Management of Recurrent and Delayed Post-Tonsillectomy and Adenoidectomy Hemorrhage in Children

Objective: To review our experience on post-tonsillectomy and/or adenoidectomy hemorrhage (PTAH) at a tertiary pediatric referral hospital and to evaluate the management and risk factors for recurrent postoperative hemorrhage and for delayed bleeding after day 14. Methods: A retrospective chart review was performed for all pediatric patients admitted to The Children’s Hospital at Westmead for PTAH between July 01, 2014, and June 30, 2019. Patients with recurrent hemorrhage and those with bleeding after day 14 were selected for subanalysis. Results: Of the 291 patients admitted for PTAH, 31 (11%) patients had recurrent postoperative hemorrhage, and 11 (4%) patients had delayed bleeding after day 14. Surgical intervention for cessation of hemorrhage was required in 88 (30%) patients, including 2 patients who required return to the theater more than once. Nine (3%) patients received blood transfusions. The average number of days between bleeding episodes was 4 days. Recurrent postoperative hemorrhage occurred in 8.5% of patients who were managed operatively at their first presentation compared to 11.4% of patients who were managed nonoperatively (odds ratio: 1.1; 95% confidence interval 0.43-2.8). No association was found between abnormal coagulation profile, surgical indication, and risk of delayed postoperative hemorrhage. Conclusions: Recurrent or delayed postoperative hemorrhage represents a small proportion of children with postoperative bleeding and cannot be reliably predicted. Management of first presentations with either a conservative or a surgical approach is reasonable since the risk of recurrent of PTAH may be unrelated to the choice of management at initial presentation. Careful preoperative counseling of patients and their families is important to help set expectations in the event of PTAH.

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Characteristics of Anterior Lens Opacities in Children

The Open Ophthalmology Journal ◽

10.2174/1874364101711010084 ◽

2017 ◽

Vol 11 (1) ◽

pp. 84-88 ◽

Cited By ~ 2

Author(s):

Lena Dixit ◽

Michael Puente ◽

Kimberly G. Yen

Keyword(s):

High Frequency ◽

Chart Review ◽

Pediatric Patients ◽

Surgical Intervention ◽

Retrospective Chart Review ◽

Common Type ◽

Lens Opacities ◽

Polar Type ◽

Over Time ◽

Systemic Associations

Background: Anterior lens opacities (ALO) are found in 3-14% of pediatric patients with cataracts. No clear guidelines exist in the management and treatment of these cataracts. Objective: To evaluate pediatric patients with anterior lens opacities and assess rate of amblyopia and need for surgery over time. Methods: A retrospective chart review was performed on patients with unilateral and bilateral anterior lens opacities (ALOs) seen between January 2008 and December 2014. Size, location, and type of ALO were noted. Refractive error, necessity for treatment of amblyopia, and interventions were recorded. Results: A total of 31 patients were included in the study. 17 patients had unilateral ALOs and 14 had bilateral ALOs. The majority of the cataracts (90.3%) were centrally located. The most common type of cataract was the polar type of cataract and the vast majority (48.4%) was < 1mm in size. 38.7% of patients had concurrent ocular conditions and 9.7% had systemic associations. 28.6% of patients with bilateral cataracts and 35.3% of the patients with unilateral cataracts were treated for amblyopia. Three patients required cataract surgery. Conclusion: About half of anterior lens opacities are less than 1mm in size and the majority are of the polar type. Risk of amblyopia in these patients is higher than in the general population. Anisometropia is the most common cause of amblyopia. Ocular associations are seen at a relatively high frequency and systemic associations can occur but are uncommon. The need for surgical intervention is infrequent; however, growth of ALOs and associated cortical changes may be risk factors for surgery.

