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Florin TA, Freedman SB, Xie J, Funk AL, Tancredi DJ, Kim K, Neuman MI, Yock-Corrales A, Bergmann KR, Breslin KA, Finkelstein Y, Ahmad FA, Avva UR, Lunoe MM, Chaudhari PP, Shah NP, Plint AC, Sabhaney VJ, Sethuraman U, Gardiner MA, Sartori LF, Wright B, Navanandan N, Mintegi S, Gangoiti I, Borland ML, Chong SL, Kwok MY, Eckerle M, Poonai N, Romero CMA, Waseem M, Nebhrajani JR, Bhatt M, Caperell K, Campos C, Becker SM, Morris CR, Rogers AJ, Kam AJ, Pavlicich V, Palumbo L, Dalziel SR, Morrison AK, Rino PB, Cherry JC, Salvadori MI, Ambroggio L, Klassen TP, Payne DC, Malley R, Simon NJ, Kuppermann N. Features Associated With Radiographic Pneumonia in Children with SARS-CoV-2. J Pediatric Infect Dis Soc 2024; 13:257-259. [PMID: 38391389 DOI: 10.1093/jpids/piae015] [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: 07/07/2023] [Indexed: 02/24/2024]
Abstract
14% of children with SARS-CoV-2 infections had radiographic pneumonia. Hypoxemia, cough, higher temperature, and older age were associated with pneumonias. In children tested, SARS-CoV-2 test results were not associated with radiographic pneumonia.
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Affiliation(s)
- Todd A Florin
- Division of Emergency Medicine, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Stephen B Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology, Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Jianling Xie
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Anna L Funk
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | | | - Kelly Kim
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Mark I Neuman
- Division of Emergency Medicine, Department of Pediatrics, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Adriana Yock-Corrales
- Department of Emergency Medicine, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", CCSS, San José, Costa Rica
| | - Kelly R Bergmann
- Department of Emergency Medicine, Children's Minnesota, Minneapolis, USA
| | - Kristen A Breslin
- Division of Emergency Medicine, Children's National Hospital, Washington, District of Columbia, USA
| | - Yaron Finkelstein
- Divisions of Emergency Medicine, and Clinical Pharmacology and Toxicology, Department of Pediatrics Hospital for Sick Children, Toronto, Canada
| | - Fahd A Ahmad
- Department of Pediatrics, Washington University School of Medicine, St. Louis, USA
| | - Usha R Avva
- Department of Emergency Medicine, Montefiore-Nyack Hospital, Nyack, New York, USA
| | - Maren M Lunoe
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, USA
| | - Pradip P Chaudhari
- Division of Emergency and Transport Medicine, Children's Hospital Los Angeles and Keck School of Medicine of the University of Southern California, Los Angeles, USA
| | - Nipam P Shah
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, USA
| | - Amy C Plint
- Division of Emergency Medicine, Children's Hospital of Eastern Ontario, Department of Pediatrics, University of Ottawa, Ottawa, Canada
| | - Vikram J Sabhaney
- Department of Paediatrics, University of British Columbia, Vancouver, Canada
| | - Usha Sethuraman
- Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, USA
| | - Michael A Gardiner
- Department of Pediatrics, Rady Children's Hospital, University of California San Diego, San Diego, USA
| | - Laura F Sartori
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Bruce Wright
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Alberta, Stollery Children's Hospital, Women's and Children's Health Research Institute, Edmonton, Canada
| | - Nidhya Navanandan
- Section of Emergency Medicine, Department of Pediatrics, Children's Hospital Colorado, University of Colorado, Aurora, USA
| | - Santiago Mintegi
- Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, UPV/EHU, Bilbao, Basque Country, Spain
| | - Iker Gangoiti
- Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, UPV/EHU, Bilbao, Basque Country, Spain
| | - Meredith L Borland
- Divisions of Emergency Medicine and Paediatrics, School of Medicine, Perth Children's Hospital, University of Western Australia, Perth, Australia
| | - Shu-Ling Chong
- Department of Emergency Medicine, KK Women's and Children's Hospital, Pediatrics Academic Clinical Programme, Emergency Medicine Academic Clinical Programme, Duke-NUS Medical School, Singapore
| | - Maria Y Kwok
- Department of Emergency Medicine, New York Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, NY, New York, USA
| | - Michelle Eckerle
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital, Cincinnati, USA
| | - Naveen Poonai
- Department of Pediatrics, Schulich School of Medicine & Dentistry, London, Canada
| | | | - Muhammad Waseem
- Department of Pediatrics, Lincoln Medical Center, New York City, Bronx, New York, USA
| | | | - Maala Bhatt
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | - Kerry Caperell
- Division of Emergency Medicine, Department of Pediatrics, University of Louisville, Norton Children's Hospital, Louisville, USA
| | - Carmen Campos
- Pediatric Emergency Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Sarah M Becker
- Department of Pediatrics, Primary Children's Hospital, Intermountain Healthcare, Salt Lake City, USA
| | - Claudia R Morris
- Division of Emergency Medicine, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, USA
| | - Alexander J Rogers
- Departments of Emergency Medicine and Pediatrics, University of Michigan School of Medicine, Ann Arbor, USA
| | - April J Kam
- Division of Emergency Medicine, Department of Pediatrics, McMaster Children's Hospital, Hamilton, Canada
| | - Viviana Pavlicich
- Departamento de Emergencia Pediátrica, Facultad de Medicina, Hospital General Pediátrico Niños de Acosta Ñu, Universidad Privada del Pacífico, San Lorenzo, Paraguay
| | - Laura Palumbo
- Department of Pediatrics, ASST Spedali Civili di Brescia - Pronto soccorso pediatrico, Brescia, Italy
| | - Stuart R Dalziel
- Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand
- Departments of Surgery and Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Andrea K Morrison
- Division of Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, USA
| | - Pedro B Rino
- Department of Pediatrics, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", RIDEPLA, Buenos Aires, Argentina
| | - Jonathan C Cherry
- Department of Pediatric Emergency Medicine, IWK Health Centre, Dalhousie University, Halifax, Canada
| | | | - Lilliam Ambroggio
- Section of Emergency Medicine, Department of Pediatrics, Children's Hospital Colorado, University of Colorado, Aurora, USA
| | - Terry P Klassen
- Department of Pediatrics and Child Health, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Canada
| | - Daniel C Payne
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Richard Malley
- Division of Infectious Diseases, Boston Children's Hospital and Harvard Medical School, Boston, USA
| | - Norma-Jean Simon
- Data Analytics and Reporting and Division of Emergency Medicine, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Nathan Kuppermann
- Departments of Emergency Medicine and Pediatrics, University of California, Davis School of Medicine, Sacramento, USA
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Yock-Corrales A, Curto DA, Gerolami A, Mota C, Vigna A, Camacho E, González-Vallejos SC, Copana-Olmos R, Gómez-Vargas J, Cassón N. Characteristics of Transport of Ill Pediatric Patients in the Emergency Department: A Latin America Multicenter Prospective Study. Pediatr Emerg Care 2024; 40:270-273. [PMID: 37272761 DOI: 10.1097/pec.0000000000002981] [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: 06/06/2023]
Abstract
OBJECTIVE The aim was to describe the characteristics of the transport system of critically ill pediatric patients in the emergency departments (EDs) in Latin America (LA). METHODOLOGY This is a prospective cross-sectional study in a 1-year period. Patients were recruited on days 1, 7, 14, 21, and 28 of each month in the EDs in LA. We included ill-pediatric patients aged 1 month to 18 years. Patients who needed transfer for a diagnostic study, with arrival mode not by ambulance, or with the impossibility of interviewing the transfer team were excluded from the study. RESULTS A total of 389 patients were included in the study. The majority were males (57%) with a median age of 49 months (interquartile range, 10-116). Thirty-three percent (129) of transfers had the participation of a coordinating center; 97.1% (375) were carried out by road ambulance, and 84.3% (323) were interhospital transfers, with a mean distance traveled of 83.2 km (SD, 105 km). The main reason for transfer in 88.17% (343) was the need for a more complex health center. The main diagnosis was respiratory distress (71; 18.2%), acute abdomen (70; 18%), Traumatic Brain Injury (33; 8.48%), multiple trauma (32; 8.23%), septic shock (31; 7.9%), and COVID-19-related illness (19; 4.8%). A total of 296 (76.5%) patients had peripheral vascular access, and 171 (44%) patients had oxygen support with 49 (28.6%) having invasive ventilation; the most frequent monitoring method (67.8%) was pulse oximetry, and 83.4% (313) did not record adverse events. Regarding the transfer team, 88% (342) had no specialized personnel, and only 62.4% (243) had a physician on their teams. CONCLUSIONS In LA, there is great variability in personnel training, equipment for pediatric transport, team composition, and characterization of critical care transport systems. Continued efforts to improve conditions in our countries may help reduce patient morbidity and mortality.
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Affiliation(s)
- Adriana Yock-Corrales
- From the Emergency Department, Hospital Nacional de Niños, Dr Carlos Sáenz Herrera, CCSS, San José, Costa Rica
| | - Danila Andrea Curto
- Emergency Department, Hospital Prof Dr J.P. Garrahan, Buenos Aires, Argentina
| | - Andrea Gerolami
- Emergency Department, Centro Hospitalario Pereira Rossell, Montevideo, Uruguay
| | - Cesar Mota
- Emergency Department, Hospital Infantil Dr Robert Reid Cabral, Santo Domingo, Dominican Republic
| | - Andrés Vigna
- Neonatal Intensive Care Unit, Departamento de Neonatología, Centro Hospitalario Pereira Rossell, Asociación Médica de San José, Montevideo, Uruguay
| | - Edgardo Camacho
- Emergency Department, Hospital Materno Infantil, Salta, Argentina
| | | | | | - Jessica Gómez-Vargas
- From the Emergency Department, Hospital Nacional de Niños, Dr Carlos Sáenz Herrera, CCSS, San José, Costa Rica
| | - Nils Cassón
- Pediatric Intensive Care Unit, Hospital de San Juan de Dios, Tarija, Bolivia
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Camporesi A, Yock-Corrales A, Gomez-Vargas J, Roland D, Gonzalez M, Barreiro S, Morello R, Brizuela M, Buonsenso D. Management and outcomes of bronchiolitis in Italy and Latin America: a multi-center, prospective, observational study. Eur J Pediatr 2024:10.1007/s00431-024-05530-6. [PMID: 38554172 DOI: 10.1007/s00431-024-05530-6] [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: 02/15/2024] [Revised: 03/14/2024] [Accepted: 03/15/2024] [Indexed: 04/01/2024]
Abstract
We aimed to describe differences in the epidemiology, management, and outcomes existing between centers located in countries which differ by geographical location and economic status during to post-pandemic bronchiolitis seasons. This was a prospective observational cohort study performed in two academic centers in Latin America (LA) and three in Italy. All consecutive children with a clinical diagnosis of bronchiolitis were included, following the same data collection form. Nine hundred forty-three patients have been enrolled: 275 from the two Latin American Centers (San Jose, 215; Buenos Aires, 60), and 668 from Italy (Rome, 178; Milano, 163; Bologna, 251; Catania, 76). Children in LA had more frequently comorbidities, and only rarely received palivizumab. A higher number of patients in LA had been hospitalized in a ward (64% versus 23.9%, p < 0.001) or in a PICU (16% versus 6.2%, p < 0.001), and children in LA required overall more often respiratory support, from low flow oxygen to invasive mechanical ventilation, except for CPAP which was more used in Italy. There was no significant difference in prescription rates for antibiotics, but a significantly higher number of patients treated with systemic steroids in Italy. CONCLUSIONS We found significant differences in the care for children with bronchiolitis in Italy and LA. Reasons behind such differences are unclear and would require further investigations to optimize and homogenize practice all over the world. WHAT IS KNOWN • Bronchiolitis is among the commest cause of morbidity and mortality in infants all over the world. WHAT IS NEW • There are significant differences on how clinicians care for bronchiolitis in different centers and continents. Differences in care can be principally due to different local practices than differences in patients severity/presentations. • Understanding these differences should be a priority to optime and standardize bronchiolitis care globally.
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Affiliation(s)
- Anna Camporesi
- Division of Pediatric Anesthesia and Intensive Care, Buzzi Children's Hospital, Milano, Italy
| | | | | | - Damian Roland
- SAPPHIRE Group, Department Population Health Sciences, Leicester University, Leicester, UK
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Children's Emergency Department, Leicester Royal Infirmary, Leicester, UK
| | - Magali Gonzalez
- Department Pediatrics Unit, Velez Sarsfield General Hospital, Buenos Aires, Argentina
| | - Sandra Barreiro
- Department Pediatrics Unit, Velez Sarsfield General Hospital, Buenos Aires, Argentina
| | - Rosa Morello
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Martin Brizuela
- Department Pediatrics Unit, Velez Sarsfield General Hospital, Buenos Aires, Argentina
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy.
- Center for Global Health Research Studies, Università Cattolica del Sacro Cuore, Rome, Italy.
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Yock-Corrales A, Lee JH, Domínguez-Rojas JÁ, Caporal P, Roa JD, Fernandez-Sarmiento J, González-Dambrauskas S, Zhu Y, Abbas Q, Kazzaz Y, Dewi DS, Chong SL. A Multicenter Study on the Clinical Characteristics and Outcomes Among Children With Moderate to Severe Abusive Head Trauma. J Pediatr Surg 2024; 59:494-499. [PMID: 37867044 DOI: 10.1016/j.jpedsurg.2023.09.038] [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: 05/21/2023] [Revised: 09/11/2023] [Accepted: 09/24/2023] [Indexed: 10/24/2023]
Abstract
INTRODUCTION We aimed to identify clinical characteristics, risk factors for diagnosis, and describe outcomes among children with AHT. METHODS We performed an observational cohort study in tertiary care hospitals from 14 countries across Asia and Ibero-America. We included patients <5 years old who were admitted to participating pediatric intensive care units (PICUs) with moderate to severe traumatic brain injury (TBI). We performed descriptive analysis and multivariable logistic regression for risk factors of AHT. RESULTS 47 (12%) out of 392 patients were diagnosed with AHT. Compared to those with accidental injuries, children with AHT were more frequently < 2 years old (42, 89.4% vs 133, 38.6%, p < 0.001), more likely to arrive by private transportation (25, 53.2%, vs 88, 25.7%, p < 0.001), but less likely to have multiple injuries (14, 29.8% vs 158, 45.8%, p = 0.038). The AHT group was more likely to suffer subdural hemorrhage (SDH) (39, 83.0% vs 89, 25.8%, p < 0.001), require antiepileptic medications (41, 87.2% vs 209, 60.6%, p < 0.001), and neurosurgical interventions (27, 57.40% vs 143, 41.40%, p = 0.038). Mortality, PICU length of stay, and functional outcomes at 3 months were similar in both groups. In the multivariable logistic regression, age <2 years old (aOR 8.44, 95%CI 3.07-23.2), presence of seizures (aOR 3.43, 95%CI 1.60-7.36), and presence of SDH (aOR 9.58, 95%CI 4.10-22.39) were independently associated with AHT. CONCLUSIONS AHT diagnosis represented 12% of our TBI cohort. Overall, children with AHT required more neurosurgical interventions and the use of anti-epileptic medications. Children younger than 2 years and with SDH were independently associated with a diagnosis of AHT. TYPE OF STUDY Observational cohort study. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Adriana Yock-Corrales
- Emergency Department.Hospital Nacional de Niños ¨Dr. Carlos Sáenz Herrera. CCSS San José, Costa Rica.
| | - Jan Hau Lee
- Children's Intensive Care Unit, KK Women's and Children's Hospital. Singapore
| | | | - Paula Caporal
- Hospital Interzonal Especializado en Pediatría "Sor María Ludovica", Buenos Aires, Argentina
| | - Juan D Roa
- Fundación Homi, Universidad Nacional de Colombia - FUCS, Bogotá, Colombia
| | - Jaime Fernandez-Sarmiento
- Department of Critical Care Medicine and Pediatrics, Universidad de La Sabana. Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
| | - Sebastián González-Dambrauskas
- Departamento de Pediatría y Unidad de Cuidados Intensivos de Niños del Centro Hospitalario Pereira Rossell, Facultad de Medicina, Universidad de la República Montevideo, Uruguay
| | - Yanan Zhu
- Singapore Clinical Research Institute, Consortium for Clinical Research and Innovation. Singapore
| | - Qalab Abbas
- Department of Paediatrics and Child Health Aga Khan University Karachi Pakistan Karachi, Karachi City, Sindh, Pakistan
| | - Yasser Kazzaz
- Department of Paediatrics, Ministry of National Guards Health Affairs, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Centre Riyadh, Saudi Arabia
| | - Dianna Sri Dewi
- KK Research Centre, KK Women's and Children's Hospital, Singapore
| | - Shu-Ling Chong
- Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore
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Fernández-Sarmiento J, Acevedo L, Niño-Serna LF, Boza R, García-Silva J, Yock-Corrales A, Yamazaki-Nakashimada MA, Faugier-Fuentes E, Del Águila O, Camacho-Moreno G, Estripeaut D, Gutiérrez IF, Luciani K, Espada G, Álvarez-Olmos MI, Pérez-Camacho P, Duarte-Passos S, Cervi MC, Cantillano EM, Llamas-Guillén BA, Saltigeral-Simental P, Criales J, Chacon-Cruz E, García-Domínguez M, Aguilar KLB, Jarovsky D, Ivankovich-Escoto G, Tremoulet AH, Ulloa-Gutierrez R. Risk Factors Associated with Intensive Care Admission in Children with Severe Acute Respiratory Syndrome Coronavirus 2-Related Multisystem Inflammatory Syndrome (MIS-C) in Latin America: A Multicenter Observational Study of the REKAMLATINA Network. J Intensive Care Med 2024:8850666241233189. [PMID: 38414438 DOI: 10.1177/08850666241233189] [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] [Indexed: 02/29/2024]
Abstract
Background: Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 varies widely in its presentation and severity, with low mortality in high-income countries. In this study in 16 Latin American countries, we sought to characterize patients with MIS-C in the pediatric intensive care unit (PICU) compared with those hospitalized on the general wards and analyze the factors associated with severity, outcomes, and treatment received. Study Design: An observational ambispective cohort study was conducted including children 1 month to 18 years old in 84 hospitals from the REKAMLATINA network from January 2020 to June 2022. Results: A total of 1239 children with MIS-C were included. The median age was 6.5 years (IQR 2.5-10.1). Eighty-four percent (1043/1239) were previously healthy. Forty-eight percent (590/1239) were admitted to the PICU. These patients had more myocardial dysfunction (20% vs 4%; P < 0.01) with no difference in the frequency of coronary abnormalities (P = 0.77) when compared to general ward subjects. Of the children in the PICU, 83.4% (494/589) required vasoactive drugs, and 43.4% (256/589) invasive mechanical ventilation, due to respiratory failure and pneumonia (57% vs 32%; P = 0.01). On multivariate analysis, the factors associated with the need for PICU transfer were age over 6 years (aOR 1.76 95% CI 1.25-2.49), shock (aOR 7.06 95% CI 5.14-9.80), seizures (aOR 2.44 95% CI 1.14-5.36), thrombocytopenia (aOR 2.43 95% CI 1.77-3.34), elevated C-reactive protein (aOR 1.89 95% CI 1.29-2.79), and chest x-ray abnormalities (aOR 2.29 95% CI 1.67-3.13). The overall mortality was 4.8%. Conclusions: Children with MIS-C who have the highest risk of being admitted to a PICU in Latin American countries are those over age six, with shock, seizures, a more robust inflammatory response, and chest x-ray abnormalities. The mortality rate is five times greater when compared with high-income countries, despite a high proportion of patients receiving adequate treatment.
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Affiliation(s)
- Jaime Fernández-Sarmiento
- Department of Pediatrics and Intensive Care, Fundación Cardioinfantil-Instituto de Cardiología, Universidad de La Sabana, Bogotá, Colombia
| | - Lorena Acevedo
- Department of Pediatrics and Intensive Care, Fundación Cardioinfantil-Instituto de Cardiología, Universidad de La Sabana, Bogotá, Colombia
| | | | - Raquel Boza
- Unidad de Cuidados Intensivos Pediátricos, Hospital Nacional de Niños "Dr Carlos Sáenz Herrera," Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
| | | | - Adriana Yock-Corrales
- Servicio de Emergencias, Hospital Nacional de Niños "Dr Carlos Sáenz Herrera," Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
| | | | - Enrique Faugier-Fuentes
- Servicio de Reumatología, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - Olguita Del Águila
- Unidad de Infectología Pediátrica, Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú
| | - German Camacho-Moreno
- Unidad de Infectología Pediátrica, Fundación Hospital Pediátrico La Misericordia (HOMI), Bogotá, Colombia
| | - Dora Estripeaut
- Servicio de Infectología, Hospital del Niño Dr José Renán Esquivel, Ciudad de Panamá, Panamá
| | - Iván F Gutiérrez
- Servicio de Infectología, Clínica Infantil Colsubsidio, Bogotá, Colombia
| | - Kathia Luciani
- Servicio de Infectología, Hospital de Especialidades Pediátricas Omar Torrijos Herrera, Ciudad de Panamá, Panamá
| | - Graciela Espada
- Servicio de Reumatología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | | | - Paola Pérez-Camacho
- Servicio de Infectología, Fundación Valle del Lili & Departamento de Pediatría, Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
| | - Saulo Duarte-Passos
- Hospital Universitario de Faculdade de Medicina de Jundiai, Sao Paolo, Brazil
| | - Maria C Cervi
- Serviço de Infectología, Faculdade de Medicina de Ribeirāo Preto, Universidade de Sāo Paulo, Sao Paulo, Brazil
| | - Edwin M Cantillano
- Unidad de Cuidados Intensivos Pediátricos, Hospital Regional del Norte, Instituto Hondureño de Seguridad Social, San Pedro de Sula, Honduras
| | | | - Patricia Saltigeral-Simental
- Servicio de Infectología, Star Médica Hospital Infantil Privado e Instituto Nacional de Pediatría, Ciudad de México, México
| | | | - Enrique Chacon-Cruz
- Servicio de Infectología. Hospital General de Tijuana, Tijuana, México
- Think Vaccines LLC, Houston, Texas, USA
| | - Miguel García-Domínguez
- Servicio de Alergología e Inmunología, Hospital Pediátrico de Sinaloa "Dr Rigoberto Aguilar Pico," Sinaloa, México
| | - Karla L Borjas Aguilar
- Servicio de Inmunología, Hospital María, Especialidades Pediátricas e Instituto Hondureño de Seguridad Social, Hospital de Especialidades, Tegucigalpa, Honduras
| | - Daniel Jarovsky
- Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Gabriela Ivankovich-Escoto
- Servicio de Inmunología y Reumatología Pediátrica, Hospital Nacional de Niños "Dr Carlos Sáenz Herrera," Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
| | - Adriana H Tremoulet
- Department of Pediatrics, University of California San Diego (UCSD) & Rady Children's Hospital, San Diego, California, USA
| | - Rolando Ulloa-Gutierrez
- Servicio de Infectología Pediátrica, Hospital Nacional de Niños "Dr Carlos Sáenz Herrera," Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
- Facultad de Medicina, Universidad de Ciencias Médicas (UCIMED), San José, Costa Rica
- Instituto de Investigación en Ciencias Médicas UCIMED (IICIMED), San José, Costa Rica
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Mai G, Lee JH, Caporal P, Roa G JD, González-Dambrauskas S, Zhu Y, Yock-Corrales A, Abbas Q, Kazzaz Y, Dewi DS, Chong SL. Initial dysnatremia and clinical outcomes in pediatric traumatic brain injury: a multicenter observational study. Acta Neurochir (Wien) 2024; 166:82. [PMID: 38353785 DOI: 10.1007/s00701-024-05919-0] [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: 08/29/2023] [Accepted: 11/21/2023] [Indexed: 02/16/2024]
Abstract
PURPOSE We aimed to investigate the association between initial dysnatremia (hyponatremia and hypernatremia) and in-hospital mortality, as well as between initial dysnatremia and functional outcomes, among children with traumatic brain injury (TBI). METHOD We performed a multicenter observational study among 26 pediatric intensive care units from January 2014 to August 2022. We recruited children with TBI under 18 years of age who presented to participating sites within 24 h of injury. We compared demographics and clinical characteristics between children with initial hyponatremia and eu-natremia and between those with initial hypernatremia and eu-natremia. We defined poor functional outcome as a discharge Pediatric Cerebral Performance Category (PCPC) score of moderate, severe disability, coma, and death, or an increase of at least 2 categories from baseline. We performed multivariable logistic regression for mortality and poor PCPC outcome. RESULTS Among 648 children, 84 (13.0%) and 42 (6.5%) presented with hyponatremia and hypernatremia, respectively. We observed fewer 14-day ventilation-free days between those with initial hyponatremia [7.0 (interquartile range (IQR) = 0.0-11.0)] and initial hypernatremia [0.0 (IQR = 0.0-10.0)], compared to eu-natremia [9.0 (IQR = 4.0-12.0); p = 0.006 and p < 0.001]. We observed fewer 14-day ICU-free days between those with initial hyponatremia [3.0 (IQR = 0.0-9.0)] and initial hypernatremia [0.0 (IQR = 0.0-3.0)], compared to eu-natremia [7.0 (IQR = 0.0-11.0); p = 0.006 and p < 0.001]. After adjusting for age, severity, and sex, presenting hyponatremia was associated with in-hospital mortality [adjusted odds ratio (aOR) = 2.47, 95% confidence interval (CI) = 1.31-4.66, p = 0.005] and poor outcome (aOR = 1.67, 95% CI = 1.01-2.76, p = 0.045). After adjustment, initial hypernatremia was associated with mortality (aOR = 5.91, 95% CI = 2.85-12.25, p < 0.001) and poor outcome (aOR = 3.00, 95% CI = 1.50-5.98, p = 0.002). CONCLUSION Among children with TBI, presenting dysnatremia was associated with in-hospital mortality and poor functional outcome, particularly hypernatremia. Future research should investigate longitudinal sodium measurements in pediatric TBI and their association with clinical outcomes.
