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McMichael BS, Nickel AJ, Christensen EW, Frenn KA, Truong WH, Laine JC, Kharbanda AB. Discriminative Accuracy of Procalcitonin and Traditional Biomarkers in Pediatric Acute Musculoskeletal Infection. Pediatr Emerg Care 2021; 37:e1220-e1226. [PMID: 32149993 DOI: 10.1097/pec.0000000000001978] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Septic arthritis (SA) is responsible for 20% of pediatric musculoskeletal infections (MSKI) and can have significant consequences. Early detection of SA is critical, and procalcitonin (PCT) has emerged as a promising biomarker. This study assessed the test performance of PCT and traditional biomarkers for suspected SA. METHODS We conducted a prospective study at two pediatric emergency departments (ED). Data collected measured serum levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood cell (WBC) count, and PCT. Box and whisker plots were generated to compare the of the biomarkers by positive MSKI or a non-MSKI diagnosis. The diagnostic performance of biomarkers was examined using the area under the receiver operating characteristic curve (AUC), and optimal cut -points were identified using the Liu method. RESULTS Procalcitonin performed reasonably well for detection of MSKI (AUC, 0.72; confidence interval [95% CI], 0.59-0.84). However, CRP and ESR performed better (AUC, 0.88 and 0.78, respectively). White blood cell count was not predictive of MSKI. Patients with a PCT value >0.1 ng/mL, ESR values >19.5 mm/h, and a temperature higher than 99.0°F were more than twice as likely to have acute MSKI. A high CRP level was most predictive of acute MSKI, and patients with levels >2.38 mg/dL were 3.5 times more likely to have acute MSKI. CONCLUSIONS Procalcitonin is a potential biomarker for the clinical differential of MSKI in the pediatric ED. Additional research is warranted to establish the optimal diagnostic level for PCT, to increase sample size, and to examine any impact on cost.
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Affiliation(s)
| | - Amanda J Nickel
- From the Children's Minnesota Research Institute, Children's Minnesota
| | - Eric W Christensen
- Health Services Management, College of Continuing and Professional Studies, University of Minnesota, Minneapolis
| | | | - Walter H Truong
- Department of Orthopedic Surgery, Gillette Children's Specialty Healthcare, St Paul
| | - Jennifer C Laine
- Department of Orthopedic Surgery, Gillette Children's Specialty Healthcare, St Paul
| | - Anupam B Kharbanda
- Department of Pediatric Emergency Medicine, Children's Minnesota, Minneapolis, MN
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Frenkel TI, Donzella B, Frenn KA, Rousseau S, Fox NA, Gunnar MR. Moderating the Risk for Attention Deficits in Children with Pre-Adoptive Adversity: The Protective Role of Shorter Duration of out of Home Placement and Children's Enhanced Error Monitoring. J Abnorm Child Psychol 2020; 48:1115-1128. [PMID: 32607754 DOI: 10.1007/s10802-020-00671-2] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Early institutional-deprivation has been found to increase risk for inattention/hyperactivity (ADHD). Notably, studies suggest that children with a history of adversity evidencing an enhanced ERP (the error-related-negativity; ERN) may be protected against attention problems. However, such protective effects of the ERN have been studied in children whom typically experienced residential instability. It is unknown whether error-monitoring is similarly protective for children with stable post-deprivation placements. The present study examined the protective effect of the ERN in a sample of children who experienced at least 3-years of stable, relatively enriched caregiving after being internationally-adopted as infants/toddlers from institutional-care. We included two groups of children adopted internationally before age three, one group adopted from institutional-care (PI:n = 80) and one comparison group adopted from foster-care (FC;n = 44). A second comparison group consisted of non-adopted children (NA;n = 48) from demographically comparable families. At five-years of age, we assessed child ADHD symptoms (parent-report) and behavioral performance and neural correlates of error-monitoring (Go/No-Go task). PI children displayed lower Go/No-Go accuracy relative to FC children, and higher levels of ADHD symptoms relative to NA controls. In both FC and PI groups, longer duration of pre-adoptive out-of-home placement was associated with inattention, especially for children with deficits in error-monitoring. Enhancing cognitive control in the form of error monitoring might be a useful intervention target to protect children from some of the negative outcomes associated with adverse early care. Furthermore, results underscore that regardless of type of pre-adoptive care, we should aim to place children in stable/permanent homes as early as possible.
