scholarly journals Self-Reported Complications after Tonsillectomy: Comparison of Responders and Nonresponders to a Mailed Questionnaire

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Rolf Haye ◽  
Liv Kari Døsen ◽  
Caryl Gay ◽  
Magnus TarAngen ◽  
Olga Shiryaeva
Keyword(s):  
Hospital Readmission ◽  
Pediatric Patients ◽  
Response Rate ◽  
Response Rates ◽  
Private Practitioner ◽  
Adult Patients ◽  
Complication Rates ◽  
Private Practitioners ◽  
Telephone Interviews ◽  
Total Response Rate

Some studies of tonsillectomy outcomes have low response rates to mailed quality control questionnaires. This study evaluated the effect of nonresponders to mailed questionnaires about posttonsillectomy complications by determining whether mail responders and nonresponders differ. Questionnaires were mailed to patients 3–6 weeks after tonsillectomy to assess postoperative complications, defined as contact with a private practitioner and/or hospital readmission related to postsurgical bleeding, pain, or infection. Nonresponders to the mailed questionnaire were interviewed by telephone 7–11 weeks postoperatively, and responses of mail and telephone responders were compared. Of 818 patients undergoing tonsillectomy during the study period, 66.3% responded by mail, and 29.5% were interviewed by telephone, for a total response rate of 95.7%. The mail response rate was significantly higher among parents of pediatric patients than among adult patients (71.4% versus 58.7%, p<0.001). In the pediatric group, overall complication rates were 65% higher among mail responders than telephone responders (20.9% versus 12.7%, p=0.049), likely due to their higher rates of both visits to private practitioners and infection, as there were no differences in rates of pediatric readmission, bleeding, or pain between the responder groups. Among adult patients, mail and telephone responders did not differ with respect to their overall complication rate (40.9% versus 34.1%, p=0.226) or their rates of readmission or bleeding. However, similar to the pediatric group, visits to a private practitioner were slightly more common among adult mail responders than telephone responders (30.6% versus 21.1%, p=0.065), as were reports of pain (p=0.001) and infection (p=0.006). Studies relying on mailed questionnaires with low response rates likely overestimate the rate of minor complications handled outside the hospital, but rates of major complications involving readmission are unlikely to be seriously biased by low response rates. Supplementing mailed questionnaires with telephone interviews may increase the validity of surgical outcome studies.

A Comparison between Pediatric and Adult Patients after Cranioplasty: Aseptic Bone Resorption Causes Earlier Revision in Children

2019 ◽  
Vol 81 (03) ◽  
pp. 227-232 ◽  
Author(s):  
Jennifer Göttsche ◽  
Friederike Fritzsche ◽  
Gertrud Kammler ◽  
Thomas Sauvigny ◽  
Manfred Westphal ◽  
...  
Keyword(s):  
Risk Factor ◽  
Bone Resorption ◽  
Pediatric Patients ◽  
Young Age ◽  
Adult Patients ◽  
Bone Flap ◽  
Complication Rates ◽  
Bone Flap Resorption ◽  
Number Of Patients ◽  
Autologous Bone

Abstract Background and Study Aims/Objective Cranioplasty, a common neurosurgical intervention following decompressive craniectomy (DC), is associated with high complication rates. Bone flap resorption in particular leads to a considerable number of patients requiring further surgery. The aim of this study was to investigate the frequency and time of occurrence of complications following cranioplastic procedures in children and adults. Material and Methods Data of children and adults who underwent cranioplasty between July 2010 and March 2018 were analyzed retrospectively. Clinical data, complications, and risk factors regarding aseptic bone resorption (ABR) were evaluated including patient age, occurrence of shunt-dependent hydrocephalus, and number of fragments in autologous bone flaps. Results Severe traumatic brain injury (TBI) was the leading cause for DC among children (66.7%), associated with a significantly higher number of fragments (p = 0.002). In the adult population, the most common cause was malignant infarction (55.9%) followed by TBI (24.6%). Pediatric patients in our institution received autologous bone flaps less frequently than adult patients (61.1% and 83.1%, respectively). Young age and a higher number of fragments in autologous bone flaps were associated with the occurrence of ABR. Children and adolescents showed significantly higher rates of aseptic bone necrosis (p = 0.007) and revision cranioplasty (p = 0.036). Kaplan-Meier estimates were used to further analyze bone flap resorption in children and adults, showing that revision surgery due to ABR was performed earlier in children (p = 0.001, log-rank test). Conclusion Pediatric patients demand specific care when cranioplasty is performed following DC. We identified age as an independent risk factor. The higher number of fragments appears to be a correlation due to the higher number of TBIs in children. Our data indicate that young age is the most important risk factor for the development of ABR as a frequent and early complication with a shorter revision-free time interval in children. Consequently, the uncritical use of cryopreserved autologous bone flaps should be questioned in this population.

