Development of a Risk-Stratification Tool for Medical Child Abuse in Failure to Thrive

PEDIATRICS ◽  
2011 ◽  
Vol 128 (6) ◽  
pp. peds.2011-1080d-peds.2011-1080d
PEDIATRICS ◽  
2011 ◽  
Vol 128 (6) ◽  
pp. e1467-e1473 ◽  
Author(s):  
C. Mash ◽  
T. Frazier ◽  
A. Nowacki ◽  
S. Worley ◽  
J. Goldfarb

Author(s):  
Massimo Imazio ◽  
Alessandro Andreis ◽  
Marta Lubian ◽  
George Lazaros ◽  
Emilia Lazarou ◽  
...  

2011 ◽  
Vol 55 (10) ◽  
pp. 4581-4588 ◽  
Author(s):  
Carol L. Moore ◽  
Mei Lu ◽  
Faiqa Cheema ◽  
Paola Osaki-Kiyan ◽  
Mary Beth Perri ◽  
...  

ABSTRACTMethicillin-resistantStaphylococcus aureus(MRSA) is a common cause of bloodstream infection (BSI) and is often associated with invasive infections and high rates of mortality. Vancomycin has remained the mainstay of therapy for serious Gram-positive infections, particularly MRSA BSI; however, therapeutic failures with vancomycin have been increasingly reported. We conducted a comprehensive evaluation of the factors (patient, strain, infection, and treatment) involved in the etiology and management of MRSA BSI to create a risk stratification tool for clinicians. This study included consecutive patients with MRSA BSI treated with vancomycin over 2 years in an inner-city hospital in Detroit, MI. Classification and regression tree analysis (CART) was used to develop a risk prediction model that characterized vancomycin-treated patients at high risk of clinical failure. Of all factors, the Acute Physiology and Chronic Health Evaluation II (APACHE-II) score, with a cutoff point of 14, was found to be the strongest predictor of failure and was used to split the population into two groups. Forty-seven percent of the population had an APACHE-II score < 14, a value that was associated with low rates of clinical failure (11%) and mortality (4%). Fifty-four percent of the population had an APACHE-II score ≥ 14, which was associated with high rates of clinical failure (35%) and mortality (23%). The risk stratification model identified the interplay of three other predictors of failure, including the vancomycin MIC as determined by Vitek 2 analysis, the risk level of the source of BSI, and the USA300 strain type. This model can be a useful tool for clinicians to predict the likelihood of success or failure in vancomycin-treated patients with MRSA bloodstream infection.


HPB ◽  
2020 ◽  
Vol 22 ◽  
pp. S353-S354
Author(s):  
G. Morris-Stiff ◽  
S Shashank Sarvepalli ◽  
N. Gupta ◽  
P. Lal ◽  
M. Matta ◽  
...  

Poisons ◽  
2017 ◽  
pp. 291-296
Author(s):  
David J. George

2008 ◽  
Author(s):  
Thomas A. Roesler ◽  
Carole Jenny

Powerful new detailed and comprehensive resource for diagnosing and treating medical child abuse. Thomas A. Roesler, MD and Carole Jenny, MD, MBA, FAAP make the case that the term Munchausen syndrome by proxy should be retired permanently and replaced with a commonsense appreciation that children can be abused by their parents in the medical environment. Physicians who find themselves providing unnecessary and harmful medical care can see the abuse for what it is, another way parents can harm children. The book offers the first detailed and comprehensive description of treatment for this form of child maltreatment. “At last. A clear, logical, and immensely practical book, showing that this is not a syndrome at all, but rather another important form of child abuse…and one which is completely preventable.” Kim Oates, Emeritus Professor of Pediatrics, The University of Sydney, Australia. “A fantastic book that will revolutionize, in a much needed way, the way we think about this disorder.” Alex V. Levin, MD, MHSc, FAAP, FAAO, FRCSC, Professor, Department of Paediatrics, Genetics, and Ophthalmology and Vision Sciences Director, Postgraduate Bioethics Education University of Toronto. “Drs. Roesler and Jenny have finally mapped the terrain of child abuse showing where medical child abuse stands in the overall landscape.” Thomas L. Dwyer, Director of Foster Care, Department of Children and Families, State of Connecticut.


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