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Radiologic and clinical outcome of isolated fourth ventricle following post-hemorrhagic hydrocephalus in children. Childs Nerv Syst 2022; 38:977-984. [PMID: 35305115 DOI: 10.1007/s00381-022-05494-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/03/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Few studies report radiologic and clinical outcome of post-hemorrhagic isolated fourth ventricle (IFV) with focus on surgical versus conservative management in neonates and children. Our aim is to investigate differences in radiological and clinical findings of IFV between patients who had surgical intervention versus patients who were treated conservatively. METHODS A retrospective analysis of patients diagnosed with IFV was performed. Data included demographics, clinical exam findings, surgical history, and imaging findings (dilated FV extent, supratentorial ventricle dilation, brainstem and cerebellar deformity, tectal plate elevation, basal cistern and cerebellar hemisphere effacement, posterior fossa upward/downward herniation). RESULTS Sixty-four (30 females) patients were included. Prematurity was 94% with 90% being < 28 weeks of gestation. Mean age at first ventricular shunt was 3.6 (range 1-19); at diagnosis of IFV, post-lateral ventricular shunting was 26.2 (1-173) months. Conservatively treated patients were 87.5% versus 12.5% treated with FV shunt/endoscopic fenestration. Severe FV dilation (41%), severe deformity of brainstem (39%) and cerebellum (47%) were noted at initial diagnosis and stable findings (34%, 47%, and 52%, respectively) were seen at last follow-up imaging. FV dilation (p = 0.0001) and upward herniation (p = 0.01) showed significant differences between surgery versus conservative management. No other radiologic or clinical outcome parameters were different between two groups. CONCLUSION Only radiologic outcome results showed stable or normal FV dilation and stable or decreased upward herniation in the surgically treated group.
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Zimmermann GDS, Siqueira LD, Bohomol E. Lean Six Sigma methodology application in health care settings: an integrative review. Rev Bras Enferm 2021; 73:e20190861. [PMID: 33338158 DOI: 10.1590/0034-7167-2019-0861] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 07/01/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to analyze the scientific production on the results of Lean Six Sigma methodology in health care institutions. METHODS an integrative literature review, with the following question: what are the results in health institutions using Lean Six Sigma and Six Sigma methodology? The search was carried out at MEDLINE, LILACS, BDENF, CINAHL, Web of Science, and Scopus, with no time frame. RESULTS thirty-four articles were included, published between 2005 and 2019, of which 52.9% came from the United States of America. The most commonly found improvements were in hospital institutions and from the perspective of customers and internal processes. CONCLUSION using Lean Six Sigma methodology proved to be effective in the different health care settings, evidencing a gap in its application regarding people engagement and training.
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Affiliation(s)
| | - Luciola Demery Siqueira
- Universidade Federal de São Paulo, Escola Paulista de Enfermagem. São Paulo, São Paulo, Brazil
| | - Elena Bohomol
- Universidade Federal de São Paulo, Escola Paulista de Enfermagem. São Paulo, São Paulo, Brazil
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Hari-Raj A, Malthaner LQ, Shi J, Leonard JR, Leonard JC. United States emergency department visits for children with cerebrospinal fluid shunts. J Neurosurg Pediatr 2021; 27:23-29. [PMID: 33720677 DOI: 10.3171/2020.6.peds19729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE CSF shunt placement is the primary therapy for hydrocephalus; however, shunt malfunctions remain common and lead to neurological deficits if missed. There is a lack of literature characterizing the epidemiology of children with possible shunt malfunctions presenting to United States emergency departments (EDs). METHODS A retrospective study was conducted of the 2006-2017 National Emergency Department Sample. The data were queried using an exhaustive list of Current Procedural Terminology and International Classification of Diseases, Ninth Revision and International Classification of Diseases, Tenth Revision codes representing children with hydrocephalus diagnoses, diagnostic imaging for shunt malfunctions, and shunt-related surgical revision procedures. RESULTS In 2017, there were an estimated 16,376 ED visits for suspected shunt malfunction. Children were more commonly male (57.9%), ages 0-4 years (42.2%), and publicly insured (55.8%). Many did not undergo diagnostic imaging (37.2%), and of those who did, most underwent head CT scans (43.7%). Between 2006 and 2017, pediatric ED visits for suspected shunt malfunction increased 18% (95% CI 12.1-23.8). The use of MRI increased substantially (178.0%, 95% CI 176.9-179.2). Visits resulting in discharge home from the ED increased by 76.3% (95% CI 73.1-79.4), and those involving no surgical intervention increased by 32.9% (95% CI 29.2-36.6). CONCLUSIONS Between 2006 and 2017, ED visits for children to rule out shunt malfunction increased, yet there was a decline in surgical intervention and an increase in discharges home from the ED. Possible contributing factors include improved clinical criteria for shunt evaluation, alternative CSF diversion techniques, changing indications for shunt placement, and increased use of advanced imaging in the ED. ABBREVIATIONS CPT = Current Procedural Terminology; ED = emergency department; ETV = endoscopic third ventriculostomy; ICD-9 = International Classification of Diseases, Ninth Revision; ICD-10 = International Classification of Diseases, Tenth Revision; NEDS = National Emergency Department Sample.
