Length-based body weight estimation in paediatric patients: The impact of habitus-A clinical observational trial

BACKGROUND

Paediatric emergency tapes provide drug dosing based on the patient's estimated body weight. Unfortunately, published data revealed an unsatisfactory accuracy. A newly developed digital algorithm for weight estimation (CLAWAR) allowing a three-staged habitus adaptation (normal, obese, or cachectic; CLAWAR-3) demonstrated a higher accuracy for weight estimation compared to paediatric emergency tapes. However, the incidence of incorrectly evaluated habitus was 27%. A five-staged habitus adaptation with figural images was suggested by Wells et al to improve habitus and weight estimation. Therefore, CLAWAR was modified with five habitus stages including figural images (CLAWAR-5). We hypothized CLAWAR-5 improves the accuracy of weight estimation.

METHODS

After obtaining informed written parental consent patients were included in this single centre, prospective clinical observation trial. Body weight estimations by CLAWAR-3 and CLAWAR-5 within ±10% of the actual body weight were compared. Furthermore, the incidence of correct evaluated habitus was calculated. McNemar Tests were used for statistical analysis. Results presented as median (interquartiles), P < .003 considered significant.

RESULTS

In total, 312 patients aged 3.3 years (0.7-6.6), with a body length of 95.9 cm (70.0-121.2), weighing 14.8 kg (8.1-22.5), were included. Both CLAWAR-3 and CLAWAR-5 showed equivalent accuracy for weight estimation within the ±10% interval (62.2% vs 60.6%, P = .609). Despite adding figural images, the incidence of correct evaluated habitus with CLAWAR-5 (46.8%) was worse than with CLAWAR-3 (66.7%).

CONCLUSION

The five-staged habitus-adapted method could not improve the accuracy of weight estimation. Furthermore, the error rate of habitus classification was not reduced by the implementation of figural images.

[Non-beneficial therapy and emotional exhaustion in end-of-life care : Results of a survey among intensive care unit personnel]

BACKGROUND

End-of-life care (EOLC) in the intensive care unit (ICU) is becoming increasingly more common but ethical standards are compromised by growing economic pressure. It was previously found that perception of non-beneficial treatment (NBT) was independently associated with the core burnout dimension of emotional exhaustion. It is unknown whether factors of the work environment also play a role in the context of EOLC.

OBJECTIVE

Is the working environment associated with perception of NBT or clinician burnout?

MATERIAL AND METHODS

Physicians and nursing personnel from 11 German ICUs who took part in an international, longitudinal prospective observational study on EOLC in 2015-2016 were surveyed using validated instruments. Risk factors were obtained by multivariate multilevel analysis.

RESULTS

The participation rate was 49.8% of personnel working in the ICU at the time of the survey. Overall, 325 nursing personnel, 91 residents and 26 consulting physicians participated. Nurses perceived NBT more frequently than physicians. Predictors for the perception of NBT were profession, collaboration in the EOLC context, excessively high workload (each p ≤ 0.001) and the numbers of weekend working days per month (p = 0.012). Protective factors against burnout included intensive care specialization (p = 0.001) and emotional support within the team (p ≤ 0.001), while emotional exhaustion through contact with relatives at the end of life and a high workload were both increased (each p ≤ 0.001).

DISCUSSION

Using the example of EOLC, deficits in the work environment and stress factors were uncovered. Factors of the work environment are associated with perceived NBT. To reduce NBT and burnout, the quality of the work environment should be improved and intensive care specialization and emotional support within the team enhanced. Interprofessional decision-making among the ICU team and interprofessional collaboration should be improved by regular joint rounds and interprofessional case discussions. Mitigating stressful factors such as communication with relatives and high workload require allocation of respective resources.

Development of consensus-based national antimicrobial stewardship competencies for UK undergraduate healthcare professional education

BACKGROUND

Healthcare professionals are involved in an array of patient- and medicine-related stewardship activities, for which an understanding and engagement with antimicrobial stewardship (AMS) is important. Undergraduate education provides an ideal opportunity to prepare healthcare professionals for these roles and activities.

