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Lanzieri TM, Chung W, Leung J, Caviness AC, Baumgardner JL, Blum P, Bialek SR, Demmler-Harrison G. Hearing Trajectory in Children with Congenital Cytomegalovirus Infection. Otolaryngol Head Neck Surg 2018; 158:736-744. [PMID: 29557247 DOI: 10.1177/0194599818758247] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives To compare hearing trajectories among children with symptomatic and asymptomatic congenital cytomegalovirus infection through age 18 years and to identify brain abnormalities associated with sensorineural hearing loss (SNHL) in asymptomatic case patients. Study Design Longitudinal prospective cohort study. Setting Tertiary medical center. Subjects and Methods The study included 96 case patients (4 symptomatic and 92 asymptomatic) identified through hospital-based newborn cytomegalovirus screening from 1982 to 1992 and 72 symptomatic case patients identified through referrals from 1993 to 2005. We used growth curve modeling to analyze hearing thresholds (0.5-8 kHz) by ear with increasing age and Cox regression to determine abnormal findings on head computed tomography scan associated with SNHL (hearing threshold ≥25 dB in any audiometric frequency) among asymptomatic case patients. Results Fifty-six (74%) symptomatic and 20 (22%) asymptomatic case patients had SNHL: congenital/early-onset SNHL was diagnosed in 78 (51%) and 10 (5%) ears, respectively, and delayed-onset SNHL in 25 (17%) and 20 (11%) ears; 49 (32%) and 154 (84%) ears had normal hearing. In affected ears, all frequency-specific hearing thresholds worsened with age. Congenital/early-onset SNHL was significantly worse (severe-profound range, >70 dB) than delayed-onset SNHL (mild-moderate range, 26-55 db). Frequency-specific hearing thresholds were significantly different between symptomatic and asymptomatic case patients at 0.5 to 1 kHz but not at higher frequencies (2-8 kHz). Among asymptomatic case patients, white matter lucency was significantly associated with SNHL by age 5 years (hazard ratio, 4.4; 95% CI, 1.3-15.6). Conclusion Congenital/early-onset SNHL frequently resulted in severe to profound loss in symptomatic and asymptomatic case patients. White matter lucency in asymptomatic case patients was significantly associated with SNHL by age 5 years.
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Affiliation(s)
- Tatiana M Lanzieri
- 1 National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Winnie Chung
- 2 National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jessica Leung
- 1 National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Jason L Baumgardner
- 1 National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Peggy Blum
- 4 Texas Children's Hospital, Houston, Texas, USA
| | - Stephanie R Bialek
- 1 National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Gail Demmler-Harrison
- 3 Baylor College of Medicine, Houston, Texas, USA.,4 Texas Children's Hospital, Houston, Texas, USA
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2
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Chumpitazi CE, Camp EA, Bhamidipati DR, Montillo AM, Chantal Caviness A, Mayorquin L, Pereira FA. Shortened preprocedural fasting in the pediatric emergency department. Am J Emerg Med 2018; 36:1577-1580. [PMID: 29395760 DOI: 10.1016/j.ajem.2018.01.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 01/07/2018] [Accepted: 01/08/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND There is no evidence of an association between fasting time and the incidence of adverse events during procedural sedation and analgesia. Pediatric and adult emergency medicine guidelines support avoiding delaying procedures based on fasting time. General pediatric guidelines outside emergent care settings continue to be vague and do not support a set fasting period for urgent and emergent procedures. OBJECTIVE To describe shortened preprocedural fasting and vomiting event rates during the implementation of a shortened fasting protocol. METHODS This was a prospective study of patients undergoing procedural sedation and analgesia (PSA) in an urban, tertiary care children's hospital emergency center from March 2010-February 2012. All consecutive patients had documentation of preprocedural fasting time and adverse events recorded on a standardized data collection form. RESULTS PSA occurred in 2426 patients with fasting data available for 2188 (90.2%); 1472 were fasted ≥6 h for solids and 716 patients were in the shortened fasting group (<6 h). There is no evidence of an association between emesis at any time and shortened fasting time unadjusted (OR = 1.18 (95% CI 0.75-1.84) or adjusted for known risk factors including age >12 years, initial ketamine dose >2.5 mg/kg or total dose >5.0 mg/kg (OR = 1.14 (95% CI 0.74-1.75). CONCLUSION Analysis of a large prospective cohort study failed to find evidence of an association between emesis and shortened fasting time upon implementation of a shortened fasting protocol for procedural sedation and analgesia.
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Affiliation(s)
- Corrie E Chumpitazi
- Department of Pediatric Emergency Medicine, Baylor College of Medicine, Houston, TX, United States.
| | - Elizabeth A Camp
- Department of Pediatric Emergency Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Divya R Bhamidipati
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | | | | | - Lesby Mayorquin
- Department of Pediatric Emergency Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Faria A Pereira
- Department of Pediatric Emergency Medicine, Baylor College of Medicine, Houston, TX, United States
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3
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Lopez AS, Lanzieri TM, Claussen AH, Vinson SS, Turcich MR, Iovino IR, Voigt RG, Caviness AC, Miller JA, Williamson WD, Hales CM, Bialek SR, Demmler-Harrison G. Intelligence and Academic Achievement With Asymptomatic Congenital Cytomegalovirus Infection. Pediatrics 2017; 140:peds.2017-1517. [PMID: 29066580 PMCID: PMC5654402 DOI: 10.1542/peds.2017-1517] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/23/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To examine intelligence, language, and academic achievement through 18 years of age among children with congenital cytomegalovirus infection identified through hospital-based newborn screening who were asymptomatic at birth compared with uninfected infants. METHODS We used growth curve modeling to analyze trends in IQ (full-scale, verbal, and nonverbal intelligence), receptive and expressive vocabulary, and academic achievement in math and reading. Separate models were fit for each outcome, modeling the change in overall scores with increasing age for patients with normal hearing (n = 78) or with sensorineural hearing loss (SNHL) diagnosed by 2 years of age (n = 11) and controls (n = 40). RESULTS Patients with SNHL had full-scale intelligence and receptive vocabulary scores that were 7.0 and 13.1 points lower, respectively, compared with controls, but no significant differences were noted in these scores among patients with normal hearing and controls. No significant differences were noted in scores for verbal and nonverbal intelligence, expressive vocabulary, and academic achievement in math and reading among patients with normal hearing or with SNHL and controls. CONCLUSIONS Infants with asymptomatic congenital cytomegalovirus infection identified through newborn screening with normal hearing by age 2 years do not appear to have differences in IQ, vocabulary or academic achievement scores during childhood, or adolescence compared with uninfected children.