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Affiliation(s)
| | - Lauren Q Malthaner
- 2The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus
| | - Junxin Shi
- 2The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus
| | - Jeffrey R Leonard
- 1The Ohio State University College of Medicine, Columbus
- 3Division of Pediatric Neurosurgery, Nationwide Children's Hospital, Columbus; and
| | - Julie C Leonard
- 1The Ohio State University College of Medicine, Columbus
- 2The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus
- 4Division of Pediatric Emergency Medicine, Nationwide Children's Hospital, Columbus, Ohio
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Niñerola A, Sánchez-Rebull MV, Hernández-Lara AB. Quality improvement in healthcare: Six Sigma systematic review. Health Policy 2020; 124:438-445. [DOI: 10.1016/j.healthpol.2020.01.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 12/19/2019] [Accepted: 01/02/2020] [Indexed: 12/26/2022]
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Akram R, Khalid A, Farman W, Shah FH, Baig H, Ajaib S. Accuracy of cranial ultrasound in the diagnosis of hydrocephalus in children under 6 months of age keeping CT scan as a gold standard. JOURNAL OF RAWALPINDI MEDICAL COLLEGE 2020. [DOI: 10.37939/jrmc/vol24.iss1.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background: CT and MRI modalities are considered a gold standard for the diagnosis of hydrocephalus. The more readily available and cheap options like sonography are being sought out for the diagnosis of this entity.
Objectives: To determine the accuracy of cranial ultrasonography in the diagnosis of hydrocephalus keeping CT scan as a gold standard.
Study design: Cross-sectional study
Place and duration of study: Department of Pediatrics, Combined Military Hospital, Rawalpindi, from 01-01-2017 to 30-06-2017
Materials and Methods: A total of 121 children with a clinical diagnosis of hydrocephalus were selected and subjected to ultrasound of the head. Subsequently, a CT scan of the head was done and both modalities were compared. The diagnostic accuracy of the ultrasound was determined to keep CT findings as to the gold standard.
Results: The mean age was 51.36 ± 34.01 days. The male gender was dominant as 81 (66.9%) patients were males. Ultrasonography of the head detected 93 (76.9%) patients with hydrocephalus while CT scan detected 90 (74.4%). Sensitivity, specificity, PPV, NPV and accuracy of USG to diagnosed hydrocephalus were 88.9%, 58.1%, 86.0%, 64.3% and 80.99% respectively
Conclusion: Ultrasonography of head is a valuable screening tool for the diagnosis of hydrocephalus.
Keywords: Hydrocephalus, Tomography, X-Ray Computed, Ultrasonography
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Ertl-Wagner B, Wagner MW. [Magnetic resonance imaging of the brain in neonates and infants]. Radiologe 2019; 59:1097-1106. [PMID: 31748980 DOI: 10.1007/s00117-019-00610-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Magnetic resonance imaging (MRI) is increasingly being used for infants and small children due to rapid sequence protocols, broader scanner availability and good monitoring possibilities. The sequence protocol should always be adapted to the individual clinical needs of the infant or toddler. For some clinical indications, such as control of ventricular width in children with shunted hydrocephalus, ultrafast protocols can be used with a scanning time of just a few minutes. For more complex clinical questions, more extensive sequence protocols are warranted. Particularly for neonates and using a rapid investigation protocol, MRI examinations can very often be performed without sedation. The necessity of using gadolinium-based contrast agents has to be critically deliberated in infants and neonates and has to be exactly tailored to the clinical needs. In many cases MRI examinations of the brain in infants and neonates do not require gadolinium-based contrast agents.
