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Şık N, Çitlenbik H, Öztürk A, Yılmaz D, Duman M. Intravenous Magnesium Sulfate for Acute Bronchiolitis: Evaluation of the Effect on Clinical Course and Outcomes. Clin Pediatr (Phila) 2024; 63:208-213. [PMID: 37735905 DOI: 10.1177/00099228231199834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
The aim of the present study was to assess the efficacy of intravenous (IV) magnesium sulfate (MgSO4) for children with bronchiolitis. A retrospective cohort study was performed at a pediatric emergency department. Aged between 1 and 24 months, children with moderate/severe bronchiolitis according to the Modified Respiratory Distress Assessment Instrument (mRDAI) score were included. Patients who received 40 mg/kg/dose of IV MgSO4 (group 1, n: 74) or not (group 2, n: 33) were compared. Respiratory rate and mRDAI score significantly decreased at the second hour of MgSO4 treatment and the decrease was observed for 4th, 8th, and 12th hours, compared with group 2. Patients in group 2 had a higher rate of requirement and an earlier start high-flow nasal cannula oxygen therapy and a longer hospital stay than group 1. Intravenous MgSO4 provided significant improvement on clinical severity, need for respiratory support, length of hospital stay, and outcomes.
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Affiliation(s)
- Nihan Şık
- Division of Pediatric Emergency Care, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Hale Çitlenbik
- Division of Pediatric Emergency Care, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Ali Öztürk
- Division of Pediatric Emergency Care, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Durgül Yılmaz
- Division of Pediatric Emergency Care, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Murat Duman
- Division of Pediatric Emergency Care, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
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Ulusoy E, Uysal Ateş Ş, Çitlenbik H, Öztürk A, Şık N, Arslan G, Yılmaz D, Yiş U, Hız S, Duman M. What is the safe observation period for seizure recurrence in pediatric emergency departments? Epilepsy Behav 2023; 139:109049. [PMID: 36603346 DOI: 10.1016/j.yebeh.2022.109049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 11/29/2022] [Accepted: 12/01/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Afebrile seizures are the common causes of emergency department (ED) admissions in childhood, and there is limited data on the observation period in emergency service follow-up of these patients in terms of seizure recurrence in the literature. This study aims to determine the seizure recurrence time in afebrile seizures and the risk factors that determine it. METHODS Patients aged between 1 month and 18 years with afebrile seizures were included in the study. Seizure recurrence times, demographic data, diagnosis of epilepsy, use of antiseizure medications, Electroencephalography (EEG) and imaging results, structural abnormalities, hospitalizations, and treatments were recorded. RESULTS The median age of 623 patients included in the study was 42 months (16.0-94.0 months) and 59.9% were male. Epilepsy was diagnosed in 372 (59.7%) of the patients. Short-acting benzodiazepine was administered in 249 of the cases. The mean observation time of the patients was 36 hours (24-98 hours). Electroencephalography (EEG) was applied in 437 (70.1%) of the patients and abnormality was detected in 53.5%. Seizure recurrence was observed in 149 patients (23.9%). The median time of seizure recurrence was 1.0 hour (0.5-4.0 hours). Eighty-six percent of the seizure recurrences (n = 129) occurred within the first six hours and 95.3% (n = 142) within the first 12 hours. Risk factors included a history of febrile seizures (p = 0.001, OR = 2.7), not receiving short-acting benzodiazepine therapy (p = 0.026, OR 1.7), previous structural abnormalities (p = 0.018, OR 1.8), and cluster seizures (p = 0.001, OR 6.7) for all patients and also EEG abnormalities in pediatric ED for first seizure (p = 0.012, OR 2.4). CONCLUSION Patients with a history of febrile seizure, previous structural abnormalities, cluster seizures, EEG abnormalities in pediatric ED, and patients who didn't receive BZD treatment were at risk for seizure recurrence in the early period. Since most seizure recurrences occur within the first 6 hours, this period is the most critical time for recurrence risk.
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Affiliation(s)
- Emel Ulusoy
- Dokuz Eylul University, Faculty of Medicine, Department of Pediatrics, Division of Pediatric Emergency Care, Izmir, Turkey
| | - Şebnem Uysal Ateş
- Dokuz Eylul University, Faculty of Medicine, Department of Pediatrics, Izmir, Turkey
| | - Hale Çitlenbik
- Dokuz Eylul University, Faculty of Medicine, Department of Pediatrics, Division of Pediatric Emergency Care, Izmir, Turkey
| | - Ali Öztürk
- Dokuz Eylul University, Faculty of Medicine, Department of Pediatrics, Division of Pediatric Emergency Care, Izmir, Turkey
| | - Nihan Şık
- Dokuz Eylul University, Faculty of Medicine, Department of Pediatrics, Division of Pediatric Emergency Care, Izmir, Turkey
| | - Gazi Arslan
- Dokuz Eylul University, Faculty of Medicine, Department of Pediatrics, Division of Pediatric Intensive Care Unit, Izmir, Turkey
| | - Durgül Yılmaz
- Dokuz Eylul University, Faculty of Medicine, Department of Pediatrics, Division of Pediatric Emergency Care, Izmir, Turkey
| | - Uluç Yiş
- Dokuz Eylul University, Faculty of Medicine, Department of Pediatrics, Division of Pediatric Neurology, Izmir, Turkey
| | - Semra Hız
- Dokuz Eylul University, Faculty of Medicine, Department of Pediatrics, Division of Pediatric Neurology, Izmir, Turkey
| | - Murat Duman
- Dokuz Eylul University, Faculty of Medicine, Department of Pediatrics, Division of Pediatric Emergency Care, Izmir, Turkey.
