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Bertoncelli CM, Bertoncelli D, Bagui SS, Bagui SC, Costantini S, Solla F. Identifying Postural Instability in Children with Cerebral Palsy Using a Predictive Model: A Longitudinal Multicenter Study. Diagnostics (Basel) 2023; 13:2126. [PMID: 37371021 DOI: 10.3390/diagnostics13122126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/07/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
Insufficient postural control and trunk instability are serious concerns in children with cerebral palsy (CP). We implemented a predictive model to identify factors associated with postural impairments such as spastic or hypotonic truncal tone (TT) in children with CP. We conducted a longitudinal, double-blinded, multicenter, descriptive study of 102 teenagers with CP with cognitive impairment and severe motor disorders with and without truncal tone impairments treated in two specialized hospitals (60 inpatients and 42 outpatients; 60 males, mean age 16.5 ± 1.2 years, range 12 to 18 yrs). Clinical and functional data were collected between 2006 and 2021. TT-PredictMed, a multiple logistic regression prediction model, was developed to identify factors associated with hypotonic or spastic TT following the guidelines of "Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis". Predictors of hypotonic TT were hip dysplasia (p = 0.01), type of etiology (postnatal > perinatal > prenatal causes; p = 0.05), male gender, and poor manual (p = 0.01) and gross motor function (p = 0.05). Predictors of spastic TT were neuromuscular scoliosis (p = 0.03), type of etiology (prenatal > perinatal > postnatal causes; p < 0.001), spasticity (quadri/triplegia > diplegia > hemiplegia; p = 0.05), presence of dystonia (p = 0.001), and epilepsy (refractory > controlled, p = 0.009). The predictive model's average accuracy, sensitivity, and specificity reached 82%. The model's accuracy aligns with recent studies on applying machine learning models in the clinical field.
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Affiliation(s)
- Carlo Marioi Bertoncelli
- Department of Computer Science, Hal Marcus College of Science & Engineering, University of West Florida, Pensacola, FL 32514, USA
- EEAP H Germain and Department of Pediatric Orthopaedic Surgery, Lenval Foundation, University Pediatric Hospital of Nice, 06000 Nice, France
- Department of Information Engineering, Computer Science and Mathematics, University of L'Aquila, 67100 L'Aquila, Italy
| | - Domenico Bertoncelli
- Department of Computer Science, Hal Marcus College of Science & Engineering, University of West Florida, Pensacola, FL 32514, USA
- Department of Information Engineering, Computer Science and Mathematics, University of L'Aquila, 67100 L'Aquila, Italy
| | - Sikha S Bagui
- Department of Computer Science, Hal Marcus College of Science & Engineering, University of West Florida, Pensacola, FL 32514, USA
| | - Subhash C Bagui
- Department of Computer Science, Hal Marcus College of Science & Engineering, University of West Florida, Pensacola, FL 32514, USA
| | - Stefania Costantini
- Department of Information Engineering, Computer Science and Mathematics, University of L'Aquila, 67100 L'Aquila, Italy
| | - Federico Solla
- EEAP H Germain and Department of Pediatric Orthopaedic Surgery, Lenval Foundation, University Pediatric Hospital of Nice, 06000 Nice, France
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Hariharan A, Sees JP, Pargas C, Rogers KJ, Niiler T, Shrader MW, Miller F. Mortality after spinal fusion in children with cerebral palsy and cerebral-palsy-like conditions: A 30-year follow-up study. Dev Med Child Neurol 2023. [PMID: 36882978 DOI: 10.1111/dmcn.15568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 01/31/2023] [Accepted: 02/09/2023] [Indexed: 03/09/2023]
Abstract
AIM To report survival probability of a large cohort of children with cerebral palsy (CP) after spinal fusion. METHOD All children with CP who had spinal fusion between 1988 and 2018 at the reporting facility were reviewed for survival. Death records of the institutional CP database, institutional electronic medical records, publicly available obituaries, and the National Death Index through the US Centers for Disease Control were searched. Survival probabilities with different surgical eras, comorbidities, ages, and curve severities were compared using Kaplan-Meier curves. RESULTS A total of 787 children (402 females, 385 males) had spinal fusion at a mean age of 14 years 1 month (standard deviation 3 years 2 months). The 30-year estimated survival was approximately 30%. Survival decreased for children who had spinal fusion at younger ages, longer postoperative hospital stays, longer postoperative intensive care unit stays, gastrostomy tubes, and pulmonary comorbidities. INTERPRETATION Children with CP who required spinal fusions had reduced long-term survival compared with an age-matched typically developing cohort; however, a substantial number survived 20 to 30 years after the surgery. This study had no comparison group of children with CP scoliosis; therefore, we do not know whether correction of scoliosis affected their survival.
