Electrographic Seizures and Outcome in Critically Ill Children

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012032
Author(s):  
France W. Fung ◽  
Zi Wang ◽  
Darshana S. Parikh ◽  
Marin Jacobwitz ◽  
Lisa Vala ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Critically Ill ◽  
Odds Ratio ◽  
Cerebral Performance Category ◽  
Unfavorable Outcome ◽  
Critically Ill Children ◽  
Acute Encephalopathy ◽  
Logistic Regression Models ◽  
Electrographic Seizures ◽  
Neurobehavioral Outcomes

Objective:To determine the association between electroencephalographic seizure (ES) and electroencephalographic (ESE) exposure and unfavorable neurobehavioral outcomes in critically ill children with acute encephalopathy.Methods:This was a prospective cohort study of acutely encephalopathic critically ill children undergoing CEEG. ES exposure was assessed as: (1) no ES/ESE, (2) ES, or (3) ESE. Outcomes assessed at discharge included the Glasgow Outcome Scale - Extended Pediatric Version (GOS-E-Peds), Pediatric Cerebral Performance Category (PCPC), and mortality. Unfavorable outcome was defined as a reduction in GOS-E-Peds or PCPC score from pre-admission to discharge. Stepwise selection was used to generate multivariate logistic regression models that assessed associations between ES exposure and outcomes while adjusting for multiple other variables.Results:Among 719 consecutive critically ill subjects, there was no evidence of ES in 535 subjects (74.4%), ES in 140 subjects (19.5%), and ESE in 44 subjects (6.1%). The final multivariable logistic regression analyses included ES exposure, age dichotomized at 1-year, acute encephalopathy category, initial EEG background category, comatose at CEEG initiation, and the Pediatric Index of Mortality 2 score. There was an association between ESE and unfavorable GOS-E-Peds (Odds Ratio 2.21, 95%CI 1.07-4.54) and PCPC (Odds Ratio 2.17, 95%CI 1.05-4.51) but not mortality. There was no association between ES and unfavorable outcome or mortality.Conclusions:Among acutely encephalopathic critically ill children, there was an association between ESE and unfavorable neurobehavioral outcomes, but no association between ESE and mortality. ES exposure was not associated with unfavorable neurobehavioral outcomes or mortality.

scholarly journals Normal Baseline Function Is Associated With Delayed Rehabilitation in Critically Ill Children

2018 ◽  
Vol 35 (4) ◽  
pp. 405-410 ◽  
Author(s):  
Shinya Miura ◽  
Beth Wieczorek ◽  
Hallie Lenker ◽  
Sapna R. Kudchadkar
Keyword(s):  
Logistic Regression ◽  
Critically Ill ◽  
Predictive Factors ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Motor Impairment ◽  
Early Mobilization ◽  
Early Rehabilitation ◽  
Critically Ill Children ◽  
Prism Score

Background: Early mobilization of patients in the adult intensive care unit (ICU) is associated with improved functional outcomes and shorter ICU stay. Although emerging evidence suggests that early mobilization in pediatric ICUs (PICUs) is safe and feasible, physical therapist (PT) consultation may be delayed because of perceptions that patient acuity precludes mobilization activities. Factors that influence timely involvement of PTs to facilitate acute rehabilitation in critically ill children have not been characterized. The aim of this study was to identify patient-level factors for early PT consultation in a tertiary care PICU before large-scale implementation of a multicomponent early mobilization program. Methods: We conducted a retrospective analysis of data from the PICU Up! Quality Improvement Initiative. The primary outcome was early rehabilitation, defined as PT consultation within the first 3 days of PICU admission. Patients (n = 100) were divided into 2 groups by outcome, and predictive factors for early rehabilitation were analyzed with logistic regression. Results: Of 100 children, 54% received early rehabilitation. In univariate analyses, higher pediatric risk of mortality (PRISM) score ( P < .001), baseline motor impairment ( P < .01), developmental delay ( P = .04), mechanical ventilation ( P = .1), and number of devices ( P = .01) were associated with early rehabilitation. In a logistic regression model, predictive factors for early rehabilitation included baseline motor impairment (adjusted odds ratio = 5.36, 95% confidence interval [CI] = 1.3-22.0) and higher PRISM score (adjusted odds ratio = 1.17, 95% CI = 1.02-1.34). Conclusions: Critically ill children with normal baseline function or lower acuity of illness are less likely to have initiation of early rehabilitation with PT prior to implementation of a unit-wide early mobilization program. Baseline motor impairment and higher PRISM scores were independently associated with early rehabilitation. These findings highlight the need for streamlined criteria for PT consultation to meet the rehabilitation needs of all critically ill patients.

