The Epidemiology of Operative Pediatric Hand Trauma: A Retrospective Chart Review

Hand ◽  
2019 ◽  
pp. 155894471989303
Author(s):  
John C. Koshy ◽  
Luke J. Grome ◽  
Kelly Schultz ◽  
Bryce Bell ◽  
Edward Reece ◽  
...  
Keyword(s):  
Chart Review ◽  
Wide Spectrum ◽  
Pediatric Population ◽  
Proximal Phalanx ◽  
Retrospective Chart Review ◽  
Hand Injuries ◽  
Hand Trauma ◽  
Average Patient ◽  
Motorized Vehicles ◽  
Complex Injuries

Background: Hand injuries are common in the pediatric population with a wide spectrum of morbidity that can occur. Simple injuries are distinguished from complex injuries by the number of fingers/systems that are involved. The epidemiology of simple and complex operative hand trauma in the pediatric population has not yet been defined. Methods: A retrospective review was performed of all pediatric patients requiring operative intervention for hand trauma at a major children’s hospital over a 3-year period (2015-2017). Data pertaining to demographics, mechanism, severity, type of surgery, and other factors related to hand trauma were then analyzed and interpreted. Results: Three hundred seventy-one pediatric hand injuries over a 3-year period required surgical intervention, with 19.2% being classified as complex. The average patient age was 11.0 years. A total of 68.7% of patients were men. Bony injuries made up 86.3% of simple injuries, with the proximal phalanx being the most commonly fractured bone. Complex injuries occurred more frequently in men and required a greater number of surgeries (1.6 vs 1.0). Of the complex injuries, only major injuries (severity score >100) required a significantly greater number of surgeries. Major hand injuries were mostly caused by motorized vehicles and required a significantly greater number of surgeries (3.8), compared with other causes of injuries. Conclusions: Operative hand injuries occur along a spectrum of morbidity in the pediatric population. While most of the injuries are simple and require only 1 procedure, more complex injuries can also occur and deserve a higher level of care and attention.

A 10-Year Review of Necrotizing Fasciitis in the Pediatric Population: Delays to Diagnosis and Management

2016 ◽  
Vol 56 (7) ◽  
pp. 627-633 ◽  
Author(s):  
Heather VanderMeulen ◽  
Jeffrey M. Pernica ◽  
Madan Roy ◽  
April J. Kam
Keyword(s):  
Necrotizing Fasciitis ◽  
Chart Review ◽  
Pediatric Population ◽  
Care Center ◽  
Tertiary Care ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
Causative Organism ◽  
Antibiotic Administration ◽  
Large Variability

Objective. To assess the promptness and appropriateness of management in pediatric cases of necrotizing fasciitis (NF). Methods. A retrospective chart review examined cases of pediatric NF treated at a pediatric tertiary care center over a 10-year period. Results. Twelve patients were identified over the 10-year period. The median (25th to 75th centile) times to appropriate antibiotic administration, infectious disease consults, surgical consults and debridement surgeries were 2.6 (2.1-3.2), 7.7 (3.4-24.4), 4.6 (1.7-21.0), and 22.1 (10.3-28.4) hours following assessment at triage. The initial antibiotic(s) administered covered the causative organism in 9 of 12 cases. The median (25th to 75th centile) length of hospital stay was 21 (14.0-35.5) days. Conclusions. The large variability in the care of these patients speaks to the range of their presenting symptomatology. The lack of a standardized approach to the pediatric patient with suspected NF results in delays in management and suboptimal antibiotic choice.