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Affiliation(s)
- Arun Hariharan
- Paley Orthopedic & Spine Institute, West Palm Beach, FL, USA
| | | | - Carlos Pargas
- Department of Orthopaedics, Nemours Children's Health, DE, Wilmington, USA
| | - Kenneth J Rogers
- Department of Orthopaedics, Nemours Children's Health, DE, Wilmington, USA
| | - Tim Niiler
- Department of Orthopaedics, Nemours Children's Health, DE, Wilmington, USA
| | | | - Freeman Miller
- Department of Orthopaedics, Nemours Children's Health, DE, Wilmington, USA
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Bertoncelli CM, Latalski M, Bertoncelli D, Bagui S, Bagui SC, Gautier D, Solla F. Prediction Model for Identifying Computational Phenotypes of Children with Cerebral Palsy Needing Neurotoxin Treatments. Toxins (Basel) 2022; 15:20. [PMID: 36668840 PMCID: PMC9867395 DOI: 10.3390/toxins15010020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 12/29/2022] Open
Abstract
Factors associated with neurotoxin treatments in children with cerebral palsy (CP) are poorly studied. We developed and externally validated a prediction model to identify the prognostic phenotype of children with CP who require neurotoxin injections. We conducted a longitudinal, international, multicenter, double-blind descriptive study of 165 children with CP (mean age 16.5 ± 1.2 years, range 12−18 years) with and without neurotoxin treatments. We collected functional and clinical data from 2005 to 2020, entered them into the BTX-PredictMed machine-learning model, and followed the guidelines, “Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis”. In the univariate analysis, neuromuscular scoliosis (p = 0.0014), equines foot (p < 0.001) and type of etiology (prenatal > peri/postnatal causes, p = 0.05) were linked with neurotoxin treatments. In the multivariate analysis, upper limbs (p < 0.001) and trunk muscle tone disorders (p = 0.02), the presence of spasticity (p = 0.01), dystonia (p = 0.004), and hip dysplasia (p = 0.005) were strongly associated with neurotoxin injections; and the average accuracy, sensitivity, and specificity was 75%. These results have helped us identify, with good accuracy, the clinical features of prognostic phenotypes of subjects likely to require neurotoxin injections.
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Affiliation(s)
- Carlo M. Bertoncelli
- Department of Computer Science, Hal Marcus College of Science & Engineering, University of West Florida, Pensacola, FL 32514, USA
- EEAP H Germain and Department of Pediatric Orthopaedic Surgery, Lenval Foundation, University Pediatric Hospital of Nice, 06000 Nice, France
- Department of Information Engineering Computer Science and Mathematics, Computer Science and Mathematics, University of L’Aquila, 67100 L’Aquila, Italy
| | - Michal Latalski
- Children Orthopaedic Department, Medical University, 20-059 Lublin, Poland
| | - Domenico Bertoncelli
- Department of Computer Science, Hal Marcus College of Science & Engineering, University of West Florida, Pensacola, FL 32514, USA
- Department of Information Engineering Computer Science and Mathematics, Computer Science and Mathematics, University of L’Aquila, 67100 L’Aquila, Italy
| | - Sikha Bagui
- Department of Computer Science, Hal Marcus College of Science & Engineering, University of West Florida, Pensacola, FL 32514, USA
| | - Subhash C. Bagui
- Department of Computer Science, Hal Marcus College of Science & Engineering, University of West Florida, Pensacola, FL 32514, USA
| | - Dechelle Gautier
- EEAP H Germain and Department of Pediatric Orthopaedic Surgery, Lenval Foundation, University Pediatric Hospital of Nice, 06000 Nice, France
| | - Federico Solla
- EEAP H Germain and Department of Pediatric Orthopaedic Surgery, Lenval Foundation, University Pediatric Hospital of Nice, 06000 Nice, France
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Yoo N, Arand B, Shi J, Yang J, Noritz G, Whitaker AT. Feeding tube use is associated with severe scoliosis in patients with cerebral palsy and limited ambulatory ability. Spine Deform 2022; 10:1415-1421. [PMID: 35764871 PMCID: PMC9579063 DOI: 10.1007/s43390-022-00540-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 06/05/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Cerebral palsy (CP) is the most common motor disorder in childhood. Scoliosis is a common complication of CP that can reach clinically severe levels, but predictors for scoliosis in CP are not well understood. Some variables identified in the literature involve the severity of the brain injury and the presence of hip deformity. We aimed to identify associations with developing severe scoliosis in a prospective cohort of patients with cerebral palsy at higher risk for severe curve progression. METHODS This study reviewed a prospectively collected database at a tertiary children's hospital. We evaluated a panel of potential associations with severe scoliosis-including age, sex, Gross Motor Function Classification System (GMFCS) class, history of hip surgery, epilepsy, and feeding tube presence-in a population of children with limited ambulatory ability defined as GMFCS level IV or V CP. Univariate analysis and multivariate logistic regression with stepwise selection was used for analysis. RESULTS Descriptive analysis showed that female sex, higher GMFCS class, history of hip surgery, non-upright seating, pelvic obliquity, presence of epilepsy, and presence of a feeding tube were associated with an increased risk for scoliosis. Multivariate logistic regression analysis revealed that the presence of a feeding tube was associated with severe scoliosis even when controlling for GMFCS and age. CONCLUSIONS Feeding tube use may stratify risk for severe scoliosis progression in patients with GMFCS IV or V CP.
