Concordancia entre el motivo de consulta y el diagnóstico final en pacientes pediátricos

2021 ◽  
Author(s):  
◽  
N. Castañeda-Villa
Keyword(s):  
Medical Records ◽  
Pediatric Patients ◽  
Interdisciplinary Team ◽  
Final Diagnosis ◽  
Definitive Diagnosis ◽  
Clinical Aspect ◽  
Observer Agreement ◽  
Medical Group ◽  
Research Assistant ◽  
Kappa Index

Concordance analysis using Cohen's Kappa index (􏰀􏰀) has been widely used in clinical research to determine the degree of agreement between two measurements made by the same observer (intra-observer agreement) or between the measurements of two observers on the same variable (inter- observer agreement). In this work, we used 􏰀􏰀 to determine the degree of inter-observer agreement between the reason for consultation and the final diagnosis issued by an interdisciplinary team of The Mexican Institute of Hearing and Language (IMAL). The institute receives around ten pediatric patients per month; the reasons for consulting these patients are diverse. In this research, 53 pediatric patients completed their studies in the IMAL and received a final diagnostic. A research assistant manually collected the data from the medical records of the IMAL Medical Direction. For example, 1) reason for consultation, 2) studies carried out, 3) recommendations, and 4) the final diagnosis. The global concordance between consultation and the definitive diagnosis was 􏰀􏰀 = 0.44 (moderate concordance). Although a Health Professional suggested the reason for consultation, it only covers a clinical aspect. Therefore, we think that the moderate concordance obtained is since an interdisciplinary medical group issues the final diagnostic, achieving a complete diagnosis; this allows the adequate medical care and rehabilitation of the pediatric patient.

The Orientation of Gastric Biopsy Samples Improves the Interobserver Agreement of the OLGA Staging System

2017 ◽  
Vol 26 (4) ◽  
pp. 351-356 ◽  
Author(s):  
Bogdan Cotruta ◽  
Cristian Gheorghe ◽  
Razvan Iacob ◽  
Mona Dumbrava ◽  
Cristina Radu ◽  
...  
Keyword(s):  
Intestinal Metaplasia ◽  
Lamina Propria ◽  
Case Series ◽  
Gastric Biopsy ◽  
Gastric Atrophy ◽  
Observer Agreement ◽  
Gastric Body ◽  
Kappa Index ◽  
Gastric Biopsies

Background & Aims: Evaluation of severity and extension of gastric atrophy and intestinal metaplasia is recommended to identify subjects with a high risk for gastric cancer. The inter-observer agreement for the assessment of gastric atrophy is reported to be low. The aim of the study was to evaluate the inter-observer agreement for the assessment of severity and extension of gastric atrophy using oriented and unoriented gastric biopsy samples. Furthermore, the quality of biopsy specimens in oriented and unoriented samples was analyzed.Methods: A total of 35 subjects with dyspeptic symptoms addressed for gastrointestinal endoscopy that agreed to enter the study were prospectively enrolled. The OLGA/OLGIM gastric biopsies protocol was used. From each subject two sets of biopsies were obtained (four from the antrum, two oriented and two unoriented, two from the gastric incisure, one oriented and one unoriented, four from the gastric body, two oriented and two unoriented). The orientation of the biopsy samples was completed using nitrocellulose filters (Endokit®, BioOptica, Milan, Italy). The samples were blindly examined by two experienced pathologists. Inter-observer agreement was evaluated using kappa statistic for inter-rater agreement. The quality of histopathology specimens taking into account the identification of lamina propria was analyzed in oriented vs. unoriented samples. The samples with detectable lamina propria mucosae were defined as good quality specimens. Categorical data was analyzed using chi-square test and a two-sided p value <0.05 was considered statistically significant.Results: A total of 350 biopsy samples were analyzed (175 oriented / 175 unoriented). The kappa index values for oriented/unoriented OLGA 0/I/II/III and IV stages have been 0.62/0.13, 0.70/0.20, 0.61/0.06, 0.62/0.46, and 0.77/0.50, respectively. For OLGIM 0/I/II/III stages the kappa index values for oriented/unoriented samples were 0.83/0.83, 0.88/0.89, 0.70/0.88 and 0.83/1, respectively. No case of OLGIM IV stage was found in the present case series. Good quality histopathology specimens were described in 95.43% of the oriented biopsy samples, and in 89.14% of the unoriented biopsy samples, respectively (p=0.0275).Conclusion: The orientation of gastric biopsies specimens improves the inter-observer agreement for the assessment of gastric atrophy.Key words:  –  –  – .Abbreviations: H. pylori: Helicobacter pylori; OLGA: operative link for gastritis assessment; OLGIM: operative link on intestinal metaplasia assessment.