Nerves in Continuity Following Hand Trauma: A Descriptive Report

Hand ◽  
2021 ◽  
pp. 155894472110643
Author(s):  
Daniel E. Pereira ◽  
Mihir J. Desai
Keyword(s):  
Chart Review ◽  
Soft Tissues ◽  
Retrospective Chart Review ◽  
Full Recovery ◽  
Hand Trauma ◽  
Slow Recovery ◽  
Sensory Assessment ◽  
Wrist Trauma ◽  
Direct Nerve

Background: Understanding the clinical presentation of nontransected nerve injuries in acute hand trauma/wrist trauma will help in early intervention, which is vital for maximizing return of function in patients. This retrospective study evaluated patients who experienced traumatic hand injuries with nerve in continuity within the zone of injury. Methods: This was a single-center retrospective chart review of 20 patients with hand or wrist trauma resulting in damage to bone, tendon, or soft tissues within Zones II to V. Patients were 18 to 70 years of age and had documented visualization of at least one nerve within the zone of injury at the time of surgery but no documented full or partial nerve transection. The cohort was characterized using descriptive statistics including mechanism of injury, extent of strength and sensation deficits, and outcomes. Resolution of symptoms was defined as full, partial, or none. Results: Of the 20 patients included in the study, 15 patients (75%) showed symptoms of impaired nerve function either prior to surgery or at the first post-surgical follow-up visit. Without direct nerve treatment, only 23% (3/13) of patients experienced full recovery based on qualitative sensory assessment. However, patients reporting pain after surgery (57%; 8/14) showed full recovery from pain despite no direct nerve treatment. Conclusions: In our retrospective cohort of patients with hand/wrist trauma that presented with an intact nerve in continuity, we found that a majority showed symptoms of nerve injury. Further, these patients showed slow recovery over time with a minority achieving partial or full recovery or improvement in pain.

scholarly journals Impact of a reduced palonosetron maximum dose on the incidence of chemotherapy-induced nausea and vomiting in pediatric patients

2021 ◽  
Author(s):  
Liza Kramer ◽  
Heidi Trinkman ◽  
Robert Arrowood ◽  
Anish Ray
Keyword(s):  
Chart Review ◽  
Pediatric Patients ◽  
Maximum Dose ◽  
Medical Center ◽  
Pediatric Population ◽  
Retrospective Chart Review ◽  
Nausea And Vomiting ◽  
Cell Transplant ◽  
The Impact ◽  
Antiemetic Agents

Background Palonosetron is a serotonin-3 (5-HT3) receptor antagonist indicated in the prevention of chemotherapy-induced nausea and vomiting (CINV) in pediatric and adult patients. Traditional dosing for palonosetron in the pediatric population has been 20 mcg/kg with a maximum dose of 1500 mcg. This study aimed to evaluate the impact of an institutional dose cap of 750 mcg on pediatric CINV. Procedure This is a retrospective chart review of admitted patients given palonosetron intended for prevention of CINV at a pediatric medical center between July 1, 2018 and June 30, 2020. Patients 1 month up to 17 years of age who received at least one dose of palonosetron prior to chemotherapy (not preceding stem cell transplant) were included. Information regarding chemotherapy, antiemetic premedication, emesis, and breakthrough antiemetic agents were recorded to quantify the instances of CINV. Results Seven hundred and seventy-one patient encounters met inclusion criteria (n=485 traditional dose, n=286 dose capped). There was no statistical difference in the instances of emesis (p=0.98) or breakthrough agents administered (p=0.65) between the two groups. Dose capping patients at 750 mcg reduced cost by approximately 34.9% compared to traditional dosing. Conclusions The use of a dose cap of palonosetron at 750 mcg maintains efficacy for prevention of CINV while reducing cost in pediatric patients receiving chemotherapy.

scholarly journals Cannabis Use for Therapeutic Purposes by Children and Youth at a Tertiary Teaching Hospital in Canada: A Retrospective Chart Review

2020 ◽  
Vol 73 (2) ◽  
Author(s):  
Régis Vaillancourt ◽  
Maria Moreno ◽  
Annie Pouliot ◽  
Erick Sell
Keyword(s):  
Chart Review ◽  
Pediatric Population ◽  
Retrospective Chart Review ◽  
Cannabis Use ◽  
Therapeutic Effects ◽  
Medical Cannabis ◽  
Tertiary Teaching ◽  
Tertiary Teaching Hospital ◽  
Douleurs Chroniques

