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Kim DK, Lee KC, Kim JK. Sacroiliitis in inflammatory bowel disease on abdominal computed tomography: prevalence, misses, and associated factors. Scand J Rheumatol 2024:1-7. [PMID: 38686835 DOI: 10.1080/03009742.2024.2337453] [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: 12/20/2023] [Accepted: 03/28/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVE To evaluate the prevalence and rate of a missed diagnosis of sacroiliitis on abdominal computed tomography (CT) in patients with inflammatory bowel disease (IBD). Factors associated with sacroiliitis were also assessed. METHOD This retrospective study included 210 patients with IBD (mean age 31.1 years) who underwent abdominal CT. Based on a validated abdominal CT scoring tool, bilateral sacroiliac (SI) joints on abdominal CT in the whole study population were retrospectively reviewed. Subsequently, patients were classified into the 'patients with sacroiliitis' group and the 'patients without sacroiliitis' group. Univariate and multivariate regression analyses were used to clarify the factors associated with sacroiliitis. RESULTS Sacroiliitis was identified in 26 out of 210 patients (12.4%). However, sacroiliitis was recognized on the primary reading in only five of these 26 patients (19.2%) and was missed on the initial report in the remaining 21 patients (80.8%). Among the 21 patients, 20 (95.2%) were finally diagnosed with axial spondyloarthritis (axSpA). There was a higher prevalence of female sex (p = 0.04), upper gastrointestinal involvement (p = 0.04), and back pain (p < 0.01) in patients with sacroiliitis than in those without sacroiliitis. However, on multivariate analysis, back pain was the only factor associated with sacroiliitis (p = 0.01). CONCLUSION Physicians should carefully evaluate SI joints on abdominal CT in patients with IBD to enable early detection of sacroiliitis, potentially leading to an early diagnosis of axSpA. In addition, if patients with IBD present with back pain, the possibility of sacroiliitis should be considered.
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Affiliation(s)
- D K Kim
- Department of Radiology, The Armed Forces Capital Hospital, Seongnam, Republic of Korea
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - K-C Lee
- Department of Radiology, The Armed Forces Capital Hospital, Seongnam, Republic of Korea
- Department of Radiology, Korea University Anam Hospital, Seoul, Republic of Korea
| | - J K Kim
- Department of Radiology, The Armed Forces Capital Hospital, Seongnam, Republic of Korea
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Lee D, Lee JH, Kwak YH, Suh D, Kwon H, Kim DK, Jung JH, Park JW, Lee HN, Kim JH. The Barriers to Recognizing and Reporting Child Physical Abuse by Emergency Physicians and Associated Factors. Pediatr Emerg Care 2024:00006565-990000000-00419. [PMID: 38498930 DOI: 10.1097/pec.0000000000003146] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
BACKGROUND Although the reporting rate of child abuse is increasing every year, the child abuse detection rate is 3.81% as of 2019 in Korea, which is significantly lower than that of developed countries for child rights. OBJECTIVE We investigated the associated factors with barriers that emergency physicians face in recognizing and reporting cases of child abuse. METHODS From May to July 2022, 240 emergency physicians working in the 15 emergency department were asked to participate in the survey via email. The questionnaire included the respondent's basic information, treatment experience for child abuse, reasons for reporting or not reporting, and opinions on measures to increase the reporting rate. We conducted a logistic regression analysis to discern the factors contributing to underreporting. RESULTS Seventy-one individuals were included in the analysis, after excluding those who had never encountered suspected cases of child abuse. A multivariable logistic regression was performed with the above variables, and although it was not statistically significant, there was a tendency for workers to report well when working at a pediatric emergency department (odds ratio [95% confidence interval], 3.97 [0.98-16.09]). The primary reason for reporting suspected abuse was the pattern of damage suspected of abuse. The first reason for not reporting suspected abuse was because they were not sure it was child abuse. Respondents answered that to report better, a quick and appropriate response from the police and confidentiality of the reporter were needed. CONCLUSIONS Physicians in pediatric emergency departments demonstrated a tendency for more proactive reporting suspected cases of child abuse.
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Affiliation(s)
- Dongwoo Lee
- From the Department of Emergency Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gyeonggi-do, Republic of Korea
| | | | | | - Dongbum Suh
- From the Department of Emergency Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gyeonggi-do, Republic of Korea
| | - Hyuksool Kwon
- From the Department of Emergency Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gyeonggi-do, Republic of Korea
| | - Do Kyun Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin Hee Jung
- Department of Emergency Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Joong Wan Park
- Department of Emergency Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ha Ni Lee
- Department of Emergency Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin Hee Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
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Jung D, Jung JH, Kim JH, Jue JH, Park JW, Kim DK, Jung JY, Lee EJ, Lee JH, Suh D, Kwon H. The Association Between Inter-Hospital Transfers and the Prognosis of Pediatric Injury in the Emergency Department. J Korean Med Sci 2024; 39:e2. [PMID: 38193324 PMCID: PMC10782044 DOI: 10.3346/jkms.2024.39.e2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/16/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Inter-hospital transfers of severely injured patients are inevitable due to limited resources. We investigated the association between inter-hospital transfer and the prognosis of pediatric injury using the Korean multi-institutional injury registry. METHODS This retrospective observational study was conducted from January 2013 to December 2017; data for hospitalized subjects aged < 18 years were extracted from the Emergency Department-based Injury in Depth Surveillance database, in which 22 hospitals are participating as of 2022. The survival rates of the direct transfer group and the inter-hospital transfer group were compared, and risk factors affecting 30-day mortality and 72- hour mortality were analyzed. RESULTS The total number of study subjects was 18,518, and the transfer rate between hospitals was 14.5%. The overall mortality rate was 2.3% (n = 422), the 72-hour mortality was 1.7% (n = 315) and the 30-day mortality rate was 2.2% (n = 407). The Kaplan-Meier survival curve revealed a lower survival rate in the inter-hospital transfer group than in the direct visit group (log-rank, P < 0.001). Cox proportional hazards regression analysis showed that inter-hospital transfer group had a higher 30-day mortality rate and 72-hour mortality (hazard ratio [HR], 1.681; 95% confidence interval [CI], 1.232-2.294 and HR, 1.951; 95% CI, 1.299-2.930) than direct visit group when adjusting for age, sex, injury severity, and head injury. CONCLUSION Among the pediatric injured patients requiring hospitalization, inter-hospital transfer in the emergency department was associated with the 30-day mortality rate and 72-hour mortality rate in Korea.
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Affiliation(s)
- Darjin Jung
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jin Hee Jung
- Department of Emergency Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
- Disaster Medicine Research Center, Seoul National University Medical Research Center, Seoul, Korea.
| | - Jin Hee Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jie Hee Jue
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Joong Wan Park
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Do Kyun Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jae Yun Jung
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Eui Jun Lee
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jin Hee Lee
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dongbum Suh
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyuksool Kwon
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Kim JH, Jung JY, Lee S, Hwang S, Park JW, Lee EJ, Lee HN, Kim DK, Kwak YH. Ideal chest compression site for cardiopulmonary resuscitation in fontan circulation patients with dextrocardia. BMC Cardiovasc Disord 2024; 24:22. [PMID: 38172727 PMCID: PMC10765782 DOI: 10.1186/s12872-023-03691-0] [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: 06/06/2023] [Accepted: 12/24/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND We aimed to identify the ideal chest compression site for cardiopulmonary resuscitation (CPR) in patients with a single ventricle with dextrocardia corrected by Fontan surgery. METHODS The most recent stored chest computed tomography images of all patients with a single ventricle who underwent Fontan surgery were retrospectively analysed. We reported that the ideal chest compression site is the largest part of the compressed single ventricle. To identify the ideal chest compression site, we measured the distance from the midline of the sternum to the point of the maximum sagittal area of the single ventricle as a deviation and calculated the area fraction of the compressed structures. RESULTS 58 patients (67.2% male) were analysed. The mean right deviation from the midline of the sternum to the ideal compression site was similar to the mean sternum width (32.85 ± 15.61 vs. 31.05 ± 6.75 mm). When chest compression was performed at the ideal site, the area fraction of the single ventricle significantly increased by 7%, which was greater than that of conventional compression (0.15 ± 0.10 vs. 0.22 ± 0.11, P < 0.05). CONCLUSIONS When performing CPR on a patient with Fontan circulation with dextrocardia, right-sided chest compression may be better than the conventional location.
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Affiliation(s)
- Jin Hee Kim
- Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Jae Yun Jung
- Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
| | - Sangyun Lee
- Department of Paediatrics, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Soyun Hwang
- Department of Paediatrics, Severance Hospital, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Joong Wan Park
- Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Eui Jun Lee
- Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Ha Ni Lee
- Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Do Kyun Kim
- Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Young Ho Kwak
- Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
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Lee HN, Park JW, Jung JY, Kim DK, Kwak YH, Hwang S, Lee EJ, Kim JH, Jue JH. Unpowered scooter injuries in children and risk factors for traumatic brain injuries: An 8-year cross-sectional study using a national registry in South Korea. Injury 2024; 55:111197. [PMID: 38007295 DOI: 10.1016/j.injury.2023.111197] [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: 01/29/2023] [Revised: 10/22/2023] [Accepted: 11/10/2023] [Indexed: 11/27/2023]
Abstract
INTRODUCTION Head trauma accounts for a large proportion of unpowered scooter injuries in children. Traumatic brain injury (TBI) is the leading cause of considerable mortality and morbidity in children, who are the main users of unpowered scooters. The aim of this study was to explore the characteristics of unpowered scooter injuries in children and to identify predictors of the occurrence of TBI. METHODS A multicentre observational retrospective study was conducted using the Emergency Department-based Injury In-depth Surveillance (EDIIS) database in South Korea. Children aged 2 to 18 years old with unpowered scooter injuries between 2011 and 2018 were eligible for inclusion in this study, and the primary outcome was TBI defined based on the International Classification of Diseases, 10th Revision (ICD-10) code. RESULTS The annual rate of unpowered scooter injuries per 1,000 injured patients increased throughout the study period from 1.4 in 2011 to 16.4 in 2018 (P for trend < 0.001). Of the 3,892 children who had unpowered scooter injuries, 353 (9.2 %) had TBI. Children were at a higher risk of unpowered scooter TBI if they were aged between 2 and 5 years (adjusted odds ratio [aOR]: 1.37; 95 % confidence interval (CI): 1.09-1.73), were male (aOR: 1.45; 95 % CI: 1.14-1.86), were injured either on sidewalks (aOR: 1.80; 95 % CI: 1.20-2.70) or on driveways (aOR: 2.31; 95 % CI: 1.41-3.79), and experienced a fall (aOR: 1.98; 95 % CI: 1.15-3.43). Additionally, children injured after a blunt force were at a lower risk of TBI (aOR: 0.28; 95 % CI: 0.15-0.53). CONCLUSION Unpowered scooter injuries in children are increasing in South Korea. It is essential for younger children riding unpowered scooters to wear helmets and for caregivers to actively supervise their children to prevent TBI.
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Affiliation(s)
- Ha Ni Lee
- Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Disaster Medicine Research Center, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Department of Emergency Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Joong Wan Park
- Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Disaster Medicine Research Center, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Department of Emergency Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
| | - Jae Yun Jung
- Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Disaster Medicine Research Center, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Do Kyun Kim
- Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Disaster Medicine Research Center, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Young Ho Kwak
- Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Disaster Medicine Research Center, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Department of Emergency Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Soyun Hwang
- Department of Pediatrics, Severance Children's Hospital, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Eui Jun Lee
- Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Jin Hee Kim
- Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Jie Hee Jue
- Department of Pediatrics, Kyungpook National University Chilgok Hospital, 807 Hoguk-ro, Buk-gu, Daegu 41404, Republic of Korea
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Choi D, Park JW, Kwak YH, Kim DK, Jung JY, Lee JH, Jung JH, Suh D, Lee HN, Lee EJ, Kim JH. Comparison of age-adjusted shock indices as predictors of injury severity in paediatric trauma patients immediately after emergency department triage: A report from the Korean multicentre registry. Injury 2024; 55:111108. [PMID: 37858444 DOI: 10.1016/j.injury.2023.111108] [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: 08/16/2023] [Revised: 09/26/2023] [Accepted: 10/05/2023] [Indexed: 10/21/2023]
Abstract
INTRODUCTION Shock index paediatric-adjusted (SIPA) was presented for early prediction of mortality and trauma team activation in paediatric trauma patients. However, the derived cut-offs of normal vital signs were based on old references. We established alternative SIPAs based on the other commonly used references and compared their predictive values. METHODS We performed a retrospective review of all paediatric trauma patients aged 1-15 years in the Emergency Department (ED)-based Injury In-depth Surveillance (EDIIS) database from January 1, 2011 to December 31, 2019. A total of 4 types of SIPA values were obtained based on the references as follows: uSIPA based on the Nelson textbook of paediatrics 21st ed., SIATLS based on the ATLS 10th guideline, SIPALS based on the PALS 2020 guideline, and SIPA. In each SIPA group, the cut-off was established by dividing the group into 4 subgroups: toddler (age 1-3), preschooler (age 4-6), schooler (age 7-12), and teenager (age 13-15). We performed an ROC analysis and calculated the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) to compare the predicted values of each SIPA in mortality, ICU admission, and emergent surgery or intervention. RESULTS A total of 332,271 patients were included. The proportion of patients with an elevated shock index was 14.9 % (n = 49,347) in SIPA, 22.8 % (n = 75,850) in uSIPA, 0.3 % (n = 1058) in SIATLS, and 4.3 % (n = 14,168) in SIPALS. For mortality, uSIPA achieved the highest sensitivity (57.0 %; 95 % confidence interval 56.9 %-57.2 %) compared to SIPA (49.4 %, 95 % CI 49.2 %-49.5 %), SIATLS (25.5 %, 95 % CI 25.4 %-25.7 %), and SIPALS (43.8 %, 95 % CI 43.7 %-44.0 %), but there were no significant differences in the negative predictive value (NPV) or area under the curve (AUC). The positive predictive value (PPV) was highest in SIATLS (5.7 %, 95 % CI 5.6 %-5.8 %) compared to SIPA (0.2 %, 95 % CI 0.2 %-0.3 %), uSIPA (0.2 %, 95 % CI 0.2 %-0.2 %), and SIPALS (0.7 %, 95 % CI 0.7 %-0.8 %). The same findings were presented in ICU admission and emergent operation or intervention. CONCLUSION The ATLS-based shock index achieved the highest PPV and specificity compared to SIPA, uSIPA, and SIPALS for adverse outcomes in paediatric trauma.