scholarly journals Endoscopic retrograde cholangiopancreatography in infants and children

2021 ◽  
Vol 09 (03) ◽  
pp. E292-E296
Author(s):  
Tone Lise Åvitsland ◽  
Lars Aabakken
Keyword(s):  
Endoscopic Retrograde Cholangiopancreatography ◽  
Medical Records ◽  
Pediatric Patients ◽  
Biliary Stricture ◽  
Infants And Children ◽  
University Hospital ◽  
Older Children ◽  
Endoscopic Retrograde ◽  
Procedure Codes ◽  
In Infants And Children

Abstract Background and study aims Previous reports have suggested that endoscopic retrograde cholangiopancreatography (ERCP) in pediatric patients are safe. However, the total number of cases presented in the literature remains small. We present results regarding safety and outcomes in pediatric patients undergoing ERCP at Oslo University Hospital. Patients and methods Patients < 18 years who underwent ERCP between April 1999 and November 2017 were identified using procedure codes. Medical records were examined for age, gender, diagnosis, indications, type of sedation, findings, interventions, and complications. Results A total of 244 procedures were performed in 158 patients. Fifty-six of these were in 53 infants (age ≤ 1 year). Mean age was 8.8 years. The youngest patient was 8 days old. Mean weight was 5.0 kg in infants, the smallest weighing 2.9 kg. Cannulation failed in 19 (7.8 %). The main indication in infants was suspicion of biliary atresia (n = 38). Six of the procedures (10.7 %) were therapeutic. In children the main indications were biliary stricture (n = 64) and investigation of primary sclerosing cholangitis (PSC) (n = 45). 119 (63.2 %) of these procedures were therapeutic.Complications were uncommon in infants; only two episodes of infection were registered. In children (> 1 year) post-ERCP pancreatitis were seen in 10.4 %. Conclusions Our retrospective series of ERCP procedures includes 56 procedures in infants, which is one of the largest series presented. Complications in infants are rare and post-ERCP pancreatitis was not seen. In older children 10.4 % experienced post-ERCP pancreatitis. In expert hands, ERCP was shown to be acceptably feasible and safe in infants and children.

scholarly journals Association between Physical Activity and Sport Participation on Hemoglobin A1c Among Children and Adolescents with Type 1 Diabetes

2021 ◽  
Vol 18 (14) ◽  
pp. 7490
Author(s):  
Kristi M. King ◽  
Jason R. Jaggers ◽  
Lindsay J. Della ◽  
Timothy McKay ◽  
Sara Watson ◽  
...  
Keyword(s):  
Physical Activity ◽  
Type 1 Diabetes ◽  
Medical Records ◽  
Hemoglobin A1c ◽  
Pediatric Patients ◽  
Sport Participation ◽  
Multiple Linear Regression Model ◽  
Significant Difference ◽  
Hba1c Levels

Purpose: To determine associations between physical activity (PA) and sport participation on HbA1c levels in children with type 1 diabetes (T1D). Method: Pediatric patients with T1D were invited to complete a PA and sport participation survey. Data were linked to their medical records for demographic characteristics, diabetes treatment and monitoring plans, and HbA1c levels. Results: Participants consisted of 71 females and 81 males, were 13 ± 3 years old with an average HbA1c level of 8.75 ± 1.81. Children accumulating 60 min of activity 3 days or more a week had significantly lower HbA1c compared to those who accumulated less than 3 days (p < 0.01) of 60 min of activity. However, there was no significant difference in HbA1c values based on sport participation groups. A multiple linear regression model indicated that PA, race, age, duration of diagnosis, and CGM use all significantly predicted HbA1c (p < 0.05). Conclusion: This study demonstrated the significant relationship between daily PA and HbA1c. Those in this sample presented with lower HbA1c values even if accumulating less than the recommended number of days of activity. Further, it was shown that sport participation alone may not be adequate enough to impact HbA1c in a similar manner.

scholarly journals Multimodal Treatment of Pediatric Ruptured Brain Arteriovenous Malformations: A Single-Center Study