ABSTRACTBackground: The study of the use of cannabis for therapeutic purposesin the pediatric population is increasing, yet data on efficacy and safety are limited. Characterization of pediatric cannabis use for therapeuticpurposes will improve understanding of the circumstances under which it occurs and the associated outcomes.Objective: To describe the use of cannabis for therapeutic purposes, regardless of authorization, in a pediatric tertiary teaching hospital.Methods: A retrospective chart review was completed for patients 18 years of age or younger who used cannabis for therapeutic purposes, regardless of authorization, between May 1, 2014, and May 1, 2017. Patients whose cannabis use was documented as recreational were excluded.Results: In total, 300 patients were identified, of whom 37 met the inclusion criteria. Of these, 30 patients had documentation of medically supervised cannabis use. Most were using cannabis for seizures (n = 28), and many of these (n = 23) were patients with seizures described as intractable or refractory. Of the 27 patients who were experiencing seizures at initiation of medical cannabis, 21 had documentation of a decrease in seizure frequency. This decrease was transient for 16 patients, with a mean duration of 130.4 days (standard deviation 99.1 days). Seven patientsself-medicated with cannabis. They obtained cannabis without author-ization and used it for chronic pain (n = 5) and/or anxiety (n = 5).Conclusions: Medically supervised cannabis use occurred most often in patients with intractable or refractory seizures. According to these data, seizure response is variable, and initial decreases may be transient forpediatric patients using cannabis. To ensure greater consistency and rigour in the conduct of prospective research and thus to generate better-quality research on the therapeutic effects of medical cannabis, development of a standardized care record is needed. RÉSUMÉContexte : Les études portant sur l’utilisation du cannabis à des fins thérapeutiques par les enfants augmentent, mais les données concernant l’efficacité et la sécurité de cette drogue sont limitées. La caractérisationde l’usage du cannabis à des fins thérapeutiques permettra de mieux comprendre les circonstances de l’utilisation de cette drogue ainsi que les effets qui lui sont associés.Objectif : Décrire l’utilisation du cannabis à des fins thérapeutiques, qu’elle soit autorisée ou non, dans un hôpital d’enseignement de soins pédiatriques tertiaires.Méthodes : Un examen rétrospectif des dossiers a été mené auprès de patients d’âge égal ou inférieur à 18 ans, qui ont fait un usage autorisé ou non de cannabis à des fins thérapeutiques entre le 1er mai 2014 et le 1er mai 2017. Les patients qui utilisaient du cannabis à des fins récréatives ont été exclus de l’étude.Résultats : Au total 300 patients ont été identifiés et 37 d’entre eux répondaient au critère d’inclusion. La prise de cannabis sous supervision médicale de 30 d’entre eux était documentée. La plupart utilisaient lecannabis en cas de crise (n = 28) et bon nombre d’entre eux (n = 23) étaient des patients dont les crises étaient décrites comme insolubles ou réfractaires. Des 27 patients qui avaient des crises au début de la prise de cannabis médical, 21 ont enregistré une diminution de la fréquence des crises. Seize patients ont obtenu une diminution éphémère, qui a duré en moyenne 130,4 jours (écart type : 99,1 jours). Sept patients se soignaienteux-mêmes à l’aide de cannabis. Ils obtenaient du cannabis sans autorisation et l’utilisaient pour soulager des douleurs chroniques (n = 5) ou leur anxiété (n = 5).Conclusions : Les patients qui subissaient des crises incurables ou réfractaires utilisaient le plus souvent du cannabis sous supervision médicale. Selon ces données, la réponse aux crises est variable et les baisses initiales du nombre de crises pourraient être éphémères chez les enfants utilisant du cannabis. Il convient de préparer un dossier de soins normalize pour mener des recherches prospectives plus cohérentes et rigoureuses et donc générer des recherches de meilleure qualité sur les effets thérapeutiques du cannabis médical.

scholarly journals 1133. Evaluation of Antibiotic Allergy Documentation in Pediatric Patients