AIM

To provide UK national consensus on a common set of antimicrobial stewardship competencies appropriate for undergraduate healthcare professional education.

METHODS

A modified Delphi approach comprising two online surveys delivered to a UK national panel of 21 individuals reflecting expertise in prescribing and medicines management with regards to the education and practice of nurses and midwives, pharmacists, physiotherapists, and podiatrists; and antimicrobial prescribing and stewardship. Data collection took place between October and December 2017.

FINDINGS

A total of 21 participants agreed to become members of the expert panel, of whom 19 (90%) completed round 1 questionnaire, and 17 (89%) completed round 2. Panelists reached a consensus, with consistently high levels of agreement reached, on six overarching competency statements (subdivided into six domains), and 55 individual descriptors essential for antimicrobial stewardship by healthcare professionals.

CONCLUSION

Due to the consistently high levels of agreement reached on competency statements and their associated descriptors, this competency framework should be used to direct education for undergraduate healthcare professionals, and those working in new clinical roles to support healthcare delivery where an understanding of, and engagement with, AMS is important. Although the competencies target basic education, they can also be used for continuing education.

Trends in use of lymphadenectomy in surgery with curative intent for intrahepatic cholangiocarcinoma

BACKGROUND

The role of routine lymph node dissection (LND) in the surgical treatment of intrahepatic cholangiocarcinoma (ICC) remains controversial. The objective of this study was to investigate the trends of LND use in the surgical treatment of ICC.

METHODS

Patients undergoing curative intent resection for ICC in 2000-2015 were identified from an international multi-institutional database. Use of lymphadenectomy was evaluated over time and by geographical region (West versus East); LND use and final nodal status were analysed relative to AJCC T categories.

RESULTS

Among the 1084 patients identified, half (535, 49·4 per cent) underwent concomitant hepatic resection and LND. Between 2000 and 2015, the proportion of patients undergoing LND for ICC nearly doubled: 44·4 per cent in 2000 versus 81·5 per cent in 2015 (P < 0·001). Use of LND increased over time among both Eastern and Western centres. The odds of LND was associated with the time period of surgery and the extent of the tumour/T status (referent T1a: OR 2·43 for T2, P = 0·001; OR 2·13 for T3, P = 0·016). Among the 535 patients who had LND, lymph node metastasis (LNM) was noted in 209 (39·1 per cent). Specifically, the incidence of LNM was 24 per cent in T1a disease, 22 per cent in T1b, 42·9 per cent in T2, 48 per cent in T3 and 66 per cent in T4 (P < 0·001). AJCC T3 and T4 categories, harvesting of six or more lymph nodes, and presence of satellite lesions were independently associated with LNM.

CONCLUSION

The rate of LNM was high across all T categories, with one in five patients with T1 disease having nodal metastasis. The trend in increased use of LND suggests a growing adoption of AJCC recommendations in the treatment of ICC.

Accuracy of near-patient vs. inbuilt spirometry for monitoring tidal volumes in an in-vitro paediatric lung model

Spirometric monitoring provides precise measurement and delivery of tidal volumes within a narrow range, which is essential for lung-protective strategies that aim to reduce morbidity and mortality in mechanically-ventilated patients. Conventional anaesthesia ventilators include inbuilt spirometry to monitor inspiratory and expiratory tidal volumes. The GE Aisys CS² anaesthesia ventilator allows additional near-patient spirometry via a sensor interposed between the proximal end of the tracheal tube and the respiratory tubing. Near-patient and inbuilt spirometry of two different GE Aisys CS² anaesthesia ventilators were compared in an in-vitro study. Assessments were made of accuracy and variability in inspiratory and expiratory tidal volume measurements during ventilation of six simulated paediatric lung models using the ASL 5000 test lung. A total of 9240 breaths were recorded and analysed. Differences between inspiratory tidal volumes measured with near-patient and inbuilt spirometry were most significant in the newborn setting (p < 0.001), and became less significant with increasing age and weight. During expiration, tidal volume measurements with near-patient spirometry were consistently more accurate than with inbuilt spirometry for all lung models (p < 0.001). Overall, the variability in measured tidal volumes decreased with increasing tidal volumes, and was smaller with near-patient than with inbuilt spirometry. The variability in measured tidal volumes was higher during expiration, especially with inbuilt spirometry. In conclusion, the present in-vitro study shows that measurements with near-patient spirometry are more accurate and less variable than with inbuilt spirometry. Differences between measurement methods were most significant in the smallest patients. We therefore recommend near-patient spirometry, especially for neonatal and paediatric patients.