Short-term Complications Associated With Surgery for High-Grade Spondylolisthesis in Adults and Pediatric Patients

Neurosurgery ◽  
2012 ◽  
Vol 71 (1) ◽  
pp. 109-116 ◽  
Author(s):  
Manish K. Kasliwal ◽  
Justin S. Smith ◽  
Christopher I. Shaffrey ◽  
Dwight Saulle ◽  
Lawrence G. Lenke ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Pediatric Patients ◽  
Case Reports ◽  
Case Series ◽  
Adult Patients ◽  
Neurological Deficits ◽  
Low Grade ◽  
Complication Rates ◽  
High Grade ◽  
Short Term

Abstract BACKGROUND: Although it is generally agreed upon that surgery for high-grade spondylolisthesis (HGS) is associated with more complications than low-grade spondylolisthesis, its description is primarily based on case reports and relatively small case series. OBJECTIVE: To assess short-term complication rates associated with the surgical treatment of HGS in pediatric and adult patients and to identify factors associated with increased complication rates. METHODS: All cases of HGS from the Scoliosis Research Society Morbidity and Mortality database for the year 2007 were reviewed. Patients were classified as pediatric (⩽18 years) or adult (&gt;18 years). Complications were tabulated, and the rates were compared between the patient groups and based on clinical and surgical factors. RESULTS: 165 cases of HGS were reported (88 pediatric, 77 adult). There were 49 complications (29.7%) in 41 patients (24.8%), with no difference in the proportions of pediatric vs adult patients with a complication (P = .86). Occurrence of new neurological deficit after surgery was the most common complication, seen in 19 (11.5%) patients. Performance of an osteotomy was associated with a higher incidence of new neurological deficits in both adult and pediatric groups (P = .02 and P = .012, respectively). Although most of the new neurological deficits improved over follow-up, 10% had no improvement. CONCLUSION: This study provides short-term complication rates associated with surgical treatment for HGS in adult and pediatric patients and may prove valuable for patient counseling, surgical planning, and in efforts to improve the safety of patient care.

scholarly journals Comparison of Intracranial Neuroendoscopic Procedures in Children versus Adults

2015 ◽  
Vol 42 (6) ◽  
pp. 427-435 ◽  
Author(s):  
Fady Girgis ◽  
Roberto Diaz ◽  
Walter Hader ◽  
Mark Hamilton
Keyword(s):  
Pediatric Patients ◽  
Endoscopic Third Ventriculostomy ◽  
Adult Population ◽  
Major Complication ◽  
Adult Patients ◽  
Therapeutic Modality ◽  
Third Ventriculostomy ◽  
Complication Rates ◽  
Common Procedure

AbstractBackground:The emphasis regarding intracranial neuroendoscopy has been traditionally advocated and focused on the role in pediatric patients, although a significant usage has developed in adult patients. In this study, we examine and contrast the role of predominantly intracranial neuroendoscopy in both a pediatric and adult population with a minimum postprocedure follow-up of 5 years.Methods:A retrospective review was conducted for patients in the two hospitals that manage neurosurgical care for Southern Alberta, Canada, undergoing neuroendoscopic surgery between 1994 and 2008. The pediatric group was defined as age ≤17 years and the adult group as age ≥18 years.Results:A total of 273 patients who underwent a total of 330 procedures with a mean postprocedure follow-up of 12.9 years were identified. There were 161 adult and 112 pediatric patients, and both groups underwent surgery by the same surgeons. The most common procedure was endoscopic third ventriculostomy, accounting for 55% of procedures. One postoperative death occurred in an adult patient. Endoscopic third ventriculostomy success 1-year postprocedure was 81%, with only three late-term failures. Postoperative infection was the most common serious complication (two pediatric/four adult patients). Adult and pediatric patients had similar major complication rates (4.2% vs 5.7%, p=0.547).Conclusions:Neuroendoscopy overall had a similar role in both pediatric and adult neurosurgical populations, with the most commonly associated complication being infection. Neuroendoscopy is an important therapeutic modality in the management of appropriate adult patients.