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

Pediatric Dermatology ◽

10.1111/pde.14320 ◽

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

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The Currarino Triad: Neurosurgical Considerations

Neurosurgery ◽

10.1227/01.neu.0000209945.87233.6a ◽

2006 ◽

Vol 58 (5) ◽

pp. 924-929 ◽

Cited By ~ 34

Author(s):

Pieter J. Emans ◽

Jasper van Aalst ◽

Ernest L.W. van Heurn ◽

Carlo Marcelis ◽

Gauke Kootstra ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Canal ◽

Chart Review ◽

Surgical Intervention ◽

Tethered Cord ◽

Retrospective Chart Review ◽

Risks And Benefits ◽

Chiari Type 1 Malformation ◽

Spine Imaging

Abstract OBJECTIVES: The Currarino triad, a relatively uncommon hereditary disorder, is often associated with tethered cord and anterior myelomeningocele. Little is known of the implications of these neuroanatomic malformations or of the neurosurgical attitude. The objective of this study is to identify the spinal cord and meningeal malformations associated with the Currarino triad and to discuss the risks and benefits of surgical intervention. METHODS: We analyzed the spinal cord malformations and the neurosurgical involvement with the Currarino triad by retrospective chart review. RESULTS: The Currarino triad neuroanatomic malformations were identified in five patients. The Currarino triad was associated with a tethered cord in three patients, a myelomeningocele in five patients, a syrinx in two patients, a fistula between the colon and spinal canal in two patients, and an Arnold-Chiari Type 1 malformation in one patient. CONCLUSION: Full spine imaging is required for all patients diagnosed with the Currarino triad. Magnetic resonance imaging of the head should be performed in every patient with neuroanatomic anomalies. Surgery of an anterior myelomeningocele is not necessarily indicated, only in the rare case in which the space-occupying aspect is expected to cause constipation or problems during pregnancy or delivery. Constipation directly after birth is seen in virtually all patients with the triad. Therefore, constipation cannot be used to diagnose a tethered cord syndrome nor indicate tethered cord release. Fistulas between the spinal canal and colon have to be operated on directly.

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Cost-effectiveness of prophylaxis against on-demand treatment in boys with severe hemophilia A in Iran

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462309990420 ◽

2009 ◽

Vol 25 (4) ◽

pp. 584-587 ◽

Cited By ~ 10

Author(s):

Aliasghar Ahmad Kia Daliri ◽

Hassan Haghparast ◽

Jahanara Mamikhani

Keyword(s):

Cost Effectiveness ◽

Chart Review ◽

Prophylactic Treatment ◽

Bleeding Event ◽

Retrospective Chart Review ◽

Third Party ◽

Bleeding Events ◽

On Demand ◽

Bleeding Episodes ◽

Hemophilia Treatment Centers

Objective: The aim of this study was to assess the incremental cost-effectiveness of on-demand versus prophylactic hemophilia therapy in Iran from a third-party payers’ perspective.Methods: A retrospective chart review of twenty-five type A hemophiliacs who were treated in three hemophilia treatment centers was conducted. The patients were boys 0–9 years old receiving one of two treatments: (i) prophylaxis with concentrate at clinic; (ii) concentrate at clinic as on-demand. Fourteen boys received on-demand infusions for bleeding events, and eleven boys received infusions prophylaxis. Data were extracted from documents in the hemophilia treatment centers during a period of approximately 6 months.Results: The patients receiving prophylactic treatment had fewer bleeding events each month (mean, 0.26 versus 2.74) but used more concentrate (225.31 versus 87.20 units/kg per month). Average monthly cost per patient in the prophylaxis group was approximately 1.9 times higher than in the on-demand group. Compared with on-demand infusion, prophylaxis costs 3,201,656 Rials (€213.45) per bleeding event prevented.Conclusion: Prophylactic care markedly reduces the number of bleeding episodes, but at considerable cost.

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

Cephalalgia ◽

10.1177/0333102419896754 ◽

2019 ◽

Vol 40 (7) ◽

pp. 701-711 ◽

Cited By ~ 2

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.

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Early Detection of Renal Dysfunction in Pediatric Sickle Cell Patients

Blood ◽

10.1182/blood.v120.21.1017.1017 ◽

2012 ◽

Vol 120 (21) ◽

pp. 1017-1017

Author(s):

Marwah W. Farooqui ◽

Santosh Saraf ◽

Victor R. Gordeuk ◽

Kimberly Czech ◽

Eunice John ◽

...