Diagnostik des »Sentinel Lymph Node« bei malignem Melanom: präoperative Lymphszintigraphie und intraoperative Sondenmessung

Ziel: Der »sentinel lymph node« (SLN) reflektiert den Befall der nachfolgenden Lymphknoten-Stationen bei Patienten mit malignem Melanom und hat damit eine erhebliche prognostische Bedeutung. Ziel der Studie war die prä- und intraoperative Lokalisierung dieses Lymphknotens mittels Lymphszintigraphie und Sondenmessung. Methoden: 38 Patienten mit malignem Melanom (Tiefenausdehnung >0,75 mm) wurden nach Injektion von 40 MBq 99Tc-Nanocoll szintigraphisch untersucht. Die Position des ersten im Abflußgebiet dargestellten Lymphknotens wurde an der Haut markiert. Unmittelbar danach wurde intraoperativ mittels einer kollimierten Sonde dieser Lymphknoten aufgesucht und nach Ex- stirpation die Aktivität des Knotens und die Restaktivität im Operations- situs gemessen. Ergebnisse: Bei allen Patienten konnte der SLN szintigraphisch lokalisiert und markiert werden. Vor und nach Exstirpation wurde die höchste Aktivität mit der Sonde im markierten Lymphknoten bestimmt. Makroskopisch und im Ultraschall und CT waren alle Lymphknoten unauffällig. Histologisch zeigten acht Patienten eine Metastasierung im lokalisierten Lymphknoten, die bei sieben Patienten eine großzügige Ausräumung des gesamten nachfolgenden Lymphgebietes nach sich zog. Schlußfolgerungen: Die vorgestellte Methode bietet die Möglichkeit, den morphologisch unauffälligen SLN sicher aufzufinden. Die operative Entfernung des diagnostisch erkannten SLN kann eine grundlegende Zäsur in der Therapie des malignen Melanoms bedeuten, da nur bei positivem Befund eine großzügige Lymphknoten-Ausräumung durchgeführt wird. Die kombinierte Lymphszintigraphie mit Sondenmessung beeinflußt entscheidend das therapeutische Vorgehen aufgrund der sicheren Lokalisation des Lymphknotens und ermöglicht hierdurch eine individuelle Therapieplanung.

Lymphsequenzszintigraphie für die nichtinvasive Langzeitbeobachtung des funktionellen Therapieerfolges nach Transplantation autologer Lymphgefäße

