Ultrasound Accuracy in Diagnosing Appendicitis in Obese Pediatric Patients

2017 ◽  
Vol 83 (10) ◽  
pp. 1063-1067 ◽  
Author(s):  
Bryan E. Love ◽  
Monica Camelo ◽  
Sarvenaz Nouri ◽  
Diego Kriger ◽  
Daniel Ludi ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Acute Appendicitis ◽  
Positive Predictive Value ◽  
Retrospective Review ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Overweight Children ◽  
Old Patients ◽  
Significant Difference ◽  
Ultrasound Technology

The use of ultrasound to diagnose appendicitis in pediatric patients has been growing with the improvement of ultrasound technology and operator skills, but its utility in the increasingly obese pediatric population has not been thoroughly investigated. A retrospective review of all pediatric (≤18 years old) patients with appendicitis who were admitted at a single hospital from 2014 to 2016 was conducted. Patients were stratified into body mass index (BMI) percentile categories based on the centers for disease control guidelines. Comparisons were then made. There were 231 patients with an average BMI percentile of 72.6; 99 (42.9%) who had an ultrasound, of which 54 (54.5%) were positive for acute appendicitis, whereas 43 (43.4%) were nondiagnostic. In patients who had a nondiagnostic ultrasound, 37 had a CT demonstrating acute appendicitis. These were compared with 123 patients who had CT alone demonstrating acute appendicitis. The CT-only group was older (12 vs 9, P < 0.005), tended to be male (78 (63%) vs 15 (41%), P = 0.019), had fewer operations performed (81 (66%) vs 30 (81%), P = 0.048) but had no significant difference in BMI percentile (75.8 vs 71.7, P = 0.465). Ultrasound had a 100 per cent positive predictive value in obese and overweight children. Ultrasound is a reliable study in obese and overweight pediatric patients with acute appendicitis.

scholarly journals Opioid Use and the Risk of Respiratory Depression and Death in the Pediatric Population

2013 ◽  
Vol 18 (4) ◽  
pp. 269-276 ◽  
Author(s):  
Marianne R. Whittaker
Keyword(s):  
Clinical Trials ◽  
Adverse Effects ◽  
Respiratory Depression ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Opioid Use ◽  
Randomized Controlled ◽  
Randomized Controlled Studies ◽  
Increased Risk ◽  
Significant Difference

BACKGROUND Pediatric patients may be at an increased risk of adverse effects from various medications. Recently, there have been a number of serious adverse events, including several pediatric patients experiencing severe respiratory depression and death as a result of the use of codeine for pain control following tonsillectomy and adenoidectomy. OBJECTIVE To assess the safety of opioid agonists in pediatric patients undergoing operative procedures or have experienced trauma and to evaluate the risk of respiratory depression and death among this population. METHODS PubMed and Medline were searched to identify randomized controlled studies from 1994 to 2012 addressing postsurgery/trauma opioid use in pediatric patients. Relative risks and confidence intervals (CIs) were calculated using data available in clinical trials. RESULTS A total of 16 clinical trials were evaluated for this review. Randomized controlled trials included studies comparing opioids versus non-opioids for a variety of painful conditions. The relative risk of respiratory depression associated with opioid use in 1 trial was 1.63 (95% CI: 0.64–6.13). The remaining 15 trials reviewed described no significant difference in respiratory depression or adverse effects associated with treatment. No deaths were attributed to opioid use in any of these studies. CONCLUSION Opioid-associated respiratory depression was very rare and no deaths were reported in the reviewed studies. These findings under the well-defined conditions of controlled studies may not be the best means of determining overall opioid-associated side effects in pediatric patients.

scholarly journals Sudden death and suicide: A comparison of brain weight

2002 ◽  
Vol 181 (1) ◽  
pp. 72-75 ◽  
Author(s):  
S. J. Hamilton ◽  
R. F. T. McMahon
Keyword(s):  
Body Mass Index ◽  
General Population ◽  
Sudden Death ◽  
Retrospective Review ◽  
Brain Weight ◽  
Post Mortem ◽  
Younger Age ◽  
Significant Difference ◽  
The Brain ◽  
Commit Suicide

