1
|
Levine DA, Uy V, Krief W, Bornstein C, Daswani D, Patel D, Kriegel M, Jamal N, Patel K, Liang T, Arroyo A, Strother C, Lim CA, Langhan ML, Hassoun A, Chamdawala H, Kaplan CP, Waseem M, Tay ET, Mortel D, Sivitz AB, Kelly C, Lee HJ, Qiu Y, Gorelik M, Platt SL, Dayan P. Predicting Delayed Shock in Multisystem Inflammatory Disease in Children: A Multicenter Analysis From the New York City Tri-State Region. Pediatr Emerg Care 2023; 39:555-561. [PMID: 36811547 DOI: 10.1097/pec.0000000000002914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 02/24/2023]
Abstract
OBJECTIVES Patients with multisystem inflammatory disease in children (MIS-C) are at risk of developing shock. Our objectives were to determine independent predictors associated with development of delayed shock (≥3 hours from emergency department [ED] arrival) in patients with MIS-C and to derive a model predicting those at low risk for delayed shock. METHODS We conducted a retrospective cross-sectional study of 22 pediatric EDs in the New York City tri-state area. We included patients meeting World Health Organization criteria for MIS-C and presented April 1 to June 30, 2020. Our main outcomes were to determine the association between clinical and laboratory factors to the development of delayed shock and to derive a laboratory-based prediction model based on identified independent predictors. RESULTS Of 248 children with MIS-C, 87 (35%) had shock and 58 (66%) had delayed shock. A C-reactive protein (CRP) level greater than 20 mg/dL (adjusted odds ratio [aOR], 5.3; 95% confidence interval [CI], 2.4-12.1), lymphocyte percent less than 11% (aOR, 3.8; 95% CI, 1.7-8.6), and platelet count less than 220,000/uL (aOR, 4.2; 95% CI, 1.8-9.8) were independently associated with delayed shock. A prediction model including a CRP level less than 6 mg/dL, lymphocyte percent more than 20%, and platelet count more than 260,000/uL, categorized patients with MIS-C at low risk of developing delayed shock (sensitivity 93% [95% CI, 66-100], specificity 38% [95% CI, 22-55]). CONCLUSIONS Serum CRP, lymphocyte percent, and platelet count differentiated children at higher and lower risk for developing delayed shock. Use of these data can stratify the risk of progression to shock in patients with MIS-C, providing situational awareness and helping guide their level of care.
Collapse
Affiliation(s)
- Deborah A Levine
- From the Departments of Emergency Medicine and Pediatrics, NewYork-Presbyterian/Weill Cornell Medicine, New York
| | - Vincent Uy
- From the Departments of Emergency Medicine and Pediatrics, NewYork-Presbyterian/Weill Cornell Medicine, New York
| | - William Krief
- Department of Pediatrics, Hofstra-Northwell School of Medicine/Cohen's Children's Medical Center, Queens
| | - Cara Bornstein
- Department of Pediatrics, Hofstra-Northwell School of Medicine/Cohen's Children's Medical Center, Queens
| | - Dina Daswani
- Departments of Pediatrics and Emergency Medicine, Maria Fareri Children's Hospital/Westchester Medical Center Health Network, Valhalla, NY
| | - Darshan Patel
- Departments of Pediatrics and Emergency Medicine, Maria Fareri Children's Hospital/Westchester Medical Center Health Network, Valhalla, NY
| | - Marni Kriegel
- Department of Emergency Medicine and Pediatrics, Hackensack University Medical Center/Hackensack Meridian School of Medicine, Hackensack, NJ
| | - Nazreen Jamal
- Department of Emergency Medicine and Pediatrics, NewYork-Presbyterian/Columbia University Valegos College of Physicians and Surgeons
| | - Kavita Patel
- Departments of Emergency Medicine and Pediatrics, New York University Grossman School of Medicine, New York
| | - Tian Liang
- Departments of Emergency Medicine and Pediatrics, New York University Grossman School of Medicine, New York
| | - Alexander Arroyo
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn
| | - Christopher Strother
- Departments of Emergency Medicine and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Czer Anthoney Lim
- Departments of Emergency Medicine and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Melissa L Langhan
- Departments of Pediatrics and Emergency Medicine, Yale University School of Medicine, New Haven CT
| | - Ameer Hassoun
- Department of Emergency Medicine, NewYork-Presbyterian Queens/Weill Cornell Medicine, Flushing
| | - Haamid Chamdawala
- Department of Pediatrics, Jacobi Hospital Center/North Central Bronx Hospital, The Bronx
| | - Carl Philip Kaplan
- Departments of Pediatrics and Emergency Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook
| | - Muhammad Waseem
- Departments of Emergency Medicine and Pediatrics, Lincoln Medical Center/Weill Cornell Medicine, The Bronx
| | - Ee Tein Tay
- Departments of Emergency Medicine and Pediatrics, New York University Grossman School of Medicine/Bellevue Hospital Center
| | - David Mortel
- Departments of Emergency Medicine and Pediatrics, Harlem Hospital Center, New York
| | - Adam B Sivitz
- Departments of Emergency Medicine and Pediatrics, Newark Beth Israel Medical Center/Children's Hospital of New Jersey, New Jersey Medical School, Rutgers University, Newark
| | - Christopher Kelly