Ziel: Die autologe Lymphgefäßtransplantation führt bei bestehendem Lymphödem zu einer signifikanten Verbesserung der Lymphabflußverhältnisse. Die vorliegende Studie untersucht, ob die Lymphsequenzszintigraphie geeignet ist, die persistierende Funktion autologer Lymphgefäßtransplantate und damit den Erfolg dieser Operationsmethode zu dokumentieren. Methoden: In die Studie gingen die Daten von 20 Patienten (17 Frauen und 3 Männer) ein. Anlaß für die Operation war in 4 Fällen ein primäres, in 16 Fällen ein sekundäres Lymphödem. Szintigraphi-sche Analogaufnahmen mit semiquantitativer Beurteilung des Lymphtransportes erfolgten als Ausgangsuntersuchung vor Transplantation und anschließend über einen Zeitraum von sieben Jahren. Ergebnisse: Bei 17 von 20 Patienten (Transplantationssitus: obere Extremität n = 12, untere Extremität n = 8) war postoperativ eine persistierende Verbesserung des Lymphtransportes im Vergleich zur präoperativen Situation an einem signifikanten Abfall der Transportindices nachweisbar. Bei 5 Patienten gelang zusätzlich die direkte szintigraphische Darstellung der Lymphgefäßtransplantate. In diesen Fällen konnte postoperativ ein signifikant höherer Abfall der Transportindices im Vergleich zu Patienten ohne szintigraphisch darstellbares Transplantat beobachtet werden. Lediglich 3 der 20 Patienten zeigten keine Besserung im Vergleich zur Ausgangssituation. Schlußfolgerungen: Somit erwies sich die Lymphsequenzszintigraphie mit semiquantitativer Einschätzung der Lymphabflußverhältnisse vor und nach autologer Lymphgefäßtransplantation als einfache, nicht invasive Untersuchungsmethode zur objektiven Beurteilung des Therapieerfolges im Langzeitverlauf. Eine szintigraphisch direkte Darstellung des autologen Lymphgefäßtransplantats scheint einen prognostisch günstigen Faktor bezüglich der postoperativen Lymphdrainage darzustellen.

Metastases in patients with malignant melanoma despite of negative sentinel lymph node: Has the concept to be changed?

Aim: The Sentinel Lymph Node (SLN) is of considerable prognostic relevance, because extended lymph node dissection may not be performed in patients presenting with histologically negative SLN. The aim of the present study was to prove the prognostic value of the SLN-concept in these patients. Methods: So far the clinical follow-up of 162 patients with histologically proven malignant melanoma and metastatically uninvolved (negative) SLN was investigated. Histological examination included standard methods (HE-Test) and special histochemical techniques (S-100, HMB-45). All patients underwent clinical examination, ultrasonic diagnosis of the regional lymph nodes, and x-ray of the chest every 3 months. Results: Despite of negative SLN-findings in 8/162 patients metastases of the malignant melanoma were found after a time period of 5-27 months. Three patients presented with recurrence in the previously mapped (negative) SLN-basin. In another case the scintigraphically visualized SLN could not be identified intraoperativelly by means of the hand-held gamma probe. One patient showed intransit-metastases or skin-metastases, respectively; another patient recurred in the scar area. One patient showed hematogenic dissemination (liver) which is not detectable by lymphoscintigraphy; in another patient metastases were found outside the primary lymphatic basin (cervical). Conclusion: In our patient group 4,9% presented with metastases despite negative SLN while published data report up to 11% (observation period 35 months), among them only 3 patients (1,9%) being real concept failures. Our results underline that there is no evidence to change this concept in patients with clinically early stage.

The clinical yield of SPECT/CT for the assessment of lymphatic transport disorders

Ziel dieser Studie war zu untersuchen, ob die zusätzliche Bildgebung mittels SPECT/CTTechnik den diagnostischen Wert der planaren Lymphszintigraphie bei Patienten mit Lymphtransportstörungen verbessern kann. Patienten, Methoden: Über einen festgelegten Zeitraum von zwei Jahren wurden 36 konsekutive Patienten (27 Frauen, 9 Männer, Alter 27–87 Jahre) in unsere Studie eingeschlossen. Zusätzlich zur planaren Lymphszintigraphie wurden weitere ergänzende SPECT/CT-Akquisitionen der betroffenen Extremitäten oder des Körperstamms durchgeführt. Insgesamt erfolgte eine prospektive Auswertung von 48 anatomischen Lymphabflussregionen mittels planarer Szintigraphie und tomographischer SPECT/CT. Ergebnisse: In 28/48 Fällen (58%) brachte die SPECT/CTBildgebung klinisch relevante Zusatzinformationen im Vergleich zur planaren Technik; darunter 27 bezüglich der exakten anatomischen Lokalisation der Transportstörungen sowie 8 Fälle, bei denen die Ausdehnung der lymphogenen Störung mittels SPECT/CT ausgedehnter beurteilt wurde als in der alleinigen planaren Szintigraphie. In 3 Fällen konnte durch die SPECT/CT differenzialdiagnostisch zwischen Lymphknoten versus Lymphozele differenziert werden. In keinem der Fälle konnten Lymphgefäße/-transplantate durch die morphologische CT-Komponente dargestellt werden. Schlussfolgerungen: Die zusätzlich zur planaren Lymphszintigraphie durchgeführte SPECT/CT präzisiert die anatomische Zuordnung lymphogen bedingter Transportstörungen und somit die Abschätzung der Ausdehnung der Pathologie. Des Weiteren löst sie Überlagerungseffekte anatomischer Strukturen durch die tomographische Akquisition auf und ermöglicht die Differenzialdiagnose von Lymphknoten versus Lymphozelen.