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Şık N, Öztürk A, Yılmaz D, Duman M. The Role of Ultrasound in Pediatric Skull Fractures: Determination of Fracture and Optic Nerve Sheath Diameter Measurements. Pediatr Emerg Care 2023; 39:91-97. [PMID: 36719390 DOI: 10.1097/pec.0000000000002895] [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: 02/01/2023]
Abstract
BACKGROUND The aim of the present study was to determine the accuracy of point-of-care ultrasound (POCUS) for detecting skull fractures and to evaluate sonographic measurements of optic nerve sheath diameter (ONSD) and ONSD/eyeball vertical diameter (EVD) ratios in children with head trauma. METHODS Children who presented with local signs of head trauma and underwent cranial computed tomography (CT) were enrolled. The suspected area was examined by POCUS to identify a skull fracture, and then the ONSD at 3 mm posterior to the globe and the EVD were measured. Ratios of ONSD measurement at 3 mm/EVD were reported. All ONSD measurements and ratios were calculated from cranial CT images. RESULTS There were 112 children enrolled in the study. The sensitivity and specificity of POCUS for skull fractures was 93.7% (95% confidence interval [CI], 82.8-98.6) and 96.8% (95% CI, 89.1-99.6), whereas the positive predictive value was 95.7% (95% CI, 85.1-98.8), and the negative predictive value was 95.3% (95% CI, 87.3-98.4). There was high agreement between POCUS and CT for identifying skull fractures (κ, 0.90 [±0.04]). In the group without elevated intracranial pressure findings on CT, patients with space-occupying lesions (SOLs) had higher sonographic ONSD measurements and ratios (P < 0.001) compared with cases without SOLs. CONCLUSIONS When used with clinical decision rules to minimize the risk for clinically important traumatic brain injury, POCUS seems to be a promising tool to detect skull fractures and calculate ONSD measurements and rates to predict the risk for SOLs and perform further risk stratification of children with minor head trauma.
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Affiliation(s)
- Nihan Şık
- From the Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
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Şık N, Ulusoy E, Çitlenbik H, Öztürk A, Er A, Yılmaz D, Duman M. The role of sonographic optic nerve sheath diameter measurements in pediatric head trauma. J Ultrasound 2022; 25:957-963. [PMID: 35396696 PMCID: PMC9705618 DOI: 10.1007/s40477-022-00676-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/09/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To determine the accuracy of bedside sonographic measurements of optic nerve sheath diameter (ONSD) and ONSD/eyeball transverse (ETD) diameter ratios to predict space-occupying lesions (SOLs) or elevated intracranial pressure (ICP) in pediatric head trauma. METHODS Children who presented to the emergency department with head trauma and underwent cranial computed tomography (CT) were enrolled and examined by ocular ultrasonography (US), and the ONSD was measured at 3 mm posterior to the globe and ETD were measured. Ratios of ONSD at 3 mm/ETD were calculated. All ONSD measurements and ratios were calculated from cranial CT images. RESULTS Subjects with elevated ICP had increased ONSD measurements and ratios. To predict elevated ICP, the AUC for ONSD at 3 mm was 0.956 (95% CI 0.896-1). At a cut-off level of 5.1 mm, the sensitivity and specificity of ONSD 3 mm values for elevated ICP were 92.9% and 94.0%. For the ONSD 3 mm/ETD ratio, it was 0.980 (95% CI 0.959-1). At a cut-off level of 0.22, the sensitivity and specificity were 100% sensitivity and 88.0%. All sonographic ONSD measurements and ratios were significantly correlated with readings calculated from cranial CT images. CONCLUSION Sonographic ONSD measurements and ratios were found to be quite sensitive to detect elevated ICP on cranial CT images. Additionally, there was a significant correlation between measurements calculated by ocular US and cranial CT scans. Bedside ocular US seems to be a promising and useful tool to determine ICP in children with head trauma.
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Affiliation(s)
- Nihan Şık
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
| | - Emel Ulusoy
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
| | - Hale Çitlenbik
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
| | - Ali Öztürk
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
| | - Anıl Er
- Division of Pediatric Emergency Care, Department of Pediatrics, Dr. Behçet Uz Children's Hospital, Izmir, Turkey
| | - Durgül Yılmaz
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
| | - Murat Duman
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey.
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Şık N, Uzun A, Öztürk A, Aydın E, Zeki Karakuş O, Duman M, Yılmaz D. Uncommon presentation of Meckel's diverticulum in a child with decompensated hypovolemic shock. ULUS TRAVMA ACIL CER 2022; 28:1031-1034. [PMID: 35775669 PMCID: PMC10493833 DOI: 10.14744/tjtes.2020.39887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 11/03/2020] [Indexed: 11/20/2022]
Abstract
Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract and may cause serious complications such as intestinal obstruction, gastrointestinal hemorrhage, or inflammation with/without perforation, which can present with non-spe-cific symptoms and signs. We report on the case of a 2.5-year-old boy admitted to our emergency department in poor condition, with compatible signs of decompensated hypovolemic shock. This case finally resulted in intestinal volvulus and internal hernia, a very rare combination of two complications of MD, as determined in the operating room.
