Dexamethasone Use in the Treatment of Pediatric Deep Neck Space Infections

Objectives: Assess the outcome of Intravenous (IV) dexamethasone in the treatment of pediatric deep neck space infections (DNSI) in combination with IV antibiotics. Methods: Retrospective chart review of pediatric patients admitted for a DNSI from March 2014 to June 2016. Patient characteristics including demographics, abscess type, antibiotic, dexamethasone, surgery, culture, and length of stay (LOS) were obtained. Patients treated with antibiotics alone versus antibiotics and dexamethasone were compared. Primary outcome measures were rate of surgical drainage and LOS. Results: Overall 153 patients with DNSI were identified, including 62 lateral neck, 18 parapharyngeal, 40 peritonsillar, 32 retropharyngeal, and 1 submandibular. All patients received antibiotics. Dexamethasone was used in 35% of patients. The rate of surgical drainage in the dexamethasone and non-dexamethasone group was 36% and 53% respectively ( P = .043). LOS was shorter for the dexamethasone group (2.9 days) compared to the non-dexamethasone group (3.8 days) but was non-significant, P-value-.09. The most common microorganisms cultured were MRSA (25), MSSA (11), and Streptococcus pyogenes (10). Conclusion: Dexamethasone use was associated with a decreased rate of surgical drainage in pediatric patients with DNSI. Further prospective study is needed to determine the role of dexamethasone in treatment.

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Perioperative Intravenous Acetaminophen in Pediatric Tonsillectomies

Hospital Pharmacy ◽

10.1177/0018578718756658 ◽

2018 ◽

Vol 53 (5) ◽

pp. 316-320 ◽

Cited By ~ 4

Author(s):

Brandi Bowman ◽

Leslie Sanchez ◽

Preeyaporn Sarangarm

Keyword(s):

Chart Review ◽

Primary Outcome ◽

Pediatric Patients ◽

Retrospective Chart Review ◽

Descriptive Statistics ◽

Pain Medications ◽

Frequent Administration ◽

Intravenous Acetaminophen ◽

Sparing Effect ◽

Opiate Administration

Purpose: This study investigated the effect of perioperative intravenous (IV) acetaminophen on opioid requirements in pediatric patients undergoing tonsillectomy at a single center. Methods: This retrospective chart review included patients who were less than 18 years old and underwent an outpatient tonsillectomy procedure. Patients who received non–Food and Drug Administration (FDA)-approved dosing of IV acetaminophen, without documented weights, and on chronic pain medications at the time of the procedure were excluded. The primary outcome was opioid requirements postoperatively prior to discharge measured as morphine equivalents per kilogram. Descriptive statistics were used to compare differences between groups. A multivariate analysis was performed, accounting for differences between groups in baseline and procedural characteristics. Results: In total, 157 patients were included in this study, of whom 55 had received IV acetaminophen and 102 had not. The average IV acetaminophen dose for was 14.5 mg/kg for patients weighing less than 50 kg (n = 22); the remaining patients received the maximum 1 g dose. Patients who received IV acetaminophen were less likely to be administered postoperative opiates as compared with those did not (45.5% vs 63.7%, odds ratio = 0.48, P = .036). There was a trend toward a decrease in total amount of opiates administered with IV acetaminophen (0 vs 0.033 µg/kg, P = .61). After adjusting for age and documented pain assessment, IV acetaminophen administration remained a significant factor for postoperative opiate administration. Conclusions: Perioperative administration of IV acetaminophen was associated with less frequent administration of symptom-directed opiates in pediatric tonsillectomies. This finding indicates that the agent may have an opioid-sparing effect in this patient population.

