.

    View details for DOI 10.1016/j.jpedsurg.2021.09.049

    View details for PubMedID 34772514

  • Epidemiology of pediatric trauma during the COVID-19 pandemic shelter in place. Surgery open science Bessoff, K. E., Han, R. W., Cho, M., Stroud, M., Urrechaga, E. M., Thorson, C. M., Russell, K. W., Rohan, A., Acker, S. N., Swain, S., Malvezzi, L., Fuchs, J. R., Chao, S. D. 2021; 6: 5-9


    Introduction: The first COVID-19 cases occurred in the US in January of 2020, leading to the implementation of shelter in place. This study seeks to define the impact of shelter in place on the epidemiology of pediatric trauma.Methods: We examined pediatric trauma admissions at 5 Level 1 and 1 Level 2 US pediatric trauma centers between January 1 and June 30, 2017-2020. Demographic and injury data were compared between pre- and post-shelter in place patient cohorts.Results: A total of 8772 pediatric trauma activations were reviewed. There was a 13% decrease in trauma volume in 2020, with a nadir at 16 days following implementation of shelter in place. Injury severity scores were higher in the post-shelter in place cohort. The incidence of nonmotorized vehicle accidents and gunshot wounds increased in the post-shelter in place cohort.Conclusion: We found an overall decrease in pediatric trauma volume following shelter in place. However, injuries tended to be more severe. Our findings help inform targeted injury prevention campaigns during future pandemics.

    View details for DOI 10.1016/j.sopen.2021.06.001

    View details for PubMedID 34308327

  • Commentary: Lighting the way forward for clinical decision making in pectus excavatum. Seminars in thoracic and cardiovascular surgery Chao, S. D. 2021

    View details for DOI 10.1053/j.semtcvs.2021.08.021

    View details for PubMedID 34481046

  • Small surgeries, big smiles: using virtual reality to reduce the need for sedation or general anesthesia during minor surgical procedures. Pediatric surgery international Taylor, J. S., Chandler, J. M., Menendez, M., Diyaolu, M., Austin, J. R., Gibson, M. L., Portelli, K. I., Caruso, T. J., Rodriguez, S., Chao, S. D. 2021


    PURPOSE: Children often require anesthesia for simple diagnostic and therapeutic procedures. The aim of this study was to evaluate the feasibility of using virtual reality (VR) to reduce sedation in children undergoing minor surgical procedures.METHOD: In this prospective, non-randomized clinical trial, pediatric patients at a free-standing children's hospital undergoing hormone implant placement, removal, or exchange were recruited to use VR and local anesthesia instead of procedural sedation or general anesthesia (GA). Patients were enrolled between November 2017 and March 2020, and were compared to historic controls who underwent similar procedures without VR between April 2016 and February 2020. Primary outcome measure was successful procedure completion without sedation or GA. Secondary measures included assessments of pain, fear and anxiety, patient compliance, procedural and recovery times.RESULTS: Twenty-eight patients underwent 29 procedures with VR. Hormone implants (72%), removals (7%), or exchanges (21%) were completed without GA, sedation or IV placement. Procedure lengths and pain scores were similar between VR patients and historic controls, but recovery times were significantly shorter in VR patients (18 vs 65min, p<0.001). Participant satisfaction scores were high, with 95% recommending VR to others.CONCLUSIONS: VR is a feasible alternative to sedation or GA for select pediatric patients undergoing minor surgical procedures.

    View details for DOI 10.1007/s00383-021-04955-6

    View details for PubMedID 34269867

  • Re: JSLS. 2020;24(3);e2020.00032. DOI: 10.4293/JSLS.2020.00032. Laparoscopic Posterior versus Lateral Transversus Abdominis Plane Block in Gynecology. JSLS : Journal of the Society of Laparoendoscopic Surgeons Austin, J. R., Chao, S. D. 2021; 25 (2)

    View details for DOI 10.4293/JSLS.2021.00014

    View details for PubMedID 34248329

  • Laparoscopic versus ultrasound-guided visualization of transversus abdominis plane blocks. Journal of pediatric surgery Diyaolu, M., Taylor, J., Austin, J., Gibson, M., Ramamurthi, R. J., Tsui, B., Chao, S. 2021


    BACKGROUND: Ultrasound-guided (US) transversus abdominis plane (TAP) block is commonly utilized as part of a multi-modal approach for postoperative pain management. This study seeks to determine whether laparoscopic-guided TAP blocks are as effective as US-guided TAP blocks among pediatric patients.METHOD: In this prospective, randomized controlled trial, pediatric patients undergoing laparoscopic procedures were randomly assigned to one of two treatment arms: US-guided TAP block (US-arm) or laparoscopic-guided TAP block (LAP-arm). Primary outcome was PACU pain scores. Secondary outcomes included PACU opioid consumption, block completion time and block accuracy.RESULTS: Twenty-five patients were enrolled in each arm. In the LAP-arm, 59% of blocks were in the transversus abdominis plane compared to 74% of TAP blocks in the US-arm (p=0.18). Blocks were completed faster in the LAP-arm (2.1±1.9vs. 7.9±3.4min, p<0.001). The average highest PACU pain score was 3.4±3.1 for the LAP-arm and 4.3±3.8 for the US-arm (p=0.37). Overall PACU pain scores and opioid consumption were similar between the groups (1.2±1.3vs. 1.6±1.6, p=0.24; 2.2±5.8vs. 0.9±1.4MME, p=0.26).CONCLUSION: Laparoscopic TAP blocks have equivalent efficacy in post-operative pain scores, narcotic use, and tissue plane accuracy as compared to US-guided TAP blocks. They are also completed faster and may result in less operating room and general anesthetic time for the pediatric patient.