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Affiliation(s)
- Nicholas Yoo
- College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Brian Arand
- Nationwide Children's Hospital, Columbus, OH, USA
| | - Junxin Shi
- Nationwide Children's Hospital, Columbus, OH, USA
| | | | - Garey Noritz
- Nationwide Children's Hospital, Columbus, OH, USA
| | - Amanda T Whitaker
- Nationwide Children's Hospital, Columbus, OH, USA.
- Shriners Hospital Northern California, University of California Davis, Sacramento, CA, USA.
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Bertoncelli CM, Altamura P, Bagui S, Bagui S, Vieira ER, Costantini S, Monticone M, Solla F, Bertoncelli D. Predicting osteoarthritis in adults using statistical data mining and machine learning. Ther Adv Musculoskelet Dis 2022; 14:1759720X221104935. [PMID: 35859927 PMCID: PMC9290106 DOI: 10.1177/1759720x221104935] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 05/16/2022] [Indexed: 11/23/2022] Open
Abstract
Background: Osteoarthritis (OA) has traditionally been considered a disease of older adults (⩾65 years old), but it may appear in younger adults. However, the risk factors for OA in younger adults need to be further evaluated. Objectives: To develop a prediction model for identifying risk factors of OA in subjects aged 20–50 years and compare the performance of different machine learning models. Methods: We included data from 52,512 participants of the National Health and Nutrition Examination Survey; of those, we analyzed only subjects aged 20–50 years (n = 19,133), with or without OA. The supervised machine learning model ‘Deep PredictMed’ based on logistic regression, deep neural network (DNN), and support vector machine was used for identifying demographic and personal characteristics that are associated with OA. Finally, we compared the performance of the different models. Results: Being a female (p < 0.001), older age (p < 0.001), a smoker (p < 0.001), higher body mass index (p < 0.001), high blood pressure (p < 0.001), race/ethnicity (lowest risk among Mexican Americans, p = 0.01), and physical and mental limitations (p < 0.001) were associated with having OA. Best predictive performance yielded a 75% area under the receiver operating characteristic curve. Conclusion: Sex (female), age (older), smoking (yes), body mass index (higher), blood pressure (high), race/ethnicity, and physical and mental limitations are risk factors for having OA in adults aged 20–50 years. The best predictive performance was achieved using DNN algorithms.
