Checklist assessment tool to evaluate suitability and success of neonatal clamp circumcision

A prospective study

Charles W. Concodora*, Max Maizels, Gregory E. Dean, Dana A. Weiss, Seth A. Alpert, John D. Edmondson, Jack S. Elder, Anthony Herndon, James M. Elmore, Karen Rychlik

*Corresponding author for this work

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background The American Academy of Pediatrics (AAP) Task Force on Circumcision has called for the development of standards of trainee proficiency in regards to evaluation and technique for neonatal clamp circumcision (NCC). At the present time, there is no standardized or general consensus on patient selection for NCC. An improved method to evaluate newborns for NCC is an important first step in this process. Therefore, the authors collaborated to identify criteria useful in the evaluation of newborns for suitability for NCC, and for assessment of success after NCC and have named it “Checklist Assessment for Neonatal Clamp Circumcision Suitability.” Methods A national multi-institutional collaboration was created to obtain consensus on objective criteria for use in determining patient suitability for NCC, and for assessing post-circumcision success outcomes. Criteria included elements from detailed medical history, bedside physical examination, and post-circumcision follow-up. Patients desiring NCC were enrolled consecutively and prospectively. The Checklist was followed to determine which newborns were suited to NCC, and NCC was done in those cases. The patients' caretakers were given post-circumcision care instructions and a follow-up appointment. Post circumcision, the Checklist was followed to determine if the procedure resulted in a successful circumcision or if there were complications. Results A total of 193 cases were enrolled prospectively and consecutively from January 2014 through October 2014. The mean age was 15 days (1–30 days). Of those 193 patients, 129 (67%) were deemed suitable for circumcision and underwent NCC. Post-circumcision assessment showed a 100% success rate with no complications. A total of 64 (23%) cases were deemed unsuitable for NCC because at least one checklist criterion was not satisfied, most commonly: penile torsion (n = 25), chordee (n = 19), and penoscrotal webbing (n = 19). Discussion Use of the Checklist in the present study has demonstrated a method of patient screening resulting in a 100% success rate with no complications. A high proportion of patients (33%) was identified as unsuited for NCC; however, the patient population consisted of newborn males referred to pediatric urology, and thus does not represent the general population, which is expected to have a lower proportion of unsuited patients. Regardless, the Checklist has the potential to enhance the decision-making process for both urologic and non-urologic care providers. Conclusions The use of the “Checklist Assessment for Neonatal Clamp Circumcision Suitability” assessment tool improves identification of patients unsuited for NCC and thereby potentially decreases the likelihood of circumcision-related complications.

Original languageEnglish (US)
Pages (from-to)235.e1-235.e5
JournalJournal of Pediatric Urology
Volume12
Issue number4
DOIs
StatePublished - Aug 1 2016

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Checklist
Prospective Studies
Newborn Infant
Pediatrics
Urology
Advisory Committees
Patient Selection
Population
Physical Examination
Decision Making
Appointments and Schedules