BackgroundRecent evidence suggests that the brain weight of individuals over the age of 60 who commit suicide is significantly higher than in those who die of natural causes.AimsTo ascertain whether brain weight is different in people of a younger age who commit suicide than in those who die accidentally.MethodA retrospective review of post-mortem reports collecting height, weight and brain weight in 100 suicide victims (87 males, mean age 38.5 years) and 100 age/gender-matched controls who died accidentally or of natural causes (87 males, mean age 38.7 years). Comparison by t-test was made of brain weight in isolation as well as brain weight corrected for height, weight and body mass index.ResultsThese results reveal no significant difference in brain weight in suicide cases compared to the general population (P > 0.05). The brain weight of those who died by hanging was significantly higher than of those who died by overdose.ConclusionsWhatever the significant neuropsychiatric elements are that influence suicidal behaviour, they do not consistently affect brain weight in the population studied.

scholarly journals Measurement of the Endotracheal Tube Diameter Using Computed Tomography Images for Pediatric Patients: Comparison with Classic Formulas

2021 ◽  
Author(s):  
Hatice Dilek Özcanoğlu ◽  
Berna Türkay ◽  
Neşe Kutlutürk Şahin ◽  
Zahide Özlem Ulubay ◽  
Ayşe Sevinç Revanlı ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Endotracheal Tube ◽  
Congenital Heart ◽  
Pediatric Patients ◽  
Transverse Diameter ◽  
External Diameter ◽  
Old Patients ◽  
Computed Tomography Images ◽  
Significant Difference ◽  
The Mean

Objective: In this retrospective study, we aimed to evaluate the compatibility of endotracheal tube (ETT) size used during surgery with tracheal diameter measured by computed tomography(CT) and classic formulas in children who underwent CT imaging preoperatively due to surgical indications. Methods: The study included preoperatively CT scanned, 0-3 year-old patients who were operated due to congenital heart diseases between June 1-October 1, 2018.Using the CT scans, transverse and anteroposterior tracheal diameters were measured from the subglottic level. As these diameters reflect the external diameter of the ETT, the inner diameter-which corresponds the ETT size-was calculated using a correction formula. Besides, Cole’s formula was used to calculate the ETT size for each child, and the tube sizes used during surgeries were obtained from anesthesia charts.ETT sizes were compared. Results: 43 patients (22 girls [51.2%],21 boys [48.8%]) were included.The mean age was 10.5±9.6 months. 18 patients (41.9%) had cyanotic, 25 patients (58.1%) had acyanotic heart disease.Mean corrected transverse and anteroposterior tracheal diameters at CT images were 4.35±0.69mm and 4.30±0.71 mm, respectively. The mean diameter calculated by Cole’s formula was 4.22±0.20 mm. The mean tube size used during surgeries was 4.37±0.60 mm. There was no statistically significant difference between the tube sizes used during the surgeries and the corrected transverse tracheal diameters from CT measurements (p>0.05). But the tube sizes used during the surgeries found significantly larger than the diameters obtained by Cole’s formula (p<0.05). Conclusion: In 0-3 years of age pediatric patients who undergo a congenital heart surgery,corrected tracheal transverse diameter measured by CT is more effective,reliable and less invasive than classic formulas for determining appropriate ETT size

COVID-19 associated multisystem inflammatory syndrome in children mimicking acute appendicitis - how to differentiate and conduct pediatric patients during the pandemic? - Proposal of a management flowchart

2021 ◽  
Vol 48 ◽  
Author(s):  
LORAINE ENTRINGER FALQUETO ◽  
CAROLINA MARTINS VISSOCI ◽  
ISABELLA CRISTINA BONETTO FERREIRA ◽  
AMANDA GINANI ANTUNES ◽  
FERNANDO ANTÔNIO BERSANI AMADO ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Acute Abdomen ◽  
Initial Phase ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Gastrointestinal Symptoms ◽  
Signs And Symptoms ◽  
Clinical History ◽  
Pediatric Hospital ◽  
Inflammatory Syndrome