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Affiliation(s)
- Tahl I Frenkel
- Baruch Ivcher School of Psychology, Interdisciplinary Center (IDC), Ziama Arkin Infancy Institute, Herzliya, Israel
| | - Bonny Donzella
- Institute of Child Development, University of Minnesota, 51 E. River Road, Minneapolis, MN, 55455, USA
| | - Kristin A Frenn
- Institute of Child Development, University of Minnesota, 51 E. River Road, Minneapolis, MN, 55455, USA
| | - Sofie Rousseau
- Baruch Ivcher School of Psychology, Interdisciplinary Center (IDC), Ziama Arkin Infancy Institute, Herzliya, Israel
| | - Nathan A Fox
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, MD, 20742, USA
| | - Megan R Gunnar
- Institute of Child Development, University of Minnesota, 51 E. River Road, Minneapolis, MN, 55455, USA.
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Byiers BJ, Merbler AM, Barney CC, Frenn KA, Panoskaltsis-Mortari A, Ehrhardt MJ, Feyma TJ, Beisang AA, Symons F. Evidence of altered salivary cytokine concentrations in Rett syndrome and associations with clinical severity. Brain Behav Immun Health 2020; 1:100008. [PMID: 38377412 PMCID: PMC8474566 DOI: 10.1016/j.bbih.2019.100008] [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: 09/16/2019] [Revised: 10/11/2019] [Accepted: 10/13/2019] [Indexed: 11/17/2022] Open
Abstract
Background Immune dysregulation may play a role in the development of Rett syndrome (RTT), a neurodevelopmental disorder caused by mutations of the MECP2 gene. Abnormal cytokine concentrations have been documented in the serum of individuals with RTT. Measurement of salivary cytokines has been investigated as a potential alternative approach to measurement in blood and serum, but it is unclear whether salivary cytokine concentrations can provide valid information about systemic immune function in neurodevelopmental disorders. The goal of this study was to evaluate the potential validity of salivary cytokines as biomarkers of immune dysregulation in RTT. Methods Saliva samples from 16 individuals with RTT (all female; age range 2-40 years) and 16 healthy control females (age range 2-40 years) were analyzed for concentrations of 12 cytokines. Between-group differences in concentrations, and correlations with clinical severity in the RTT group were evaluated. Results Concentrations of several salivary cytokines (IL-1β, IL-6, IL-8, IL-10, GM-CSF, TNF-α, and VEGF) were increased in RTT compared to controls. The same cytokines showed significant positive correlations with clinical severity scores. There were no differences in concentrations of IL-2, IL-4, IL-5, IL-12p70, and IFN-γ. Conclusion The results suggest that salivary cytokines may be a possible indicator of immune dysregulation in RTT. Future research should investigate whether these results can be applied to other neurodevelopmental disorders.
