S257 – Complications in Pediatric Adenoidectomy

Objectives 1) To determine the rate of complication following adenoidectomy without tonsillectomy. 2) To determine how the rate of complication varies between pediatric patients under 36 months of age and those from 37 months to 17 years. Methods The charts of 253 patients ages 6 months to 17 years who underwent adenoidectomy without associated tonsillectomy between July 2003 and January 2007 at the Hershey Medical Center were reviewed for any complication following the procedure. Comparison was made between the group under 36 months of age and the group older than 36 months. Results At least 1 complication was encountered in 24.9% of the patients. However, complications requiring extra attention such as a prolonged hospital stay or visit to the emergency department affected only 6.32% of the patients. The most common intra-operative complications was lip abrasion, the most common early post-operative one was fever, and the most common late complication was a diagnosis of otitis media. No statistically significant difference in the rates of complications was seen between patients under 36 months of age vs. those over. Conclusions Though the rate of complications due to adenoidectomy is fairly high, the rate of more serious complications is low. There is no statistically significant difference in rate of complication between the age groups studied.

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Point-of-Care Ultrasound-Directed Evaluation of Elbow Effusion

Clinical Practice and Cases in Emergency Medicine ◽

10.5811/cpcem.2019.5.41674 ◽

2019 ◽

Vol 3 (3) ◽

pp. 286-288

Author(s):

Peter Patitsas ◽

Richard Davis ◽

Robert Strony

Keyword(s):

Emergency Department ◽

Best Practices ◽

Point Of Care ◽

Robotic Prostatectomy ◽

Point Of Care Ultrasound ◽

Prolonged Hospital Stay ◽

Ultrasound Guided ◽

The Right ◽

Department Evaluation ◽

Prolonged Hospital

A 53-year-old male presented with pain in the right elbow that was sudden in onset and progressively worsening over approximately eight hours. The pain was exacerbated with any movement of the elbow. Of note, he had been recently admitted for robotic prostatectomy and had a prolonged hospital stay requiring a course of antibiotics. This case report details the emergency department evaluation of septic arthritis of the elbow with a focus on best practices for ultrasound- guided elbow arthrocentesis.

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DEFINING A SAFE ZONE FOR ALL INSIDE LATERAL MENISCUS REPAIRS IN PEDIATRIC PATIENTS: A MAGNETIC RESONANCE IMAGING STUDY

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00170 ◽

2019 ◽

Vol 7 (3_suppl) ◽

pp. 2325967119S0017

Author(s):

Jennifer Beck ◽

Kendall Shifflett ◽

Danielle Greg ◽

Edward Ebramzadeh ◽

Richard E. Bowen

Keyword(s):

Pediatric Patients ◽

Age Groups ◽

Lateral Meniscus ◽

Safe Zone ◽

Neurovascular Bundle ◽

Posterior Horn ◽

Popliteus Tendon ◽

Anterior Edge ◽

Group I ◽

Significant Difference

Purpose All-inside posterior horn lateral meniscal (PHLM) repair puts the popliteal neurovascular bundle (PVNB) at risk of injury by meniscal repair devices. The purpose of this study was to establish a safe zone of all-inside meniscal fixation in pediatric patients using MRI measurements between the popliteus tendon (PT) and popliteal neurovascular bundle (PNVB). We hypothesize that males and older age groups will have a larger distance between PT and PNVB. Methods Axial MRIs of 250 pediatric (5-16 yrs.) patients were retrospectively reviewed. Patients were grouped by age: group I (5-7yrs.): 61; II (8-10yrs.): 59; III (11-13yrs.): 60; IV (14-16yrs.): 70. At the level of the lateral meniscus, two lines starting at the lateral patella tendon border ending at the medial edge of the PT (D1) and the lateral edge of the PNVB (D2) were made on an axial knee MRI. D3 connected D1 to D2 at the meniscocapsular junction of the PHLM. D4 was derived geometrically, parallel and 8 mm anterior to D3 simulating the anterior edge of the PHLM. Results Analysis showed significant correlation between age and sex for D3 (p<0.0001). For D3, there were significant differences among all age groups, except between groups III and IV. Average (STD) D3 for age groups was: 14.1mm(3.1), 15.8(2.5), 17.0(3.3), 17.2(3.1). For D4, the average (STD) was: 11.9 mm(2.9); 13.9(2.5); 15.4(3.0); 15.2(2.9). There was significant difference in D3 and D4 in males versus females (17.6 vs 15.7 mm; p <0.001; 14.9 vs 13.2; p <0.001), particularly in III and IV (17.0 vs 13.8 and 16.8 vs 13.9). Conclusions This study provides normative data of the distance between popliteal neurovascular bundle and popliteus tendon at the meniscocapsular junction (D3) and anterior edge of the posterior horn lateral meniscus (D4) with the knee in full extension. Combined with previous studies showing the addition of knee flexion increases the distance between the meniscus and the neurovascular bundle, surgeons can use this data to improve safety of posterior horn lateral meniscus repair in pediatric patients.