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The effect of polysomnography on pediatric adenotonsillectomy postoperative management

Otolaryngology ◽

10.1016/j.otohns.2004.10.007 ◽

2005 ◽

Vol 132 (2) ◽

pp. 263-270 ◽

Cited By ~ 13

Author(s):

Anthony A. Rieder ◽

Valerie Flanary

Keyword(s):

Length Of Stay ◽

Airway Obstruction ◽

Complication Rate ◽

Chart Review ◽

Pediatric Patients ◽

Upper Airway ◽

Retrospective Chart Review ◽

Postoperative Management ◽

Postoperative Course

OBJECTIVE: We retrospectively investigated the effect and predictability of preoperative polysomnography (PSG) on the postoperative course of younger pediatric patients undergoing adenotonsillectomy. STUDY DESIGN AND SETTING: A retrospective chart review was performed for patients 3 years of age and younger who had undergone adenotonsillectomy between July 1997 and July 2002 at the Children's Hospital of Wisconsin. RESULTS: Two hundred eighty-two patients were identified. Forty-three patients had preoperative PSG. No correlation between the severity of PSG results and postoperative course was identified. CONCLUSIONS: The role of PSG in upper airway obstruction and OSA remains controversial. This study suggests that although the complication rate may be higher in this younger population, these complications do not appear to have a large impact on their length of stay. SIGNIFICANCE: This study suggests that the 3-years-and-younger group, in the absence of other comorbidities, can safely undergo adenotonsillectomy without undergoing preoperative PSG. EBM raing: C.

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Glycemic Control in Pediatric Patients on Extracorporeal Membrane Oxygenation

The Journal of Pediatric Pharmacology and Therapeutics ◽

10.5863/1551-6776-18.3.227 ◽

2013 ◽

Vol 18 (3) ◽

pp. 227-235

Author(s):

Kathryn L. Wierer ◽

Rachel A. Pagryzinski ◽

Qun Xiang

Keyword(s):

Glycemic Control ◽

Extracorporeal Membrane Oxygenation ◽

Glucose Control ◽

Chart Review ◽

Primary Outcome ◽

Pediatric Patients ◽

Retrospective Chart Review ◽

Serum Glucose ◽

Multiple Factors ◽

Membrane Oxygenation

OBJECTIVES To determine whether glycemic control has an effect on outcomes for pediatric patients on extracorporeal membrane oxygenation (ECMO) therapy, while controlling for multiple factors. METHODS A single-center retrospective chart review was performed on 82 patients who required ECMO from January 1, 2008, to December 31, 2010. All glucose concentrations collected while patients were on ECMO were analyzed; multiple other factors that may have affected mortality were also recorded. Primary outcome was mortality, and secondary outcomes were length of time on ECMO and length of time until death or discharge from the hospital. RESULTS Of 82 patients, 53 patients survived ECMO (64.6%). Glucose control had no effect on survival of patients on ECMO (p=0.56), even when controlling for multiple factors (p=0.48). Similarly, statistical evaluation showed no differences for hospital mortality in relationship to controlled serum glucose (p=0.50). Patients with controlled glucose spent an average of 31.5% more time on ECMO than non-controlled patients (p=0.048). CONCLUSIONS In this study, glycemic control, defined as serum glucose concentration between 60 mg/dL and 250 mg/dL for >95% of the time on ECMO, had no statistically significant effect on mortality for patients on ECMO. Future studies could focus on tighter glucose control or specific dextrose/glucose protocols to evaluate whether improved glucose control would have an effect on morbidity and mortality.

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Role of Vitamin D Levels in Venous Thrombosis

Blood ◽

10.1182/blood-2021-148146 ◽

2021 ◽

Vol 138 (Supplement 1) ◽

pp. 4255-4255

Author(s):

Marwah W Farooqui ◽

Yhana Chavis ◽

Nailah Ghouse ◽

Julia Bank ◽

Michelle Chan ◽

...

Keyword(s):

