Predictors and risk factors for admission to critical care in cervicofacial infections: a Maxillofacial Trainee Research Collaborative (MTReC) study

Cervicofacial infections carry significant morbidity. Patients present on a broad spectrum of severity, with some requiring outpatient management and others admission to higher level care. Recognition of risk factors is helpful in decision making regarding the need for admission to higher level care. Prospective data were captured on 1002 patients in 25 centres across 17 regions of the United Kingdom (UK) by the Maxillofacial Trainee Research Collaborative (MTReC). Patients admitted to critical care were compared with those who received ward-level care. Multivariate and receiver operating characteristic curve analyses were used to identify predictors for critical care admission. Our results show that the best predictor for critical care admission is the presence of three or more features of airway compromise (AUC 0.779), followed by C-reactive protein (CRP) >100 mg/L (OR 2.70; 95% CI 1.59 to 4.58; p < 0.005), submandibular space involvement (OR 3.82; 95% CI 1.870 to 7.81; p = 0.003), white cell count (WCC) >12 × 10⁹/ dl (1.05; 95% CI 1.01 to 1.10; p = 0.03), and positive systemic inflammatory response syndrome criteria (OR 2.78; CI 1.35 to 5.80; p = 0.006). Admission to critical care is multifactorial, however, the presence of three or more features of airway compromise is the best predictor. Awareness of this alongside other key clinical findings in cervicofacial infections may allow for the early recognition of patients who may require escalation to critical care.

Primary school children’s diet assessment with a 7-day diary – comparison between Italy and Poland

Background

Dietary habits acquired in childhood are often followed in later life, and if unfavourable may result in negative long-term health consequences. The study aimed to assess diet of primary school children with an interactive 7-day food diary in the form of a colouring book.

Methods

At first the study was conducted among 428 primary school children from Calderara di Reno (Italy). After questionnaire's translation and adjustment, the study continued as a pilot-study among 83 children from Wałbrzych (Poland). Under supervision of parents and teachers children completed a 7-day food diary. The quality of diet was evaluated with KIDMED test. Composition of breakfast was rated due to content of water (+1), carbohydrates (+1), proteins (+1), fibre (+1), vitamins/minerals (+1), free sugars (-1), assuming adequate breakfast if scored &gt; =3 points and contained source of protein or carbohydrates. Statistical analysis with chi-square test was performed.

Results

Adherence to the model diet was medium or high among 64.49% of Italian and 40% of Polish children (p &lt; 0.001). Significantly more Italian children had adequate breakfast each day during a week (51.17% vs 27.71%, p &lt; 0.001) and each school day (51.40% vs 34.94%, p = 0.006). There was no difference in number of children consuming well-balanced breakfast during a weekend (p = 0.749). Consumption of fruits and vegetables in both groups was far below recommended level- 75.9% of Italian and 81.9% of Polish children ate less than 3 portions of fruits and vegetables per day.

Conclusions

The study underlines the need for improvement of children's diet and increase in parent's awareness of family eating habits. This 7-day diary is a innovative tool, which allows identification of incorrect dietary behaviours among children and enables school professionals to design adapted health promotion activities and educational programmes for pupils and parents, aiming to increase knowledge about the role of diet and nutrition in health.

Key messages

There is a constant need for nutritional education and healthy lifestyle promotion among children, parents and teachers. Assessment of children’s diet and screening for unfavourable dietary habits may be helpful in planning health promotion and preventive activities at schools.

Dega pelvic osteotomy: indications, results and complications

PURPOSE

Developmental dysplasia of the hip (DDH) after walking age is difficult to treat. Dega pelvic osteotomy is combined with open reduction and femoral osteotomy to obtain concentric stable reduction with good coverage of the femoral head. The purpose of this study is to evaluate the use of the Dega osteotomy in the treatment of DDH in two different age groups.

METHODS

A total of 45 patients (52 hips) with a mean age of 3.9 years (1.2 to 12.8) were treated with open reduction, Dega osteotomy and femoral osteotomy. There were 38 dislocated and 14 subluxated hips. Bilateral DDH was observed in seven female patients. Radiographic parameters included acetabular index, centre-edge angle of Wiberg and migration percentage. The final radiographic outcome was evaluated according to the Severin classification.

RESULTS

The mean follow-up period was four years (3 to 9). According to the Severin criteria 78.8% were types I or II whereas 21.2% showed types III or IV. There was no statistically significant difference in final outcome between children less than three years of age and older children at the time of surgery.One hip in children with unilateral involvement had developed coxa magna, that interfered with hip concentricity. Three hips (5.8%) showed avascular necrosis of the femoral head.

CONCLUSION

Dega osteotomy is a safe and adequate procedure for the management of developmental dysplasia of the hip in walking patients with low complication rates. Restoring the acetabulum to normal or nearly normal can result in good medium-term results.

LEVEL OF EVIDENCE

III.