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Affiliation(s)
- B Ertl-Wagner
- Derek Harwood Nash Chair of Pediatric Neuroradiology, Division Head Neuroradiology, SickKids-The Hospital for Sick Children, University of Toronto, 555 University Ave, M5G 1X8, Toronto, Ontario, Canada.
| | - M W Wagner
- Chief Fellow Pediatric Neuroradiology, SickKids-The Hospital for Sick Children, University of Toronto, 555 University Ave, M5G 1X8, Toronto, Ontario, Canada
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Trauma Bay Disposition of Infants and Young Children With Mild Traumatic Brain Injury and Positive Head Imaging. Pediatr Crit Care Med 2019; 20:1061-1068. [PMID: 31232854 PMCID: PMC7050196 DOI: 10.1097/pcc.0000000000002033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To describe the disposition of infants and young children with isolated mild traumatic brain injury and neuroimaging findings evaluated at a level 1 pediatric trauma center, and identify factors associated with their need for ICU admission. DESIGN Retrospective cohort. SETTING Single center. PATIENTS Children less than or equal to 4 years old with mild traumatic brain injury (Glasgow Coma Scale 13-15) and neuroimaging findings evaluated between January 1, 2013, and December 31, 2015. Polytrauma victims and patients requiring intubation or vasoactive infusions preadmission were excluded. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Two-hundred ten children (median age/weight/Glasgow Coma Scale: 6 mo/7.5 kg/15) met inclusion criteria. Most neuroimaging showed skull fractures with extra-axial hemorrhage/no midline shift (30%), nondisplaced skull fractures (28%), and intracranial hemorrhage without fractures/midline shift (19%). Trauma bay disposition included ICU (48%), ward (38%), intermediate care unit and home (7% each). Overall, 1% required intubation, 4.3% seizure management, and 4.3% neurosurgical procedures; 15% were diagnosed with nonaccidental trauma. None of the ward/intermediate care unit patients were transferred to ICU. Median ICU/hospital length of stay was 2 days. Most patients (99%) were discharged home without neurologic deficits. The ICU subgroup included all patients with midline shift, 62% patients with intracranial hemorrhage, and 20% patients with skull fractures. Across these imaging subtypes, the only clinical predictor of ICU admission was trauma bay Glasgow Coma Scale less than 15 (p = 0.018 for intracranial hemorrhage; p < 0.001 for skull fractures). A minority of ICU patients (18/100) required neurocritical care and/or neurosurgical interventions; risk factors included neurologic deficit, loss of consciousness/seizures, and extra-axial hemorrhage (especially epidural hematoma). CONCLUSIONS Nearly half of our cohort was briefly monitored in the ICU (with disposition mostly explained by trauma bay imaging, rather than clinical findings); however, less than 10% required ICU-specific interventions. Although ICU could be used for close neuromonitoring to prevent further neurologic injury, additional research should explore if less conservative approaches may preserve patient safety while optimizing healthcare resource utilization.
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Radiation Dose Reduction in Children With Hydrocephalus Using Ultrafast Brain MRI. J Am Coll Radiol 2019; 16:1173-1176. [DOI: 10.1016/j.jacr.2019.02.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 02/14/2019] [Accepted: 02/16/2019] [Indexed: 11/20/2022]
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Magnetresonanztomographie des Gehirns bei Säuglingen und Kleinkindern. Monatsschr Kinderheilkd 2019. [DOI: 10.1007/s00112-019-0742-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Subramony A, Kocolas I, Srivastava R. Pediatric Hospitalists Improving Patient Care Through Quality Improvement. Pediatr Clin North Am 2019; 66:697-712. [PMID: 31230617 DOI: 10.1016/j.pcl.2019.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This article reviews the industrial underpinnings of the quality improvement (QI) movement and describes how QI became integrated within the larger health care landscape, including hospital medicine. QI methodologies and a framework for using them are described. Key components that make up a successful QI clinical project are outlined, with a focus on the essential role of pediatric hospitalists and practical professional tips to be successful. QI training opportunities are reviewed with opportunities for hospitalists to get involved in QI on a national level. National QI networks are showcased, with multiple examples of advanced improvement projects that have significantly improved patient outcomes highlighted.