Electrographic seizures and status epilepticus in critically ill children and neonates with encephalopathy

2013 ◽  
Vol 12 (12) ◽  
pp. 1170-1179 ◽  
Author(s):  
Nicholas S Abend ◽  
Courtney J Wusthoff ◽  
Ethan M Goldberg ◽  
Dennis J Dlugos
Keyword(s):  
Status Epilepticus ◽  
Critically Ill ◽  
Critically Ill Children ◽  
Electrographic Seizures

Clinical Features and Risk Factors Associated with Mortality in Critically ill Children Requiring Continuous Renal Replacement Therapy

2020 ◽  
Author(s):  
Muhterem Duyu ◽  
Ceren Turkozkan
Keyword(s):  
Risk Factors ◽  
Respiratory Failure ◽  
Renal Replacement Therapy ◽  
Renal Disease ◽  
Continuous Renal Replacement Therapy ◽  
Critically Ill ◽  
Odds Ratio ◽  
Critically Ill Children ◽  
Factors Associated ◽  
High Lactate

Abstract Background: The aims of this study were to describe the epidemiology and demographic characteristics of critically ill children requiring continuous renal replacement therapy (CRRT) at our pediatric intensive care unit (PICU) and to explore risk factors associated with mortality. Methods: A retrospective cohort of 121 critically ill children who received CRRT from May 2015 to May 2020 in the PICU of a tertiary healthcare institution was evalauted. The demographic information, admission diagnosis, indication for CRRT, clinical variables at the initiation of CRRT, time related variables and the laboratory results at initiation of CRRT were compared between survivors and non-survivors.Results: The most common diagnoses were renal disease (30.6%), hemato-oncological disease (12.4%), and sepsis (11.6%). The overall mortality was 29.8%. When compared according to diagnosis at admission, we found that patients with hemato-oncologic disease (73.3%) and those with pneumonia/respiratory failure (72.7%) had the highest mortality, while patients with renal disease had the lowest mortality (5.4%). The most common CRRT indications were: electrolyte or acid base imbalance (38.8%), acute kidney injury (29.8%) and fluid overload (14.9%). There was no relationship between mortality and indication for CRRT. The time interval between PICU admission and CRRT initiation was also unassociated with mortality (p=0.146). In patients diagnosed with sepsis, time until the initiation of CRRT was significantly shorter in survivors compared to non-survivors (p=0.004). Based on multivariate logistic regression, presence of comorbidity (odds ratio: 5.71; %95 CI: 1.16-27.97), being diagnosed with pneumonia/respiratory failure at admission (odds ratio: 16.16; %95 CI: 1.56-167.01), and high lactate level at the initiation of CRRT (odds ratio: 1.43; %95 CI: 1.17-1.79) were independently associated with mortality.Conclusions: In the context of the population studied mortality rate was lower than previously reported. In critically ill children requiring CRRT, mortality seems to be related to underlying disease, presence of comorbidity, and high lactate levels at CRRT initiation. We also found that early initiation of CRRT in sepsis can reduce mortality.

scholarly journals Effects of Older Adult Driving Resumption on All-Cause Mortality

2019 ◽  
Vol 75 (10) ◽  
pp. 2263-2267
Author(s):  
Kendra L Ratnapradipa ◽  
Jing Wang ◽  
Marla Berg-Weger ◽  
and Mario Schootman
Keyword(s):  
Logistic Regression ◽  
Older Adult ◽  
Mortality Risk ◽  
Odds Ratio ◽  
Regression Models ◽  
Adjusted Odds Ratio ◽  
Community Dwelling ◽  
Driving Cessation ◽  
Logistic Regression Models ◽  
All Cause Mortality

Abstract Objectives Driving cessation is associated with adverse social and health outcomes including increased mortality risk. Some former drivers resume driving. Do resumed drivers have a different mortality risk compared to former drivers or continued drivers? Method We analyzed National Health and Aging Trends Study (2011–2015) data of community-dwelling self-responding ever drivers (n = 6,189) with weighted stratified life tables and discrete time logistic regression models to characterize mortality risk by driving status (continued, resumed, former), adjusting for relevant sociodemographic and health variables. Results Overall, 14% (n = 844) of participants died and 52% (n = 3,209) completed Round 5. Former drivers had the highest mortality (25%), followed by resumed (9%) and continued (6%) drivers. Former drivers had 2.4 times the adjusted odds of mortality compared with resumed drivers (adjusted odds ratio [aOR] = 2.41; 95% confidence interval [CI] = 1.51, 3.83), with no difference between continued and resumed drivers (aOR = 1.22; 95% CI = 0.74, 1.99). Discussion Those who resumed driving had better survival than those who did not. Practice implications include driver rehabilitation and retraining to safely promote and prolong driving.