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Affiliation(s)
- Carlo M Bertoncelli
- Department of Computer Science, Hal Marcus College of Science and Engineering, University of West Florida, Pensacola, FL 32514, USA
| | - Paola Altamura
- Department of Medicinal Chemistry and Pharmaceutical Technology, University of Chieti, Chieti, Italy
| | - Sikha Bagui
- Department of Computer Science, Hal Marcus College of Science and Engineering, University of West Florida, Pensacola, FL, USA
| | - Subhash Bagui
- Department of Computer Science, Hal Marcus College of Science and Engineering, University of West Florida, Pensacola, FL, USA
| | - Edgar Ramos Vieira
- Department of Physical Therapy, Florida International University, Miami, FL, USA
| | - Stefania Costantini
- Department of Information Engineering Computer Science and Mathematics, University of L'Aquila, L'Aquila, Italy
| | - Marco Monticone
- Department of Medical Sciences and Public Health and Department of Physical Medicine and Rehabilitation, University of Cagliari, Cagliari, Italy
| | - Federico Solla
- Department of Pediatric Orthopaedic Surgery, Lenval University Pediatric Hospital of Nice, Nice, France
| | - Domenico Bertoncelli
- Department of Computer Science, Hal Marcus College of Science and Engineering, University of West Florida, Pensacola, FL, USA
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Bertoncelli CM, Altamura P, Bertoncelli D, Rampal V, Vieira ER, Solla F. PredictMed: A Machine Learning Model for Identifying Risk Factors of Neuromuscular Hip Dysplasia: A Multicenter Descriptive Study. Neuropediatrics 2021; 52:343-350. [PMID: 33352605 DOI: 10.1055/s-0040-1721703] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Neuromuscular hip dysplasia (NHD) is a common and severe problem in patients with cerebral palsy (CP). Previous studies have so far identified only spasticity (SP) and high levels of Gross Motor Function Classification System as factors associated with NHD. The aim of this study is to develop a machine learning model to identify additional risk factors of NHD. This was a cross-sectional multicenter descriptive study of 102 teenagers with CP (60 males, 42 females; 60 inpatients, 42 outpatients; mean age 16.5 ± 1.2 years, range 12-18 years). Data on etiology, diagnosis, SP, epilepsy (E), clinical history, and functional assessments were collected between 2007 and 2017. Hip dysplasia was defined as femoral head lateral migration percentage > 33% on pelvic radiogram. A logistic regression-prediction model named PredictMed was developed to identify risk factors of NHD. Twenty-eight (27%) teenagers with CP had NHD, of which 18 (67%) had dislocated hips. Logistic regression model identified poor walking abilities (p < 0.001; odds ratio [OR] infinity; 95% confidence interval [CI] infinity), scoliosis (p = 0.01; OR 3.22; 95% CI 1.30-7.92), trunk muscles' tone disorder (p = 0.002; OR 4.81; 95% CI 1.75-13.25), SP (p = 0.006; OR 6.6; 95% CI 1.46-30.23), poor motor function (p = 0.02; OR 5.5; 95% CI 1.2-25.2), and E (p = 0.03; OR 2.6; standard error 0.44) as risk factors of NHD. The accuracy of the model was 77%. PredictMed identified trunk muscles' tone disorder, severe scoliosis, E, and SP as risk factors of NHD in teenagers with CP.
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Affiliation(s)
- Carlo M Bertoncelli
- Department of Physical Therapy, Nicole Wertheim College of Nursing & Health Sciences, Florida International University, Miami, Florida, United States.,E.E.A.P. H. Germain, Children Hospital, PredictMed Lab, Nice, France
| | - Paola Altamura
- Department of Medicinal Chemistry and Pharmaceutical Technology, University of Chieti, Chieti, Italy
| | - Domenico Bertoncelli
- Department of Information Engineering, Computer Science and Mathematics, University of L'Aquila, L'Aquila, Italy
| | - Virginie Rampal
- Department of Pediatric Orthopaedic Surgery, Lenval Children's University Hospital of Nice, Nice, France
| | - Edgar Ramos Vieira
- Department of Physical Therapy, Nicole Wertheim College of Nursing & Health Sciences, Florida International University, Miami, Florida, United States
| | - Federico Solla
- Department of Pediatric Orthopaedic Surgery, Lenval Children's University Hospital of Nice, Nice, France
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Clinical predictive model of lumbar curve Cobb angle below selective fusion for thoracic adolescent idiopathic scoliosis: a longitudinal multicenter descriptive study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:827-836. [PMID: 34143310 DOI: 10.1007/s00590-021-03054-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 06/09/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To implement a clinically applicable, predictive model for the lumbar Cobb angle below a selective thoracic fusion in adolescent idiopathic scoliosis. METHODS A series of 146 adolescents with Lenke 1 or 2 idiopathic scoliosis, surgically treated with posterior selective fusion, and minimum follow-up of 5 years (average 7) was analyzed. The cohort was divided in 2 groups: if lumbar Cobb angle at last follow-up was, respectively, ≥ or < 10°. A logistic regression-based prediction model (PredictMed) was implemented to identify variables associated with the group ≥ 10°. The guidelines of the TRIPOD statement were followed. RESULTS Mean Cobb angle of thoracic main curve was 56° preoperatively and 25° at last follow-up. Mean lumbar Cobb angle was 33° (20; 59) preoperatively and 11° (0; 35) at last follow-up. 53 patients were in group ≥ 10°. The 2 groups had similar demographics, flexibility of both main and lumbar curves, and magnitude of the preoperative main curve, p > 0.1. From univariate analysis, mean magnitude of preoperative lumbar curves (35° vs. 30°), mean correction of main curve (65% vs. 58%), mean ratio of main curve/distal curve (1.9 vs. 1.6) and distribution of lumbar modifiers were statistically different between groups (p < 0.05). PredictMed identified the following variables significantly associated with the group ≥ 10°: main curve % correction at last follow-up (p = 0.01) and distal curve angle (p = 0.04) with a prediction accuracy of 71%. CONCLUSION The main modifiable factor influencing uninstrumented lumbar curve was the correction of main curve. The clinical model PredictMed showed an accuracy of 71% in prediction of lumbar Cobb angle ≥ 10° at last follow-up. LEVEL OF EVIDENCE IV Longitudinal comparative study.