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Affiliation(s)
| | | | - Angelika H. Claussen
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sherry S. Vinson
- Texas Children’s Hospital, Houston, Texas;,Baylor College of Medicine, Houston, Texas; and
| | - Marie R. Turcich
- Texas Children’s Hospital, Houston, Texas;,Baylor College of Medicine, Houston, Texas; and
| | - Isabella R. Iovino
- Texas Children’s Hospital, Houston, Texas;,Baylor College of Medicine, Houston, Texas; and
| | - Robert G. Voigt
- Texas Children’s Hospital, Houston, Texas;,Baylor College of Medicine, Houston, Texas; and
| | | | - Jerry A. Miller
- Texas Children’s Hospital, Houston, Texas;,P3S Corporation, San Antonio, Texas
| | | | - Craig M. Hales
- National Center for Immunization and Respiratory Diseases, and
| | | | - Gail Demmler-Harrison
- Texas Children’s Hospital, Houston, Texas;,Baylor College of Medicine, Houston, Texas; and
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4
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Lanzieri TM, Chung W, Flores M, Blum P, Caviness AC, Bialek SR, Grosse SD, Miller JA, Demmler-Harrison G. Hearing Loss in Children With Asymptomatic Congenital Cytomegalovirus Infection. Pediatrics 2017; 139:peds.2016-2610. [PMID: 28209771 PMCID: PMC5330400 DOI: 10.1542/peds.2016-2610] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/20/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To assess the prevalence, characteristics, and risk of sensorineural hearing loss (SNHL) in children with congenital cytomegalovirus infection identified through hospital-based newborn screening who were asymptomatic at birth compared with uninfected children. METHODS We included 92 case-patients and 51 controls assessed by using auditory brainstem response and behavioral audiometry. We used Kaplan-Meier survival analysis to estimate the prevalence of SNHL, defined as ≥25 dB hearing level at any frequency and Cox proportional hazards regression analyses to compare SNHL risk between groups. RESULTS At age 18 years, SNHL prevalence was 25% (95% confidence interval [CI]: 17%-36%) among case-patients and 8% (95% CI: 3%-22%) in controls (hazard ratio [HR]: 4.0; 95% CI: 1.2-14.5; P = .02). Among children without SNHL by age 5 years, the risk of delayed-onset SNHL was not significantly greater for case-patients than for controls (HR: 1.6; 95% CI: 0.4-6.1; P = .5). Among case-patients, the risk of delayed-onset SNHL was significantly greater among those with unilateral congenital/early-onset hearing loss than those without (HR: 6.9; 95% CI: 2.5-19.1; P < .01). The prevalence of severe to profound bilateral SNHL among case-patients was 2% (95% CI: 1%-9%). CONCLUSIONS Delayed-onset and progression of SNHL among children with asymptomatic congenital cytomegalovirus infection continued to occur throughout adolescence. However, the risk of developing SNHL after age 5 years among case-patients was not different than in uninfected children. Overall, 2% of case-patients developed SNHL that was severe enough for them to be candidates for cochlear implantation.
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Affiliation(s)
| | - Winnie Chung
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Marily Flores
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Peggy Blum
- Texas Children’s Hospital, Houston, Texas; and
| | | | | | - Scott D. Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jerry A. Miller
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas;,P3S Corporation, San Antonio, Texas
| | - Gail Demmler-Harrison
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas;,Texas Children’s Hospital, Houston, Texas; and
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5
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Abstract
CONTEXT Enterovirus infection commonly causes fever in infants aged 0 to 90 days and, without testing, is difficult to differentiate from serious bacterial infection. OBJECTIVE To determine the cost savings of routine enterovirus testing and identify subgroups of infants with greater potential impact from testing among infants 0 to 90 days old with fever. DATA SOURCES Studies were identified systematically from published and unpublished literature by using Embase, Medline, the Cochrane database, and conference proceedings. STUDY SELECTION Inclusion criteria were original studies, in any language, of enterovirus infection including the outcomes of interest in infants aged 0 to 90 days. DATA EXTRACTION Standardized instruments were used to appraise each study. The evidence quality was evaluated using Grading of Recommendations Assessment, Development, and Evaluation criteria. Two investigators independently searched the literature, screened and critically appraised the studies, extracted the data, and applied the Grading of Recommendations Assessment, Development, and Evaluation criteria. RESULTS Of the 257 unique studies identified and screened, 32 were completely reviewed and 8 were included. Routine enterovirus testing was associated with reduced hospital length of stay and cost savings during peak enterovirus season. Cerebrospinal fluid pleocytosis was a poor predictor of enterovirus meningitis. The studies were all observational and the evidence was of low quality. CONCLUSIONS Enterovirus polymerase chain reaction testing, independent of cerebrospinal fluid pleocytosis, can reduce length of stay and achieve cost savings, especially during times of high enterovirus prevalence. Additional study is needed to identify subgroups that may achieve greater cost savings from testing to additionally enhance the efficiency of testing.