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S403-S403
Author(s):  
Kristin H Wheatley ◽  
Lauren Sterner ◽  
Tibisay I Villalobos-Fry
Keyword(s):  
Broad Spectrum ◽  
Chart Review ◽  
Adverse Reactions ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Retrospective Chart Review ◽  
Adverse Outcomes ◽  
Antibiotic Allergy ◽  
Broad Spectrum Antibiotics ◽  
Standardize Evaluation

Abstract Background Antibiotics are the most prescribed drug class in children and use often results in reports of adverse reactions. Of these adverse reactions, allergic reactions are documented with an incidence of 10% of all antibiotic prescriptions. Documentation of the details of the reaction is incomplete in as many as 66–84% of encounters leading to increased use of broad-spectrum antibiotics and associated adverse outcomes. The purpose of this study was to determine the incidence of complete antibiotic allergy documentation and how antibiotic selection was affected in pediatric patients. Methods A retrospective chart review of electronic medical records was conducted for pediatric patients admitted to a pediatric unit with a documented antibiotic allergy between September 1, 2015 and May 31, 2017. Results The study sample included 536 encounters, 424 individual patients and 689 total allergies. Of all admissions during the study period, 10.3% of encounters had at least one antibiotic allergy documented. Approximately 40% of the encounters were in patients aged 12–17 years. A specific antibiotic was identified in 510 instances (74.0%) whereas an antibiotic class was documented in the remaining 179 instances (26.0%). Amoxicillin was the most commonly reported agent (25.4%). Rash (33.5%) and hives (14.8%) were the most commonly reported reactions. No reaction documentation was found in 78 entries (11.3%). Sixty-six entries (9.6%) did not include a date of occurrence and 452 (65.6%) did not include any specific comments regarding the allergy. Following evaluation of allergy documentation, 87 entries (12.6%) were classified as complete. Empiric broad-spectrum antibiotics were prescribed in 184 encounters (82.5%) compared with narrow-spectrum antibiotic therapy in 39 encounters (17.5%) when an allergy was documented. Conclusion Incomplete documentation of antibiotic allergies was identified in almost 90% of encounters within the pediatric population admitted to Lehigh Valley Reilly Children’s Hospital. Due to the preferential use of broad-spectrum antibiotics in patients with documented antibiotic allergies, an initiative is underway to standardize evaluation and documentation of allergies in patients receiving care within the health network. Disclosures All authors: No reported disclosures.

scholarly journals Developing a Respiratory Depression Scorecard for Capnography Monitoring

2013 ◽  
Vol 4 (3) ◽  
Author(s):  
Katie Felhofer
Keyword(s):  
Risk Factors ◽  
Pulse Oximetry ◽  
Respiratory Depression ◽  
Chart Review ◽  
Medical Center ◽  
Hospital Setting ◽  
Retrospective Chart Review ◽  
University Of Minnesota ◽  
Average Patient ◽  
The University

Pulse oximetry is the most common way to measure a patient's respiratory status in the hospital setting; however, capnography monitoring is a more accurate and sensitive technique which can more comprehensively measure respiratory function. Due to the limited number of capnography monitoring equipment at the University of Minnesota Medical Center-Fairview (UMMC-Fairview), we analyzed which patients should preferentially be chosen for capnography monitoring over pulse oximetry based on risk of respiratory depression. We conducted a retrospective chart review of all serious opioid-induced over-sedation events that occurred at UMMCFairview between January 1, 2008 and June 30, 2012. Thirteen risk factors were identified which predispose patients to respiratory depression. The average patient demonstrated 3.75 risk factors. The most commonly occurring risk factor was the concomitant use of multiple opioids or an opioid and a CNS-active sedative, followed by an ASA score 䊫 3. Based on this data, we developed a scorecard for choosing patients at the most risk of developing respiratory depression; these patients are the best candidates for capnography. Although further studies are necessary to corroborate this research, at this time giving extra consideration to patients demonstrating the previously stated risk factors is prudent when assessing those patients most in need of capnography.   Type: Student Project