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Affiliation(s)
- Dongmuk Choi
- Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Joong Wan Park
- Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Disaster Medicine Research Center, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Department of Emergency Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
| | - Young Ho Kwak
- Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Disaster Medicine Research Center, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Department of Emergency Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Do Kyun Kim
- Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Disaster Medicine Research Center, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Jae Yun Jung
- Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Disaster Medicine Research Center, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Jin Hee Lee
- Disaster Medicine Research Center, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Department of Emergency Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Department of Emergency Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, Bundang-gu, Seong-Nam, 13620, Republic of Korea
| | - Jin Hee Jung
- Disaster Medicine Research Center, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Department of Emergency Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea
| | - Dongbum Suh
- Disaster Medicine Research Center, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Department of Emergency Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, Bundang-gu, Seong-Nam, 13620, Republic of Korea
| | - Ha Ni Lee
- Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Disaster Medicine Research Center, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Department of Emergency Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Eui Jun Lee
- Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Jin Hee Kim
- Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
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Kim JS, Kim MS, Kim DK, Lee SH. Magnetic Resonance Imaging Characteristics of a Lateral Ligament Injury in Acute Ankle Sprains Among Athletes. Orthop J Sports Med 2023; 11:23259671231207688. [PMID: 37954866 PMCID: PMC10637175 DOI: 10.1177/23259671231207688] [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: 05/18/2023] [Accepted: 05/30/2023] [Indexed: 11/14/2023] Open
Abstract
Background It is important to identify the location and pattern of lateral ligament injuries that are related to the development and prognosis of chronic ankle instability in athletes with ankle sprains. Purpose To describe the location and pattern of lateral ligament injuries on magnetic resonance imaging (MRI) in elite-level or amateur athletes with acute ankle sprains and to further assess the risk of associated concomitant injuries. Study Design Cross-sectional study; Level of evidence, 3. Methods The anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) of 110 athletes with an ankle lateral ligament injury (mean age, 24.7 years) were evaluated. MRI scans were evaluated for the location and pattern of ATFL and CFL tears such as sleeve avulsions as well as concomitant deltoid ligament injuries, bone contusions, and osteochondral lesions of the talus (OLTs). Results On MRI, 52 (47.3%) athletes had an isolated ATFL tear, 56 (50.9%) athletes had both ATFL and CFL tears, and 2 (1.8%) athletes had an isolated CFL tear. ATFL injuries occurred at the fibula, midsubstance, and talus in approximately equal numbers, whereas the majority of CFL injuries occurred at the calcaneal insertion. Concomitant deltoid ligament injuries were identified in 18 (16.4%) athletes. In addition, concomitant bone contusions and OLTs were identified in 38 (34.5%) and 6 (5.5%) athletes, respectively. Using linear-by-linear analysis, CFL injuries correlated with concomitant deltoid ligament and bone injuries (P = .023 and P = .001, respectively) and a sleeve injury pattern (P = .005). Conclusion After an acute ankle ligament rupture, almost all athletes involved in this study had injured their ATFL, and approximately 50% had a concomitant injury to the CFL. The rate of sleeve-type CFL injuries at the calcaneal insertion was high, and concomitant deltoid ligament injuries and OLTs were associated with this pattern of injury.
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Affiliation(s)
- Jin Su Kim
- Department of Orthopedic Surgery, Sejong Sports Medicine and Performance Center, Seoul, Republic of Korea
| | - Min Seok Kim
- Department of Orthopedic Surgery, Wonkwang University Hospital, School of Medicine, Wonkwang University, Iksan, Republic of Korea
| | - Do Kyun Kim
- Department of Orthopedic Surgery, Wonkwang University Hospital, School of Medicine, Wonkwang University, Iksan, Republic of Korea
| | - Sung Hyun Lee
- Department of Orthopedic Surgery, Wonkwang University Hospital, School of Medicine, Wonkwang University, Iksan, Republic of Korea
- Musculoskeletal and Immune Disease Research Institute, School of Medicine, Wonkwang University, Iksan, Republic of Korea
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Kowalchuk RO, Mullikin TC, Spears GM, Rose PS, Siontis BL, Kim DK, Costello BA, Morris JM, Gao RW, Shiraishi S, Lucido J, Olivier K, Owen D, Stish BJ, Waddle MR, Laack Ii NN, Park SS, Brown PD, Merrell KW. Assessment of Minimum Dose as a Strong Predictor of Local Failure after Spine SBRT. Int J Radiat Oncol Biol Phys 2023; 117:e120-e121. [PMID: 37784669 DOI: 10.1016/j.ijrobp.2023.06.909] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Stereotactic body radiation therapy (SBRT) has demonstrated robust clinical benefits in carefully selected patients, improving local control and even overall survival (OS). Even so, a wide range of dose-fractionation schemes are used in clinical practice. We seek to assess a large database to determine clinical and dosimetric predictors of local failure after spine SBRT. MATERIALS/METHODS From a large institutional database, spine SBRT treatments with subsequent imaging follow-up to assess local control were identified. Patients were treated with a simultaneous integrated boost technique using 1 or 3 fractions, generally delivering 20-24 Gy in 1 fraction to the high dose volume and 16 Gy to the low dose volume (or 30-36 Gy and 24 Gy for 3 fraction treatments). Exclusions included: lack of imaging follow-up, proton therapy, and benign primary histologies. Statistical analyses included Cox proportional hazards analyses and the robust log-rank statistic for cut-point analysis. The cumulative incidence of local failure with death as a competing risk was considered as the primary endpoint. RESULTS A total of 522 eligible spine SBRT treatments (68% single fraction) were identified in 377 unique patients. Patients had a median OS of 43.7 months (95% confidence interval: 34.3-54.4). The cumulative incidence of local failure was 19.3% (15.3-23.2) at 1 year and 25.6% (21.1-29.9) at 2 years. Univariate analysis identified that the minimum dose (normalized for the prescription dose) was a strong predictor of local failure (p = 0.0093). Among patients treated with a single fraction, statistical significance was maintained (p = 0.024). No other dosimetric factors were predictive of local failure. In a cut point analysis, the log-rank statistic was maximized at 15.8 Gy minimum dose for single-fraction treatment (HR = 0.51, 95% CI: 0.34 - 0.75, p = 0.0009). Cumulative incidence of local failure was 15.1% (9.8-20.2) vs. 24.7% (17.2-31.5) at 1 year using this cut-off. Comparable local control was demonstrated with a minimum dose of 14 Gy (HR = 0.57, 95%: 0.37 - 0.87, p = 0.009), with reduced local control with lower minimum doses. Among a range of clinical factors assessed, only epidural and soft tissue involvement were predictive of local failure (HR = 1.80 and 1.98, respectively). Multivariable analyses incorporating soft tissue involvement, epidural extension, and multilevel disease confirmed the 15.8 Gy cutoff for single fraction cases (HR = 0.58, 95% CI: 0.38-0.88, p = 0.011). CONCLUSION Spine SBRT offers favorable local control using a range of dose-fractionation schemes; however, minimum dose has a strong association with local control, unlike any other dosimetric factors tested. Furthermore, statistical significance was maintained even when considering epidural extension and potential limitations from dose to the spinal cord. Our data suggests that the minimum dose should be prioritized during treatment planning, ideally to at least 14 - 15.8 Gy for single fraction.
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Affiliation(s)
- R O Kowalchuk
- University of Virginia / Riverside Radiosurgery Center, Newport News, VA
| | - T C Mullikin
- Department of Radiation Oncology, Duke University, Rochester, MN
| | - G M Spears
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - P S Rose
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - B L Siontis
- Division of Medical Oncology, Mayo Clinic, Rochester, MN
| | - D K Kim
- Department of Radiology, Mayo Clinic, Rochester, MN
| | - B A Costello
- Division of Medical Oncology, Mayo Clinic, Rochester, MN
| | - J M Morris
- Department of Radiology, Mayo Clinic, Rochester, MN
| | - R W Gao
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - S Shiraishi
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - J Lucido
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - K Olivier
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - D Owen
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - B J Stish
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - M R Waddle
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - N N Laack Ii
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - S S Park
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - P D Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - K W Merrell
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
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9
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Jung JH, Hwang S, Jung JY, Park JW, Lee EJ, Lee HN, Kim JH, Kim DK, Kwak YH. Brain natriuretic peptide as a clinical screening tool for the diagnosis of Kawasaki disease. Medicine (Baltimore) 2023; 102:e34319. [PMID: 37478221 PMCID: PMC10662796 DOI: 10.1097/md.0000000000034319] [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: 01/28/2023] [Accepted: 06/22/2023] [Indexed: 07/23/2023] Open
Abstract
N-terminal pro-brain natriuretic peptide (NT-proBNP) has been studied as a diagnostic screening tool for Kawasaki disease (KD). However, brain natriuretic peptide (BNP) has been less studied while has less variability among age groups. We aimed to find out if BNP can be used as a diagnostic screening tool for KD in Korea. This was a retrospective cohort study performed in a single pediatric emergency department. Patients younger than 19 years of age who presented with fever and underwent BNP examination for suspected KD was included. The primary outcome was the diagnostic performance of BNP for KD, and the secondary outcome was the diagnostic performance of BNP for coronary artery aneurysm (CAA). We also derived a scoring system for predicting KD and CAA. Of the 778 patients who were finally included, 400 were not diagnosed with KD and 378 were diagnosed with KD. The odds ratio of BNP at the cutoff of 30 pg/mL for KD was 7.80 (95% CI, 5.67-10.73) in the univariate analysis and 3.62 (95% CI, 2.33-5.88) in the multivariable analysis. The odds ratio of BNP at the cutoff of 270 pg/mL for CAA was 3.67 (95% CI, 2.18-6.19) in the univariate analysis and 2.37 (95% CI, 1.16-8.74) in the multivariable analysis. The AUC of KD and CAA were 0.884 and 0.726, respectively, which was the highest AUCs among all variables. Additionally, we proposed a scoring system for KD and CAA. It is important to clinically suspect KD and CAA in children with high BNP levels.
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Affiliation(s)
- Jae Ho Jung
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Soyun Hwang
- Department of Pediatrics, Severance Children’s Hospital, Seoul, Republic of Korea
| | - Jae Yun Jung
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Joong Wan Park
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eui Jun Lee
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ha Ni Lee
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jin Hee Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Do Kyun Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Young Ho Kwak
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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10
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Amrhein TJ, Williams JW, Gray L, Malinzak MD, Cantrell S, Deline CR, Carr CM, Kim DK, Goldstein KM, Kranz PG. Efficacy of Epidural Blood Patching or Surgery in Spontaneous Intracranial Hypotension: A Systematic Review and Evidence Map. AJNR Am J Neuroradiol 2023; 44:730-739. [PMID: 37202114 PMCID: PMC10249694 DOI: 10.3174/ajnr.a7880] [Citation(s) in RCA: 3] [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: 02/23/2023] [Accepted: 04/21/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Spontaneous intracranial hypotension is an important cause of treatable secondary headaches. Evidence on the efficacy of epidural blood patching and surgery for spontaneous intracranial hypotension has not been synthesized. PURPOSE Our aim was to identify evidence clusters and knowledge gaps in the efficacy of treatments for spontaneous intracranial hypotension to prioritize future research. DATA SOURCES We searched published English language articles on MEDLINE (Ovid), the Web of Science (Clarivate), and EMBASE (Elsevier) from inception until October 29, 2021. STUDY SELECTION We reviewed experimental, observational, and systematic review studies assessing the efficacy of epidural blood patching or surgery in spontaneous intracranial hypotension. DATA ANALYSIS One author performed data extraction, and a second verified it. Disagreements were resolved by consensus or adjudicated by a third author. DATA SYNTHESIS One hundred thirty-nine studies were included (median, 14 participants; range, 3-298 participants). Most articles were published in the past decade. Most assessed epidural blood patching outcomes. No studies met level 1 evidence. Most were retrospective cohort or case series (92.1%, n = 128). A few compared the efficacy of different treatments (10.8%, n = 15). Most used objective methods for the diagnosis of spontaneous intracranial hypotension (62.3%, n = 86); however, 37.7% (n = 52) did not clearly meet the International Classification of Headache Disorders-3 criteria. CSF leak type was unclear in 77.7% (n = 108). Nearly all reported patient symptoms using unvalidated measures (84.9%, n = 118). Outcomes were rarely collected at uniform prespecified time points. LIMITATIONS The investigation did not include transvenous embolization of CSF-to-venous fistulas. CONCLUSIONS Evidence gaps demonstrate a need for prospective study designs, clinical trials, and comparative studies. We recommend using the International Classification of Headache Disorders-3 diagnostic criteria, explicit reporting of CSF leak subtype, inclusion of key procedural details, and using objective validated outcome measures collected at uniform time points.
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Affiliation(s)
- T J Amrhein
- From the Department of Radiology (T.J.A., L.G., M.D.M., P.G.K.), Duke University Medical Center, Durham, North Carolina
| | - J W Williams
- Division of General Internal Medicine (J.W.W., K.M.G.)
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (J.W.W., K.M.G.), Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - L Gray
- From the Department of Radiology (T.J.A., L.G., M.D.M., P.G.K.), Duke University Medical Center, Durham, North Carolina
| | - M D Malinzak
- From the Department of Radiology (T.J.A., L.G., M.D.M., P.G.K.), Duke University Medical Center, Durham, North Carolina
| | - S Cantrell
- Duke University Medical Center Library (S.C.), Duke University School of Medicine, Durham, North Carolina
| | - C R Deline
- Spinal CSF Leak Foundation (C.R.D.), Spokane, Washington
| | - C M Carr
- Department of Radiology (C.M.C., D.K.K.), Mayo Clinic, Rochester, Minnesota
| | - D K Kim
- Department of Radiology (C.M.C., D.K.K.), Mayo Clinic, Rochester, Minnesota
| | - K M Goldstein
- Division of General Internal Medicine (J.W.W., K.M.G.)
