Dysphagia in Pediatric Patients with Tracheostomy

Objective: Post-tracheotomy swallowing function has not been well described in the pediatric population. This study aims to (1) determine differences in swallowing functioning pre- and post-tracheotomy and (2) examine the association between postoperative dysphagia and indication for tracheotomy, age at the time of tracheotomy, and time between tracheotomy and modified barium swallow (MBS). Methods: A retrospective chart review was performed on 752 patients who underwent a tracheotomy from 2003 to 2018 and had adequate documentation for review. Patients were included if they received a post-operative MBS. Descriptive statistics, logistic regression, and Fisher’s exact test were used to analyze the data. Results: The cohort included 233 patients. The mean age at the time of tracheotomy was 25 months (±50.5). The indications for the tracheotomy were upper airway obstruction (110/233, 47.2%), chronic respiratory failure (104/233, 44.6%), and neurologic disease (19/233, 8.2%). The mean time from tracheotomy to post-operative MBS was 224 days (±297.7). Of the patients who had documented pre- and post-tracheotomy diets, nearly half of patients had improvement in their swallowing function after tracheotomy placement (82/195; 42.1%). Post-tracheotomy MBS recommended thickened liquids in 30.9% of the patients (72/233) and 42.5% (99/233) were recommended thin liquids. The remainder (62/233, 26.6%) remained nothing by mouth (NPO). Patients with neurological disease as the indication for the tracheotomy were more likely to remain NPO ( P = .039). Conclusion: A tracheotomy can functionally and anatomically affect swallowing in pediatric patients. The majority of our studied cohort was able to resume some form of an oral diet postoperatively based on MBS. This study highlights the need for objective measurements of swallowing in the postoperative tracheotomy patient to allow for safe and timely commencement of an oral diet. Level of Evidence Level 3.

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Are the First and Second Hip in Staged Bilateral Total Hip Arthroplasty Equal? A Hospital Adverse Event and Perioperative Risk Comparison

The Journal of Hip Surgery ◽

10.1055/s-0041-1729868 ◽

2021 ◽

Author(s):

Jesus M. Villa ◽

Tejbir S. Pannu ◽

Carlos A. Higuera ◽

Juan C. Suarez ◽

Preetesh D. Patel ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Adverse Events ◽

Hip Arthroplasty ◽

Retrospective Chart Review ◽

Consecutive Series ◽

Level Of Evidence ◽

Exact Test ◽

Total Hip ◽

Discharge Disposition ◽

The Mean

AbstractHospital adverse events remain a significant issue; even “minor events” may lead to increased costs. However, to the best of our knowledge, no previous investigation has compared perioperative events between the first and second hip in staged bilateral total hip arthroplasty (THA). In the current study, we perform such a comparison. A retrospective chart review was performed on a consecutive series of 172 patients (344 hips) who underwent staged bilateral THAs performed by two surgeons at a single institution (2010–2016). Based on chronological order of the staged arthroplasties, two groups were set apart: first-staged THA and second-staged THA. Baseline-demographics, length of stay (LOS), discharge disposition, hospital adverse events, and hospital transfusions were compared between groups. Statistical analyses were performed using independent t-tests, Fisher's exact test, and/or Pearson's chi-squared test. The mean time between staged surgeries was 465 days. There were no significant differences in baseline demographics between first-staged THA and second-staged THA groups (patients were their own controls). The mean LOS was significantly longer in the first-staged THA group than in the second (2.2 vs. 1.8 days; p < 0.001). Discharge (proportion) to a facility other than home was noticeably higher in the first-staged THA group, although not statistically significant (11.0 vs. 7.6%; p = 0.354). The rate of hospital adverse events in the first-staged THA group was almost twice that of the second (37.2 vs. 20.3%; p = 0.001). There were no significant differences in transfusion rates. However, these were consistently better in the second-staged THA group. When compared with the first THA, our findings suggest overall shorter LOS and fewer hospital adverse events following the second. Level of Evidence Level III.

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Seven years follow-up of corneal cross-linking (CXL) in pediatric patients: Evaluation of treated and untreated eye

European Journal of Ophthalmology ◽

10.1177/11206721211020632 ◽

2021 ◽

pp. 112067212110206

Author(s):

Iliya Simantov ◽

Lior Or ◽

Inbal Gazit ◽

Biana Dubinsky-Pertzov ◽

David Zadok ◽

...