- Department of Emergency Medicine, NewYork-Presbyterian/Brooklyn Methodist Hospital, Brooklyn
| | | | | | | | - Shari L Platt
- From the Departments of Emergency Medicine and Pediatrics, NewYork-Presbyterian/Weill Cornell Medicine, New York
| | - Peter Dayan
- Emergency Medicine, NewYork-Presbyterian/Columbia University Valegos College of Physicians and Surgeons, New York, NY
| |
Collapse
|
2
|
Waltuch T, Munjal K, Loo GT, Lim CA. AiRDose: Developing and Validating an Augmented Reality Smartphone Application for Weight Estimation and Dosing in Children. Pediatr Emerg Care 2022; 38:e1257-e1261. [PMID: 35482502 DOI: 10.1097/pec.0000000000002587] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 11/26/2022]
Abstract
OBJECTIVES Inaccurate weight estimation is a contributing factor to medical error in pediatric emergencies, especially in the prehospital setting. Current American Heart Association guidelines recommend the use of length-based weight estimation tools such as the Broselow tape. We developed the AiRDose smartphone application that uses augmented reality to provide length-based weight estimates, as well as medication dosing, defibrillation energy, and equipment sizing recommendations; AiRDose was programmed to use Broselow conversions to obtain these estimates. The primary objective was to compare the length estimated by AiRDose with the actual length obtained by the standard tape measure. The secondary objectives were to compare the estimated weights and critical medication doses from AiRDose with current established methods. METHODS In this prospective validation study, lengths and estimated weights were obtained for children presenting to 2 emergency departments using AiRDose, Broselow, and a standard tape measure; actual weight was recorded from the patient chart. Using the AiRDose estimated weights, hypothetical doses of epinephrine and lorazepam were calculated and compared with doses recommended via Broselow and to actual weight-based doses. Spearman rank correlation coefficients were calculated. We defined an acceptable difference of 20% between AiRDose and standard measurements as clinically relevant. RESULTS Five hundred forty-nine children (mean age, 4.8 years; standard deviation [SD], 2.9 years) were recruited. There were 99.6% of AiRDose lengths within a 20% difference of tape-measure lengths. There was a significant correlation between AiRDose and tape-measure length measurements (r = 0.989, P < 0.0001), and between AiRDose and Broselow weights (r = 0.983, P < 0.0001) and AiRDose and actual weights (r = 0.886, P < 0.0001). AiRDose lorazepam and epinephrine doses correlated significantly with Broselow lorazepam (r = 0.963, P < 0.0001) and epinephrine (r = 0.966, P < 0.0001) doses. CONCLUSIONS Anthropometric estimates and medication dose recommendations provided by AiRDose strongly correlate with established techniques. Further study will establish the feasibility of using AiRDose to accurately obtain weight estimates and medication doses for pediatric patients in the prehospital setting.
Collapse
Affiliation(s)
- Temima Waltuch
- From the Department of Emergency Medicine, Hackensack University Medical Center, Hackensack, NJ
| | | | | | | |
Collapse
|
3
|
Whitney R, Centrone WA, Mamani HS, Falkenstein K, Levine RS, Harris J, Hazlitt M, Lim CA. Impact of a collaborative childhood anaemia intervention programme in Peru. Trop Med Int Health 2021; 26:680-686. [PMID: 33605012 DOI: 10.1111/tmi.13564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/08/2023]
Abstract
OBJECTIVES To evaluate the impact of a 12-month multi-modal public health intervention programme for treating and preventing anaemia among children aged 6 months to 4 years in an underserved community in Peru. METHODS The intervention included nutritional education, use of a Lucky Iron Fish® cooking tool, and dietary supplementation. The primary outcome measure was anaemia resolution. Secondary outcomes included absolute changes in haemoglobin, change in knowledge survey scores and adherence to interventions. Chi-square test and Mann-Whitney U-test were employed to identify associations between anaemia and intervention-related measures. Variables found to be significantly associated in bivariate analysis or of clinical importance were included in a logistic regression model. RESULTS Of the 406 children enrolled, 256 (63.1%) completed the programme. Of those, 34.0% had anaemia at baseline; this decreased to 13.0% over 12 months. The mean haemoglobin for all ages at baseline was 11.3 g/dL (SD 0.9). At 12 months, the mean was 11.9 g/dL (SD 0.8), with a mean increase of 0.5 g/dL (95% CI 0.4-0.6). Children with anaemia at baseline saw an increase of 1.19 g/dL at the 12-month follow-up (95% CI 1.12-1.37). Parents correctly answered 79.0% of knowledge assessment questions at baseline, which increased to 86.6% at 12 months. CONCLUSIONS We observed a reduction in the prevalence of mild to moderate anaemia among study participants in this vulnerable population and conclude that multi-modal intervention programmes providing nutrition education in conjunction with low-cost iron supplementation and easy-to-use Lucky Iron Fish® cooking tools may reduce and prevent anaemia in children.