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (J.W.W., K.M.G.), Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - P G Kranz
- From the Department of Radiology (T.J.A., L.G., M.D.M., P.G.K.), Duke University Medical Center, Durham, North Carolina
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11
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Wagle S, Benson JC, Madhavan AA, Carr CM, Garza I, Diehn FE, Kim DK. The clue is in the kidneys: greater renal contrast medium accumulation on ipsilateral side down CT myelogram after lateral decubitus digital subtraction myelogram as a predictor of laterality of cerebrospinal fluid leak. Clin Radiol 2023:S0009-9260(23)00173-3. [PMID: 37225571 DOI: 10.1016/j.crad.2023.04.009] [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: 07/20/2022] [Revised: 03/31/2023] [Accepted: 04/23/2023] [Indexed: 05/26/2023]
Abstract
AIM To assess the potential correlation of the laterality of a cerebrospinal fluid (CSF)-venous fistula with the laterality of decubitus computed tomography (CT) myelogram (post decubitus digital subtraction myelogram) based on which side demonstrated more renal contrast medium excretion. MATERIALS AND METHODS Patients with CSF-venous fistulas diagnosed at lateral decubitus digital subtraction myelograms were reviewed retrospectively. Patients who did not have CT myelogram following one or both left and right lateral decubitus digital subtraction myelograms were excluded. Two neuroradiologists independently interpreted the CT myelogram for the presence or absence of renal contrast, and whether subjectively more renal contrast medium was visualised on the left or right lateral decubitus CT myelogram. RESULTS Renal contrast medium was seen in lateral decubitus CT myelograms in 28 of 30 (93.3%) patients with CSF-venous fistulas. Having more renal contrast medium in right lateral decubitus CT myelogram was 73.9% sensitive and 71.4% specific for the diagnosis of a right-sided CSF-venous fistula, whereas having more renal contrast medium in the left lateral decubitus CT myelogram was 71.4% sensitive and 82.6% specific for a left-sided CSF-venous fistula (p=0.02). CONCLUSION When the CSF-venous fistula lies on the dependent side of a decubitus CT myelogram performed after decubitus digital subtraction myelogram, relatively more renal contrast medium is visualised compared to when the fistula lies on the non-dependent side.
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Affiliation(s)
- S Wagle
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - J C Benson
- Department of Radiology, Mayo Clinic, Rochester, MN, USA.
| | - A A Madhavan
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - C M Carr
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - I Garza
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - F E Diehn
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - D K Kim
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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12
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Siminski CP, Carr CM, Kallmes DF, Oien MP, Atkinson JLD, Benson JC, Diehn FE, Kim DK, Liebo GB, Lehman VT, Madhavan AA, Mark IT, Morris PP, Shlapak DP, Verdoorn JT, Morris JM. Fluoroscopy- and CT-Guided Gold Fiducial Marker Placement for Intraoperative Localization during Spinal Surgery: Review of 179 Cases at a Single Institution-Technique and Safety Profile. AJNR Am J Neuroradiol 2023; 44:618-622. [PMID: 37080723 PMCID: PMC10171395 DOI: 10.3174/ajnr.a7854] [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] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 03/16/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND AND PURPOSE Wrong-level spinal surgery, especially in the thoracic spine, remains a challenge for a variety of reasons related to visualization, such as osteopenia, large body habitus, severe kyphosis, radiographic misinterpretation, or anatomic variation. Preoperative fiducial marker placement performed in a dedicated imaging suite has been proposed to facilitate identification of thoracic spine vertebral levels. In this current study, we report our experience using image-guided percutaneous gold fiducial marker placement to enhance the accuracy and safety of thoracic spinal surgical procedures. MATERIALS AND METHODS A retrospective review was performed of all fluoroscopy- or CT-guided gold fiducial markers placed at our institution between January 3, 2019, and March 16, 2022. A chart review of 179 patients was performed detailing the procedural approach and clinical information. In addition, the method of gold fiducial marker placement (fluoroscopy/CT), procedure duration, spinal level of the gold fiducial marker, radiation dose, fluoroscopy time, surgery date, and complications (including whether wrong-level surgery occurred) were recorded. RESULTS A total of 179 patients (104 female) underwent gold fiducial marker placement. The mean age was 57 years (range, 12-96 years). Fiducial marker placement was performed by 13 different neuroradiologists. All placements were technically successful without complications. All 179 (100%) operations were performed at the correct level. Most fiducial markers (143) were placed with fluoroscopy with the most common location at T6-T8. The most common location for placement in CT was at T3 and T4. CONCLUSIONS All operations guided with gold fiducial markers were performed at the correct level. There were no complications of fiducial marker placement.
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Affiliation(s)
- C P Siminski
- From the Mayo Clinic Alix School of Medicine (C.P.S.)
| | - C M Carr
- Department of Radiology (C.M.C., D.F.K., M.P.O., F.E.D., D.K.K., G.B.L., V.T.L., A.A.M., I.T.M., P.P.M., D.P.S., J.T.V., J.M.M.), Mayo Clinic, Rochester, Minnesota
| | - D F Kallmes
- Department of Radiology (C.M.C., D.F.K., M.P.O., F.E.D., D.K.K., G.B.L., V.T.L., A.A.M., I.T.M., P.P.M., D.P.S., J.T.V., J.M.M.), Mayo Clinic, Rochester, Minnesota
| | - M P Oien
- Department of Radiology (C.M.C., D.F.K., M.P.O., F.E.D., D.K.K., G.B.L., V.T.L., A.A.M., I.T.M., P.P.M., D.P.S., J.T.V., J.M.M.), Mayo Clinic, Rochester, Minnesota
| | | | - J C Benson
- Department of Neuroradiology (J.L.D.A., J.C.B.)
| | - F E Diehn
- Department of Radiology (C.M.C., D.F.K., M.P.O., F.E.D., D.K.K., G.B.L., V.T.L., A.A.M., I.T.M., P.P.M., D.P.S., J.T.V., J.M.M.), Mayo Clinic, Rochester, Minnesota
| | - D K Kim
- Department of Radiology (C.M.C., D.F.K., M.P.O., F.E.D., D.K.K., G.B.L., V.T.L., A.A.M., I.T.M., P.P.M., D.P.S., J.T.V., J.M.M.), Mayo Clinic, Rochester, Minnesota
| | - G B Liebo
- Department of Radiology (C.M.C., D.F.K., M.P.O., F.E.D., D.K.K., G.B.L., V.T.L., A.A.M., I.T.M., P.P.M., D.P.S., J.T.V., J.M.M.), Mayo Clinic, Rochester, Minnesota
| | - V T Lehman
- Department of Radiology (C.M.C., D.F.K., M.P.O., F.E.D., D.K.K., G.B.L., V.T.L., A.A.M., I.T.M., P.P.M., D.P.S., J.T.V., J.M.M.), Mayo Clinic, Rochester, Minnesota
| | - A A Madhavan
- Department of Radiology (C.M.C., D.F.K., M.P.O., F.E.D., D.K.K., G.B.L., V.T.L., A.A.M., I.T.M., P.P.M., D.P.S., J.T.V., J.M.M.), Mayo Clinic, Rochester, Minnesota
| | - I T Mark
- Department of Radiology (C.M.C., D.F.K., M.P.O., F.E.D., D.K.K., G.B.L., V.T.L., A.A.M., I.T.M., P.P.M., D.P.S., J.T.V., J.M.M.), Mayo Clinic, Rochester, Minnesota
| | - P P Morris
- Department of Radiology (C.M.C., D.F.K., M.P.O., F.E.D., D.K.K., G.B.L., V.T.L., A.A.M., I.T.M., P.P.M., D.P.S., J.T.V., J.M.M.), Mayo Clinic, Rochester, Minnesota
| | - D P Shlapak
- Department of Radiology (C.M.C., D.F.K., M.P.O., F.E.D., D.K.K., G.B.L., V.T.L., A.A.M., I.T.M., P.P.M., D.P.S., J.T.V., J.M.M.), Mayo Clinic, Rochester, Minnesota
| | - J T Verdoorn
- Department of Radiology (C.M.C., D.F.K., M.P.O., F.E.D., D.K.K., G.B.L., V.T.L., A.A.M., I.T.M., P.P.M., D.P.S., J.T.V., J.M.M.), Mayo Clinic, Rochester, Minnesota
| | - J M Morris
- Department of Radiology (C.M.C., D.F.K., M.P.O., F.E.D., D.K.K., G.B.L., V.T.L., A.A.M., I.T.M., P.P.M., D.P.S., J.T.V., J.M.M.), Mayo Clinic, Rochester, Minnesota
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13
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Hwang S, Lee JH, Kwak YH, Kim DK, Jung JH, Jung JY, Kwon H, Suh D, Choi YJ, Lee SU, Park JW. Predictors of Caregiver Satisfaction With Pediatric Laceration Repair in the Pediatric Emergency Department. Pediatr Emerg Care 2023; 39:324-328. [PMID: 37115990 DOI: 10.1097/pec.0000000000002604] [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
OBJECTIVES The objective of this study was to define the care factors that are important to caregivers' satisfaction with pediatric laceration repair and the overall emergency department (ED) experience. METHODS This was a cross-sectional observation study performed in an urban tertiary hospital. The caregivers of patients younger than 18 years who presented to the ED for laceration repair completed a survey. Demographic data were analyzed. Univariate and multivariate logistic regressions were used to determine the factors related to satisfaction with the laceration repair and the overall ED experience. RESULTS Fifty-five caregivers were enrolled. Most of the children had facial lacerations (n = 44, 80%). The median length of ED stay was 181 minutes (interquartile range [IQR], 157-208 minutes). The children's median age was 41.8 months (IQR, 23-91 months); the caregivers' median age was 37 years (IQR, 35-41 years). Most lacerations were repaired by plastic surgeons (81.8%). In the multivariate regression analysis, preparation before the procedure, mid-income family, caring attitude of the nurse, cosmetic outcome, and measures to control the patient's anxiety were significantly related to the caregiver's satisfaction with laceration repair (P < 0.05), whereas preparation before the procedure and ED environment were significantly related to the caregiver's satisfaction with the overall ED experience (P < 0.05). CONCLUSIONS Preparation before the procedure was significantly related to the caregiver's satisfaction with both pediatric laceration repair and the overall PED experience. The strongest predictors were cosmetic outcome for laceration repair and preparation for the procedure for the overall PED experience. Our findings suggest that improvements in various aspects will increase parent satisfaction.
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Affiliation(s)
- Soyun Hwang
- From the Department of Emergency Medicine, Seoul National University Hospital, Seoul
| | | | - Young Ho Kwak
- From the Department of Emergency Medicine, Seoul National University Hospital, Seoul
| | - Do Kyun Kim
- From the Department of Emergency Medicine, Seoul National University Hospital, Seoul
| | - Jin Hee Jung
- Department of Emergency Medicines, SMG-SNU Boramae Medical Center, Seoul
| | - Jae Yun Jung
- From the Department of Emergency Medicine, Seoul National University Hospital, Seoul
| | - Hyuksool Kwon
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Gyeonggi
| | - Dongbum Suh
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Gyeonggi
| | - Yoo Jin Choi
- Department of Emergency Medicine, Ajou University School of Medicine, Gyeonggi
| | - Se Uk Lee
- Department of Emergency Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Joong Wan Park
- From the Department of Emergency Medicine, Seoul National University Hospital, Seoul
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14
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Huls SJ, Shlapak DP, Kim DK, Leng S, Carr CM. Reply. AJNR Am J Neuroradiol 2023; 44:E17. [PMID: 36822825 PMCID: PMC10187820 DOI: 10.3174/ajnr.a7803] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Affiliation(s)
- S J Huls
- Department of RadiologyMayo Clinic, Ringgold Standard InstitutionRochester, Minnesota
| | - D P Shlapak
- Department of RadiologyMayo Clinic, Ringgold Standard InstitutionRochester, Minnesota
| | - D K Kim
- Department of RadiologyMayo Clinic, Ringgold Standard InstitutionRochester, Minnesota
| | - S Leng
- Department of RadiologyMayo Clinic, Ringgold Standard InstitutionRochester, Minnesota
| | - C M Carr
- Department of RadiologyMayo Clinic, Ringgold Standard InstitutionRochester, Minnesota
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15
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Kim M, Lee JH, Kwak YH, Kim HK, Kwon H, Suh D, Kim DK, Lee HN, Kim JH, Jue JH, Hwang S. Delta Neutrophil Index Does Not Differentiate Bacterial Infection without Bacteremia from Viral Infection in Pediatric Febrile Patients. Children (Basel) 2023; 10:children10010161. [PMID: 36670711 PMCID: PMC9857165 DOI: 10.3390/children10010161] [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] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/03/2023] [Accepted: 01/10/2023] [Indexed: 01/17/2023]
Abstract
Introduction: We sought to determine whether the delta neutrophil index (DNI), a marker that is reported to be used to predict the diagnosis, prognosis, and disease severity of bacteremia and sepsis, is useful in differentiating bacterial infection without bacteremia (BIWB) from viral infections (VI) in pediatric febrile patients in the emergency department (ED). Method: We conducted a retrospective analysis of febrile patients’ medical records from the pediatric ED of the teaching hospital. The patients with BIWB and those with VI were identified with a review of medical records. The primary outcome was the diagnostic performance of DNI in differentiating BIWB from VI. The secondary outcome was a comparison of the diagnostic performances of DNI, CRP, WBC, and neutrophil count between the two groups. Results: A total of 151 (26.3%) patients were in the BIWB group, and 423 (73.7%) were in the VI group. There was no significant difference in DNI between the two groups (3.51 ± 6.90 vs. 3.07 ± 5.82, mean ± SD, BIWB vs. VI). However, CRP levels were significantly higher in the BIWB group than in the VI group (4.56 ± 5.45 vs. 1.39 ± 2.12, mean ± SD, BIWB vs. VI, p < 0.05). The AUROCs of DNI, WBC count, neutrophil levels, RDW, and CRP levels were 0.5016, 0.5531, 0.5631, 0.5131, and 0.7389, respectively, and only CRP levels were helpful in differentiating BIWB from VI. Conclusion: In the absence of bacteremia, DNI would not be helpful in differentiating BIWB from VI in pediatric febrile patients.