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Affiliation(s)
- Anupama Subramony
- Department of Pediatrics, Cohen Children's Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 269-01 76th Avenue, New Hyde Park, NY 11040, USA.
| | - Irene Kocolas
- Division of Inpatient Medicine, Department of Pediatrics, University of Utah School of Medicine/Primary Children's Hospital, Intermountain Healthcare, 100 Mario Capecchi Drive, Salt Lake City, UT 84113, USA
| | - Raj Srivastava
- Division of Inpatient Medicine, Department of Pediatrics, University of Utah School of Medicine/Primary Children's Hospital, Healthcare Delivery Institute, Intermountain Healthcare, 5026 State Street, Murray, UT 84107, USA
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Flynn R, Newton AS, Rotter T, Hartfield D, Walton S, Fiander M, Scott SD. The sustainability of Lean in pediatric healthcare: a realist review. Syst Rev 2018; 7:137. [PMID: 30205842 PMCID: PMC6134523 DOI: 10.1186/s13643-018-0800-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 08/21/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lean is a quality improvement management system from the Toyota manufacturing industry. Since the early 2000's, Lean has been used as an intervention for healthcare improvement. Lean is intended to reduce costs and improve customer value through continuous improvement. Despite its extensive use, the contextual factors and mechanisms that influence the sustainability of Lean in healthcare have not been well studied. Realist synthesis is one approach to "unpack" the causal explanations of how and why Lean is sustained or not in healthcare. We conducted a realist synthesis using the context (C) + mechanim (M) = outcome (O) heuristic, to further develop and refine an initial program theory with seven CMO hypotheses, on the sustainability of Lean efforts across pediatric healthcare. METHODS Our search strategy was multi-pronged, iterative, and purposeful in nature, consisting of database, gray literature, and contact with three healthcare organizations known for Lean implementation. We included primary research studies, published and unpublished case studies or reports, if they included Lean implementation with a pediatric focus and sustainability outcome. We used the Normalization Process Theory and the National Health Services Sustainability Model, an operational definition for Lean and a comprehensive definition for sustainability as guidance for data extraction and analysis. Our initial program theory with was refined using a blend of abductive and retroductive analytical processes. RESULTS We identified six published primary research studies, two published quality improvement case studies, and three unpublished quality improvement case reports. Five CMO hypotheses from our initial program theory were substantially supported after synthesis, "sense-making and value congruency," "staff engagement and empowerment," and the "ripple effect" or causal pathway between Lean implementation outcomes that served as facilitating or hindering contexts for sustainability. Overall, there was variation with the conceptualization and measurement of sustainability. CONCLUSIONS This study is the first to examine Lean sustainability in pediatric healthcare using realist methods. Future research should examine whether the predictors of implementation are the same or different to sustainability and evaluate the underlying mechanisms that influence the sustainability of Lean. There is also a need for research to develop and test conceptual models and frameworks on sustainability. SYSTEMATIC REVIEW REGISTRATION PROSPERO-CRD42015032252 .
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Affiliation(s)
- Rachel Flynn
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Amanda S. Newton
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Thomas Rotter
- Healthcare Quality Programs, Queen’s University School of Nursing, Kingston, ON K7L 3N6 Canada
| | - Dawn Hartfield
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Sarah Walton
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Michelle Fiander
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, L.S. Skaggs Building 4838, Salt Lake City, UT 84112 USA
| | - Shannon D. Scott
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada
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Radic JAE, Cochrane DD. Choosing Wisely Canada: Pediatric Neurosurgery Recommendations. Paediatr Child Health 2018; 23:383-387. [PMID: 30455575 PMCID: PMC6234424 DOI: 10.1093/pch/pxy012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVES Choosing Wisely Canada is an evidence-based, patient-focused, physician-led campaign to improve the delivery of medical care in Canada. The goal of this study was to produce Canadian recommendations for physicians treating patients with selected paediatric neurosurgery issues. METHODS Paediatric neurosurgeons practicing in Canada were invited to participate. Suggestions were obtained using an anonymous questionnaire, and then ranked anonymously by the participating surgeons. Suggestions that received consensus from participants were discussed at the 2016 annual Canadian Pediatric Neurosurgery Study Group meeting. Suggestions that were not evidence based, or that would not have a substantive population impact were eliminated. All remaining suggestions were anonymously ranked by the group and the top five recommendations were submitted to Choosing Wisely Canada. RESULTS The final five recommendations include: 1) don't order a computed tomography scan to investigate macrocephaly (order an ultrasound or magnetic resonance imaging scan); 2) don't image a midline dimple related to the coccyx in an asymptomatic infant or child; 3) don't use computed tomography scans for routine imaging of children with hydrocephalus. Fast sequence nonsedated magnetic resonance imaging scans or ultrasounds provide adequate information to assess patients without exposing them to radiation or an anesthetic; 4) don't recommend helmets for mild to severe positional flattening; 5) don't do routine surveillance imaging for incidentally discovered Chiari I malformation. CONCLUSIONS Five Choosing Wisely Canada recommendations were produced to support care of patients with paediatric neurosurgical issues. While these recommendations will apply to the majority of children with the involved conditions, occasionally, deviation from these recommendations may be clinically indicated.