    View details for DOI 10.1016/j.jpedsurg.2021.02.025

    View details for PubMedID 33771368

  • Does shock index, pediatric age-adjusted predict mortality by trauma center type? The journal of trauma and acute care surgery Austin, J. R., Ye, C., Lee, M. O., Chao, S. D. 2021; 91 (4): 649-654


    Pediatric trauma patients are treated at adult trauma centers (ATCs), mixed pediatric and ATCs (MTC), or pediatric trauma centers (PTCs). Shock index, pediatric age-adjusted (SIPA) can prospectively identify severely injured children. This study characterized the differences in mortality and hospital length of stay (LOS) among pediatric trauma patients with elevated SIPA (eSIPA) at different trauma centers types.Pediatric patients (1-14 years) were queried from the 2013 to 2016 National Trauma Data Bank. Patients with eSIPA were included for analysis. The primary outcome was mortality. Secondary outcomes included rates of splenectomy, computed tomography chest scans, laparotomy, and hospital LOS. Unadjusted frequencies and multivariable regression analyses were performed. An alpha level of 0.01 was used to determine significance.Out of 189,003 pediatric trauma patients, 15,832 were included for analysis. After controlling for age, race, sex, payment method, Injury Severity Score, Glasgow Coma Scale score, hospital teaching status, and number of hospital beds, there was no significant difference in mortality among eSIPA patients at ATCs (odds ratio [OR], 0.753; p = 0.078) and MTCs (OR, 1.051; p = 0.776) when compared with PTCs. This remained true even among the most severely injured eSIPA patients (Injury Severity Score > 25). Splenectomy rates were higher at ATCs (OR, 3.234; p = 0.005), as were computed tomography chest scan rates (ATC OR, 4.423; p < 0.001; MTC OR, 6.070; p < 0.001) than at PTCs. There was a trend toward higher splenectomy rates at MTCs (OR, 2.910; p = 0.030) compared with PTCs, but this did not reach statistical significance. Laparotomy rates and hospital LOS were not significantly different.Among eSIPA pediatric trauma patients, there was no difference in mortality between trauma center types. However, other secondary findings indicate that specialty care at PTCs may help optimize the care of pediatric trauma patients.Retrospective cohort study, level IV.

    View details for DOI 10.1097/TA.0000000000003197

    View details for PubMedID 34559163

  • Financial burden of pediatric firearm-related injury admissions in the United States. PloS one Taylor, J. S., Madhavan, S., Han, R. W., Chandler, J. M., Tenakoon, L., Chao, S. 2021; 16 (6): e0252821


    Pediatric firearm-related injuries pose a significant public health problem in the United States, yet the associated financial burden has not been well described. This is the first study examining national data on the cost of initial hospitalization for pediatric firearm-related injuries. In this retrospective review, the Healthcare Cost and Utilization Project Kids' Inpatient Database from the years 2003, 2006, 2009, and 2012 was used to identify all patients 18 years of age and under who were admitted with firearm-related injuries. We compared demographic and discharge-level data including injury severity score, hospital length of stay, income quartile, injury intent, and inflation-adjusted hospital costs across age groups (0-5, 6-9, 10-15, 16-18 years). There were approximately 4,753 pediatric firearm-related admissions each year, with a median hospitalization cost of $12,984 per patient. Annual initial hospitalization costs for pediatric firearm injuries were approximately $109 million during the study period. Pediatric firearm-related injuries predominately occured among older teenagers (74%, 16-18 years), males (89%), black individuals (55%), and those from the lowest income quartile (53%). We found significant cost variation based on patient race, income quartile, injury severity score, intent, hospital length of stay, disposition, and hospital region. Inflation-adjusted hospitalization costs have increased significantly over the study period (p < 0.001). Pediatric firearm-related injuries are a large financial burden to the United States healthcare system. There are significant variations in cost based on predictable factors like hospital length of stay and injury severity score; however, there are also substantial discrepancies based on hospital region, patient race, and income quartile that require further investigation.

    View details for DOI 10.1371/journal.pone.0252821

    View details for PubMedID 34161341

  • Firearm Legislation Stringency and Firearm-Related Fatalities among Children in the US JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS Madhavan, S., Taylor, J. S., Chandler, J. M., Staudenmayer, K. L., Chao, S. D. 2019; 229 (2): 150–57
  • Correction to: Delayed appearance of mature ganglia in an infant with an atypical presentation of total colonic and small bowel aganglionosis: a case report. BMC pediatrics Salimi Jazi, F., Chandler, J. M., Thorson, C. M., Sinclair, T. J., Hazard, F. K., Kerner, J. A., Dutta, S., Dunn, J. C., Chao, S. D. 2019; 19 (1): 172


    Following publication of the original article [1], the authors reported error on the images/figures used which also resulted in un-sequential order. The updated figures and captions are provided below.

    View details for DOI 10.1186/s12887-019-1507-6

    View details for PubMedID 31138158

  • Delayed appearance of mature ganglia in an infant with an atypical presentation of total colonic and small bowel aganglionosis: a case report BMC PEDIATRICS Jazi, F., Chandler, J. M., Thorson, C. M., Sinclair, T. J., Hazard, F. K., Kerner, J. A., Dutta, S., Dunn, J. Y., Chao, S. D. 2019; 19
  • Delayed appearance of mature ganglia in an infant with an atypical presentation of total colonic and small bowel aganglionosis: a case report. BMC pediatrics Salimi Jazi, F., Chandler, J. M., Thorson, C. M., Sinclair, T. J., Hazard, F. K., Kerner, J. A., Dutta, S., Dunn, J. C., Chao, S. D. 2019; 19 (1): 93


    BACKGROUND: Total colonic and small bowel aganglionosis (TCSA) occurs in less than 1% of all Hirschsprung's disease patients. Currently, the mainstay of treatment is surgery. However, in patients with TCSA, functional outcomes are often poor. A characteristic transition zone in TCSA can be difficult to identify which may complicate surgery and may often require multiple operations.CASE PRESENTATION: We present the case of a male infant who was diagnosed with biopsy-proven total colonic aganglionosis with extensive small bowel involvement as a neonate. The patient was diverted at one month of age based on leveling biopsies at 10cm from the Ligament of Treitz. At 7months of age, during stoma revision for a prolapsed stoma, intra-operative peristalsis was observed in nearly the entire length of the previously aganglionic bowel, and subsequent biopsies demonstrated the appearance of mature ganglion cells in a previously aganglionic segment.CONCLUSIONS: TCSA remains a major challenge for pediatric surgeons. Our case introduces new controversy to our understanding of aganglionosis. Our observations warrant further research into the possibility of post-natal ganglion maturation and encourage surgeons to consider a more conservative surgical approach.