Comparing face-to-face to web data collection: unit response and costs in a national health survey (Preprint)

2020 ◽  
Author(s):  
Elise Braekman ◽  
Stefaan Demarest ◽  
Rana Charafeddine ◽  
Sabine Drieskens ◽  
Finaba Berete ◽  
...  
Keyword(s):  
Data Collection ◽  
Response Rate ◽  
Response Rates ◽  
Demographic Characteristics ◽  
Unit Response ◽  
Cost Advantage ◽  
Web Data ◽  
Demographic Groups ◽  
Considerable Cost ◽  
The Difference

BACKGROUND Potential is seen in web data collection for population health surveys due to a combination of its cost-effectiveness, implementation ease and the increased internet penetration. Nonetheless, web modes may lead to lower and more selective unit response rates than traditional modes and hence may increase bias in the measured indicators. OBJECTIVE This research assesses the unit response and costs of a web versus F2F study. METHODS Alongside the F2F Belgian Health Interview Survey of 2018 (BHIS2018; n gross sample used: 7,698), a web survey (BHISWEB; n gross sample=6,183) is organized. Socio-demographic data on invited individuals is obtained from the national register and census linkages. Unit response rates considering the different sampling probabilities of both surveys are calculated. Logistic regression analyses examine the association between mode system (web vs. F2F) and socio-demographic characteristics on unit non-response. The costs per completed web questionnaire are compared with these for a completed F2F questionnaire. RESULTS The unit response rate is lower in BHISWEB (18.0%) versus BHIS2018 (43.1%). A lower web response is found among all socio-demographic groups, however, the difference is higher among people older than 65, low educated people, people with a non-Belgian nationality, people living alone and these living in Brussels Capital. Not the same socio-demographic characteristics are associated with non-response in both studies. Having another European (OR (95% CI): 1.60 (1.20-2.13)) or a non-European nationality (OR (95% CI): 2.57 (1.79-3.70)) (compared to having the Belgian nationality) and living in the Brussels Capital (95% CI): 1.72 (1.41-2.10)) or Walloon (OR (95% CI): 1.47 (1.15 - 1.87) region (compared to living in the Flemish region) is only in BHISWEB associated with a higher non-response. In BHIS2018 younger people (OR (95% CI): 1.31 (1.11-1.54)) are more likely to be non-respondent than older people, this was not found BHISWEB. In both studies, lower educated people have a higher change to be non-respondent, but this effect is more pronounced in BHISWEB (OR low vs. high education level (95% CI): Web 2.71 (2.21-3.39)); F2F 1.70 (1.48-1.95)). The BHISWEB study has a considerable cost advantage; the total cost per completed questionnaire is almost three times lower (€41) compared to the F2F data collection (€111). CONCLUSIONS The F2F unit response rate is generally higher, yet for certain groups the difference between web versus F2F is more limited. A considerable cost advantage of web collection is found. It is therefore worthwhile to experiment with adaptive mixed-mode designs to optimize financial resources without increasing selection bias; e.g. only inviting socio-demographic groups more eager to participate online for web surveys while remaining to focus on increasing the F2F response rates for other groups. CLINICALTRIAL Studies approved by the Ethics Committee of the University hospital of Ghent

Non-Pediatric Nurses’ Willingness to Provide Care to Pediatric Patients during a Disaster: An Assessment of Pediatric Surge Capacity in Four Midwestern Hospitals