ABSTRACT Introduction: the new coronavirus pandemic has been a reality throughout 2020, and it has brought great challenges. The virus predominantly manifests in the pediatric population with mild symptoms. However, an increase in the incidence of Multisystemic Inflammatory Syndrome in Children (MIS-C) associated with COVID-19 has been described in the literature. MIS-C manifests mainly with fever and gastrointestinal symptoms and may mimic acute abdomen due to acute appendicitis. The objective of this study is to propose a care flowchart for suspected cases of acute appendicitis in the initial phase in pandemic times, considering the possibility of MIS-C. This situation was brought up by a patient treated in a pediatric hospital in Brazil. Discussion: It was possible to identify common signs and symptoms in the reported patient and those published cases that may serve as alerts for early identification of MIS-C cases. Based on the literature review and on the similarities between the syndrome and the inflammatory acute abdomen in children, we elaborated an initial approach for these cases to facilitate the identification, early diagnosis, and management. The flowchart considers details of the clinical history, physical examination, and complementary exams prior to the indication of appendectomy in patients with initial phase symptoms. Conclusion: MIS-C, although rare and of poorly known pathophysiology, is most often severe and has a high mortality risk. The use of the proposed flowchart can help in the diagnosis and early treatment of MIS-C.

scholarly journals Accuracy Score on Raja Isteri Pengiran Anak Saleha (RIPASA) and Pediatric Appendicitis (PAS) for Diagnosing Acute Appendicitis in Children

2020 ◽  
Vol 3 (2) ◽  
pp. 102-111
Author(s):  
Shalita Dastamuar ◽  
M. Roby ◽  
Sindu Saksono ◽  
Erial Bahar
Keyword(s):  
Acute Appendicitis ◽  
Pediatric Patients ◽  
Histopathological Examination ◽  
Pediatric Population ◽  
Cross Sectional Study ◽  
Accuracy Score ◽  
Cross Sectional ◽  
Clinical Scoring ◽  
Surgical Field ◽  
Sensitivity Specificity

Abstract Introduction. Acute appendicitis is the most common case of acute abdomen. Diagnosis of acute appendicitis is still difficult and is one of the problems in the surgical field. The Clinical Scoring System (CSS) has been developed to help doctors classify risk categories. PAS has been widely evaluated in the pediatric population. In another study it was found that RIPASA had better sensitivity, specificity, and accuracy than PAS in pediatric patients. Methods. This study is a cross sectional study to assess the level of concordance between RIPASA and PAS scores in diagnosing acute appendicitis, with the gold standard of Histopathological examination. Samples were taken by consecutive method, in 30 patients aged <18 years for 1 year. Results. This study had an average age of 10.10 ± 3.745 years. Histopathologically early acute appendicitis 3.3%, acute suppurative appendicitis as much as 20%, acute gangrenous appendicitis 73.3% and others 3.3%. Using a cut-off point value of 9.5 for RIPASA and 7 for PAS, the sensitivity, Specificity, Accuracy of 82.75%, 100%, 80% for RIPASA, and 75.8%, 100%, 73.3% for PAS. Conclusion. The RIPASA score on the cut-off treshold 9.5 has better sensitivity and accuracy than PAS in diagnosing acute appendicitis in pediatric patients and can be used as CSS to assist in making decisions regarding the diagnosis of acute appendicitis in children.