Vitamin D ◽

Venous Thromboembolism ◽

Vitamin D Deficiency ◽

Chart Review ◽

Retrospective Chart Review ◽

P Value ◽

International Studies ◽

Vitamin D Levels ◽

Cancer Associated Thrombosis

Abstract Venous thromboembolism (VTE) is a complex condition that impacts over 900,000 people in the United States annually. It is estimated that about 100,000 people in the US die from deep vein thrombosis (DVT) or pulmonary embolism (PE) annually. Several biomarkers, including Vitamin D most recently, have been investigated and linked to the risk of developing VTE or recurrent VTE. Vitamin D is known to control the expression of over 200 genes and it has shown to have anti-thrombotic effects through various mechanisms. There is emerging data regarding its role in the coagulation pathway, platelet activation, inflammatory pathways and endothelial activation (1). There have been a few international studies linking Vitamin D deficiency to VTE(2). However; no such study has been replicated in the North American population where the prevalence of Vitamin D deficiency is 40%. The focus of this study will be to determine the prevalence of Vitamin D deficiency in patients with VTE. Based on the role of Vitamin D in the pathway for thrombogenesis and antithrombin effects, there is likely a correlation between VTE and Vitamin D levels. This is a retrospective chart review of all patients admitted to Franciscan Health- Olympia Fields with VTE between July 2018 and June2020. A total of 181 patients with VTE were reviewed. Data such as age, gender, race, D-dimer, and Vitamin D levels were collected. Vitamin D levels <30ng/mL was defined as deficient. In addition, further data collection, included provoked vs unprovoked VTE, presence of malignancy, and the severity of DVT and PE based on location and extent of the VTE (severity was scored on a scale of 1-3 with 1 being mild and 3 as severe). A regression analysis was done to find a correlation between several variables and T-test was used to determine P-value. Of the 181 patients, 110 had a vitamin D level documented at the time of their VTE and data was specifically analyzed for this subgroup. There were 46 males and 64 females, 53.6%AA, 7.3% Hispanic, 38.2% Caucasian, and 0.9% unknown. 25.5% had an unprovoked VTE event and 74.5% had a provoked event. 39 patients had a known active malignancy and a likely cancer associated thrombosis. 85.7% of patients with unprovoked DVT had a low Vitamin D level. In patients with cancer associated thrombosis there was no significant correlation with vitamin D levels. A strong correlation was noted between vitamin D levels and the severity of PE (p value=0.036). This retrospective chart review from a patient population at a community hospital indicates that there is some correlation between venous thromboembolism and Vitamin D levels. Specifically, it appears that patients with an unprovoked VTE have low Vitamin D levels suggesting that vitamin D deficiency may be a risk factor for VTE development as indicated by previous international studies (2). In addition, it appears that there is an inverse relationship between the severity of PE and vitamin D levels. Perhaps Vitamin D may be used as a biomarker for VTE risk assessment and management. Large scale studies are needed in the future to determine the exact relationship between VTE and Vitamin D and further studies are needed to test the role of vitamin D supplementation and risk of recurrent VTE. Disclosures No relevant conflicts of interest to declare.

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System intervention in community pharmacy setting: Leading to better patient care through reducing harm associated with coprescribing benzodiazepines and opioids

Journal of Opioid Management ◽

10.5055/jom.2021.0679 ◽

2021 ◽

Vol 17 (6) ◽

pp. 445-453

Author(s):

Angelina Vascimini, PharmD ◽

Kevin Duane, PharmD ◽

Stacey Curtis, PharmD

Keyword(s):

Chart Review ◽

Primary Outcome ◽

Community Pharmacists ◽

Retrospective Chart Review ◽

Secondary Outcome ◽

Post Intervention ◽

Improvement Project ◽

System Intervention ◽

Secondary Outcomes ◽

Pharmacy Setting

Objective: The opioid epidemic is frequently discussed including the staggering numbers involved with coprescribing opioids and benzodiazepines associated with death. Community pharmacists, with the help of a system intervention, have a unique opportunity to help reduce the coprescribing of benzodiazepines and opioids and reduce the associated risk of death.Design: A single center retrospective chart review was conducted after a system intervention was placed, as a quality improvement project, from November 2019 to May 2020.Setting: Independent community pharmacy.Patients/participants: Data included demographics, dosing of each medication pre- and post-intervention, and naloxone status.Main outcome(s) measures: The primary outcome evaluated was reduction in dose/discontinuation of these prescriptions. The secondary outcome evaluated was the number of naloxone prescriptions ordered per protocol and picked up.Results: The primary outcome did not show statistical difference; however, the secondary outcomes showed statistical significance.Conclusion: In conclusion, community pharmacists, with the help of evolving technologies, can reduce harm associated with the coprescribing of benzodiazepines and opioids.