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Affiliation(s)
- Maro Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul 13620, Republic of Korea
| | - Jin Hee Lee
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul 13620, Republic of Korea
- Disaster Medicine Research Center, Seoul National University Medical Research Center, Seoul 03080, Republic of Korea
- Correspondence: ; Tel.: +82-31-787-7586
| | - Young Ho Kwak
- Disaster Medicine Research Center, Seoul National University Medical Research Center, Seoul 03080, Republic of Korea
- Department of Emergency Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Hyun Kyung Kim
- Department of Laboratory Medicine, Cancer Research Institute, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Hyuksool Kwon
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul 13620, Republic of Korea
| | - Dongbum Suh
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul 13620, Republic of Korea
| | - Do Kyun Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Ha Ni Lee
- Department of Emergency Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Jin Hee Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Jie Hee Jue
- Department of Emergency Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Soyun Hwang
- Department of Pediatrics, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
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Lee HN, Park JW, Hwang S, Jung JY, Kim DK, Kwak YH, Lee EJ. Effect of a Virtual Reality Environment Using a Domed Ceiling Screen on Procedural Pain During Intravenous Placement in Young Children: A Randomized Clinical Trial. JAMA Pediatr 2023; 177:25-31. [PMID: 36409508 PMCID: PMC9679961 DOI: 10.1001/jamapediatrics.2022.4426] [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] [Received: 03/11/2022] [Accepted: 08/24/2022] [Indexed: 11/23/2022]
Abstract
Importance Distraction using virtual reality (VR) has been found to provide a clinically significant reduction in the experience of pain during various painful procedures. Commercially available VR systems usually require the user to wear a head-mounted display helmet, which can be challenging for young children, and whether VR can reduce pain during intravenous (IV) placement in young children is currently unknown. Objective To determine whether a VR environment using a novel domed ceiling screen reduces distress among children over the course of IV placement compared with standard care in a pediatric emergency department. Design, Setting, and Participants This randomized clinical trial was conducted from June 3, 2020, to February 8, 2021, at an urban tertiary academic children's hospital. Included were children aged 6 months to 4 years undergoing IV placement in the pediatric emergency department. Intervention Children in the intervention group lay on a bed to experience a VR animation using a domed ceiling screen during the IV placement procedure, which was performed as usual. Children in the control group also lay on a bed during the procedure but did not view a VR animation. Main Outcomes and Measures The primary outcome was pain scores measured using the Face, Legs, Activity, Cry, and Consolability (FLACC) scale at 4 time points during IV placement: immediately after the child lay down on the bed (T1), the moment the tourniquet was applied (T2), the moment a sterile alcohol swab was applied (T3), and the moment the needle penetrated the skin (T4). Results Of the 88 children included in the final analysis, 44 received VR distraction (median [IQR] age, 24.0 [14.5-44.0] months; 27 boys [61.4%]), and 44 received standard care (median [IQR] age, 23.0 [15.0-40.0] months; 26 boys [59.1%]). The median [IQR] FLACC scores at T4 were 6.0 (1.8-7.5) in the intervention group and 7.0 (5.5-7.8) in the control group. The ordinal logistic regression model showed that children in the VR intervention group vs the control group had a lower probability of higher FLACC scores (odds ratio, 0.53; 95% CI, 0.28-0.99; P = .046). Conclusions and Relevance The findings of this trial indicate that displaying VR using a domed ceiling screen may be an effective distraction method that reduces distress in young children undergoing IV placement. Trial Registration isrctn.org Identifier: KCT0005122.
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Affiliation(s)
- Ha Ni Lee
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Joong Wan Park
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Soyun Hwang
- Department of Pediatrics, Severance Children’s Hospital, Seoul, Korea
| | - Jae Yun Jung
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Do Kyun Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Young Ho Kwak
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Eui Jun Lee
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
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Kwon W, Chang SA, Jeon K, Bak M, Park TK, Yang JH, Kim DK. Pulmonary arterial angioplasty in peripheral pulmonary arterial stenosis in RNF213 vasculopathy: effective but high-risk treatment with reperfusion injury. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1975] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
p.Arg4810Lys variant of the ring finger protein 213 (RNF213) vasculopathy is a nonsyndromatic vasculopathy involving multisystemic organs including pulmonary arteries. Peripheral pulmonary arterial stenosis (PPAS) with diffuse stenosis and beaded appearance is a unique feature of this disease and no treatment option has been tried before.
Methods
We performed BPA for PPAS in RNF213 patients (n=7). Severity of pulmonary hypertension was assessed by echocardiography and right heart catheterization at the baseline. Several clinical and hemodynamic parameters were followed up after each BPA sessions.
Results
All of the patients had dyspnea on exertion. Right ventricular dysfunction was observed in six patients and NT-proBNP was elevated (949.2±1148.1 pg/mL). Baseline echocardiography showed severe pulmonary hypertension (70.1±19.2 mmHg). Pulmonary arterial ballooning was performed to all patients, but stenting (n=6) and cutting balloon (n=1) was necessary due to elastic recoil. Improvement of clinical and hemodynamic parameters was achieved in six patients after 5.3 sessions of BPA in average. Reperfusion edema was seen in four patients, eventually leading to death in one patient.
Conclusions
Pulmonary arterial angioplasty, when coupled with stenting, is an effective treatment for PPAS with RNF213 vasculopathy. Although reperfusion injury was common and fatal in a few cases, it is the only modality to improve the patient's symptom and hemodynamics till now. Careful selection of the target population should be preceded to perform the intervention.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- W Kwon
- Samsung Medical Center , Seoul , Korea (Republic of)
| | - S A Chang
- Samsung Medical Center , Seoul , Korea (Republic of)
| | - K Jeon
- Samsung Medical Center , Seoul , Korea (Republic of)
| | - M Bak
- Samsung Medical Center , Seoul , Korea (Republic of)
| | - T K Park
- Samsung Medical Center , Seoul , Korea (Republic of)
| | - J H Yang
- Samsung Medical Center , Seoul , Korea (Republic of)
| | - D K Kim
- Samsung Medical Center , Seoul , Korea (Republic of)
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18
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Huls SJ, Shlapak DP, Kim DK, Leng S, Carr CM. Utility of Dual-Energy CT to Improve Diagnosis of CSF Leaks on CT Myelography following Lateral Decubitus Digital Subtraction Myelography with Negative Findings. AJNR Am J Neuroradiol 2022; 43:1539-1543. [PMID: 36574327 PMCID: PMC9575522 DOI: 10.3174/ajnr.a7628] [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] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/12/2022] [Indexed: 01/26/2023]
Abstract
CSF leaks, including CSF-venous fistulas, which cause spontaneous intracranial hypotension, remain difficult to diagnose, even on digital subtraction myelography and CT myelography. Dual-energy CT technology has been used to improve diagnostic utility within multiple organ systems. The capability of dual-energy CT to create virtual monoenergetic images can be leveraged to increase conspicuity of contrast in CSF-venous fistulas and direct epidural CSF leakage to improve the diagnostic utility of CT myelography. Six cases (in 5 patients) are shown in which virtual monoenergetic images demonstrate a leak location that was either occult or poorly visible on high- or low-kilovolt series. This clinical report describes the novel application of dual-energy CT for the detection of subtle CSF leaks including CSF-venous fistulas.
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Affiliation(s)
- S J Huls
- From the Department of Radiology, Mayo Clinic, Ringgold Standard Institution, Rochester, Minnesota
| | - D P Shlapak
- From the Department of Radiology, Mayo Clinic, Ringgold Standard Institution, Rochester, Minnesota
| | - D K Kim
- From the Department of Radiology, Mayo Clinic, Ringgold Standard Institution, Rochester, Minnesota
| | - S Leng
- From the Department of Radiology, Mayo Clinic, Ringgold Standard Institution, Rochester, Minnesota
| | - C M Carr
- From the Department of Radiology, Mayo Clinic, Ringgold Standard Institution, Rochester, Minnesota
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19
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Lee B, Park JD, Kwak YH, Kim DK. Pediatric triage modifications based on vital signs: a nationwide study. Clin Exp Emerg Med 2022; 9:224-229. [PMID: 36153876 PMCID: PMC9561195 DOI: 10.15441/ceem.21.108] [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: 06/15/2021] [Accepted: 01/26/2022] [Indexed: 11/23/2022] Open
Abstract
Objective To analyze the clinical significance of a heart rate (HR) or respiratory rate (RR) higher or lower than the normal in pediatric triage. Methods A retrospective observational study was conducted with data from the Korean National Emergency Department Information System. The subjects were children <15 years of age in 2016. Reported HRs and RRs were divided into seven groups: grade -3 (3 or more standard deviations [SDs]<normal), grade -2 (2 SDs<normal), grade -1 (1 SD<normal), grade 0 (normal), grade 1 (1 SD>normal), grade 2 (2 SDs>normal), and grade 3 (3 or more SDs>normal). The main outcomes were hospitalization and intensive care unit (ICU) admission rates. Logistic regression analysis was used to analyze the relationship of the outcomes according to grade in each group. Results Data for 981,297 patients were analyzed. Hospitalization and ICU admission rates increased significantly in the higher HR group (grades 1 to 3; odds ratio [OR], 1.353; P<0.001; OR, 1.747; P<0.001; respectively) and in the higher RR group (OR, 1.144; P<0.001; OR, 1.396; P<0.001; respectively), compared with grade 0 group. In the lower HR group (grades -1 to -3), the hospitalization rate decreased (OR, 0.928; P<0.001), whereas the ICU admission rate increased (OR, 1.207; P=0.001). Although the hospitalization rate increased. In the lower RR group (OR, 1.016; P=0.008), the ICU admission rate did not increase (OR, 0.973; P=0.338). Conclusion Deviations in HR and RR above normal are related to increased risks of hospitalization and ICU admission. However, this association may not apply to deviations below normal.
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Affiliation(s)
- Bongjin Lee
- Department of Pediatrics, Seoul National University Hospital, Seoul, Korea
| | - June Dong Park
- Department of Pediatrics, Seoul National University Hospital, Seoul, Korea
| | - Young Ho Kwak
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Do Kyun Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
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20
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Babcock JC, Johnson DR, Benson JC, Kim DK, Luetmer PH, Shlapak DP, Cross CP, Johnson MP, Cutsforth-Gregory JK, Carr CM. Diffuse Calvarial Hyperostosis and Spontaneous Intracranial Hypotension: A Case-Control Study. AJNR Am J Neuroradiol 2022; 43:978-983. [PMID: 35772803 DOI: 10.3174/ajnr.a7557] [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: 03/25/2022] [Accepted: 05/06/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Diagnosing spontaneous intracranial hypotension and associated CSF leaks can be challenging, and additional supportive imaging findings would be useful to direct further evaluation. This retrospective study evaluated whether there was a difference in the prevalence of calvarial hyperostosis in a cohort of patients with spontaneous intracranial hypotension compared with an age- and sex-matched control population. MATERIALS AND METHODS Cross-sectional imaging (CT of the head or brain MR imaging examinations) for 166 patients with spontaneous intracranial hypotension and 321 matched controls was assessed by neuroradiologists blinded to the patient's clinical status. The readers qualitatively evaluated the presence of diffuse or layered calvarial hyperostosis and measured calvarial thickness in the axial and coronal planes. RESULTS A significant difference in the frequency of layered hyperostosis (31.9%, 53/166 subjects versus 5.0%, 16/321 controls, P < .001, OR = 11.58) as well as the frequency of overall (layered and diffuse) hyperostosis (38.6%, 64/166 subjects versus 13.2%, 42/321 controls, P < .001, OR = 4.66) was observed between groups. There was no significant difference in the frequency of diffuse hyperostosis between groups (6.6%, 11/166 subjects versus 8.2%, 26/321 controls, P = .465). A significant difference was also found between groups for calvarial thickness measured in the axial (P < .001) and coronal (P < .001) planes. CONCLUSIONS Layered calvarial hyperostosis is more prevalent in spontaneous intracranial hypotension compared with the general population and can be used as an additional noninvasive brain imaging marker of spontaneous intracranial hypotension and an underlying spinal CSF leak.
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Affiliation(s)
- J C Babcock
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - D R Johnson
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - J C Benson
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - D K Kim
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - P H Luetmer
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - D P Shlapak
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - C P Cross
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - M P Johnson
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | | | - C M Carr
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
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21
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Cho S, Hwang S, Jung JY, Kwak YH, Kim DK, Lee JH, Jung JH, Park JW, Kwon H, Suh D. Validation of Pediatric Emergency Care Applied Research Network (PECARN) rule in children with minor head trauma. PLoS One 2022; 17:e0262102. [PMID: 35041677 PMCID: PMC8765658 DOI: 10.1371/journal.pone.0262102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 12/18/2021] [Indexed: 11/25/2022] Open
Abstract
The Pediatric Emergency Care Applied Research Network (PECARN) rule is commonly used for predicting the need for computed tomography (CT) scans in children with mild head trauma. The objective of this study was to validate the PECARN rule in Korean children presenting to the pediatric emergency department (PED) with head trauma. This study was a multicenter, retrospective, observational cohort study in two teaching PEDs in Korea between August 2015 and August 2016. In this observational study, 448 patients who visited PEDs were included in the final analysis. Risk stratification was performed with clinical decision support software based on the PECARN rule, and decisions to perform CT scans were subsequently made. Patients were followed-up by phone call between 7 days and 90 days after discharge from the PED. The sensitivity and specificity were analyzed. The sensitivity was 100% for all age groups, and no cases of clinically important traumatic brain injury (ciTBI) were identified in the very-low-risk group. CT scans were performed for 14.7% of patients in this study and for 33.8% in the original PECARN study. The PECARN rule successfully identified low-risk patients, and no cases of ciTBI were missed despite the reduced proportion of patients undergoing CT scans.
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Affiliation(s)
- Sooje Cho
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Soyun Hwang
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
- * E-mail:
| | - Jae Yun Jung
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Young Ho Kwak
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Do Kyun Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jin Hee Lee
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jin Hee Jung
- Department of Emergency Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Joong Wan Park
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyuksool Kwon
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dongbum Suh
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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22
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Lee HN, Hwang S, Jung JY, Park JW, Kim DK, Kwak YH. Tablet personal computer distraction during intravenous placement for young children in the pediatric emergency department: A pilot study. Pediatr Int 2022; 64:e15150. [PMID: 35510723 DOI: 10.1111/ped.15150] [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: 06/22/2021] [Revised: 01/16/2022] [Accepted: 01/21/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Intravenous (IV) placement is a common procedure experienced by children visiting the pediatric emergency department (PED). However, uncontrolled anxiety and pain cause children to interfere with the procedure. In this pilot study, we sought to evaluate the effectiveness of tablet personal computers as a distraction method during IV placement. METHODS This is a single-center pilot study conducted at a tertiary teaching hospital. Children visiting the PED were eligible if they were aged 3-5 years and required IV placement during the PED visit. After written consent was obtained from the guardian, the child was randomly assigned to a control group or an intervention group. For the intervention group, an animated video was played via tablet PC during IV placement. For both groups, children's anxiety, heart rate, and pain scale scores (the Face, Legs, Activity, Cry, Consolability and Evaluation Enfant Douleur) and guardian satisfaction were recorded. RESULTS 22 children were eligible for the final analysis. There was no significant difference in the pain scale scores between the two groups, with the exception of the degree of pain relief after the procedure measured using Evaluation Enfant Douleur (intervention group: 6.0, interquartile range (IQR): 4.2-6.8, and control group; 3.0, IQR: 2.0-3.8, P = 0.011) and Face, Legs, Activity, Cry, Consolability (intervention group: 4.0, IQR: 4.0-4.2 and control group; 3.0, IQR: 1.5-3.5, P = 0.043). CONCLUSION In this pilot study, distraction using tablet personal computers may have reduced children's distress during the recovery phase after venipuncture. Further study with a larger sample size and different methods of distraction is essential.