Keywords

  • Clamp circumcision
  • Medical education
  • Neonatal
  • Pediatrics

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Urology

Cite this

Concodora, Charles W. ; Maizels, Max ; Dean, Gregory E. ; Weiss, Dana A. ; Alpert, Seth A. ; Edmondson, John D. ; Elder, Jack S. ; Herndon, Anthony ; Elmore, James M. ; Rychlik, Karen. / Checklist assessment tool to evaluate suitability and success of neonatal clamp circumcision : A prospective study. In: Journal of Pediatric Urology. 2016 ; Vol. 12, No. 4. pp. 235.e1-235.e5.
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title = "Checklist assessment tool to evaluate suitability and success of neonatal clamp circumcision: A prospective study",
abstract = "Background The American Academy of Pediatrics (AAP) Task Force on Circumcision has called for the development of standards of trainee proficiency in regards to evaluation and technique for neonatal clamp circumcision (NCC). At the present time, there is no standardized or general consensus on patient selection for NCC. An improved method to evaluate newborns for NCC is an important first step in this process. Therefore, the authors collaborated to identify criteria useful in the evaluation of newborns for suitability for NCC, and for assessment of success after NCC and have named it “Checklist Assessment for Neonatal Clamp Circumcision Suitability.” Methods A national multi-institutional collaboration was created to obtain consensus on objective criteria for use in determining patient suitability for NCC, and for assessing post-circumcision success outcomes. Criteria included elements from detailed medical history, bedside physical examination, and post-circumcision follow-up. Patients desiring NCC were enrolled consecutively and prospectively. The Checklist was followed to determine which newborns were suited to NCC, and NCC was done in those cases. The patients' caretakers were given post-circumcision care instructions and a follow-up appointment. Post circumcision, the Checklist was followed to determine if the procedure resulted in a successful circumcision or if there were complications. Results A total of 193 cases were enrolled prospectively and consecutively from January 2014 through October 2014. The mean age was 15 days (1–30 days). Of those 193 patients, 129 (67{\%}) were deemed suitable for circumcision and underwent NCC. Post-circumcision assessment showed a 100{\%} success rate with no complications. A total of 64 (23{\%}) cases were deemed unsuitable for NCC because at least one checklist criterion was not satisfied, most commonly: penile torsion (n = 25), chordee (n = 19), and penoscrotal webbing (n = 19). Discussion Use of the Checklist in the present study has demonstrated a method of patient screening resulting in a 100{\%} success rate with no complications. A high proportion of patients (33{\%}) was identified as unsuited for NCC; however, the patient population consisted of newborn males referred to pediatric urology, and thus does not represent the general population, which is expected to have a lower proportion of unsuited patients. Regardless, the Checklist has the potential to enhance the decision-making process for both urologic and non-urologic care providers. Conclusions The use of the “Checklist Assessment for Neonatal Clamp Circumcision Suitability” assessment tool improves identification of patients unsuited for NCC and thereby potentially decreases the likelihood of circumcision-related complications.",
keywords = "Clamp circumcision, Medical education, Neonatal, Pediatrics",
author = "Concodora, {Charles W.} and Max Maizels and Dean, {Gregory E.} and Weiss, {Dana A.} and Alpert, {Seth A.} and Edmondson, {John D.} and Elder, {Jack S.} and Anthony Herndon and Elmore, {James M.} and Karen Rychlik",
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Concodora, CW, Maizels, M, Dean, GE, Weiss, DA, Alpert, SA, Edmondson, JD, Elder, JS, Herndon, A, Elmore, JM & Rychlik, K 2016, 'Checklist assessment tool to evaluate suitability and success of neonatal clamp circumcision: A prospective study', Journal of Pediatric Urology, vol. 12, no. 4, pp. 235.e1-235.e5. https://doi.org/10.1016/j.jpurol.2016.05.028

Checklist assessment tool to evaluate suitability and success of neonatal clamp circumcision : A prospective study. / Concodora, Charles W.; Maizels, Max; Dean, Gregory E.; Weiss, Dana A.; Alpert, Seth A.; Edmondson, John D.; Elder, Jack S.; Herndon, Anthony; Elmore, James M.; Rychlik, Karen.

In: Journal of Pediatric Urology, Vol. 12, No. 4, 01.08.2016, p. 235.e1-235.e5.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Checklist assessment tool to evaluate suitability and success of neonatal clamp circumcision

T2 - A prospective study

AU - Concodora, Charles W.

AU - Maizels, Max

AU - Dean, Gregory E.

AU - Weiss, Dana A.

AU - Alpert, Seth A.

AU - Edmondson, John D.

AU - Elder, Jack S.

AU - Herndon, Anthony

AU - Elmore, James M.