scholarly journals Treatment of electrographic seizures and status epilepticus in critically ill children: A single center experience

Seizure ◽  
2013 ◽  
Vol 22 (6) ◽  
pp. 467-471 ◽  
Author(s):  
Nicholas S. Abend ◽  
Sarah M. Sanchez ◽  
Robert A. Berg ◽  
Dennis J. Dlugos ◽  
Alexis A. Topjian
Keyword(s):  
Status Epilepticus ◽  
Critically Ill ◽  
Critically Ill Children ◽  
Single Center ◽  
Single Center Experience ◽  
Electrographic Seizures

scholarly journals Mitral valve thickening in acute rheumatic fever as a predictor of late valvar dysfunction

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259737
Author(s):  
Telêmaco Luis da Silva ◽  
Antonio Pazin-Filho ◽  
Minna M. D. Romano ◽  
Virgínia P. L. Ferriani ◽  
José A. Marin-Neto ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Mitral Valve ◽  
Rheumatic Fever ◽  
Odds Ratio ◽  
Acute Rheumatic Fever ◽  
Univariate Analysis ◽  
Multivariate Logistic Regression ◽  
Valve Dysfunction ◽  
Logistic Regression Models ◽  
Important Health

Background Rheumatic heart disease (RHD) complicating acute rheumatic fever (ARF) remains an important health problem in developing countries. No definitive diagnostic test for ARF exists and the role of Doppler echocardiography (DEC) for long-term prognostic evaluation following ARF is not well established. Objective To investigate the prognostic value of DEC in patients with ARF as a predictor of chronic valve dysfunction. Methods Prospectively enrolled patients with clinical ARF had a DEC performed soon after diagnosis and repeated at 1, 3, 6 and 12 months and thereafter at every 1–2 years. We defined chronic valve dysfunction by ≥ 3 of the following: increased valve thickening, commissure fusion, subvalvular thickening, reduced leaflet mobility, non-trivial mitral and/or aortic regurgitation. We performed univariate analysis and developed multivariate logistic regression models to identify variables that may influence evolution to RHD. p <0.05 was considered significant. Results We evaluated 70(57% men) patients, 10.8±5.6 years-old during the ARF episode and followed for 95±26 months. Chronic valve dysfunction was identified in 36(51.4%) which fulfilled criteria for RHD and 10(27.8%) of them died or underwent valve surgery. Univariate analysis showed that mitral valve thickening and presence of mitral regurgitation at baseline DEC, were associated with RHD(p<0.01). Multivariate logistic regression showed that only mitral valve thickness either as a continuous (Odds-Ratio:5.8;95%CI:1.7–19.7) or as a categorical variable (Odds-Ratio:4.04;95%CI:1.06–15.3) was an independent predictor of chronic valve dysfunction. Conclusions Mitral leaflets thickening documented at the time of diagnosis of ARF is a consistent prognostic marker for the subsequent evolution to RHD.

scholarly journals Analysis of oral risk-factors for ventilator-associated pneumonia in critically ill patients

2020 ◽  
Author(s):  
Ademar Takahama ◽  
Vitoria Iaros de Sousa ◽  
Elisa Emi Tanaka ◽  
Evelise Ono ◽  
Fernanda Akemi Nakanishi Ito ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Logistic Regression ◽  
Physical Examination ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Cross Sectional Study ◽  
Ventilator Associated Pneumonia ◽  
Cross Sectional ◽  
Logistic Regression Models

Abstract Objective: This a cross-sectional study to evaluate the association between oral health findings and ventilator-associated pneumonia (VAP) among critically ill patients in intensive care units (ICU). Material and Methods: Data were collected from medical records, and a detailed oral physical examination was performed on 663 critically ill patients on mechanical ventilation. Data were statistically analysed using univariate and logistic regression models relating the development of VAP with the oral findings. Results: At oral physical examination, the most frequent findings were tooth loss (568 - 85.67%), coated tongue (422 - 63.65%) and oral bleeding (192 - 28.96%). Patients with a coated tongue or oral bleeding on the first day of ICU hospitalization developed more VAP than did patients without these conditions (20.14% vs 13.69%: p=0.02; 23.44% vs 15.50%: p=0.01, respectively). In the logistic regression, a coated tongue and oral bleeding were considered independent risk factors for VAP development [OR=1.60 (1.02-2.47) and OR=1.59 (1.05 – 2.44), respectively]. Conclusions: The presence of a coated tongue and oral bleeding in ICU admission could be considered markers for the development of VAP. Clinical relevance: The results of this paper reinforces the importance of proper maintenance of oral hygiene before intubation, which may lead to a decrease in the incidence of VAP in the ICU. This is particularly important in the COVID-19 current scenario, where more people are expected to need mechanical ventilation, consequently increasing cases of VAP.