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Clinical and follow-up study of bronchiolitis obliterans in pediatric patients in China

European Journal of Inflammation ◽

10.1177/1721727x17733392 ◽

2017 ◽

Vol 15 (3) ◽

pp. 152-159 ◽

Cited By ~ 1

Author(s):

Li Huang ◽

Yaping Xie ◽

Huifeng Fan ◽

Gen Lu ◽

Jialu Yu ◽

...

Keyword(s):

Risk Factors ◽

Bronchiolitis Obliterans ◽

Pediatric Patients ◽

Medical Center ◽

Pulmonary Function Tests ◽

Age At Onset ◽

Airflow Obstruction ◽

High Resolution Computed Tomography ◽

Significant Difference ◽

Post Infectious

Bronchiolitis obliterans (BO) is in general a rare and life-threatening form of non-reversible obstructive lung disease in which the bronchioles are compressed and narrowed by fibrosis and/or inflammation. The purpose of this study was to evaluate the clinical features of BO in pediatric patients and explore its risk factors. The medical records of 35 pediatric patients with BO at Guangzhou Women and Children’s Medical Center were evaluated. The age at onset of symptoms was 2–42 months (mean 13.3 ± 8.9 months), with age at diagnosis of 5 months–4 years (mean 17.8 ± 9.0 months). High-resolution computed tomography findings included mosaic pattern (100%), atelectasis (37.1%), air trapping (31.4%), and bronchiectasis (20.0%). Three patients received lung biopsies and mainly exhibited an inflammatory process surrounding the lumen of bronchioles. BO predominantly resulted from post-infectious causes (91.4%) which were primarily caused by adenovirus (50%), followed by Mycoplasma pneumoniae (46.7%) and influenza (20%). Pulmonary function tests (PFTs) showed severe and fixed airflow obstruction, decreased compliance, and increased resistance. No significant difference was found between before and after steroid treatment ( P > 0.05). Two patients died owing to severe pulmonary complications, one of whom had inherent immunodeficiency. Our study suggests that the occurrence of BO, especially post-infectious BO, in China is relatively high and might result from primary immunodeficiency diseases in severe cases. Recurrent aspiration pneumonia caused by congenital dysplasia of the larynx and vaccination not on schedule might be potential risk factors for persistent and recurrent BO.

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Incidence of bleeding in children undergoing circumcision with ketorolac administration

Canadian Urological Association Journal ◽

10.5489/cuaj.4632 ◽

2017 ◽

Vol 12 (1) ◽

pp. E6-9 ◽

Cited By ~ 1

Author(s):

Bruce Gao ◽

Taylor Remondini ◽

Navraj Dhaliwal ◽

Adrian Frusescu ◽

Premal Patel ◽

...

Keyword(s):

Emergency Department ◽

Adverse Effects ◽

Pain Control ◽

Pediatric Patients ◽

Surgical Patients ◽

Risk Of Bleeding ◽

Perioperative Bleeding ◽

Number Of Patients ◽

Increased Risk ◽

Significant Difference

Introduction: Circumcision is the most common surgical procedure performed by pediatric urologists. Ketorolac has been shown to have an efficacy similar to morphine in multimodal analgesic regimens without the commonly associated adverse effects. Concerns with perioperative bleeding limit the use of ketorolac as an adjunct for pain control in surgical patients. As such, we sought to evaluate our institutional outcomes with respect to ketorolac and postoperative bleeding.Methods: We retrospectively reviewed all pediatric patients undergoing circumcision from January 1, 2014 to December 31, 2015 at the Alberta Children’s Hospital. Demographics, perioperative analgesic regimens, and return to emergency department or clinic for bleeding were gathered through chart review.Results: A total of 475 patients undergoing circumcisions were studied, including 150 (32%) who received perioperative ketorolac and 325 (68%) who received standard analgesia. Patients receiving ketorolac were more likely to return to the emergency department or clinic for bleeding (ketorolac group 19/150 [13%], non-ketorolac group 16/325 [5.0%]; p=0.005). Patients receiving ketorolac were more likely to have postoperative sanguineous drainage (ketorolac group 96/150 [64%], non-ketorolac group 150/325 [46%]; p<0.001). There was no significant difference in the number of patients requiring postoperative admission or further medical intervention.Conclusions: Although a promising analgesic, ketorolac requires additional investigation for safe usage in circumcisions due to possible increased risk of bleeding.

