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Low Prevalence of Severe Underlying Pathology in Children With Recurrent Respiratory Tract Infections. Pediatr Infect Dis J 2021; 40:e424-e426. [PMID: 34260493 DOI: 10.1097/inf.0000000000003256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
No underlying pathology could be detected in 64% of 208 children presenting with recurrent respiratory tract infections in general pediatric practice. Asthma/preschool wheezing and adenoid hypertrophy were commonly diagnosed. None of the children had a severe primary immunodeficiency or severe pulmonary illness such as cystic fibrosis. Our findings can guide pediatricians in their diagnostic approach of children with respiratory tract infections.
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Chan SS, Kotecha MK, Rigsby CK, Iyer RS, Alazraki AL, Anupindi SA, Bardo DME, Brown BP, Chandra T, Dorfman SR, Garber MD, Moore MM, Nguyen JC, Shet NS, Siegel A, Valente JH, Karmazyn B. ACR Appropriateness Criteria® Pneumonia in the Immunocompetent Child. J Am Coll Radiol 2020; 17:S215-S225. [PMID: 32370966 DOI: 10.1016/j.jacr.2020.01.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 01/25/2020] [Indexed: 12/27/2022]
Abstract
Pneumonia is one of the most common acute infections and the single greatest infectious cause of death in children worldwide. In uncomplicated, community-acquired pneumonia in immunocompetent patients, the diagnosis is clinical and imaging has no role. The first role of imaging is to identify complications associated with pneumonia such as pleural effusion, pulmonary abscess, and bronchopleural fistula. Radiographs are recommended for screening for these complications and ultrasound and CT are recommended for confirmation. The second role of imaging is to identify underlying anatomic conditions that may predispose patients to recurrent pneumonia. CT with intravenously administered contrast is recommended for this evaluation. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Manish K Kotecha
- Research Author, Children's Mercy Hospital, Kansas City, Missouri
| | - Cynthia K Rigsby
- Panel Chair, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Ramesh S Iyer
- Panel Vice-Chair, Seattle Children's Hospital, Seattle, Washington
| | | | | | | | - Brandon P Brown
- Riley Hospital for Children Indiana University, Indianapolis, Indiana
| | | | | | - Matthew D Garber
- University of Florida College of Medicine Jacksonville, Jacksonville, Florida; American Academy of Pediatrics
| | - Michael M Moore
- Penn State Health Children's Hospital, Hershey, Pennsylvania
| | - Jie C Nguyen
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Narendra S Shet
- Children's National Health System, Washington, District of Columbia
| | - Alan Siegel
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Jonathan H Valente
- Alpert Medical School of Brown University, Providence, Rhode Island; American College of Emergency Physicians
| | - Boaz Karmazyn
- Specialty Chair, Riley Hospital for Children Indiana University, Indianapolis, Indiana
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Wick EH, Johnson K, Demarre K, Faherty A, Parikh S, Horn DL. Reliability and Construct Validity of the Penetration-Aspiration Scale for Quantifying Pediatric Outcomes after Interarytenoid Augmentation. Otolaryngol Head Neck Surg 2019; 161:862-869. [PMID: 31426703 DOI: 10.1177/0194599819856299] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess the reliability and construct validity of the Penetration-Aspiration Scale in children. STUDY DESIGN This was a retrospective cohort study of pre- and postoperative video modified barium swallow studies from children who underwent interarytenoid injection augmentation for unexplained persistent pharyngeal dysphagia. Two pediatric speech and language pathologists reviewed each study twice in a blinded and randomized fashion. SETTING Tertiary academic pediatric hospital. SUBJECTS AND METHODS Thirty children were identified with adequate pre- and postoperative modified barium swallow studies within 4 weeks of intervention. Children were separated into clinical outcome groups based on ability to advance to thinner diet consistencies postoperatively. Construct validity was assessed with a mixed linear model to test the hypothesis that only the clinically improved group would receive better Penetration-Aspiration Scale scores after surgery. Reliability was assessed by calculating chance-corrected agreement between raters (interrater) and raters' repeat evaluations (intrarater). RESULTS Inter- and intrarater reliabilities (Cohen's κ) were both excellent. Results of the mixed model revealed a significant interaction between outcome group and pre- and postoperative time interval. As hypothesized, this involved a significant improvement in Penetration-Aspiration Scale score only in the improved group. CONCLUSIONS These findings suggest that the Penetration-Aspiration Scale is a reliable and valid measure of clinical response to interarytenoid injection augmentation in children.