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Affiliation(s)
- Gawin Mai
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Jan Hau Lee
- Children's Intensive Care Unit, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
- SingHealth Paediatrics Academic Clinical Programme, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Paula Caporal
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Montevideo, Uruguay
| | - Juan D Roa G
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Montevideo, Uruguay
- Pediatric Intensive Care Unit, Los Cobos Medical Center, Universidad del Bosque, Ak. 9 #131a-40, Usaquén, Bogotá, Cundinamarca, Colombia
| | - Sebastián González-Dambrauskas
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Montevideo, Uruguay
- Departamento de Pediatría y Unidad de Cuidados Intensivos, de Niños del Centro Hospitalario Pereira Rossell, Facultad de Medicina, Universidad de la República, Bulevar Artigas 1590, Lord Ponsoby 2410, 11600, Montevideo, Uruguay
| | - Yanan Zhu
- Singapore Clinical Research Institute, Consortium for Clinical Research and Innovation, 23 Rochester Park, #06-01, Singapore, 139234, Singapore
| | - Adriana Yock-Corrales
- Emergency Department, National Children's Hospital "Dr. Carlos Saenz Herrera" CCSS, San José, Costa Rica
| | - Qalab Abbas
- Departments of Pediatrics and Child Health, National Stadium Road, Aga Khan University Hospital, Karachi, Karachi City, Sindh, 74800, Pakistan
| | - Yasser Kazzaz
- Department of Paediatrics, Ministry of National Guards Health Affairs, Prince Mutib Ibn Abdullah Ibn Abdulaziz Rd, Ar Rimayah, Riyadh, 11426, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdul Aziz Medical City, Jeddah, 22384, Saudi Arabia
- King Abdullah International Medical Research Centre, King Abdul Aziz Medical City, Riyadh, 22384, Saudi Arabia
| | - Dianna Sri Dewi
- KK Research Centre, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Shu-Ling Chong
- Department of Emergency Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.
- SingHealth Paediatrics Academic Clinical Programme, Emergency Medicine Academic Clinical Programme, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
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7
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Craig S, Collings M, Gray C, Benito J, Velasco R, Lyttle MD, Roland D, Schuh S, Shihabuddin B, Kwok M, Mahajan P, Johnson M, Zorc J, Khanna K, Fernandes R, Yock-Corrales A, Santhanam I, Cheema B, Ong GYK, Jaiganesh T, Powell C, Nixon G, Dalziel S, Babl FE, Graudins A. Analysis of guideline recommendations for treatment of asthma exacerbations in children: a Pediatric Emergency Research Networks (PERN) study. Arch Dis Child 2024:archdischild-2023-326739. [PMID: 38325912 DOI: 10.1136/archdischild-2023-326739] [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: 12/09/2023] [Accepted: 01/23/2024] [Indexed: 02/09/2024]
Abstract
RATIONALE There is significant practice variation in acute paediatric asthma, particularly severe exacerbations. It is unknown whether this is due to differences in clinical guidelines. OBJECTIVES To describe and compare the content and quality of clinical guidelines for the management of acute exacerbations of asthma in children between geographic regions. METHODS Observational study of guidelines for the management of acute paediatric asthma from institutions across a global collaboration of six regional paediatric emergency research networks. MEASUREMENTS AND MAIN RESULTS 158 guidelines were identified. Half provided recommendations for at least two age groups, and most guidelines provided treatment recommendations according to asthma severity.There were consistent recommendations for the use of inhaled short-acting beta-agonists and systemic corticosteroids. Inhaled anticholinergic therapy was recommended in most guidelines for severe and critical asthma, but there were inconsistent recommendations for its use in mild and moderate exacerbations. Other inhaled therapies such as helium-oxygen mixture (Heliox) and nebulised magnesium were inconsistently recommended for severe and critical illness.Parenteral bronchodilator therapy and epinephrine were mostly reserved for severe and critical asthma, with intravenous magnesium most recommended. There were regional differences in the use of other parenteral bronchodilators, particularly aminophylline.Guideline quality assessment identified high ratings for clarity of presentation, scope and purpose, but low ratings for stakeholder involvement, rigour of development, applicability and editorial independence. CONCLUSIONS Current guidelines for the management of acute paediatric asthma exacerbations have substantial deficits in important quality domains and provide limited and inconsistent guidance for severe exacerbations.
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Affiliation(s)
- Simon Craig
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
- Department of Paediatric Emergency, Monash Health, Clayton, Victoria, Australia
| | - Madeline Collings
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| | - Charmaine Gray
- Adelaide Medical School, Discipline of Paediatrics, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Paediatric Emergency, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Javier Benito
- Department of Pediatric Emergency, Cruces University Hospital, Bilbao, Basque Country, Spain
- University of the Basque Country, Bilabo, Basque Country, Spain
| | - Roberto Velasco
- Pediatric Emergency Unit, Hospital Universitari Parc Taul, Sabadell, Spain
- Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Mark D Lyttle
- Emergency Department, Bristol Royal Hospital for Children, Bristol, UK
- Research in Emergency Care Avon Collaborative Hub (REACH), University of the West of England, Bristol, UK
| | - Damian Roland
- SAPPHIRE Group, Health Sciences, University of Leicester, Leicester, UK
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Department of Children's Emergency, Leicester Royal Infirmary, Leicester, UK
| | - Suzanne Schuh
- Division of Pediatric Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- SickKids Research Institute, Toronto, Ontario, Canada
| | - Bashar Shihabuddin
- Division of Emergency Medicine, Nationwide Children's Hospital, Colombus, Ohio, USA
- College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Maria Kwok
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Columbia University Irving Medical Center, New York, New York, USA
- Department of Pediatric Emergency, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
| | - Prashant Mahajan
- Emergency Medicine and Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Mike Johnson
- Department of Pediatrics, Division of Pediatric Emergency Medicine, The University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Joseph Zorc
- Division of Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kajal Khanna
- Department of Emergency Medicine, School of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Ricardo Fernandes
- Department of Pediatrics, Hospital de Santa Maria, Lisboa, Portugal
- Clinical Pharmacology Unit, University of Lisbon, Lisboa, Portugal
| | - Adriana Yock-Corrales
- Department of Emergency, Hospital Nacional de Ninos Dr Carlos Saenz Herrera, C.C.S.S, San Jose, Costa Rica
| | - Indumathy Santhanam
- National Health Mission, Tamil Nadu, India
- PREM Simulation Laboratory, Institute of Child Health, Madras Medical College, Chennai, India
| | - Baljit Cheema
- Department of Paediatrics & Child Health, University of Cape Town Faculty of Health Sciences, Western Cape, South Africa
| | - Gene Yong-Kwang Ong
- Children's Emergency Department, KK Women's and Children's Hospital, Singapore
- Medical School, Duke University and the National University of Singapore, Singapore
| | | | - Colin Powell
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Gillian Nixon
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
- Department of Respiratory Medicine, Monash Children's Hospital, Clayton, Victoria, Australia
| | - Stuart Dalziel
- Departments of Surgery and Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
- Department of Children's Emergency, Starship Children's Health, Auckland, New Zealand
| | - Franz E Babl
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
- Department of Emergency, Royal Children's Hospital, Melbourne, Victoria, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Departments of Paediatrics and Critical Care, University of Melbourne, Melbourne, Victoria, Australia
| | - Andis Graudins
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Monash Emergency Service, Emergency Department, Dandenong Hospital, Monash Health, Dandenong, Victoria, Australia
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8
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Yea C, Barton M, Bitnun A, Morris SK, El Tal T, Ulloa-Gutierrez R, Brenes-Chacon H, Yock-Corrales A, Ivankovich-Escoto G, Soriano-Fallas A, Hernandez-de Mezerville M, Gill P, Nateghian A, Aski BH, Manafi AA, Dwilow R, Bullard J, Papenburg J, Scuccimarri R, Lefebvre MA, Cooke S, Dewan T, Restivo L, Lopez A, Sadarangani M, Roberts A, Wong J, Saux NL, Bowes J, Purewal R, Lautermilch J, Foo C, Merckx J, Robinson J, Yeh EA. Neurological involvement in hospitalized children with SARS-CoV-2 infection: a multinational study. Can J Neurol Sci 2024; 51:40-49. [PMID: 36597285 PMCID: PMC9947047 DOI: 10.1017/cjn.2022.347] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 12/09/2022] [Accepted: 12/12/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND OBJECTIVES Neurological involvement associated with SARS-CoV-2 infection is increasingly recognized. However, the specific characteristics and prevalence in pediatric patients remain unclear. The objective of this study was to describe the neurological involvement in a multinational cohort of hospitalized pediatric patients with SARS-CoV-2. METHODS This was a multicenter observational study of children <18 years of age with confirmed SARS-CoV-2 infection or multisystemic inflammatory syndrome (MIS-C) and laboratory evidence of SARS-CoV-2 infection in children, admitted to 15 tertiary hospitals/healthcare centers in Canada, Costa Rica, and Iran February 2020-May 2021. Descriptive statistical analyses were performed and logistic regression was used to identify factors associated with neurological involvement. RESULTS One-hundred forty-seven (21%) of 697 hospitalized children with SARS-CoV-2 infection had neurological signs/symptoms. Headache (n = 103), encephalopathy (n = 28), and seizures (n = 30) were the most reported. Neurological signs/symptoms were significantly associated with ICU admission (OR: 1.71, 95% CI: 1.15-2.55; p = 0.008), satisfaction of MIS-C criteria (OR: 3.71, 95% CI: 2.46-5.59; p < 0.001), fever during hospitalization (OR: 2.15, 95% CI: 1.46-3.15; p < 0.001), and gastrointestinal involvement (OR: 2.31, 95% CI: 1.58-3.40; p < 0.001). Non-headache neurological manifestations were significantly associated with ICU admission (OR: 1.92, 95% CI: 1.08-3.42; p = 0.026), underlying neurological disorders (OR: 2.98, 95% CI: 1.49-5.97, p = 0.002), and a history of fever prior to hospital admission (OR: 2.76, 95% CI: 1.58-4.82; p < 0.001). DISCUSSION In this study, approximately 21% of hospitalized children with SARS-CoV-2 infection had neurological signs/symptoms. Future studies should focus on pathogenesis and long-term outcomes in these children.
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Affiliation(s)
- Carmen Yea
- Neuroscience and Mental Health, SickKids Research Institute, Toronto, Ontario, Canada
| | - Michelle Barton
- Department of Pediatrics, University of Western Ontario, London, Ontario, Canada
| | - Ari Bitnun
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Shaun K. Morris
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tala El Tal
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Rheumatology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rolando Ulloa-Gutierrez
- Department of Pediatrics, Hospital Nacional de Niños “Dr. Carlos Sáenz Herrera”, Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
| | - Helena Brenes-Chacon
- Department of Pediatrics, Hospital Nacional de Niños “Dr. Carlos Sáenz Herrera”, Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
| | - Adriana Yock-Corrales
- Department of Pediatrics, Hospital Nacional de Niños “Dr. Carlos Sáenz Herrera”, Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
| | - Gabriela Ivankovich-Escoto
- Department of Pediatrics, Hospital Nacional de Niños “Dr. Carlos Sáenz Herrera”, Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
| | - Alejandra Soriano-Fallas
- Department of Pediatrics, Hospital Nacional de Niños “Dr. Carlos Sáenz Herrera”, Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
| | - Marcela Hernandez-de Mezerville
- Department of Pediatrics, Hospital Nacional de Niños “Dr. Carlos Sáenz Herrera”, Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
| | - Peter Gill
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Alireza Nateghian
- Department of Pediatrics, Iran University of Medical Sciences, Tehran, Iran
| | | | - Ali Anari Manafi
- Department of Pediatrics, Iran University of Medical Sciences, Tehran, Iran
| | - Rachel Dwilow
- Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jared Bullard
- Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jesse Papenburg
- Division of Pediatric Infectious Diseases, Dept. of Pediatrics, Montreal Children’s Hospital (McGill University Health Centre), Montreal, Quebec, Canada
- Division of Microbiology, Dept. of Clinical Laboratory Medicine, Optilab Montreal, McGill University Health Centre, Montreal, Quebec, Canada
| | - Rosie Scuccimarri
- Division of Rheumatology, Montreal Children’s Hospital (McGill University Health Centre), Montreal, Quebec, Canada
| | - Marie-Astrid Lefebvre
- Division of Pediatric Infectious Diseases, Dept. of Pediatrics, Montreal Children’s Hospital (McGill University Health Centre), Montreal, Quebec, Canada
| | - Suzette Cooke
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Tammie Dewan
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Lea Restivo
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | | | - Manish Sadarangani
- BC Children’s Hospital, Vancouver, BC, Canada
- Vaccine Evaluation Center, University of British Columbia, Vancouver, BC, Canada
| | | | - Jacqueline Wong
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Nicole Le Saux
- Department of Pediatrics, University of Ottawa, Ontario, Canada
| | - Jennifer Bowes
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Rupeena Purewal
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Janell Lautermilch
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Cheryl Foo
- Department of Pediatrics, Memorial University, St. John’s, Newfoundland and Labrador, Canada
| | - Joanna Merckx
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Joan Robinson
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - E. Ann Yeh
- Neuroscience and Mental Health, SickKids Research Institute, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Division of Neurology, The Hospital of Sick Children, Toronto, Ontario, Canada
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9
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Qadri SK, Lee JH, Zhu Y, Caporal P, Roa G JD, González-Dambrauskas S, Yock-Corrales A, Abbas Q, Kazzaz Y, Shi L, Sri Dewi D, Chong SL. A multicenter observational study on outcomes of moderate and severe pediatric traumatic brain injuries-time to reappraise thresholds for treatment. Acta Neurochir (Wien) 2023; 165:3197-3206. [PMID: 37728830 DOI: 10.1007/s00701-023-05741-0] [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: 05/16/2023] [Accepted: 07/22/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE Children with moderate traumatic brain injury (modTBI) (Glasgow Coma Scale (GCS) 9-13) may benefit from better stratification. We aimed to compare neurocritical care utilization and functional outcomes between children with high GCS modTBI (hmodTBI, GCS 11-13), low GCS modTBI (lmodTBI, GCS 9-10), and severe TBI (sTBI, GCS ≤ 8). We hypothesized that patients with lmodTBI have higher neurocritical care needs and worse outcomes than patients with hmodTBI and are similar to patients with sTBI. METHODS Prospective observational study from June 2018 to October 2022 in 28 pediatric intensive care units (PICU) in Asia, South America, and Europe. We included children (age < 18 years) with modTBI and sTBI admitted to PICU and measured functional outcomes at 3 months using the Glasgow Outcome Scale-Extended Pediatric Revision (GOS-E Peds, scale 1-8, 1 = upper good recovery, 8 = death). RESULTS We analyzed 409 patients: 98 (24%) and 311 (76%) with modTBI and sTBI, respectively. Patients with lmodTBI (vs. hmodTBI) were more likely to have invasive ICP monitoring (32.3% vs. 4.5%, p < 0.001), longer PICU stay (days, median [IQR]; 5.00 [4.00, 9.75] vs 4.00 [2.00, 5.00], p = 0.007), and longer hospital stay (days, median [IQR]: 13.00 [8.00, 17.00] vs. 8.00 [5.00, 12, 25], p = 0.015). Median GOS-E Peds scores were significantly different (hmodTBI (1.00 [1.00, 3.00]), lmodTBI (3.00 [IQR 2.00, 5.75]), and sTBI (5.00 [IQR 1.00, 6.00]) (p < 0.001)). After adjusting for age, sex, presence of polytrauma and cerebral edema, lmodTBI, and sTBI remained significantly associated with higher GOS-E scores (adjusted coefficient (standard error): 1.24 (0.52), p = 0.018, and 1.27 (0.33), p < 0.001, respectively) compared with hmodTBI. CONCLUSIONS Children with lmodTBI have higher rates of neurocritical care utilization and worse functional outcomes than those with hmodTBI but better than those with sTBI. Children with lmodTBI may benefit from guideline-based management similar to what is implemented in children with sTBI. This work was performed in hospitals within the PACCMAN and LARed networks. No reprints will be ordered.
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Affiliation(s)
- Syeda Kashfi Qadri
- Children's Intensive Care Unit, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.
- Duke-NUS Medical School, SingHealth Duke-NUS Paediatrics Academic Clinical Programme, Singapore, Singapore.
| | - Jan Hau Lee
- Children's Intensive Care Unit, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
- Duke-NUS Medical School, SingHealth Duke-NUS Paediatrics Academic Clinical Programme, Singapore, Singapore
| | - Yanan Zhu
- Department of Epidemiology, Consortium for Clinical Research and Innovation, Singapore Clinical Research Institute, Singapore, Singapore
| | - Paula Caporal
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Buenos Aires, Argentina
- Pediatric Critical Care Unit - HIAEP Sor María Ludovica, La Plata, Buenos Aires, Argentina
| | - Juan D Roa G
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Bogotá, Colombia
- Pediatric Critical Care Unit - Fundacion Homi, Bogotá, Colombia
| | - Sebastián González-Dambrauskas
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Montevideo, Uruguay
- Departamento de Pediatría Y Unidad de Cuidados Intensivos de Niños del Centro Hospitalario Pereira Rossell, Facultad de Medicina, Universidad de La República, Montevideo, Uruguay
| | - Adriana Yock-Corrales
- Emergency Department, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", CCSS, San José, Costa Rica
| | | | - Yasser Kazzaz
- Department of Pediatrics, College of Medicine, Ministry of National Guards Health AffairsKing Saud Bin Abdulaziz University for Health SciencesKing Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Luming Shi
- Department of Epidemiology, Consortium for Clinical Research and Innovation, Singapore Clinical Research Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Dianna Sri Dewi
- Department of Epidemiology, Consortium for Clinical Research and Innovation, Singapore Clinical Research Institute, Singapore, Singapore
| | - Shu-Ling Chong
- Duke-NUS Medical School, SingHealth Duke-NUS Paediatrics Academic Clinical Programme, Singapore, Singapore
- Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore, Singapore
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10
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Craig S, Xu Y, Robas K, Iramain R, Yock-Corrales A, Soto-Martinez ME, Rino P, Belen Alvarez Ricciardi M, Piantanida S, Mahant S, Ubuane PO, Odusote O, Kwok M, Johnson MD, Paniagua N, Benito Fernandez J, Ong GY, Lyttle MD, Gong J, Roland D, Dalziel SR, Nixon GM, Powell CVE, Graudins A, Babl FE. Core outcomes and factors influencing the experience of care for children with severe acute exacerbations of asthma: a qualitative study. BMJ Open Respir Res 2023; 10:e001723. [PMID: 37968074 PMCID: PMC10661079 DOI: 10.1136/bmjresp-2023-001723] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 10/27/2023] [Indexed: 11/17/2023] Open
Abstract
OBJECTIVE To identify the outcomes considered important, and factors influencing the patient experience, for parents and caregivers of children presenting to hospital with a severe acute exacerbation of asthma. This work contributes to the outcome-identification process in developing a core outcome set (COS) for future clinical trials in children with severe acute asthma. DESIGN A qualitative study involving semistructured interviews with parents and caregivers of children who presented to hospital with a severe acute exacerbation of asthma. SETTING Hospitals in 12 countries associated with the global Pediatric Emergency Research Networks, including high-income and middle-income countries. Interviews were conducted face-to-face, by teleconference/video-call, or by phone. FINDINGS Overall, there were 54 interviews with parents and caregivers; 2 interviews also involved the child. Hospital length of stay, intensive care unit or high-dependency unit (HDU) admission, and treatment costs were highlighted as important outcomes influencing the patient and family experience. Other potential clinical trial outcomes included work of breathing, speed of recovery and side effects. In addition, the patient and family experience was impacted by decision-making leading up to seeking hospital care, transit to hospital, waiting times and the use of intravenous treatment. Satisfaction of care was related to communication with clinicians and frequent reassessment. CONCLUSIONS This study provides insight into the outcomes that parents and caregivers believe to be the most important to be considered in the process of developing a COS for the treatment of acute severe exacerbations of asthma.