First experiences with a new radiopharmaceutical for sentinel lymph node detection in malignant melanoma

Aim of this study was to localize the sentinel lymph node by lymphoscintigraphy using technetium-99m colloidal rhenium sulphide (Nanocis®), a new commercially available radiopharmaceutical. Due to the manufacturers’ instructions it is licensed for lymphoscintigraphy. Patients, methods: 35 consecutive patients with histologically proved malignant melanoma, but without clinical evidence of metastases, were preoperatively examined by injecting 20-40 MBq Nanocis® with (mean particle size: 100 nm; range: 50-200 nm) intradermally around the lesion. Additionally blue dye was injected intaoperatively. A hand-held gamma probe guided sentinel node biopsy. Results: During surgery, the preoperatively scintigraphically detected sentinel lymph nodes were identified in 34/35 (97%) patients. The number of sentinel nodes per patient ranged from one to four (mean: n = 1.8). Histologically, metastatic involvement of the sentinel lymph node was found in 12/35 (34%) patients; the sentinel lymph node positive-rate (14/63 SLN) was 22%. Thus, it is comparable to the findings of SLN-mapping using other technetium-99m-labeled nanocolloides. Conclusion: 99mTc-bound colloidal rhenium sulphide is also suitable for sentinel node mapping.

Lymph kinetics with technetium-99m labeled radiopharmaceuticals

Aim of this study was to characterize suitable technetium- 99m labeled tracers for lymphoscintigraphy by comparative animal tests. Animals, methods: To evaluate the influence of the particle size and the organ tracer-uptake on lymphtransport animal experiments were performed on six different agents (including one control group). Activity distributions were examined in Sprague-Dawley-rats by lymphoscintigraphy; the maximum uptake (count-rate) of the whole body and in lymph nodes were analyzed by regions- of-interest-technique, respectively. Additionally, for characterization of lymphatic and extralymphatic traceruptake an intra-individual relative count-rate ratio of the liver, lung, kidneys, and spleen has been calculated following organ extraction. Results: Organ specific differences of distribution were clearly demonstrated. Our results indicate that the kinetics of lymphoscintigraphic 99mTc-bound agents substantially depends on particle size. Reliable transport from the interstitium to initial lymph vessels and lymph node uptake suggested for tracers suited for lymphoscintigraphy a median size of about <100 nm. Conclusion: Our data could improve standardization of diagnostic methods and lead to an objective consideration of therapeutic procedures.

Radiation exposure of patients undergoing nuclear medicine procedures in Germany between 1996 and 2000