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An Evaluation of the Effects of Elevated Body Mass Index on Skeletal Age

10.21203/rs.3.rs-888046/v1 ◽

2021 ◽

Author(s):

Michael H. French ◽

Michael S. Kung ◽

W. Nathan Holmes ◽

Hossein Aziz ◽

Evelyn S. Thomas ◽

...

Keyword(s):

Chart Review ◽

Pediatric Patients ◽

Intraclass Correlation ◽

Retrospective Chart Review ◽

Skeletal Age ◽

Chronological Age ◽

Age Group ◽

Obese Children ◽

Significant Difference ◽

Hand Radiographs

Abstract BackgroundMany treatment decisions in children’s Orthopaedics are based on age. This study determined whether a discrepancy between chronological age (CA) and skeletal age (SA) is dependent on BMI and if overweight or obese children would have an advanced SA.Materials and Methods120 children between ages 8-17 with an adequate hand radiograph and a correlating BMI were enrolled by retrospective chart review. Stratification based on age, sex, ethnicity, and BMI percentile was performed. For each age group, 6 males and 6 females were selected with 50% of each group having an elevated BMI. Two blinded physicians independently evaluated hand radiographs and recorded the SA. Statistical analyses evaluated inter-rater reliability and any discrepancy between groups.ResultsThe final statistical analysis included 96 children. The Intraclass Correlation Coefficient for SA determined by the two reviewers was excellent at 0.95. A difference of 13 months was found between CA and SA in the elevated BMI cohort versus the non-elevated BMI cohort, (p<0.001). No significant difference was seen between CA and SA for the non-elevated cohort (p=0.72), while matching for age and sex. ConclusionChronological age and skeletal age are not always equivalent especially in pediatric patients who are overweight or obese.

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65 Complication rate of cuffed versus uncuffed PICC lines placed by interventional radiology in pediatric patients

Paediatrics & Child Health ◽

10.1093/pch/pxab061.050 ◽

2021 ◽

Vol 26 (Supplement_1) ◽

pp. e46-e46

Author(s):

Maria Al Bandari ◽

John Donnellan ◽

Filomena Tavares

Keyword(s):

Chart Review ◽

Pediatric Patients ◽

Retrospective Chart Review ◽

Electronic Record ◽

Subject Area ◽

Mechanical Failure ◽

Complication Rates ◽

Tertiary Referral Centre ◽

Complications Rate ◽

Premature Removal

Abstract Primary Subject area Paediatric Radiology Background Peripherally inserted central catheters are commonly used in pediatrics to offer stable access for administering prolonged courses of antibiotics, chemotherapy, parenteral nutrition, or other intravenous fluids. Objectives To assess the complication rates of cuffed versus uncuffed PICCs in a pediatric tertiary referral centre. Design/Methods Research ethics board approval was sought and granted. A dual arm study design was employed with a retrospective chart review of PICCs inserted between June 2017 - June 2018, and a prospective chart review of PICCS inserted between January 2019 - June 2019 at a large tertiary pediatric referral center. Data collected from the electronic record included age, weight, and diagnosis. Line type, size, location, insertion and removal dates, and indications were recorded. Primary outcome was removal of PICC after completion of therapy or premature removal due to the following complications: infection, thrombosis, or mechanical failure (defined as catheter breakage, blockage, or dislodgement). Results The study included 266 patients. Across all patients weighing < 10 kg, 90.5% of those with cuffed PICCs and 65% of those with uncuffed catheters completed therapy. The predominant complication resulting in premature removal was mechanical failure, but this was only observed in patients with uncuffed catheters (25%). Infection was also observed only in uncuffed catheters (10%), and thrombosis (4.8%) was only in the cuffed lines. For patients weighing ≥ 10 kg, 86% of those with cuffed PICCs and 77.2% with uncuffed catheters completed therapy. More complications were observed in uncuffed catheters (infection 7.7%, mechanical failure 6.6%, thrombosis 5%). Infection resulting in premature removal occurred in 7% of cuffed catheters. There was no reported mechanical failure or thrombosis in the cuffed group. The distribution of diagnoses was relatively homogenous between the groups for most diagnoses. However, there was a higher percentage of oncology patients in the uncuffed group (23%) than the cuffed group (7%) due to the need for power-injectable lines, which were not available in a cuffed variant during this study. Conclusion All-cause pediatric PICC-associated complications rate in the neonate group for patients < 10kg in the uncuffed group is 35% and in the cuffed group is 4.8%. Whereas in the pediatric group ≥ 10kg, all-cause pediatric PICC-associated complications rate in the uncuffed group is 19.3% and in the cuffed group is 7%. There were no mechanical complications in the cuffed group and the vast majority of lines made it to completion of therapy. This work supports utilization of cuffed PICC lines in selected pediatric patients.