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Affiliation(s)
- Sowdhamini S Wallace
- Section of Pediatric Hospital Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas; and
| | - Michelle A Lopez
- Section of Pediatric Hospital Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas; and
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7
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Shah MI, Chantal Caviness A, Mendez DR. Prospective pilot derivation of a decision tool for children at low risk for testicular torsion. Acad Emerg Med 2013; 20:271-8. [PMID: 23517259 DOI: 10.1111/acem.12086] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 09/11/2012] [Accepted: 09/12/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The purpose of this study was to derive a pilot clinical decision tool with 100% negative predictive value for testicular torsion based on prospectively collected data in children with acute scrotal pain. METHODS This was a prospective cohort study of a convenience sample of newborn to 21-year-old males evaluated for acute (72 hours or less) scrotal pain at an urban children's hospital emergency department (ED). A pediatric emergency medicine fellow or attending physician documented history and examination findings on a standardized data collection form. The study investigators used ultrasound (US), operative reports, or clinical follow-up to identify patients who had testicular torsion. Pearson's chi-square test and odds ratios (OR) were used to identify factors associated with the diagnosis of testicular torsion. The authors also used a recursive partitioning model to create a low-risk decision tool for testicular torsion. RESULTS Of the 450 eligible patients, 228 (51%) were enrolled, with a mean (± SD) age of 9.9 (± 4.1) years, including 21 (9.2%, 95% confidence interval [CI] = 5.8% to 13.7%) with testicular torsion. The derived clinical decision tool consisted of three variables: horizontal or inguinal testicular lie (OR = 18.17, 95% CI = 6.2 to 53.2), nausea or vomiting (OR = 5.63, 95% CI = 2.08 to 15.22), and age 11 to 21 years (OR = 3.9, 95% CI = 1.27 to 11.97). These variables had a sensitivity of 100% (95% CI = 98% to 100%) and negative predictive value of 100% (95% CI = 98% to 100%) for the diagnosis of testicular torsion. CONCLUSIONS Based on a decision tool derived with recursive partitioning, study patients with all of the following characteristics had no risk of testicular torsion: normal testicular lie, lack of nausea or vomiting, and age 0 to 10 years. Future research should focus on externally validating this tool to optimize emergent evaluation when testicular torsion is likely, while minimizing routine sonographic evaluation when patients are unlikely to have a serious condition requiring immediate management.
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Affiliation(s)
- Manish I. Shah
- Department of Pediatrics; Section of Emergency Medicine; Baylor College of Medicine; Houston TX
| | - A. Chantal Caviness
- Department of Pediatrics; Section of Emergency Medicine; Baylor College of Medicine; Houston TX
| | - Donna R. Mendez
- Department of Pediatrics; Section of Emergency Medicine; Baylor College of Medicine; Houston TX
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8
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Mian AI, Laham FR, Cruz AT, Garg H, Macias CG, Caviness AC, Piedra PA. Nitric oxide metabolites as biomarkers for influenza-like acute respiratory infections presenting to the emergency room. Open Respir Med J 2012; 6:127-34. [PMID: 23166571 PMCID: PMC3499797 DOI: 10.2174/1874306401206010127] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Revised: 09/07/2012] [Accepted: 09/11/2012] [Indexed: 11/22/2022] Open
Abstract
AIMS Nitric oxide (NO) is increased in the respiratory tract in pulmonary infections. The aim was to determine whether nasal wash NO metabolites could serve as biomarkers of viral pathogen and disease severity in children with influenza-like illness (ILI) presenting to the emergency department (ED) during the 2009 influenza A H1N1 pandemic. METHODS Children ≤18 years old presenting to the ED with ILI were eligible. Nasal wash specimens were tested for NO metabolites, nitrate and nitrite, by HPLC and for respiratory viruses by real-time PCR. RESULTS Eighty-nine patients with ILI were prospectively enrolled during Oct-Dec, 2009. In the entire cohort, nasal wash nitrite was low to undetectable (interquartile range [IQR], 0 - 2 μM), while median nitrate was 3.4 μM (IQR 0-8.6). Rhinovirus (23%), respiratory syncytial virus (RSV) (20%), novel H1N1 (19%), and adenovirus (11%) were the most common viruses found. Children with RSV subtype B-associated ILI had higher nitrate compared to all other viruses combined (P=0.002). CONCLUSION Concentration of NO-derived nitrate in nasal secretions in children in the ED is suggestive of viral pathogen causative for ILI, and thus might be of clinical utility. Predictive potential of this putative biomarker for ILI needs further evaluation in sicker patients in a prospective manner.
