Background: Lymph node status is a prognostic factor in Wilms tumor, and adequate lymph node sampling is strongly recommended. This study investigates the impact of lymph node ratio (LNR) (number of positive to examined lymph nodes) on overall survival in children with resected Wilms tumors. Methods: This retrospective National Cancer Database analysis included children (<18 years) who underwent resection with lymph node sampling for unilateral, non-metastatic Wilms tumor. Results: Among 2206 patients, the median age was three years, the median tumor size was 10.5 cm, and the median number of examined nodes was five. A total of 82.1% of patients had an LNR of 0, 5.4% had an LNR < 0.2, and 12.5% had an LNR ≥ 0.2. In multivariable Cox regression, LNR ≥ 0.2 was associated with worse survival (HR = 1.75, 95%CI: 1.03–2.97, p = 0.04), along with increasing age (HR = 1.11, 95%CI: 1.05–1.17, p < 0.001) and tumor size (HR = 1.03, 95%CI: 1.00–1.06, p = 0.03). Conclusions: LNR is an independent prognostic factor in Wilms tumor and may refine risk stratification and guide treatment decisions.

Prior studies examined the relationship between physician sex and electronic health records (EHR) utilization patterns to assess for provider gender equity, although this has not been explored among pediatric surgical subspecialists. We hypothesized that female surgeons received more inbox messages and had longer message lengths compared to male surgeons. Surgeons who performed at least five surgical procedures at a free-standing children's hospital between January 2021 and December 2022 were stratified based on sex. EHR utilization data were retrospectively extracted. Message types were restricted to those from patients, health care team members, or results, opting to omit other automated messages from the EHR that were not initiated by a person. Primary outcomes were number of inbox messages received adjusting for the volume of surgical cases performed and message length. Univariate and multivariate analyses were performed to identify outcome predictors. 41 female and 79 male surgeons were included in the final analysis. There was a median of 693 messages received by surgeons over the study period (median of 1.8 messages per surgeon per case). Male surgeons tended to be further out from training but there were no significant differences in terms of surgical case count or characteristics. Surgeon sex was a significant predictor of inbox message count in univariate analysis (incidence rate ratio 1.58 favoring female surgeons, p = 0.03), but not in multivariate analysis, after correcting for case complexity. Surgeon sex was not a significant predictor of message length in either univariate or multivariate analysis. Surgeon sex was not a significant predictor of inbox message count or message length among a cohort of pediatric surgical subspecialists. Ensuring gender equity with respect to EHR activities reaffirms our commitment to avoiding bias. III.

Introduction: Disparities in diabetes technology use and glycemic outcomes among US youth with type 1 diabetes (T1D) are strongly associated with race/ethnicity and insurance. The Social Deprivation Index (SDI) offers a multidimensional measure of area-level socioeconomic disadvantage linked to poorer health outcomes in pediatric populations. Methods: We conducted a retrospective cohort study of 1,541 youth aged <19 years who were newly diagnosed with T1D between 2018 and 2022 at a single tertiary care center. SDI was calculated from address and categorized into quintiles (Q1 least deprived). Primary outcomes included time to continuous glucose monitor (CGM) and insulin pump initiation and hemoglobin A1c (A1c) over 12 months. Differences by SDI quintile were assessed using interval-censored Cox proportional hazards and linear mixed-effects models. Results: Within 1 year, 84% initiated CGM and 50% initiated pump therapy. Time to CGM initiation increased across SDI quintiles; patients in Q3–Q5 were significantly less likely to initiate CGM than Q1 (Q3: HR, 95% CI: 0.81, 0.66–0.99, p = 0.036; Q4: 0.81, 0.67–0.98, p = 0.027; Q5: 0.69, 0.56–0.86; p = 0.001). Hispanic, non-Hispanic black, and Medicaid-insured patients had lower CGM uptake. Pump initiation was significantly lower only in Q5. Among CGM users, Q5 had higher A1c than Q1 (difference 0.80%, p = 0.001). Among non-pump users, Q4 and Q5 had higher A1c than Q1. AID users had lower A1c than pump-only users (7.0% vs. 7.2%, p = 0.003). Conclusion: A1c is lower across all SDI levels with CGM use, but disparities persist. Addressing structural barriers is essential to achieving equity.

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