AU - Rychlik, Karen

PY - 2016/8/1

Y1 - 2016/8/1

N2 - Background The American Academy of Pediatrics (AAP) Task Force on Circumcision has called for the development of standards of trainee proficiency in regards to evaluation and technique for neonatal clamp circumcision (NCC). At the present time, there is no standardized or general consensus on patient selection for NCC. An improved method to evaluate newborns for NCC is an important first step in this process. Therefore, the authors collaborated to identify criteria useful in the evaluation of newborns for suitability for NCC, and for assessment of success after NCC and have named it “Checklist Assessment for Neonatal Clamp Circumcision Suitability.” Methods A national multi-institutional collaboration was created to obtain consensus on objective criteria for use in determining patient suitability for NCC, and for assessing post-circumcision success outcomes. Criteria included elements from detailed medical history, bedside physical examination, and post-circumcision follow-up. Patients desiring NCC were enrolled consecutively and prospectively. The Checklist was followed to determine which newborns were suited to NCC, and NCC was done in those cases. The patients' caretakers were given post-circumcision care instructions and a follow-up appointment. Post circumcision, the Checklist was followed to determine if the procedure resulted in a successful circumcision or if there were complications. Results A total of 193 cases were enrolled prospectively and consecutively from January 2014 through October 2014. The mean age was 15 days (1–30 days). Of those 193 patients, 129 (67%) were deemed suitable for circumcision and underwent NCC. Post-circumcision assessment showed a 100% success rate with no complications. A total of 64 (23%) cases were deemed unsuitable for NCC because at least one checklist criterion was not satisfied, most commonly: penile torsion (n = 25), chordee (n = 19), and penoscrotal webbing (n = 19). Discussion Use of the Checklist in the present study has demonstrated a method of patient screening resulting in a 100% success rate with no complications. A high proportion of patients (33%) was identified as unsuited for NCC; however, the patient population consisted of newborn males referred to pediatric urology, and thus does not represent the general population, which is expected to have a lower proportion of unsuited patients. Regardless, the Checklist has the potential to enhance the decision-making process for both urologic and non-urologic care providers. Conclusions The use of the “Checklist Assessment for Neonatal Clamp Circumcision Suitability” assessment tool improves identification of patients unsuited for NCC and thereby potentially decreases the likelihood of circumcision-related complications.

AB - Background The American Academy of Pediatrics (AAP) Task Force on Circumcision has called for the development of standards of trainee proficiency in regards to evaluation and technique for neonatal clamp circumcision (NCC). At the present time, there is no standardized or general consensus on patient selection for NCC. An improved method to evaluate newborns for NCC is an important first step in this process. Therefore, the authors collaborated to identify criteria useful in the evaluation of newborns for suitability for NCC, and for assessment of success after NCC and have named it “Checklist Assessment for Neonatal Clamp Circumcision Suitability.” Methods A national multi-institutional collaboration was created to obtain consensus on objective criteria for use in determining patient suitability for NCC, and for assessing post-circumcision success outcomes. Criteria included elements from detailed medical history, bedside physical examination, and post-circumcision follow-up. Patients desiring NCC were enrolled consecutively and prospectively. The Checklist was followed to determine which newborns were suited to NCC, and NCC was done in those cases. The patients' caretakers were given post-circumcision care instructions and a follow-up appointment. Post circumcision, the Checklist was followed to determine if the procedure resulted in a successful circumcision or if there were complications. Results A total of 193 cases were enrolled prospectively and consecutively from January 2014 through October 2014. The mean age was 15 days (1–30 days). Of those 193 patients, 129 (67%) were deemed suitable for circumcision and underwent NCC. Post-circumcision assessment showed a 100% success rate with no complications. A total of 64 (23%) cases were deemed unsuitable for NCC because at least one checklist criterion was not satisfied, most commonly: penile torsion (n = 25), chordee (n = 19), and penoscrotal webbing (n = 19). Discussion Use of the Checklist in the present study has demonstrated a method of patient screening resulting in a 100% success rate with no complications. A high proportion of patients (33%) was identified as unsuited for NCC; however, the patient population consisted of newborn males referred to pediatric urology, and thus does not represent the general population, which is expected to have a lower proportion of unsuited patients. Regardless, the Checklist has the potential to enhance the decision-making process for both urologic and non-urologic care providers. Conclusions The use of the “Checklist Assessment for Neonatal Clamp Circumcision Suitability” assessment tool improves identification of patients unsuited for NCC and thereby potentially decreases the likelihood of circumcision-related complications.

KW - Clamp circumcision

KW - Medical education

KW - Neonatal

KW - Pediatrics

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