Practice Characteristics of Pediatric Otolaryngology Same-Day Appointments

2021 ◽  
pp. 014556132110581
Author(s):  
Jenna Berg ◽  
Alexander Tu ◽  
Dwight Jones ◽  
Katie Geelan-Hansen
Keyword(s):  
Patient Satisfaction ◽  
Otitis Media ◽  
Chart Review ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Demographic Data ◽  
Retrospective Chart Review ◽  
Pediatric Otolaryngology ◽  
Practice Characteristics ◽  
Day Clinic

Objectives This study aims to assess characteristics of same-day clinic appointments in a pediatric population at an academic otolaryngology practice. Methods Retrospective chart review of patients aged 18 or younger who had same-day clinic appointments between January 1, 2016, and December 31, 2018, at a single academic institution. Demographic data, diagnosis(es), procedures, and operations completed were included in the analysis. Results There were 363 same-day visits by 322 patients in the 3-year study period. Two hundred sixty-nine (269) of these visits were from new patients. Otitis media and rhinosinusitis were the most frequently coded diagnoses. One hundred forty-four (144) procedures were completed the day of the visit and 169 operations were performed as a result of the same-day visit. If the patient had a procedure or operation performed, they were more likely to have been referred by another provider. Conclusions Providing same-day appointments can help provide timely and appropriate otolaryngology specialty care to pediatric patients. Further evaluation is needed to determine the effects on patient satisfaction as well as no-show rates.

scholarly journals Tongue Blade Bite Test Predicts Mandible Fractures

2016 ◽  
Vol 9 (2) ◽  
pp. 121-124 ◽  
Author(s):  
John Neiner ◽  
Rachael Free ◽  
Gloria Caldito ◽  
Tara Moore-Medlin ◽  
Cherie-Ann Nathan
Keyword(s):  
Predictive Value ◽  
Chart Review ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Retrospective Chart Review ◽  
High Sensitivity ◽  
Ct Scans ◽  
Facial Trauma ◽  
Institutional Review ◽  
Mandible Fractures

The aim of the study is to evaluate the utility of a simple tongue blade bite test in predicting mandible fractures and use this test as an alternative screening tool for further workup. This is a retrospective chart review. An institutional review board approved the retrospective review of patients evaluated by the Department of Otolaryngology at a single institution for facial trauma performed from November 1, 2011, to February 27, 2014. Patients who had a bite test documented were included in the study. CT was performed in all cases and was used as the gold standard to diagnose mandible fractures. Variables analyzed included age, sex, fracture type/location on CT, bite test positivity, and operative intervention. A total of 86 patients met the inclusion criteria and of those 12 were pediatric patients. Majority of the patients were male (80.2%) and adult (86.0%; average age: 34.3 years). Fifty-seven patients had a negative bite test and on CT scans had no mandible fracture. Twenty-three patients had a positive bite test and a CT scan confirmed fracture. The bite test revealed a sensitivity of 88.5% (95% CI: 69.8–97.6%), specificity of 95.0% (95% CI:86.1–99%), positive predictive value [PPV] of 88.5% (95% CI: 69.8–97.6%), and negative predictive value [NPV] of 95.0% (95% CI: 86.1–99.0%). Among pediatric patients, the sensitivity was 100% (95% CI: 29.9–100%), specificity was 88.9% (95% CI: 68.4–100%), PPV was 75.0% (95% CI: 19.4–99.4%), and NPV was 100% (95% CI: 63.1–100%). The tongue blade bite test is a quick inexpensive diagnostic tool for the otolaryngologist with high sensitivity and specificity for predicting mandible fractures. In the pediatric population, where avoidance of unnecessary CT scans is of highest priority, a wider range of data collection should be undertaken to better assess its utility.

scholarly journals Prevalence of beta-lactam allergy: a retrospective chart review of drug allergy assessment in a predominantly pediatric population

2016 ◽  
Vol 12 (1) ◽  
Author(s):  
Elissa M. Abrams ◽  
Andrew Wakeman ◽  
Tom V. Gerstner ◽  
Richard J. Warrington ◽  
Alexander G. Singer
Keyword(s):  
Drug Allergy ◽  
Chart Review ◽  
Pediatric Population ◽  
Retrospective Chart Review ◽  
Beta Lactam
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