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Affiliation(s)
- Nihan Şık
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylül University Faculty of Medicine, İzmir-Türkiye
| | - Aslıhan Uzun
- Department of Pediatrics, Dokuz Eylül University Faculty of Medicine, İzmir-Türkiye
| | - Ali Öztürk
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylül University Faculty of Medicine, İzmir-Türkiye
| | - Efil Aydın
- Department of Pediatric Surgery, Dokuz Eylül University Faculty of Medicine, İzmir-Türkiye
| | - Osman Zeki Karakuş
- Department of Pediatric Surgery, Dokuz Eylül University Faculty of Medicine, İzmir-Türkiye
| | - Murat Duman
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylül University Faculty of Medicine, İzmir-Türkiye
| | - Durgül Yılmaz
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylül University Faculty of Medicine, İzmir-Türkiye
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Duman M, Şık N, Tekşam Ö, Akça H, Kurt F, Çağlar AA, Yıldız LA, Taşar MA, Fidancı İ, Yayla BCC, Yılmaz D, Güngör E, Demir Ş, Çokuğraş H, Cebeci SO, Önal P, Saz EU, Yurtseven A, Uysalol M, Yıldız R, Gümüş S, Bal A, Bayturan SŞ, Zengin N, Atik S, Çiftdoğan DY, Berksoy E, Çiçek A, Şahin S, Kızıl MC, Kara Y, Apa H, Ulusoy E, Kara AA, Yesil E, Erdem M, Turan C, Arslanoglu S, Duyu M, Besli GE, Arslan G, Oflu AT, Çeleğen M, Buldu E, Pişkin İE, Kardeş H, Yılmaz HL, Yıldızdaş D, Gökulu G, Çay P, Özer U, Güleryüz OD, Çolak Ö, Güneysu ST. COVID-19 disease in children presenting to the pediatric emergency department: A multicenter study with 8886 cases from Turkey. Am J Emerg Med 2022; 59:133-140. [PMID: 35849960 PMCID: PMC9181308 DOI: 10.1016/j.ajem.2022.06.015] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/03/2022] [Accepted: 06/04/2022] [Indexed: 11/16/2022] Open
Abstract
Background The aim was to evaluate the epidemiological, clinical, laboratory, and radiologic data of children with SARS-CoV-2 positivity by polymerase chain reaction (PCR) together with treatment strategies and clinical outcomes and to evaluate cases of multisystem inflammatory syndrome in children (MIS-C) in this population. Methods This was a multicenter retrospective observational cohort study performed in the pediatric emergency departments of 19 tertiary hospitals. From March 11, 2020, to May 31, 2021, children who were diagnosed with confirmed nasopharyngeal/tracheal specimen SARS-CoV-2 PCR positivity or positivity for serum-specific antibodies against SARS-CoV-2 were included. Demographics, presence of chronic illness, symptoms, history of contact with SARS-CoV-2 PCR-positive individuals, laboratory and radiologic investigations, clinical severity, hospital admissions, and prognosis were recorded. Results A total of 8886 cases were included. While 8799 (99.0%) cases resulted in a diagnosis of SARS-CoV-2 with PCR positivity, 87 (1.0%) patients were diagnosed with MIS-C. Among SARS-CoV-2 PCR-positive patients, 51.0% were male and 8.5% had chronic illnesses. The median age was 11.6 years (IQR: 5.0–15.4) and 737 (8.4%) patients were aged <1 year. Of the patients, 15.5% were asymptomatic. The most common symptoms were fever (48.5%) and cough (30.7%) for all age groups. There was a decrease in the rate of fever as age increased (p < 0.001); the most common age group for this symptom was <1 year with the rate of 69.6%. There was known contact with a SARS-CoV-2 PCR-positive individual in 67.3% of the cases, with household contacts in 71.3% of those cases. In terms of clinical severity, 83 (0.9%) patients were in the severe-critical group. There was hospital admission in 1269 (14.4%) cases, with 106 (1.2%) of those patients being admitted to the pediatric intensive care unit (PICU). Among patients with MIS-C, 60.9% were male and the median age was 6.4 years (IQR: 3.9–10.4). Twelve (13.7%) patients presented with shock. There was hospital admission in 89.7% of these cases, with 29.9% of the patients with MIS-C being admitted to the PICU. Conclusion Most SARS-CoV-2 PCR-positive patients presented with a mild clinical course. Although rare, MIS-C emerges as a serious consequence with frequent PICU admission. Further understanding of the characteristics of COVID-19 disease could provide insights and guide the development of therapeutic strategies for target groups.
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Affiliation(s)
- Murat Duman
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey.
| | - Nihan Şık
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Özlem Tekşam
- Hacettepe University Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Halise Akça
- Ankara City Hospital, Department of Pediatric Emergency Medicine, Ankara, Turkey
| | - Funda Kurt
- Ankara City Hospital, Department of Pediatric Emergency Medicine, Ankara, Turkey
| | - Ayla Akca Çağlar
- Ankara City Hospital, Department of Pediatric Emergency Medicine, Ankara, Turkey
| | - Leman Akcan Yıldız
- Ankara City Hospital, Department of Pediatric Emergency Medicine, Ankara, Turkey
| | - Medine Ayşin Taşar
- University of Health Sciences, Ankara Training and Research Hospital, Pediatric Emergency Department, Ankara, Turkey
| | - İlknur Fidancı
- University of Health Sciences, Ankara Training and Research Hospital, Pediatric Emergency Department, Ankara, Turkey
| | - Burcu Ceylan Cura Yayla
- University of Health Sciences, Ankara Training and Research Hospital, Pediatric Emergency Department, Ankara, Turkey
| | - Durgül Yılmaz
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Emre Güngör
- Hacettepe University Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Şule Demir
- Aydın Gynecology and Childhood Hospital, Pediatric Emergency Department, Aydın, Turkey
| | - Haluk Çokuğraş
- Cerrahpasa Faculty of Medicine, İstanbul University-Cerrahpasa, Istanbul, Turkey
| | - Sinem Oral Cebeci
- Cerrahpasa Faculty of Medicine, İstanbul University-Cerrahpasa, Istanbul, Turkey
| | - Pınar Önal
- Cerrahpasa Faculty of Medicine, İstanbul University-Cerrahpasa, Istanbul, Turkey
| | | | | | - Metin Uysalol
- Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Division of Pediatric Emergency, Istanbul, Turkey
| | - Raif Yıldız
- Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Division of Pediatric Emergency, Istanbul, Turkey
| | - Süheyla Gümüş
- Istanbul University, Istanbul Faculty of Medicine, Department of Pediatrics, Division of Pediatric Emergency, Istanbul, Turkey
| | - Alkan Bal
- Manisa Celal Bayar University Faculty of Medicine, Hafsa Sultan Hospital, Manisa, Turkey
| | - Semra Şen Bayturan
- Manisa Celal Bayar University Faculty of Medicine, Hafsa Sultan Hospital, Manisa, Turkey
| | - Neslihan Zengin
- Manisa Celal Bayar University Faculty of Medicine, Hafsa Sultan Hospital, Manisa, Turkey
| | - Sinem Atik
- Manisa Celal Bayar University Faculty of Medicine, Hafsa Sultan Hospital, Manisa, Turkey
| | - Dilek Yılmaz Çiftdoğan
- Pediatric Emergency Medicine Clinic, University of Health Sciences, Tepecik Education and Research Hospital, Izmir, Turkey
| | - Emel Berksoy
- Pediatric Emergency Medicine Clinic, University of Health Sciences, Tepecik Education and Research Hospital, Izmir, Turkey
| | - Alper Çiçek