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Risk and Protective Factors Affecting Children in Foster Care: A Pilot Study of the Role of Siblings*

The Canadian Journal of Psychiatry ◽

10.1177/070674379203700904 ◽

1992 ◽

Vol 37 (9) ◽

pp. 616-622 ◽

Cited By ~ 41

Author(s):

M.B. Thorpe ◽

G.T. Swart

Keyword(s):

Foster Care ◽

Protective Factors ◽

School Performance ◽

Extracurricular Activities ◽

Chart Review ◽

Retrospective Chart Review ◽

Factors Affecting ◽

Children In Foster Care ◽

High Risk Children

A retrospective chart review of 115 siblings (from 48 families) simultaneously taken into the care of a Children's Aid Society was conducted. These children were a very neglected group at great risk of developing mental illness. There was a significant correlation between the number of symptoms the child had while in the receiving home and the time spent in foster care. Protective factors correlated with fewer symptoms at home but not while the child was in care. Being in care resulted in better performance at school, fewer symptoms and involvement in more extracurricular activities. High risk children made up their losses. While in foster care, 53% were eventually separated from their siblings. Children were more likely to be separated from their siblings if they were older, their father was physically ill or their parents were separated. Children who were separated from their siblings had more risk factors and placements while in care. However, they had fewer symptoms and better school performance while they were in foster care and fewer symptoms at discharge than the siblings who stayed together.

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Is Orally Administered Pentobarbital a Safe and Effective Alternative to Chloral Hydrate for Pediatric Procedural Sedation?

The Journal of Pediatric Pharmacology and Therapeutics ◽

10.5863/1551-6776-23.6.460 ◽

2018 ◽

Vol 23 (6) ◽

pp. 460-465

Author(s):

Jordan Anderson ◽

Sevilay Dalabih ◽

Esma Birisi ◽

Abdallah Dalabih

Keyword(s):

Chart Review ◽

Chloral Hydrate ◽

Pediatric Patients ◽

Age Groups ◽

Retrospective Chart Review ◽

Final Analysis ◽

Age Group ◽

Imaging Studies ◽

Airway Complications ◽

Adequate Sedation

OBJECTIVES Chloral hydrate had been extensively used for children undergoing sedation for imaging studies, but after the manufacturer discontinued production, pediatric sedation providers explored alternative sedation medications. Those medications needed to be at least as safe and as effective as chloral hydrate. In this study, we examined if pentobarbital is a suitable replacement for chloral hydrate. METHODS Subjects who received pentobarbital were recruited from a prospectively collected database, whereas we used a retrospective chart review to study subjects who received chloral hydrate. Sedation success was defined as the ability to provide adequate sedation using a single medication. We included electively performed sedations for subjects aged 2 months to 3 years who received either pentobarbital or chloral hydrate orally. We excluded subjects stratified as American Academy of Anesthesiologists category III or higher and those who received sedation for electroencephalogram. The data collected captured subject demographics and complications. RESULTS Five hundred thirty-four subjects were included in the final analysis, 368 in the chloral hydrate group and 166 in the pentobarbital group. Subjects who received pentobarbital had a statistically significant higher success rate [136 (82%) vs 238 (65%), p < 0.001], but longer sleeping time (18.1% vs 0%, p < 0.001) in all age groups. Subjects who received chloral hydrate had a higher risk of airway complications in the <1 year of age group (6.5% vs 1.8%, p = 0.03). CONCLUSIONS For pediatric patients younger than 3 years of age undergoing sedation for imaging studies, oral pentobarbital may be at least as effective and as safe as chloral hydrate, making it an acceptable and practical alternative.

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