    View details for PubMedID 30953480

  • Firearm Legislation Stringency and Firearm-Related Fatalities among Children in the United States. Journal of the American College of Surgeons Madhavan, S., Taylor, J. S., Chandler, J. M., Staudenmayer, K. L., Chao, S. D. 2019


    BACKGROUND: Firearm-related injuries are the second leading cause of pediatric death in the U.S. We sought to evaluate the effectiveness of both state child access prevention (CAP) laws and gun regulations on pediatric firearm mortality. We hypothesized that states with more stringent firearm legislation had lower pediatric firearm mortality.STUDY DESIGN: We used 2014-2015 firearm mortality data from the Web-Based Injury Statistics Query and Reporting System, 2014 Brady scores (used to quantify stringency of state gun regulations) and CAP laws. State-level covariates were obtained from government sources including the Bureau of Labor Statistics and the Department of Education. Spearman rank correlations and linear regression were used to determine the relationship between overall pediatric firearm mortality and gun regulations. We also examined the relationship between gun regulations and firearm related homicides and suicides.RESULTS: Annually, there were approximately 2,715 pediatric firearm fatalities among children; 62.1% were homicides and 31.4% suicides. There was a moderate negative correlation between states' firearm legislation stringency and overall pediatric firearm mortality (rho=-0.66, p<0.001), and between CAP laws and firearm suicide rates (rho=-0.56, p<0.001). After controlling for poverty, unemployment, substance abuse, and the number of registered firearms, the association between firearm legislation stringency and overall pediatric firearm mortality remained significant (p=0.04). The association between CAP laws and firearm suicide rate remained significant after controlling for socioeconomic factors, registered firearms, and other firearm legislation (p=0.04).CONCLUSIONS: Strict gun legislation and CAP laws are associated with fewer pediatric firearm fatalities and firearm suicides, respectively, though no such association was identified with pediatric firearm homicides. While more studies are needed to determine causality, state-level legislation could play an important role in reducing pediatric firearm-related deaths.

    View details for PubMedID 30928667

  • Letter to the Editor: Early Consequences of Pectus Excavatum Surgery on Self-Esteem and General Quality of Life WORLD JOURNAL OF SURGERY Darling, C., Chao, S., Ramamurthi, R., Tsui, B. 2019; 43 (3): 963–64
  • Management of hepatitis B infected pregnant women: a cross-sectional study of obstetricians. BMC pregnancy and childbirth Chao, S. D., Cheung, C. M., Chang, E. T., Pei, A. n., So, S. K. 2019; 19 (1): 275


    Our study aims to describe how obstetricians manage pregnant women infected with chronic hepatitis B in a region with a large high-risk population.We performed a cross-sectional study among practicing obstetricians in Santa Clara County, California. All obstetricians practicing in Santa Clara County were invited to participate in the study. Obstetricians were recruited in person or by mail to complete a voluntary, multiple choice survey on hepatitis B (HBV). Survey questions assessed basic HBV knowledge and obstetricians' self-reported clinical practices of the management of HBV-infected pregnant women. Pooled descriptive analyses were calculated for the cohort, as well as, correlation coefficients to evaluate the association between reported clinical practices and hepatitis B knowledge.Among 138 obstetricians who completed the survey, 94% reported routinely testing pregnant women for hepatitis B surface antigen (HBsAg) with each pregnancy. Only 60.9% routinely advised HBsAg-positive patients to seek specialist evaluation for antiviral treatment and monitoring and fewer than half (48.6%) routinely provided them with HBV information. While most respondents recognized the potential complications of chronic HBV (94.2%), only 21% were aware that chronic HBV carries a 25% risk of liver related death when left unmonitored and untreated, and only 25% were aware of the high prevalence of chronic HBV in the foreign-born Asian, Native Hawaiian and Pacific Islander population. Obstetricians aware of the high risk of perinatal HBV transmission were more likely to test pregnant women for HBV DNA or hepatitis B e-antigen in HBV-infected women (r = 0.18, p = 0.033). Obstetricians who demonstrated knowledge of the long-term consequences of untreated HBV infection were no more likely to refer HBV-infected women to specialists for care (r = 0.02, p = 0.831).Our study identified clear gaps in the practice patterns of obstetricians that can be readily addressed to enhance the care they provide to HBV-infected pregnant women.

    View details for DOI 10.1186/s12884-019-2421-5

    View details for PubMedID 31375078

  • 3D Optical Imaging for Pectus Excavatum Assessment. The Annals of thoracic surgery Taylor, J. S., Madhavan, S. n., Szafer, D. n., Pei, A. n., Koppolu, R. n., Barnaby, K. n., Wall, J. K., Chao, S. D. 2019


    Corrective surgery for pectus excavatum often relies on the Haller index (HI), derived from chest radiographs or computed tomography; however, this exposes children to potentially unnecessary radiation. Our aim was to develop a novel 3D optical imaging technique to accurately measure chest wall dimensions in a clinically relevant manner.Patients with pectus excavatum were imaged using a 3D structured light scanner. Patient characteristics, including height, weight, BMI, and radiographic HIs (rHI) were recorded. We defined the optical index (OI) as the ratio of the lateral to anterior-posterior measurements obtained from the 3D optical images, and compared those to patients' rHIs. Two-thirds of the patients' images were used to develop a predictive model of the rHI, utilizing their OI and biometric data in multilinear regression modeling. The predictive model was applied to the remaining images, and the predicted HIs (pHI) were compared to the rHIs.Forty-two patients (ages 5-35) with pectus excavatum underwent optical imaging; 31 had recent chest radiographs, with rHIs ranging from 2.00-7.20. The OIs derived from the images correlated closely with rHIs (R=0.850). Our predictive model, utilizing patients' OI, height, and weight was able to accurately estimate their rHIs with a median error of 8.11% (IQR 3.5-17.4%).3D optical imaging of patients with pectus excavatum is emerging as an alternative method to assess HIs without the use of ionizing radiation. Additional studies will focus on volumetric quantification of chest wall deformities, utilizing the 3D capabilities of this technology.