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Affiliation(s)
- Simon Craig
- Department of Paediatrics, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
- Paediatric Emergency Department, Monash Medical Centre Clayton, Clayton, Victoria, Australia
- Emergency Research, Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Yao Xu
- Department of Paediatrics, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Kael Robas
- Department of Paediatrics, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Ricardo Iramain
- Paediatric Emergency Department, Hospital de Clinicas, Asuncion, Paraguay
| | - Adriana Yock-Corrales
- Emergency Department, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera". Caja Costarricense Seguro Social, San José, Costa Rica
| | - Manuel E Soto-Martinez
- Department of Pediatrics, School of Medicine, Universidad de Costa Rica, San José, Costa Rica
- Respiratory Medicine Division, Department of Pediatrics, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera". Caja Costarricense Seguro Social, San José, Costa Rica
| | - Pedro Rino
- Pediatric Emergency Department, Hospital de Pediatria Prof Dr Juan P Garrahan, Buenos Aires, Argentina
- Universidad de Buenos Aires, Buenos Aires, Argentina
| | | | - Sofia Piantanida
- Pediatric Emergency Department, Hospital de Pediatria Prof Dr Juan P Garrahan, Buenos Aires, Argentina
| | - Sanjay Mahant
- Child Health Evaluative Services, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Peter Odion Ubuane
- Institute of Maternal and Child Health/Department of Paediatrics, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Olatunde Odusote
- Institute of Maternal and Child Health/Department of Paediatrics, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Maria Kwok
- Department of Emergency Medicine, Columbia University Irving Medical Center, New York, New York, USA
- Division of Emergency Medicine, New York Presbyterian Hospital-Morgan Stanley Children's Hospital, New York, New York, USA
| | - Michael D Johnson
- Division of Paediatric Emergency Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Emergency Department, Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Natalia Paniagua
- Pediatric Emergency Department, Cruces University Hospital, Barakaldo, País Vasco, Spain
- Paediatric Emergency Department. Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, UPV/EHU, Bilbao, Basque Country, Spain
| | - Javier Benito Fernandez
- Pediatric Emergency Department, Cruces University Hospital, Barakaldo, País Vasco, Spain
- Paediatric Emergency Department. Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, UPV/EHU, Bilbao, Basque Country, Spain
| | - Gene Y Ong
- Children's Emergency Department, KK Women's and Children's Hospital, Singapore
| | - Mark D Lyttle
- Research in Emergency Care Avon Collaborative Hub (REACH), University of the West of England, Bristol, UK
- Emergency Department, Bristol Royal Hospital for Children, Bristol, UK
| | - Jin Gong
- Department of Paediatrics, Affiliated Renhe Hospital of China, Yichang, Hubei, China
- Department of Paediatrics, China Three Gorges University, Yichang, Hubei, China
| | - Damian Roland
- SAPPHIRE Group, Health Sciences, University of Leicester, Leicester, UK
- Paediatric Emergency Medicine Leicester Academic Group, Children's Emergency Department, Leicester Royal Infirmary, Leicester, UK
| | - Stuart R Dalziel
- Children's Emergency Department, Starship Hospital, Auckland, New Zealand
- Departments of Surgery and Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
| | - Gillian M Nixon
- Department of Paediatrics, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
- Department of Respiratory Medicine, Monash Children's Hospital, Clayton, Victoria, Australia
| | - Colin V E Powell
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
- Sidra Medicine Department of Emergency Medicine, Doha, Ad-Dawhah, Qatar
| | - Andis Graudins
- Emergency Department, Monash Health, Dandenong Hospital, Dandenong, Victoria, Australia
- Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - Franz E Babl
- Department of Paediatrics, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
- Emergency Research, Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Emergency Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
- Departments of Paediatrics and Critical Care, University of Melbourne, Parkville, Victoria, Australia
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11
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Xie J, Kuppermann N, Florin TA, Tancredi DJ, Funk AL, Kim K, Salvadori MI, Yock-Corrales A, Shah NP, Breslin KA, Chaudhari PP, Bergmann KR, Ahmad FA, Nebhrajani JR, Mintegi S, Gangoiti I, Plint AC, Avva UR, Gardiner MA, Malley R, Finkelstein Y, Dalziel SR, Bhatt M, Kannikeswaran N, Caperell K, Campos C, Sabhaney VJ, Chong SL, Lunoe MM, Rogers AJ, Becker SM, Borland ML, Sartori LF, Pavlicich V, Rino PB, Morrison AK, Neuman MI, Poonai N, Simon NJE, Kam AJ, Kwok MY, Morris CR, Palumbo L, Ambroggio L, Navanandan N, Eckerle M, Klassen TP, Payne DC, Cherry JC, Waseem M, Dixon AC, Ferre IB, Freedman SB. Impact of SARS-CoV-2 Infection on the Association Between Laboratory Tests and Severe Outcomes Among Hospitalized Children. Open Forum Infect Dis 2023; 10:ofad485. [PMID: 37869403 PMCID: PMC10588618 DOI: 10.1093/ofid/ofad485] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/28/2023] [Indexed: 10/24/2023] Open
Abstract
Background To assist clinicians with identifying children at risk of severe outcomes, we assessed the association between laboratory findings and severe outcomes among severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected children and determined if SARS-CoV-2 test result status modified the associations. Methods We conducted a cross-sectional analysis of participants tested for SARS-CoV-2 infection in 41 pediatric emergency departments in 10 countries. Participants were hospitalized, had laboratory testing performed, and completed 14-day follow-up. The primary objective was to assess the associations between laboratory findings and severe outcomes. The secondary objective was to determine if the SARS-CoV-2 test result modified the associations. Results We included 1817 participants; 522 (28.7%) SARS-CoV-2 test-positive and 1295 (71.3%) test-negative. Seventy-five (14.4%) test-positive and 174 (13.4%) test-negative children experienced severe outcomes. In regression analysis, we found that among SARS-CoV-2-positive children, procalcitonin ≥0.5 ng/mL (adjusted odds ratio [aOR], 9.14; 95% CI, 2.90-28.80), ferritin >500 ng/mL (aOR, 7.95; 95% CI, 1.89-33.44), D-dimer ≥1500 ng/mL (aOR, 4.57; 95% CI, 1.12-18.68), serum glucose ≥120 mg/dL (aOR, 2.01; 95% CI, 1.06-3.81), lymphocyte count <1.0 × 109/L (aOR, 3.21; 95% CI, 1.34-7.69), and platelet count <150 × 109/L (aOR, 2.82; 95% CI, 1.31-6.07) were associated with severe outcomes. Evaluation of the interaction term revealed that a positive SARS-CoV-2 result increased the associations with severe outcomes for elevated procalcitonin, C-reactive protein (CRP), D-dimer, and for reduced lymphocyte and platelet counts. Conclusions Specific laboratory parameters are associated with severe outcomes in SARS-CoV-2-infected children, and elevated serum procalcitonin, CRP, and D-dimer and low absolute lymphocyte and platelet counts were more strongly associated with severe outcomes in children testing positive compared with those testing negative.
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Affiliation(s)
| | - Nathan Kuppermann
- Davis School of Medicine, University of California, Sacramento, California, USA
| | - Todd A Florin
- Ann and Robert H. Lurie Children’s Hospital of Chicago, Northwestern University, Chicago, Illinois, USA
| | - Daniel J Tancredi
- Davis School of Medicine, University of California, Sacramento, California, USA
| | - Anna L Funk
- University of Calgary, Calgary, Alberta, Canada
| | - Kelly Kim
- University of Calgary, Calgary, Alberta, Canada
| | | | | | - Nipam P Shah
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | | | | | - Fahd A Ahmad
- Washington University School of Medicine, St.Louis, Missouri, USA
| | | | - Santiago Mintegi
- University of the Basque Country, UPV/EHU Bilbao, Basque Country, Spain
| | - Iker Gangoiti
- University of the Basque Country, UPV/EHU Bilbao, Basque Country, Spain
| | - Amy C Plint
- University of Ottawa, Ottawa, Ontario, Canada
| | - Usha R Avva
- Montefiore-Nyack Hospital, Nyack, NewYork, New York, USA
| | | | | | | | | | - Maala Bhatt
- Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | | | | | - Carmen Campos
- Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - Shu-Ling Chong
- Duke-NUS Medical School, SingHealth Duke-NUS Global Health Institute, Singapore
| | - Maren M Lunoe
- UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Sarah M Becker
- Primary Children’s Hospital, Intermountain Healthcare, Salt Lake City, Utah, USA
| | | | - Laura F Sartori
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Pedro B Rino
- Hospital de Pediatría “Prof. Dr. Juan P. Garrahan,” RIDEPLA, Buenos Aires, Argentina
| | | | | | - Naveen Poonai
- Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Norma-Jean E Simon
- Ann and Robert H Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA
| | - April J Kam
- McMaster Children’s Hospital, Hamilton, Ontario, Canada
| | - Maria Y Kwok
- Columbia University Irving Medical Center, NewYork, New York, USA
| | - Claudia R Morris
- Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Laura Palumbo
- ASST Spedali Civili di Brescia—Pronto Soccorso Pediatrico, Brescia, Italy
| | | | | | - Michelle Eckerle
- University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | | | - Daniel C Payne
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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12
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Yock-Corrales A, Naranjo-Zuñiga G. Regional Perspective of Antimicrobial Stewardship Programs in Latin American Pediatric Emergency Departments. Antibiotics (Basel) 2023; 12:antibiotics12050916. [PMID: 37237820 DOI: 10.3390/antibiotics12050916] [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: 03/13/2023] [Revised: 05/06/2023] [Accepted: 05/13/2023] [Indexed: 05/28/2023] Open
Abstract
Antibiotic stewardship (AS) programs have become a priority for health authorities to reduce the number of infections by super-resistant microorganisms. The need for these initiatives to minimize the inadequate use of antimicrobials is essential, and the election of the antibiotic in the emergency department usually impacts the choice of treatment if the patients need hospital admission, becoming an opportunity for antibiotic stewardship. In the pediatric population, broad-spectrum antibiotics are more likely to be overprescribed without any evidence-based management, and most of the publications have focused on the prescription of antibiotics in ambulatory settings. Antibiotic stewardship efforts in pediatric emergency departments in Latin American settings are limited. The lack of literature on AS programs in the pediatric emergency departments in Latin America (LA) limits the information available. The aim of this review was to give a regional perspective on how pediatric emergency departments in LA are working towards antimicrobial stewardship.
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Affiliation(s)
- Adriana Yock-Corrales
- Emergency Department, Hospital Nacional de Niños "Dr. Carlos Saenz Herrera", Caja Costarricense del Seguro Social (CCSS), San José P.O. Box 1654-1000, Costa Rica
| | - Gabriela Naranjo-Zuñiga
- Infectious Disease Department, Hospital Nacional de Niños "Dr. Carlos Saenz Herrera", Caja Costarricense del Seguro Social (CCSS), San José P.O. Box 1654-1000, Costa Rica
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13
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Gray CS, Xu Y, Babl FE, Dalziel S, Powell CVE, Chong SL, Roland D, Lyttle MD, Fernandes RM, Benito J, Johnson M, Yock-Corrales A, Santhanam I, Schuh S, Cheema B, Couper J, Craig S. International perspective on research priorities and outcome measures of importance in the care of children with acute exacerbations of asthma: a qualitative interview study. BMJ Open Respir Res 2023; 10:10/1/e001502. [PMID: 36849194 PMCID: PMC9972434 DOI: 10.1136/bmjresp-2022-001502] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 02/09/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Acute exacerbations of asthma are common in children, however, treatment decisions for severe exacerbations are challenging due to a lack of robust evidence. In order to create more robust research, a core set of outcome measures needs to be developed. In developing these outcomes, it is important to understand the views of clinicians who care for these children in particular, views that relate to outcome measures and research priorities. METHODS To determine the views of clinicians, a total of 26 semistructured interviews based on the theoretical domains framework were conducted. These included experienced clinicians from emergency, intensive care and inpatient paediatrics across 17 countries. The interviews were recorded, and later transcribed. All data analyses were conducted in Nvivo by using thematic analysis. RESULTS The length of stay in hospital and patient-focused parameters, such as timing to return to school and normal activity, were the most frequently highlighted outcome measures, with clinicians identifying the need to achieve a consensus on key core outcome measure sets. Most research questions focused on understanding the best treatment options, including the role of novel therapies and respiratory support. CONCLUSION Our study provides an insight into what research questions and outcome measures clinicians view as important. In addition, information on how clinicians define asthma severity and measure treatment success will assist with methodological design in future trials. The current findings will be used in parallel with a further Paediatric Emergency Research Network study focusing on the child and family perspectives and will contribute to develop a core outcome set for future research.
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Affiliation(s)
- Charmaine S Gray
- Adelaide Medical School, Discipline of Paediatrics, The University of Adelaide, Adelaide, South Australia, Australia .,Paediatric Emergency Department, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Yao Xu
- Zhuhai City People's Hospital, Zhuhai, Guangdong, China.,Department of Paediatrics, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Franz E Babl
- Murdoch Children's Research Institute; Departments of Paediatrics and Critical Care, University of Melbourne, Parkville, Victoria, Australia.,Emergency Department, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Stuart Dalziel
- Children's Emergency Department, Starship Children's Health, Auckland, New Zealand.,Surgery and Paediatrics, The University of Auckland Faculty of Health and Medical Sciences, Auckland, New Zealand
| | - Colin V E Powell
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK.,Department of Emergency Medicine, Sidra Medicine, Doha, Ad-Dawhah, Qatar
| | - Shu-Ling Chong
- Department of Emergency Medicine, KK Women's and Children's Hospital, SingHealth Paediatrics Academic Clinical Programme, Singapore
| | - Damian Roland
- SAPPHIRE Group, Health Sciences, University of Leicester, Leicester, UK.,Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Children's Emergency Department, Leicester Royal Infirmary, Leicester, UK
| | - Mark D Lyttle
- Paediatric Emergency Department, Bristol Royal Hospital for Children, Bristol, UK.,Research in Emergency Care Avon Collaborative Hub (REACH), University of the West of England, Bristol, UK
| | - Ricardo M Fernandes
- Department of Pediatrics, Hospital de Santa Maria, Lisboa, Portugal.,Clinical Pharmacology Unit, University of Lisbon, Lisboa, Portugal
| | - Javier Benito
- Pediatric Emergency Department, Cruces University Hospital. Biocruces Bizkaia Health Research Institute, Bilbao, Spain
| | - Mike Johnson
- Department of Pediatrics, University of Utah Health, Salt Lake City, Utah, USA
| | - Adriana Yock-Corrales
- Emergency Department, Hospital Nacional de Ninos "Dr Carlos Saenz Herrera", CCSS, San Jose, Costa Rica
| | - Indumathy Santhanam
- Regional Collaborative Center, Institute of Child Health, Madras Medical College, Egmore, Chennai, India
| | - Suzanne Schuh
- Hospital for Sick Children Research Institute, Univsersity of Toronto, Toronto, Ontario, Canada.,Division of Pediatric Emergency Medicine, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Baljit Cheema
- Department of Paediatrics & Child Health, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Jenny Couper
- Adelaide Medical School, Discipline of Paediatrics, The University of Adelaide, Adelaide, South Australia, Australia
| | - Simon Craig
- Department of Paediatrics, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia.,Paediatric Emergency Department, Monash Medical Centre, Monash Health, Clayton, Victoria, Australia
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14
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Buonsenso D, Roland D, Yock-Corrales A, González-Dambrauskas S, Brodin P, Santiago-Garcia B, Soriano-Arandes A, Koenraads M, De Luca D, Whittaker E. The challenges of doing paediatric research during the first year of the covid-19 pandemic. BMJ 2022; 379:o2750. [PMID: 36379549 DOI: 10.1136/bmj.o2750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
- Center for Global Health Research and Studies, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Damian Roland
- Sapphire Group, Health Sciences, Leicester University, Leicester, UK
- Paediatric Emergency Medicine Leicester Academic Group, Children's Emergency Department, Leicester Royal Infirmary, Leicester, UK
| | - Adriana Yock-Corrales
- Pediatric Emergency Department, Hospital Nacional de Niños "Dr Carlos Sáenz Herrera," San José, Costa Rica
| | - Sebastián González-Dambrauskas
- Cuidados Intensivos Pediátricos Especializados, Casa de Galicia, Montevideo, Uruguay
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Montevideo, Uruguay
| | - Petter Brodin
- Pediatric Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Antoni Soriano-Arandes
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Daniele De Luca
- Division of Paediatrics and Neonatal Critical Care, A Béclère Medical Centre, Paris Saclay University Hospitals, Paris, France
| | - Elizabeth Whittaker
- Department of Paediatrics, Imperial College Healthcare NHS Trust, London, UK
- Section of Paediatric Infectious Disease, Department of Infectious Disease, Imperial College London, UK
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15
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Fustiñana A, Yock-Corrales A, Casson N, Galvis L, Iramain R, Lago P, Da Silva APP, Paredes F, Zamarbide MP, Aprea V, Kohn-Loncarica G. Adherence to Pediatric Sepsis Treatment Recommendations at Emergency Departments: A Multicenter Study in Latin America. Pediatr Emerg Care 2022; 38:e1496-e1502. [PMID: 35802481 DOI: 10.1097/pec.0000000000002801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Sepsis is one of the most urgent health care issues worldwide. Guidelines for early identification and treatment are essential to decrease sepsis-related mortality. Our aim was to collect data on the epidemiology of pediatric septic shock (PSS) from the emergency department (PED) and to assess adherence to recommendations for its management in the first hour. METHODS A multicenter, prospective, cross-sectional study was conducted evaluating children with PSS seen at the PED of 10 tertiary-care centers in Latin America. Adherence to guidelines was evaluated. RESULTS We included 219 patients (median age, 3.7 years); 43% had comorbidities, 31% risk factors for developing sepsis, 74% clinical signs of "cold shock," and 13% of "warm shock," 22% had hypotension on admission. Consciousness was impaired in 55%. A peripheral line was used as initial access in 78% (median placement time, 10 minutes). Fluid and antibiotics infusion was achieved within a median time of 30 minutes (interquartile range [IQR], 20-60 minutes) and 40 minutes (IQR, 20-60 minutes), respectively; 40% responded inadequately to fluids requiring vasoactive drugs (median time at initiation, 60 minutes; IQR, 30-135 minutes). Delay to vasoactive drug infusion was significantly longer when a central line was placed compared to a peripheral line (median time, 133 minutes [59-278 minutes] vs 42 minutes [30-70 minutes], respectively [ P < 0.001]). Adherence to all treatment goals was achieved in 13%. Mortality was 10%. An association between mortality and hypotension on admission was found (26.1% with hypotension vs 4.9% without; P < 0.001). CONCLUSIONS We found poor adherence to the international recommendations for the treatment of PSS in the first hour at the PED in third-level hospitals in Latin America.
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16
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Bergmann KR, Khant M, Lammers S, Arroyo AC, Avendano P, Chaudoin L, Cohen SG, Deanehan JK, Kornblith AE, Lam SHF, Lin-Martore M, Malia L, Pade KH, Park DB, Sivitz A, Shahar-Nissan K, Snelling PJ, Tessaro MO, Thomas-Mohtat R, Whitcomb V, Yock-Corrales A, Walsh P, Watson D, Madhok M. Accuracy and Interrater Reliability of Point-of-Care Ultrasonography Image Interpretation for Intussusception. Pediatr Emerg Care 2022; 38:442-447. [PMID: 36040465 DOI: 10.1097/pec.0000000000002786] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to determine the accuracy and interrater reliability of (1) point-of-care ultrasound (POCUS) image interpretation for identification of intussusception and (2) reliability of secondary signs associated with intussusception among experts compared with novice POCUS reviewers. METHODS We conducted a planned secondary analysis of a prospective, convenience sample of children aged 3 months to 6 years who were evaluated with POCUS for intussusception across 17 international pediatric emergency departments between October 2018 and December 2020. A random sample of 100 POCUS examinations was reviewed by novice and expert POCUS reviewers. The primary outcome was identification of the presence or absence of intussusception. Secondary outcomes included intussusception size and the presence of trapped free fluid or echogenic foci. Accuracy was summarized using sensitivity and specificity, which were estimated via generalized mixed effects logistic regression. Interrater reliability was summarized via Light's κ statistics with bootstrapped standard errors (SEs). Accuracy and reliability of expert and novice POCUS reviewers were compared. RESULTS Eighteen expert and 16 novice POCUS reviewers completed the reviews. The average expert sensitivity was 94.5% (95% confidence interval [CI], 88.6-97.5), and the specificity was 94.3% (95% CI, 90.3-96.7), significantly higher than the average novice sensitivity of 84.7% (95% CI, 74.3-91.4) and specificity of 80.4% (95% CI, 72.4, 86.7). κ was significantly greater for expert (0.679, SE 0.039) compared with novice POCUS reviewers (0.424, SE 0.044; difference 0.256, SE 0.033). For our secondary outcome measure of intussusception size, κ was significantly greater for experts (0.661, SE 0.038) compared with novices (0.397, SE 0.041; difference 0.264, SE 0.029). Interrater reliability was weak for expert and minimal for novice reviewers regarding the detection of trapped free fluid and echogenic foci. CONCLUSIONS Expert POCUS reviewers demonstrate high accuracy and moderate interrater reliability when identifying intussusception via image interpretation and perform better than novice reviewers.