- Pediatric Emergency Medicine Clinic, University of Health Sciences, Tepecik Education and Research Hospital, Izmir, Turkey
| | - Sabiha Şahin
- Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Mahmut Can Kızıl
- Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Yalçın Kara
- Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Hurşit Apa
- Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Izmir, Turkey
| | - Emel Ulusoy
- Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Izmir, Turkey
| | - Aybüke Akaslan Kara
- Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Izmir, Turkey
| | - Edanur Yesil
- Mersin City Training and Research Hospital, Mersin, Turkey
| | - Meltem Erdem
- Mersin City Training and Research Hospital, Mersin, Turkey
| | - Caner Turan
- Mersin City Training and Research Hospital, Mersin, Turkey
| | - Sertac Arslanoglu
- Istanbul Medeniyet University Faculty of Medicine, Goztepe Prof Dr Suleyman Yalcin City Hospital, Istanbul, Turkey
| | - Muhterem Duyu
- Istanbul Medeniyet University Faculty of Medicine, Goztepe Prof Dr Suleyman Yalcin City Hospital, Istanbul, Turkey
| | - Gulser Esen Besli
- Istanbul Medeniyet University Faculty of Medicine, Goztepe Prof Dr Suleyman Yalcin City Hospital, Istanbul, Turkey
| | - Gazi Arslan
- Derince Training and Research Hospital, Kocaeli, Turkey
| | - Ayşe Tolunay Oflu
- Afyonkarahisar Health Sciences University Faculty of Medicine, Department of Pediatrics, Afyon, Turkey
| | - Mehmet Çeleğen
- Afyonkarahisar Health Sciences University Faculty of Medicine, Department of Pediatrics, Afyon, Turkey
| | - Ebru Buldu
- Afyonkarahisar Health Sciences University Faculty of Medicine, Department of Pediatrics, Afyon, Turkey
| | - İbrahim Etem Pişkin
- Zonguldak Bulent Ecevit University Faculty of Medicine, Department of Pediatrics, Zonguldak, Turkey
| | - Hakan Kardeş
- Zonguldak Bulent Ecevit University Faculty of Medicine, Department of Pediatrics, Zonguldak, Turkey
| | | | | | - Gamze Gökulu
- Cukurova University, Faculty of Medicine, Adana, Turkey
| | - Pınar Çay
- Cukurova University, Faculty of Medicine, Adana, Turkey
| | - Utku Özer
- Cukurova University, Faculty of Medicine, Adana, Turkey
| | | | - Özlem Çolak
- Gazi University, Faculty of Medicine, Department of Pediatric Emergency, Ankara, Turkey
| | - Songül Tomar Güneysu
- Gazi University, Faculty of Medicine, Department of Pediatric Emergency, Ankara, Turkey
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Şık N, Çakan Başerdem KA, Başerdem O, Appak Ö, Sayıner AA, Yılmaz D, Duman M. Distribution of Viral Respiratory Pathogens During the COVID-19 Pandemic: A Single-Center Pediatric Study from Turkey. Turk Arch Pediatr 2022; 57:354-359. [PMID: 35781241 PMCID: PMC9131830 DOI: 10.5152/turkarchpediatr.2022.21350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Objective To evaluate the distribution and characteristics of respiratory viral pathogens and to assess the epidemiological data, clinical features, and prognoses of infected children in a pediatric emergency department during the COVID-19 pandemic. Materials and Methods Between September 1, 2020, and April 30, 2021, patients aged between 0 and 18 years arrived at the pediatric emergency department and were tested by nasopharyngeal/tracheal specimen polymerase chain reaction for both SARS-CoV-2 and other viral respiratory pathogens. Demographics, symptoms, laboratory and radiologic investigations, respiratory viruses detected by PCR, presence of co-infection and co-infecting viruses, need for respiratory support, hospitalization, length of hospital stay, and prognosis were recorded. Results There were 327 patients for whom PCR tests were performed and 118 (36.0%) of them had positive results for SARS-CoV-2 and/or other respiratory viruses. Rhinovirus was the most commonly detected pathogen with 74 (62.7%) cases, followed by enterovirus with 38 (32.2%) and adenovirus with 20 (16.9%) cases. There was no detection of influenza virus or respiratory syncytial. SARS-CoV-2 PCR results were positive in 14 (11.9%) cases and there was only 1 co-infection of SARS-CoV-2 occurring together with rhinovirus. For 43 (36.4%) patients, there was co-infection, and among co-infections, the most common was that of rhinovirus and enterovirus, seen in 37 (86.0%) cases. Conclusion A decrease was observed in the positivity rate of respiratory viral pathogens, while no cases of influenza virus or respiratory syncytial virus were observed in our study. Circulating viruses may change due to multifactorial approaches during the COVID-19 pandemic.
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Affiliation(s)
- Nihan Şık
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | | | - Oğuzhan Başerdem
- Department of Pediatrics, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Özgür Appak
- Department of Medical Microbiology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Ayça Arzu Sayıner
- Department of Medical Microbiology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Durgül Yılmaz
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Murat Duman
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
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Şık N, Şenol HB, Çağlar A, Yılmaz D, Duman M. Early application of non-invasive ventilation for children with pulmonary edema after drowning. Pediatr Int 2022; 64:e14858. [PMID: 34057774 DOI: 10.1111/ped.14858] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 12/13/2020] [Revised: 02/15/2021] [Accepted: 05/27/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND The present study aimed to assess the efficacy of non-invasive ventilation (NIV) on the clinical course, oxygenation, need for invasive mechanical ventilation (IMV), and outcomes for children with pulmonary edema after drowning. METHODS We conducted a retrospective chart review. Children who were referred to the pediatric emergency department due to drowning-related pulmonary edema and underwent NIV between May 2014 and October 2020 were included. Demographics, vital signs, clinical findings, and results of laboratory and radiologic investigations were recorded. Patients were divided into six groups using the Szpilman classification system. The need for IMV, the need for pediatric intensive care unit admission, and the length of NIV treatment and stay in the pediatric intensive care unit were recorded for each patient. RESULTS Twenty-five patients were enrolled. According to the Szpilman classification, 13 (52.0%) patients were evaluated as grade 3 and 12 (48.0%) as grade 4. All patients were treated with bi-level positive airway pressure in the spontaneous / timed mode. A significant increase in oxygen saturation (SpO₂) and SpO₂/fraction of inspired oxygen ratios was observed from the beginning of NIV treatment and this increase was also observed for the second and fourth hours. There was a decrease in respiratory rate at the fourth hour of NIV treatment. No patient subsequently deteriorated to require IMV. CONCLUSIONS We have reported a favorable clinical course of drowning patients who underwent early use of NIV in the pediatric emergency department. Management of drowning patients with pulmonary edema by NIV with close follow-up can be successfully applied in selected cases.