    View details for DOI 10.1016/j.athoracsur.2019.04.074

    View details for PubMedID 31201783

  • Impact of licensed federal firearm suppliers on firearm-related mortality Chao, S. D., Kastenberg, Z. J., Madhavan, S., Staudenmayer, K. LIPPINCOTT WILLIAMS & WILKINS. 2019: 123–27
  • Strict Firearm Legislation Is Associated with Lower Firearm-Related Fatalities among Children and Teens in the US Chao, S. D., Madhavan, S. ELSEVIER SCIENCE INC. 2018: E33–E34
  • Impact of Licensed Federal Firearm Suppliers on Firearm-Related Mortality. The journal of trauma and acute care surgery Chao, S. D., Kastenberg, Z. J., Madhavan, S., Staudenmayer, K. L. 2018


    BACKGROUND: Legal firearm sales occur largely through suppliers that have Federal Firearm Licensees (FFLs). Since FFL density might reflect ease-of-access to firearm purchases, we hypothesized that the number of FFL dealers would be associated with firearm-related deaths. We further hypothesized that licensee-type subsets would be associated with differential risks for gun-related deaths.METHODS: We used data from the National Center for Health Statistics National Vital Statistics System (2008-2014) and national data on Federal Firearms Licensees for 2014. Correlation analysis and linear regression analysis were performed to determine the relationship between different licensee types and firearm-related deaths. We controlled for population, number of statewide registered firearms, and the density of other types of FFLs.RESULTS: We identified a total of 65,297 FFLs. There was a moderate correlation (R = 0.53, rho = 0.48) between total FFL density and firearm-related death rates. Further analysis by type of firearm-related death showed a strong correlation (R = 0.81, rho = 0.76) between total FFL density and firearm-related suicide rates. No correlation was found between total FFL density and firearm-related homicide rate. Among individual FFL types, FFL02 (firearm dealing pawnshop) density was the only FFL-type found to be correlated with firearm-related death rates. We found a strong correlation between FFL02 density and overall firearm-related death rate (R = 0.69, rho = 0.78) and firearm-related suicide rate (R = 0.72, rho = 0.78). Linear regression analysis showed that even while controlling for number of registered firearms and population, the number of firearm-dealing pawnshops remained significantly associated with overall firearm-related deaths and firearm-related suicides.CONCLUSION: Access to legally-distributed firearms is associated with firearm-related death rates, particularly firearm-related suicides. Specifically, firearm-dealing pawnshops were associated with suicide-related deaths. These findings suggest that deeper exploration of legal firearm access and firearm-related injuries would benefit discussion of preventative measures.LEVEL OF EVIDENCE: IV TYPE OF STUDY: Prognostic and Epidemiological.

    View details for PubMedID 30212424

  • A Simplified Method for Three-Dimensional Optical Imaging and Measurement of Patients with Chest Wall Deformities. Journal of laparoendoscopic & advanced surgical techniques. Part A Szafer, D., Taylor, J. S., Pei, A., de Ruijter, V., Hosseini, H., Chao, S., Wall, J. 2018


    BACKGROUND: Pectus excavatum and carinatum are two of the most commonly observed chest wall deformities in pediatrics. The standard diagnostic evaluation for these conditions includes either chest radiograph (CXR) or computed tomography (CT). Our research aims to develop a novel and reliable way of quantifying chest wall deformities in the clinic setting without radiation exposure.METHODS: Using a handheld structured light scanner, we created three-dimensional (3D) models of patients with chest wall deformities through an IRB-approved protocol. Raters from a variety of backgrounds were then asked to take measurements based on the 3D model utilizing commercially available 3D graphical software. The standard deviation of the measurements and intraclass correlation coefficient (ICC) were then calculated to quantify inter-rater reliability.RESULTS: Sixty patients with pectus excavatum (Haller index range 2.0-6.38) and pectus carinatum were enrolled and imaged in our outpatient clinic using a structured light scanner. Five patients were used to verify interuser reliability. The standard deviation of all the measurements was 2.2mm. The ICC for absolute agreement was 0.99139, with 1.0 being perfect correlation.CONCLUSION: Structured light scanners provide an alternative approach to quantifying chest wall deformities in pediatric patients without radiation exposure. Our method is highly reliable, even among users with minimal image processing or 3D modeling experience. Our protocol can potentially be used to track treatment progress in children with chest wall deformities.

    View details for PubMedID 30207836

  • A Simplified Method for Three-Dimensional Optical Imaging and Measurement of Patients with Chest Wall Deformities Szafer, D., Taylor, J. S., Pei, A., de Ruijter, V., Hosseini, H., Chao, S., Wall, J. MARY ANN LIEBERT, INC. 2019: 267–71
  • Initial experience with peroral endoscopic myotomy for treatment of achalasia in children JOURNAL OF PEDIATRIC SURGERY Kethman, W. C., Thorson, C. M., Sinclair, T. J., Berquist, W. E., Chao, S. D., Wall, J. K. 2018; 53 (8): 1532–36
  • Letter to the Editor: Early Consequences of Pectus Excavatum Surgery on Self-Esteem and General Quality of Life. World journal of surgery Darling, C., Chao, S., Ramamurthi, R., Tsui, B. 2018

    View details for PubMedID 29882100

  • Pleomorphic myxoid liposarcoma in an adolescent with Li-Fraumeni syndrome. Pediatric surgery international Sinclair, T. J., Thorson, C. M., Alvarez, E., Tan, S., Spunt, S. L., Chao, S. D. 2017


    We present the case of a 15-year-old female with a right perineal mass that was found to be pleomorphic myxoid liposarcoma, a recently recognized, rare subtype of liposarcoma. The patient had a strong family history of malignancy and genetic screening revealed a pathogenic TP53 mutation consistent with Li-Fraumeni syndrome.