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Affiliation(s)
- Kelly R Bergmann
- From the Department of Emergency Medicine, Children's Minnesota, Minneapolis, MN
| | - Marshal Khant
- From the Department of Emergency Medicine, Children's Minnesota, Minneapolis, MN
| | - Shea Lammers
- From the Department of Emergency Medicine, Children's Minnesota, Minneapolis, MN
| | - Alexander C Arroyo
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY
| | - Pablo Avendano
- Division of Pediatric Emergency Medicine, University of Minnesota Masonic Children's Hospital, Minneapolis, MN
| | - Lindsey Chaudoin
- Department of Emergency Medicine, Atrium Health's Carolinas Medical Center, Charlotte, NC
| | - Stephanie G Cohen
- Department of Pediatrics and Emergency Medicine, Children's Healthcare Atlanta and Emory University, Atlanta, GA
| | - J Kate Deanehan
- Department of Pediatric Emergency Medicine, Johns Hopkins Children's Center, Baltimore, MD
| | - Aaron E Kornblith
- Departments of Emergency Medicine and Pediatrics, University of California, San Francisco, San Francisco
| | - Samuel H F Lam
- Department of Emergency Medicine, Sutter Medical Center Sacramento, Sacramento, CA
| | - Margaret Lin-Martore
- Departments of Emergency Medicine and Pediatrics, University of California, San Francisco, San Francisco
| | - Laurie Malia
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York Presbyterian-Morgan Stanley Children's Hospital, New York, NY
| | - Kathryn H Pade
- Department of Pediatrics, University of California, San Diego, CA
| | - Daniel B Park
- Department of Pediatrics and Emergency Medicine, University of North Carolina, Chapel Hill, NC
| | - Adam Sivitz
- Department of Emergency Medicine, Newark Beth Israel Medical Center, Newark, NJ
| | - Keren Shahar-Nissan
- Department of Emergency Medicine, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Peter J Snelling
- Department of Pediatric Emergency Medicine, Gold Coast University Hospital and Griffith University, Southport, Queensland, Australia
| | - Mark O Tessaro
- Division of Pediatric Emergency Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rosemary Thomas-Mohtat
- Department of Pediatric Emergency Medicine, Children's National Hospital, Washington, DC
| | - Valerie Whitcomb
- From the Department of Emergency Medicine, Children's Minnesota, Minneapolis, MN
| | - Adriana Yock-Corrales
- Department of Emergency Medicine, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera," CCSS, San José, Costa Rica
| | - Paige Walsh
- Department of Research and Sponsored Programs, Children's Minnesota, Minneapolis, MN
| | - Dave Watson
- Department of Research and Sponsored Programs, Children's Minnesota, Minneapolis, MN
| | - Manu Madhok
- From the Department of Emergency Medicine, Children's Minnesota, Minneapolis, MN
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17
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Robinson J, Dewan T, Morris SK, Bitnun A, Gill P, Tal TE, Laxer RM, Yeh EA, Yea C, Ulloa-Gutierrez R, Brenes-Chacon H, Yock-Corrales A, Ivankovich-Escoto G, Soriano-Fallas A, Mezerville MHD, Papenburg J, Lefebvre MA, Nateghian A, Aski BH, Manafi A, Dwilow R, Bullard J, Cooke S, Restivo L, Lopez A, Sadarangani M, Roberts A, Le Saux N, Bowes J, Purewal R, Lautermilch J, Wong JK, Piche D, Top KA, Foo C, Panetta L, Merckx J, Barton M. SARS-CoV-2 infection in technology-dependent children: a multicenter case series. Infection 2022; 51:737-741. [PMID: 36038707 PMCID: PMC9423690 DOI: 10.1007/s15010-022-01910-y] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/16/2022] [Indexed: 11/27/2022]
Abstract
Purpose The objective of this study was to describe the clinical course and outcomes in children with technology dependence (TD) hospitalized with SARS-CoV-2 infection. Methods Seventeen pediatric hospitals (15 Canadian and one each in Iran and Costa Rica) included children up to 17 years of age admitted February 1, 2020, through May 31, 2021, with detection of SARS-CoV-2. For those with TD, data were collected on demographics, clinical course and outcome. Results Of 691 children entered in the database, 42 (6%) had TD of which 22 had feeding tube dependence only, 9 were on supplemental oxygen only, 3 had feeding tube dependence and were on supplemental oxygen, 2 had a tracheostomy but were not ventilated, 4 were on non-invasive ventilation, and 2 were on mechanical ventilation prior to admission. Three of 42 had incidental SARS-CoV-2 infection. Two with end-stage underlying conditions were transitioned to comfort care and died. Sixteen (43%) of the remaining 37 cases required increased respiratory support from baseline due to COVID-19 while 21 (57%) did not. All survivors were discharged home. Conclusion Children with TD appear to have an increased risk of COVID-19 hospitalization. However, in the absence of end-stage chronic conditions, all survived to discharge.
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Affiliation(s)
- Joan Robinson
- Department of Pediatrics, University of Alberta, 3-556ECHA, Edmonton, AB, T6G 1C9, Canada.
| | - Tammie Dewan
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Shaun K Morris
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Ari Bitnun
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Peter Gill
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Tala El Tal
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Ronald M Laxer
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - E Ann Yeh
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Carmen Yea
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Rolando Ulloa-Gutierrez
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, San José, Costa Rica
| | - Helena Brenes-Chacon
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, San José, Costa Rica
| | - Adriana Yock-Corrales
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, San José, Costa Rica
| | - Gabriela Ivankovich-Escoto
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, San José, Costa Rica
| | - Alejandra Soriano-Fallas
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, San José, Costa Rica
| | - Marcela Hernandez-de Mezerville
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, San José, Costa Rica
| | - Jesse Papenburg
- Department of Pediatrics, McGill University, Montreal, QC, Canada
| | | | - Alireza Nateghian
- Department of Pediatrics, Iran University of Medical Sciences, Tehran, Iran
| | | | - Ali Manafi
- Department of Pediatrics, Iran University of Medical Sciences, Tehran, Iran
| | - Rachel Dwilow
- Department of Pediatrics, University of Manitoba, Winnipeg, MB, Canada
| | - Jared Bullard
- Department of Pediatrics, University of Manitoba, Winnipeg, MB, Canada
| | - Suzette Cooke
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Lea Restivo
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Alison Lopez
- British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Manish Sadarangani
- British Columbia Children's Hospital, Vancouver, BC, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Ashley Roberts
- British Columbia Children's Hospital, Vancouver, BC, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Nicole Le Saux
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | - Jennifer Bowes
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | - Rupeena Purewal
- Department of Pediatrics, University of Saskatchewan, Saskatoon, SK, Canada
| | - Janell Lautermilch
- Department of Pediatrics, University of Saskatchewan, Saskatoon, SK, Canada
| | | | - Dominique Piche
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Karina A Top
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Cheryl Foo
- Department of Pediatrics, Memorial University, St John's, NL, Canada
| | - Luc Panetta
- Department of Pediatrics, Universite de Montreal, Montreal, QC, Canada
| | - Joanna Merckx
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Michelle Barton
- Department of Pediatrics, Western University, London, ON, Canada
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Gonzalez-Dambrauskas S, Vasquez-Hoyos P, Camporesi A, Cantillano EM, Dallefeld S, Dominguez-Rojas J, Francoeur C, Gurbanov A, Mazzillo-Vega L, Shein SL, Yock-Corrales A, Karsies T. Paediatric critical COVID-19 and mortality in a multinational prospective cohort. Lancet Reg Health Am 2022; 12:100272. [PMID: 35599855 PMCID: PMC9111167 DOI: 10.1016/j.lana.2022.100272] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND To understand critical paediatric coronavirus disease 2019 (COVID-19) and evaluate factors associated with mortality in children from high and low-middle income countries. METHODS Prospective, observational study of critically ill children hospitalised for COVID-19 in 18 countries throughout North America, Latin America, and Europe between April 1 and December 31, 2020. Associations with mortality were evaluated using logistic regression. FINDINGS 557 patients (median age, 8 years; 24% <2 years) were enrolled from 55 sites (63% Latin American). Half had comorbidities. Invasive (41%) or non-invasive (20%) ventilation and vasopressors (56%) were the most common support modalities. Hospital mortality was 10% and higher in children <2 years old (15%; odds ratio 1·94, 95%CI 1·08-3·49). Most who died had pulmonary disease. When adjusted for age, sex, region, and illness severity, mortality-associated factors included cardiac (aOR 2·89; 95%CI 1·2-6·94) or pulmonary comorbidities (aOR 4·43; 95%CI 1·70-11·5), admission hypoxemia (aOR 2·44; 95%CI 1·30-4·57), and lower respiratory symptoms (aOR 2·96; 95%CI 1·57-5·59). MIS-C (aOR 0·25; 95%CI 0·1-0·61) and receiving methylprednisolone (aOR 0·5; 95%CI 0·25-0·99), IVIG (aOR 0·32; 95%CI 0·16-0·62), or anticoagulation (aOR 0·49; 95%CI 0·25-0·95) were associated with lower mortality although these associations might be limited to children >2 years old. INTERPRETATION We identified factors associated with COVID-19 mortality in critically ill children from both high and low-middle income countries, including higher mortality with younger age and COVID-related pulmonary disease but lower mortality in MIS-C. Further research is needed on optimal treatments for younger children and respiratory failure in paediatric COVID-19. FUNDING None.
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Affiliation(s)
- Sebastian Gonzalez-Dambrauskas
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network) and Cuidados Intensivos Pediátricos Especializados (CIPe) Casa de Galicia, Montevideo, Uruguay
| | - Pablo Vasquez-Hoyos
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Universidad Nacional de Colombia and Sociedad de Cirugía Hospital de San José, FUCS, Bogota, Colombia
| | - Anna Camporesi
- Division of Pediatric Anesthesia and ICU, Department of Pediatrics. Children's Hospital Vittore Buzzi, Milan, Italy
| | - Edwin Mauricio Cantillano
- UCIP. Hospital Regional del Norte, Instituto Hondureño de Seguridad Social, San Pedro Sula, Honduras
| | - Samantha Dallefeld
- Pediatric Critical Care Medicine, Dell Children's Medical Center of Central Texas, Austin, TX, USA
| | - Jesus Dominguez-Rojas
- Departamento Pediatría Universidad Nacional Federico Villarreal. UCIP Hospital de Emergencia Villa El Salvador, Lima, Perú
| | - Conall Francoeur
- Department of Pediatrics, Division of Pediatric Critical Care, CHU de Québec – Université Laval Research Center, Québec, Québec, Canada
| | - Anar Gurbanov
- Department of Pediatric Critical Care Medicine, Ankara University Faculty of Medicine, Ankara, Turkey
| | | | - Steven L. Shein
- Division of Pediatric Critical Care Medicine, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio, USA
| | - Adriana Yock-Corrales
- Emergency Department. Hospital Nacional de Niños “Dr. Carlos Sáenz Herrera”, CCSS. San José, Costa Rica
| | - Todd Karsies
- Division of Pediatric Critical Care, Nationwide Children's Hospital, Columbus, Ohio, USA
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19
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Schober T, Caya C, Barton M, Bayliss A, Bitnun A, Bowes J, Brenes-Chacon H, Bullard J, Cooke S, Dewan T, Dwilow R, El Tal T, Foo C, Gill P, Haghighi Aski B, Kakkar F, Lautermilch J, Lefebvre MA, Leifso K, Le Saux N, Lopez A, Manafi A, Merckx J, Morris SK, Nateghian A, Panetta L, Petel D, Piché D, Purewal R, Restivo L, Roberts A, Sadarangani M, Scuccimarri R, Soriano-Fallas A, Tehseen S, Top KA, Ulloa-Gutierrez R, Viel-Theriault I, Wong J, Yea C, Yeh A, Yock-Corrales A, Robinson JL, Papenburg J. Risk factors for severe PCR-positive SARS-CoV-2 infection in hospitalised children. BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2022-001440. [PMID: 36053578 PMCID: PMC9358955 DOI: 10.1136/bmjpo-2022-001440] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 06/19/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To identify risk factors for severe disease in children hospitalised for SARS-CoV-2 infection. DESIGN Multicentre retrospective cohort study. SETTING 18 hospitals in Canada, Iran and Costa Rica from 1 February 2020 to 31 May 2021. PATIENTS Children<18 years of age hospitalised for symptomatic PCR-positive SARS-CoV-2 infection, including PCR-positive multisystem inflammatory syndrome in children (MIS-C). MAIN OUTCOME MEASURE Severity on the WHO COVID-19 Clinical Progression Scale was used for ordinal logistic regression analyses. RESULTS We identified 403 hospitalisations. Median age was 3.78 years (IQR 0.53-10.77). At least one comorbidity was present in 46.4% (187/403) and multiple comorbidities in 18.6% (75/403). Eighty-one children (20.1%) met WHO criteria for PCR-positive MIS-C. Progression to WHO clinical scale score ≥6 occurred in 25.3% (102/403). In multivariable ordinal logistic regression analyses adjusted for age, chest imaging findings, laboratory-confirmed bacterial and/or viral coinfection, and MIS-C diagnosis, presence of a single (adjusted OR (aOR) 1.90, 95% CI 1.13 to 3.20) or multiple chronic comorbidities (aOR 2.12, 95% CI 1.19 to 3.79), obesity (aOR 3.42, 95% CI 1.76 to 6.66) and chromosomal disorders (aOR 4.47, 95% CI 1.25 to 16.01) were independent risk factors for severity. Age was not an independent risk factor, but different age-specific comorbidities were associated with more severe disease in age-stratified adjusted analyses: cardiac (aOR 2.90, 95% CI 1.11 to 7.56) and non-asthma pulmonary disorders (aOR 3.07, 95% CI 1.26 to 7.49) in children<12 years old and obesity (aOR 3.69, 1.45-9.40) in adolescents≥12 years old. Among infants<1 year old, neurological (aOR 10.72, 95% CI 1.01 to 113.35) and cardiac disorders (aOR 10.13, 95% CI 1.69 to 60.54) were independent predictors of severe disease. CONCLUSION We identified risk factors for disease severity among children hospitalised for PCR-positive SARS-CoV-2 infection. Comorbidities predisposing children to more severe disease may vary by age. These findings can potentially guide vaccination programmes and treatment approaches in children.
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Affiliation(s)
- Tilmann Schober
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Chelsea Caya
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Michelle Barton
- Department of Pediatrics, Western University, London, Ontario, Canada
| | - Ann Bayliss
- Department of Pediatrics, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Ari Bitnun
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Bowes
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Helena Brenes-Chacon
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Ninos Dr Carlos Saenz Herrera, San Jose, San José, Costa Rica
| | - Jared Bullard
- Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Suzette Cooke
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Tammie Dewan
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Rachel Dwilow
- Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tala El Tal
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Cheryl Foo
- Department of Pediatrics, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Peter Gill
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Behzad Haghighi Aski
- Department of Pediatrics, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Fatima Kakkar
- Department of Pediatrics, Universite de Montreal, Montreal, Quebec, Canada
| | - Janell Lautermilch
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Kirk Leifso
- Department of Pediatrics, Queen's University, Kingston, Ontario, Canada
| | - Nicole Le Saux
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Alison Lopez
- British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Ali Manafi
- Department of Pediatrics, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Joanna Merckx
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Shaun K Morris
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Alireza Nateghian
- Department of Pediatrics, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Luc Panetta
- Department of Pediatrics, Universite de Montreal, Montreal, Quebec, Canada
| | - Dara Petel
- Department of Pediatrics, Western University, London, Ontario, Canada
| | - Dominique Piché
- Department of Pediatrics, Dalhousie University, Halifax, British Columbia, Canada
| | - Rupeena Purewal
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Lea Restivo
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Ashley Roberts
- British Columbia Children's Hospital, Vancouver, British Columbia, Canada.,Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Manish Sadarangani
- Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada.,Vaccine Evaluation Center, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Rosie Scuccimarri
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Alejandra Soriano-Fallas
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Ninos Dr Carlos Saenz Herrera, San Jose, San José, Costa Rica
| | - Sarah Tehseen
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Karina A Top
- Department of Pediatrics, Dalhousie University, Halifax, British Columbia, Canada
| | - Rolando Ulloa-Gutierrez
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Ninos Dr Carlos Saenz Herrera, San Jose, San José, Costa Rica
| | | | - Jacqueline Wong
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Carmen Yea
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Ann Yeh
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Adriana Yock-Corrales
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Ninos Dr Carlos Saenz Herrera, San Jose, San José, Costa Rica
| | - Joan L Robinson
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Jesse Papenburg
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada .,Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
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20
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Funk AL, Kuppermann N, Florin TA, Tancredi DJ, Xie J, Kim K, Finkelstein Y, Neuman MI, Salvadori MI, Yock-Corrales A, Breslin KA, Ambroggio L, Chaudhari PP, Bergmann KR, Gardiner MA, Nebhrajani JR, Campos C, Ahmad FA, Sartori LF, Navanandan N, Kannikeswaran N, Caperell K, Morris CR, Mintegi S, Gangoiti I, Sabhaney VJ, Plint AC, Klassen TP, Avva UR, Shah NP, Dixon AC, Lunoe MM, Becker SM, Rogers AJ, Pavlicich V, Dalziel SR, Payne DC, Malley R, Borland ML, Morrison AK, Bhatt M, Rino PB, Beneyto Ferre I, Eckerle M, Kam AJ, Chong SL, Palumbo L, Kwok MY, Cherry JC, Poonai N, Waseem M, Simon NJ, Freedman SB. Post-COVID-19 Conditions Among Children 90 Days After SARS-CoV-2 Infection. JAMA Netw Open 2022; 5:e2223253. [PMID: 35867061 PMCID: PMC9308058 DOI: 10.1001/jamanetworkopen.2022.23253] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Little is known about the risk factors for, and the risk of, developing post-COVID-19 conditions (PCCs) among children. OBJECTIVES To estimate the proportion of SARS-CoV-2-positive children with PCCs 90 days after a positive test result, to compare this proportion with SARS-CoV-2-negative children, and to assess factors associated with PCCs. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study, conducted in 36 emergency departments (EDs) in 8 countries between March 7, 2020, and January 20, 2021, included 1884 SARS-CoV-2-positive children who completed 90-day follow-up; 1686 of these children were frequency matched by hospitalization status, country, and recruitment date with 1701 SARS-CoV-2-negative controls. EXPOSURE SARS-CoV-2 detected via nucleic acid testing. MAIN OUTCOMES AND MEASURES Post-COVID-19 conditions, defined as any persistent, new, or recurrent health problems reported in the 90-day follow-up survey. RESULTS Of 8642 enrolled children, 2368 (27.4%) were SARS-CoV-2 positive, among whom 2365 (99.9%) had index ED visit disposition data available; among the 1884 children (79.7%) who completed follow-up, the median age was 3 years (IQR, 0-10 years) and 994 (52.8%) were boys. A total of 110 SARS-CoV-2-positive children (5.8%; 95% CI, 4.8%-7.0%) reported PCCs, including 44 of 447 children (9.8%; 95% CI, 7.4%-13.0%) hospitalized during the acute illness and 66 of 1437 children (4.6%; 95% CI, 3.6%-5.8%) not hospitalized during the acute illness (difference, 5.3%; 95% CI, 2.5%-8.5%). Among SARS-CoV-2-positive children, the most common symptom was fatigue or weakness (21 [1.1%]). Characteristics associated with reporting at least 1 PCC at 90 days included being hospitalized 48 hours or more compared with no hospitalization (adjusted odds ratio [aOR], 2.67 [95% CI, 1.63-4.38]); having 4 or more symptoms reported at the index ED visit compared with 1 to 3 symptoms (4-6 symptoms: aOR, 2.35 [95% CI, 1.28-4.31]; ≥7 symptoms: aOR, 4.59 [95% CI, 2.50-8.44]); and being 14 years of age or older compared with younger than 1 year (aOR, 2.67 [95% CI, 1.43-4.99]). SARS-CoV-2-positive children were more likely to report PCCs at 90 days compared with those who tested negative, both among those who were not hospitalized (55 of 1295 [4.2%; 95% CI, 3.2%-5.5%] vs 35 of 1321 [2.7%; 95% CI, 1.9%-3.7%]; difference, 1.6% [95% CI, 0.2%-3.0%]) and those who were hospitalized (40 of 391 [10.2%; 95% CI, 7.4%-13.7%] vs 19 of 380 [5.0%; 95% CI, 3.0%-7.7%]; difference, 5.2% [95% CI, 1.5%-9.1%]). In addition, SARS-CoV-2 positivity was associated with reporting PCCs 90 days after the index ED visit (aOR, 1.63 [95% CI, 1.14-2.35]), specifically systemic health problems (eg, fatigue, weakness, fever; aOR, 2.44 [95% CI, 1.19-5.00]). CONCLUSIONS AND RELEVANCE In this cohort study, SARS-CoV-2 infection was associated with reporting PCCs at 90 days in children. Guidance and follow-up are particularly necessary for hospitalized children who have numerous acute symptoms and are older.