Children ◽  
2021 ◽  
Vol 8 (3) ◽  
pp. 215
Author(s):  
Lukasz Antkowiak ◽  
Monika Putz ◽  
Marta Rogalska ◽  
Marek Mandera
Keyword(s):  
Medical Records ◽  
Arteriovenous Malformations ◽  
Pediatric Patients ◽  
Interventional Treatment ◽  
Digital Subtraction ◽  
Brain Arteriovenous Malformations ◽  
Single Center Study ◽  
Complete Obliteration ◽  
Multimodality Approach ◽  
Related Mortality

Bleeding from ruptured brain arteriovenous malformations (bAVMs) represents the most prevalent cause of pediatric intracranial hemorrhage, being also the most common initial bAVM manifestation. A therapeutic approach in these patients should aim at preventing rebleeding and associated significant morbidity and mortality. The purpose of this study was to determine the clinical outcomes of pediatric patients who initially presented at our institution with ruptured bAVMs and to review our experience with a multimodality approach in the management of pediatric ruptured bAVMs. We retrospectively reviewed pediatric patients’ medical records with ruptured bAVMs who underwent interventional treatment (microsurgery, embolization, or radiosurgery; solely or in combination) at our institution between 2011 and 2020. We identified 22 patients. There was no intraoperative and postoperative intervention-related mortality. Neither procedure-related complications nor rebleeding were observed after interventional treatment. Modified Rankin Scale (mRS) assessment at discharge revealed 19 patients (86.4%) with favorable outcomes (mRS 0–2) and 3 patients (13.6%) classified as disabled (mRS 3). Microsurgery ensured the complete obliteration in all patients whose postoperative digital subtraction angiography (DSA) was available. Management of high-grade bAVMs with radiosurgery or embolization can provide satisfactory outcomes without a high disability risk.

scholarly journals Adenomatous Polyps in Adolescent Girl and Boy: A Report of Two Cases

2016 ◽  
Vol 2016 ◽  
pp. 1-3
Author(s):  
Laleh Vahedi Larijani ◽  
Maryam Ghasemi ◽  
Hassan Karami
Keyword(s):  
Pediatric Patients ◽  
Colonic Polyps ◽  
Definitive Diagnosis ◽  
Adenomatous Polyps ◽  
Common Symptom ◽  
Tubular Adenoma ◽  
Tubulovillous Adenoma ◽  
Benign Adenoma ◽  
Juvenile Type ◽  
Rectal Hemorrhage

A polyp is defined as a mass of the mucosal surface that protrudes into the lumen of the gastrointestinal tract. Neoplastic epithelial polyps are classified histologically as either benign adenoma or malignant carcinoma. The colonic polyps that most commonly present in children occur sporadically and individually and are of the juvenile type; they are most frequently associated with painless rectal hemorrhage (which is the most common symptom). Adenomatous polyps are similar to other nontumoral polyps, and it is very rare for children to have symptoms other than rectal bleeding. This report describes two rare cases of polyps in pediatric patients. An 11-year-old girl presented with tubulovillous adenoma and a 13-year-old boy with tubular adenoma; both patients complained of rectal hemorrhage as well as anemia and abdominal pain. Epithelial adenoma is a tumor that is rarely found in adults or children. Colonoscopic perforation and biopsy are mandatory for establishing a definitive diagnosis and avoiding medical mismanagement.

Measuring Inter-observer Agreement in Contour Delineation of Medical Imaging in a Dummy Run Using Fleiss’ Kappa

2012 ◽  
Vol 51 (06) ◽  
pp. 489-494 ◽  
Author(s):  
T. Schimek-Jasch ◽  
U. Nestle ◽  
G. Rücker
Keyword(s):  
Medical Imaging ◽  
Locally Advanced ◽  
Multicenter Trial ◽  
Observer Agreement ◽  
Radiotherapy Planning ◽  
Quality Assurance Program ◽  
Advanced Lung Cancer ◽  
Weighted Sums ◽  
Slice Thickness ◽  
Kappa Index