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Affiliation(s)
- Ha Ni Lee
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seodaemun-gu, Korea
| | - Soyun Hwang
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seodaemun-gu, Korea
| | - Jae Yun Jung
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seodaemun-gu, Korea
| | - Joong Wan Park
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seodaemun-gu, Korea
| | - Do Kyun Kim
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seodaemun-gu, Korea
| | - Young Ho Kwak
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seodaemun-gu, Korea
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23
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Paek SH, Kim DK, Kwak YH, Jung JY, Lee S, Park JW. Effectiveness of the implementation of pediatric intussusception clinical pathway: A pre- and postintervention trial. Medicine (Baltimore) 2021; 100:e27971. [PMID: 35049201 PMCID: PMC9191323 DOI: 10.1097/md.0000000000027971] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 11/09/2021] [Indexed: 12/13/2022] Open
Abstract
Intussusception is common among children at the pediatric emergency department (ED) with acute abdomen. Diagnosis and treatment delay remain a challenge. This study aimed to evaluate the impact of intussusception clinical pathways (CPs) implementation, including bedside point-of-care ultrasonography, on patient management in a pediatric ED.In January 2017, an intussusception management protocol was implemented for children with symptoms of intussusception. We retrospectively examined the charts of patients diagnosed with intussusception during the preprotocol (January 2015 to December 2016) and postprotocol (January 2017 to January 2019) periods and compared their outcomes.A total of 106 and 108 patients were included in the preprotocol and postprotocol groups, respectively. After CP implementation, the median door-to-ultrasonography time decreased from 66.5 (range: 13, 761) to 54 (20, 191) minutes; meanwhile, door-to-reduction time decreased from 121.5 (37, 1077) to 80.5 (40, 285) minutes; the median ED length of stay decreased from 440 to 303.5 minutes; and finally, admission rate increased from 18.9% to 40.7% (P < .01). There was no between-group difference in the rates of complications, readmission, emergency surgery, or reduction failure.The implementation of an intussusception CP decreased time-to-diagnosis, time-to-treatment, and ED length of stay estimates among children screened using point-of-care ultrasonography. The present findings suggest that the implementation of an intussusception CP may improve the efficiency of time and resource use.
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Affiliation(s)
- So Hyun Paek
- Department of Emergency Medicine, CHA Bundang Medical Center, Gyeonggi-do, Republic of Korea
| | - Do Kyun Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Young Ho Kwak
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae Yun Jung
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seuk Lee
- Department of Emergency Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Joong Wan Park
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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24
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Park YS, Lee JH, Kwak YH, Jung JY, Kwon H, Choi YJ, Suh DB, Lee B, Kim MJ, Kim DK. A clinical prediction tool to predict urinary tract infection in pediatric febrile patients younger than 2 years old: a retrospective analysis of a fever registry. Clin Exp Emerg Med 2021; 8:314-324. [PMID: 35000359 PMCID: PMC8743680 DOI: 10.15441/ceem.20.134] [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: 10/12/2020] [Revised: 11/28/2020] [Accepted: 12/16/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Urinary tract infection (UTI) is a significant issue in young febrile patients due to potential long-term complications. Early detection of UTI is crucial in pediatric emergency departments (PEDs). We developed a tool to predict UTIs in children. METHODS Clinical data of patients <24 months of age with a fever and UTI or viral infection were extracted from the fever registry collected in two PEDs. Stepwise multivariate logistic regression was performed to establish predictors of identified eligible clinical variables for the derivation of the prediction model. RESULTS A total of 1,351 patients were included in the analysis, 643 patients from A hospital (derivation set) and 708 patients from B hospital (validation set). In the derivation set, there were more girls and a lower incidence of a past history of UTI, older age, less fever without source, and more family members with upper respiratory symptoms in the viral infection group. The stepwise regression analysis identified sex (uncircumcised male), age (≤12 months), a past history of UTI, and family members with upper respiratory symptoms as significant variables. CONCLUSION Young febrile patients in the PED were more likely to have UTIs if they were uncircumcised boys, were younger than 12 months of age, had a past history of UTIs, or did not have families with respiratory infections. This clinical prediction model may help determine whether to perform urinalysis in the PED.
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Affiliation(s)
- Yun Seong Park
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jin Hee Lee
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Young Ho Kwak
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Yun Jung
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hyuksool Kwon
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yoo Jin Choi
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Dong Bum Suh
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Bongjin Lee
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Min-Jung Kim
- Department of Emergency Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Do Kyun Kim
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
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25
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Lee HN, Bae W, Park JW, Jung JY, Hwang S, Kim DK, Kwak YH. Virtual reality environment using a dome screen for procedural pain in young children during intravenous placement: A pilot randomized controlled trial. PLoS One 2021; 16:e0256489. [PMID: 34464411 PMCID: PMC8407539 DOI: 10.1371/journal.pone.0256489] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 08/03/2021] [Indexed: 12/05/2022] Open
Abstract
We assessed the feasibility and potential efficacy of a virtual reality (VR) environment using a dome screen as a distraction method in young children during intravenous (IV) placement in the pediatric emergency department. This randomized controlled pilot study enrolled children aged 2 to 6 years who underwent IV placement into either the intervention group or the control group. Children in the intervention group experienced VR using a dome screen during IV placement. The child’s pain intensity was measured using the Face, Legs, Activity, Cry, and Consolability (FLACC) scale at four time points of IV placement: immediately after arrival to the blood collection room (base); immediately after the child laid down on the bed (preparation); when the tourniquet was applied (tourniquet); and the moment at which the needle penetrated the skin (venipuncture). The guardian’s satisfaction and rating of the child’s distress were assessed using a 5-point Likert-type questionnaire. We recruited 19 children (9 in the intervention group and 10 in the control group). Five children in the control group were excluded from the analysis because of missing video recordings (n = 3), failed first attempt at IV placement (n = 1), and the child’s refusal to lie on the bed during the procedure (n = 1). No side effects of VR were reported during the study period. Although the average FLACC scale score at each time point (preparation, tourniquet, venipuncture) was lower in the intervention group than the control group, the difference was not statistically significant (2.3, interquartile range [IQR]: 2.0–3.0; vs. 3.3, IQR: 2.7–6.7, P = 0.255). There were no statistically significant differences between the groups in the guardian’s satisfaction and anxiety or his/her rating of the child’s pain and anxiety. The guardians and emergency medical technicians reported satisfaction with the use of VR with a dome screen and considered it a useful distraction during the procedure. VR using a dome screen is a feasible distraction method for young children during IV placement. A larger clinical trial with further development of the VR environment and study process is required to adequately evaluate the efficacy of VR using a dome screen.
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Affiliation(s)
- Ha Ni Lee
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Woori Bae
- Department of Emergency Medicine, Seoul St. Mary Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joong Wan Park
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- * E-mail:
| | - Jae Yun Jung
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Soyun Hwang
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Do Kyun Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Young Ho Kwak
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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26
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Lee SU, Joo YH, Chang I, Kim DK, Lee JC, Jung JY, Park JW, Kwak YH. Novel Simulation Model That Realizes Arterial and Venous Blood Flow for Ultrasound-Guided Central Venous Catheter Insertion in Children. IEEE J Transl Eng Health Med 2021; 9:1800305. [PMID: 34350069 PMCID: PMC8313016 DOI: 10.1109/jtehm.2021.3093203] [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] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 04/22/2021] [Accepted: 06/07/2021] [Indexed: 11/11/2022]
Abstract
Objective: We developed and validated a realistic simulation model for
ultrasound-guided central venous catheter insertion in children that is easy to
build and inexpensive and can automatically reproduce arterial and venous blood
flow. Methods: The simulation model was constructed with a chicken breast, two
DWP-385 water pumps, two types of tubes and a controller. An elastic rubber
tourniquet and a silicone tube were connected to each water pump, which
generated different continuous flows mimicking those of the pediatric internal
carotid artery and internal jugular vein, respectively. Both tubes were inserted
into a piece of chicken breast and connected to the controller. Then, we
provided a simulation program of ultrasound-guided central venous catheter
insertion using our novel model to resident emergency medicine physicians. We
also collected data on their knowledge and confidence levels regarding the
procedure before and after the simulation via questionnaires utilizing a 5-point
Likert scale. Results: The flow patterns of the artery and vein were well
demonstrated with our model. A total of 11 resident physicians were enrolled.
The knowledge and confidence regarding the discrimination of arteries and veins
were significantly improved after training with our simulation model (p-value
< 0.01). The subjective similarity and usefulness of our model also
scored high on the questionnaire (median: 4; interquartile range in both
categories: 4–5). Conclusion: Our novel simulation model is useful and
realistic for ultrasound-guided central venous catheter insertion training.
Clinical impact: This controlled motor system can be applied to many simulation
models of artery and vein circulation.
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Affiliation(s)
- Se Uk Lee
- Department of Emergency MedicineSamsung Medical CenterSeoul06351Republic of Korea
| | - Yoon Ha Joo
- Interdisciplinary Program in BioengineeringSeoul National University Graduate SchoolSeoul03080Republic of Korea
| | - Ikwan Chang
- Department of Emergency MedicineKangwon National University College of MedicineChuncheon24289Republic of Korea
| | - Do Kyun Kim
- Department of Emergency MedicineSeoul National University HospitalSeoul03080Republic of Korea
| | - Jung Chan Lee
- Department of Biomedical EngineeringSeoul National University College of MedicineSeoul03080Republic of Korea
| | - Jae Yun Jung
- Department of Emergency MedicineSeoul National University HospitalSeoul03080Republic of Korea
| | - Joong Wan Park
- Department of Emergency MedicineSeoul National University HospitalSeoul03080Republic of Korea
| | - Young Ho Kwak
- Department of Emergency MedicineSeoul National University HospitalSeoul03080Republic of Korea
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27
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Lee J, Kim DK, Kang EK, Kim JT, Na JY, Park B, Yeom SR, Oh JS, Jhang WK, Jeong SI, Jung JH, Choi YH, Choi JY, Park JD, Hwang SO. 2020 Korean Guidelines for Cardiopulmonary Resuscitation. Part 6. Pediatric basic life support. Clin Exp Emerg Med 2021; 8:S65-S80. [PMID: 34034450 PMCID: PMC8171176 DOI: 10.15441/ceem.21.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 04/06/2021] [Indexed: 12/28/2022] Open
Affiliation(s)
- Jisook Lee
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Do Kyun Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Eun Kyeong Kang
- Department of Pediatrics, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Jin-Tae Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Yoon Na
- Department of Pediatrics, Hanyang University Medical Center, Hanyang University College of Medicine, Seoul, Korea
| | - Bobae Park
- Department of Nursing, Seoul National University Hospital, Seoul, Korea
| | - Seok Ran Yeom
- Department of Emergency Medicine, Pusan National University College of Medicine, Busan, Korea
| | - Joo Suk Oh
- Department of Emergency Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Won Kyoung Jhang
- Department of Pediatrics, Children's Hospital Asan Medical Center, Seoul, Korea
| | - Soo In Jeong
- Department of Pediatrics, Ajou University Hospital, Suwon, Korea
| | - Jin Hee Jung
- Department of Emergency Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Yu Hyeon Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Jea Yeon Choi
- Department of Emergency Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - June Dong Park
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Oh Hwang
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
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28
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Choi YH, Kim DK, Kang EK, Kim JT, Na JY, Park B, Yeom SR, Oh JS, Lee J, Jhang WK, Jeong SI, Jung JH, Choi JY, Park JD, Hwang SO. 2020 Korean Guidelines for Cardiopulmonary Resuscitation. Part 7. Pediatric advanced life support. Clin Exp Emerg Med 2021; 8:S81-S95. [PMID: 34034451 PMCID: PMC8171177 DOI: 10.15441/ceem.21.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 03/28/2021] [Indexed: 02/05/2023] Open
Affiliation(s)
- Yu Hyeon Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Do Kyun Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Eun Kyeong Kang
- Department of Pediatrics, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Jin-Tae Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Yoon Na
- Department of Pediatrics, Hanyang University Medical Center, Hanyang University College of Medicine, Seoul, Korea
| | - Bobae Park
- Department of Nursing, Seoul National University Hospital, Seoul, Korea
| | - Seok Ran Yeom
- Department of Emergency Medicine, Pusan National University College of Medicine, Busan, Korea
| | - Joo Suk Oh
- Department of Emergency Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Jisook Lee
- Department of Emergency Medicine, Ajou University College of Medicine, Suwon, Korea
| | - Won Kyoung Jhang
- Department of Pediatrics, Children's Hospital, Asan Medical Center, Seoul, Korea
| | - Soo In Jeong
- Department of Pediatrics, Ajou University Hospital, Suwon, Korea
| | - Jin Hee Jung
- Department of Emergency Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Jea Yeon Choi
- Department of Emergency Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - June Dong Park
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Oh Hwang
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
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29
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Shlapak D, Kim DK, Diehn FE, Benson JC, Lehman VT, Liebo GB, Morris JM, Morris PP, Verdoom JT, Carr CM. Reply. AJNR Am J Neuroradiol 2021; 42:E45. [PMID: 33888455 DOI: 10.3174/ajnr.a7126] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- D Shlapak
- Department of RadiologyMayo ClinicRochester, Minnesota
| | - D K Kim
- Department of RadiologyMayo ClinicRochester, Minnesota
| | - F E Diehn
- Department of RadiologyMayo ClinicRochester, Minnesota
| | - J C Benson
- Department of RadiologyMayo ClinicRochester, Minnesota
| | - V T Lehman
- Department of RadiologyMayo ClinicRochester, Minnesota
| | - G B Liebo
- Department of RadiologyMayo ClinicRochester, Minnesota
| | - J M Morris
- Department of RadiologyMayo ClinicRochester, Minnesota
| | - P P Morris
- Department of RadiologyMayo ClinicRochester, Minnesota
| | - J T Verdoom
- Department of RadiologyMayo ClinicRochester, Minnesota
| | - C M Carr
- Department of RadiologyMayo ClinicRochester, Minnesota
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30
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Abstract
OBJECTIVE This retrospective study investigated the nature and severity of venom-induced consumption coagulopathy (VICC) and determined the clotting factors involved in VICC in patients after envenomation by South Korea's snakes. Additionally, we studied the effectiveness of antivenom for the treatment of VICC after envenomation. METHODS Included patients were divided into three groups according to the severity of VICC (no VICC, partial VICC, and complete VICC). Data, including changes in coagulation parameters during hospitalization and clotting factors at presentation, were collected and analyzed. RESULTS One hundred nineteen patients who presented at our emergency department within 3 h after snake envenomation were included. VICC developed in 34 patients (27 patients with partial VICC and 7 patients with complete VICC). Two of 34 patients with VICC required blood transfusions. Five patients with complete VICC had an undetectable fibrinogen concentration at presentation. Three patients with complete VICC had an unmeasurable INR and aPTT within 24 h. The median times of the most extreme values were 10 h for INR, 12 h for aPTT, and 16 h for fibrinogen after presentation in the VICC group. The D-dimer concentration peaked at a median of 63.5 h after presentation. The activities of factors II and X were significantly reduced in the complete VICC group (factor II: 88 (84-99.3)% in the non-VICC group vs. 69 (49.5-83.5)% in the complete VICC group; factor X:94 (83-102) in the non-VICC group vs. 70 (66.5-79.8)% in the complete VICC group), while there was no difference in factor V activity at presentation. The time from bite to first antivenom administration did not correlate with the time course and most extreme concentrations for fibrinogen and D-dimer within the VICC groups. DISCUSSION AND CONCLUSION VICC occurs in approximately one-quarter of snakebite patients in South Korea; however, VICC itself does not appear to lead to clinical deterioration. Fibrinogen is an early diagnostic maker for complete VICC. Clotting factors II and X are involved in VICC. Future investigations should explore the mechanism of VICC from Korean snakebites and the effect of antivenom on VICC.