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Affiliation(s)
- Breanne J. Byiers
- Department of Educational Psychology, 56 E River Rd, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Alyssa M. Merbler
- Department of Educational Psychology, 56 E River Rd, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Chantel C. Barney
- Gillette Children’s Specialty Healthcare, 200 University Ave E, St. Paul, Minnesota, 55101, USA
| | - Kristin A. Frenn
- Gillette Children’s Specialty Healthcare, 200 University Ave E, St. Paul, Minnesota, 55101, USA
| | - Angela Panoskaltsis-Mortari
- Cancer Center and Department of Pediatrics, Division of Blood and Marrow Transplantation, 2450 Riverside Ave, University of Minnesota, Minneapolis, MN, 55454, USA
| | - Michael J. Ehrhardt
- Cancer Center and Department of Pediatrics, Division of Blood and Marrow Transplantation, 2450 Riverside Ave, University of Minnesota, Minneapolis, MN, 55454, USA
| | - Timothy J. Feyma
- Gillette Children’s Specialty Healthcare, 200 University Ave E, St. Paul, Minnesota, 55101, USA
| | - Arthur A. Beisang
- Gillette Children’s Specialty Healthcare, 200 University Ave E, St. Paul, Minnesota, 55101, USA
| | - Frank Symons
- Department of Educational Psychology, 56 E River Rd, University of Minnesota, Minneapolis, MN, 55455, USA
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Frenn KA, Hendrickson M, Kharbanda AB. Reducing pediatric CT usage through web-based education. Radiol Manage 2014; 36:12-18. [PMID: 25004681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A grant from the AHRA and Toshiba Putting Patients First program enabled Fairview Health System in Minneapolis, MN to launch an interactive education website which provides best practice information for CT usage in head trauma and appendicitis cases. The website, PEMguidelines.org contains educational sections geared toward both clinicians and patients and families. The site provides evidenced based guidelines for the management of head trauma and appendicitis. PEMguidelines.org was rolled out in 2012 as part of a three pronged intervention strategy. A linkto the website was included in new clinical order-sets within the Fairview electronic health system. Clinical decision support aids were also embedded in the medical record system. Fairview held provider education sessions for ED physicians and staff to introduce and promote the new approach. Results from a six month period after the initial roll out indicate a decrease of 15% in abdominal CT scans for suspected appendicitis cases, while the numbers of missed cases did not increase.This initial evidence supports the effectiveness of this multilevel strategy in improving the safety and cost-effectiveness of pediatric CT use in diagnosis of appendicitis.
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Güler OE, Hostinar CE, Frenn KA, Nelson CA, Gunnar MR, Thomas KM. Electrophysiological evidence of altered memory processing in children experiencing early deprivation. Dev Sci 2012; 15:345-58. [PMID: 22490175 DOI: 10.1111/j.1467-7687.2011.01131.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Associations between early deprivation and memory functioning were examined in 9- to 11-year-old children. Children who had experienced prolonged institutional care prior to adoption were compared to children who were adopted early from foster care and children reared in birth families. Measures included the Paired Associates Learning task from the Cambridge Neuropsychological Test and Automated Battery (CANTAB) and a continuous recognition memory task during which ERPs were also recorded. Children who experienced prolonged institutionalization showed deficits in both behavioral memory measures as well as an attenuated P300 parietal memory effect. Results implicate memory function as one of the domains that may be negatively influenced by early deprivation in the form of institutional care.
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Affiliation(s)
- O Evren Güler
- Department of Psychology, Augsburg College, 2211 Riverside Ave., Minneapolis, MN 55454, USA.
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Pollak SD, Nelson CA, Schlaak MF, Roeber BJ, Wewerka SS, Wiik KL, Frenn KA, Loman MM, Gunnar MR. Neurodevelopmental effects of early deprivation in postinstitutionalized children. Child Dev 2010; 81:224-36. [PMID: 20331664 PMCID: PMC2846096 DOI: 10.1111/j.1467-8624.2009.01391.x] [Citation(s) in RCA: 313] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The neurodevelopmental sequelae of early deprivation were examined by testing (N = 132) 8- and 9-year-old children who had endured prolonged versus brief institutionalized rearing or rearing in the natal family. Behavioral tasks included measures that permit inferences about underlying neural circuitry. Children raised in institutionalized settings showed neuropsychological deficits on tests of visual memory and attention, as well as visually mediated learning and inhibitory control. Yet, these children performed at developmentally appropriate levels on similar tests where auditory processing was also involved and on tests assessing executive processes such as rule acquisition and planning. These findings suggest that specific aspects of brain-behavioral circuitry may be particularly vulnerable to postnatal experience.
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