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Carter M, Hua R, Pitt JB, Zeineddin S, Perez A, Sands L, Kujawa S, Lehane A, Stake C, Reynolds M, Abdullah F, Goldstein SD. Utility of White Light Scanning as an Alternative to Computed Tomography to Evaluate Severity of Pectus Excavatum Deformity. J Pediatr Surg 2024; 59:1694-1702. [PMID: 38772759 DOI: 10.1016/j.jpedsurg.2024.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 04/15/2024] [Accepted: 04/23/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND Pectus excavatum (PE) severity and surgical candidacy are determined by computed tomography (CT)-delineated Haller Index (HI) and Correction Index (CI). White light scanning (WLS) has been proposed as a non-ionizing alternative. The purpose of this retrospective study is to create models to determine PE severity using WLS as a non-ionizing alternative to CT. METHODS Between November 2015 and February 2023, CT and WLS were performed for children ≤18 years undergoing evaluation at a high-volume, chest-wall deformity clinic. Separate quadratic discriminate analysis models were developed to predict CT HI ≥ 3.25 and CT CI ≥ 28% indicating surgical candidacy. Two bootstrap forest models were trained on WLS measurements and patient demographics to predict CT HI and CT CI values then compared to actual index values by intraclass correlation coefficient (ICC). RESULTS In total, 242 patients were enrolled (86.4% male, mean [SD] age 15.2 [1.3] years). Quadratic discriminate analysis models predicted CT HI ≥ 3.25 with specificity = 91.7%, PPV = 97.7% (AUC = 0.91), and CT CI ≥ 28% with specificity = 92.3%, PPV = 93.5% (AUC = 0.84). Bootstrap forest model predicted CT HI with training dataset ICC (95% CI) = 0.91 (0.88-0.93, R2 = 0.85) and test dataset ICC (95% CI) = 0.86 (0.71-0.94, R2 = 0.77). For CT CI, training dataset ICC (95% CI) = 0.91 (0.81-0.93, R2 = 0.86) and test dataset ICC (95% CI) = 0.75 (0.50-0.88, R2 = 0.63). CONCLUSIONS Using noninvasive and nonionizing WLS imaging, we can predict PE severity at surgical threshold with high specificity obviating the need for CT. Furthermore, we can predict actual CT HI and CI with moderate-excellent reliability. We anticipate this point-of-care tool to obviate the need for most cross-sectional imaging during surgical evaluation of PE. LEVEL OF EVIDENCE Level III. STUDY TYPE Study of Diagnostic Test.
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Affiliation(s)
- Michela Carter
- Division of Pediatric Surgery, Department of Surgery, Northwestern University's Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States.
| | - Rui Hua
- Division of Pediatric Surgery, Department of Surgery, Northwestern University's Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Shirley Ryan AbilityLab, Chicago, IL, United States
| | - J Benjamin Pitt
- Division of Pediatric Surgery, Department of Surgery, Northwestern University's Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Suhail Zeineddin
- Division of Pediatric Surgery, Department of Surgery, Northwestern University's Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Amparo Perez
- Division of Pediatric Surgery, Department of Surgery, Northwestern University's Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Laurie Sands
- Division of Pediatric Surgery, Department of Surgery, Northwestern University's Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Suzanne Kujawa
- Division of Pediatric Surgery, Department of Surgery, Northwestern University's Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Alison Lehane
- Division of Pediatric Surgery, Department of Surgery, Northwestern University's Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Christine Stake
- Division of Pediatric Surgery, Department of Surgery, Northwestern University's Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Marleta Reynolds
- Division of Pediatric Surgery, Department of Surgery, Northwestern University's Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Fizan Abdullah
- Division of Pediatric Surgery, Department of Surgery, Northwestern University's Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Seth D Goldstein
- Division of Pediatric Surgery, Department of Surgery, Northwestern University's Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
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Carter M, Zeineddin S, Bai I, Pitt JB, Hua R, Kwon S, Ghomrawi HMK, Abdullah F. Step cadence as a novel objective postoperative recovery metric in children who undergo laparoscopic appendectomy. Surgery 2024; 175:1176-1183. [PMID: 38195303 DOI: 10.1016/j.surg.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/28/2023] [Accepted: 12/12/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Daily step counts from consumer wearable devices have been used to objectively assess postsurgical recovery in children. However, step cadence, defined as steps taken per minute, may be a more specific measure of physiologic status. The purpose of this study is to define objective normative physical activity recovery trajectories after laparoscopic appendectomy using this novel metric. We hypothesized that patients would have a progressive increase in peak cadence until reaching a plateau representing baseline status, and this would occur earlier for simple compared with complicated appendicitis. METHODS Children aged 3 to 18 years were enrolled after laparoscopic appendectomy for simple or complicated appendicitis between March 2019 and December 2022 at a tertiary children's hospital. Participants wore a Fitbit for 21 postoperative days. The peak 1-minute cadence and peak 30-minute cadence were determined each postoperative day. Piecewise linear regression was conducted to generate normative peak step cadence recovery trajectories for simple and complicated appendicitis. RESULTS A total of 147 children met criteria (53.7% complicated appendicitis). Patients with simple appendicitis reached plateau postoperative day 10 at a mean peak 1-minute cadence of 111 steps/minute and a mean peak 30-minute cadence of 77 steps/minute. The complicated appendicitis recovery trajectory reached a plateau postoperative day 13 at a mean peak 1-minute cadence of 106 steps/minute and postoperative day 15 at a mean peak 30-minute cadence of 75 steps/minute. CONCLUSION Using step cadence, we defined procedure-specific normative peak cadence recovery trajectories after laparoscopic appendectomy. This can empower clinicians to set data-driven expectations for recovery after surgery and establish the groundwork for consumer wearable devices as a post-discharge remote monitoring tool.