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Affiliation(s)
- Nihan Şık
- Division of Pediatric Emergency Care, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Hüseyin Bahadır Şenol
- Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Aykut Çağlar
- Division of Pediatric Emergency Care, Department of Pediatrics, Faculty of Medicine, Adnan Menderes University, Aydın, Turkey
| | - Durgül Yılmaz
- Division of Pediatric Emergency Care, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Murat Duman
- Division of Pediatric Emergency Care, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
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Şık N, Çakan Başerdem KA, Akyol Ş, Tüfekçi Ö, Yılmaz D, Duman M. Bicytopenia in a 15-Year-Old Adolescent: A Rare Side Effect of Fusidic Acid. Turk Arch Pediatr 2021; 56:654-656. [DOI: 10.5152/turkarchpediatr.2021.21155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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10
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Şık N, Çakan Başerdem KA, Akyol Ş, Tüfekçi Ö, Yılmaz D, Duman M. Pediatric Astrovirus Gastroenteritis: One-Year Prospective Irish Study. Turk Arch Pediatr 2021; 56:650-653. [PMID: 35110069 PMCID: PMC8848637 DOI: 10.5152/turkarchpediatr.2021.21184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Nihan Şık
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | | | - Şefika Akyol
- Division of Pediatric Hematology Oncology, Department of Pediatrics, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Özlem Tüfekçi
- Division of Pediatric Hematology, Department of Pediatrics, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Durgül Yılmaz
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Murat Duman
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylul University School of Medicine, Izmir, Turkey
- Corresponding author:Murat Duman✉
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Şık N, Uzun A, Öztürk A, Tüfekçi Ö, Yılmaz Ş, Yılmaz D, Ören H, Duman M. Pediatric trauma: Blood product transfusion characteristics in a pediatric emergency department, a single center experience. Transfus Apher Sci 2021; 61:103288. [PMID: 34627713 DOI: 10.1016/j.transci.2021.103288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/28/2021] [Accepted: 09/30/2021] [Indexed: 11/27/2022]
Abstract
AIM To investigate clinical and laboratory data, management and outcomes of pediatric trauma patients who initially received blood product transfusions. METHODS Between January 2011-January 2021, traumatic children who underwent blood product transfusions within 24 h of arrival at the emergency department were included. Demographics, clinical and laboratory data, Injury Severity Score (ISS), volume of transfused blood products and crystalloid boluses in 24 h were recorded. Massive transfusion (MT) was defined as transfusion of ≥40 mL/kg of all blood products in 24 h. RESULTS Among 32 cases, 8 (25.0 %) patients met the MT threshold criterion. Length of pediatric intensive care unit (PICU) stay and mechanical ventilation (MV) were longer for patients who received MT although there was no difference for age, ISS, volume of crystalloid boluses, length of hospital stay, and 30-day mortality between those who received MT or not. Volume of crystalloid boluses was higher in patients who died than those who survived but the volume of blood products was similar for two groups. An APTT value of >37.5 s was identified as a predictor of 30-day mortality (OR = 48.000, 95 % CI: 3.704-621.998, p: 0.003). CONCLUSION Children who received MT had longer durations of MV and PICU stay than those who did not receive, but there was no significance for ISS, volume of crystalloid boluses, hospital stay, or mortality between two groups. Volume of crystalloid boluses was higher in patients who died than those who survived. An APTT value of >37.5 s can be used to predict 30-day mortality.
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Affiliation(s)
- Nihan Şık
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Aslıhan Uzun
- Department of Pediatrics, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Ali Öztürk
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Özlem Tüfekçi
- Division of Pediatric Hematology, Department of Pediatrics, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Şebnem Yılmaz
- Division of Pediatric Hematology, Department of Pediatrics, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Durgül Yılmaz
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Hale Ören
- Division of Pediatric Hematology, Department of Pediatrics, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Murat Duman
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey.