Keyword(s):

Visual Acuity ◽

Pediatric Patients ◽

Pediatric Population ◽

Corneal Thickness ◽

Cross Linking ◽

Uncorrected Distance Visual Acuity ◽

Mild Reduction ◽

Change In The Mean ◽

The Mean

Background: Retrospective cohort study evaluating long term keratoconus progression amongst cross-linking (CXL) treated pediatric patients in the treated and the fellow untreated eyes. Methods: Data on 60 eyes of 30 patients, 18 years old or younger, who underwent CXL in at least one eye was collected and analyzed. Follow-up measurements taken from the treated and untreated eye up to 7 years after CXL treatment, were compared to baseline measurements. Parameters included uncorrected distance visual acuity (UCDVA), best-corrected spectacle visual acuity (BCSVA), manifest refraction, pachymetry, corneal tomography, and topography. Results: Mean age of patients was 16 ± 2.1 years. For the treated eyes, during follow-up period mean UCDVA had improved (from 0.78 ± 0.22 at baseline to 0.58 ± 0.26 logMAR at 7 years; p = 0.13), as well as mean BCSVA (from 0.23 ± 0.107 at baseline to 0.172 ± 0.05 logMAR at 7 years; p = 0.37). The mean average keratometry showed a significant flattening (from 49.95 ± 4.04 to 47.94 ± 3.3 diopters (D); p < 0.001), However there was no change in the mean maximal keratometry. The mean minimal corneal thickness (MCT) showed a significant mild reduction of 26 µm ( p = 0.006). Although statistically insignificant, the mean manifest cylinder was also reduced to 2D ( p = 0.15). During the follow-up period, eight untreated eyes (26.6%) deteriorated and underwent CXL, while only one treated eye (3.33%) required an additional CXL. Conclusion: CXL is a safe and efficient procedure in halting keratoconus progression in the pediatric population, the fellow eye needs to be carefully monitored but only a 25% of the patients will require CXL in that eye during a period of 7 years.

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384 Post-Operative ICU Admission for Elective Craniotomy for Intra-axial Brain Tumor Resection

Neurosurgery ◽

10.1093/neuros/nyx417.384 ◽

2017 ◽

Vol 64 (CN_suppl_1) ◽

pp. 291-292

Author(s):

Farhan A Mirza ◽

Catherine Y Wang ◽

Thomas Pittman

Keyword(s):

Brain Tumor ◽

Pediatric Patients ◽

Prolonged Mechanical Ventilation ◽

Pediatric Population ◽

External Ventricular Drain ◽

Tumor Resection ◽

Retrospective Chart Review ◽

Icu Admission ◽

Icu Stay ◽

Brain Tumor Resection

Abstract INTRODUCTION We reviewed our practice at the University of Kentucky in order to assess the safety of admitting adult and pediatric patients to floor beds after craniotomy, exclusively for intra-axial brain tumor resection. METHODS Retrospective chart review of patients, adults and pediatric, who underwent craniotomy by a single surgeon (TP) for intra axial brain tumor resection between January 2012 and December 2015. 413 patient charts were reviewed, 16 were omitted due to incomplete records. RESULTS >421 craniotomies for intra axial brain tumor resection were performed. 397 patients underwent surgery, 35 of whom were <18 years of age.188 females and 209 males. 351 patients (331 adults, 20 pediatric) were admitted to floor beds. In this group, length of operation was <4 hours in 346 patients (99.1%) and >4 hours in only 5 patients (0.9%). 3 patients (0.8%) required transfer to ICU within 24 hours of floor admission. 55 adult patients required ICU stay for various reasons: 9 patients had pre-operative or intra operative EVD placement; 15 patients required prolonged ventilation; 1 patient had to be taken back to the operating room for hemorrhage evacuation; 5 had intraventricular tumors and were planned ICU admissions; 26 patients were admitted pre-operatively to an ICU bed on a non neurosurgical service and were returning to their assigned beds. In the pediatric population, 15 patients required ICU stay: 8 were for EVD management and 7 for prolonged operation or frequent neurological evaluations. In this group, the length of operation was <4 hours in 40 patients(57.1%) and >4 hours in 30 patients (42.9%). CONCLUSION Admitting adult and pediatric patients to floor beds after craniotomy for intra-axial brain tumor resection is safe. There are some conditions that mandate ICU admission: these include prolonged mechanical ventilation and the presence of an external ventricular drain.