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Affiliation(s)
- Michela Carter
- Division of Pediatric Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Suhail Zeineddin
- Division of Pediatric Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Iris Bai
- Division of Pediatric Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - J Benjamin Pitt
- Division of Pediatric Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Rui Hua
- Division of Pediatric Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Shirley Ryan AbilityLab, Chicago, IL
| | - Soyang Kwon
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Hassan M K Ghomrawi
- Division of Pediatric Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Medicine (Rheumatology), Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Fizan Abdullah
- Division of Pediatric Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
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Effah Kaufmann E, Tackie R, Pitt JB, Mba S, Akwetey B, Quaye D, Mills G, Nyame C, Bulley H, Glucksberg M, Ghomrawi H, Appeadu-Mensah W, Abdullah F. Feasibility of Leveraging Consumer Wearable Devices with Data Platform Integration for Patient Vital Monitoring in Low-Resource Settings. Int J Telemed Appl 2024; 2024:8906413. [PMID: 38362543 PMCID: PMC10869189 DOI: 10.1155/2024/8906413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/05/2024] [Accepted: 01/30/2024] [Indexed: 02/17/2024] Open
Abstract
Manual monitoring of vital signs, which often fails to capture the onset of deterioration, is the main monitoring modality in most Ghanaian hospitals due to the high cost and inadequate supply of patient bedside monitors. Consumer wearable devices (CWDs) are emerging, relatively low-cost technologies for continuous monitoring of physiological status; however, their validity has not been established in low-resource clinical settings. We aimed to (1) investigate the validity of the heart rate (HR) and oxygen saturation (SpO2) data from two widely used CWDs, the Fitbit Versa 2 and Xiaomi Mi Smart Band 6, against gold standard bedside monitors in one Ghanaian hospital and (2) develop a web application to capture and display CWD data in a clinician-friendly way. A healthy volunteer simultaneously wore both CWDs and blood pressure cuffs to measure HR and SpO2. To test for concordance, we conducted the Bland-Altman and mean absolute percentage error analyses. We also developed a web application that retrieves and displays CWD data in near real time as text and graphical trends. Compared to gold standards (patient monitor and manual), the Fitbit Versa 2 had 96.87% and 96.67% measurement accuracies for HR, and the Xiaomi Mi Smart Band 6 had 94.24% and 93.21% measurement accuracies for HR. The Xiaomi Mi Smart Band 6 had 98.79% measurement accuracy for SpO2. The strong concordance between CWD and gold standards supports the potential implementation of these devices as a novel method of vital sign monitoring to replace manual monitoring, thus saving costs and improving patient outcomes. Further studies are needed for confirmation.
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Affiliation(s)
| | - Richmond Tackie
- Department of Biomedical Engineering, University of Ghana, Accra, Ghana
| | - J. Benjamin Pitt
- Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Samuel Mba
- Department of Biomedical Engineering, University of Ghana, Accra, Ghana
| | - Bismark Akwetey
- Department of Biomedical Engineering, University of Ghana, Accra, Ghana
| | - Danielle Quaye
- Department of Biomedical Engineering, University of Ghana, Accra, Ghana
| | - Godfrey Mills
- Department of Computer Engineering, University of Ghana, Accra, Ghana
| | | | | | | | - Hassan Ghomrawi
- Northwestern University Feinberg School of Medicine, Chicago, USA
| | | | - Fizan Abdullah
- Northwestern University Feinberg School of Medicine, Chicago, USA
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