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Affiliation(s)
- Asad I Mian
- Dept of Pediatrics, Section of Emergency Medicine, Texas Children’s Hospital, Baylor College of Medicine, Houston
TX 77030, USA
| | - Federico R Laham
- Dept. of Pediatrics, Section of Infectious Diseases, Texas Children’s Hospital, Baylor College of Medicine, Houston TX
77030, USA
| | - Andrea T Cruz
- Dept of Pediatrics, Section of Emergency Medicine, Texas Children’s Hospital, Baylor College of Medicine, Houston
TX 77030, USA
- Dept. of Pediatrics, Section of Infectious Diseases, Texas Children’s Hospital, Baylor College of Medicine, Houston TX
77030, USA
| | - Harsha Garg
- Brown Foundation Institute of Molecular Medicine, University of Texas - Houston Health Science Center, Houston TX
77030, USA
| | - Charles G Macias
- Dept of Pediatrics, Section of Emergency Medicine, Texas Children’s Hospital, Baylor College of Medicine, Houston
TX 77030, USA
| | - A. Chantal Caviness
- Dept of Pediatrics, Section of Emergency Medicine, Texas Children’s Hospital, Baylor College of Medicine, Houston
TX 77030, USA
| | - Pedro A Piedra
- Dept. of Pediatrics, Section of Infectious Diseases, Texas Children’s Hospital, Baylor College of Medicine, Houston TX
77030, USA
- Molecular Virology & Microbiology, Baylor College of Medicine, Houston TX 77030, USA
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9
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Kabue MM, Buck WC, Wanless SR, Cox CM, McCollum ED, Caviness AC, Ahmed S, Kim MH, Thahane L, Devlin A, Kochelani D, Kazembe PN, Calles NR, Mizwa MB, Schutze GE, Kline MW. Mortality and clinical outcomes in HIV-infected children on antiretroviral therapy in Malawi, Lesotho, and Swaziland. Pediatrics 2012; 130:e591-9. [PMID: 22891234 PMCID: PMC3962849 DOI: 10.1542/peds.2011-1187] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To determine mortality and immune status improvement in HIV-infected pediatric patients on antiretroviral treatment (ART) in Malawi, Lesotho, and Swaziland. METHODS We conducted a retrospective cohort study of patients aged <12 years at ART initiation at 3 sites in sub-Saharan Africa between 2004 and 2009. Twelve-month and overall mortality were estimated, and factors associated with mortality and immune status improvement were evaluated. RESULTS Included in the study were 2306 patients with an average follow-up time on ART of 2.3 years (interquartile range 1.5-3.1 years). One hundred four patients (4.5%) died, 9.0% were lost to follow-up, and 1.3% discontinued ART. Of the 104 deaths, 77.9% occurred in the first year of treatment with a 12-month mortality rate of 3.5%. The overall mortality rate was 2.25 deaths/100 person-years (95% confidence interval [CI] 1.84-2.71). Increased 12-month mortality was associated with younger age; <6 months (hazard ratio [HR] = 8.11, CI 4.51-14.58), 6 to <12 months (HR = 3.43, CI 1.96-6.02), and 12 to <36 months (HR = 1.92, CI 1.16-3.19), and World Health Organization stage IV (HR = 4.35, CI 2.19-8.67). Immune status improvement at 12 months was less likely in patients with advanced disease and age <12 months. CONCLUSIONS Despite challenges associated with pediatric ART in developing countries, low mortality and good treatment outcomes can be achieved. However, outcomes are worse in younger patients and those with advanced disease at the time of ART initiation, highlighting the importance of early diagnosis and treatment.
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Affiliation(s)
- Mark M. Kabue
- Baylor College of Medicine Abbott Fund Children’s Clinical Centre of Excellence, Lilongwe, Malawi
| | - W. Chris Buck
- Baylor College of Medicine Abbott Fund Children’s Clinical Centre of Excellence, Lilongwe, Malawi;,Baylor College of Medicine International Pediatric AIDS Initiative at Texas Children’s Hospital, and
| | - Sebastian R. Wanless
- Baylor College of Medicine International Pediatric AIDS Initiative at Texas Children’s Hospital, and
| | - Carrie M. Cox
- Baylor College of Medicine Abbott Fund Children’s Clinical Centre of Excellence, Lilongwe, Malawi;,Baylor College of Medicine International Pediatric AIDS Initiative at Texas Children’s Hospital, and
| | - Eric D. McCollum
- Baylor College of Medicine Abbott Fund Children’s Clinical Centre of Excellence, Lilongwe, Malawi;,Baylor College of Medicine International Pediatric AIDS Initiative at Texas Children’s Hospital, and
| | - A. Chantal Caviness
- Baylor College of Medicine, Department of Pediatrics and Texas Children’s Hospital, Houston, Texas
| | - Saeed Ahmed
- Baylor College of Medicine Abbott Fund Children’s Clinical Centre of Excellence, Lilongwe, Malawi;,Baylor College of Medicine International Pediatric AIDS Initiative at Texas Children’s Hospital, and
| | - Maria H. Kim
- Baylor College of Medicine Abbott Fund Children’s Clinical Centre of Excellence, Lilongwe, Malawi;,Baylor College of Medicine International Pediatric AIDS Initiative at Texas Children’s Hospital, and
| | - Lineo Thahane
- Baylor College of Medicine Bristol-Myers Squibb Children’s Clinical Centre of Excellence, Maseru, Lesotho; and
| | - Andrew Devlin
- Baylor College of Medicine Bristol-Myers Squibb Children’s Clinical Centre of Excellence, Maseru, Lesotho; and
| | - Duncan Kochelani
- Baylor College of Medicine Bristol-Myers Squibb Children’s Clinical Centre of Excellence, Mbabane, Swaziland
| | - Peter N. Kazembe
- Baylor College of Medicine Abbott Fund Children’s Clinical Centre of Excellence, Lilongwe, Malawi
| | - Nancy R. Calles
- Baylor College of Medicine International Pediatric AIDS Initiative at Texas Children’s Hospital, and,Baylor College of Medicine, Department of Pediatrics and Texas Children’s Hospital, Houston, Texas
| | - Michael B. Mizwa
- Baylor College of Medicine International Pediatric AIDS Initiative at Texas Children’s Hospital, and
| | - Gordon E. Schutze
- Baylor College of Medicine International Pediatric AIDS Initiative at Texas Children’s Hospital, and,Baylor College of Medicine, Department of Pediatrics and Texas Children’s Hospital, Houston, Texas
| | - Mark W. Kline
- Baylor College of Medicine International Pediatric AIDS Initiative at Texas Children’s Hospital, and,Baylor College of Medicine, Department of Pediatrics and Texas Children’s Hospital, Houston, Texas