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Affiliation(s)
- Elizabeth H Wick
- Department of Otolaryngology, Barnes-Jewish Hospital-Washington University in St Louis, St Louis, Missouri, USA
| | - Kaalan Johnson
- Department of Otolaryngology, University of Washington Medical Center, Seattle, Washington, USA.,Department of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Kim Demarre
- Department of Speech and Language Pathology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Amy Faherty
- Department of Speech and Language Pathology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Sanjay Parikh
- Department of Otolaryngology, University of Washington Medical Center, Seattle, Washington, USA.,Department of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA
| | - David L Horn
- Department of Otolaryngology, University of Washington Medical Center, Seattle, Washington, USA.,Department of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA
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Montella S, Corcione A, Santamaria F. Recurrent Pneumonia in Children: A Reasoned Diagnostic Approach and a Single Centre Experience. Int J Mol Sci 2017; 18:ijms18020296. [PMID: 28146079 PMCID: PMC5343832 DOI: 10.3390/ijms18020296] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 01/20/2017] [Accepted: 01/24/2017] [Indexed: 12/26/2022] Open
Abstract
Recurrent pneumonia (RP), i.e., at least two episodes of pneumonia in one year or three episodes ever with intercritical radiographic clearing of densities, occurs in 7.7%–9% of children with community-acquired pneumonia. In RP, the challenge is to discriminate between children with self-limiting or minor problems, that do not require a diagnostic work-up, and those with an underlying disease. The aim of the current review is to discuss a reasoned diagnostic approach to RP in childhood. Particular emphasis has been placed on which children should undergo a diagnostic work-up and which tests should be performed. A pediatric case series is also presented, in order to document a single centre experience of RP. A management algorithm for the approach to children with RP, based on the evidence from a literature review, is proposed. Like all algorithms, it is not meant to replace clinical judgment, but it should drive physicians to adopt a systematic approach to pediatric RP and provide a useful guide to the clinician.
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Affiliation(s)
- Silvia Montella
- Department of Translational Medical Sciences, Federico II University, Via Pansini 5, 80131 Naples, Italy.
| | - Adele Corcione
- Department of Translational Medical Sciences, Federico II University, Via Pansini 5, 80131 Naples, Italy.
| | - Francesca Santamaria
- Department of Translational Medical Sciences, Federico II University, Via Pansini 5, 80131 Naples, Italy.
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Serel Arslan S, Demir N, Karaduman AA. Both pharyngeal and esophageal phases of swallowing are associated with recurrent pneumonia in pediatric patients. CLINICAL RESPIRATORY JOURNAL 2016; 12:767-771. [PMID: 27925397 DOI: 10.1111/crj.12592] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 10/24/2016] [Accepted: 11/23/2016] [Indexed: 11/27/2022]
Abstract
INTRODUCTION One of the underlying causes of recurrent pneumonia in children is swallowing dysfunction, with aspiration syndrome. Swallowing dysfunction should be considered not only a problem of the oropharyngeal phase but also a problem of the esophageal phase. OBJECTIVES This study aimed to determine the relationship between findings from a swallowing study and a history of recurrent pneumonia in pediatric patients. METHODS A videofluroscopic swallowing study of 274 pediatric patients who had swallowing dysfunction was conducted. Information on a history of recurrent pneumonia during a 1-year period was obtained from hospital files. RESULTS The median age of the participants was 33 months (min =10, max = 180), of whom 51.8% were females. In the study, 83.2% of the patients had cerebral palsy, 7.7% had syndromic symptoms, 3.6% had muscular dystrophy, and 5.5% were classified as "other." During the 1-year period, 67.9% of the participants had a history of recurrent pneumonia history. Furthermore, 66.4% had oral dysfunction, 32.5% had laryngeal penetration, 46.4% had aspiration, 45.3% had abnormal esophageal body function, and 35.8% had reflux symptoms. There was no correlation between oral dysfunction and recurrent pneumonia (P = .902), but there was a positive correlation between recurrent pneumonia and laryngeal penetration (P < .001, r = .26), aspiration (P < .001, r =.49), abnormal esophageal body function (P = .002, r = .18), and reflux (P < .001, r = .22). CONCLUSION Both pharyngeal swallowing disorders, such as penetration and aspiration, and esophageal disorders and reflux may result in recurrent pneumonia in pediatric patients. Thus, all phases of deglutition should be considered and followed up during swallowing evaluation.