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Şık N, Duman M, Yılmaz D, Karaoğlu Asrak H, Erbaş İC, Çakıl Güzin A, Özdem Alataş Ş, Appak Ö, Sayıner AA, Belet N. Evaluation of COVID-19 Disease and the Effect of Trends in Intervention Measures: The Pediatric Perspective from a Tertiary Care Hospital in Turkey. Balkan Med J 2021; 38:222-228. [PMID: 34274911 PMCID: PMC8880974 DOI: 10.5152/balkanmedj.2021.21045] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: COVID-19 is an emerging disease of global public health concern. Aims: To evaluate the epidemiological, clinical, laboratory, and radiologic findings and the clinical outcomes of children who were diagnosed with SARS-CoV-2 by polymerase chain reaction (PCR), and to evaluate the effect of the trends in intervention measures. Study Design: Between April 2, 2020 and January 16, 2021, children aged 0-18 years who had presented at the pediatric emergency department and were diagnosed with confirmed SARS-CoV-2 by PCR were enrolled. Methods: Details on demographics, epidemiologic characteristics, clinical findings, laboratory data, and radiologic investigations, hospital admissions, and prognosis were recorded. According to clinical severity, patients were divided into 5 groups as asymptomatic, mild, moderate, severe, or critical. We classified the outbreak into 3 periods. The first was between April 2, 2020, the date when the first pediatric case of our hospital was detected, and June 1, 2020, when restrictive measures were relaxed. The second period was between June 1, 2020 and November 15, 2020, when restrictive measures were re-implemented. The third period was between November 15, 2020 and January 16, 2021. Results: A total of 600 patients [median age: 10.3 years (IQR: 4.4-15.1); 304 females] were enrolled. Among them, 25.0% were asymptomatic, while the 3 most common symptoms among symptomatic cases were fever, cough, and fatigue. There was contact with a COVID-19 PCR-positive individual in 73.5% of the cases, with 76.6% of those being a household contact. There were 23 (3.9%) moderate, severe, or critical cases in terms of clinical severity. The presence of chronic disease, a pathological physical chest examination, and procalcitonin levels of >0.05 ng/mL were identified as predictors of being moderate, severe, or critical. Twenty-four (4.0%) patients were admitted to the hospital; 14 (2.3%) to the ward and 10 (1.6%) to the pediatric intensive care unit. In the second intervention period, we observed a rapidly increasing number of new cases daily, especially in August. From September, an increase was observed, being particularly marked from October to November 18. Since then, there was a decrease in the daily number of cases. Conclusion: The majority of the cases were asymptomatic or had a mild clinical presentation. The presence of chronic disease, a pathological physical chest examination, and procalcitonin levels of >0.05 ng/mL were identified as predictors of being moderate, severe, or critical in terms of clinical severity. Strict intervention measures seem to be effective in containing the spread of COVID-19.
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Affiliation(s)
- Nihan Şık
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Murat Duman
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Durgül Yılmaz
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Hatice Karaoğlu Asrak
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - İrem Ceren Erbaş
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Ayşe Çakıl Güzin
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Şilem Özdem Alataş
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Özgür Appak
- Department of Medical Microbiology, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Ayça Arzu Sayıner
- Department of Medical Microbiology, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Nurşen Belet
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Dokuz Eylül University School of Medicine, İzmir, Turkey
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Şık N, Erbaş İM, Demir K, Yılmaz D, Duman M. Bedside sonographic measurements of optic nerve sheath diameter in children with diabetic ketoacidosis. Pediatr Diabetes 2021; 22:618-624. [PMID: 33538381 DOI: 10.1111/pedi.13188] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Received: 12/05/2020] [Revised: 01/19/2021] [Accepted: 01/29/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Bedside sonographic assessment of the optic nerve sheath has gained popularity for evaluating intracranial pressure in recent years. OBJECTIVE To investigate the bedside sonographic measurements of optic nerve sheath diameter (ONSD) and ONSD/eyeball diameter ratios, which are related with cerebral edema (CE), in children with diabetic ketoacidosis (DKA) before and after treatment. METHODS Children aged 12 months to 18 years, who were diagnosed with DKA were included. The ONSD was measured at 3 mm posterior to the globe in the anterior axial transbulbar view. The eyeball transverse diameter (ETD) and eyeball vertical diameter (EVD) were measured and ratios of ONSD/ETD and ONSD/EVD were calculated. Bedside ultrasound (US) examinations were performed at the beginning and at the end of fluid therapy. RESULTS About 43 patients were enrolled. About 12 (27.9%) patients had mild, 14 (32.6%) moderate, and 17 (39.5%) severe DKA. At baseline, the ONSD measurements and ratios were significantly higher in severe DKA group than in those with mild or moderate DKA group. All ONSD measurements, ONSD/ETD, and ONSD/EVD ratios at the end of therapy were significantly lower compared with baseline measurements. At the end of therapy, ONSD measurements and ratios were similar among DKA severity groups. CONCLUSION The ONSD measurements and ratios decreased from the beginning of DKA treatment, which could be considered as an indicator of an increase in intracranial pressure at the time of admission. Ocular US may serve as a promising tool to perform further risk stratification of children with DKA and to identify DKA-related CE.
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Affiliation(s)
- Nihan Şık
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - İbrahim Mert Erbaş
- Division of Pediatric Endocrinology, Department of Pediatrics, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Korcan Demir
- Division of Pediatric Endocrinology, Department of Pediatrics, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Durgül Yılmaz
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Murat Duman
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
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Şık N, Çitlenbik H, Öztürk A, Yılmaz D, Duman M. Point of care diaphragm ultrasound: An objective tool to predict the severity of pneumonia and outcomes in children. Pediatr Pulmonol 2021; 56:1666-1672. [PMID: 33656255 DOI: 10.1002/ppul.25352] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 02/25/2021] [Accepted: 02/28/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Pneumonia is one of the most common serious infections in children. Scoring systems have been adopted to quantify the severity of the disease, but they were based on clinical findings that can vary according to the subjective assessment of the clinician. We hypothesized that diaphragm ultrasound (DUS) parameters may be a new useful tool to objectively score the severity of the disease and predict outcomes in children with pneumonia. METHODS Children diagnosed with pneumonia, aged between 1 month and 18 years, were prospectively evaluated in the pediatric emergency department. The Pediatric Respiratory Severity Score was used to indicate the severity of the disease and DUS was performed. Diaphragm thickness at the end of inspiration and expiration, thickening fraction (TF), diaphragm excursion, inspiratory slope (IS), expiratory slope (ES), and total duration time of the respiratory cycle were calculated. RESULTS There were 96 patients enrolled in the study. Inspiratory slope and ES measurements had positive correlations with respiratory rate and length of stay in the hospital and negative correlations with oxygen saturation levels. Furthermore, TF values were negatively correlated with respiratory rate and length of stay in the emergency department. Patients with higher clinical scores had increased IS and ES and decreased TF values. CONCLUSION DUS can be a promising and useful tool to assess diaphragmatic dysfunction in patients diagnosed with pneumonia. Diaphragm parameters, especially TF, IS, and ES, may provide objective and reliable information to predict the severity of the illness, the need for respiratory support, and outcomes.