Periorbital and Globe Injuries in Pediatric Orbital Fractures: A Retrospective Review of 116 Patients at a Level 1 Trauma Center

2020 ◽  
pp. 194338752093369
Author(s):  
Jordan Halsey ◽  
Marvin Argüello-Angarita ◽  
Osward Y. Carrasquillo ◽  
Ian C. Hoppe ◽  
Edward S. Lee ◽  
...  
Keyword(s):  
Retrospective Review ◽  
Trauma Center ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Orbital Floor ◽  
Orbital Fracture ◽  
Orbital Fractures ◽  
Orbital Floor Fractures ◽  
Level 1 ◽  
Level 1 Trauma Center

Study Design: Retrospective chart review of pediatric and globe injuries associated with orbital fractures.ObjectiveOur study seeks to examine these injuries and their association with orbital fractures at our trauma center to gain a better understanding of how to approach pediatric patients with orbital fractures. Methods: A retrospective review of all facial fractures in pediatric patients at an urban level 1 trauma center was performed for the years 2002 to 2014. Patient demographics were collected, as well as orbital fracture location, mechanism of injury, concomitant injuries, ophthalmologic documentation, imaging, and perioperative records. Results: One hundred sixteen pediatric patients over a 12-year period sustained an orbital fracture. The orbital floor was the most commonly fractured orbital bone in our series (60%). Thirty-four (30%) of the pediatric patients with orbital fractures had documented periorbital and/or globe injuries at the time of presentation. The most common periorbital injury was entrapment related to orbital floor fractures. Significant eyelid lacerations were present in seven patients, with five of these patients had canalicular injuries and two had canthal malposition. Five pediatric patients presented with traumatic optic neuropathy. Two patients had ruptured globes requiring enucleation. Conclusions: Periorbital soft tissue and globe injuries associated with orbital fractures occurs in a substantial number of pediatric patients. There are no guidelines for treatment of these type of injuries in the pediatric population. Further research should be performed to better understand the appropriate management of periorbital injuries in conjunction with surgical management of the orbital fractures

scholarly journals Comparison of the use of Alvarado and AIR scores as an adjunct to the clinical diagnosis of acute appendicitis in the pediatric population

2019 ◽  
Vol 2 (2) ◽  
pp. e000040 ◽  
Author(s):  
Aya Musbahi ◽  
Darren Rudd ◽  
Matei Dordea ◽  
Bussa Gopinath ◽  
Vijay Kurup
Keyword(s):  
Acute Appendicitis ◽  
Clinical Diagnosis ◽  
Pediatric Population ◽  
White Cell Count ◽  
Radiation Risk ◽  
Scoring Systems ◽  
Negative Appendectomy ◽  
Diagnostic Dilemma ◽  
Significant Difference ◽  
The Usa

BackgroundAcute appendicitis is one of the most common causes of acute abdominal pain with an incidence of 1.17 per 1000 and lifetime risk of approximately 7%. It remains the most common indication for emergency abdominal surgery in childhood. Diagnosis of acute appendicitis is particularly difficult in young women and the pediatric population. In the USA, CT imaging is used to avert diagnostic dilemma, however the procedure is associated with radiation risk in this vulnerable population. Additionally, the procedure has high cost and variable availability.MethodsA retrospective study involving all suspected pediatric cases of appendicitis between the ages of 5 and 17 who were operated on between 2012 and 2015 was carried out. Data were collated from clinical notes on age, sex, ultrasound findings; postoperative complications, white cell count, neutrophils, C-reactive protein, histology result, and number of days to theater. All patients in the time period were retrospectively scored on the Alvarado and Appendicitis Inflammatory Response (AIR) scores.ResultsA total of 239 patients between 11 and 17 (mean 13.6±SE) years of age were included in the study. Of these, 79 had preoperative ultrasound, of which 52 were negative, and only one patient had CT scan. 213 of the patients had an appendicectomy and 26 had diagnostic laparoscopy with no appendicectomy. Of the 213 appendixes removed, 71 were histopathologically normal, giving a negative appendectomy rate of 33.3%. 28 appendixes were perforated. The average number of days from admission to theater was 1.0 SE in males and 1.424 in females (p=0.0498). The average number of days from admission to theater in those who had ultrasound was 2.03 days compared with 0.75 in those who did not have ultrasound (p<0.0001). AIR scoring that was high and medium risk showed slightly lower negative appendicectomy rates but not significantly different.ConclusionsOur study has found no significant difference between the AIR scores and Alvarado. There is a role for scoring systems to be used to aid in the decision to undergo imaging and as an adjunct to clinical diagnosis.