    View details for DOI 10.1007/s00383-017-4063-x

    View details for PubMedID 28160093

  • Initial experience with peroral endoscopic myotomy for treatment of achalasia in children. Journal of pediatric surgery Kethman, W. C., Thorson, C. M., Sinclair, T. J., Berquist, W. E., Chao, S. D., Wall, J. K. 2017


    Achalasia is a primary esophageal motility disorder characterized by aperistalsis of the esophagus and failed relaxation of the lower esophageal sphincter that presents rarely in childhood. The peroral endoscopic myotomy (POEM) procedure is an emerging treatment for achalasia in adults that has recently been introduced into pediatric surgical practice.This is a prospective case series of all children referred to Stanford University Lucile Packard Children's Hospital with manometry-confirmed achalasia who underwent a POEM procedure from 2014 to 2016.We enrolled 10 subjects ranging in age from 7 to 17years (M=13.4). The mean pre- and 1-month post-procedure Eckardt scores were 7 (SD=2.5) and 2.4 (SD=2) (p<0.001), respectively. The median procedure time for the entire cohort was 142min (range 60-259min) with ongoing improvement with increased experience (R2=0.6, p=0.008). There were no major adverse events.The POEM procedure can be successfully completed in children for the treatment of achalasia with demonstrated short-term post-operative improvement in symptoms. The adoption of advanced endoscopic techniques by pediatric surgeons may enable development of unique intraluminal approaches to congenital anomalies and other childhood diseases.Treatment Study - Level IV.

    View details for PubMedID 28827050

  • A multidisciplinary approach to laparoscopic sleeve gastrectomy among multiethnic adolescents in the United States. Journal of pediatric surgery Jaramillo, J. D., Snyder, E. n., Farrales, S. n., Stevens, M. n., Wall, J. K., Chao, S. n., Morton, J. n., Pratt, J. S., Hammer, L. n., Shepard, W. E., Bruzoni, M. n. 2017


    Childhood obesity has become a serious public health problem in our country with a prevalence that is disproportionately higher among minority groups. Laparoscopic sleeve gastrectomy (LSG) is gaining attention as a safe bariatric alternative for severely obese adolescents.A retrospective study on morbidly obese adolescents that underwent LSG at our institution from 2009 to 2017. Primary outcomes were weight loss as measured by change in BMI and percent excess weight loss (%EWL) at 1 year after surgery, resolution of comorbidities and occurrence of complications.Thirty-eight patients, of whom 71% were female and 74% were ethnic minorities, underwent LSG between 2009 and 2016. Mean age was 16.8years, mean weight was 132.0kg and mean BMI was 46.7. There were no surgical complications. Mean %EWL was 19.4%, 27.9%, 37.4%, 44.9%, and 47.7% at 1.5, 3, 6, 9, and 12month follow up visits, respectively. Comorbidity resolution rates were 100% for hypertension and nonalcoholic fatty liver disease, 91% for diabetes, 44% for prediabetes, 82% for dyslipidemia and 89% for OSA.LSG is an effective and safe method of treatment of morbid obesity in adolescents as it can significantly decrease excess body weight and resolve comorbid conditions. Further studies are needed to investigate the long-term effects of LSG in adolescents.Descriptive case series with prospective database.IV.

    View details for PubMedID 28697852

  • A Multidisciplinary Approach to Laparoscopic Sleeve Gastrectomy Among Multiethnic Adolescents in the United States Jaramillo, J. D., Snyder, E., Farrales, S., Wall, J. K., Chao, S., Hammer, L. D., Albanese, C., Morton, J. M., Bruzoni, M. ELSEVIER SCIENCE INC. 2016: E153
  • Case Report: Rapid staged abdominal closure using Gore-Tex (R) mesh as a bridge to primary omphalocele sac closure JOURNAL OF PEDIATRIC SURGERY CASE REPORTS Kethman, W. C., Sinclair, T. C., Abrajano, C. T., Chao, S., Wall, J. K. 2016; 9: 37–39
  • Endoscopic Division of Duodenal Web Causing Near Obstruction in 2-Year-Old with Trisomy 21 JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES Wood, L. S., Kastenberg, Z., Sinclair, T., Chao, S., Wall, J. K. 2016; 26 (5): 413-417


    Surgical intervention for duodenal atresia most commonly entails duodenoduodenostomy in the neonatal period. Occasionally, type I duodenal atresia with incomplete obstruction may go undiagnosed until later in life. Endoscopic approach to dividing intestinal webs has been reported as successful in patients as young as 7 days of age, and can be a useful modality particularly in patients with comorbidities who may not tolerate open or laparoscopic surgery.A 2-year-old female with a history of trisomy 21 and tetralogy of Fallot underwent laparoscopic and endoscopic exploration of intestinal obstruction as seen on upper gastrointestinal series for symptoms of recurrent emesis and weight loss. After laparoscopy confirmed a duodenal web as the cause of intestinal obstruction, endoscopic division of the membrane was carried out with a triangle tip electrocautery knife and 15 mm radially dilating balloon.The patient tolerated the procedure well, and also tolerated full age-appropriate diet by time of discharge on postoperative day 2. She remains asymptomatic as of 6 months postoperatively.This report describes a successful endoscopic approach for definitive treatment of a duodenal web in a 2-year-old girl with trisomy 21, and laparoscopy confirmed no intraabdominal obstructive process or complication from endoscopy. Endoscopy enables minimal recovery time and suggests an improved method of duodenal web division over pure surgical intervention.