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Affiliation(s)
- Julia A E Radic
- Division of Neurosurgery, British Columbia Children’s Hospital, Vancouver, British Columbia
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Tekes A, Senglaub SS, Ahn ES, Huisman TAGM, Jackson EM. Ultrafast Brain MRI Can Be Used for Indications beyond Shunted Hydrocephalus in Pediatric Patients. AJNR Am J Neuroradiol 2018; 39:1515-1518. [PMID: 30002051 DOI: 10.3174/ajnr.a5724] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 05/18/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Evaluation of shunted hydrocephalus is the most common indication for ultrafast brain MRI. Radiation-/sedation-free imaging capabilities make this protocol more desirable over CT and standard brain MRI. We hypothesized that ultrafast brain MRI can be used for selected indications beyond shunted hydrocephalus without adverse outcomes. MATERIALS AND METHODS Ultrafast brain MRI was performed with axial, sagittal, and coronal HASTE. The radiology information system was used to identify pediatric patients (0-18 years of age) who underwent ultrafast brain MRI between March 2014 and May 2016. A retrospective chart review was completed to identify indications other than shunted hydrocephalus, such as ventriculomegaly, macrocephaly, or intracranial cyst. All ultrafast brain MRIs were evaluated by a certified neuroradiologist and a neurosurgeon. Ultrafast brain MRI was deemed of sufficient diagnostic value for these indications if no further standard brain MRI was required for the study indication or if additional imaging was performed for an alternate indication. RESULTS The radiology information system identified 800 patients who had undergone an ultrafast brain MRI during the study period. One hundred twenty-two of these patients had ventriculomegaly, macrocephaly, or intracranial cyst as the study indication. Twenty-one of the 122 patients were excluded due to insufficient follow-up. Of the remaining 101 patients, only 5 had a standard brain MRI for the same indication, with no additional clinically significant information identified on those studies. CONCLUSIONS These results suggest that ultrafast brain MRI is sufficient to evaluate ventriculomegaly, macrocephaly, or intracranial cyst. Ultrafast brain MRI is radiation- and sedation-free; therefore, we recommend its use as the primary screening neuroimaging study for these indications.
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Affiliation(s)
- A Tekes
- From the Department of Radiology (A.T., T.A.G.M.H.), Division of Pediatric Radiology and Pediatric Neuroradiology
| | - S S Senglaub
- Department of Neurosurgery (S.S.S., E.S.A., E.M.J.), Division of Pediatric Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - E S Ahn
- Department of Neurosurgery (S.S.S., E.S.A., E.M.J.), Division of Pediatric Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - T A G M Huisman
- From the Department of Radiology (A.T., T.A.G.M.H.), Division of Pediatric Radiology and Pediatric Neuroradiology
| | - E M Jackson
- Department of Neurosurgery (S.S.S., E.S.A., E.M.J.), Division of Pediatric Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Greene AM, Bailey CR, Young M, Wolfgang E, Tekes A, Huisman TA, Durand DJ. Applying the National Committee for Quality Assurance Patient-Centered Specialty Practice Framework to Radiology. J Am Coll Radiol 2017. [DOI: 10.1016/j.jacr.2017.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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