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Affiliation(s)
- Nihan Şık
- Division of Pediatric Emergency Care, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Hale Çitlenbik
- Division of Pediatric Emergency Care, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Ali Öztürk
- Division of Pediatric Emergency Care, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Durgül Yılmaz
- Division of Pediatric Emergency Care, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Murat Duman
- Division of Pediatric Emergency Care, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
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15
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Şık N, Öztürk A, Koşay MC, Yılmaz D, Duman M. Accuracy of point-of-care ultrasound for determining the adequacy of pediatric forearm fracture reductions. Am J Emerg Med 2021; 48:243-248. [PMID: 33992985 DOI: 10.1016/j.ajem.2021.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/05/2021] [Accepted: 05/05/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The objective of the present study was to the determine the accuracy of point-of-care ultrasound (POCUS) in assessing closed reduction (CR) of pediatric forearm fractures in a pediatric emergency setting. METHODS After determination of the need for CR using X-ray images by an orthopedic consultant, POCUS examinations were performed just before and after the reduction attempt. The transducer was positioned longitudinally over the dorsal, volar, and lateral surfaces of the radius and ulna to view the fracture site. The presence of angulation, displacement, or bayonetting of the fracture fragments was recorded. The adequacy of realignment according to the POCUS and the orthopedic consultant's final determination were recorded. RESULTS Sixty-two patients were enrolled in the study and 96 bones were evaluated. The sensitivity and specificity of POCUS for adequacy of CR were 95.8% [95% confidence interval (CI): 88.3-99.1)] and 95.8% (95% CI: 78.8-99.8), the positive predictive value was 98.5% (95% CI: 91.0-99.7), and the negative predictive value was 88.4% (95% CI: 71.6-95.8). The corresponding positive and negative likelihood ratios were 23 (3.37-156.77) and 0.04 (0.01-0.12). There was high agreement between POCUS and X-ray images for predicting adequacy of CR [κ: 0.892 (±0.053)]. There was also a significant correlation between POCUS and X-ray measurements of angulation and displacement performed before and after CR, respectively (p < 0.001). CONCLUSION Our study has reported the successful use of POCUS for the management of pediatric forearm fractures in a pediatric emergency department. Point-of-care ultrasound can minimize radiation exposure and appears to be an alternative and accurate tool for reduction attempts.
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Affiliation(s)
- Nihan Şık
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Ali Öztürk
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Mustafa Can Koşay
- Department of Orthopedics and Traumatology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Durgül Yılmaz
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Murat Duman
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey.
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Şık N, Çitlenbik H, Öztürk A, Yılmaz D, Duman M. Point of care diaphragm ultrasound in acute bronchiolitis: A measurable tool to predict the clinical, sonographic severity of the disease, and outcomes. Pediatr Pulmonol 2021; 56:1053-1059. [PMID: 33442908 DOI: 10.1002/ppul.25268] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Received: 09/14/2020] [Revised: 12/04/2020] [Accepted: 01/07/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The aim of this study was to evaluate diaphragmatic parameters in bronchiolitis patients and identify correlations between clinical and sonographic severity scores and outcomes to develop a more objective and useful tool in the emergency department. METHODS Children aged between 1 and 24 months and diagnosed with acute bronchiolitis were included in the study. The Modified Respiratory Distress Assessment Instrument (mRDAI) score was used to quantify the clinical severity of the disease. Lung ultrasound was performed and a bronchiolitis ultrasound score (BUS) was calculated. Diaphragm ultrasound was then performed and diaphragm thickness at the end of inspiration and expiration, thickening fraction, diaphragm excursion (EXC), inspiratory slope (IS), expiratory slope (ES), and total duration time of the respiratory cycle were measured. RESULTS There were 104 patients evaluated in this study. The mRDAI score and BUS had a significant positive correlation. There was a positive correlation between IS and respiratory rate at admission. As the clinical score increased, IS, ES, and EXC measurements rose and they were positively correlated. Values of IS, ES, and EXC were higher in the moderate-severe group than the mild group for both mRDAI and BUS scores. Inspiratory slope values were correlated with the length of stay in the hospital. CONCLUSION Values of IS and ES were correlated with clinical and sonographic severity scores. Moreover, IS was a good predictor of outcome. Diaphragm ultrasound appears to be an objective and useful tool to help the physician make decisions regarding the evaluation and management of bronchiolitis.
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Affiliation(s)
- Nihan Şık
- Division of Pediatric Emergency Care, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Hale Çitlenbik
- Division of Pediatric Emergency Care, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Ali Öztürk
- Division of Pediatric Emergency Care, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Durgül Yılmaz
- Division of Pediatric Emergency Care, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Murat Duman
- Division of Pediatric Emergency Care, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
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Şık N, Özlü C, Karaoğlu Asrak H, Erbaş İC, Çakıl Güzin A, Atakul G, Atay Ö, Appak Ö, Sayıner AA, Uzuner N, Asilsoy S, Belet N, Yılmaz D, Duman M. [Evaluation of SARS-CoV-2 PCR Positive Cases in the Pediatric Emergency Department]. MIKROBIYOL BUL 2020; 54:629-637. [PMID: 33107292 DOI: 10.5578/mb.70086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In December 2019, a previously unknown type of coronavirus was detected in China and named as "severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)". The World Health Organization has named the SARS-CoV-2 related as coronavirus disease-2019 (COVID-19) and declared it as a pandemic. There is a limited data about the COVID-19 disease for the pediatric patients. In this study, it was aimed to evaluate the epidemiological, clinical, laboratory and radiologic findings, treatment and clinical outcomes of patients admitted to the pediatric emergency department with the suspicion of COVID-19. Between March 11 and June 16, 2020, patients aged between 1 month-18 years admitted to the pediatric emergency department and who have an indication for sampling for the polymerase chain reaction (PCR) method with the suspicion of COVID-19 according to the current guidelines published by the Ministry of Health were included in the study. The demographic characteristics, symptoms, durations and the history of contact with the suspected/definite COVID-19 cases were questioned in the patients with positive results. Physical examination, laboratory and imaging data of the patients were recorded. According to clinical severity, patients were divided into five groups. Treatment methods, ward/intensive care unit admission, length of stay at hospital, and prognosis were recorded. Of the 237 patients included in the study, 45 (18.9%) of the samples were positive and 192 (81.1%) were negative. There was a history of contact with COVID-19 positive case in 38 (85.6%) of COVID-19 PCR positive patients. The mean time for onset of symptoms after contact was 3.5 ± 1.7 days. Twenty-one of the patients (46.6%) were asymptomatic and the most common symptom was fever (34.1%) and cough (27.3%). Of the patients whose laboratory tests were requested, lymphopenia wasdetected in 50% and 52.3% of procalcitonin, 23.5% of C-reactive protein and 64.7% of D-dimer values were found to be high. Chest radiography was obtained from 45.4% of the patients; 90.0% were evaluated as normal, bronchovascular change, pleural effusion and consolidation were detected in one of each (5.0%) patient. Thorax computed tomography (CT) was obtained from 4 (9.0%) patients. One patient had normal CT findings, two patients had consolidation, one patient had peripheral ground-glass appearance and one patient had pleural effusion. Antibiotics were started in 38.6% of the patients and the most commonly used antibiotic was azithromycin (34.1%). Oseltamivir was started in one (2.3%) patient, and 10 (24.7%) patients were treated with hydroxychloroquine. There were no serious and critical cases according to the clinical severity. Pediatric patients constitute a small part of COVID-19 individuals in the community, and a significant part of them are asymptomatic, and patients who are symptomatic present with a mild clinic. In our study, most of the patients had a history of contact with COVID-19 positive cases, therefore, it should be questioned when evaluating a pediatric patient. There were no specific findings for COVID-19 positive patients in terms of laboratory and radiology.