    View details for DOI 10.1089/lap.2015.0462

    View details for Web of Science ID 000376469600014

    View details for PubMedID 26913816

  • Salvage of a failed open gastrocutaneous fistula repair with an endoscopic over-the-scope clip JOURNAL OF PEDIATRIC SURGERY CASE REPORTS Jaramillo, J., Hyun, J., Abrajano, C., Koppolu, R., Chao, S., Hartman, G., Wall, J. 2016; 8: 40–41
  • Multimodality Renal Failure in a Patient with OEIS Complex. AJP reports Santoro, J. D., Chao, S., Hsieh, M. H., Lee, H. C. 2015; 5 (2): e161-4


    Omphalocele-exstrophy of the bladder-imperforate anus-spinal defect (OEIS) complex is a rare constellation of clinical abnormalities with wide phenotypic presentation. We describe a case of a preterm neonate with OEIS complex with acute renal failure, and the challenges in diagnosis and management of this patient as renal failure can be a multifactorial process when encountered with this rare complex.

    View details for DOI 10.1055/s-0035-1554799

    View details for PubMedID 26495176

    View details for PubMedCentralID PMC4603852

  • Medical training fails to prepare providers to care for patients with chronic hepatitis B infection. World journal of gastroenterology Chao, S. D., Wang, B., Chang, E. T., Ma, L., So, S. K. 2015; 21 (22): 6914-6923


    To investigate physicians' knowledge including chronic hepatitis B (CHB) diagnosis, screening, and management in various stages of their training.A voluntary 20-question survey was administered in Santa Clara County, CA where Asian and Pacific Islanders (API) account for a third of the population. Among the 219 physician participants, there were 63 interns, 60 second-year residents, 26 chief residents and 70 attending physicians. The survey asked questions regarding respondents' demographics, general hepatitis B virus knowledge questions (i.e., transmission, prevalence, diagnostic testing, prevention, and treatment options), as well as, self-reported practice behavior and confidence in knowledge.Knowledge about screening and managing patients with CHB was poor: only 24% identified the correct tests to screen for CHB, 13% knew the next steps for patients testing positive for CHB, 18% knew the high prevalence rate among API, and 31% knew how to screen for liver cancer. Wald chi-square analysis determined the effect of training level on knowledge; in all cases except for knowledge of liver cancer screening (P = 0.0032), knowledge did not significantly increase with length in residency training or completion of residency.Even in a high-risk region, both medical school and residency training have not adequately prepared physicians in the screening and management of CHB.

    View details for DOI 10.3748/wjg.v21.i22.6914

    View details for PubMedID 26078568

    View details for PubMedCentralID PMC4462732

  • Initial Results of Endoscopic Gastrocutaneous Fistula Closure in Children Using an Over-the-Scope Clip. Journal of laparoendoscopic & advanced surgical techniques. Part A Wright, R., Abrajano, C., Koppolu, R., Stevens, M., Nyznyk, S., Chao, S., Bruzoni, M., Wall, J. 2015; 25 (1): 69-72


    Gastrocutaneous fistula (GCF) occurs commonly in pediatric patients after removal of long-term gastrostomy tubes. Although open repair is generally successful, endoscopic approaches may offer benefits in terms of incisional complications, postoperative pain, and procedure time. In addition, endoscopic approaches may offer particular benefit in patients with varied degrees of skin irritation or erosion surrounding a GCF, making surgical repair difficult, or patients with significant comorbidities, making minimal intervention and anesthesia time preferable. Over-the-scope (OSC) clips are a new technology that enables endoscopic closure of intestinal fistulas up to 2 cm in diameter. Six pediatric patients underwent endoscopic GCF closure using OSC clips under Institutional Review Board approval. The procedure was technically successful in 5 of 6 cases with an average operating time of 29 minutes. The technical failure required an open revision, whereas all other patients reported full healing of the GCF site at 1 month. All successful cases were performed as outpatients without postoperative narcotics. In addition, all patients reported high satisfaction with the procedure and cosmetic results. Endoscopic GCF closure using an OSC clip is technically feasible in the pediatric population. Based on limited cases with a 1-month follow-up, the functional and cosmetic results of technically successful cases are excellent. Endoscopic GCF closure is a potential alternative to standard surgical closure in patients with skin irritation or erosion and/or significant comorbidities.

    View details for DOI 10.1089/lap.2014.0379

    View details for PubMedID 25531644

  • Introduction of the Per-Oral Endoscopic Myotomy Technique to Pediatric Surgical Practice J Pediatr Surg Case Rep Chao, S. D., Russo, M., Wright, R., Rivas, H., Wall, J. K. 2014; 2 (6)
  • Introduction of the per-oral endoscopic myotomy technique to pediatric surgical practice Journal of Pediatric Surgery Case Reports Chao, S., Russo, M., Wright, R., Rivas, H., Wall, J. 2014
  • Intraoperative functional luminal imaging to assess esophagogastric junction distensibility during per-oral endoscopic myotomy in pediatric patients J Gastroint Dig Syst Wright, R., Chao, S. D., Wall, J. K. 2014; 4 (4)
  • Education and counseling of pregnant patients with chronic hepatitis B: perspectives from obstetricians and perinatal nurses in santa clara county, california. Asian Pacific journal of cancer prevention Yang, E. J., Cheung, C. M., So, S. K., Chang, E. T., Chao, S. D. 2013; 14 (3): 1707-1713


    Background: This study aimed to better understand the barriers to perinatal hepatitis B prevention and to identify the reasons for poor hepatitis B knowledge and delivery of education to hepatitis B surface-antigen- positive pregnant women among healthcare providers in Santa Clara County, California. Materials and Methods: Qualitative interviews were conducted with 16 obstetricians and 17 perinatal nurses in Santa Clara County, California, which has one of the largest populations in the United States at high risk for perinatal hepatitis B transmission. Results: Most providers displayed a lack of self-efficacy attributed to insufficient hepatitis B training and education. They felt discouraged from counseling and educating their patients because of a lack of resources and discouraging patient attitudes such as stigma and apathy. Providers called for institutional changes from the government, hospitals, and nonprofit organizations to improve care for patients with chronic hepatitis B. Conclusions: Early and continuing provider training, increased public awareness, and development of comprehensive resources and new programs may contribute to reducing the barriers for health care professionals to provide counseling and education to pregnant patients with chronic hepatitis B infection.