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Affiliation(s)
- J M Moon
- Department of Emergency Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea.,Department of Emergency Medicine, Chonnam National University Hwasun Hospital, Jeollanam-do, Republic of Korea
| | - B J Chun
- Department of Emergency Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea.,Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Y S Cho
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - J C Kim
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Y J Koo
- Department of Agricultural Chemistry, Chonnam National University, Gwangju, Republic of Korea
| | - K H Park
- Department of Emergency Medical Rescue, Nambu University, Gwangju, Republic of Korea.,Department of Medical science, Chonnam National University Graduate School, Gwangju, Republic of Korea
| | - S D Lee
- Department of Emergency Medicine in Trauma Center, Wonkwang University Hospital, Iksan, Republic of Korea
| | - J S Ahn
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Jeollanam-do, Republic of Korea
| | - D K Kim
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - S J Ryu
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
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31
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Choi DH, Jung JY, Suh D, Choi JY, Lee SU, Choi YJ, Kwak YH, Kim DK. Impact of the COVID-19 Outbreak on Trends in Emergency Department Utilization in Children: a Multicenter Retrospective Observational Study in Seoul Metropolitan Area, Korea. J Korean Med Sci 2021; 36:e44. [PMID: 33527786 PMCID: PMC7850866 DOI: 10.3346/jkms.2021.36.e44] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 01/12/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Understanding the changes in emergency department (ED) visit patterns during the coronavirus disease 2019 (COVID-19) outbreak is important for effectively operating EDs during the pandemic. We aimed to analyze the changes in pediatric ED visits during the COVID-19 pandemic and examine the relationship between the number of ED visits and the stringency of government social distancing measures. METHODS This multicenter retrospective study used data of pediatric (age < 18 years) ED visits in Seoul metropolitan area from June 1, 2018, to May 31, 2020. Patient demographics, ED results, and diagnoses were compared during the COVID-19 period and the previous year. To evaluate the effect of the stringency of social distancing measures on the number of ED visits, a Poisson regression model was developed with month, year, and the average monthly Government Response Stringency Index (GRSI) as fixed effects. RESULTS In total, 190,732 patients were included. The number of pediatric ED visits during the COVID-19 period was 58.1% lower than in the previous year. There were disproportionate decreases in the numbers of ED visits for children in early childhood (66.5%), low-acuity children (55.2-63.8%), those who did not use an ambulance (59.0%), and those visiting the ED for noninjury complaints (64.9%). The proportion of admissions increased from 11.9% to 16.6%. For every 10-point increase in the GRSI, there was a 15.1% decrease in monthly ED visits. CONCLUSION A striking decrease in pediatric ED visits was observed during the COVID-19 outbreak, the scale which was associated with the stringency of government policies. Changes in the number and characteristics of children visiting the ED should be considered to facilitate the effective operation of EDs during the pandemic.
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Affiliation(s)
- Dong Hyun Choi
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jae Yun Jung
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea.
| | - Dongbum Suh
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jea Yeon Choi
- Department of Emergency Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Se Uk Lee
- Department of Emergency Medicine, Samsung Medical Center, Seoul, Korea
| | - Yoo Jin Choi
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Young Ho Kwak
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Do Kyun Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
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32
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Benson JC, Giannini C, Cohen Cohen S, Van Gompel J, Kim DK, Port J, Diehn F, Eckel L, Carr C. Optic Nerve Choristoma Mimicking a Neurenteric Cyst. AJNR Am J Neuroradiol 2021; 42:228-232. [PMID: 33303524 DOI: 10.3174/ajnr.a6892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 07/29/2020] [Accepted: 08/27/2020] [Indexed: 11/07/2022]
Abstract
Optic nerve choristomas are rare entities in which a developmental focus of histologically normal tissue is abnormally located within or along a segment of the optic nerve. Although benign, choristomas may demonstrate slow growth, ultimately resulting in visual field deficits due to compression of the adjacent nerve in the few cases reported in the anterior fossa. Choristomas may have cystic components, though this has not been described in such lesions along the optic nerve. Here, a predominantly cystic optic nerve choristoma is described, with radiologic features mimicking those of an anterior cranial fossa neurenteric cyst. The case highlights the radiology-pathology correlates of choristomas and reviews the surgical approach and management of patients with such lesions.
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Affiliation(s)
- J C Benson
- From the Departments of Radiology (J.C.B., D.K.K., J.P., F.D., L.E., C.C.)
| | | | - S Cohen Cohen
- Neurosurgery (S.C.C., J.V.G.), Mayo Clinic, Rochester, Minnesota
| | - J Van Gompel
- Neurosurgery (S.C.C., J.V.G.), Mayo Clinic, Rochester, Minnesota
| | - D K Kim
- From the Departments of Radiology (J.C.B., D.K.K., J.P., F.D., L.E., C.C.)
| | - J Port
- From the Departments of Radiology (J.C.B., D.K.K., J.P., F.D., L.E., C.C.)
| | - F Diehn
- From the Departments of Radiology (J.C.B., D.K.K., J.P., F.D., L.E., C.C.)
| | - L Eckel
- From the Departments of Radiology (J.C.B., D.K.K., J.P., F.D., L.E., C.C.)
| | - C Carr
- From the Departments of Radiology (J.C.B., D.K.K., J.P., F.D., L.E., C.C.)
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33
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Lee G, Kim DK, Park JW, Kwak YH, Jung JY. Trampoline-related injuries in children: a nationwide cross-sectional study in South Korea. Clin Exp Emerg Med 2020; 7:190-196. [PMID: 33028062 PMCID: PMC7550808 DOI: 10.15441/ceem.19.060] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 10/18/2019] [Indexed: 11/23/2022] Open
Abstract
Objective Trampoline-related injuries have increased in South Korea. However, little research has been conducted on this topic. This study aimed to show the characteristics of pediatric trampoline-related injuries in South Korea and to investigate the factors associated with admission. Methods A retrospective, cross-sectional study was conducted using data from South Korea’s Emergency Department-based Injury In-depth Surveillance registry for dates between January 2011 and December 2016. All patients under 18 years of age with trampoline-related injuries were included. We divided the patients into two groups based on whether they were admitted or discharged. Odds ratios with 95% confidence intervals were calculated to evaluate the factors associated with hospital admission for pediatric trampoline-related injuries. Results A total of 2,745 patients were enrolled and the incidence increased over time (P for trend<0.01). The most common injury site was the lower extremity (45%). Fracture was the most frequent diagnosis (34.3%). Compared to the discharge group, the adjusted odds ratios (95% confidence intervals) for hospital admission were 3.53 (1.73–7.17) for the teenage group, 2.62 (1.82–3.77) for upper extremity injuries, 18.48 (7.95–42.95) for fractures, 2.28 (1.35–3.86) for falls, and 2.04 (1.15–3.60) for collisions. Conclusion Trampoline-related injuries in children have increased over time in South Korea. Most occur in children under the age of 12 years, but children between the ages of 13 and 18 years are at a higher risk for hospitalization. Also, injuries of the upper extremity, fracture, falling, and collision are risk factors for admission. Preventive strategies are needed to reduce trampoline-related injuries in children.
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Affiliation(s)
- Geonmoo Lee
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Do Kyun Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Joong Wan Park
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Young Ho Kwak
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea.,Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Yun Jung
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
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34
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Kannan B, Campbell DL, Vasconcelos F, Winik R, Kim DK, Kjaergaard M, Krantz P, Melville A, Niedzielski BM, Yoder JL, Orlando TP, Gustavsson S, Oliver WD. Generating spatially entangled itinerant photons with waveguide quantum electrodynamics. Sci Adv 2020; 6:6/41/eabb8780. [PMID: 33028523 PMCID: PMC7541065 DOI: 10.1126/sciadv.abb8780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 08/21/2020] [Indexed: 05/31/2023]
Abstract
Realizing a fully connected network of quantum processors requires the ability to distribute quantum entanglement. For distant processing nodes, this can be achieved by generating, routing, and capturing spatially entangled itinerant photons. In this work, we demonstrate the deterministic generation of such photons using superconducting transmon qubits that are directly coupled to a waveguide. In particular, we generate two-photon N00N states and show that the state and spatial entanglement of the emitted photons are tunable via the qubit frequencies. Using quadrature amplitude detection, we reconstruct the moments and correlations of the photonic modes and demonstrate state preparation fidelities of 84%. Our results provide a path toward realizing quantum communication and teleportation protocols using itinerant photons generated by quantum interference within a waveguide quantum electrodynamics architecture.
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Affiliation(s)
- B Kannan
- Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - D L Campbell
- Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - F Vasconcelos
- Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - R Winik
- Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - D K Kim
- MIT Lincoln Laboratory, 244 Wood Street, Lexington, MA 02420, USA
| | - M Kjaergaard
- Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - P Krantz
- Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - A Melville
- MIT Lincoln Laboratory, 244 Wood Street, Lexington, MA 02420, USA
| | - B M Niedzielski
- MIT Lincoln Laboratory, 244 Wood Street, Lexington, MA 02420, USA
| | - J L Yoder
- MIT Lincoln Laboratory, 244 Wood Street, Lexington, MA 02420, USA
| | - T P Orlando
- Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - S Gustavsson
- Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - W D Oliver
- Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- MIT Lincoln Laboratory, 244 Wood Street, Lexington, MA 02420, USA
- Department of Physics, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
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35
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Hwang S, Choi YJ, Jung JY, Choi Y, Ham EM, Park JW, Kwon H, Kim DK, Kwak YH. Pain Passport as a tool to improve analgesic use in children with suspected fractures in emergency departments. Korean J Pain 2020; 33:386-394. [PMID: 32989203 PMCID: PMC7532291 DOI: 10.3344/kjp.2020.33.4.386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/13/2020] [Accepted: 07/17/2020] [Indexed: 11/09/2022] Open
Abstract
Background In the emergency department (ED), adequate pain control is essential for managing patients; however, children with pain are known to receive less analgesia than adults with pain. We introduce the Pain Passport to improve pain management in paediatric patients with suspected fractures in the ED. Methods This was a before-and-after study. We reviewed the medical records of paediatric patients who were primarily diagnosed with fractures from May to August 2015. After the introduction of the Pain Passport, eligible children were enrolled from May to August 2016. Demographics, analgesic administration rates, time intervals between ED arrival and analgesic administration, and satisfaction scores were obtained. We compared the analgesic prescription rate between the two periods using multiple logistic regression. Results A total of 58 patients were analysed. The baseline characteristics of subjects during the two periods were not significantly different. Before the introduction of the Pain Passport, 9 children (31.0%) were given analgesics, while after the introduction of the Pain Passport, a significantly higher percentage of patients (24/29, 82.8%) were treated with analgesics (P < 0.001). The median administration times were 112 (interquartile range [IQR], 64-150) minutes in the pre-intervention period and 24 (IQR, 20-74) minutes in the post-intervention period. The median satisfaction score for the post-intervention period was 4 (IQR, 3-5). The adjusted odds ratio for providing analgesics in the post-intervention period was 25.91 (95% confidence interval, 4.36-154.02). Conclusions Patient-centred pain scoring with the Pain Passport improved pain management in patients with suspected fractures in the paediatric ED.
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Affiliation(s)
- Soyun Hwang
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yoo Jin Choi
- Department of Emergency Medicine, Ajou University Hospital, Suwon, Korea
| | - Jae Yun Jung
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yeongho Choi
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Eun Mi Ham
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Joong Wan Park
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyuksool Kwon
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnan, Korea
| | - Do Kyun Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Young Ho Kwak
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
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36
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Pope MC, Carr CM, Brinjikji W, Kim DK. Safety of Consecutive Bilateral Decubitus Digital Subtraction Myelography in Patients with Spontaneous Intracranial Hypotension and Occult CSF Leak. AJNR Am J Neuroradiol 2020; 41:1953-1957. [PMID: 32883671 DOI: 10.3174/ajnr.a6765] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 07/01/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Digital subtraction myelography performed with the patient in the lateral decubitus position has the potential for increased sensitivity over prone-position myelography in the detection of spinal CSF-venous fistulas, a well-established cause of spontaneous intracranial hypotension. We report on the safety of performing routine, consecutive-day right and left lateral decubitus digital subtraction myelography in these patients. MATERIALS AND METHODS In this retrospective case series, all patients undergoing consecutive-day lateral decubitus digital subtraction myelography for suspected spinal CSF leak between September 2018 and September 2019 were identified. Chart review was performed to identify any immediate or delayed adverse effects associated with the procedures. Procedural parameters were also analyzed due to inherent variations associated with the positive-pressure myelography technique that was used. RESULTS A total of 60 patients underwent 68 pairs of consecutive-day lateral decubitus digital subtraction myelographic examinations during the study period. No major adverse effects were recorded. Various minor adverse effects were observed, including pain requiring analgesics (27.2%), nausea/vomiting requiring antiemetics (8.1%), and transient neurologic effects such as syncope, vertigo, altered mental status, and autonomic dysfunction (5.1%). Minor transient neurologic effects were correlated with increasing volumes of intrathecal saline injectate used for thecal sac prepressurization. CONCLUSIONS In patients with spontaneous intracranial hypotension and suspected spontaneous spinal CSF leak, consecutive-day lateral decubitus digital subtraction myelography demonstrates an acceptable risk profile without evidence of neurotoxic effects from cumulative intrathecal contrast doses. Higher intrathecal saline injectate volumes may correlate with an increased incidence of minor transient periprocedural neurologic effects.