The aim of this study was to estimate both the frequency and effective dose of nuclear medicine procedures performed in Germany between 1996 and 2000 for different subgroups of patients. Methods: Electronically archived data from 14 hospitals and 10 private practices were restored and statistically analyzed. The effective dose per examination was calculated according to ICRP publication 80 using the tissue weighting factors given in ICRP publication 60. Based on the data collected, statistical parameters were computed to characterize the frequency and effective dose of the various nuclear medicine procedures. Results: In total, 604,771 nuclear medicine procedures performed in 433,709 patients were analyzed. On average, 1.4 examinations were carried out per patient and year. The median effective dose was 1.7 [5.-95. percentile; mean: 0.4–8.5; 2.9] mSv per examination and 2.3 [0.5–11.2; 3.5] mSv per patient. Interestingly, the mean effective dose per examination, but not the number of examinations per year increased with the age of the patients. Most frequent were examinations of the thyroid (36.7%), the skeleton (27.1%) and the cardiovascular system (11.1%), which were associated with a median effective dose of 0.5 [0.5–1.1; 0.7] mSv, 3.4 [2.9–5.1; 3.6] mSv and 7.3 [3.2–21.0; 9.5] mSv, respectively. Over the five-year period examined, the total annual number of PET procedures (222.3%) as well as of examinations of thyroid (24.5%), skeleton (17.9%), and the cardiovascular system (14.9%) increased markedly, whereas a decrease was observed for brain (-39.3%), lung (-20.2%) and renal (-15.0%) scans. Conclusion: The age- and gender-specific data presented in this study provide detailed public health information on both the current status and recent trends in the practice of diagnostic nuclear medicine examinations.

Aquisition of age- and sex-dependent patient data for the calculation of annual radiation exposure in nuclear medicine: a German pilot study

Aim: A pilote study for estimation of radiation exposure due to diagnostic procedures in nuclear medicine using routine data of hospitals and practices in Germany. Methods: Hospitals and practices willing to participate in the study supplied data of one year (1997), containing information on patients´ identification number, age, sex, type of diagnostic procedure, radiopharmaceutical, administered activity, type of health insurance (private/ public), inpatient/outpatient status, and so-called Leistungsziffer, which describes the type of medical performances in Germany. The effective dose per examination was calculated according to ICRP 80. Mean, standard deviation, median, 5th and 95th percentiles of the effective dose were calculated, stratified by type of organ system and also by sex and age, including patients of ≥18 years. Results: 82 039 examinations from patients of 9 hospitals and practices were analyzed. The median (5-95th percentiles) of the effective dose per examination for all patients was 2.9 mSv (0.4-8.5 mSv); 1.2 examinations per patient and year were performed on average. The three most frequent examinations were bone scans (median 3.4 mSv; 2.9-5.1), thyroid (0.9 mSv; 0.4-2.2) and cardiovascular studies (7.3 mSv; 3.8-20.2). The median effective dose for 18 to 40 years old women was 1.0 mSv (0.4-5.8), for women between 41 and 65 years 2.2 mSv (0.4-7.3) and for women older than 65 years 2.4 mSv (0.5- 7.6). The corresponding values for men were 2.6 mSv (0.3-7.6); 3.3 mSv (0.4-9.1), and 3.4 mSv (0.5- 8.8). Conclusion: It was possible to gain an accurate determination of radiation exposure of diagnostic procedures in nuclear medicine by routine data.

Effectiveness of tip rotation in fibreoptic bronchoscopy under different experimental conditions: an in vitro crossover study

Background

Proper manipulation of fibreoptic bronchoscopes is essential for successful tracheal intubation or diagnostic bronchoscopy. Failure of proper navigation and rotation of the fibrescope may lead to difficulties in advancing the fibrescope and might also be responsible for (unnecessary) difficulties and delays in fibreoptic tracheal intubation, with subsequent hypoxaemia. The present study, therefore, aimed to assess the effectiveness of tip rotation in flexible bronchoscopes in different experimental conditions.

Methods

Five differently sized pairs of fibrescopes (outer diameters of 2.2, 2.4, 3.5, 4.2, and 5.2 mm) were inserted into paediatric airway manikins via an appropriately sized laryngeal mask and were turned clockwise or anticlockwise at the fibrescope body or cord to 45, 90, and 180°, with the cord held either straight or bent. The primary outcome measure was the ratio of rotation measured at the tip over the rotation performed with the fibrescope body or cord.

Results

Overall, the 'body' turn was significantly less effective when a bent cord was present (mean difference ranging from 29.8% (95% confidence interval 8.8-50.9) to 117.4% (93.6-141.2). This difference was diminished when the 'cord' turn was performed. Smaller fibrescopes, with outer diameters of 2.2 and 2.4 mm, were inferior with respect to the transmission of 'body' rotation to the tip.

