scholarly journals Perioperative Intravenous Acetaminophen in Pediatric Tonsillectomies

2018 ◽  
Vol 53 (5) ◽  
pp. 316-320 ◽  
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.

scholarly journals Glycemic Control in Pediatric Patients on Extracorporeal Membrane Oxygenation

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.

scholarly journals Evaluation of a clinical protocol using intranasal fentanyl for treatment of vaso-occlusive crisis in sickle cell patients in the emergency department

2019 ◽  
Vol 25 (5) ◽  
pp. 293-299
Author(s):  
Hugo Paquin ◽  
Evelyne D Trottier ◽  
Yves Pastore ◽  
Nancy Robitaille ◽  
Marie-Joelle Dore Bergeron ◽  
...  
Keyword(s):  
Emergency Department ◽  
Sickle Cell ◽  
Chart Review ◽  
Primary Outcome ◽  
Retrospective Chart Review ◽  
Hospitalization Rates ◽  
Number Of Patients ◽  
Implementation Period ◽  
Administration Time ◽  
Opiate Administration

Abstract Background Vaso-occlusive crisis (VOC) is one of the most frequent causes of emergency visits and admission in children with sickle cell disease (SCD). Objectives This study aims to evaluate whether the use of a new pain management pathway using intranasal (IN) fentanyl from triage leads to improved care, translated by a decrease in time to first opiate dose. Methods We performed a retrospective chart review of patients with SCD who presented to the emergency department (ED) with VOC, in the period pre- (52 patients) and post- (44 patients) implementation period of the protocol. Time to first opiate was the primary outcome and was evaluated pre- and postimplementation. Patients received a first opiate dose within 52.3 minutes of registration (interquantile range [IQR] 30.6, 74.6), corresponding to a 41.4-minute reduction in the opiate administration time (95% confidence interval [CI] −56.1, −27.9). There was also a 43% increase in the number of patients treated with a nonintravenous (IV) opiate as first opiate dose (95% CI 26, 57). In patients who were discharged from the ED, there was a 49% decrease in the number of IV line insertions (95% CI −67, −22). There was no difference in the hospitalization rates (difference of 6 [95% CI −13, 25]). Conclusions This study validates the use of our protocol using IN fentanyl as first treatment of VOC in the ED by significantly reducing the time to first opiate dose and the number of IVs.

Dexamethasone Use in the Treatment of Pediatric Deep Neck Space Infections

2019 ◽  
Vol 129 (4) ◽  
pp. 376-379 ◽  
Author(s):  
James B. Tansey ◽  
John Hamblin ◽  
Madhu Mamidala ◽  
Jerome Thompson ◽  
Jennifer Mclevy ◽  
...  
Keyword(s):  
Chart Review ◽  
Primary Outcome ◽  
Pediatric Patients ◽  
Retrospective Chart Review ◽  
Patient Characteristics ◽  
P Value ◽  
Surgical Drainage ◽  
Dexamethasone Group ◽  
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.

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

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.

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

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.

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

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 &lt; 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 &lt; 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.

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

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 &lt; 0.001], but longer sleeping time (18.1% vs 0%, p &lt; 0.001) in all age groups. Subjects who received chloral hydrate had a higher risk of airway complications in the &lt;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.

A sixteen‐year single‐center retrospective chart review of Spitz nevi and spitzoid neoplasms in pediatric patients

2020 ◽  
Vol 37 (6) ◽  
pp. 1073-1082
Author(s):  
Olivia M.T. Davies ◽  
Jacquelyn Majerowski ◽  
Annette Segura ◽  
Scott W. Kelley ◽  
Olayemi Sokumbi ◽  
...  
Keyword(s):  
Chart Review ◽  
Pediatric Patients ◽  
Retrospective Chart Review ◽  
Single Center ◽  
Spitz Nevi

Clinical features and sex differences in pediatric post-traumatic headache: A retrospective chart review at a Boston area concussion clinic

Cephalalgia ◽  
2019 ◽  
Vol 40 (7) ◽  
pp. 701-711 ◽  
Author(s):  
Haley McEvoy ◽  
David Borsook ◽  
Scott A Holmes
Keyword(s):  
Clinical Features ◽  
Chart Review ◽  
Pediatric Patients ◽  
Clinical Presentation ◽  
Retrospective Chart Review ◽  
Post Injury ◽  
Equivalent Representation ◽  
Childhood Education ◽  
History Of ◽  
Post Traumatic

Background Often concussion/mTBI triggers a chronic headache syndrome called persistent post-traumatic headache (P-PTH) that can last from months to years post-injury, and produce significant disruption of childhood education, social interaction and development. Although prevalent and highly disabling, P-PTH is underrepresented in headache and pain research and lacks clear definition and pathophysiology. Clinical presentation of P-PTH frequently resembles that of other headache disorders, like migraine, yet the pathophysiological mechanisms are distinct and not fully understood, making the disorder difficult to treat in the clinical setting. Methods In a retrospective analysis of 1506 pediatric patients attending Boston Children’s Hospital clinics, demographic trends, symptom features, and the influence of sex on clinical presentation of PTH are presented. We compare clinical characteristics of P-PTH with a published cohort of migraine patients to evaluate the clinical features that are unique to P-PTH. Results Findings show that despite equivalent representation of sex in the clinic, P-PTH is expressed more in females than males and is weighted towards somatic symptoms. Relative to migraine, PTH is less associated with a family history of headache. Conclusions The ability to identify persons with PTH can help manage risk factors and identify persons likely to develop persistent post-concussion symptoms.

A Descriptive Report of Bleeding Complications Secondary to Warfarin Therapy

2003 ◽  
Vol 38 (1) ◽  
pp. 36-39 ◽  
Author(s):  
Daphne Bernard ◽  
Arjun P. Dutta ◽  
Monika N. Daftary
Keyword(s):  
Medical Records ◽  
Chart Review ◽  
Warfarin Therapy ◽  
Common Factors ◽  
Retrospective Chart Review ◽  
Descriptive Statistics ◽  
Bleeding Complications ◽  
Comorbid Conditions ◽  
Factors Associated ◽  
Anticoagulation Intensity

Purpose This study identified factors that contributed to bleeding complications associated with warfarin therapy that were documented as adverse drug reactions (ADRs). Methods A retrospective chart review was performed using the Medical Records Department's “E” code list of anticoagulant-related ADRs. Descriptive statistics were used to identify common factors associated with bleeding complications related to warfarin use. Results Patients 60 years of age or older experienced 78% of all events; a majority (81%) of reports involved the presence of comorbid conditions such as congestive heart failure, carcinoma, or sepsis. A supratherapeutic INR was documented for 75% of patients with anticoagulant-related ADRS. Conclusions Age, comorbid conditions, and anticoagulation intensity were identified as possible factors contributing to documented ADRs associated with warfarin therapy.

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