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Affiliation(s)
- M C Pope
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - C M Carr
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - W Brinjikji
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - D K Kim
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
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Shlapak DP, Kim DK, Diehn FE, Benson JC, Lehman VT, Liebo GB, Morris JM, Morris PP, Verdoorn JT, Carr CM. Time to Resolution of Inadvertent Subdural Contrast Injection during a Myelogram: When Can the Study Be Reattempted? AJNR Am J Neuroradiol 2020; 41:1958-1962. [PMID: 32855185 DOI: 10.3174/ajnr.a6725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 06/15/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Inadvertent subdural contrast injections can occur during any myelogram. Currently, there are no guidelines defining when residual subdural iodinated contrast will be cleared and no longer interfere with subsequent procedure and imaging. We investigated the time to resolution of subdural contrast using a 2-day lateral decubitus digital subtraction myelogram and associated CT myelogram data in patients undergoing evaluation for spontaneous intracranial hypotension. MATERIALS AND METHODS Retrospective review of 63 patients with lateral decubitus digital subtraction myelograms from September 4, 2018, to October 1, 2019, was performed. Patients with 2-day lateral decubitus digital subtraction myelograms on 2 consecutive days, with or without a same-day CT myelogram on day 1 and with a same-day CT myelogram on day 2, were included. Patients with next-day CT covering at least the abdomen and pelvis after either-day injection were also included. In cases of subdural injection, next-day CT scans were evaluated for residual subdural contrast. RESULTS Of 49 included patients, 5 had subdural injection on day 1, with the second-day CT myelogram available for review. One of these 5 patients had subdural injections on 2 different days and subsequently had chest/abdomen/pelvis CTA a day after the second subdural injection. In all 6 cases of subdural injections, there was complete resolution of subdural contrast on the next-day CT, with the shortest time to resolution of approximately 20.5 hours (range, 20.5-28.5 hours). CONCLUSIONS Our study suggests that resolution of inadvertently injected subdural contrast occurs within 1 day, and the myelogram can be reattempted as early as the next day.
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Affiliation(s)
- D P Shlapak
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - D K Kim
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - F E Diehn
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - J C Benson
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - V T Lehman
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - G B Liebo
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - J M Morris
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - P P Morris
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - J T Verdoorn
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - C M Carr
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
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Benson JC, Vizcaino MA, Kim DK, Carr C, Rose P, Eckel L, Diehn F. Exophytic Lumbar Vertebral Body Mass in an Adult with Back Pain. AJNR Am J Neuroradiol 2020; 41:1786-1790. [PMID: 32819895 DOI: 10.3174/ajnr.a6749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/02/2020] [Indexed: 12/18/2022]
Abstract
Chordomas are rare primary bone malignancies derived from notochord remnants. The tumors often are slow-growing and often present with indolent, nonspecific symptoms. Nevertheless, chordomas are locally aggressive and highly prone to local recurrence, necessitating precise planning before biopsy and/or surgical resection. Familiarity with the imaging features of chordomas is, therefore, essential. This case highlights the typical imaging and pathologic features of a spinal chordoma as well as the surgical approach and the patient's subsequent outcome.
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Affiliation(s)
- J C Benson
- From the Departments of Radiology (J.C.B., D.K.K., C.C., L.E., F.D.)
| | | | - D K Kim
- From the Departments of Radiology (J.C.B., D.K.K., C.C., L.E., F.D.)
| | - C Carr
- From the Departments of Radiology (J.C.B., D.K.K., C.C., L.E., F.D.)
| | - P Rose
- Orthopedic Surgery (P.R.), Mayo Clinic, Rochester, Minnesota
| | - L Eckel
- From the Departments of Radiology (J.C.B., D.K.K., C.C., L.E., F.D.)
| | - F Diehn
- From the Departments of Radiology (J.C.B., D.K.K., C.C., L.E., F.D.)
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Bond KM, Benson JC, Cutsforth-Gregory JK, Kim DK, Diehn FE, Carr CM. Spontaneous Intracranial Hypotension: Atypical Radiologic Appearances, Imaging Mimickers, and Clinical Look-Alikes. AJNR Am J Neuroradiol 2020; 41:1339-1347. [PMID: 32646948 DOI: 10.3174/ajnr.a6637] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 04/30/2020] [Indexed: 12/19/2022]
Abstract
Spontaneous intracranial hypotension is a condition characterized by low CSF volume secondary to leakage through a dural defect with no identifiable cause. Patients classically present with orthostatic headaches, but this symptom is not specific to spontaneous intracranial hypotension, and initial misdiagnosis is common. The most prominent features of spontaneous intracranial hypotension on intracranial MR imaging include "brain sag" and diffuse pachymeningeal enhancement, but these characteristics can be seen in several other conditions. Understanding the clinical and imaging features of spontaneous intracranial hypotension and its mimickers will lead to more prompt and accurate diagnoses. Here we discuss conditions that mimic the radiologic and clinical presentation of spontaneous intracranial hypotension as well as other disorders that CSF leaks can imitate.
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Affiliation(s)
- K M Bond
- From the Mayo Clinic School of Medicine (K.M.B.), Rochester, Minnesota
| | - J C Benson
- Departments of Radiology (J.C.B., D.K.K., F.E.D., C.M.C.)
| | | | - D K Kim
- Departments of Radiology (J.C.B., D.K.K., F.E.D., C.M.C.)
| | - F E Diehn
- Departments of Radiology (J.C.B., D.K.K., F.E.D., C.M.C.)
| | - C M Carr
- Departments of Radiology (J.C.B., D.K.K., F.E.D., C.M.C.)
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Canepa J, Torgerson J, Kim DK, Lindahl E, Takahashi R, Whitelock K, Heying M, Wilkinson SP. Characterizing osmolyte chemical class hierarchies and functional group requirements for thermal stabilization of proteins. Biophys Chem 2020; 264:106410. [PMID: 32574923 DOI: 10.1016/j.bpc.2020.106410] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/25/2020] [Accepted: 05/31/2020] [Indexed: 12/20/2022]
Abstract
Osmolytes are naturally occurring organic compounds that protect cellular proteins and other macromolecules against various forms of stress including temperature extremes. While biological studies have correlated the accumulation of certain classes of osmolytes with specific forms of stress, including thermal stress, it remains unclear whether or not these observations reflect an intrinsic chemical class hierarchy amongst the osmolytes with respect to effects on protein stability. In addition, very little is known in regards to the molecular elements of the osmolytes themselves that are essential for their functions. In this study, we use differential scanning fluorimetry to quantify the thermal stabilizing effects of members from each of the three main classes of protecting osmolytes on two model protein systems, C-reactive protein and tumor necrosis factor alpha. Our data reveals the absence of a strict chemical class hierarchy amongst the osmolytes with respect to protein thermal stabilization, and indicates differential responses of these proteins to certain osmolytes. In the second part of this investigation we dissected the molecular elements of amino acid osmolytes required for thermal stabilization of myoglobin and C-reactive protein. We show that the complete amino acid zwitterion is required for thermal stabilization of myoglobin, whereas removal of the osmolyte amino group does not diminish stabilizing effects on C-reactive protein. These disparate responses of proteins to osmolytes and other small molecules are consistent with previous observations that osmolyte effects on protein stability are protein-specific. Moreover, the data reported in this study support the view that osmolyte effects cannot be fully explained by considering only the solvent accessibility of the polypeptide backbone in the native and denatured states, and corroborate the need for more complex models that take into account the entire protein fabric.
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Affiliation(s)
- J Canepa
- Department of Chemistry & Biochemistry, California Polytechnic State University, San Luis Obispo, CA, USA
| | - J Torgerson
- Department of Chemistry & Biochemistry, California Polytechnic State University, San Luis Obispo, CA, USA
| | - D K Kim
- Department of Chemistry & Biochemistry, California Polytechnic State University, San Luis Obispo, CA, USA
| | - E Lindahl
- Department of Chemistry & Biochemistry, California Polytechnic State University, San Luis Obispo, CA, USA
| | - R Takahashi
- Department of Chemistry & Biochemistry, California Polytechnic State University, San Luis Obispo, CA, USA
| | - K Whitelock
- Department of Chemistry & Biochemistry, California Polytechnic State University, San Luis Obispo, CA, USA
| | - M Heying
- Department of Chemistry & Biochemistry, California Polytechnic State University, San Luis Obispo, CA, USA
| | - S P Wilkinson
- Department of Chemistry & Biochemistry, California Polytechnic State University, San Luis Obispo, CA, USA.
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Yun JK, Chong BK, Kim HJ, Lee IS, Gong CS, Kim BS, Lee GD, Choi S, Kim HR, Kim DK, Park SI, Kim YH. Comparative outcomes of robot-assisted minimally invasive versus open esophagectomy in patients with esophageal squamous cell carcinoma: a propensity score-weighted analysis. Dis Esophagus 2020; 33:5610078. [PMID: 31665266 DOI: 10.1093/dote/doz071] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 04/15/2019] [Revised: 06/16/2019] [Indexed: 02/06/2023]
Abstract
Robots are increasingly used in minimally invasive surgery. We evaluated the clinical benefits of robot-assisted minimally invasive esophagectomy (RAMIE) in comparison with the conventional open esophageal surgery. From 2012 to 2016, 371 patients with esophageal squamous cell carcinoma underwent an Ivor Lewis or McKeown procedure at our institution. Of these, 130 patients underwent laparoscopic gastric conduit formation followed by RAMIE, whereas 241 patients underwent conventional esophageal surgery, including laparotomy and open esophagectomy (OE). We compared the short- and long-term clinical outcomes of these patients using the propensity score-based inverse probability of treatment weighting technique (IPTW). Among the early outcomes, the OE group showed a higher incidence of pneumonia (P = 0.035) and a higher requirement for vasopressors (P = 0.001). Regarding the long-term outcomes, all-cause mortality was significantly higher (P = 0.001) and disease-free survival was lower (P = 0.006) in the OE group. Wound-related problems also occurred more frequently in the OE group (P = 0.020) during the long-term follow-up. There was no statistical intergroup difference in the recurrence rates (P = 0.191). The Cox proportional-hazard analysis demonstrated that wound problems (HR 0.16, 95% CI 0.02-0.57; P = 0.017), pneumonia (HR 0.23, 95% CI 0.06-0.68; P = 0.019), and use of vasopressors (HR 0.14, 95% CI 0.08-0.25; P = 0.001) were independent predictors of mortality. RAMIE could be a better surgical option for selected patients with esophageal squamous cell carcinoma.
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Affiliation(s)
- J K Yun
- Division of Thoracic Surgery, Department of Thoracic & Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - B K Chong
- Division of Thoracic Surgery, Department of Thoracic & Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - H J Kim
- Division of Thoracic Surgery, Department of Thoracic & Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - I-S Lee
- Division of Stomach Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - C-S Gong
- Division of Stomach Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - B S Kim
- Division of Stomach Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - G D Lee
- Division of Thoracic Surgery, Department of Thoracic & Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - S Choi
- Division of Thoracic Surgery, Department of Thoracic & Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - H R Kim
- Division of Thoracic Surgery, Department of Thoracic & Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - D K Kim
- Division of Thoracic Surgery, Department of Thoracic & Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - S-I Park
- Division of Thoracic Surgery, Department of Thoracic & Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Y-H Kim
- Division of Thoracic Surgery, Department of Thoracic & Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Park JW, Kwon H, Jung JY, Choi YJ, Lee JS, Cho WS, Lee JC, Kim HC, Lee SU, Kwak YH, Kim DK. "Weighing Cam": A New Mobile Application for Weight Estimation in Pediatric Resuscitation. PREHOSP EMERG CARE 2020; 24:441-450. [PMID: 31368831 DOI: 10.1080/10903127.2019.1651432] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: We evaluated the validity of a newly developed mobile application (i.e. the Weighing Cam) for pediatric weight estimation compared with that of the Broselow tape. Methods: We developed an application that estimates the weight of pediatric patients using a smartphone camera and displays the drug dosage, device size, and defibrillation energy on the screen of the smartphone. We enrolled a convenience sample of pediatric patients aged <16 years who presented at two pediatric emergency departments of two tertiary academic hospitals in South Korea. The pediatric patients' heights and weights were measured; then, one researcher estimated the weights using the application. Using the measured height, we determined the weight estimated by the Broselow tape. We compared the estimated measurements by determining the mean percentage error (MPE), mean absolute percentage error, root mean square percentage error, and percentages predicted within 10% and 20% of the actual. Results: In total, 480 patients were enrolled in 16 age categories, each with 15 males and 15 females of different ages. The Weighing Cam demonstrated a lower bias (mean difference: -1.98% [95% confidence interval -2.91% to -1.05%] for MPE) and a higher proportion of estimated weights within 10% of the actual weights than the Broselow tape (mean difference: 9.1% [95% confidence interval 3.0% to 15.1%]). The Weighing Cam showed better performance in terms of accuracy and precision than the Broselow tape in all subgroups stratified by age or body mass index percentile. Conclusions: The Weighing Cam may estimate pediatric patients' weights more accurately than the Broselow tape. The Weighing Cam may be useful for pediatric resuscitation in both prehospital and hospital settings.
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Choi IC, Park JW, Jung JY, Kim DK, Kwak YH, Suh D, Lee SU. The Author's Response: Pediatric Injuries in Kids Cafés and Risk Factors for Significant Injuries: a 6-Year Cross-Sectional Study Using a Multicenter Injury Registry in Korea. J Korean Med Sci 2020; 35:e147. [PMID: 32329261 DOI: 10.3346/jkms.2020.35.e147] [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] [Received: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 11/20/2022] Open
Affiliation(s)
- Ik Chang Choi
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Joong Wan Park
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea.
| | - Jae Yun Jung
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Do Kyun Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Young Ho Kwak
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Dongbum Suh
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Se Uk Lee
- Department of Emergency Medicine, Samsung Medical Center, Seoul, Korea
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Lee B, Chang I, Kim DK, Park JD. Factors Associated with Triage Modifications Using Vital Signs in Pediatric Triage: a Nationwide Cross-Sectional Study in Korea. J Korean Med Sci 2020; 35:e102. [PMID: 32329255 PMCID: PMC7183845 DOI: 10.3346/jkms.2020.35.e102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 02/16/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Previous studies on inter-rater reliability of pediatric triage systems have compared triage levels classified by two or more triage providers using the same information about individual patients. This overlooks the fact that the evaluator can decide whether or not to use the information provided. The authors therefore aimed to analyze the differences in the use of vital signs for triage modification in pediatric triage. METHODS This was an observational cross-sectional study of national registry data collected in real time from all emergency medical services beyond the local emergency medical centers (EMCs) throughout Korea. Data from patients under the age of 15 who visited EMC nationwide from January 2016 to December 2016 were analyzed. Depending on whether triage modifications were made using respiratory rate or heart rate beyond the normal range by age during the pediatric triage process, they were divided into down-triage and non-down-triage groups. The proportions in the down-triage group were analyzed according to the triage provider's profession, mental status, arrival mode, presence of trauma, and the EMC class. RESULTS During the study period, 1,385,579 patients' data were analyzed. Of these, 981,281 patients were eligible for triage modification. The differences in down-triage proportions according to the profession of the triage provider (resident, 50.5%; paramedics, 47.7%; specialist, 44.9%; nurses, 44.2%) was statistically significant (P < 0.001). The triage provider's professional down-triage proportion according to the medical condition of the patients showed statistically significant differences except for the unresponsive mental state (P = 0.502) and the case of air transport (P = 0.468). CONCLUSION Down-triage proportion due to abnormal heart rates and respiratory rates was significantly different according to the triage provider's condition. The existing concept of inter-rater reliability of the pediatric triage system needs to be reconsidered.