Collapse
Affiliation(s)
- Rachel Whitney
- Department of Emergency Medicine and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | - Robert S Levine
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | | | - Czer Anthoney Lim
- Department of Emergency Medicine and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
5
|
Hong C, Aung MM, Kanagasabai K, Lim CA, Liang S, Tan KS. The association between oral health status and respiratory pathogen colonization with pneumonia risk in institutionalized adults. Int J Dent Hyg 2017; 16:e96-e102. [PMID: 29120096 DOI: 10.1111/idh.12321] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study aimed to assess the oral health and the prevalence of pre-existing oral colonization with respiratory pathogens in dependent elderly, and whether these factors influence pneumonia development. MATERIALS AND METHODS Participants residing in a long-term care facility received bedside oral examinations, and information on their oral health (caries status, calculus index and debris index) was obtained. Samples from the tongue and teeth were collected at baseline and at time of pneumonia development. Sputum was collected at the time of pneumonia diagnosis. Samples were assessed for Haemophilus influenzae, Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus and Streptococcus pneumoniae by polymerase chain reaction. RESULTS This was a 1-year longitudinal study of 60 dependent elderly (mean age: 64.2 ± 14.1 years). Seventeen patients (28.3%) developed pneumonia. The mean Decayed, Missing and Filled Teeth and Simplified Oral Hygiene Index were 22.8 ± 9.2 and 4.0 ± 1.0, respectively. At baseline, 48.3% were orally colonized with ≥1 respiratory pathogens. The presence of H. influenzae (P = .002) and P. aeruginosa (P = .049) in the sputum was significantly associated with their colonization on the tongue at baseline. In the bivariate analyses, pneumonia development was associated with naso-gastric feeding tube (P = .0001), H. influenzae (P = .015) and P. aeruginosa (P = .003) tongue colonization at baseline and calculus index (P = .002). Multivariate analyses revealed that calculus index (P = .09) and the presence of tracheostomy (P = .037) were associated with pneumonia. CONCLUSIONS The calculus amount and tongue colonization with respiratory pathogens are risk factors for pneumonia development. Oral hygiene measures to remove tongue biofilm and calculus may reduce pneumonia development.
Collapse
Affiliation(s)
- Chl Hong
- Faculty of Dentistry, Discipline of Orthodontics and Paediatric Dentistry, National University of Singapore, Singapore, Singapore
| | - M M Aung
- Ren Ci Hospital, Singapore, Singapore
| | - K Kanagasabai
- CQMU [Clinical Quality Management Unit], Ren Ci Hospital, Singapore, Singapore
| | - C A Lim
- Faculty of Dentistry, Discipline of Oral Sciences, National University of Singapore, Singapore, Singapore
| | - S Liang
- Department of Biostatistics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - K S Tan
- Faculty of Dentistry, Discipline of Oral Sciences, National University of Singapore, Singapore, Singapore
| |
Collapse
|
6
|
Abstract
5' untranslated and partial core (C) region sequence of hepatitis C virus (HCV) in 21 Singaporean and 15 Indonesian isolates were amplified by reverse-transcription polymerase chain reaction and sequenced with the use of conserved primer sequences deduced from HCV genomes identified in other geographical regions. The HCV genotypes are predominantly that of Simmonds type 1 and less of type 2 and 3 with the latter genotype currently not detected in Indonesia. The 5' untranslated sequences are related to HCV-1. DK-7 (Denmark), US-11 (United States of America), HCV-J4, SA-10 (South Africa), T-3 (Taiwan), HCV-J6, HCV-J8, Eb-1 and Eb-8. When compared with the prototype HCV-1, insertions are found within the 5' untranslated region of Singaporean isolates and not in the Indonesians. There are Singaporean and Indonesian isolates that have sequences within the 5' untranslated region that differ slightly from each other. Microheterogeneity is observed in the core region of two Singaporeans and one Indonesian isolate. Finally, not all HCV isolates can be amplified with the conserved core sequence primers when compared with the ease with which these isolates can be amplified with 5' untranslated region conserved primers.
Collapse
Affiliation(s)
- W C Ng
- Department of Medicine, National University of Singapore, Singapore
| | | | | | | | | | | | | | | |
Collapse
|