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Estimating the Entrance Surface Dose in the Eyes, Thyroid, and Parotid Gland Regions in Adult and Pediatric Groups: A Cone-Beam Computed Tomography Technique

Frontiers in Biomedical Technologies ◽

10.18502/fbt.v9i1.8139 ◽

2021 ◽

Author(s):

Reza Omidi ◽

Fariba Farhadi Birgani ◽

Ali Asghar Parach ◽

Hamed Zamani ◽

Saman Dalvand ◽

...

Keyword(s):

Computed Tomography ◽

Parotid Gland ◽

Cone Beam Computed Tomography ◽

Pediatric Patients ◽

Age Groups ◽

Cone Beam ◽

Surface Dose ◽

Parotid Glands ◽

Entrance Surface Dose ◽

Significant Difference

Purpose: This study aimed to determine the Entrance Surface Dose (ESD) of sensitive organs in Cone-Beam Computed Tomography (CBCT) imaging of the maxillofacial region in the two age groups of adult and pediatric. Materials and Methods: In this work, the measurements were performed using Thermo Luminescent Dosimeters (TLD-GR200). The imaging was performed using a PROMAX 3D CBCT scanner for 30 adults and 20 pediatric patients. The ESD value for each patient in the region of eyes, thyroid, and parotid glands was measured by 15 TLDs during CBCT of maxillofacial. Results: The highest and lowest mean values of ESDs were related to the parotid and thyroid gland regions in adults, 4.77 ± 0.61 mGy and 0.37 ± 0.16 mGy, respectively. In addition, these values were obtained 2.97 ± 0.36 mGy and 0.35 ± 0.12 mGy in pediatric groups as the highest and lowest values in that order. The results showed that the ESD values of the parotid gland regions in maxilla and mandible examinations had a significant difference (P <0.05). In addition, there was a significant difference between the ESD values of the parotid gland regions among the adults and pediatric groups (P <0.05). Conclusion: According to the results, the ESD values in both age groups were higher in the parotid gland region during maxillofacial CBCT examinations. Therefore, it is recommended to set radiation parameters like mAs as low as possible for reducing the patient dose, especially pediatric patients due to the more sensitive organs.

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Aprepitant and Fosaprepitant Use in Children and Adolescents at an Academic Medical Center

The Journal of Pediatric Pharmacology and Therapeutics ◽

10.5863/1551-6776-19.2.127 ◽

2014 ◽

Vol 19 (2) ◽

pp. 127-131 ◽

Cited By ~ 3

Author(s):

Alexandra Shillingburg ◽

Lisa Biondo

Keyword(s):

Children And Adolescents ◽

Pediatric Patients ◽

Medical Center ◽

Academic Medical Center ◽

Retrospective Chart Review ◽

Primary Prophylaxis ◽

Emetogenic Chemotherapy ◽

Record System ◽

Patients Âgés ◽

Academic Medical

OBJECTIVE: To describe the use of aprepitant and fosaprepitant, a neurokinin 1 (NK-1) receptor inhibitor, in children and adolescents at a large academic medical center, for the prevention and management of chemotherapy-induced nausea and vomiting (CINV). METHODS: A retrospective chart review was conducted using an electronic medical record system to evaluate the use of aprepitant and fosaprepitant in all pediatric patients that were discharged from a single academic medical center between February 25, 2009 and May 25, 2012. RESULTS: Twenty-six patients were included in this review and received a total of 287 doses over the span of 114 cycles. Mean age was 10.1 years, with a range of 11 months to 17 years old. In 16 of 26 patients, aprepitant was used as the primary prophylaxis. Of those patients who received primary prophylaxis, 6 of 16 received it for highly emetogenic chemotherapy, and 10 of 16 received it for moderately emetogenic chemotherapy. Intravenous fosaprepitant was used in 7 of 26 patients, ages 13 to 17 (median 14) years old. No adverse effects attributable to aprepitant were reported. CONCLUSIONS: Use of aprepitant and fosaprepitant in pediatric patients appeared to be well tolerated. No currently published reports data using aprepitant in a patient younger than 32 months old, whereas we reported its use in patients as young as 11 months old.

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LO039: The effect of desaturations on subsequent medical visits in infants discharged from the emergency department with bronchiolitis

CJEM ◽

10.1017/cem.2016.76 ◽

2016 ◽

Vol 18 (S1) ◽

pp. S43-S43

Author(s):

T. Principi ◽

A. Coates ◽

P. Parkin ◽

D. Stephens ◽

Z. DaSilva ◽

...