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Laos CM, DiStefano MC, Cruz AT, Caviness AC, Hsu DC, Patel B. Mobile pediatric emergency response team: patient satisfaction during the novel H1N1 influenza outbreak. Acad Emerg Med 2012; 19:274-9. [PMID: 22435859 DOI: 10.1111/j.1553-2712.2012.01289.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The objective was to determine child caregiver satisfaction with a nontraditional pediatric emergency department (ED) venue during the 2009 novel H1N1 influenza outbreak. METHODS Between May 1 and 7, 2009, the Texas Children's Hospital (TCH) ED used a six-bed outdoor facility, the Mobile Pediatric Emergency Response Team (MPERT), to evaluate patients with suspected novel H1N1 influenza. Parents and caregivers of patients evaluated in the MPERT were surveyed by telephone using a validated questionnaire to evaluate satisfaction with the facility. RESULTS Of 353 patients, 155 caregivers (44%) completed questionnaires; 127 had wrong numbers, 71 did not answer, and 15 were on a no-call list. Survey responders felt that nurses and doctors explained concepts well (nurses 92%, doctors 94%), 91% felt TCH prepared them well for taking care of their children at home, 94% were satisfied with the medical care received, and 88% were not bothered by the outdoor setting. When asked to rate their MPERT experience on a scale of 0 (worst possible) to 10 (best possible), the median score was 9 (range 1 to 10). CONCLUSIONS The MPERT facility alleviated patient volume surge and potentially prevented transmission during H1N1 outbreak. While these were health care provider goals, caregiver expectations were also met. Caregivers perceived MPERT as an acceptable alternative to receiving care in the regular ED, felt that physicians and nurses communicated well, and felt that medical care was good to excellent. Use of the MPERT did not negatively affect overall caregiver satisfaction with TCH. These findings suggest that families of pediatric patients are amenable to nontraditional ED venues during periods of ED crowding.
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Affiliation(s)
- Carla M Laos
- Dell Children's Medical Center, Pediatric Emergency Medicine, Austin, TX, USA
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11
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Mian AI, Du Y, Garg HK, Caviness AC, Goldstein SL, Bryan NS. Urinary nitrate might be an early biomarker for pediatric acute kidney injury in the emergency department. Pediatr Res 2011; 70:203-7. [PMID: 21532528 DOI: 10.1203/pdr.0b013e31822188b4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
NO is involved in normal kidney function and perturbed in acute kidney injury (AKI). We hypothesized that urinary concentration of NO metabolites, nitrite, and nitrate would be lower in children with early AKI presenting to the emergency department (ED), when serum creatinine (SCr) was uninformative. Patients up to 19 y were recruited if they had a urinalysis and SCr obtained for routine care. Primary outcome, AKI, was defined by pediatric Risk, Injury, Failure, Loss of function, End-stage renal disease (pRIFLE) criteria. Urinary nitrite and nitrate were determined by HPLC. A total of 252 patients were enrolled, the majority (93%) of whom were without AKI. Although 18 (7%) had AKI by pRIFLE, 50% may not have had it identified by the SCr value alone at the time of visit. Median urinary nitrate was lower for injury versus risk (p = 0.03); this difference remained significant when the injury group was compared against the combined risk and no AKI groups (p = 0.01). Urinary nitrite was not significantly different between groups. Thus, low urinary nitrate is associated with AKI in the pediatric ED even when SCr is normal. Predictive potential of this putative urinary biomarker for AKI needs further evaluation in sicker patients.
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Affiliation(s)
- Asad I Mian
- Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas 77030, USA
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12
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Wallace SS, Cruz AT, Quinonez RA, Caviness AC. Risk factors for complications in hospitalized young infants presenting with uncomplicated pertussis. Hosp Pediatr 2011; 1:16-22. [PMID: 24510925 DOI: 10.1542/hpeds.2011-0007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE We sought to identify risk factors for complications in hospitalized young infants with uncomplicated pertussis. METHODS Retrospective cohort study of hospitalized infants 0 to 6 months of age with confirmed pertussis from 2005 to 2009. Subjects presenting without complications or need for initial intensive care admission were deemed to have uncomplicated pertussis. Complications during hospitalization were defined as apnea, pneumonia, seizures, or encephalopathy. Univariate analysis was performed by estimating odds ratios (OR) and 95% confidence intervals (CI) for the association between each variable and the occurrence of complications. Multivariable analysis was performed using logistic regression. Clinical variables included demographics, historical, laboratory, and imaging data. RESULTS Of 126 study subjects, 46 (36.5%) developed complications in the hospital: 43 with apnea (two required endotracheal intubation), seven with pneumonia, and three with seizures; there were no cases of encephalopathy and no deaths. Age less than 60 days (OR, 2.71; 95% CI, 1.08-6.82), cough duration less than 7 days (OR, 5.38; 95% CI, 1.79-16.18), history of color change (OR, 5.24; 95% CI, 1.14-24.07), parental intervention (OR, 10.05; 95% CI, 1.67-60.39), and need for oxygen in the emergency department (OR. 3.94; 95% CI. 1.37-11.36) were associated with development of complications. The median duration of cough at the time of complication was 9 days (range 2-30 days). Initial complete blood cell count and radiographic findings were not associated with complications. CONCLUSIONS Infants with uncomplicated pertussis may be at low risk for developing respiratory failure or death. Historical information may assist practitioners in determining risk for serious complications.