SummaryBackground: In medical imaging used for planning of radiation therapy, observers delineate contours of a treatment volume in a series of images of uniform slice thickness.Objective: To summarize agreement in contouring between an arbitrary number of observers by a single number, we generalized the kappa index proposed by Zijdenbos et al. (1994).Methods: Observers characterized voxels by allocating them to one of two categories, inside or outside the contoured region. Fleiss’ kappa was used to measure association between n indistinguishable observers. Given the number Vi of voxels contoured by exactly i observers (i = 1, …, n), the resulting overall kappa is representable as a ratio of weighted sums of the Vi .Results: Overall kappa was applied to analyze inter-center variations in a multicenter trial on radiotherapy planning in patients with locally advanced lung cancer. A contouring dummy run was performed within the quality assurance program. Contouring was done twice, once before and once after a training program. Observer agreement was enhanced from 0.59 (with a 95% confidence interval (CI) of 0.51 – 0.67) to 0.69 (95% CI 0.59 – 0.78)Conclusion: By contrast to average pairwise indices, overall kappa measures observer agreement for more than two observers using the full information about overlapping volumes, while not distinguishing between observers. It is particularly adequate for measuring observer agreement when identification of observers is not possible or desirable and when there is no gold standard.

scholarly journals Occult Foreign Body Aspirations in Pediatric Patients: 20-years of Experience

2020 ◽  
Author(s):  
Bo Liu ◽  
Fengxia Ding ◽  
Yong An ◽  
Yonggang Li ◽  
Zhengxia Pan ◽  
...  
Keyword(s):  
Foreign Body ◽  
Medical Records ◽  
Foreign Bodies ◽  
Pediatric Patients ◽  
Previous History ◽  
Rigid Bronchoscopy ◽  
Diagnostic Difficulties ◽  
History Of ◽  
Male Patients ◽  
Symptoms And Signs

Abstract Background: The purpose of our study was to assess the frequency of occult foreign body aspiration (FBA) and to evaluate the diagnostic difficulties and therapeutic methods for these patients. Methods: Between May 2000 and May 2020, 3557 patients with the diagnosis of FBA were treated in our department. Thirty-five patients with occult FBA were included in this study. A retrospective analysis of medical records was performed. Results: Twenty-three male patients (65.7%) and 12 female patients (34.3%) were hospitalized due to occult FBA. The average age was 3.60 years (range 9 months-12 years). Most of the patients were younger than 3 years old (n=25, 71.4%). Coughing (n=35, 100%) and wheezing (n=18, 51.4%) were the main symptoms and signs. All the patients were found to have a FBA under the fiberoptic bronchoscope. The most common organic foreign bodies were peanuts (n=10) and the most common inorganic foreign bodies were pen caps (n=5). The extraction of foreign bodies under rigid bronchoscopy was applied successfully in 34 patients. Only one patient needed a surgical intervention. Conclusions: Occult FBA should always be considered in the differential diagnosis of chronic or recurrent respiratory diseases that are poorly explained, even in the absence of a previous history of aspiration.

scholarly journals GAMBARAN PENGGUNAAN TERAPI GEA (GASTROENTERITIS ) PADA PASIEN ANAK DI RSUD BATARA SIANG PANGKEP SULSEL

2021 ◽  
Vol 3 (3) ◽  
pp. 189-198
Author(s):  
Dwi Fitrah Wahyuni ◽  
Riska Riska
Keyword(s):  
Experimental Study ◽  
Medical Records ◽  
Pediatric Patients ◽  
Diarrheal Disease ◽  
Evaluation Study ◽  
Initial Therapy ◽  
Regional Hospital ◽  
Inclusion Criteria ◽  
South Sulawesi ◽  
Appropriate Therapy

GEA (Gastroenteritis) or diarrhea is a disease caused by digestive tract disorders that are infected by bacteria. Treatment of early diarrhea, especially the choice of initial therapy, greatly affects the success of providing appropriate and appropriate therapy. This study aims to determine the rationality of therapy in pediatric patients at Batara Siang Pangkep Regional Hospital, South Sulawesi City. This study is a non-experimental study with a retrospective descriptive evaluation study using patient medical records. The samples that met the inclusion criteria were 65 patients. Acute diarrhea was mostly found in men as many as 38 patients (58%) while for women as many as 27 patients (42%). Characteristics of age 1-3 years (82%). The result showed that there are 3 therapeutic regimen in pediatric patient namely cotrimoxazole,electrolit, and zinc. So from these data meet the standards of management of diarrheal disease in children.