Pediatric occipital condyle morphometric analysis using computed tomography with evaluation for occipital condyle screw placement

2019 ◽  
Vol 23 (5) ◽  
pp. 634-638 ◽  
Author(s):  
Angela G. Viers ◽  
Khoi D. Nguyen ◽  
Perounsack X. Moon ◽  
Scott E. Forseen ◽  
Ian M. Heger
Keyword(s):  
Morphometric Analysis ◽  
Pediatric Patients ◽  
Medical Center ◽  
Statistical Significance ◽  
Critical Evaluation ◽  
Screw Placement ◽  
Occipital Condyle ◽  
Old Patients ◽  
Significant Difference ◽  
Occipital Condyles

OBJECTIVEOccipitocervical fusions in the pediatric population are rare but can be challenging because of the smaller anatomy. The procedure is even more exacting in patients with prior suboccipital craniectomy. A proposed method for occipitocervical fusion in such patients is the use of occipital condyle screws. There is very limited literature evaluating the pediatric occipital condyle for screw placement. The authors examined the occipital condyle in pediatric patients to determine if there was an age cutoff at which condylar screw placement is contraindicated.METHODSThe authors performed a retrospective morphometric analysis of the occipital condyle in 518 pediatric patients aged 1 week–9 years old. Patients in their first decade of life whose occipital condyle was demonstrated on CT imaging in the period from 2009 to 2013 at the Augusta University Medical Center and Children’s Hospital of Georgia were eligible for inclusion in this study. Exclusion criteria were an age older than 10 years; traumatic, inflammatory, congenital, or neoplastic lesions of the occipital condyles; and any previous surgery of the occipitocervical junction. Descriptive statistical analysis was performed including calculation of the mean, standard deviation, and confidence intervals for all measurements. Probability values were calculated using the Student t-test with statistical significance determined by p < 0.05.RESULTSOverall, male patients had statistically significantly larger occipital condyles than the female patients, but this difference was not clinically significant. There was no significant difference in left versus right occipital condyles. There were statistically significant differences between age groups with a general trend toward older children having larger occipital condyles. Overall, 20.65% of all patients evaluated had at least one measurement that would prevent occipital condyle screw placement including at least one patient in every age group.CONCLUSIONSOccipital condyle screw fixation is feasible in pediatric patients younger than 10 years. More importantly, all pediatric patients should undergo critical evaluation of the occipital condyle in the axial, sagittal, and coronal planes preoperatively to determine individual suitability for occipital condyle screw placement.

Suitability of the Subaxial Cervical Laminae for Laminar Screws in the Pediatric Population: A Radiologic Anatomical Study

2021 ◽  
pp. 1-7
Author(s):  
Feyza Karagoz Guzey ◽  
Ilker Gulec ◽  
Burak Eren
Keyword(s):  
Pediatric Patients ◽  
Pediatric Population ◽  
Spinous Process ◽  
Age Groups ◽  
Anatomical Study ◽  
Age Group ◽  
Safety And Efficacy ◽  
Laminar Screw ◽  
Significant Difference ◽  
Laminar Thickness