Conclusions

'Cord' turning of the fibrescope appears to be more effective in rotating the tip than a turn of the fibrescope 'body' only. Straightening the fibrescope cord and combined 'body' and 'cord' turning are recommended.

Early versus late recurrence of intrahepatic cholangiocarcinoma after resection with curative intent

BACKGROUND

The objective of this study was to investigate the characteristics, treatment and prognosis of early versus late recurrence of intrahepatic cholangiocarcinoma (ICC) after hepatic resection.

METHODS

Patients who underwent resection with curative intent for ICC were identified from a multi-institutional database. Data on clinicopathological characteristics, initial operative details, timing and sites of recurrence, recurrence management and long-term outcomes were analysed.

RESULTS

A total of 933 patients were included. With a median follow-up of 22 months, 685 patients (73·4 per cent) experienced recurrence of ICC; 406 of these (59·3 per cent) developed only intrahepatic disease recurrence. The optimal cutoff value to differentiate early (540 patients, 78·8 per cent) versus late (145, 21·2 per cent) recurrence was defined as 24 months. Patients with early recurrence had extrahepatic disease more often (44·1 per cent versus 28·3 per cent in those with late recurrence; P < 0·001), whereas late recurrence was more often only intrahepatic (71·7 per cent versus 55·9 per cent for early recurrence; P < 0·001). From time of recurrence, overall survival was worse among patients who had early versus late recurrence (median 10 versus 18 months respectively; P = 0·029). In multivariable analysis, tumour characteristics including tumour size, number of lesions and satellite lesions were associated with an increased risk of early intrahepatic recurrence. In contrast, only the presence of liver cirrhosis was independently associated with an increased likelihood of late intrahepatic recurrence (hazard ratio 1·99, 95 per cent c.i. 1·11 to 3·56; P = 0·019).

CONCLUSION

Early and late recurrence after curative resection for ICC are associated with different risk factors and prognosis. Data on the timing of recurrence may inform decisions about the degree of postoperative surveillance, as well as help counsel patients with regard to their risk of recurrence.

Comparison of a paediatric emergency ruler with a digital algorithm for weight and age estimation

BACKGROUND

Emergency tapes like the "Paediatric-Emergency-Ruler" (PaedER) provide drug dosing and recommend medical airway equipment based on estimated patient bodyweight and age. Previous studies have revealed unsatisfactory accuracy in bodyweight estimation, due to the tapes' length-based weight categories. Therefore, we developed a digital algorithm allowing continuous length-based estimation of weight and age. The aim of this study was to compare the new algorithm with the PaedER regarding accuracy in estimating bodyweight and recommendation of medical airway equipment.

METHODS

Patients with a body length suitable for the PaedER were included in this single centre, prospective clinical observation trial after obtaining informed written parental consent. Bodyweight estimations by the algorithm and PaedER within ± 10% and ± 20% of the actual bodyweight were compared. Furthermore, medical airway equipment suggested by the PaedER and algorithm were compared with the equipment actually used for anaesthesia. Wilcoxon- and McNemar-Tests were used for statistical analysis. Results are median (interquartiles), P < 0.05 was considered significant.

RESULTS

In total, 489 patients aged 2.0 years (0.4-5.9), with a body length of 89.0 cm (63.5-114.5), weighing 12.8 kg (6.3-19.6), were included. The algorithm's precision of bodyweight estimation within ± 10%/± 20% was significantly higher at 64.0%/91.6% than the PaedER at 55.4%/81.8% (P < 0.001). Compared to PaedER the algorithm showed a higher incidence of correctly recommended medical airway equipment based on its accuracy for age and bodyweight estimation.

CONCLUSION

The new digital algorithm is an alternative to conventional emergency tapes, showing improved accuracy regarding length-based estimation of bodyweight and recommendation of medical airway equipment.