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Cruz AT, Demmler-Harrison GJ, Caviness AC, Buffone GJ, Revell PA. Performance of a rapid influenza test in children during the H1N1 2009 influenza a outbreak. Pediatrics 2010; 125:e645-50. [PMID: 20156902 DOI: 10.1542/peds.2009-3060] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To evaluate the performance of a rapid influenza diagnostic test (RIDT) in detecting H1N1 2009 influenza A virus in respiratory samples from pediatric patients in comparison to that of real-time reverse-transcriptase polymerase chain reaction (rRT-PCR) and viral culture. Methodology. This was a cross-sectional diagnostic-accuracy study conducted at a tertiary care children's hospital. Patients for whom the RIDT (BinaxNOW [Binax, Inc, Portland, ME]), viral culture, and rRT-PCR results were known were included. Sensitivity, specificity, and likelihood ratios (LRs) were calculated. RESULTS A total of 3030 specimens had RIDT results paired with both rRT-PCR and viral culture results. With rRT-PCR as the reference, overall test sensitivity was 45% (95% confidence interval [CI]: 43.3%-46.3%) and specificity was 98.6% (95% CI: 98.1%-99%). Positive and negative LRs were 32.9 (95% CI: 22.9-45.4) and 0.56 (95% CI: 0.54-0.58), respectively. RIDT sensitivity was significantly higher in young infants and children younger than 2 years than in older children. Using viral culture as the reference standard, RIDT sensitivity was 55.5% (95% CI: 51.9%-95.6%) and specificity was 95.6% (95% CI: 95%-96.1%). The positive and negative LRs were 12.6 and 0.47, respectively. CONCLUSIONS The RIDT had relatively poor sensitivity but excellent specificity in this consecutive series of respiratory specimens obtained from pediatric patients. Although a positive RIDT result was highly accurate in predicting infection with influenza type A H1N1 2009 in children, a negative RIDT result did not preclude a child having H1N1. Therefore, for children at high risk with influenza-like illnesses during high-prevalence periods of influenza, empiric initiation of antiviral therapy should be considered for patients with a negative RIDT result.
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Affiliation(s)
- Andrea T Cruz
- Baylor College of Medicine, 6621 Fannin St, Suite A210, MC 1-1481, Houston, TX 77030, USA.
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Caviness AC, Jones JL, Deguzman MA, Shook JE. P EDIATRIC R ESTRAINT U SE I S A SSOCIATED WITH R EDUCED T RANSPORTS BY E MERGENCY M EDICAL S ERVICES P ROVIDERS AFTER M OTOR V EHICLE C RASHES. PREHOSP EMERG CARE 2009; 7:448-52. [PMID: 14582096 DOI: 10.1080/312703002168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To determine the association between pediatric restraint use during motor vehicle crashes and patient transports by emergency medical services (EMS) providers. METHODS Children under 16 years of age who were involved in motor vehicle crashes in Houston or Harris County, Texas, in 1997 were identified from Texas Department of Public Safety (DPS) crash data. DPS data were linked probabilistically to City of Houston Fire Department EMS data to identify whether the children were transported from the scene by EMS. Odds ratios were calculated to determine the association between restraint use and EMS transport. Logistic regression was used to control for age and injury severity in this relationship. RESULTS From the linked data for 1997, 1,696 children were involved in reported automobile or truck crashes to which EMS responded. Of the 1,580 children about whom information concerning restraint use was available, 1,309 (83%) were wearing some type of safety restraint and 1,342 (85%) were transported by EMS. Adjusting for injury severity, children wearing safety restraints during motor vehicle crashes were 60% (95% confidence interval 34-75%) less likely to be transported by EMS than those not wearing safety restraints during such crashes. CONCLUSIONS The use of safety restraints during motor vehicle crashes is associated with a reduction in the number of children transported from the scene by EMS providers. This effect is independent of age and injury severity.
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Affiliation(s)
- A Chantal Caviness
- Pediatric Emergency Medicine, Baylor Injury Center, Baylor College of Medicine, Houston, TX 77030-2399, USA.
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Caviness AC, Demmler GJ, Almendarez Y, Selwyn BJ. The prevalence of neonatal herpes simplex virus infection compared with serious bacterial illness in hospitalized neonates. J Pediatr 2008; 153:164-9. [PMID: 18534225 DOI: 10.1016/j.jpeds.2008.02.031] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2007] [Revised: 12/14/2007] [Accepted: 02/14/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine the prevalence of herpes simplex virus (HSV) relative to other viral infections and serious bacterial illnesses (SBIs) in hospitalized neonates admitted from a pediatric emergency department over a 5-year period. STUDY DESIGN Retrospective prevalence study of laboratory-confirmed viral infections and culture-proven SBIs, with electronic databases and medical record review. RESULTS A total 5817 neonates were included: 8.4% with viral infection, 4.6% with SBIs. Of 960 neonates with documented fever, 17.2% had viral infections (0.3% HSV infection) and 14.2% had SBIs (1.3% bacterial meningitis). Of 204 neonates with fever and cerebrospinal fluid (CSF) pleocytosis, 1.0% had HSV infection and 5.4% had bacterial meningitis. Of 124 neonates with fever and mononuclear CSF pleocytosis, 1.6% had HSV and 0.8% had bacterial meningitis. Of 187 neonates with hypothermia, 1.1% had HSV infection presenting as a sepsis-like syndrome. CONCLUSIONS In febrile neonates admitted to the hospital from the emergency department, the prevalence of HSV infection was similar to that of bacterial meningitis, suggesting that HSV infection be considered in the differential diagnosis of neonatal fever, especially in the presence of mononuclear CSF pleocytosis. HSV infection should also be considered in neonates with hypothermia and a sepsis-like syndrome.