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Affiliation(s)
- Bongjin Lee
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Korea
| | - Ikwan Chang
- Department of Emergency Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Do Kyun Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - June Dong Park
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.
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Choi IC, Park JW, Jung JY, Kim DK, Kwak YH, Suh D, Lee SU. Pediatric Injuries in Kids Cafés and Risk Factors for Significant Injuries: a 6-Year Cross-Sectional Study Using a Multicenter Injury Registry in Korea. J Korean Med Sci 2020; 35:e37. [PMID: 32056399 PMCID: PMC7025906 DOI: 10.3346/jkms.2020.35.e37] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 12/18/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND A kids café is a popular indoor playground in Korea that combines a playground for young children and a café for their caregivers. There have been no national reports about kids café-related injuries in Korea. This study investigated kids café-related injuries in Korea registered in a multicenter injury surveillance database and analyzed the risk factors for significant kids café-related injuries. METHODS A multicenter cross-sectional study was performed using the Emergency Department-based Injury In-depth Surveillance registry in Korea between 2011 and 2016. Significant injury was defined as an injury requiring hospitalization or surgery. A multivariable logistic regression model was used to obtain the adjusted odds ratios (aORs) for factors associated with significant kids café-related injuries. RESULTS Among 1,537,617 injured patients, we extracted 891 patients who were injured in kids cafés. Of these, 46 (5.2%) were admitted, and 39 (4.4%) underwent surgery. The most common injured anatomical site, injury type, and mechanism were lower extremity (28.2%), superficial injury (27.2%), and slip (27.1%), respectively. Among injury-inducing factors, significant injuries were most commonly caused by a trampoline (28.1%), and rock climbing equipment was the only risk factor in a kids café that led to significant injury after adjusting for age, sex, injury mechanism, and injured anatomical sites (aOR, 14.94; 95% confidence interval, 1.51-147.72). CONCLUSION The rock climbing equipment in a kids café can cause serious injury to children. Establishing safety regulations for rock climbing equipment in kids cafés may have the greatest impact in reducing significant injuries requiring hospitalization or surgery.
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Affiliation(s)
- Ik Chang Choi
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Joong Wan Park
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea.
| | - Jae Yun Jung
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Do Kyun Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Young Ho Kwak
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Dongbum Suh
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Se Uk Lee
- Department of Emergency Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
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Hwang S, Kim J, Jung JY, Ham EM, Park JW, Kwon H, Kim DK, Kwak YH. The epidemiology of childhood intussusception in South Korea: An observational study. PLoS One 2019; 14:e0219286. [PMID: 31860649 PMCID: PMC6924652 DOI: 10.1371/journal.pone.0219286] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 06/20/2019] [Indexed: 11/19/2022] Open
Abstract
Intussusception is one of the most common causes of intestinal obstruction in young children. We report a retrospective, observational study of the epidemiology of intussusception in South Korea using the National Health Insurance Service-National Sample Cohort (NHIS-NSC). A cohort of newborns born between 2002 and 2008 was selected. The primary objective was to assess the incidence of intussusception in the pediatric population of Korea. The secondary objectives were to describe the basic epidemiological characteristics of intussusception and to identify risk factors. A total of 362 children were identified. The highest incidence of intussusception (2.6 per 1,000) was observed in children aged 1-2 years. A total of 58.8% of the children were male, and there was no significant difference in incidence according to the birth year (P = 0.804). Most of the children diagnosed with intussusception underwent air reduction, while only 0.6% had surgery. In all, 82.3% of the children were admitted to the hospital, 0.8% of them had to be admitted to the ICU, and the 6-month mortality was only 0.3%. In this retrospective, observational study, the incidence of intussusception was highest among children between 1 and 2 years of age. Most of the children underwent air reduction.
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Affiliation(s)
- Soyun Hwang
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Joonghee Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnan-si, Gyeonggi-do, Republic of Korea
| | - Jae Yun Jung
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- * E-mail:
| | - Eun Mi Ham
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Joong Wan Park
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyuksool Kwon
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnan-si, Gyeonggi-do, Republic of Korea
| | - Do Kyun Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Young Ho Kwak
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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Kim DK, Brinjikji W, Morris PP, Diehn FE, Lehman VT, Liebo GB, Morris JM, Verdoorn JT, Cutsforth-Gregory JK, Farb RI, Benson JC, Carr CM. Lateral Decubitus Digital Subtraction Myelography: Tips, Tricks, and Pitfalls. AJNR Am J Neuroradiol 2019; 41:21-28. [PMID: 31857327 DOI: 10.3174/ajnr.a6368] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 10/29/2019] [Indexed: 11/07/2022]
Abstract
Digital subtraction myelography is a valuable diagnostic technique to detect the exact location of CSF leaks in the spine to facilitate appropriate diagnosis and treatment of spontaneous spinal CSF leaks. Digital subtraction myelography is an excellent diagnostic tool for assessment of various types of CSF leaks, and lateral decubitus digital subtraction myelography is increasingly being used to diagnose CSF-venous fistulas. Lateral decubitus digital subtraction myelography differs from typical CT and fluoroscopy-guided myelograms in many ways, including equipment, supplies, and injection and image-acquisition techniques. Operators should be familiar with techniques, common pitfalls, and artifacts to improve diagnostic yield and prevent nondiagnostic examinations.
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Affiliation(s)
- D K Kim
- From the Departments of Radiology (D.K.K., W.B., P.P.M., F.E.D., V.T.L., G.B.L., J.M.M., J.T.V., J.C.B., C.M.C.)
| | - W Brinjikji
- From the Departments of Radiology (D.K.K., W.B., P.P.M., F.E.D., V.T.L., G.B.L., J.M.M., J.T.V., J.C.B., C.M.C.)
| | - P P Morris
- From the Departments of Radiology (D.K.K., W.B., P.P.M., F.E.D., V.T.L., G.B.L., J.M.M., J.T.V., J.C.B., C.M.C.)
| | - F E Diehn
- From the Departments of Radiology (D.K.K., W.B., P.P.M., F.E.D., V.T.L., G.B.L., J.M.M., J.T.V., J.C.B., C.M.C.)
| | - V T Lehman
- From the Departments of Radiology (D.K.K., W.B., P.P.M., F.E.D., V.T.L., G.B.L., J.M.M., J.T.V., J.C.B., C.M.C.)
| | - G B Liebo
- From the Departments of Radiology (D.K.K., W.B., P.P.M., F.E.D., V.T.L., G.B.L., J.M.M., J.T.V., J.C.B., C.M.C.)
| | - J M Morris
- From the Departments of Radiology (D.K.K., W.B., P.P.M., F.E.D., V.T.L., G.B.L., J.M.M., J.T.V., J.C.B., C.M.C.)
| | - J T Verdoorn
- From the Departments of Radiology (D.K.K., W.B., P.P.M., F.E.D., V.T.L., G.B.L., J.M.M., J.T.V., J.C.B., C.M.C.)
| | | | - R I Farb
- Department of Medical Imaging (R.I.F.), Division of Neuroradiology, Toronto Western Hospital, Toronto, Ontario, Canada
| | - J C Benson
- From the Departments of Radiology (D.K.K., W.B., P.P.M., F.E.D., V.T.L., G.B.L., J.M.M., J.T.V., J.C.B., C.M.C.)
| | - C M Carr
- From the Departments of Radiology (D.K.K., W.B., P.P.M., F.E.D., V.T.L., G.B.L., J.M.M., J.T.V., J.C.B., C.M.C.)
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Choi YJ, Kim J, Jung JY, Kwon H, Park JW, Kwak YH, Kim DK, Lee JH. Corrigendum to “Febrile seizures: Are they truly benign? Longitudinal analysis of risk factors and future risk of afebrile epileptic seizure based on the national sample cohort in South Korea, 2002–2013” [Seizure 64 (January) (2019) 77–83]. Seizure 2019; 73:88. [DOI: 10.1016/j.seizure.2019.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Lee HN, Kwak YH, Jung JY, Lee SU, Park JW, Kim DK. Are parents' statements reliable for diagnosis of serious bacterial infection among children with fever without an apparent source?: A retrospective study. Medicine (Baltimore) 2019; 98:e17530. [PMID: 31626114 PMCID: PMC6824753 DOI: 10.1097/md.0000000000017530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Serious bacterial infection (SBI) is a major cause of morbidity and mortality in children. Distinguishing SBI from self-limiting viral infections is a very important task in the emergency department (ED), especially in the children with fever without source (FWS). The aim of this study was to analyze whether parents' statements about clinical manifestations, which were categorized according to grades, are related to the actual diagnosis of SBI in children with FWS.Retrospective analysis was conducted using prospectively acquired cohort data for all febrile children in the pediatric ED of Seoul National University Hospital from August 2016 to August 2017. The association of clinical manifestations and SBI was the main outcome of this study. The SBIs included diagnoses such as bacteremia, bacterial meningitis, urinary tract infection, and pneumonia. Clinical manifestations including activity, urination, and feeding were categorized into 3 or 4 grades according to the parents' statements. The linear-by-linear association test was used to examine linear associations between the severity of clinical manifestations and SBI. Receiver operating characteristic curves for clinical manifestations were constructed for patients with SBI. Area under the curve (AUC) statistics and 95% confidence intervals (CIs) were obtained to evaluate the predictive performance of clinical manifestations.There was no linear association between SBI and non-SBI when compared by severity of the clinical manifestations, such as duration of fever (P = .299), activity (P = .781), feeding (P = .161), and urination (P = .834). The AUC was 0.54 (95% CI 0.41-0.67) for duration of fever, 0.52 for activity (95% CI 0.40-0.64), 0.42 for feeding (95% CI 0.32-0.53), and 0.51 for urination (95% CI 0.39-0.62).There was no evidence that the test performance of the clinical manifestations is valid for predicting SBIs, even considering the severity of manifestations. For optimal evaluation of the children with FWS, more comprehensive approach including laboratory tests, are needed.
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Affiliation(s)
- Ha Ni Lee
- Department of Emergency Medicine, Seoul National University Hospital, Jongno-gu
| | - Young Ho Kwak
- Department of Emergency Medicine, Seoul National University Hospital, Jongno-gu
| | - Jae Yun Jung
- Department of Emergency Medicine, Seoul National University Hospital, Jongno-gu
| | - Se Uk Lee
- Department of Emergency Medicine, Seoul National University Hospital, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Dongjak-gu, Seoul, Republic of Korea
| | - Joong Wan Park
- Department of Emergency Medicine, Seoul National University Hospital, Jongno-gu
| | - Do Kyun Kim
- Department of Emergency Medicine, Seoul National University Hospital, Jongno-gu
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Sung J, Ahn KT, Cho BR, Lee SY, Kim BJ, Kim DK, Park JI, Lee WS. 1423Adherence to triple component antihypertensive regimen is higher in single-pill combination than two-pill regimen: data from a randomized controlled trial using medication event monitoring system. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0069] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Simplicity of regimen is known to be an important determinant of medication adherence and using single-pill combination (SPC) in hypertension treatment resulted in better adherence and persistence than free-equivalent combination. However, this finding has been studied only in dual-component antihypertensive treatments and in observational studies using medication possession ratio as an index of adherence. Medication event monitoring system (MEMS) is considered to be the gold standard in estimating medication adherence.
Purpose
To investigate the superiority in adherence of triple-component SPC compared to equivalent two-pill regimen using MEMS
Methods
This is a multi-center open-label randomized controlled trial. Inclusion criteria were hypertensive patients whose clinic blood pressure is not adequately controlled (systolic >140 mmHg or diastolic >90 mmHg) with combination antihypertensive regimen comprising two of three classes (angiotensin receptor blocker, calcium channel blocker and thiazide diuretics) for at least 4 weeks. Eligible patients were randomized either to single-pill (triple-component SPC, olmesartan/amlodipine/ hydrochlorothiazide 20/5/12.5 mg) or two-pill (dual-component SPC + one free pill, olmesartan/hydrochlorothiazide 20/12.5 mg + amlodipine 5 mg) groups and maintained for 12 weeks. Medications were dispensed in MEMS. Primary outcomes were the difference of percentage of dose taken (PDT) and percentage of days with prescribed dose taken correctly (PDTc) between single- and two-pill therapy, calculated from MEMS data.
Results
From 8 hospitals, 146 hypertensive patients were randomized into single- and two-pill groups. Final analysis was done in 65 and 66 patients in each group from which adherence index could be obtained. Baseline clinical characteristics of the two groups were not different. The single-pill group had significantly higher PDT and PDTc compared to the two-pill group. (median (25–75 percentile) (%), PDT 95.1 (87.9 - 100.0) vs 91.2 (79.8 - 96.5); PDTc 93.1 (79.8 - 96.5) vs 91.3 (70.7 - 96.4), p = both 0.04, by Wilcoxon rank sum test)
Percent dose taken
Conclusion
Single-pill combination of triple-component antihypertensive regimen showed superior adherence compared to equivalent two-pill therapy. Reducing pill burden by using SPC is a relevant strategy to enhance the adherence to multi-drug antihypertensive therapy.
Acknowledgement/Funding
Daiichi-Sankyo
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Affiliation(s)
- J Sung
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (Republic of)
| | - K T Ahn
- Chungnam National University Hospital, Daejeon, Korea (Republic of)
| | - B R Cho
- Kangwon National University Hospital, Chooncheon, Korea (Republic of)
| | - S Y Lee
- Ilsan Paik Hospital, Goyang, Korea (Republic of)
| | - B J Kim
- Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea (Republic of)
| | - D K Kim
- Busan Paik Hospital, Busan, Korea (Republic of)
| | - J I Park
- VHS Medical Center, Seoul, Korea (Republic of)
| | - W S Lee
- Chung-Ang University Hospital, Seoul, Korea (Republic of)
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