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Affiliation(s)
- Anna L Funk
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nathan Kuppermann
- Department of Emergency Medicine, University of California, Davis School of Medicine, Sacramento
- Department of Pediatrics, University of California, Davis School of Medicine, Sacramento
| | - Todd A Florin
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Division of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Daniel J Tancredi
- Department of Pediatrics, University of California, Davis School of Medicine, Sacramento
| | - Jianling Xie
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kelly Kim
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Yaron Finkelstein
- Division of Emergency Medicine, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Clinical Pharmacology and Toxicology, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mark I Neuman
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts
| | | | - Adriana Yock-Corrales
- Emergency Department, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera," CCSS, San José, Costa Rica
| | - Kristen A Breslin
- Department of Emergency Medicine and Trauma Services, Children's National Hospital, Washington, DC
| | - Lilliam Ambroggio
- Department of Pediatrics, University of Colorado, Aurora
- Section of Emergency Medicine, Children's Hospital Colorado, Aurora
| | - Pradip P Chaudhari
- Division of Emergency and Transport Medicine, Children's Hospital Los Angeles and Keck School of Medicine of the University of Southern California, Los Angeles
| | - Kelly R Bergmann
- Department of Emergency Medicine, Children's Minnesota, Minneapolis
| | - Michael A Gardiner
- Department of Pediatrics, University of California, San Diego, Rady Children's Hospital, San Diego
| | | | - Carmen Campos
- Pediatric Emergency Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Fahd A Ahmad
- Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Laura F Sartori
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Nidhya Navanandan
- Department of Pediatrics, University of Colorado, Aurora
- Section of Emergency Medicine, Children's Hospital Colorado, Aurora
| | - Nirupama Kannikeswaran
- Division of Emergency Medicine, Children's Hospital of Michigan, Detroit
- Department of Pediatrics, Central Michigan University, Mt Pleasant
| | - Kerry Caperell
- Department of Pediatrics, University of Louisville, Louisville, Kentucky
- Department of Pediatrics, Norton Children's Hospital, Louisville, Kentucky
| | - Claudia R Morris
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Santiago Mintegi
- Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, UPV/EHU Bilbao, Basque Country, Spain
| | - Iker Gangoiti
- Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, UPV/EHU Bilbao, Basque Country, Spain
| | - Vikram J Sabhaney
- Department of Paediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Amy C Plint
- Division of Emergency Medicine, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Terry P Klassen
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Usha R Avva
- Department of Emergency Medicine, Montefiore-Nyack Hospital, Nyack, New York
| | - Nipam P Shah
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Alabama at Birmingham
| | - Andrew C Dixon
- University of Alberta, Stollery Children's Hospital, Women's and Children's Health Research Institute, Edmonton, Alberta, Canada
| | - Maren M Lunoe
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sarah M Becker
- Primary Children's Hospital, Intermountain Healthcare, Salt Lake City, Utah
| | - Alexander J Rogers
- Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor
- Department of Pediatrics, University of Michigan School of Medicine, Ann Arbor
| | - Viviana Pavlicich
- Departamento de Emergencia Pediátrica, Hospital General Pediátrico Niños de Acosta Ñu, Facultad de Medicina, Universidad Privada del Pacífico, San Lorenzo, Paraguay
| | - Stuart R Dalziel
- Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand
- Department of Surgery, University of Auckland, Auckland, New Zealand
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Daniel C Payne
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Richard Malley
- Division of Infectious Diseases, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Meredith L Borland
- Emergency Department, Perth Children's Hospital, Perth, Western Australia
- Division of Emergency Medicine, School of Medicine, University of Western Australia, Perth, Australia
- Division of Paediatrics, School of Medicine, University of Western Australia, Perth, Australia
| | - Andrea K Morrison
- Division of Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee
| | - Maala Bhatt
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Pedro B Rino
- Hospital de Pediatría "Prof Dr. Juan P. Garrahan," RIDEPLA, Buenos Aires, Argentina
| | | | - Michelle Eckerle
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Pediatric Emergency Medicine, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - April J Kam
- Department of Pediatrics, Division of Emergency Medicine, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Shu-Ling Chong
- Department of Emergency Medicine, KK Women's and Children's Hospital, Duke-NUS Medical School, SingHealth Duke-NUS Global Health Institute, Singapore
| | - Laura Palumbo
- ASST Spedali Civili di Brescia-Pronto soccorso pediatrico, Brescia, Italy
| | - Maria Y Kwok
- Department of Emergency Medicine, New York Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, New York
| | - Jonathan C Cherry
- Department of Pediatric Emergency Medicine, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Naveen Poonai
- Department of Pediatrics, Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Muhammad Waseem
- Department of Emergency Medicine, Lincoln Medical Center, New York, New York
| | - Norma-Jean Simon
- Division of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
- Data Analytics and Reporting, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Stephen B Freedman
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Section of Gastroenterology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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21
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Yock-Corrales A, Gomez-Vargas J, Ulloa-Gutierrez R, Brizuela M, Del Aguila O, Kozicki V, Lenzi J, Buonsenso D. Clinical Outcomes of Pediatric COVID-19 During Two Waves of Different Variants Circulation in Latin America. Indian J Pediatr 2022; 89:727. [PMID: 35244879 PMCID: PMC8895099 DOI: 10.1007/s12098-022-04113-3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/24/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Adriana Yock-Corrales
- Pediatric Emergency Department, Hospital Nacional de Niños "Dr Carlos Sáenz Herrera", CCSS, San José, 957-1100, Costa Rica.
| | - Jessica Gomez-Vargas
- Pediatric Emergency Department, Hospital Nacional de Niños "Dr Carlos Sáenz Herrera", CCSS, San José, 957-1100, Costa Rica
| | - Rolando Ulloa-Gutierrez
- Infectious Disease Division, Hospital Nacional de Niños "Dr Carlos Sáenz Herrera", CCSS, San José, Costa Rica
| | - Martin Brizuela
- Pediatric Infectious Disease, Hospital Isidoro Iriarte, Quilmes, Buenos Aires, Argentina
| | - Olguita Del Aguila
- Unidad de Infectología Pediátrica del Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú
| | - Verónica Kozicki
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Jacopo Lenzi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli and Global Health Research Institute, Istituto Di Igiene, Università Cattolica del Sacro Cuore, Roma, Italia
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Merckx J, Cooke S, El Tal T, Bitnun A, Morris SK, Yeh EA, Yea C, Gill P, Papenburg J, Lefebvre MA, Scuccimarri R, Ulloa-Gutierrez R, Brenes-Chacon H, Yock-Corrales A, Ivankovich-Escoto G, Soriano-Fallas A, Mezerville MHD, Dewan T, Restivo L, Nateghian A, Aski BH, Manafi A, Dwilow R, Bullard J, Lopez A, Sadarangani M, Roberts A, Barton M, Petel D, Le Saux N, Bowes J, Purewal R, Lautermilch J, Tehseen S, Bayliss A, Wong JK, Leifso K, Foo C, Robinson J. Predictors of severe illness in children with multisystem inflammatory syndrome after SARS-CoV-2 infection: a multicentre cohort study. CMAJ 2022; 194:E513-E523. [PMID: 35410860 PMCID: PMC9001008 DOI: 10.1503/cmaj.210873] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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] [Accepted: 02/17/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND SARS-CoV-2 infection can lead to multisystem inflammatory syndrome in children (MIS-C). We sought to investigate risk factors for admission to the intensive care unit (ICU) and explored changes in disease severity over time. METHODS We obtained data from chart reviews of children younger than 18 years with confirmed or probable MIS-C who were admitted to 15 hospitals in Canada, Iran and Costa Rica between Mar. 1, 2020, and Mar. 7, 2021. Using multivariable analyses, we evaluated whether admission date and other characteristics were associated with ICU admission or cardiac involvement. RESULTS Of 232 children with MIS-C (median age 5.8 yr), 130 (56.0%) were male and 50 (21.6%) had comorbidities. Seventy-three (31.5%) patients were admitted to the ICU but none died. We observed an increased risk of ICU admission among children aged 13-17 years (adjusted risk difference 27.7%, 95% confidence interval [CI] 8.3% to 47.2%), those aged 6-12 years (adjusted risk difference 25.2%, 95% CI 13.6% to 36.9%) or those with initial ferritin levels greater than 500 μg/L (adjusted risk difference 18.4%, 95% CI 5.6% to 31.3%). Children admitted to hospital after Oct. 31, 2020, had numerically higher rates of ICU admission (adjusted risk difference 12.3%, 95% CI -0.3% to 25.0%) and significantly higher rates of cardiac involvement (adjusted risk difference 30.9%, 95% CI 17.3% to 44.4%). At Canadian sites, the risk of ICU admission was significantly higher for children admitted to hospital between December 2020 and March 2021 than those admitted between March and May 2020 (adjusted risk difference 25.3%, 95% CI 6.5% to 44.0%). INTERPRETATION We observed that age and higher ferritin levels were associated with more severe MIS-C. We observed greater severity of MIS-C later in the study period. Whether emerging SARS-CoV-2 variants pose different risks of severe MIS-C needs to be determined.
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Affiliation(s)
- Joanna Merckx
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Suzette Cooke
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Tala El Tal
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Ari Bitnun
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Shaun K Morris
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - E Ann Yeh
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Carmen Yea
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Peter Gill
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Jesse Papenburg
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Marie-Astrid Lefebvre
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Rosie Scuccimarri
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Rolando Ulloa-Gutierrez
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Helena Brenes-Chacon
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Adriana Yock-Corrales
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Gabriela Ivankovich-Escoto
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Alejandra Soriano-Fallas
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Marcela Hernandez-de Mezerville
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Tammie Dewan
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Lea Restivo
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Alireza Nateghian
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Behzad Haghighi Aski
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Ali Manafi
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Rachel Dwilow
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Jared Bullard
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Alison Lopez
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Manish Sadarangani
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Ashley Roberts
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Michelle Barton
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Dara Petel
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Nicole Le Saux
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Jennifer Bowes
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Rupeena Purewal
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Janell Lautermilch
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Sarah Tehseen
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Ann Bayliss
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Jacqueline K Wong
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Kirk Leifso
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Cheryl Foo
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta
| | - Joan Robinson
- Department of Epidemiology (Merckx), Biostatistics and Occupational Health, McGill University, Montréal, Que.; Department of Pediatrics (Cooke, Dewan, Restivo), University of Calgary, Calgary, Alta.; Department of Pediatrics (El Tal, Bitnun, Morris, Yeh, Yea, Gill), University of Toronto, Toronto, Ont.; Department of Pediatrics (Papenburg, Lefebvre, Scuccimarri), McGill University, Montréal, Que.; Department of Pediatrics (Ulloa-Gutierrez, Brenes-Chacon, Yock-Corrales, Ivankovich-Escoto, Soriano-Fallas, Hernandez-de Mezerville), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica; Department of Pediatrics (Nateghian, Haghighi Aski, Manafi), Iran University of Medical Sciences, Tehran, Iran; Department of Pediatrics (Dwilow, Bullard), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Lopez, Sadarangani, Roberts), University of British Columbia; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute, Vancouver, BC; Department of Pediatrics (Barton, Petel), Western University, London, Ont.; Department of Pediatrics (Le Saux, Bowes), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Purewal, Lautermilch, Tehseen), University of Saskatchewan, Saskatoon, Sask.; Department of Pediatrics (Bayliss), Trillium Health Partners, Mississauga, Ont.; Department of Pediatrics (Wong), McMaster University, Hamilton, Ont.; Department of Pediatrics (Leifso), Queen's University, Kingston, Ont.; Department of Pediatrics (Foo), Memorial University, St John's, NL; Department of Pediatrics (Robinson), University of Alberta, Edmonton, Alta.
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23
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Apuy M, Yock-Corrales A, Moreno AM, Gutierrez A. Streptococcus Pyogenes Epiglottitis in a Child: A Case Report. Cureus 2022; 14:e24123. [PMID: 35573512 PMCID: PMC9106533 DOI: 10.7759/cureus.24123] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2022] [Indexed: 11/22/2022] Open
Abstract
Acute epiglottitis in children is a rare entity since the introduction of the vaccine against Haemophilus influenzae; however, it should be considered as part of the differential diagnosis when facing a patient with evidence of upper airway obstruction. This study describes the case of a three-year-old child who arrived at the emergency department with fever, respiratory distress, and stridor. After ventilatory failure, the patient was intubated and antibiotics were initiated. The results of the bacteria culture confirmed Streptococcus pyogenes infection. This case report intends to describe and review the differential diagnoses of epiglottitis, as well as its management and prognosis.
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Affiliation(s)
- Massiel Apuy
- Pediatrics, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", San Jose, CRI
| | - Adriana Yock-Corrales
- Pediatric Emergency Medicine, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", San Jose, CRI
| | - Ana Maria Moreno
- Pediatrics, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", San Jose, CRI
| | - Andrea Gutierrez
- Pediatrics, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", San Jose, CRI
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24
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Santhanam I, Moodley P, Jayaraman B, Yock-Corrales A, Cheema B, Craig S, Jahn HK. Triage and resuscitation tools for low and middle income countries: how to catch the killer? Arch Dis Child Educ Pract Ed 2022; 107:71-76. [PMID: 34112664 DOI: 10.1136/archdischild-2021-321981] [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: 03/06/2021] [Revised: 04/22/2021] [Accepted: 04/27/2021] [Indexed: 11/04/2022]
Abstract
Under-5 mortality rates in low and middle-income countries (LMIC) remain high. One major contributing factor is the failure to recognise critically unwell children when they first present to hospital. This leads to delayed or inadequate resuscitation and an increased risk of death.Triage is a key skill in this setting to sort the queue and prioritise patients, even when staff and equipment are scarce. In LMIC, children generally present late in their illness and often have progressed to some degree of multiorgan dysfunction.Following triage, a structured systematic primary survey is critical to ensure the detection of subtle signs of multiorgan dysfunction. Repeated physiological assessments of the child guide subsequent resuscitation management decisions, which depend somewhat on the resources available.It is possible to achieve significant improvements in survival of critically unwell children presenting for emergency care in the resource-limited setting. The three key steps in the patient's journey that we can influence in emergency care are triage, primary survey and initial stabilisation. Resources that address these steps have been developed for all settings. However, these resources were developed in a specific clinical context, and must therefore be adapted to local structures and processes. A systematic approach to triage and resuscitation saves lives.
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Affiliation(s)
- Indumathy Santhanam
- Pediatric Emergency Medicine, Institute of Child Health and Hospital for Children, Chennai, Tamil Nadu, India
| | - Prinetha Moodley
- Department of Paediatrics, Paarl Hospital, Paarl, Western Cape, South Africa.,Department of Paediatrics, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, Western Cape, South Africa
| | - Balaji Jayaraman
- Paediatrics, Government Dharmapuri Medical College, Dharmapuri, Tamil Nadu, India
| | | | - Baljit Cheema
- Department of Paediatrics, University of Cape Town, Rondebosch, Western Cape, South Africa.,Paediatric Retrieval, Specialised Paediatric Retrieval Including Neonatal Transfer (SPRINT) Team, Cape Town, South Africa
| | - Simon Craig
- Emergency Department, Monash Medical Centre Clayton, Clayton, Victoria, Australia.,Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Haiko Kurt Jahn
- Emergency Department, Gold Coast University Hospital, Southport, Queensland, Australia .,Center of Emergency Medicine, Friedrich Schiller University Jena, Jena, Thüringen, Germany
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25
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Mota Curiel C, Yock-Corrales A, Contreras C, Corona L, Pavlichiv V, Álvarez E, González Del Rey J. Pediatric Emergency Medicine Training: A Survey of Current Status in Latin America. Pediatr Emerg Care 2022; 38:e766-e770. [PMID: 35100775 DOI: 10.1097/pec.0000000000002398] [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: 11/26/2022]
Abstract
Pediatric emergency medicine (PEM) is a relatively new and rapidly evolving subspecialty in many countries. The purposes of this study were to describe the characteristics and to find common/shared practices in current available PEM fellowship programs across Latin America. METHODS An electronic, multicenter survey was created and stored on Google forms. The survey was in Spanish language and included 30 questions about the characteristics of the pediatric emergency program, history of the program, and support expected from the Latin American Pediatric Emergency Society. RESULTS A total of 11 PEM programs in 6 countries were acknowledged in Latin America. All programs are placed in pediatric tertiary care hospitals. All PEM programs were approved by the local universities and the Ministries of Health in each country. Difficulties to start a PEM program included a lack of physicians properly trained in PEM who could direct the program, physician instructors in specific topics, places to complete rotations of the future fellows, and getting the local health authorities to acknowledge the importance of the program. With regard to the duration of the program, 72.7% (8) have a 2-year curriculum and 27.3% (3) have a 1-year curriculum. Four (36.4%) program directors mentioned an admission examination as a requirement, 4 (36.4%) needed an examination plus an interview, 3 (27.3%) mentioned that it is necessary just like an interview, and 2 (18.2%) mentioned that the physicians are admitted with a scholarship. With regard to the structure of the programs and rotations included, most of the programs have rotations that are compulsory in different pediatric subspecialties. In 80% of the programs, fellows are evaluated based on different technical skill procedures that they need to learn and perform during PEM fellowship training. The PEM fellowship is recognized by different societies in emergency medicine and pediatrics, except in Dominican Republic where it is only recognized by the Ministry of Health and the university. After completion of the program in 90% (10) of the programs, graduates are not guaranteed a job, and in half, there is no mechanism implemented for recertification of the pediatric emergency physicians by the local medical council. CONCLUSIONS In Latin America, postgraduate programs in pediatric emergencies are a response to a need for health systems. Being an innovative specialty, it surpassed each country's own challenges, until it was able to reach an internationally standardized level, with a great diversity of pedagogical methodology, which the product has been to offer a high quality of emergency care to children.
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Affiliation(s)
- César Mota Curiel
- From the Emergency Department, Hospital Infantil Dr. Robert Reid Cabral, Santo Domingo, Dominican Republic
| | - Adriana Yock-Corrales
- Emergency Department, Hospital Nacional de Niños, San José, Costa Rica University of Costa Rica, San José, Costa Rica
| | - Cristina Contreras
- From the Emergency Department, Hospital Infantil Dr. Robert Reid Cabral, Santo Domingo, Dominican Republic
| | - Lisandra Corona
- From the Emergency Department, Hospital Infantil Dr. Robert Reid Cabral, Santo Domingo, Dominican Republic
| | - Viviana Pavlichiv
- Emergency Department, Hospital General Pediátrico Niños de Acosta Ñ Asunción, San Lorenzo, Paraguay
| | - Eugenia Álvarez
- Emergency Department, Hospital San Juan de Dios Ciudad Guatemala, Guatemala City, Guatemala
| | - Javier González Del Rey
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center Cincinnati, OH
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26
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Funk AL, Florin TA, Kuppermann N, Tancredi DJ, Xie J, Kim K, Neuman MI, Ambroggio L, Plint AC, Mintegi S, Klassen TP, Salvadori MI, Malley R, Payne DC, Simon NJ, Yock-Corrales A, Nebhrajani JR, Chaudhari PP, Breslin KA, Finkelstein Y, Campos C, Bergmann KR, Bhatt M, Ahmad FA, Gardiner MA, Avva UR, Shah NP, Sartori LF, Sabhaney VJ, Caperell K, Navanandan N, Borland ML, Morris CR, Gangoiti I, Pavlicich V, Kannikeswaran N, Lunoe MM, Rino PB, Kam AJ, Cherry JC, Rogers AJ, Chong SL, Palumbo L, Angelats CM, Morrison AK, Kwok MY, Becker SM, Dixon AC, Poonai N, Eckerle M, Wassem M, Dalziel SR, Freedman SB. Outcomes of SARS-CoV-2-Positive Youths Tested in Emergency Departments: The Global PERN-COVID-19 Study. JAMA Netw Open 2022; 5:e2142322. [PMID: 35015063 PMCID: PMC8753506 DOI: 10.1001/jamanetworkopen.2021.42322] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
IMPORTANCE Severe outcomes among youths with SARS-CoV-2 infections are poorly characterized. OBJECTIVE To estimate the proportion of children with severe outcomes within 14 days of testing positive for SARS-CoV-2 in an emergency department (ED). DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study with 14-day follow-up enrolled participants between March 2020 and June 2021. Participants were youths aged younger than 18 years who were tested for SARS-CoV-2 infection at one of 41 EDs across 10 countries including Argentina, Australia, Canada, Costa Rica, Italy, New Zealand, Paraguay, Singapore, Spain, and the United States. Statistical analysis was performed from September to October 2021. EXPOSURES Acute SARS-CoV-2 infection was determined by nucleic acid (eg, polymerase chain reaction) testing. MAIN OUTCOMES AND MEASURES Severe outcomes, a composite measure defined as intensive interventions during hospitalization (eg, inotropic support, positive pressure ventilation), diagnoses indicating severe organ impairment, or death. RESULTS Among 3222 enrolled youths who tested positive for SARS-CoV-2 infection, 3221 (>99.9%) had index visit outcome data available, 2007 (62.3%) were from the United States, 1694 (52.6%) were male, and 484 (15.0%) had a self-reported chronic illness; the median (IQR) age was 3 (0-10) years. After 14 days of follow-up, 735 children (22.8% [95% CI, 21.4%-24.3%]) were hospitalized, 107 (3.3% [95% CI, 2.7%-4.0%]) had severe outcomes, and 4 children (0.12% [95% CI, 0.03%-0.32%]) died. Characteristics associated with severe outcomes included being aged 5 to 18 years (age 5 to <10 years vs <1 year: odds ratio [OR], 1.60 [95% CI, 1.09-2.34]; age 10 to <18 years vs <1 year: OR, 2.39 [95% CI 1.38-4.14]), having a self-reported chronic illness (OR, 2.34 [95% CI, 1.59-3.44]), prior episode of pneumonia (OR, 3.15 [95% CI, 1.83-5.42]), symptoms starting 4 to 7 days prior to seeking ED care (vs starting 0-3 days before seeking care: OR, 2.22 [95% CI, 1.29-3.82]), and country (eg, Canada vs US: OR, 0.11 [95% CI, 0.05-0.23]; Costa Rica vs US: OR, 1.76 [95% CI, 1.05-2.96]; Spain vs US: OR, 0.51 [95% CI, 0.27-0.98]). Among a subgroup of 2510 participants discharged home from the ED after initial testing and who had complete follow-up, 50 (2.0%; 95% CI, 1.5%-2.6%) were eventually hospitalized and 12 (0.5%; 95% CI, 0.3%-0.8%) had severe outcomes. Compared with hospitalized SARS-CoV-2-negative youths, the risk of severe outcomes was higher among hospitalized SARS-CoV-2-positive youths (risk difference, 3.9%; 95% CI, 1.1%-6.9%). CONCLUSIONS AND RELEVANCE In this study, approximately 3% of SARS-CoV-2-positive youths tested in EDs experienced severe outcomes within 2 weeks of their ED visit. Among children discharged home from the ED, the risk was much lower. Risk factors such as age, underlying chronic illness, and symptom duration may be useful to consider when making clinical care decisions.