Keyword(s):

Sickle Cell Disease ◽

Renal Dysfunction ◽

Sickle Cell ◽

Chart Review ◽

Pediatric Patients ◽

Retrospective Chart Review ◽

The Other ◽

Cell Disease ◽

Urine Protein ◽

Sickle Cell Nephropathy

Abstract Abstract 1017 In sickle cell disease, patients are predisposed to renal dysfunction and eventual renal failure as they reach adulthood. Many advances have been made within the field of sickle cell anemia, yet to this day sickle cell nephropathy remains an important cause of mortality in adult patients. Previous studies have determined that proteinuria and hematuria are two useful markers of sickle cell nephropathy. Currently, the best marker for detecting early renal dysfunction is proteinuria on urine dipstick due to its ease of use and efficiency. Our goal in this study is to determine the age at which the first signs of renal dysfunction appear. Pediatric patients with sickle cell disease were selected for a retrospective chart review to determine age of onset for renal abnormalities. The sickle cell pediatric roster was used from the Children's Hospital University of Illinois to study a total of 175 patients within the age range of 0–31 years. Urinalysis was captured at patient's baseline when available and possible risk factors for glomerular dysfunction were studied. Factors such as urine protein and blood on dipstick were recorded and proteinuria was further quantified by using the urine protein to creatinine ratio. Blood on dipstick was further analyzed by red blood cells on microscopic urinalysis. Patients with positive urine for blood on dipstick with <5 RBCs on microscopic UA were marked as patients with hemoglobinuria. Other factors such as sickle cell hemoglobin type, LDH, reticulocyte count, HbF, and hydroxyurea treatment were also recorded to look for correlation with predictors of early renal dysfunction. The Fisher's exact test was used to compute the (two-tailed) probability. Urinalysis results were available for 141 of the 175 pediatric patients from the sickle cell roster. From the 141 patients that were studied 65% of the patients had urinalysis done at baseline, the other 35% had UA when acutely ill. The mean overall age was 9.9 years and a total of 25 of the 141 (17.7%) patients were observed to have proteinuria on dipstick. In the proteinuria group, 64% of the UA were obtained at baseline and the other 36% were during a sick visit. The majority (66%) of these ‘sick’ patients were febrile under the age of 7. Obtaining a UA during an acute illness could skew our results since pediatric patients who are acutely ill may have transient proteinuria but none at baseline. In our pediatric sickle cell population, about 14% had hemoglobinuria. Analysis of only baseline UA showed that no patients under the age of 5 at baseline had proteinuria and there is a strong correlation between age and proteinuria (R2 = 0.81, p<0.02). Similarly there is a correlation between age and hemoglobinuria (R2 = 0.57). Hemoglobinuria is occasionally observed in 11.4% of children <5 years of age, and at 12.9% in the teenage group. A significant increase in incidence of hemoglobinuria is noted in the young adults (40%). Of the 16 patients with hemoglobinuria only 8 had concurrent proteinuria. A larger sample size is needed to determine whether proteinuria and hemoglobinuria are independent versus correlated markers of early renal dysfunction. Preliminary analyses of baseline UA found no correlations between proteinuria and Hb level, LDH, reticulocytes, serum creatinine, or creatinine clearance. From this retrospective chart review in this pediatric sickle cell disease population, it can be deduced that proteinuria becomes a concern in sickle patients in the adolescent years while hemoglobinuria appears in late teen to young adult years. It can be concluded that the first clinical signs of renal dysfunction which lead to nephropathy in sickle patients are more frequently seen in adolescent to late teen years and this is likely the marks the beginning of the deterioration of kidney function. Further studies are needed for multivariate analysis of other markers (GFR, Cr, Cr Clearance) of nephropathy and to improve early detection of renal dysfunction by conducting longitudinal studies. Our goal is to improve our current practice by routine screening in sickle patients to preserve renal function and improve the morbidity and mortality related to sickle cell nephropathy in the aging patient. Disclosures: No relevant conflicts of interest to declare.

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