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Caviness AC, Demmler GJ, Swint JM, Cantor SB. Cost-effectiveness Analysis of Herpes Simplex Virus Testing and Treatment Strategies in Febrile Neonates. ACTA ACUST UNITED AC 2008; 162:665-74. [DOI: 10.1001/archpedi.162.7.665] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Trautner BW, Caviness AC, Gerlacher GR, Demmler G, Macias CG. Prospective evaluation of the risk of serious bacterial infection in children who present to the emergency department with hyperpyrexia (temperature of 106 degrees F or higher). Pediatrics 2006; 118:34-40. [PMID: 16818546 PMCID: PMC2077849 DOI: 10.1542/peds.2005-2823] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Previous studies of children with temperatures > or = 106 degrees F (hyperpyrexia) disagree as to whether hyperpyrexia confers a high risk of serious bacterial infection. OBJECTIVES The purpose of this study was to determine (1) the risk of serious bacterial infection in children with hyperpyrexia and (2) whether clinical presentation can identify hyperpyrexic patients at risk for serious bacterial infection. METHODS Data were collected prospectively on all children <18 years of age presenting to a pediatric emergency department during a 2-year period with rectal temperatures of > or = 106 degrees F. History, physical examination, complete blood cell counts, blood cultures, and nasopharyngeal viral cultures were obtained on all of the patients. RESULTS Of 130828 visits, 103 children had hyperpyrexia (1 per 1270 patient visits). Of the 103 subjects, 20 had serious bacterial infection, and 22 had laboratory-proven viral illness (including 1 subject with bacterial/viral coinfection). The presence of a chronic underlying illness was associated with an increased risk of serious bacterial infection. The presence of rhinorrhea or any viral symptom was associated with a decreased risk of serious bacterial infection, although diarrhea itself was associated with an increased risk of serious bacterial infection. Age, maximum temperature, and total white blood cell count were not predictive of either bacterial or viral illness. CONCLUSIONS Children with hyperpyrexia are at equally high risk for serious bacterial infection and for viral illness. Bacterial and viral coinfection also occurs. No aspect of the clinical presentation reliably distinguishes between bacterial and viral illness. We recommend consideration of antibiotic treatment for all children presenting to the emergency department with hyperpyrexia without confirmed viral illness.
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Affiliation(s)
- Barbara W Trautner
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA.
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Sockrider MM, Abramson S, Brooks E, Caviness AC, Pilney S, Koerner C, Macias CG. Delivering tailored asthma family education in a pediatric emergency department setting: a pilot study. Pediatrics 2006; 117:S135-44. [PMID: 16777829 DOI: 10.1542/peds.2005-2000k] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Many children are brought to the pediatric emergency department (ED) with acute asthma symptoms. Emergency asthma care is costly, and many ED visits may be preventable. Families often do not have written asthma action plans and lack asthma self-management skills. This study tests a tailored self-management intervention delivered in the ED for families of children with asthma. The primary hypotheses were that the intervention group would have greater confidence to manage asthma 14 days postintervention and more well-asthma visits and fewer urgent care/ED visits at 9 and 12 months. METHODS This randomized intervention/usual-care study was part of a larger ED asthma surveillance project in 4 urban pediatric ED sites. Asthma educators used a computer-based resource to tailor the intervention messages and provide a customized asthma action plan and educational summary. Children with acute asthma were enrolled during an ED visit, and follow-up telephone interviews were conducted during the next 9 months. The ED clinician classified the child's acute and chronic severity. RESULTS To date, 464 subjects aged 1 to 18 years have been enrolled. The ED clinicians reported that 46% had intermittent and 54% had persistent chronic severity with 51% having mild acute severity episodes. The confidence level to prevent asthma episodes and keep them from getting worse was significantly higher in the intervention group at 14 days postintervention. More subjects in the intervention group reported well-asthma visits by 9 months. Return ED visits were significantly lower in the intervention group in those with intermittent asthma. Twelve-month follow-up is in process. CONCLUSIONS The tailored ED self-management intervention demonstrates significant effects on caregiver self-confidence and well-visit follow-up. Additional evaluation is needed to determine what impact this intervention has long-term.
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Affiliation(s)
- Marianna M Sockrider
- Department of Pediatrics, Baylor College of Medicine, 6621 Fannin, MC 1040.00, Houston, Texas 77030, USA.
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Macias CG, Caviness AC, Sockrider M, Brooks E, Kronfol R, Bartholomew LK, Abramson S, Shearer W. The effect of acute and chronic asthma severity on pediatric emergency department utilization. Pediatrics 2006; 117:S86-95. [PMID: 16777836 DOI: 10.1542/peds.2005-2000f] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Our goal was to teach emergency department (ED) physicians how to use standardized criteria for diagnosing and classifying asthma severity and to describe the patterns of pediatric ED utilization of these criteria for classification of both acute and chronic severity. METHOD A health care provider education module was developed and implemented in 4 participating EDs in southeast Texas to educate ED physicians and health care providers on the diagnosis and acute and chronic severity classification of pediatric asthma patients. We undertook both retrospective (medical chart extraction) and prospective surveillance over a 2-year period of all children presenting to 1 of 4 EDs with acute asthma. Demographic characteristics, classification of severity, health care resource utilization, and primary physician contact information were collected. RESULTS The health care provider educational intervention was provided for 84 different physicians. A subset of 16 physicians was randomly tested preintervention and postintervention. Mean mock-scenario scores at 2 weeks showed an improvement of 55.6%, which was sustained at retesting at 6 months. Over the 2-year period, 6222 individual pediatric ED encounters were entered into the surveillance database. The median age of presentation was 5 years. More than 32% of the patients in the study were uninsured. The majority of the patients in each category had asthma of mild severity: mild intermittent chronic (58.7%) and mild acute (53.9%). CONCLUSIONS Physicians who completed a health care provider education module learned to effectively diagnose asthma and recognize standardized acute and chronic severity classifications. The majority of children with asthma who presented to the Texas Emergency Department Asthma Surveillance project's participating EDs were classified as having mild acute severity and mild intermittent chronic disease. Almost one third of these patients did not have health insurance.