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Affiliation(s)
- Anna L. Funk
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Todd A. Florin
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Division of Emergency Medicine, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Nathan Kuppermann
- Departments of Emergency Medicine and Pediatrics, University of California, Davis School of Medicine, Sacramento
| | - Daniel J. Tancredi
- Department of Pediatrics, University of California, Davis School of Medicine, Sacramento
| | - Jianling Xie
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kelly Kim
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mark I. Neuman
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Lilliam Ambroggio
- Section of Emergency Medicine, Children’s Hospital Colorado, Department of Pediatrics, University of Colorado, Aurora
| | - Amy C. Plint
- Children’s Hospital of Eastern Ontario, Division of Emergency Medicine, Departments of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Santiago Mintegi
- Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, UPV/EHU, Bilbao, Basque Country, Spain
| | - Terry P. Klassen
- Children’s Hospital Research Institute of Manitoba, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Richard Malley
- Division of Infectious Diseases, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Daniel C. Payne
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Norma-Jean Simon
- Data Analytics and Reporting, Division of Emergency Medicine, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | | | | | - Pradip P. Chaudhari
- Division of Emergency and Transport Medicine, Children’s Hospital Los Angeles, Los Angeles, California
- Keck School of Medicine of the University of Southern California, Los Angeles, California
| | | | - Yaron Finkelstein
- Divisions of Emergency Medicine and Clinical Pharmacology and Toxicology, Department of Pediatrics Hospital for Sick Children, Toronto, Ontario, Canada
| | - Carmen Campos
- Hospital Universitario Miguel Servet, Pediatric Emergency Department, Zaragoza, Spain
| | - Kelly R. Bergmann
- Department of Emergency Medicine, Children’s Minnesota, Minneapolis, Minnesota
| | - Maala Bhatt
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Fahd A. Ahmad
- Department of Pediatrics, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Michael A. Gardiner
- Rady Children’s Hospital, Department of Pediatrics, University of California, San Diego, San Diego, California
| | - Usha R. Avva
- School of Medicine Hackensack Meridian Health, Hackensack, New Jersey
| | - Nipam P. Shah
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham
| | - Laura F. Sartori
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Vikram J. Sabhaney
- Department of Paediatrics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Kerry Caperell
- Norton Children’s Hospital, University of Louisville, Louisville, Kentucky
| | - Nidhya Navanandan
- Section of Emergency Medicine, Children’s Hospital Colorado, Department of Pediatrics, University of Colorado, Aurora
| | - Meredith L. Borland
- Perth Children’s Hospital, Divisions of Emergency Medicine and Paediatrics, School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Claudia R. Morris
- Department of Pediatrics, Division of Emergency Medicine, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Iker Gangoiti
- Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, UPV/EHU, Bilbao, Basque Country, Spain
| | - Viviana Pavlicich
- Departamento de Emergencia Pediátrica, Hospital General Pediátrico Niños de Acosta Ñu, Facultad de Medicina, Universidad Privada del Pacífico, San Lorenzo, Paraguay
| | | | - Maren M. Lunoe
- UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Pedro B. Rino
- Hospital de Pediatría “Prof Dr Juan P. Garrahan”, RIDEPLA, Buenos Aires, Argentina
| | - April J. Kam
- Department of Pediatrics, Division of Emergency Medicine, McMaster Children’s Hospital, Hamilton, Ontario, Canada
| | - Jonathan C. Cherry
- Department of Pediatric Emergency Medicine, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Alexander J. Rogers
- Departments of Emergency Medicine and Pediatrics, University of Michigan School of Medicine, Ann Arbor
| | - Shu-Ling Chong
- Department of Emergency Medicine, KK Women’s and Children’s Hospital, Duke-NUS Medical School, SingHealth Duke-NUS Global Health Institute, Singapore
| | - Laura Palumbo
- ASST Spedali Civili di Brescia - Pronto soccorso pediatrico, Brescia, Italy
| | | | - Andrea K. Morrison
- Division of Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Maria Y. Kwok
- Department of Emergency Medicine, New York Presbyterian Morgan Stanley Children’s Hospital, Columbia University Irving Medical Center, New York
| | - Sarah M. Becker
- University of Utah School of Medicine and Primary Children’s Hospital, Salt Lake City, Utah
| | - Andrew C. Dixon
- University of Alberta, Stollery Children’s Hospital, Women’s and Children’s Health Research Institute, Edmonton, Alberta, Canada
| | - Naveen Poonai
- Child Health Research Institute, Division of Paediatric Emergency Medicine, Departments of Pediatrics, Internal Medicine, Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Michelle Eckerle
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Pediatric Emergency Medicine, Cincinnati Children’s Hospital, Cincinnati, Ohio
| | | | - Stuart R. Dalziel
- Children’s Emergency Department, Starship Children’s Hospital, Auckland, New Zealand
- Departments of Surgery and Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Stephen B. Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology, Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Merckx J, Morris SK, Bitnun A, Gill P, El Tal T, Laxer RM, Yeh A, Yea C, Ulloa-Gutierrez R, Brenes-Chacon H, Yock-Corrales A, Ivankovich-Escoto G, Soriano-Fallas A, Hernandez-de Mezerville M, Papenburg J, Lefebvre MA, Nateghian A, Haghighi Aski B, Manafi A, Dwilow R, Bullard J, Cooke S, Dewan T, Restivo L, Lopez A, Sadarangani M, Roberts A, Barton M, Petel D, Le Saux N, Bowes J, Purewal R, Lautermilch J, Tehseen S, Bayliss A, Wong JK, Viel-Thériault I, Piche D, Top KA, Leifso K, Foo C, Panetta L, Robinson J. Infants hospitalized for acute COVID-19: disease severity in a multicenter cohort study. Eur J Pediatr 2022; 181:2535-2539. [PMID: 35217918 PMCID: PMC8880297 DOI: 10.1007/s00431-022-04422-x] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/07/2022] [Accepted: 02/13/2022] [Indexed: 02/02/2023]
Abstract
Age is the most important determinant of COVID-19 severity. Infectious disease severity by age is typically J-shaped, with infants and the elderly carrying a high burden of disease. We report on the comparative disease severity between infants and older children in a multicenter retrospective cohort study of children 0 to 17 years old admitted for acute COVID-19 from February 2020 through May 2021 in 17 pediatric hospitals. We compare clinical and laboratory characteristics and estimate the association between age group and disease severity using ordinal logistic regression. We found that infants comprised one-third of cases, but were admitted for a shorter period (median 3 days IQR 2-5 versus 4 days IQR 2-7), had a lower likelihood to have an increased C-reactive protein, and had half the odds of older children of having severe or critical disease (OR 0.50 (95% confidence interval 0.32-0.78)). Conclusion: When compared to older children, there appeared to be a lower threshold to admit infants but their length of stay was shorter and they had lower odds than older children of progressing to severe or critical disease. What is Known: • A small proportion of children infected with SARS-CoV-2 require hospitalization for acute COVID-19 with a subgroup needing specialized intensive care to treat more severe disease. • For most infectious diseases including viral respiratory tract infections, disease severity by age is J-shaped, with infants having more severe disease compared to older children. What is New: • One-third of admitted children for acute COVID-19 during the first 14 months of the pandemic were infants. • Infants had half the odds of older children of having severe or critical disease.
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Affiliation(s)
- Joanna Merckx
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, McGill College, Suite 1200, Montreal, QC, H3A 1G1, Canada.
| | - Shaun K. Morris
- Department of Pediatrics, University of Toronto, Toronto, ON Canada
| | - Ari Bitnun
- Department of Pediatrics, University of Toronto, Toronto, ON Canada
| | - Peter Gill
- Department of Pediatrics, University of Toronto, Toronto, ON Canada
| | - Tala El Tal
- Department of Pediatrics, University of Toronto, Toronto, ON Canada
| | - Ronald M. Laxer
- Department of Pediatrics, University of Toronto, Toronto, ON Canada
| | - Ann Yeh
- Department of Pediatrics, University of Toronto, Toronto, ON Canada
| | - Carmen Yea
- Department of Pediatrics, University of Toronto, Toronto, ON Canada
| | - Rolando Ulloa-Gutierrez
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, San José, Costa Rica
| | - Helena Brenes-Chacon
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, San José, Costa Rica
| | - Adriana Yock-Corrales
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, San José, Costa Rica
| | - Gabriela Ivankovich-Escoto
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, San José, Costa Rica
| | - Alejandra Soriano-Fallas
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, San José, Costa Rica
| | - Marcela Hernandez-de Mezerville
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, San José, Costa Rica
| | - Jesse Papenburg
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, McGill College, Suite 1200, Montreal, QC H3A 1G1 Canada ,Department of Pediatrics, McGill University, Montreal, QC Canada
| | | | - Alireza Nateghian
- Department of Pediatrics, University of Medical Sciences, Tehran, Iran
| | | | - Ali Manafi
- Department of Pediatrics, University of Medical Sciences, Tehran, Iran
| | - Rachel Dwilow
- Department of Pediatrics, University of Manitoba, Winnipeg, MB Canada
| | - Jared Bullard
- Department of Pediatrics, University of Manitoba, Winnipeg, MB Canada
| | - Suzette Cooke
- Department of Pediatrics, University of Calgary, Calgary, AB Canada
| | - Tammie Dewan
- Department of Pediatrics, University of Calgary, Calgary, AB Canada
| | - Lea Restivo
- Department of Pediatrics, University of Calgary, Calgary, AB Canada
| | - Alison Lopez
- British Columbia Children’s Hospital, Vancouver, BC Canada
| | - Manish Sadarangani
- British Columbia Children’s Hospital, Vancouver, BC Canada ,Department of Pediatrics, University of British Columbia, Vancouver, BC Canada ,Vaccine Evaluation Center, BC Children’s Hospital Research Institute, Vancouver, BC Canada
| | - Ashley Roberts
- British Columbia Children’s Hospital, Vancouver, BC Canada ,Department of Pediatrics, University of British Columbia, Vancouver, BC Canada
| | - Michelle Barton
- Department of Pediatrics, Western University, London, ON Canada
| | - Dara Petel
- Department of Pediatrics, Western University, London, ON Canada
| | - Nicole Le Saux
- Department of Pediatrics, University of Ottawa, Ottawa, ON Canada
| | - Jennifer Bowes
- Department of Pediatrics, University of Ottawa, Ottawa, ON Canada
| | - Rupeena Purewal
- Department of Pediatrics, University of Saskatchewan, Saskatoon, SK Canada
| | - Janell Lautermilch
- Department of Pediatrics, University of Saskatchewan, Saskatoon, SK Canada
| | - Sarah Tehseen
- Department of Pediatrics, University of Saskatchewan, Saskatoon, SK Canada
| | - Ann Bayliss
- Department of Pediatrics, Trillium Health Partners, Mississauga, ON Canada
| | | | | | - Dominique Piche
- Department of Pediatrics, Dalhousie University, Halifax, NS Canada
| | - Karina A. Top
- Department of Pediatrics, Dalhousie University, Halifax, NS Canada
| | - Kirk Leifso
- Department of Pediatrics, Queen’s University, Kingston, ON Canada
| | - Cheryl Foo
- Department of Pediatrics, Memorial University, St John’s, Newfoundland and Labrador, Canada
| | - Luc Panetta
- Department of Pediatrics, Université de Montréal, Montreal, QC Canada
| | - Joan Robinson
- Department of Pediatrics, University of Alberta, Edmonton, AB Canada
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Yock-Corrales A, Casson N, Sosa-Soto G, Orellana RA. Pediatric Critical Care Transport: Survey of Current State in Latin America. Latin American Society of Pediatric Intensive Care Transport Committee. Pediatr Emerg Care 2022; 38:e295-e299. [PMID: 33105465 DOI: 10.1097/pec.0000000000002273] [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: 11/25/2022]
Abstract
METHODS An electronic, anonymous, multicenter survey housed by Monkey Survey was sent to physicians in LA and included questions about hospital and pediatric critical transport, resources available and level of car. Nineteen Latin-American countries were asked to complete the survey. RESULTS A total of 212 surveys were analyzed, achieving a representativity of 19 LA countries, being most participants (59.4%, n = 126) from South America (Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Paraguay, Peru, Uruguay and Venezuela). Most surveys were conducted by physicians of tertiary level centers (60.8%, n = 129), most of the institutions were classified by the participants as public health care centers (81.6%, n = 173). Most of the surveyed physicians (63.7%, n = 135) reported that there is a coordination center for critical care transport (CCT). In most cases, physicians report that a unified transport system for pediatric critical patients does not exist in their countries (67.45%, n = 143). Only 59 (30.7%) surveys reported the use of an exclusively pediatric critical care transport system. Most of these transport systems are described as a mixture of public and private efforts (51.56%, n = 99), but there is also a considerable involvement of government-funded critical transport systems (43.75%, n = 84). Specific training for personnel devoted to transportation of critically ill patients is reported in 55.6% (90), and the medical equipment necessary to carry out the transport is available in 67.7%. The majority (83.95%, n = 136) mentioned that access to advanced life support courses is possible. Training in triage and disaster is available in 44.1%. Physicians and registered nurse were identified as the transport providers in 41.5%, and only one third were made by pediatricians-pediatric nurse. The main reasons for transfers were respiratory illness, neonatal pathologies, trauma, infectious diseases, and neurological conditions. Overall, pediatric transport was reported as insufficient (70.19%, n = 148) by the surveyed physicians in LA and nonexisting by some of them (6.83%, n = 15). There were no regulations or laws in the majority of the surveyed countries (63.13%), and in the places where physicians reported regulatory laws, there were no dissemination (84.9%) by the local authorities. CONCLUSIONS In LA, there is a great variability in personnel training, equipment for pediatric-neonatal transport, transport team composition, and characterization of critical care transport systems. Continued efforts to improve conditions in our countries by generating documents that standardize practices and generating scientific information on the epidemiology of pediatric transfers, especially of critically ill patients, may help reduce patient morbidity and mortality.
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Affiliation(s)
- Adriana Yock-Corrales
- From the Pediatric Emergency Department, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", CCSS, San José, Costa Rica
| | - Nils Casson
- Pediatric Critical Care Unit, Hospital Regional San Juan de Dios, Tarija, Bolivia
| | | | - Renan A Orellana
- Pediatric Critical Care Unit, Texas Children's Hospital, Houston, TX
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Yock-Corrales A, Campos-Miño S, Escalante Kanashiro R. [Latin American Consensus on Pediatric Cardiopulmonary Resuscitation. An Executive Summary from the CPR Committee, Latin American Society of Pediatric Intensive Care (SLACIP)]. Andes Pediatr 2021; 92:943-953. [PMID: 35506808 DOI: 10.32641/andespediatr.v92i6.3818] [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] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 09/02/2021] [Indexed: 06/14/2023]
Abstract
Cardiopulmonary Resuscitation (CPR) is a critical procedure with potential consequences over futu re vitality and functionality in survivors. In this document, we present a pragmatic and regional point of view on diagnosis, management, and prognostication in pediatric CPR developed by the Com mittee on CPR of the Latin American Society of Pediatric Intensive Care (SLACIP). We have chosen the main CPR topics with the aim of contribute for a better prevention and management of CPR, standardize the management of the post-cardiac arrest syndrome and neuro-prognostication, and identify opportunities for regional research. We have followed the Executive Summary published in 2020 by the International Liaison Committee on Resuscitation, ILCOR, adapted it to our reality, and developed this narrative review of pediatric CPR with the contribution of Latin American experts.
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Fernández-Sarmiento J, De Souza DC, Martinez A, Nieto V, López-Herce J, Soares Lanziotti V, Arias López MDP, De Carvalho WB, Oliveira CF, Jaramillo-Bustamante JC, Díaz F, Yock-Corrales A, Ruvinsky S, Munaico M, Pavlicich V, Iramain R, Márquez MP, González G, Yunge M, Tonial C, Cruces P, Palacio G, Grela C, Slöcker-Barrio M, Campos-Miño S, González-Dambrauskas S, Sánchez-Pinto NL, Celiny García P, Jabornisky R. Latin American Consensus on the Management of Sepsis in Children: Sociedad Latinoamericana de Cuidados Intensivos Pediátricos [Latin American Pediatric Intensive Care Society] (SLACIP) Task Force: Executive Summary. J Intensive Care Med 2021; 37:753-763. [PMID: 34812664 DOI: 10.1177/08850666211054444] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The aim of this study was to develop evidence-based recommendations for the diagnosis and treatment of sepsis in children in low- and middle-income countries (LMICs), more specifically in Latin America. Design: A panel was formed consisting of 27 experts with experience in the treatment of pediatric sepsis and two methodologists working in Latin American countries. The experts were organized into 10 nominal groups, each coordinated by a member. Methods: A formal consensus was formed based on the modified Delphi method, combining the opinions of nominal groups of experts with the interpretation of available scientific evidence, in a systematic process of consolidating a body of recommendations. The systematic search was performed by a specialized librarian and included specific algorithms for the Cochrane Specialized Register, PubMed, Lilacs, and Scopus, as well as for OpenGrey databases for grey literature. The GRADEpro GDT guide was used to classify each of the selected articles. Special emphasis was placed on search engines that included original research conducted in LMICs. Studies in English, Spanish, and Portuguese were covered. Through virtual meetings held between February 2020 and February 2021, the entire group of experts reviewed the recommendations and suggestions. Result: At the end of the 12 months of work, the consensus provided 62 recommendations for the diagnosis and treatment of pediatric sepsis in LMICs. Overall, 60 were strong recommendations, although 56 of these had a low level of evidence. Conclusions: These are the first consensus recommendations for the diagnosis and management of pediatric sepsis focused on LMICs, more specifically in Latin American countries. The consensus shows that, in these regions, where the burden of pediatric sepsis is greater than in high-income countries, there is little high-level evidence. Despite the limitations, this consensus is an important step forward for the diagnosis and treatment of pediatric sepsis in Latin America.
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Affiliation(s)
- Jaime Fernández-Sarmiento
- Fundación Cardioinfantil - Instituto de Cardiología, Universidad de la Sabana, CES Graduate School, Bogotá, Colombia
| | - Daniela Carla De Souza
- Hospital Universitario da Universidad de São Paulo and Hospital Sírio Libanês, Sao Paulo, Brazil
| | | | - Victor Nieto
- Department of Critical Care Medicine, Cobos Medical Center, Chief Research Group GriBos, Bogotá, Colombia
| | - Jesús López-Herce
- Department of Pediatric Intensive Care, Hospital General Universitario Gregorio Marañón; Department of Public and Maternal-Infant Health, Universidad Complutense de Madrid, Red de Salud Maternoinfantil y del Desarrollo, Madrid, España
| | - Vanessa Soares Lanziotti
- Pediatric Intensive Care Unit & Research and Education Division/Maternal and Child Health Postgraduate Program, Institute of Pediatrics, Federal University of Rio De Janeiro, Rio De Janeiro, Brazil
| | - María Del Pilar Arias López
- Pediatric Intensive Care Unit, Hospital de Niños Ricardo Gutierrez, Programa SATI-Q, Sociedad Argentina de Terapia Intensiva, Buenos Aires, Argentina
| | - Werther Brunow De Carvalho
- Neonatology and Intensive Care Pediatrics, Department of Medical University of São Paulo, São Paulo, Brazil
| | | | - Juan Camilo Jaramillo-Bustamante
- Department of Pediatrics and Intensive Care, Hospital General de Medellín, Universidad de Antioquia, Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Medellín, Colombia
| | - Franco Díaz
- Instituto de Ciencias e Innovacion en Medicina, Universidad del Desarrollo y Hospital El Carmen de Maipu, Santiago, Chile
| | - Adriana Yock-Corrales
- Emergency Department, Hospital Nacional de Niños "Dr. Carlos Saenz Herrera", CCSS, Pediatric Emergency Physician, San José, Costa Rica
| | - Silvina Ruvinsky
- Department of Infectious Diseases, Hospital de Pediatría Juan P. Garrahan, Latin American Society of Infectious Disease, Buenos Aires, Argentina
| | - Manuel Munaico
- Pediatric Intensive Care Unit, Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú
| | - Viviana Pavlicich
- Hospital General Pediátrico Niños de Acosta Ñu, Universidad Privada del Pacífico, Asunción, Paraguay
| | - Ricardo Iramain
- Pediatric Emergency Department, Hospital de Clínicas, Universidad Nacional de Asunción, Asunción, Paraguay
| | - Marta Patricia Márquez
- Department of Pediatric Intensive Care, Instituto Nacional de Pediatría, Ciudad de México, México
| | - Gustavo González
- Pediatric Intensive Care Unit, Complejo Médico "CHURUCA VISCA", Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Mauricio Yunge
- Department of Pediatric Intensive Care, Clínica Los Condes, Santiago, Chile
| | - Cristian Tonial
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Hospital São Lucas, Porto Alegre, RS, Brazil
| | - Pablo Cruces
- Department of Pediatric Intensive Care, Hospital El Carmen de Maipú, Centro de Investigación de Medicina Veterinaria, Facultad de Ciencias de la Vida, Universidad Andres Bello, Chile
| | - Gladys Palacio
- Department of Pediatric Intensive Care Unit Ricardo Gutiérrez Children's Hospital, Buenos Aires, Argentina
| | - Carolina Grela
- Universidad de la República, Centro Hospitalario Pereira Rossell, Montevideo, Uruguay
| | | | - Santiago Campos-Miño
- Department of Pediatric Intensive Care Unit, Hospital Metropolitano, Latin American Center for Clinical Research, Quito - Ecuador
| | - Sebastian González-Dambrauskas
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network) - Montevideo, Uruguay. Specialized Pediatric Intensive Care, Casa de Galicia, Montevideo, Uruguay
| | - Nelson L Sánchez-Pinto
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Pedro Celiny García
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Escola de Medicina, Serviço de Medicina Intensiva e Emergência, Porto Alegre, RS, Brazil
| | - Roberto Jabornisky
- Department of Pediatrics, Facultad de Medicina, Universidad Nacional del Nordeste, Argentina
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Kohn-Loncarica GA, Fustiñana AL, Jabornisky RM, Pavlicich SV, Prego-Pettit J, Yock-Corrales A, Luna-Muñoz CR, Casson NA, Álvarez-Gálvez EA, Zambrano IR, Contreras-Núñez C, Santos CM, Paniagua-Lantelli G, Gutiérrez CE, Amantea SL, González-Dambrauskas S, Sánchez MJ, Rino PB, Mintegi S, Kissoon N. How Are Clinicians Treating Children With Sepsis in Emergency Departments in Latin America?: An International Multicenter Survey. Pediatr Emerg Care 2021; 37:e757-e763. [PMID: 31058761 DOI: 10.1097/pec.0000000000001838] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 11/25/2022]
Abstract
OBJECTIVE Guidelines adherence in emergency departments (EDs) relies partly on the availability of resources to improve sepsis care and outcomes. Our objective was to assess the management of pediatric septic shock (PSS) in Latin America's EDs and to determine the impact of treatment coordinated by a pediatric emergency specialist (PEMS) versus nonpediatric emergency specialists (NPEMS) on guidelines adherence. METHODS Prospective, descriptive, and multicenter study using an electronic survey administered to PEMS and NPEMS who treat PSS in EDs in 14 Latin American countries. RESULTS We distributed 2164 surveys with a response rate of 41.5%, of which 22.5% were PEMS. Overall American College of Critical Care Medicine reported guidelines adherence was as follows: vascular access obtained in 5 minutes, 76%; fluid infusion technique, 60%; administering 40 to 60 mL/kg within 30 minutes, 32%; inotropic infusion by peripheral route, 61%; dopamine or epinephrine in cold shock, 80%; norepinephrine in warm shock, 57%; and antibiotics within 60 minutes, 82%. Between PEMS and NPEMS, the following differences were found: vascular access in 5 minutes, 87.1% versus 72.7% (P < 0.01); fluid infusion technique, 72.3% versus 55.9% (P < 0.01); administering 40 to 60 mL/kg within 30 minutes, 42% versus 29% (P < 0.01); inotropic infusion by peripheral route, 75.7% versus 56.3% (P < 0.01); dopamine or epinephrine in cold shock, 87.1% versus 77.3% (P < 0.05); norepinephrine in warm shock, 67.8% versus 54% (P < 0.01); and antibiotic administration within first 60 minutes, 90.1% versus 79.3% (P < 0.01), respectively. Good adherence criteria were followed by 24%. The main referred barrier for sepsis care was a failure in its recognition, including the lack of triage tools. CONCLUSIONS In some Latin American countries, there is variability in self-reported adherence to the evidence-based recommendations for the treatment of PSS during the first hour. The coordination by PEMS support greater adherence to these recommendations.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Pedro B Rino
- Unidad Emergencias, Hospital de Pediatría Prof. Dr. Juan P. Garrahan y Universidad de Buenos Aires, Buenos Aires
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Yock-Corrales A, Lenzi J, Ulloa-Gutiérrez R, Gómez-Vargas J, Antúnez-Montes OY, Rios Aida JA, del Aguila O, Arteaga-Menchaca E, Campos F, Uribe F, Díaz RH, Buitrago AP, Londoño LMB, Kozicki V, Brizuela M, Buonsenso D. Acute Abdomen and Appendicitis in 1010 Pediatric Patients With COVID-19 or MIS-C: A Multinational Experience from Latin America. Pediatr Infect Dis J 2021; 40:e364-e369. [PMID: 34260501 PMCID: PMC8443421 DOI: 10.1097/inf.0000000000003240] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/20/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND To date, there are only sporadic reports of acute abdomen and appendicitis in children with coronavirus disease 2019 (COVID-19) and multisystem inflammatory syndrome in children (MIS-C). METHODS Children 17 years of age or younger assessed in 5 Latin American countries with a diagnosis of microbiologically confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and children fulfilling MIS-C definition were included. For children with acute abdomen, we investigate main radiologic patterns, surgical treatment and intraoperative findings, outcomes. FINDINGS One-thousand ten children were enrolled. Forty-two children (4.2%) had a clinical diagnosis of acute abdomen. Four (9.5%) were diagnosed with MIS-C and did not undergo surgery. The remaining 38 children (3.8%) underwent abdominal surgery due to suspected appendicitis, 34 of them (89.7%) had an intraoperative diagnosis of acute appendicitis (AA), while 4 of them had nonsurgical findings. Eight children died (0.8%), none of them being diagnosed with appendicitis. Children with AA were significantly older than those without (P < 0.0001). Children with complicated appendicitis had more frequently fever (85.7% vs. 60%), intestinal distension on the abdominal radiograph (7.1% vs. none), leukocytosis (85.7% vs. 40%) and high levels of C-reactive protein (35.7% vs. 5%), although differences were not statistically significant. CONCLUSIONS Our study showed that children may present with acute abdomen during COVID-19 or MIS-C, which is not always associated with intraoperative findings of appendicitis, particularly in case of MIS-C. Further studies are needed to better characterize children with acute abdomen during COVID-19 or MIS-C, to avoid delay in diagnosis of surgical conditions and at the same time, minimize unnecessary surgical approaches.