2021 ◽  
pp. 1-6
Author(s):  
Terri Rebmann ◽  
Rachel L. Charney ◽  
Rebecca L. Eschmann ◽  
M. Colleen Fitzpatrick
Keyword(s):  
Pediatric Patients ◽  
Response Rate ◽  
Mass Casualty ◽  
Pediatric Care ◽  
Pediatric Nurses ◽  
Surge Capacity ◽  
Factors Associated ◽  
Pediatric Hospitals ◽  
Survey Response Rate ◽  
Mass Casualty Event

Abstract Objective: To assess non-pediatric nurses’ willingness to provide care to pediatric patients during a mass casualty event (MCE). Methods: Nurses from 4 non-pediatric hospitals in a major metropolitan Midwestern region were surveyed in the fall of 2018. Participants were asked about their willingness to provide MCE pediatric care. Hierarchical logistical regression was used to describe factors associated with nurses’ willingness to provide MCE pediatric care. Results: In total, 313 nurses were approached and 289 completed a survey (response rate = 92%). A quarter (25.3%, n = 73) would be willing to provide MCE care to a child of any age; 12% (n = 35) would provide care only to newborns in the labor and delivery area, and 16.6% (n = 48) would only provide care to adults. Predictors of willingness to provide care to a patient of any age during an MCE included providing care to the youngest-age children during routine duties, reporting confidence in calculating doses and administering pediatric medications, working in the emergency department, being currently or previously certified in PALS, and having access to pediatric-sized equipment in the unit or hospital. Conclusion: Pediatric surge capacity is lacking among nurses. Increasing nurses’ pediatric care self-efficacy could improve pediatric surge capacity and minimize morbidity and mortality during MCEs.

scholarly journals Macrophage Activation Syndrome in Adults: A Retrospective Case Series

2021 ◽  
Vol 9 ◽  
pp. 232470962110264
Author(s):  
Taylor Warmoth ◽  
Malvika Ramesh ◽  
Kenneth Iwuji ◽  
John S. Pixley
Keyword(s):  
Macrophage Activation Syndrome ◽  
Macrophage Activation ◽  
Pediatric Patients ◽  
Inflammatory Diseases ◽  
Systemic Juvenile Idiopathic Arthritis ◽  
Case Series ◽  
Adult Patients ◽  
Retrospective Case ◽  
Life Threatening ◽  
Activation Syndrome

Macrophage activation syndrome (MAS) is a form of hemophagocytic lymphohistocytosis that occurs in patients with a variety of inflammatory rheumatologic conditions. Traditionally, it is noted in pediatric patients with systemic juvenile idiopathic arthritis and systemic lupus erythematous. It is a rapidly progressive and life-threatening syndrome of excess immune activation with an estimated mortality rate of 40% in children. It has become clear recently that MAS occurs in adult patients with underlying rheumatic inflammatory diseases. In this article, we describe 6 adult patients with likely underlying MAS. This case series will outline factors related to diagnosis, pathophysiology, and review present therapeutic strategies.

scholarly journals CGRP-antibodies, topiramate and botulinum toxin type A in episodic and chronic migraine: A systematic review and meta-analysis

Cephalalgia ◽  
2021 ◽  
pp. 033310242110181
Author(s):  
Florian Frank ◽  
Hanno Ulmer ◽  
Victoria Sidoroff ◽  
Gregor Broessner
Keyword(s):  
Systematic Review ◽  
Monoclonal Antibodies ◽  
Botulinum Toxin ◽  
Response Rate ◽  
Meta Analysis ◽  
Botulinum Toxin Type A ◽  
Type A ◽  
Response Rates ◽  
Botulinum Toxin Type ◽  
Odds Ratios