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Bertoncelli C, Altamura P, Vieira ER, Bertoncelli D, Solla F. Predicting Hip Dysplasia in Teenagers with Cerebral Palsy in order to Optimize Prevention and Rehabilitation. A Longitudinal Descriptive Study. Dev Neurorehabil 2021; 24:166-172. [PMID: 33058745 DOI: 10.1080/17518423.2020.1819459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To develop a predictive model of neuromuscular hip dysplasia (NHD) in teenagers with cerebral palsy (CP) to optimize rehabilitation. DESIGN A longitudinal, multicenter, double-blinded, descriptive study of one hundred and two teenagers with CP (age 16.5 ± 1.2 years, range 12-18 years). Data on etiology, diagnosis, spasticity, epilepsy, clinical history, and functional assessments were collected from 2005 to 2017 and entered in the prediction model "PredictMed." RESULTS Poor walking abilities [p < .001; Odd Ratio (OR) Infinity], scoliosis (p 0.01; OR 3.22), trunk muscles' tone disorder (p 0.002; OR 4.81), spasticity (p 0.006; OR 6.6), poor motor function (p 0.02; OR 5.5), and epilepsy (p 0.03; OR 2.6) were predictors of NHD development. The accuracy of the model was 77%. CONCLUSION Trunk muscles' tone disorder, severe scoliosis, epilepsy, and spasticity were predictors of NHD in teenagers with CP. Based on the results we have developed appropriate preventative rehabilitation interventions.
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Affiliation(s)
- Carlo Bertoncelli
- Nicole Wertheim College of Nursing and Health Sciences, Department of Physical Therapy, Florida International University, Miami, FL, USA.,PredictMed Lab, EEAP H. Germain, Children Hospital, Nice, France
| | - Paola Altamura
- Department of Medicinal Chemistry and Pharmaceutical Technology, University of Chieti, Chieti, Italy
| | - Edgar Ramos Vieira
- Nicole Wertheim College of Nursing and Health Sciences, Department of Physical Therapy, Florida International University, Miami, FL, USA
| | - Domenico Bertoncelli
- Department of Information Engineering, Computer Science and Mathematics, University of L'Aquila, L'Aquila, Italy
| | - Federico Solla
- Department of Pediatric Orthopaedic Surgery, Lenval University Pediatric Hospital of Nice, Nice, France
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Arvanitakis M, Gkolfakis P, Despott EJ, Ballarin A, Beyna T, Boeykens K, Elbe P, Gisbertz I, Hoyois A, Mosteanu O, Sanders DS, Schmidt PT, Schneider SM, van Hooft JE. Endoscopic management of enteral tubes in adult patients - Part 1: Definitions and indications. European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2021; 53:81-92. [PMID: 33260229 DOI: 10.1055/a-1303-7449] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
ESGE recommends considering the following indications for enteral tube insertion: (i) clinical conditions that make oral intake impossible (neurological conditions, obstructive causes); (ii) acute and/or chronic diseases that result in a catabolic state where oral intake becomes insufficient; and (iii) chronic small-bowel obstruction requiring a decompression gastrostomy.Strong recommendation, low quality evidence.ESGE recommends the use of temporary feeding tubes placed through a natural orifice (either nostril) in patients expected to require enteral nutrition (EN) for less than 4 weeks. If it is anticipated that EN will be required for more than 4 weeks, percutaneous access should be considered, depending on the clinical setting.Strong recommendation, low quality evidence.ESGE recommends the gastric route as the primary option in patients in need of EN support. Only in patients with altered/unfavorable gastric anatomy (e. g. after previous surgery), impaired gastric emptying, intolerance to gastric feeding, or with a high risk of aspiration, should the jejunal route be chosen.Strong recommendation, moderate quality evidence.ESGE suggests that recent gastrointestinal (GI) bleeding due to peptic ulcer disease with risk of rebleeding should be considered to be a relative contraindication to percutaneous enteral access procedures, as should hemodynamic or respiratory instability.Weak recommendation, low quality evidence.ESGE suggests that the presence of ascites and ventriculoperitoneal shunts should be considered to be additional risk factors for infection and, therefore, further