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Affiliation(s)
- Adriana Yock-Corrales
- From the Pediatric Emergency Department, Hospital Nacional de Niños “Dr. Carlos Sáenz Herrera”, CCSS, San José, Costa Rica
| | - Jacopo Lenzi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum – University of Bologna, Bologna, Italy
| | - Rolando Ulloa-Gutiérrez
- Infectious Disease Department, Hospital Nacional de Niños “Dr. Carlos Sáenz Herrera”, CCSS, San José, Costa Rica
| | - Jessica Gómez-Vargas
- From the Pediatric Emergency Department, Hospital Nacional de Niños “Dr. Carlos Sáenz Herrera”, CCSS, San José, Costa Rica
| | - Omar Yassef Antúnez-Montes
- Departamento de Docencia e Investigación, Instituto Latinoamericano de Ecografía en Medicina (ILEM), Ciudad de Mexico, Mexico
| | | | - Olguita del Aguila
- Department of Pediatrics, Unidad de Infectología Pediátrica del Hospital Nacional Edgardo Rebagliati Martins-Lima-Perú
| | | | - Francisco Campos
- Department of Pediatrics, Hospital Madre Niño San Bartolome, Lima, Peru
| | - Fadia Uribe
- Department of Pediatrics, Hospital Madre Niño San Bartolome, Lima, Peru
| | | | - Andrea Parra Buitrago
- Department of Pediatrics, Hospital Pablo Tobon Uribe Medellin, Colombia
- Department of Pediatrics, Fundacion Neumologica Colombiana, Bogotà, Colombia
| | | | - Verónica Kozicki
- Pediatric Infectious Disease, Hospital isidoro Iriarte, Quilmes, Buenos Aires, Argentina
| | - Martin Brizuela
- Pediatric Infectious Disease, Hospital isidoro Iriarte, Quilmes, Buenos Aires, Argentina
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Pediatrics, Global Health Research Institute, Istituto di Igiene, Università Cattolica del Sacro Cuore, Roma, Italia
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Campos-Gómez X, Martínez-Lara N, Juncos-Moyano A, Yock-Corrales A. Validation of the Pediatric Canadian Triage and Acuity Scale at the Emergency Department of a Tertiary Children's Hospital in Costa Rica. Cureus 2021; 13:e16191. [PMID: 34258132 PMCID: PMC8257034 DOI: 10.7759/cureus.16191] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2021] [Indexed: 12/03/2022] Open
Abstract
Background: The Pediatric Canadian Triage and Acuity Scale (PedCTAS) is a recognized system that prioritizes care by the severity of illness. The goal of this study was to describe and analyze the results from the implementation of the PedCTAS in a tertiary children’s hospital in Costa Rica. Methods: This was a retrospective observational study of children presenting to the emergency department (ED) from 1st January to 31st December of 2019 in the only children’s hospital in Costa Rica. Outcome measures were hospitalization, ICU admission, waiting times from triage to physician time (TPT), left without being seen (LWBS), length of stay (LOS), in relation to the triage level, and final disposition. Results: A total of 93,001 patients were admitted to the ED. The proportion for hospitalizations according to triage category was 85.3%, 40%, 14%, 4.3%, and 2% for patients triaged at CTAS levels I, II, III, IV, and V respectively. A total of 2045 (2.19%) patients were LWBS. Some 585 (0.62%) patients were admitted to ICU. Median TPT for each category was for levels I:12 min, II:20 min, III:22 min, IV:34 min, and V:54 min. The LOS in the ED patients triaged as levels I and II stayed longer and the mortality rate was also higher in patients classified as levels I and II. The mortality rate was for level I patients 44.2% (23 patients) and level II 1.4% (8 patients). Conclusions: This study shows evidence of validation of the PedCTAS in a developing country in Latin America. Implementation of a validated triage tool in our country helps us to provide improvements in the care of pediatric patients in the ED.
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Affiliation(s)
- Xiomara Campos-Gómez
- Emergency, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", CCSS, San Jose, CRI
| | - Natalia Martínez-Lara
- Emergency, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", CCSS, San Jose, CRI
| | | | - Adriana Yock-Corrales
- Emergency, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", CCSS, San Jose, CRI
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Bergmann KR, Arroyo AC, Tessaro MO, Nielson J, Whitcomb V, Madhok M, Yock-Corrales A, Guerrero-Quesada G, Chaudoin L, Berant R, Shahar-Nissan K, Deanehan JK, Lam SHF, Snelling PJ, Avendano P, Cohen SG, Friedman N, Ekpenyong A, Pade KH, Park DB, Lin-Martore M, Kornblith AE, Montes-Amaya G, Thomas-Mohtat R, Jin J, Watson D, Sivitz A. Diagnostic Accuracy of Point-of-Care Ultrasound for Intussusception: A Multicenter, Noninferiority Study of Paired Diagnostic Tests. Ann Emerg Med 2021; 78:606-615. [PMID: 34226072 DOI: 10.1016/j.annemergmed.2021.04.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/13/2021] [Accepted: 04/27/2021] [Indexed: 01/09/2023]
Abstract
STUDY OBJECTIVE To determine the diagnostic accuracy of point-of-care ultrasound (POCUS) performed by experienced clinician sonologists compared to radiology-performed ultrasound (RADUS) for detection of clinically important intussusception, defined as intussusception requiring radiographic or surgical reduction. METHODS We conducted a multicenter, noninferiority, observational study among a convenience sample of children aged 3 months to 6 years treated in tertiary care emergency departments across North and Central America, Europe, and Australia. The primary outcome was diagnostic accuracy of POCUS and RADUS with respect to clinically important intussusception. Sample size was determined using a 4-percentage-point noninferiority margin for the absolute difference in accuracy. Secondary outcomes included agreement between POCUS and RADUS for identification of secondary sonographic findings. RESULTS The analysis included 256 children across 17 sites (35 sonologists). Of the 256 children, 58 (22.7%) had clinically important intussusception. POCUS identified 60 (23.4%) children with clinically important intussusception. The diagnostic accuracy of POCUS was 97.7% (95% confidence interval [CI] 94.9% to 99.0%), compared to 99.3% (95% CI 96.8% to 99.9%) for RADUS. The absolute difference between the accuracy of RADUS and that of POCUS was 1.5 percentage points (95% CI -0.6 to 3.6). Sensitivity for POCUS was 96.6% (95% CI 87.2% to 99.1%), and specificity was 98.0% (95% CI 94.7% to 99.2%). Agreement was high between POCUS and RADUS for identification of trapped free fluid (83.3%, n=40/48) and decreased color Doppler signal (95.7%, n=22/23). CONCLUSION Our findings suggest that the diagnostic accuracy of POCUS performed by experienced clinician sonologists may be noninferior to that of RADUS for detection of clinically important intussusception. Given the limitations of convenience sampling and spectrum bias, a larger randomized controlled trial is warranted.
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Affiliation(s)
- Kelly R Bergmann
- Department of Pediatric Emergency Medicine, Children's Minnesota, Minneapolis, MN.
| | - Alexander C Arroyo
- Department of Pediatric Emergency Medicine, Maimonides Medical Center, Brooklyn, NY
| | - Mark O Tessaro
- Division of Pediatric Emergency Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jonathan Nielson
- Department of Pediatric Emergency Medicine, Children's Minnesota, Minneapolis, MN
| | - Valerie Whitcomb
- Department of Pediatric Emergency Medicine, Children's Minnesota, Minneapolis, MN
| | - Manu Madhok
- Department of Pediatric Emergency Medicine, Children's Minnesota, Minneapolis, MN
| | - Adriana Yock-Corrales
- Department of Emergency Medicine, Hospital Nacional de Niños: "Dr. Carlos Sáenz Herrera," CCSS, San José, Costa Rica
| | - German Guerrero-Quesada
- Department of Surgery, Hospital Nacional de Niños: "Dr. Carlos Sáenz Herrera," CCSS, San José, Costa Rica
| | - Lindsey Chaudoin
- Department of Emergency Medicine, Atrium Health's Carolinas Medical Center, Charlotte, NC
| | - Ron Berant
- Department of Emergency Medicine, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Keren Shahar-Nissan
- Department of Emergency Medicine, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - J Kate Deanehan
- Department of Pediatric Emergency Medicine, Johns Hopkins Children's Center, Baltimore, MD
| | - Samuel H F Lam
- Department of Emergency Medicine, Sutter Medical Center Sacramento, Sacramento, CA
| | - Peter J Snelling
- Department of Pediatric Emergency Medicine, Gold Coast University Hospital and Griffith University, Southport, Queensland, Australia
| | - Pablo Avendano
- Division of Pediatric Emergency Medicine, University of Minnesota Masonic Children's Hospital, Minneapolis, MN
| | - Stephanie G Cohen
- Department of Pediatrics and Emergency Medicine, Children's Healthcare Atlanta and Emory University, Atlanta, GA
| | - Nir Friedman
- Department of Pediatric Emergency Medicine, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - Atim Ekpenyong
- Department of Pediatrics, University of California, San Diego, CA
| | - Kathryn H Pade
- Department of Pediatrics, University of California, San Diego, CA
| | - Daniel B Park
- Department of Pediatrics and Emergency Medicine, University of North Carolina, Chapel Hill, NC
| | - Margaret Lin-Martore
- Department of Emergency Medicine and Pediatrics, University of California, San Francisco, San Francisco, CA
| | - Aaron E Kornblith
- Department of Emergency Medicine and Pediatrics, University of California, San Francisco, San Francisco, CA
| | - Gerardo Montes-Amaya
- Department of Pediatric Emergency Medicine, Hospital Infantil Ciudad Juárez, Chihuahua, Mexico
| | - Rosemary Thomas-Mohtat
- Department of Pediatric Emergency Medicine, Children's National Hospital, Washington, DC
| | - Jing Jin
- Department of Research and Sponsored Programs, Children's Minnesota, Minneapolis, MN
| | - Dave Watson
- Department of Research and Sponsored Programs, Children's Minnesota, Minneapolis, MN
| | - Adam Sivitz
- Department of Emergency Medicine, Newark Beth Israel Medical Center, Newark, NJ
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Yock-Corrales A, Soto-Roldan J, Corella-Elizondo D. Tendencias en las consultas a los servicios de emergencias durante la pandemia por covid-19. AMC 2021. [DOI: 10.51481/amc.v63i3.1138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objetivo: En Costa Rica se observó una disminución en las atenciones en los Servicios de Emergencias al inicio de la pandemia por lo que el objetivo de este estudio es la descripción de este fenómeno, su duración, así como implicaciones en nuestro país.Métodos: Es un estudio descriptivo observacional retrospectivo de las atenciones en los Servicios de Emergencias de los Hospitales pertenecientes a la Caja Costarricense del Seguro Social durante el 1 de enero al 31 de diciembre del 2020.Resultados: Se incluyeron 25 Servicios de Emergencias. Las atenciones durante el periodo de estudio fueron de 1.549.024 millones de visitas y la cantidad de revaloraciones a 4,038,029. El rango de atenciones en los diferentes SEM tuvo un rango de 19070 mil a 122251 mil durante el periodo del estudio. Se observó que 850 707 (54,9%) eran del sexo femenino. La mayor cantidad de pacientes atendidos en los SEM tenían edades entre los 20 a 44 años con 693 379 (44.7%) atenciones, seguido del grupo entre los 45 a 64 años con 328 979 (21.2%). Lo que respecta a la clasificación de la agudeza de los pacientes por medio del sistema de triaje canadiense, un 40% (620 449) fueron catalogados como categoría 3, un 39.8%(616 855) categoría 4, 14%(218 124), 5.3%(82 360) categoría 2 y por último 0.6%(9206) pacientes como categoría 1. Respeto a pacientes con el diagnóstico asociado a SARS CoV-2 se observó que 88 793 en los Servicios de Emergencias tuvieron dichos diagnósticos durante el periodo del estudio.Conclusiones: La tendencia a la baja en las consultas al Servicio de Emergencias en Costa Rica, reproduce las tendencias reportadas en la bibliografía a nivel mundial. La explicación para este fenómeno es multifactorial. Existen una gran cantidad de cambios “estructurales” tanto en los servicios de emergencias como en hospitalización y el sistema de salud en general, que con mucha probabilidad deberán cambiarse de manera definitiva y prioritaria. No solo para la atención de esta pandemia sino con miras a que dichos sistemas se encuentren mejor preparados para próximos eventos infecciosos de cualquier tipo.
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Naranjo-Zúñiga G, Yock-Corrales A, Mora-Mesén C, Campos-Villalobos M, Ulloa-Gutierrez R. [Epidemiology, clinical manifestations and microbiology of children with necrotizing fasciitis in a Costa Rican pediatric hospital]. Rev Chilena Infectol 2021; 37:446-449. [PMID: 33399665 DOI: 10.4067/s0716-10182020000400446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/28/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Despite the significant associated morbidity of necrotizing fasciitis (NF), few studies have been published and this is the larger pediatric series in Latin America. AIM To describe the epidemiology, clinical characteristics and microbiology of NF in Costa Rican children. METHODS Review of clinical and pathological records, period April 2002 to April 2014, in patients under 13 years of age. RESULTS 19/22 patients met the inclusion requirement, 12 had co-morbidity: 26% with a history of recent surgery and 21% were neonates. Etiology was documented in blood cultures in 26% and by tissue culture in 63% (one third of them polymicrobial). Pseudomonas aeruginosa, Escherichia coli and Staphylococcus aureus were the three most common etiologic agents. Case fatality rate was 42%, one of the highest in our region. CONCLUSION NF is a serious, unusual pathology, frequently associated with neonatology and post-surgical patients, with a mixed etiology that requires the association of antimicrobials and early surgery. Its lethality is high in our setting, over previously published series.
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Affiliation(s)
| | | | - Cinthya Mora-Mesén
- Centro de Ciencias Médicas de la Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Niños de Costa Rica, Costa Rica
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Mackay MT, Lee M, Yock-Corrales A, Churilov L, Donnan GA, Monagle P, Babl FE. Differentiating arterial ischaemic stroke from migraine in the paediatric emergency department. Dev Med Child Neurol 2018; 60:1117-1122. [PMID: 29655223 DOI: 10.1111/dmcn.13772] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 02/20/2018] [Indexed: 01/03/2023]
Abstract
AIM To estimate the strengths of association between clinical features and migraine or arterial ischaemic stroke (AIS) in children presenting to the emergency department. METHOD Eighty-four children with migraine, prospectively recruited from 2009 to 2010, were compared with 55 children with AIS, prospectively/retrospectively recruited from 2003 to 2010. Odds ratios were calculated via logistic regression to measure associations between clinical features and process-of-care factors, and migraine and AIS. RESULTS Median age was 13 years 5 months (interquartile range 12y 11mo-13y 10mo) for migraine and 5 years (interquartile range 3y 7mo-8y) for patients with AIS. All cases of AIS and 30% of migraine cases underwent neuroimaging. Over 40% of children with migraine had vomiting, numbness, or visual disturbance; other symptoms were uncommon. Fifty-five per cent had no signs on physician assessment. Weakness or speech disturbance were common in patients with AIS. Significant clinical features associated with increased odds of AIS included sudden symptom onset, weakness, seizures, speech disturbance, and ataxia, and signs of face, arm, or leg weakness, inability to walk, dysarthria, dysphasia, and altered consciousness (p<0.05). Significant features associated with decreased odds of AIS included older age, vomiting, visual, sensory, other symptoms, and absent focal signs on assessment (p<0.05). INTERPRETATION Presenting features can discriminate childhood AIS from migraine. These differences inform decisions about urgency and type of neuroimaging in children presenting to the emergency department with brain attack symptoms. WHAT THE PAPER ADDS Weakness, seizures, ataxia, speech, or walking difficulties are more frequent in arterial ischaemic stroke (AIS). Vomiting, visual, or sensory disturbance and absent focal signs are more frequent in migraine. Identifying features of AIS and migraine guides neuroimaging in children with brain attack symptoms.
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Affiliation(s)
- Mark T Mackay
- Department of Neurology, Royal Children's Hospital, Parkville, Vic., Australia.,Murdoch Children's Research Institute, Parkville, Vic., Australia.,University of Melbourne, Parkville, Vic., Australia.,Florey Institute of Neurosciences and Mental Health, Parkville, Vic., Australia
| | - Michelle Lee
- Emergency Department, Royal Children's Hospital Melbourne, Parkville, Vic., Australia
| | | | - Leonid Churilov
- University of Melbourne, Parkville, Vic., Australia.,Florey Institute of Neurosciences and Mental Health, Parkville, Vic., Australia
| | - Geoffrey A Donnan
- University of Melbourne, Parkville, Vic., Australia.,Florey Institute of Neurosciences and Mental Health, Parkville, Vic., Australia
| | - Paul Monagle
- Murdoch Children's Research Institute, Parkville, Vic., Australia.,University of Melbourne, Parkville, Vic., Australia.,Department of Haematology, Royal Children's Hospital, Parkville, Vic., Australia
| | - Franz E Babl
- Murdoch Children's Research Institute, Parkville, Vic., Australia.,University of Melbourne, Parkville, Vic., Australia.,Emergency Department, Royal Children's Hospital Melbourne, Parkville, Vic., Australia
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38
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Soto-Martínez ME, Yock-Corrales A, Camacho-Badilla K, Abdallah S, Duggan N, Avila-Benedictis L, Romero JJ, Soto-Quirós ME. The current prevalence of asthma, allergic rhinitis, and eczema related symptoms in school-aged children in Costa Rica. J Asthma 2018; 56:360-368. [PMID: 29693462 DOI: 10.1080/02770903.2018.1455860] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Asthma prevalence in Costa Rica is among the highest worldwide. We aimed to determine the prevalence of asthma among school-age children in the Central Highland Area of Costa Rica. METHODS Cross-sectional study using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was performed. Parents or guardians of children aged 6-13 years completed written questionnaires. RESULTS Total of 2817 school-aged children returned these questionnaires (74.1% return rate). The prevalence of asthma, rhinitis, and eczema was 21.9%, 42.6%, and 19.2%, respectively. The co-existence of the 3 diseases was seen in 22.6% of children with asthma. Boys had a slightly higher prevalence of these conditions, and younger children had higher prevalence of asthma and eczema, but lower prevalence of rhinitis than older children. The use of acetaminophen and antibiotics in the first 12 months of life showed a significant association with the prevalence of asthma, rhinitis, and eczema. Wheezing with exercise, dry cough at night, and ever rhinitis was highly associated with asthma symptoms in the last 12 months. In contrast, no association was found between children exposed to smoking at home. Frequent traffic next to the house was reported more frequently by the parents of children with asthma, although no significant association was found. CONCLUSION The prevalence of asthma showed a significant decrease compared to previous studies. However, there was an unexpected high prevalence of rhinitis. Exposure to acetaminophen and antibiotic during the first year of life was highly associated with asthma symptoms.
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Affiliation(s)
- M E Soto-Martínez
- a Respiratory Department , Hospital Nacional de Niños , Costa Rica.,b Department of Pediatrics , Hospital Nacional de Niños and University of Costa Rica , San José , Costa Rica.,c School of Public Health, Tullane University , New Orleans , LA , USA
| | - A Yock-Corrales
- b Department of Pediatrics , Hospital Nacional de Niños and University of Costa Rica , San José , Costa Rica.,c School of Public Health, Tullane University , New Orleans , LA , USA.,d Emergency Department , Hospital Nacional de Niños , Costa Rica
| | - K Camacho-Badilla
- b Department of Pediatrics , Hospital Nacional de Niños and University of Costa Rica , San José , Costa Rica.,c School of Public Health, Tullane University , New Orleans , LA , USA.,e Department of Infectious Diseases , Hospital Nacional de Niños , San José , Costa Rica
| | - S Abdallah
- b Department of Pediatrics , Hospital Nacional de Niños and University of Costa Rica , San José , Costa Rica
| | - N Duggan
- c School of Public Health, Tullane University , New Orleans , LA , USA
| | - L Avila-Benedictis
- b Department of Pediatrics , Hospital Nacional de Niños and University of Costa Rica , San José , Costa Rica
| | - J J Romero
- f School of Veterinary Medicine, Population Medicine Research Program, National University of Costa Rica , Heredia , Costa Rica
| | - M E Soto-Quirós
- a Respiratory Department , Hospital Nacional de Niños , Costa Rica.,b Department of Pediatrics , Hospital Nacional de Niños and University of Costa Rica , San José , Costa Rica
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Mackay MT, Yock-Corrales A, Churilov L, Monagle P, Donnan GA, Babl FE. Accuracy and Reliability of Stroke Diagnosis in the Pediatric Emergency Department. Stroke 2017; 48:1198-1202. [PMID: 28336681 DOI: 10.1161/strokeaha.116.015571] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 12/20/2016] [Accepted: 01/13/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Access to acute stroke interventions in the emergency department (ED) relies on correct clinical diagnosis. Our aims were to determine the accuracy and reliability of pediatric ED physician diagnosis of childhood stroke and other conditions presenting with brain attack symptoms. METHODS Prospective study of consecutive children aged 1 month to 18 years presenting to the ED from June 2009 to December 2010 with focal neurological deficits. Accuracy (sensitivity, specificity, and receiver operator characteristic curves [ROCs]) and interrater agreement (κ) were determined, between ED physician diagnoses, as recorded in the electronic hospital administrative software system, and final neurological diagnosis, after completion of diagnostic work-up. RESULTS Two-hundred eighty-seven children with 301 consecutive presentations were recruited. The most common final brain attack diagnoses included migraine in 84 children, first seizure in 48, Bell's palsy in 29, stroke in 21, and conversion disorders in 18 children. Sensitivity of ED physician stroke diagnosis was 62%, and specificity was 98% (ROC, 0.8). Inter-rater agreement for ED physician and final stroke diagnosis was substantial (κ=0.61). ED physician diagnostic accuracy and reliability was highest for Bell's palsy (ROC=0.98; κ=0.96), and lowest for central nervous system demyelination (ROC=0.5; κ=-0.01) and cerebellitis (ROC=0.50; κ=0.50). CONCLUSIONS ED physician diagnostic accuracy and reliability varies considerably across disorders presenting with brain attack symptoms. Clinical recognition tools are required to assist pediatric ED physicians with diagnosis of stroke and other serious neurological disorders.