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Affiliation(s)
- Selen Serel Arslan
- Faculty of Health Sciences, Department of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Numan Demir
- Faculty of Health Sciences, Department of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Aynur Ayşe Karaduman
- Faculty of Health Sciences, Department of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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Bernardini R, Ricci G, Cipriani F, Civitelli F, Indinnimeo L, Minasi D, Terracciano L, Duse M. Beyond the “Choosing wisely”: a possible attempt. Ital J Pediatr 2016; 42:55. [PMID: 27236414 PMCID: PMC4884351 DOI: 10.1186/s13052-016-0265-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 05/18/2016] [Indexed: 11/17/2022] Open
Abstract
Since the fundamental principles of the medical profession were clearly defined in a physician charter in 2002, special considerations have been expressed about the adequate distribution of health care resources taking in account the individual patient needs to optimize the health care service. The correct application of procedures represents a key point in order to reach the appropriateness of care, that means to avoid unnecessary or inappropriate procedures as well as the underutilization of the necessary procedures. In this context, the Choosing wisely campaign have been widely used and disclosed and even the Italian Society of Pediatric Allergology and Immunology - SIAIP has been working to make recommendations in order to ensure the appropriateness of care in the field of allergy and optimize the use of health care resources.
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Hughes D. Recurrent pneumonia . . . Not! Paediatr Child Health 2014; 18:459-60. [PMID: 24426804 DOI: 10.1093/pch/18.9.459] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2013] [Indexed: 11/13/2022] Open
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Saad K, Mohamed SA, Metwalley KA. Recurrent/Persistent Pneumonia among Children in Upper Egypt. Mediterr J Hematol Infect Dis 2013; 5:e2013028. [PMID: 23667726 PMCID: PMC3647710 DOI: 10.4084/mjhid.2013.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Accepted: 04/10/2013] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVES Recurrent/persistent pneumonia in children continues to be a major challenge for the pediatricians. The aim of our study was to establish the prevalence and underlying causes of recurrent/persistent pneumonia in children in Upper Egypt. SETTINGS Assiut University Children Hospital, Assiut, Egypt. PATIENTS AND METHODS Patients, admitted for pneumonia to the hospital during 2 years, were investigated with microbiological, biochemical, immunological and radiological tests in order to establish the prevalence of recurrent/persistent pneumonia and to find out its underlying causes. RESULTS 113 out of 1228 patients (9.2%) met the diagnosis of recurrent/persistent pneumonia. Identified causes were; aspiration syndrome (17.7%), pulmonary TB (14.0%), congenital heart disease (11.5%), bronchial asthma (9.7%), immune deficiency disorders (8.8%) and vitamin D deficiency rickets (7.0%). Other causes included; congenital anomalies of the respiratory tract, interstitial lung diseases, bronchiectasis, and sickle cell anemia. No predisposing factors could be identified in 15% of cases. CONCLUSION Approximately 1 out of 10 children with diagnosis of pneumonia in Assiut University Children Hospital had recurrent/persistent pneumonia. The most frequent underlying cause for recurrent/persistent pneumonia was aspiration syndrome, followed by pulmonary TB.
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Affiliation(s)
- Khaled Saad
- Department of Pediatrics, Assiut University, Assiut 71516, Egypt
- Correspondence to: Khaled Saad, Department of Pediatrics, Faculty of medicine, University of Assiut, Assiut 71516, Egypt, Tel +20-106-080-182*, Fax +20-88-236-8371. E-mail:
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Everard ML. The unified airway - a bug's eye view. Paediatr Respir Rev 2012; 13:133-4. [PMID: 22726866 DOI: 10.1016/j.prrv.2012.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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