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Clinical features and neuropsychiatric comorbidities in pediatric patients with tic disorders: A retrospective chart review study from South Korea

10.21203/rs.3.rs-29173/v3 ◽

2020 ◽

Author(s):

Eu Gene Park ◽

Young-Hoon Kim

Keyword(s):

Pediatric Patients ◽

Retrospective Chart Review ◽

Tic Disorders ◽

Functional Impairments ◽

Diagnostic And Statistical Manual ◽

High Prevalence ◽

Tic Severity ◽

Lip Movement ◽

The Mean ◽

Neuropsychiatric Comorbidities

Abstract Background: Tic disorders are childhood-onset neuropsychiatric disorders characterized by multiple motor or vocal tics with frequent comorbidities and a broad spectrum of phenotypic presentations. In this study, we aimed to investigate the clinical characteristics and comorbid neuropsychiatric conditions in pediatric patients with tic disorders. Methods: We retrospectively reviewed the medical records of 119 pediatric patients (89 males, 30 females) who were diagnosed with tic disorders according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) at Uijeongbu St. Mary’s Hospital, Republic of Korea, between January 2012 and July 2019.Results: The mean age of tic onset was 6.9 years (range, 1–14) and the mean age at diagnosis was 8 years (range, 1–17). The mean lag between tic onset and diagnosis was 13.3 months (range, 0.25–132). The most common, first-presenting tics were eye blinking (50.4%), followed by jaw or lip movement (29.4%) and throat clearing (29.4%). Thirty-seven (31.1%) patients had at least one co-occurring neuropsychiatric disorder at the time of tic diagnosis. Subtypes of tic disorders, types of initial tics, and presence of neuropsychiatric comorbidities were not associated with tic severity. Tic severity was associated with greater functional impairment and tic noticeability (p <0.05). A relatively shorter time to diagnosis was associated with tic severity (Spearman’s ρ = –0.14, p = 0.11).Conclusions: The evolving nature of tic expression and severity, high prevalence of neuropsychiatric comorbidities, and associated functional impairments emphasize the importance of comprehensive assessment during the disease course for determining and prioritizing goals of treatment.

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Characterization of organ dysfunction and mortality in pediatric patients with trauma with acute traumatic coagulopathy

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2019-000382 ◽

2020 ◽

Vol 5 (1) ◽

pp. e000382 ◽

Cited By ~ 1

Author(s):

Alison Nair ◽

Heidi Flori ◽

Mitchell Jay Cohen

Keyword(s):

Hospital Mortality ◽

Organ Dysfunction ◽

Pediatric Patients ◽

Injury Severity ◽

Pediatric Population ◽

Arterial Hypotension ◽

Acute Traumatic Coagulopathy ◽

Level Of Evidence ◽

Coagulation Testing ◽

Traumatic Coagulopathy

BackgroundTraumatic injuries are a leading cause of mortality and morbidity in pediatric patients and abnormalities in hemostasis play an important role in these poor outcomes. One such abnormality, acute traumatic coagulopathy (ATC), is a near immediate endogenous response to injury and has recently been described in the pediatric population. This study aims to evaluate the epidemiology of pediatric ATC, specifically its association with organ dysfunction.MethodsAll patients with trauma presenting to the University of California, Benioff Children’s Hospital Oakland between 2006 and 2015 with coagulation testing drawn at presentation were included. Patients were excluded if they (1) were >18 years of age, (2) were admitted with a non-mechanical mechanism of injury, (3) were on anticoagulation medications, or (4) had coagulation testing >4 hours after injury. ATC was defined as an international normalized ratio (INR) ≥1.3. The primary outcome was new or progressive multiple organ dysfunction syndrome (MODS) and secondary outcomes included in-hospital mortality and other morbidities.ResultsOf the 7382 patients that presented in the 10-year study period, 545 patients met criteria for analysis and 88 patients (16%) presented with ATC. Patients with ATC were more likely to develop MODS than those without ATC (68.4% vs 7.7%, p<0.001) and had higher in-hospital mortality (26.1% vs 0.4%, p<0.001) than those without ATC. Along with arterial hypotension and an Injury Severity Score ≥30, ATC was independent predictor of MODS and in-hospital mortality. An isolated elevated INR was associated with MODS and in-hospital mortality while an isolated elevated partial thromboplastin time was not.ConclusionsPediatric ATC was associated with organ dysfunction, mortality, and other morbidities. ATC along with arterial hypotension and high injury severity were independent predictors of organ dysfunction and mortality. Pediatric ATC may be biologically distinct from adult ATC and further studies are needed.Level of evidenceIV, epidemiologic.