Background The approval of monoclonal antibodies for prevention of migraine has revolutionized treatment for patients. Oral preventatives are still considered first line treatments as head-to-head trials comparing them with antibodies are lacking. Methods The main purpose of this study was to provide a comparative overview of the efficacy of three commonly prescribed migraine preventative medication classes. For this systematic review and meta-analysis, we searched the databases CENTRAL, EMBASE, and MEDLINE until 20 March 2020. We included RCTs reporting the 50% response rates for topiramate, Botulinum Toxin Type A and monoclonal antibodies against CGRP(r). Studies were excluded if response rates were not reported, treatment allocation was unclear, or if study quality was insufficient. Primary outcome measure were the 50% response rates. The pooled odds ratios with 95% confidence intervals were calculated with the random effects model. The study was registered at PROSPERO (CRD42020222880). Findings We identified 6552 reports. Thirty-two were eligible for our review. Studies assessing monoclonal antibodies included 13,302 patients and yielded pooled odds ratios for the 50% response rate of 2.30 (CI: 2.11–2.50). Topiramate had an overall effect estimate of 2.70 (CI: 1.97–3.69) with 1989 included patients and Botulinum Toxin Type A achieved 1.28 (CI: 0.98–1. 67) with 2472 patients included. Interpretation Topiramate, botulinum toxin type A and monoclonal antibodies showed higher odds ratios in achieving a 50% response rate compared to placebo. Topiramate numerically demonstrated the greatest effect size but also the highest drop-out rate.

scholarly journals Risk Factors for Failure After Anterior Cruciate Ligament Reconstruction in a Pediatric Population: A Prediction Algorithm

2021 ◽  
Vol 9 (3) ◽  
pp. 232596712199116
Author(s):  
Nicholas J. Lemme ◽  
Daniel S. Yang ◽  
Brooke Barrow ◽  
Ryan O’Donnell ◽  
Alan H. Daniels ◽  
...  
Keyword(s):  
Risk Factors ◽  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Pediatric Patients ◽  
Cruciate Ligament ◽  
Adult Patients ◽  
Collateral Ligament ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate

Background: Anterior cruciate ligament reconstruction (ACLR) in pediatric patients is becoming increasingly common. There is growing yet limited literature on the risk factors for revision in this demographic. Purpose: To (1) determine the rate of pediatric revision ACLR in a nationally representative sample, (2) ascertain the associated patient- and injury-specific risk factors for revision ACLR, and (3) examine the differences in the rate and risks of revision ACLR between pediatric and adult patients. Study Design: Case-control study; Level of evidence, 3. Methods: The PearlDiver patient record database was used to identify adult patients (age ≥20 years) and pediatric patients (age <20 years) who underwent primary ACLR between 2010 and 2015. At 5 years postoperatively, the risk of revision ACLR was compared between the adult and pediatric groups. ACLR to the contralateral side was also compared. Multivariate logistic regression was used to determine the significant risk factors for revision ACLR and the overall reoperation rates in pediatric and adult patients; from these risk factors, an algorithm was developed to predict the risk of revision ACLR in pediatric patients. Results: Included were 2055 pediatric patients, 1778 adult patients aged 20 to 29 years, and 1646 adult patients aged 30 to 39 years who underwent ACLR. At 5 years postoperatively, pediatric patients faced a higher risk of revision surgery when compared with adults (18.0 % vs 9.2% [adults 20-29 years] and 7.1% [adults 30-39 years]; P < .0001), with significantly decreased survivorship of the index ACLR ( P < .0001; log-rank test). Pediatric patients were also at higher risk of undergoing contralateral ACLR as compared with adults (5.8% vs 1.6% [adults 20-29 years] and 1.9% [adults 30-39 years]; P < .0001). Among the pediatric cohort, boys (odds ratio [OR], 0.78; 95% CI, 0.63-0.96; P = .0204) and patients >14 years old (OR, 0.62; 95% CI, 0.45-0.86; P = .0035) had a decreased risk of overall reoperation; patients undergoing concurrent meniscal repair (OR, 1.84; 95% CI, 1.43-2.38; P < .0001) or meniscectomy (OR, 2.20; 95% CI, 1.72-2.82; P < .0001) had an increased risk of revision surgery. According to the risk algorithm, the highest probability for revision ACLR was in girls <15 years old with concomitant meniscal and medial collateral ligament injury (36% risk of revision). Conclusion: As compared with adults, pediatric patients had an increased likelihood of revision ACLR, contralateral ACLR, and meniscal reoperation within 5 years of an index ACLR. Families of pediatric patients—especially female patients, younger patients, and those with concomitant medial collateral ligament and meniscal injuries—should be counseled on such risks.

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