Keyword(s):

Emergency Department ◽

Primary Outcome ◽

Tertiary Care ◽

Pediatric Emergency ◽

Acute Bronchiolitis ◽

Prolonged Hospital Stay ◽

Rates Of Return ◽

Medical Visits ◽

Emergency Department Discharge ◽

Prolonged Hospital

Introduction: Bronchiolitis is the most common lower respiratory tract infection among infants, characterized by wheeze and respiratory distress. Reliance on pulse oximetry has been associated with increased hospitalizations, prolonged hospital stay and escalation of care. The objectives were to determine if there is a difference in the proportion of unscheduled medical visits within 72 hours of emergency department discharge in infants with bronchiolitis who desaturate to <90% for at least one minute during home oximetry monitoring versus those without desaturations. Methods: This is a prospective cohort study from 2008 to 2013 enrolling 118 otherwise healthy infant aged 6 weeks to 12 months discharged home from a tertiary care pediatric emergency department with a diagnosis of acute bronchiolitis. The primary outcome was unscheduled medical visits for bronchiolitis, a visit to any health care provider due to concerns about respiratory symptoms, within 72 hours of discharge in infants with and without desaturations. Secondary outcomes included examination of the severity and duration of the desaturations, delayed hospitalizations within 72 hours of discharge and the effect of activity on desaturations. Results: During a mean monitoring period of 19 hours, 75/118 (64%) infants had at least one desaturation event (median continuous duration 3.4 minutes). 59/118 infants (50%) had at least 3 desaturations, 12 (10%) desaturated for >10% monitored time and 51(43%) had desaturations lasting ≥ 3 minutes continuously. 59/118 (50%) infants desaturated to ≤ 80% and 29 (24%) to ≤ 70% for ≥ 1 minute. A total 18/75 infants with desaturations (24.0%) had an unscheduled visit for bronchiolitis versus 11/43 of their non-desaturating counterparts (25.6%) [Difference - 1.6%; 95%CI -0.15 to ∞, p=0.66]. One of 75 desaturating infants (1.3%) and 2/43 (4.6%) of those without desaturations were hospitalized within 72 hours [Difference of -3.3%; 95% CI -0.04 to 0.10, p = 0.27]. Seventy seven percent of infants with desaturations experienced them during sleep or while feeding. Conclusion: The majority of infants with mild bronchiolitis experienced recurrent or sustained desaturations after discharge home. Children with and without desaturations had comparable rates of return for care, with no difference in unscheduled return medical visits and delayed hospitalizations.

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Use of Maximum Surgical Order Schedule (MSBOS) among pediatric patients to optimize blood utilization

Annals of Pediatric Surgery ◽

10.1186/s43159-019-0005-9 ◽

2019 ◽

Vol 15 (1) ◽

Author(s):

Johann Paulo S. Guzman ◽

Leandro L. Resurreccion ◽

Maria Beatriz P. Gepte

Keyword(s):

Surgical Procedures ◽

Pediatric Patients ◽

Medical Center ◽

Adult Population ◽

Age Groups ◽

Subsequent Development ◽

Cross Sectional Study ◽

Utilization Rate ◽

Cross Sectional ◽

Blood Utilization

Abstract Background Evaluating blood ordering and subsequent development of a blood ordering schedule can decrease over-ordering of blood among pediatric surgical patients. The objective is to assess our practice of blood utilization using various blood utilization indices and calculate the Maximal Surgical Blood Order Schedule (MSBOS). This is a cross-sectional study for 3 years that included patients (≤ 18 years old) who underwent major surgical procedures in the Philippine Children’s Medical Center. Data included type of surgery, age and sex, number of units crossmatched, number of units transfused, and timing of transfusion. Indices were calculated. Results This study revealed that the utilization rate was only 39.1% of blood among a total of 5314 cases done. The indices were analyzed according to different procedures among different age groups. Procedures for head and neck, colorectal, ostomy, solid tumors, genitourinary abnormalities, upper gastrointestinal, and appendectomy had CT (crossmatched to transfusion) ratio exceeding 2.0, indicating inappropriate blood ordering. Major abdominal, major thoracic, and hepatobiliary surgery all have CT ratio < 2.0. MSBOS was calculated, and a requisition of 1 unit of blood among patients undergoing these procedures is suggested. Conclusions The MSBOS is largely utilized to the adult population but its creation can also be utilized among pediatric patients. Our data shows that in majority of elective pediatric surgical procedures, routine crossmatch is not necessary which is proven by our high underutilization of requested blood products.

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