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FUNCTIONAL INDEPENDENCE OF PEDIATRIC PATIENTS WITH MUCOPOLYSACCHARIDOSES

Acta Ortopédica Brasileira ◽

10.1590/1413-785220192704187274 ◽

2019 ◽

Vol 27 (4) ◽

pp. 212-215

Author(s):

Paloma Silva Lopes ◽

Diógenes Pires Serra Filho ◽

Marcos Antônio Almeida Matos

Keyword(s):

Pediatric Patients ◽

Case Series ◽

Functional Independence Measure ◽

Functional Independence ◽

Cross Sectional Study ◽

Cognitive Domain ◽

Level Of Evidence ◽

Cross Sectional ◽

Documentary Analysis ◽

The Mean

ABSTRACT Objective: To measure the functional independence to perform activities of daily living of pediatric patients diagnosed with mucopolysaccharidoses. Methods: A descriptive cross-sectional study was carried out with the population of pediatric patients with a confirmed enzymatic diagnosis of mucopolysaccharidoses, enrolled in the Orthopedics outpatient clinic of a hospital in the State of Bahia. The data were collected between October 2016 and March 2017, based on the documentary analysis of the assessment forms used in the department. The variables of this study comprised sex, age, type of MPS and level of functional independence, measured by the Functional Independence Measure scale. Results: Twenty-six patients participated in the study. These were predominantly male (61.5%), with a mean age of 10 ± 4.5 years, affected by MPS VI (73.1%). In the motor domain, the mean score was 65 (± 19.9 points); the cognitive domain obtained a mean score equal to 28 (± 8.2 points); and the total FIM score was 93 (± 26.5). Conclusion: Impaired functional independence was observed among children and adolescents with mucopolysaccharidoses. Tasks related to dressing, toileting, bathing, problem solving and social interaction were those that required the most assistance and/or supervision. Level of Evidence IV, Case Series.

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The Impact of Upper Airway Stimulation on Swallowing Function

Ear Nose & Throat Journal ◽

10.1177/0145561319853519 ◽

2019 ◽

Vol 98 (8) ◽

pp. 496-499 ◽

Cited By ~ 1

Author(s):

Colin Huntley ◽

Adam Vasconcellos ◽

Michael Mullen ◽

David W. Chou ◽

Haley Geosits ◽

...

Keyword(s):

Assessment Tool ◽

Medical Center ◽

Academic Medical Center ◽

Upper Airway ◽

Apnea Hypopnea Index ◽

Swallowing Function ◽

Upper Airway Stimulation ◽

Obstructive Sleep ◽

The Mean ◽

The Impact

Objective: To evaluate the impact of upper airway stimulation therapy (UAS) on swallowing function in patients with obstructive sleep apnea. Study Design: Prospective cohort study. Setting: Academic medical center. Participants and Outcome Measures: We recorded demographic, preoperative polysomnogram (PSG), operative, and postoperative PSG data. We assessed the patients swallowing function using the Eating Assessment Tool (EAT-10) dysphagia questionnaire. This was administered both pre- and postoperatively. The postoperative EAT-10 survey was administered at least 3 months after UAS implantation. Results: During the study period, 27 patients underwent UAS implantation, completed the pre- and postoperative EAT-10 questionnaire, met inclusion/exclusion criteria, and were included in the study. The cohort consisted of 16 men and 11 women with a mean age of 63.63 years. The mean preoperative BMI, Epworth Sleepiness Scale (ESS), and Apnea Hypopnea Index (AHI) were 29.37, 10.33, and 34.90, respectively. The mean postoperative ESS and AHI were 5.25 and 7.59, respectively. These were both significantly lower than the preoperative values ( P = .026 and P < .001). The mean pre- and postoperative EAT-10 scores were 0.37 and 0.22, respectively ( P = .461). Conclusion: Our data suggest that UAS likely does not lead to postoperative dysphagia.

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Safety and Tolerability of Lidocaine Infusions as a Component of Multimodal Postoperative Analgesia in Children

The Journal of Pediatric Pharmacology and Therapeutics ◽

10.5863/1551-6776-24.1.34 ◽

2019 ◽

Vol 24 (1) ◽

pp. 34-38 ◽

Cited By ~ 2

Author(s):