<b><i>Introduction:</i></b> The laminar screw method was popularized during recent years. Since no data exist in the literature on its suitability for subaxial levels in the pediatric population, a radiologic anatomical study was planned to evaluate the suitability of the laminae for laminar screws in children. <b><i>Methods:</i></b> The laminar thicknesses from C3 to C7 were measured in axial sections in 120 pediatric patients using computed tomography. The patients were divided into 3 age-groups: ages 4–6, 7–9, and 10–12. Each age-group consisted of 20 boys and 20 girls. The suitability of the laminae was evaluated for 3.5-mm-thick commercially available screws and also for the 3-mm screws that could be produced in the future. If the height of the base of the spinous process is ≥ 9 mm, the segment was accepted as suitable for the bilateral screw, and ≥5 mm is for the unilateral screw. Additionally, laminar thickness and length were measured for possible short screws longer than 15 mm in the laminae that were distally thin but proximally thick. <b><i>Results:</i></b> The C4 and C5 levels had the thinnest (2.77 ± 0.6 mm and 2.81 ± 0.6 mm, respectively) and C7 had the thickest laminae (4.66 ± 0.6 mm) in all age-groups. No significant differences were found between boys and girls and right and left laminae. According to the age-groups, an increase in laminar thickness was possible by growing, but only C7 laminae thickness was statistically different between 10–12 and 4–6 age-groups (<i>p</i> &#x3c; 0.001). The last rate of the suitability was 9.1% for the 3.5-mm-thick screws and 13.75% for the 3-mm-thick screws after deletion of the bilateral insertion due to the short base of the spinous process and adding the possible short screws in the distally thin but proximally thick laminae. The rates increased with age, but the only statistically significant difference was found between 4–6- and 10–12-year-old age-groups (<i>p</i> &#x3c; 0.001). <b><i>Conclusions:</i></b> Laminar screws may be suitable for some levels of C7, C6, and C3 even in the young pediatric population. The use of thinner screws (3 mm) may increase the suitability rate. Therefore, laminar screw choice may be considered as a salvage method in pediatric patients, and all laminae may be evaluated individually for suitability. This study did not evaluate the safety and efficacy of the method in children, and these issues must be studied further.

Pipeline embolization of cerebral aneurysms in pediatric patients: combined systematic review of patient-level data and multicenter retrospective review

2021 ◽  
pp. 1-9
Author(s):  
Nathan A Shlobin ◽  
Eytan Raz ◽  
Maksim Shapiro ◽  
Luke Moretti ◽  
Donald R Cantrell ◽  
...  
Keyword(s):  
Systematic Review ◽  
Scale Score ◽  
Retrospective Review ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Cerebral Aneurysms ◽  
Patient Level Data ◽  
Patient Level ◽  
Level Data

OBJECTIVE Cerebral aneurysms in the pediatric population are rare and optimal treatment strategies are not as well characterized as in adults. The Pipeline embolization device (PED) is an endoluminal flow diverter that is commonly used to treat aneurysms in adults, but experience with this device in children is limited. The authors sought to further characterize PED use and outcomes in this specific population by performing both a systematic review of patient-level data from studies reporting the use of the PED to treat pediatric aneurysms and a retrospective review of their experience. METHODS A systematic review of the PubMed, Embase, and Scopus databases was performed to identify studies reporting the use of the PED in pediatric patients (age ≤ 18 years). Disaggregated data regarding demographics, aneurysm characteristics, treatment, and outcomes were collected. Retrospective data from the authors’ two institutions were also included. RESULTS Thirty studies comprising patient-level data on 43 pediatric patients with 47 aneurysms were identified. An additional 9 patients with 9 aneurysms were included from the authors' institutions for a total of 52 patients with 56 aneurysms. The mean patient age was 11.1 years. Presentations included aneurysm rupture (17.3%) and symptomatic mass effect (23.1%). Aneurysms were located in the anterior circulation in 55.4% of cases, and 73.2% were described as nonsaccular. Imaging follow-up was available for 89.3% with a mean follow-up of 13.3 months. Aneurysm occlusion was reported in 75%, with 1 case each (1.8%) demonstrating significant in-stent stenosis and parent vessel occlusion. Clinical follow-up was reported in 90.4% with a mean follow-up of 14.7 months. Good functional outcomes (modified Rankin Scale score of 0–1 or Glasgow Outcome Scale score of 5) were reported in 65.4% of the total population. Two major complications were reported, including 1 death. CONCLUSIONS Despite substantial differences in aneurysm location and type between published pediatric and adult patient populations treated with the PED, the use of the PED in the pediatric population appears to be safe. While the short-term effectiveness is also similar to that of adults, additional studies are needed to further characterize the long-term outcomes and better define the use of this device in pediatric patients.

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