Can Lactate Clearance Predict Mortality in Critically Ill Children?

2021 ◽  
Author(s):  
Azza A. Moustafa ◽  
Abeer S. Elhadidi ◽  
Mona A. El-Nagar ◽  
Hadir M. Hassouna
Keyword(s):  
Critically Ill ◽  
Odds Ratio ◽  
Survival Curve ◽  
Tertiary Care ◽  
Prognostic Significance ◽  
Lactate Clearance ◽  
Critically Ill Children ◽  
Multivariate Logistic Regression Model ◽  
Arterial Blood ◽  
Group A

AbstractSerial evaluation of blood lactate, including lactate clearance, may have greater value over single measurement at the time of presentation. The rationale of the current study was to evaluate the use of lactate clearance after 6 hours of admission to pediatric intensive care unit (PICU) as a predictor of mortality in critically ill children. A prospective observational study was conducted in a nine-bed PICU of a tertiary care teaching hospital over a period of 6 months. Lactate levels were measured in arterial blood samples of 76 patients at the time of admission and 6 hours later. According to calculated lactate clearance, patients were divided into group A (lactate clearance more than 0) which included 71% of patients and group B (lactate clearance ≤0) which included 29% of patients. Lactate level at admission was a poor predictor of mortality (area under receiver operating characteristic curve [AUC] = 0.519, p = 0.789). Lactate clearance after 6 hours of admission was a significant predictor of mortality (AUC = 0.766, p < 0.001). Using Kaplan–Meier survival curve, overall survival was significantly better among group A (p < 0.001). Using multivariate logistic regression model, lactate clearance after 6 hours (odds ratio = 0.98, 95% confidence interval [CI]: 0.96–0.99) and The Pediatric Index of Mortality 2 (PIM2) score (odds ratio = 4.7, 95% CI: 1.85–12.28) had independent prognostic significance as regard to mortality (p = 0.030, 0.001 respectively). We conclude that lactate clearance after 6 hours of admission can predict mortality in critically ill children.

Risk factors for hospital-associated venous thromboembolism in critically ill children following cardiothoracic surgery or therapeutic cardiac catheterisation

2017 ◽  
Vol 28 (2) ◽  
pp. 234-242 ◽  
Author(s):  
Christie M. Atchison ◽  
Ernest Amankwah ◽  
Jean Wilhelm ◽  
Shilpa Arlikar ◽  
Brian R. Branchford ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Venous Thromboembolism ◽  
Confidence Interval ◽  
Critically Ill ◽  
Odds Ratio ◽  
Cardiothoracic Surgery ◽  
Critically Ill Children ◽  
Cardiovascular Intensive Care

AbstractBackgroundPaediatric hospital-associated venous thromboembolism is a leading quality and safety concern at children’s hospitals.ObjectiveThe aim of this study was to determine risk factors for hospital-associated venous thromboembolism in critically ill children following cardiothoracic surgery or therapeutic cardiac catheterisation.MethodsWe conducted a retrospective, case–control study of children admitted to the cardiovascular intensive care unit at Johns Hopkins All Children’s Hospital (St. Petersburg, Florida, United States of America) from 2006 to 2013. Hospital-associated venous thromboembolism cases were identified based on ICD-9 discharge codes and validated using radiological record review. We randomly selected two contemporaneous cardiovascular intensive care unit controls without hospital-associated venous thromboembolism for each hospital-associated venous thromboembolism case, and limited the study population to patients who had undergone cardiothoracic surgery or therapeutic cardiac catheterisation. Odds ratios and 95% confidence intervals for associations between putative risk factors and hospital-associated venous thromboembolism were determined using univariate and multivariate logistic regression.ResultsAmong 2718 admissions to the cardiovascular intensive care unit during the study period, 65 met the criteria for hospital-associated venous thromboembolism (occurrence rate, 2%). Restriction to cases and controls having undergone the procedures of interest yielded a final study population of 57 hospital-associated venous thromboembolism cases and 76 controls. In a multiple logistic regression model, major infection (odds ratio=5.77, 95% confidence interval=1.06–31.4), age ⩽1 year (odds ratio=6.75, 95% confidence interval=1.13–160), and central venous catheterisation (odds ratio=7.36, 95% confidence interval=1.13–47.8) were found to be statistically significant independent risk factors for hospital-associated venous thromboembolism in these children. Patients with all three factors had a markedly increased post-test probability of having hospital-associated venous thromboembolism.ConclusionMajor infection, infancy, and central venous catheterisation are independent risk factors for hospital-associated venous thromboembolism in critically ill children following cardiothoracic surgery or cardiac catheter-based intervention, which, in combination, define a high-risk group for hospital-associated venous thromboembolism.

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