    View details for PubMedID 23679261

  • Low Levels of Knowledge and Preventive Practices Regarding Vertical Hepatitis B Transmission among Perinatal Nurses JOGNN-JOURNAL OF OBSTETRIC GYNECOLOGIC AND NEONATAL NURSING Chao, S. D., Cheung, C. M., Yang, E. J., So, S. K., Chang, E. T. 2012; 41 (4): 494-505


    To evaluate current levels of hepatitis-B-related knowledge and clinical practice among perinatal nurses.Cross-sectional study.Santa Clara County, California, home to one of the largest U.S. populations at risk of perinatal hepatitis B transmission.Perinatal nurses (N = 518) from eight birthing hospitals.In 2008-2010, nurses completed a baseline survey evaluating existing hepatitis-B-related knowledge and preventive clinical practices, participated in an educational seminar, received instructional materials about hepatitis B, and completed a follow-up knowledge survey.Eighty percent of perinatal nurses had provided health care to a pregnant woman with chronic hepatitis B, but only 51% routinely provided patients with educational information about hepatitis B. While 75% routinely informed patients about effective methods to prevent mother-to-child transmission, only a small minority (17-34%) educated infected women about standard recommendations for protecting themselves and household members. One fourth or fewer nurses correctly answered most questions about hepatitis B prevalence, risks, and symptoms. After the educational seminar, knowledge increased statistically significantly.Existing knowledge about hepatitis B is limited, and nationally recommended preventive clinical practices are commonly overlooked by perinatal nurses. This lack of knowledge and preventive care represents a noteworthy gap and an opportunity for targeted training and education to improve perinatal hepatitis B prevention and medical management of infected mothers.

    View details for DOI 10.1111/j.1552-6909.2012.01379.x

    View details for Web of Science ID 000306476300006

    View details for PubMedID 22697047

  • The Jade Ribbon Campaign: A systematic, evidence-based public awareness campaign to improve Asian and Pacific Islander health J Comm in Healthcare Chao, S. D., So, S. K. 2011; 4 (1)
  • The Jade Ribbon Campaign: A Model Program for Community Outreach and Education to Prevent Liver Cancer in Asian Americans JOURNAL OF IMMIGRANT AND MINORITY HEALTH Chao, S. D., Chang, E. T., Le, P. V., Prapong, W., Kiernan, M., So, S. K. 2009; 11 (4): 281-290


    The Jade Ribbon Campaign (JRC) is a culturally targeted, community-based outreach program to promote the prevention, early detection, and management of chronic hepatitis B virus (HBV) infection and liver cancer among Asian Americans. In 2001, 476 Chinese American adults from the San Francisco Bay Area attended an HBV screening clinic and educational seminar. The prevalence of chronic HBV infection was 13%; only 8% of participants showed serologic evidence of protective antibody from prior vaccination. Participants reported low preventive action before the clinic, but after one year, 67% of those with chronic HBV infection had consulted a physician for liver cancer screening, and 78% of all participants had encouraged family members to be tested for HBV. The increase in HBV awareness, screening, and physician follow-up suggests that culturally aligned interventions similar to the JRC may help reduce the disproportionate burden of disease to chronic HBV infection among Asian Americans.

    View details for DOI 10.1007/s10903-007-9094-2

    View details for Web of Science ID 000281505100005

    View details for PubMedID 17990118

  • Eliminating the Threat of Chronic Hepatitis B in the Asian and Pacific Islander Community: A Call to Action ASIAN PACIFIC JOURNAL OF CANCER PREVENTION Chao, S. D., Chang, E. T., So, S. K. 2009; 10 (3): 507-512


    Chronic hepatitis B in the Asian and Pacific Islander (API) population is among our nation's greatest ethnic and racial health disparities. Despite comprising 4.3% of the population, API make up a disproportionate half of the 1.2-2 million Americans living with chronic hepatitis B. As many as two-thirds of API are not aware of their infection because they have not been tested. This lack of knowledge prevents them from undergoing life-saving liver cancer screening and potential treatment. Likewise, those not protected are unaware that they should be vaccinated. Instead, there is a pervasive lack of awareness among API and healthcare providers. New concerted public health actions are needed to eliminate this major health disparity.

    View details for Web of Science ID 000270750100033

    View details for PubMedID 19640200

  • Short waitlist time does not adversely impact outcome following liver transplantation for hepatocellular carcinoma AMERICAN JOURNAL OF TRANSPLANTATION Chao, S. D., Roberts, J. P., Farr, M., Yao, F. Y. 2007; 7 (6): 1594-1600


    It has been suggested that patients with hepatocellular carcinoma (HCC) undergoing living donor liver transplantation (LDLT) have worse recurrence-free survival compared to deceased donor liver transplantation (CLT), leading to the hypothesis that short waitlist time or fast-tracking may include more aggressive tumors that would have been selected out by traditionally longer waitlist time. The primary aim of the present study was to evaluate the impact of waitlist time on HCC recurrence. The study cohort included 100 patients meeting T2 criteria by imaging before undergoing CLT (n = 90) or LDLT (n = 10). The 5-year recurrence-free probability was 89.9% for the entire cohort, and 91.9%, 90.5% and 86.6%, respectively, for waitlist time of 3 months or less, 3-6 months and > 6 months (p = 0.81). In the Cox proportional hazards model, waitlist time was also not a significant predictor of HCC recurrence. Tumor under-staging was observed in 20.5% of patients with waitlist time 3 months or less and 23.0% for waitlist time > 3 months (p = 0.81). In conclusion, our results failed to show an association between waitlist time and outcome after CLT or LDLT for HCC, and provided evidence disputing a significant role of waitlist time in the selection against HCC with unfavorable tumor biology.