Features of diagnostics and treatment of pvcrd in children

Reflection ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. 42-47
Author(s):  
E.V. Mikhaylova ◽  
◽  
E.V. Tur ◽  
T.S. Abaeva ◽  
◽  
...  
Keyword(s):  
Key Words ◽  
Retrospective Analysis ◽  
Medical Records ◽  
Pediatric Patients ◽  
Clinical Course ◽  
Common Type ◽  
Laser Coagulation ◽  
Preoperative Preparation ◽  
Clinical Hospital ◽  
Low Degree

Purpose. To identify the clinical course of the «risk-forms» of peripheral vitreochorioretinal dystrophy (PVCRD) depending on sex, age, type and degree of refraction in children, as well as to establish the characteristics of the diagnosis and treatment of PVCRD in childhood. Methods. A retrospective analysis of medical records of pediatric patients who underwent peripheral prophylactic laser retinal coagulation (PPLRC) regarding the «risk-forms» of PVHRD at the ophthalmology department of MAUZ Children’s Clinical Hospital No. 1 from 2017 to 2019 was performed. 241 childr (293 eyes) aged 7 to 17 years (mean age 14.1 ± 2.4 years) were operated. Results. PVCRD in children is asymptomatic and it is detected at the age of 7 to 17 years, regardless of gender, the peak of occurrence is 10–14 years. The most common type of PVCRD is «lattice» dystrophy. PVCRD is predominant in low degree myopia. Quite a lot of cases of PVCRD detected in emmetropic refraction, as well as in hyperopic refraction and combined astigmatism. Conclusions. A thorough examination of the periphery of the fundus is necessary in all children, regardless of age and refraction. The parameters of laser coagulation in children differ from those in adults. Given the characteristics of childhood, the success of the operation depends on the correct preoperative preparation, including psychological preparation, contact of the surgeon with the child during the operation. Key words: peripheral dystrophy; ophthalmoscopy; mydriasis; laser coagulation; children. vitreochorioretinal

scholarly journals Diagnostic performance and utility of very high-resolution ultrasonography in diagnosing giant cell arteritis of the temporal artery

2019 ◽  
Vol 3 (2) ◽  
Author(s):  
Johnny K M Sundholm ◽  
Tom Pettersson ◽  
Anders Paetau ◽  
Anders Albäck ◽  
Taisto Sarkola
Keyword(s):  
High Resolution ◽  
Temporal Artery ◽  
Final Diagnosis ◽  
Thickness Measurement ◽  
Observer Agreement ◽  
Diagnostic Utility ◽  
Temporal Artery Biopsy ◽  
Glucocorticoid Treatment ◽  
Non Invasive ◽  
Very High

Abstract Objective Very-high resolution US (VHRU; 55 MHz) provides improved resolution and could provide non-invasive diagnostic information in GCA of the temporal artery. The objective of this study was to assess the diagnostic utility of VHRU-derived intima thickness (VHRU-IT) in comparison to high-resolution US halo-to-Doppler ratio (HRU-HDR) in patients referred for temporal artery biopsy. Methods VHRU and HRU of the temporal artery were performed before a biopsy procedure in 78 prospectively recruited consecutive patients who had received glucocorticoid treatment for a median of 8 days (interquartile range 0–13 days) before imaging. Based on the final diagnosis and biopsy findings, the study population was divided into the following four groups: non GCA (n = 40); clinical GCA with no inflammation on biopsy (n = 15); clinical GCA with inflammation limited to adventitia (n = 9); and clinical GCA with transmural inflammation (TMI; n = 11). Results Both VHRU and HRU were useful for identifying subjects with TMI, with VHRU outperforming HRU (area under curve: VHRU-IT 0.99, 95% CI 0.97, 1.00; HRU-HDR 0.74, 95% CI 0.52, 0.96; P=0.026). The diagnostic utility for diagnosing clinical GCA (negative biopsy) or inflammation limited to the adventitia was poor for both VHRU and HRU-HDR. From 5 days after initiation of glucocorticoid treatment, VHRU-IT was increased in eight of nine patients, whereas HRU-HDR was positive in three of seven patients. Both methods showed excellent inter-observer agreement (Cohen’s κ: VHRU-IT 0.873; HRU-HDR 0.811). Conclusion In suspected GCA, VHRU allows non-invasive real-time imaging of TMI manifestations of the temporal artery wall. VHRU-derived intimal thickness measurement seems to be more sensitive than the halo sign and HRU-HDR in detecting TMI in patients with prolonged glucocorticoid treatment.

Sign in / Sign up

Export Citation Format

Share Document