Katherine Lemming ◽

Gary Fang ◽

Marcia L. Buck

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Adverse Effects ◽

Dose Reduction ◽

Postoperative Analgesia ◽

Pediatric Patients ◽

Pediatric Population ◽

Postoperative Pain Management ◽

Nuss Procedure ◽

The Mean

OBJECTIVES Use of lidocaine as part of a multimodal approach to postoperative pain management has increased in adults; however, limited information is available regarding safety and tolerability in pediatrics. This study's primary objective was to evaluate the incidence of adverse effects related to lidocaine infusions in a sample of pediatric patients. METHODS A retrospective analysis was conducted in pediatric patients receiving lidocaine infusion for the management of postoperative analgesia at the University of Virginia Health System. RESULTS A total of 50 patients with 51 infusions were included in the final analysis. The median patient age was 14 years (range, 2–17 years). The most frequent surgeries were spinal fusion (30%), Nuss procedure for pectus excavatum (16%), and nephrectomy (6%). The mean ± SD starting rate was 13.6 ± 6.5 mcg/kg/min. The mean infusion rate during administration was 15.2 ± 6.3 mcg/kg/min, with 14.4 ± 6.2 mcg/kg/min at discontinuation. The mean length of therapy was 30.6 ± 22 hours. A total of 12 infusions (24%) were associated with adverse effects, primarily neurologic ones, including paresthesias in the upper extremities (10%) and visual disturbances (4%). The average time to onset was 16.2 ± 15.2 hours. Seven infusions were discontinued, whereas the remaining infusions resulted in either dose reduction or continuation without further incident. No patients experienced toxicity requiring treatment with lipid emulsion. CONCLUSIONS In this sample, lidocaine was a well-tolerated addition to multimodal postoperative pain management in the pediatric population. Although adverse effects were common, they were mild and resolved with either dose reduction or discontinuation.

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Effect of the COVID-19 Outbreak on Pediatric Patients’ Admissions to the Emergency Department in an Italian Orthopedic Trauma Hub

10.21203/rs.3.rs-108215/v1 ◽

2020 ◽

Author(s):

Fabio Verdoni ◽

Martina Ricci ◽

Cristina Di grigoli ◽

Nicolò Rossi ◽

Domenico Curci ◽

...

Keyword(s):

Pediatric Patients ◽

Pediatric Population ◽

Northern Italy ◽

Orthopedic Trauma ◽

Discharge Diagnosis ◽

Color Code ◽

Level Of Evidence ◽

Italian Government ◽

Rapid Diffusion ◽

Type Of Injury

Abstract Background: The rapid diffusion of Coronavirus disease (Covid-19) in Northern Italy led Italian government to dictate national lockdown since March 12th 2020 to May 5th 2020. Aim of the study is to analyze the differences in the number of pediatric patients’ admission to the Emergency Room (ER) and in the type and causes of injury. Methods: The pediatric population was divided in a Pandemic group (PG) and Non-Pandemic group (NP). Sex, age, triage color-code at admission, declared cause of trauma and presence of symptoms related to COVID-19 infection, discharge diagnosis and discharge modes were investigated. Results: The Lockdown period led to a reduction of 87.0% in the ER admissions with a particular decrease in patients older than 12 years old from 41.8% in NG to 22.3% in PG. Moreover, a trend towards more severe codes was observed in the PG and the diagnosis of fracture was less frequent in NG (p<0,0001) and injuries at home were more frequent (34.8% compared to 6.8% in NG).Conclusions: A significant decrease in the ER attendances in our Trauma Hub center was reported after the outbreak of Covid-19 pandemic. Furthermore, a shift in the cause and type of injury undoubtedly was observed and only the most serious traumas sought the medical care with an higher percentage of severe triage codes and fractures.Level of evidence: III

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Aspiration and Swallowing Dysfunction in Pediatric Patients

ICAN Infant Child & Adolescent Nutrition ◽

10.1177/1941406411423967 ◽

2011 ◽

Vol 3 (6) ◽

pp. 336-343 ◽

Cited By ~ 6

Author(s):

Claire Kane Miller

Keyword(s):

Pediatric Patients ◽

Respiratory Health ◽

Pediatric Population ◽

Upper Airway ◽

Oral Intake ◽

Therapeutic Strategies ◽

Infants And Children ◽

Airway Protection ◽

Swallowing Dysfunction ◽

Structural Abnormalities

Early identification and management of aspiration associated with oral intake will help contribute to the best possible outcome for infants and children who have airway protection issues with swallowing. Though the incidence and prevalence of aspiration specifically related to swallowing dysfunction across medical conditions in the pediatric population is unknown, there is accumulating evidence of swallowing-related aspiration in infants and children with diagnoses that include structural abnormalities of the upper airway, central nervous system abnormalities, and progressive neurological disease. Chronic aspiration is associated with compromised respiratory health, progressive lung disease, bronchiectasis, and respiratory failure; thus, early detection and appropriate management is crucial. Determining the etiology and effect of aspiration is complex, and multiple evaluations are often required. This article will focus on instrumental studies of swallowing physiology used in the diagnosis and management of swallowing dysfunction and aspiration. Therapeutic strategies to improve airway protection during swallowing will also be described.

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