    View details for DOI 10.1111/j.1600-6143.2007.01800.x

    View details for Web of Science ID 000246576700020

    View details for PubMedID 17430396

  • Anomalies of the corpus callosum: An MR analysis of the phenotypic spectrum of associated malformations AMERICAN JOURNAL OF ROENTGENOLOGY Hetts, S. W., Sherr, E. H., Chao, S., Gobuty, S., Barkovich, A. J. 2006; 187 (5): 1343-1348


    We sought to categorize the structural brain anomalies associated with abnormalities of the corpus callosum and anterior and hippocampal commissures in a large cohort.Brain MR images of adult and pediatric patients from our institution and from a national support organization (the ACC Network) were retrospectively evaluated for the type and severity of commissural anomalies and the presence and type of other structural abnormalities.Of 142 cases that were reviewed, 82 patients had agenesis of the corpus callosum (ACC), while 60 had hypogenesis of the corpus callosum (HCC). Of the overall cohort, almost all had reduced white matter volume outside the commissures, the majority had malformations of cortical development (most commonly heterotopia or abnormal sulcation), many had noncallosal midline anomalies (including abnormal anterior or hippocampal commissures and interhemispheric cysts and lipomas), and several patients had abnormalities of the cerebellum or brainstem. Sixty-six patients had Probst bundles, which were more common in patients with ACC than in those with HCC. Probst bundles were present in all four patients who had ACC or HCC but no other midline, cortical, or posterior fossa anomalies.Isolated commissural anomalies were rare in the populations of patients examined. Most cases of ACC and HCC were associated with complex telencephalic, diencephalic, or rhombencephalic malformations. Reduced cerebral hemispheric white matter volume and malformations of cortical development were seen in more than half of the patients, suggesting that many commissural anomalies are part of an overall cerebral dysgenesis. ACC and HCC appear to lie along a dysgenetic spectrum, as opposed to representing distinct disorders.

    View details for DOI 10.2214/AJR.05.0146

    View details for Web of Science ID 000241510800035

    View details for PubMedID 17056927

  • Single infusion of myeloid progenitors reduces death from Aspergillus fumigatus following chemotherapy-induced neutropenia BLOOD Bitmansour, A., Cao, T. M., Chao, S., Shashidhar, S., Brown, J. M. 2005; 105 (9): 3535-3537


    Hematopoietic progenitors committed to the myeloid lineage, the common myeloid and granulocyte-monocyte progenitors (CMP/GMP), have been shown to protect against opportunistic pathogens following myeloablative radiation; however, the efficacy of this approach has not been studied in the setting of chemotherapy-induced neutropenia. In this mouse model, the infusion of CMP/GMP on the day after 5-fluorouracil (5-FU) administration (D+1) resulted in a significant increase in the number of splenic neutrophils by D+8 when compared with 5-FU-only controls (P = .02), the majority of which were CMP/GMP-derived (54%). Moreover, 19% and 28% of neutrophils in the blood and bone marrow, respectively, were CMP/GMP-derived. Survival following intranasal challenge with the fungus Aspergillus fumigatus was significantly higher in CMP/GMP-infused mice than the controls (56% and 33% respectively; P = .019). Thus, a single infusion of CMP/GMP enhances tissue neutrophil content and increases survival against a lethal challenge with A fumigatus in the setting of chemotherapy-induced neutropenia.

    View details for DOI 10.1182/blood-2004-2004-07-2676

    View details for Web of Science ID 000228797400029

    View details for PubMedID 15576478

    View details for PubMedCentralID PMC1895020

  • Central nervous system aspergillosis in an immunocompetent patient: cure in a hospice setting with very high-dose itraconazole. The American journal of hospice & palliative care Palanisamy, A., Chao, S. D., Fouts, M., Kerr, D. 2005; 22 (2): 139-144


    Aspergillosis of the central nervous system (CNS) is a rare condition with exceedingly high mortality. This study describes the case of an immunocompetent 42-year-old man with a history of intravenous drug use and hepatitis C who developed multiple Aspergillus lesions in the cerebellum. Despite neurosurgery and antifungal therapy with amphotericin B, he had a protracted hospital course with multiple complications, eventually developing cognitive and motor impairment due to progressive cerebellar lesions. After transfer to hospice and palliative care service, oral itraconazole was escalated to 1600 mg/day with the hope of palliating headache, nausea, and cognitive impairment. Remarkably, the patient stabilized and improved over time. After 14 months, this unprecedented high-dose regimen was discontinued, and the patient was discharged home with only mild cerebellar motor impairment.

    View details for PubMedID 15853093

  • Lack of drug interaction conformity in commonly used drug compendia for selected at-risk dermatologic drugs AMERICAN JOURNAL OF CLINICAL DERMATOLOGY Chao, S. D., Maibach, H. I. 2005; 6 (2): 105-111


    Systemic treatments that have significant efficacy for dermatologic conditions can often cause severe adverse reactions when improperly combined with interacting drugs. We have noted discrepancies in the reporting of such drug-drug interactions among major drug compendia used in hospitals and physicians' offices.The aim of this study was to compare the consistency of drug-drug interaction listings among four of the most widely used English language drug compendia in the US.Drug monographs from Mosby's GenRx, USP DI, AHFS Drug Information, and the Physicians' Desk Reference were compared. The respective drug-drug interactions provided by the various compendia for four systemic agents -- dapsone, erythromycin, methotrexate and prednisone -- commonly prescribed for dermatologic purposes were compiled.We found considerable discrepancies among the compendia with respect to the number of drug interactions listed. Agreement among the compendia was especially poor when more than two sources were compared.There is a need for a drug compendium that reconciles drug-drug interaction reporting discrepancies under standardized criteria based on the scientific literature and clinical significance.

    View details for Web of Science ID 000228512000005

    View details for PubMedID 15799682