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Affiliation(s)
- Mark T Mackay
- From the Department of Neurology (M.T.M.), Department of Haematology (P.M.), and Emergency Department (F.B.), Royal Children's Hospital Melbourne, Parkville, Victoria, Australia; Murdoch Childrens Research Institute, Parkville, Victoria, Australia (M.T.M., F.B.); Florey Institute of Neurosciences and Mental Health, Parkville, Victoria, Australia (M.T.M., L.C., G.A.D.); University of Melbourne, Parkville, Victoria, Australia (M.T.M., L.C., P.M., G.A.D., F.B.); and Emergency Department, Hospital Nacional de Ninos, San Jose, Costa Rica (A.Y.-C.).
| | - Adriana Yock-Corrales
- From the Department of Neurology (M.T.M.), Department of Haematology (P.M.), and Emergency Department (F.B.), Royal Children's Hospital Melbourne, Parkville, Victoria, Australia; Murdoch Childrens Research Institute, Parkville, Victoria, Australia (M.T.M., F.B.); Florey Institute of Neurosciences and Mental Health, Parkville, Victoria, Australia (M.T.M., L.C., G.A.D.); University of Melbourne, Parkville, Victoria, Australia (M.T.M., L.C., P.M., G.A.D., F.B.); and Emergency Department, Hospital Nacional de Ninos, San Jose, Costa Rica (A.Y.-C.)
| | - Leonid Churilov
- From the Department of Neurology (M.T.M.), Department of Haematology (P.M.), and Emergency Department (F.B.), Royal Children's Hospital Melbourne, Parkville, Victoria, Australia; Murdoch Childrens Research Institute, Parkville, Victoria, Australia (M.T.M., F.B.); Florey Institute of Neurosciences and Mental Health, Parkville, Victoria, Australia (M.T.M., L.C., G.A.D.); University of Melbourne, Parkville, Victoria, Australia (M.T.M., L.C., P.M., G.A.D., F.B.); and Emergency Department, Hospital Nacional de Ninos, San Jose, Costa Rica (A.Y.-C.)
| | - Paul Monagle
- From the Department of Neurology (M.T.M.), Department of Haematology (P.M.), and Emergency Department (F.B.), Royal Children's Hospital Melbourne, Parkville, Victoria, Australia; Murdoch Childrens Research Institute, Parkville, Victoria, Australia (M.T.M., F.B.); Florey Institute of Neurosciences and Mental Health, Parkville, Victoria, Australia (M.T.M., L.C., G.A.D.); University of Melbourne, Parkville, Victoria, Australia (M.T.M., L.C., P.M., G.A.D., F.B.); and Emergency Department, Hospital Nacional de Ninos, San Jose, Costa Rica (A.Y.-C.)
| | - Geoffrey A Donnan
- From the Department of Neurology (M.T.M.), Department of Haematology (P.M.), and Emergency Department (F.B.), Royal Children's Hospital Melbourne, Parkville, Victoria, Australia; Murdoch Childrens Research Institute, Parkville, Victoria, Australia (M.T.M., F.B.); Florey Institute of Neurosciences and Mental Health, Parkville, Victoria, Australia (M.T.M., L.C., G.A.D.); University of Melbourne, Parkville, Victoria, Australia (M.T.M., L.C., P.M., G.A.D., F.B.); and Emergency Department, Hospital Nacional de Ninos, San Jose, Costa Rica (A.Y.-C.)
| | - Franz E Babl
- From the Department of Neurology (M.T.M.), Department of Haematology (P.M.), and Emergency Department (F.B.), Royal Children's Hospital Melbourne, Parkville, Victoria, Australia; Murdoch Childrens Research Institute, Parkville, Victoria, Australia (M.T.M., F.B.); Florey Institute of Neurosciences and Mental Health, Parkville, Victoria, Australia (M.T.M., L.C., G.A.D.); University of Melbourne, Parkville, Victoria, Australia (M.T.M., L.C., P.M., G.A.D., F.B.); and Emergency Department, Hospital Nacional de Ninos, San Jose, Costa Rica (A.Y.-C.)
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MacKay MT, Yock-Corrales A, Churilov L, Donnan GA, Babl FE, Monagle P. Abstract WMP110: Differentiating Childhood Arterial Ischemic Stroke From Migraine in the Pediatric Emergency Department. Stroke 2017. [DOI: 10.1161/str.48.suppl_1.wmp110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective:
Migraine, a typically benign disorder, is the most common stroke mimic in children presenting with brain attacks. We aimed to identify clinical features which discriminate childhood arterial ischaemic stroke (AIS) from migraine.
Methods:
Fifty-five consecutive children with AIS, presenting to a tertiary pediatric emergency department (ED), prospectively/retrospectively recruited from 2003-2010, were compared to 84 children with migraine, prospectively recruited from 2009-2010.
Results:
Health professional referral, (odds ratio (OR), 5.71, 95% confidence intervals 2.54-12.81), ambulance transport (OR 2.95, 1.45-5.97), high triage category assignment (OR 2.41, 1.06-5.49), sudden onset (OR 2.74, 1.18-6.39), symptoms of focal weakness (OR 6.96, 3.24-14.93), seizures (OR 7.44, 1.99-27.81), speech disturbance (OR 3.06, 1.48-6.32), and ataxia (OR 4.88, 1.63-14.65) were significantly associated with increased odds of AIS diagnosis. Signs of face (OR 155.37, 20.03-1205.33), arm (OR 15.58, 6.41-37.84), or leg weakness (OR 15.40, 5.75-41.27), inability to walk (OR 14.18, 3.07-65.41), dysarthria (OR 47.21, 6.07-367.13), dysphasia (OR 12.76, 1.52-106.97) and altered consciousness (OR 2.45, 1.03-5.85) were also significantly associated with increased odds of AIS diagnosis, In contrast, vomiting (OR 0.23, 0.10-0.53), visual symptoms (OR 0.24, 0.10-0.57), other symptoms (OR 0.06, 0.01-0.48) and absence of neurological signs on ED physician assessment (OR 0.05, 0.01-0.17) were associated with decreased odds of AIS diagnosis.
Conclusion:
Differing presenting symptoms and signs allow discrimination of childhood AIS from migraine. These findings can inform decisions about urgency and type of diagnostic neuroimaging in the ED for children presenting with brain attack symptoms.
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Affiliation(s)
- Mark T MacKay
- Neurology, The Royal Children’s Hosp, Parkville, Australia
| | | | - Leonid Churilov
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - Geoffrey A Donnan
- Neurology, The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - Franz E Babl
- Emergency, The Royal Children’s Hosp, Melbourne, Australia
| | - Paul Monagle
- Paediatrics, The Univ of Melbourne, Melbourne, Australia
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MacKay MT, Yock-Corrales A, Churilov L, Monagle P, Donnan GA, Babl FE. Abstract 173: Accuracy and Reliability of Brain Attack Diagnoses Including Stroke in the Pediatric Emergency Department. Stroke 2017. [DOI: 10.1161/str.48.suppl_1.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives:
Access to acute stroke interventions in the emergency department (ED) relies on correct clinical diagnosis. Our aims were to determine the accuracy and reliability of pediatric ED physician diagnosis of childhood stroke and other conditions presenting with brain attack symptoms.
Methods:
Prospective study of consecutive children aged one month-18 years presenting to the ED from June 2009-December 2010 with focal neurological deficits. Accuracy (sensitivity, specificity, receiver operator characteristic curves (ROCs)), and inter-rater agreement (kappa (κ )) were determined, between ED physician diagnoses, as recorded in the electronic hospital administrative software system, and final neurological diagnosis, following completion of diagnostic work-up.
Results:
Two-hundred-eighty seven children with 301 consecutive presentations were recruited. The most common final brain attack diagnoses included migraine in 84 children, first seizure in 48, Bell’s palsy in 29, stroke in 21, and conversion disorders in 18 children. Sensitivity of ED physician stroke diagnosis was 62% and specificity was 98% (ROC 0.8). Inter-rater agreement for ED physician and final stroke diagnosis was substantial (κ 0.61). ED physician diagnostic accuracy and reliability was highest for Bell’s palsy (ROC 0.98, κ 0.96), and lowest for CNS demyelination (ROC 0.5, κ -0.01) and cerebellitis (ROC 0.50, κ 0.50).
Conclusions:
ED physician diagnostic accuracy and reliability varies considerably across disorders presenting with brain attack symptoms. Clinical recognition tools are required to assist pediatric ED physicians with diagnosis of stroke and other serious neurological disorders.
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Affiliation(s)
- Mark T MacKay
- Neurology, The Royal Children’s Hosp, Parkville, Australia
| | | | - Leonid Churilov
- Biostatistics, The Florey Institute of Neuroscience and Mental Health, Parkville, Australia
| | - Paul Monagle
- Paediatrics, Univ of Melbourne, Parkville, Australia
| | - Geoffrey A Donnan
- The Florey Institute of Neuroscience and Mental Health, Parkville, Australia
| | - Franz E Babl
- Emergency, The Royal Children’s Hosp, Parkville, Australia
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Mackay MT, Yock-Corrales A, Churilov L, Monagle P, Donnan GA, Babl FE. Differentiating Childhood Stroke From Mimics in the Emergency Department. Stroke 2016; 47:2476-81. [PMID: 27601378 PMCID: PMC5049943 DOI: 10.1161/strokeaha.116.014179] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [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: 05/24/2016] [Accepted: 07/19/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE Clinical identification of stroke in the pediatric emergency department is critical for improving access to hyperacute therapies. We identified key clinical features associated with childhood stroke or transient ischemic attack compared with mimics. METHODS Two hundred and eighty consecutive children presenting to the emergency department with mimics, prospectively recruited over 18 months from 2009 to 2010, were compared with 102 children with stroke or transient ischemic attack, prospectively/retrospectively recruited from 2003 to 2010. RESULTS Cerebrovascular diagnoses included arterial ischemic stroke (55), hemorrhagic stroke (37), and transient ischemic attack (10). Mimic diagnoses included migraine (84), seizures (46), Bell's palsy (29), and conversion disorders (18). Being well in the week before presentation (odds ratio [OR] 5.76, 95% confidence interval [CI] 2.25-14.79), face weakness (OR 2.94, 95% CI 1.19-7.28), arm weakness (OR 8.66, 95% CI, 2.50-30.02), and inability to walk (OR 3.38, 95% CI 1.54-7.42) were independently associated with increased odds of stroke diagnosis. Other symptoms were independently associated with decreased odds of stroke diagnosis (OR 0.28, 95% CI 0.10-0.77). Associations were not observed between seizures or loss of consciousness. Factors associated with stroke differed by arterial and hemorrhagic subtypes. CONCLUSIONS Being well in the week before presentation, inability to walk, face and arm weakness are associated with increased odds of stroke. The lack of positive or negative association between stroke and seizures or loss of consciousness is an important difference to adults. Pediatric stroke pathways and bedside tools need to factor in differences between children and adults and between stroke subtypes.
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Affiliation(s)
- Mark T Mackay
- From the Department of Neurology (M.T.M.) and Emergency Department (F.E.B.), Royal Children's Hospital Melbourne, Parkville, Australia; Murdoch Childrens Research Institute, Parkville, Australia (M.T.M., P.M., F.E.B.); Florey Institute of Neurosciences and Mental Health, Parkville, Australia (M.T.M., L.C., G.A.D.); Department of Pediatrics (M.T.M., P.M., F.E.B.) and Department of Medicine (L.C., G.A.D.), University of Melbourne, Parkville, Australia; Hospital Nacional de Ninos, San Jose, Costa Rica (A.Y.-C.); and Department of Haematology, Royal Children's Hospital, Parkville, Australia (P.M.).
| | - Adriana Yock-Corrales
- From the Department of Neurology (M.T.M.) and Emergency Department (F.E.B.), Royal Children's Hospital Melbourne, Parkville, Australia; Murdoch Childrens Research Institute, Parkville, Australia (M.T.M., P.M., F.E.B.); Florey Institute of Neurosciences and Mental Health, Parkville, Australia (M.T.M., L.C., G.A.D.); Department of Pediatrics (M.T.M., P.M., F.E.B.) and Department of Medicine (L.C., G.A.D.), University of Melbourne, Parkville, Australia; Hospital Nacional de Ninos, San Jose, Costa Rica (A.Y.-C.); and Department of Haematology, Royal Children's Hospital, Parkville, Australia (P.M.)
| | - Leonid Churilov
- From the Department of Neurology (M.T.M.) and Emergency Department (F.E.B.), Royal Children's Hospital Melbourne, Parkville, Australia; Murdoch Childrens Research Institute, Parkville, Australia (M.T.M., P.M., F.E.B.); Florey Institute of Neurosciences and Mental Health, Parkville, Australia (M.T.M., L.C., G.A.D.); Department of Pediatrics (M.T.M., P.M., F.E.B.) and Department of Medicine (L.C., G.A.D.), University of Melbourne, Parkville, Australia; Hospital Nacional de Ninos, San Jose, Costa Rica (A.Y.-C.); and Department of Haematology, Royal Children's Hospital, Parkville, Australia (P.M.)
| | - Paul Monagle
- From the Department of Neurology (M.T.M.) and Emergency Department (F.E.B.), Royal Children's Hospital Melbourne, Parkville, Australia; Murdoch Childrens Research Institute, Parkville, Australia (M.T.M., P.M., F.E.B.); Florey Institute of Neurosciences and Mental Health, Parkville, Australia (M.T.M., L.C., G.A.D.); Department of Pediatrics (M.T.M., P.M., F.E.B.) and Department of Medicine (L.C., G.A.D.), University of Melbourne, Parkville, Australia; Hospital Nacional de Ninos, San Jose, Costa Rica (A.Y.-C.); and Department of Haematology, Royal Children's Hospital, Parkville, Australia (P.M.)
| | - Geoffrey A Donnan
- From the Department of Neurology (M.T.M.) and Emergency Department (F.E.B.), Royal Children's Hospital Melbourne, Parkville, Australia; Murdoch Childrens Research Institute, Parkville, Australia (M.T.M., P.M., F.E.B.); Florey Institute of Neurosciences and Mental Health, Parkville, Australia (M.T.M., L.C., G.A.D.); Department of Pediatrics (M.T.M., P.M., F.E.B.) and Department of Medicine (L.C., G.A.D.), University of Melbourne, Parkville, Australia; Hospital Nacional de Ninos, San Jose, Costa Rica (A.Y.-C.); and Department of Haematology, Royal Children's Hospital, Parkville, Australia (P.M.)
| | - Franz E Babl
- From the Department of Neurology (M.T.M.) and Emergency Department (F.E.B.), Royal Children's Hospital Melbourne, Parkville, Australia; Murdoch Childrens Research Institute, Parkville, Australia (M.T.M., P.M., F.E.B.); Florey Institute of Neurosciences and Mental Health, Parkville, Australia (M.T.M., L.C., G.A.D.); Department of Pediatrics (M.T.M., P.M., F.E.B.) and Department of Medicine (L.C., G.A.D.), University of Melbourne, Parkville, Australia; Hospital Nacional de Ninos, San Jose, Costa Rica (A.Y.-C.); and Department of Haematology, Royal Children's Hospital, Parkville, Australia (P.M.)
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Mackay MT, Churilov L, Donnan G, Yock-Corrales A, Babl F, Monagle P. Abstract T MP61: Diagnostic Accuracy of Adult Bedside Stroke Recognition Tools in Childhood Stroke. Stroke 2015. [DOI: 10.1161/str.46.suppl_1.tmp61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective:
Bedside stroke recognition tools improve diagnostic accuracy in adult stroke. Our aim was to assess the diagnostic utility of the CPSS and ROSIER tools in children presenting to the emergency department (ED) with brain attack symptoms.
Methods:
The Cincinnati Prehospital Stroke Scale (CPSS ) and the Recognition of Stroke in the Emergency Room (ROSIER) tool were retrospectively applied to 101 consecutive children with stroke, presenting from 2003-2010, and 279 children with mimics, presenting to the ED from 2009-2010. A positive CPSS was defined as ≥1 positive sign (face or arm weakness, speech disturbance). A positive ROSIER was defined as a score of ≥1. Diagnostic accuracy of the tools in determining the patients’ true status were estimated for arterial (AIS), hemorrhagic (HS) and combined stroke subtypes versus mimics.
Results:
The CPSS and ROSIER tools correctly discriminated combined stroke subtypes from mimics (diagnostic odds ratio (DOR) 5.6 and 4.7 respectively) and AIS from mimics (DOR 15.1 and 13.4 respectively) but not HS from mimics (DOR 1.2 for both tools). CPSS and ROSIER accuracy were fair for AIS versus mimics (ROC 0.79 and 0.77 respectively), fair to poor for combined stroke subtypes versus mimics (ROC 0.70 and 0.68 respectively) and failed for HS versus mimics (ROC 0.51 and 0.52 respectively). Reasons for limited accuracy include different spectrum of mimics, lower overall prevalence, higher proportion of HS subtype and common seizure occurrence in childhood stroke.
Conclusions:
Adult stroke recognition tools correctly discriminate combined stroke types and AIS subtype from mimics but their limited accuracy suggest further modifications are required to improve diagnostic utility for identification of childhood stroke in the ED.
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Affiliation(s)
- Mark T Mackay
- Paediatrics, The Univ of Melbourne, Melbourne, Australia
| | - Leonid Churilov
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - Geoffrey Donnan
- The Florey Institute of Neurosciences and Mental Health, Melbourne, Australia
| | | | - Franz Babl
- Emergency, The Royal Children's Hosp, Melbourne, Australia
| | - Paul Monagle
- Paediatrics, The Univ of Melbourne, Melbourne, Australia
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Mackay MT, Chua ZK, Lee M, Yock-Corrales A, Churilov L, Monagle P, Donnan GA, Babl FE. Stroke and nonstroke brain attacks in children. Neurology 2014; 82:1434-40. [DOI: 10.1212/wnl.0000000000000343] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Mackay MT, Lee M, Churilov L, Yock-Corrales A, Donnan G, Monagle P, Babl F. Abstract 37: Pediatric Brain Attacks: Differentiating Between Stroke and Mimics in the Emergency Room. Stroke 2014. [DOI: 10.1161/str.45.suppl_1.37] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective:
Timely recognition of stroke in the pediatric emergency room (ER) is critical to improving access to hyper-acute therapies. We aimed to identify key clinical features which discriminate between stroke and non-stroke brain attacks (mimics).
Methods:
Two-hundred and eighty consecutive children presenting to the ER with non-stroke brain attacks, prospectively recruited over 18 months in 2009-2010, were compared to 104 children with stroke, prospectively/retrospectively recruited from 2003-2010. Brain attack was defined as acute onset focal brain dysfunction with ongoing symptoms or signs on arrival to the ER. Exclusion criteria included known epilepsy, hydrocephalus, head trauma and isolated headache.
Results:
Stroke diagnoses included arterial ischemic stroke (AIS) (55), hemorrhagic stroke (HS) (37), TIA (10) and sinovenous thrombosis (2). The most common mimic diagnoses included migraine (87), first seizure (46), Bell’s palsy (29) and conversion disorder (18). Children with stroke were more likely to have sudden onset of symptoms (85% vs. 71%), arrive by ambulance (63% vs. 33%) and receive higher triage category (43% vs. 23%) than mimics (p<0.001 all variables). Symptoms with good discriminatory value (stroke vs. mimic) included focal weakness (58% vs. 34%), altered consciousness (31% vs. 19%) and speech disturbance (36% vs. 16%) (p<0.001 all variables). Signs with good discriminatory value included focal weakness of the face (45% vs. 14%), arm (47% vs. 13%) or leg (38% vs. 15%), dysarthria (22% vs. 5%), dysphasia (11% vs 3%) and altered consciousness (43% vs. 23%) (p<0.001 all variables). Absence of focal neurological signs (20% stroke vs 35% mimic) on examination predicted mimic (p=0.005).
Conclusions:
Focal weakness and speech disturbance predict stroke diagnosis in children with brain attack symptoms, findings which are similar to adults. These findings will inform the development of pediatric bedside stroke recognition tools to improve rapid recognition of stroke by emergency physicians.
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Affiliation(s)
- Mark T Mackay
- Neurology, The Royal Children's Hosp, Melbourne, Australia
| | - Michelle Lee
- Paediatrics, Univ of Melbourne, Melbourne, Australia
| | - Leonid Churilov
- Statistics and Informatics Platform, The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | | | - Geoffrey Donnan
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - Paul Monagle
- Paediatrics, The Univ of Melbourne, Melbourne, Australia
| | - Franz Babl
- Emergency, The Royal Children's Hosp, Melbourne, Australia
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Yock-Corrales A, Babl FE, Mosley IT, Mackay MT. Can the FAST and ROSIER adult stroke recognition tools be applied to confirmed childhood arterial ischemic stroke? BMC Pediatr 2011; 11:93. [PMID: 22014183 PMCID: PMC3214127 DOI: 10.1186/1471-2431-11-93] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Accepted: 10/21/2011] [Indexed: 11/28/2022] Open
Abstract
Background Stroke recognition tools have been shown to improve diagnostic accuracy in adults. Development of a similar tool in children is needed to reduce lag time to diagnosis. A critical first step is to determine whether adult stoke scales can be applied in childhood stroke. Our objective was to assess the applicability of adult stroke scales in childhood arterial ischemic stroke (AIS) Methods Children aged 1 month to < 18 years with radiologically confirmed acute AIS who presented to a tertiary emergency department (ED) (2003 to 2008) were identified retrospectively. Signs, symptoms, risk factors and initial management were extracted. Two adult stroke recognition tools; ROSIER (Recognition of Stroke in the Emergency Room) and FAST (Face Arm Speech Test) scales were applied retrospectively to all patients to determine test sensitivity. Results 47 children with AIS were identified. 34 had anterior, 12 had posterior and 1 child had anterior and posterior circulation infarcts. Median age was 9 years and 51% were male. Median time from symptom onset to ED presentation was 21 hours but one third of children presented within 6 hours. The most common presenting stroke symptoms were arm (63%), face (62%), leg weakness (57%), speech disturbance (46%) and headache (46%). The most common signs were arm (61%), face (70%) or leg weakness (57%) and dysarthria (34%). 36 (78%) of children had at least one positive variable on FAST and 38 (81%) had a positive score of ≥1 on the ROSIER scale. Positive scores were less likely in children with posterior circulation stroke. Conclusion The presenting features of pediatric stroke appear similar to adult strokes. Two adult stroke recognition tools have fair to good sensitivity in radiologically confirmed childhood AIS but require further development and modification. Specificity of the tools also needs to be determined in a prospective cohort of children with stroke and non-stroke brain attacks.
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