preventive precautions must be taken in these cases.Weak recommendation, low quality evidence.ESGE recommends that percutaneous tube placement (percutaneous endoscopic gastrostomy [PEG], percutaneous endoscopic gastrostomy with jejunal extension [PEG-J], or direct percutaneous endoscopic jejunostomy [D-PEJ]) should be considered to be a procedure with high hemorrhagic risk, and that in order to reduce this risk, specific guidelines for antiplatelet or anticoagulant use should be followed strictly.Strong recommendation, low quality evidence.ESGE recommends refraining from PEG placement in patients with advanced dementia.Strong recommendation, low quality evidence.ESGE recommends refraining from PEG placement in patients with a life expectancy shorter than 30 days.Strong recommendation, low quality evidence*.
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Affiliation(s)
- Marianna Arvanitakis
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Paraskevas Gkolfakis
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Edward J Despott
- Royal Free Unit for Endoscopy and Centre for Gastroenterology, UCL Institute for Liver and Digestive Health, The Royal Free Hospital, London, United Kingdom
| | - Asuncion Ballarin
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Torsten Beyna
- Department of Gastroenterology and Therapeutic Endoscopy, Evangelisches Krankenhaus Düsseldorf, Germany
| | - Kurt Boeykens
- Nutrition Support Team, AZ Nikolaas Hospital, Sint-Niklaas, Belgium
| | - Peter Elbe
- Department of Upper Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden.,Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Ingrid Gisbertz
- Department of Gastroenterology, Bernhoven Hospital, Uden, The Netherlands
| | - Alice Hoyois
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Ofelia Mosteanu
- Department of Gastroenterology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - David S Sanders
- Academic Unit of Gastroenterology, Royal Hallamshire Hospital and University of Sheffield, United Kingdom
| | - Peter T Schmidt
- Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden.,Department of Medicine, Ersta Hospital, Stockholm, Sweden
| | - Stéphane M Schneider
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Gastroentérologie et Nutrition, Nice, France
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
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Dipasquale V, Gottrand F, Sullivan PB, Romano C. Top-ten tips for managing nutritional issues and gastrointestinal symptoms in children with neurological impairment. Ital J Pediatr 2020; 46:35. [PMID: 32216797 PMCID: PMC7099819 DOI: 10.1186/s13052-020-0800-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/17/2020] [Indexed: 12/17/2022] Open
Abstract
The prevalence of children with neurological impairment (NI) presenting feeding difficulties and gastrointestinal symptoms is rising. The most recent guidelines recommend early nutritional assessment and intervention in order to prevent undernutrition and growth failure, along with the proper diagnosis and treatment of some frequent gastrointestinal symptoms, such as gastroesophageal reflux disease (GERD) and constipation, which can further worsen the feeding process and nutritional status. Nonetheless, the nutritional issues and growth deficits of children with NI are often considered to be of low priority or under recognised by healthcare providers. The present article proposes ten top tips that highlight the major points along the nutritional management pathway of NI children. The implementation of these tips in all healthcare settings could potentially improve patient outcomes and reduce morbidity and mortality.
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Affiliation(s)
- Valeria Dipasquale
- Department of Human Pathology in Adulthood and Childhood "G. Barresi", Pediatric Gastroenterology and Cystic Fibrosis Unit, University of Messina, Via Consolare Valeria, 98124, Messina, Italy
| | - Frederic Gottrand
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, CHU Lille, Lille, France
| | | | - Claudio Romano
- Department of Human Pathology in Adulthood and Childhood "G. Barresi", Pediatric Gastroenterology and Cystic Fibrosis Unit, University of Messina, Via Consolare Valeria, 98124, Messina, Italy.
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