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Affiliation(s)
- Nihan Şık
- Dokuz Eylul University Faculty of Medicine, Department of Pediatrics, Izmir, Turkey
| | - Canan Özlü
- Dokuz Eylul University Faculty of Medicine, Department of Pediatrics, Izmir, Turkey
| | | | - İrem Ceren Erbaş
- Dokuz Eylul University Faculty of Medicine, Department of Pediatrics, Izmir, Turkey
| | - Ayşe Çakıl Güzin
- Dokuz Eylul University Faculty of Medicine, Department of Pediatrics, Izmir, Turkey
| | - Gizem Atakul
- Dokuz Eylul University Faculty of Medicine, Department of Pediatrics, Izmir, Turkey
| | - Özge Atay
- Dokuz Eylul University Faculty of Medicine, Department of Pediatrics, Izmir, Turkey
| | - Özgür Appak
- Dokuz Eylul University Faculty of Medicine, Department of Medical Microbiology, Izmir, Turkey
| | - Ayça Arzu Sayıner
- Dokuz Eylul University Faculty of Medicine, Department of Medical Microbiology, Izmir, Turkey
| | - Nevin Uzuner
- Dokuz Eylul University Faculty of Medicine, Department of Pediatrics, Izmir, Turkey
| | - Suna Asilsoy
- Dokuz Eylul University Faculty of Medicine, Department of Pediatrics, Izmir, Turkey
| | - Nurşen Belet
- Dokuz Eylul University Faculty of Medicine, Department of Pediatrics, Izmir, Turkey
| | - Duygül Yılmaz
- Dokuz Eylul University Faculty of Medicine, Department of Pediatrics, Izmir, Turkey
| | - Murat Duman
- Dokuz Eylul University Faculty of Medicine, Department of Pediatrics, Izmir, Turkey
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Ulusoy E, Çitlenbik H, Akgül F, Öztürk A, Şık N, Ulusoy O, Küme T, Yılmaz D, Duman M. Is Ischemia-Modified Albumin a Reliable Marker in Accurate Diagnosis of Appendicitis in Children? World J Surg 2019; 44:1309-1315. [PMID: 31820057 DOI: 10.1007/s00268-019-05323-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 01/20/2023]
Abstract
BACKGROUND Acute appendicitis is one of the most common abdominal emergencies. Despite all improvements in diagnostic techniques, there are still ongoing problems as proper diagnosis, misdiagnosis and perforated appendicitis. The aim of this study is to demonstrate the clinical value of IMA in patients with appendicitis and to determine the accurate diagnosis of appendicitis in clinically suspected patients. METHODS Pediatric patients with acute abdominal pain who had the Pediatric Appendicitis Score (PAS) ≥ 7 (n = 109) and a control group of 35 patients were included in this prospective case-control study. Patients were divided into two groups: patients with appendicitis (pathologically confirmed) (n = 78) and no appendicitis (n = 31). No appendicitis included observation patients and negative appendectomy. Serum samples were collected for routine laboratory parameters and IMA before surgery. RESULTS Patients with appendicitis had significantly higher IMA levels than no appendicitis and control groups (p = 0.001 and p < 0.001; respectively). Moreover, patients with negative appendectomy had significantly lower IMA levels than patients with appendicitis (p = 0.009). IMA and PAS were used together, and in the ROC analysis, we obtained 0.81 AUC for PAS and 0.89 AUC for PAS and IMA. CONCLUSION The current study indicated that IMA is a reliable marker for accurate diagnosis of appendicitis. The combination of IMA with PAS score has been shown to facilitate the diagnosis of appendicitis.
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Affiliation(s)
- Emel Ulusoy
- Department of Pediatrics, Division of Pediatric Emergency Care, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Hale Çitlenbik
- Department of Pediatrics, Division of Pediatric Emergency Care, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Fatma Akgül
- Department of Pediatrics, Division of Pediatric Emergency Care, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Ali Öztürk
- Department of Pediatrics, Division of Pediatric Emergency Care, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Nihan Şık
- Department of Pediatrics, Division of Pediatric Emergency Care, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Oktay Ulusoy
- Department of Pediatric Surgery, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Tuncay Küme
- Department of Biochemistry, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Durgül Yılmaz
- Department of Pediatrics, Division of Pediatric Emergency Care, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Murat Duman
- Department of Pediatrics, Division of Pediatric Emergency Care, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey.
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