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Affiliation(s)
- Charles G Macias
- Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine, Baylor College of Medicine, MC 1-1481, 6621 Fannin St, Houston, Texas 77030, USA.
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Abstract
BACKGROUND Hospital emergency department (ED) visits for non-urgent care have been increasing since the late 1950s. This study investigated the prevalence and characteristics of pediatric ED visits for dental problems during a five-year period. METHODS This retrospective study included newborns through 17-year-olds with dental complaints identified from the electronic register of the ED of Texas Children's Hospital, Houston, between January 1997 and December 2001. The authors described patient characteristics, diagnoses, factors associated with ED use for nontraumatic problems and annual changes in ED visits for dental and nondental complaints. RESULTS Of the 1,102 subjects, 809 (73.4 percent) had nontraumatic and 293 (26.6 percent) had traumatic dental complaints. The study revealed a 121 percent increase in ED visits for dental complaints and a 66-fold increase in admissions between 1997 and 2001. Of the inpatient admissions, 68 percent were the result of caries and its sequelae. CONCLUSIONS This study revealed a substantial increase in ED visits and hospital admissions for dental problems during the study period. The majority of dental problems were nontraumatic in nature. PRACTICE IMPLICATIONS Dental care experts should be available in ED settings in which increases in such visits are seen. Studies must be conducted to explore ways of keeping patients from seeking care in EDs inappropriately.
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Smitherman HF, Caviness AC, Macias CG. Retrospective review of serious bacterial infections in infants who are 0 to 36 months of age and have influenza A infection. Pediatrics 2005; 115:710-8. [PMID: 15741376 DOI: 10.1542/peds.2004-1112] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Previous studies of febrile children who were 3 to 36 months of age and had clinically recognizable viral syndromes have shown low rates of concurrent bacteremia. We sought to determine the prevalence of serious bacterial infections (SBIs) among children with influenza A, a viral syndrome that can be established definitively by specific tests. METHODS We performed a retrospective cross-sectional study of patients who were 0 to 36 months of age and presented with fever to the emergency department (ED) over 4 consecutive influenza seasons. Chest radiographs and urine and cerebrospinal fluid cultures also were reviewed. RESULTS Of 705 included patients, 163 (23%) were influenza positive (IP) and 542 (77%) were influenza negative (IN). Only 1 IP patient was bacteremic (0.6%) versus 23 of the 542 IN control subjects (4.2%). Two (1.8%) of 110 IP cases had urinary tract infections versus 38 (9.9%) of the 382 IN control subjects. Thirteen (25.4%) of 51 IP patients had radiographic evidence of pneumonia versus 99 (41.9%) of 236 IN control subjects. There were no cases of meningitis in 41 cerebrospinal fluid samples obtained from IP patients versus 4 (2.2%) cases of culture-positive meningitis in 179 IN control subjects. A total of 16 (9.8%) SBIs were identified in the IP cases versus 153 (28.2%) in the IN control subjects. CONCLUSIONS Febrile children with influenza A had a lower prevalence of bacteremia, urinary tract infections, consolidative pneumonia, or any SBI compared with those without influenza A infection in this study.
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Affiliation(s)
- Hannah F Smitherman
- Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine, 6621 Fannin St, MC 1-1481, Houston, TX 77030, USA.
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Caviness AC, Cantor SB, Allen CH, Ward MA. A cost-effectiveness analysis of bacterial endocarditis prophylaxis for febrile children who have cardiac lesions and undergo urinary catheterization in the emergency department. Pediatrics 2004; 113:1291-6. [PMID: 15121944 DOI: 10.1542/peds.113.5.1291] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To prevent bacterial endocarditis (BE) in those at risk, the American Heart Association recommends antibiotics for patients who have a known urinary tract infection and are about to undergo urinary catheterization (UC). In young children who have cardiac lesions and undergo UC for fever without a source, the problem with prophylaxis only in the presence of infected urine is that the presence of urinary tract infection is unknown before testing. This study was conducted to determine the cost-effectiveness of BE prophylaxis before UC in febrile children aged 0-24 months with moderate-risk cardiac lesions. METHODS We evaluated the cost-effectiveness of BE prophylaxis compared with no prophylaxis from the societal perspective. Clinical outcomes were based on BE incidence and quality-adjusted life years (QALYs). Probabilities were derived from the medical literature. Costs were derived from national and local sources in US dollars for the reference year 2000, using a discount rate of 3%. RESULTS On the basis of the analysis, prophylaxis prevents 7 BE cases per 1 million children treated. When antibiotic-associated deaths were included, the no-prophylaxis strategy was more effective and less costly than the prophylaxis strategy. When antibiotic-associated deaths were excluded, amoxicillin cost 10 million dollars per QALY gained and 70 million dollars per case prevented. For vancomycin, it was 13 million dollars per QALY gained and 95 million dollars per case prevented. The results were robust to variations in the prophylactic efficacy of antibiotics, incidence of bacteremia after UC, incidence of BE after bacteremia, and costs associated with BE prophylaxis and treatment. CONCLUSION In the emergency department, BE prophylaxis before UC in febrile children who are aged 0 to 24 months and have moderate-risk cardiac lesions is not a cost-effective use of health care resources.
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Affiliation(s)
- A Chantal Caviness
- Section of Pediatric Emergency Medicine, Baylor College of Medicine, Houston, Texas, USA.
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