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Hummel K, Michelson A, Zmora R, de Ferranti S, Jenkins K, Saleeb SF. Implementation of the International Consortium of Health Outcomes Measurement CHD standard set in patients undergoing pulmonary valve replacement. Cardiol Young 2024:1-6. [PMID: 38711375 DOI: 10.1017/s1047951124000866] [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] [Indexed: 05/08/2024]
Abstract
BACKGROUND Despite the burden of CHD, a high cost and utilization condition, an implementation of long-term outcome measures is lacking. The objective of this study is to pilot the implementation of the International Consortium of Health Outcomes Measurement CHD standard set in patients undergoing pulmonary valve replacement, a procedure performed in mostly well patients with diverse CHD. METHODS Patients ≥ 8 years old undergoing catheterization-based pulmonary valve replacement were approached via various approaches for patient-reported outcomes, with a follow-up assessment at 3 months post-procedure. Implementation strategy analysis was performed via a hybrid type 2 design. RESULTS Of the 74 patients undergoing pulmonary valve replacement, 32 completed initial patient-reported outcomes with variable response rates by strategy (email and in-person explanation 100%, email only 54%, and email followed by text/call 64%). Ages ranged 8-67 years (mean 30). Pre-procedurally, 34% had symptomatic arrhythmias, which improved post-procedure. For those in school, 43% missed ≥ 6 days per year, and over half had work absenteeism. Financial concerns were reported in 34%. Patients reported high satisfaction with life (50% [n = 16]) and health-related quality of life (90% [n = 26]). Depression symptoms were reported in 84% (n = 27) and anxiety in 62.5% (n = 18), with tendency towards improvement post-procedurally. CONCLUSION Pilot implementation of the International Consortium of Health Outcomes Measurement CHD standard set in pulmonary valve replacement patients reveals a significant burden of disease not previously reported. Barriers to the implementation include a sustainable, automated system for patient-reported outcome collection and infrastructure to assess in real time. This provides an example of implementing cardiac outcomes set in clinical practice.
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Affiliation(s)
- Kevin Hummel
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Ariane Michelson
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | | | - Sarah de Ferranti
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - Kathy Jenkins
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - Susan F Saleeb
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
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2
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Zaidi AH, Saleeb SF, Gurvitz M, Bucholz E, Gauvreau K, Jenkins KJ, de Ferranti SD. Social Determinants of Health Including Child Opportunity Index Leading to Gaps in Care for Patients With Significant Congenital Heart Disease. J Am Heart Assoc 2024; 13:e028883. [PMID: 38353239 PMCID: PMC11010070 DOI: 10.1161/jaha.122.028883] [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: 11/23/2022] [Accepted: 10/11/2023] [Indexed: 02/21/2024]
Abstract
BACKGROUND Gaps in care (GIC) are common for patients with congenital heart disease (CHD) and can lead to worsening clinical status, unplanned hospitalization, and mortality. Understanding of how social determinants of health (SDOH) contribute to GIC in CHD is incomplete. We hypothesize that SDOH, including Child Opportunity Index (COI), are associated with GIC in patients with significant CHD. METHODS AND RESULTS A total of 8554 patients followed at a regional specialty pediatric hospital with moderate to severe CHD seen in cardiology clinic between January 2013 and December 2015 were retrospectively reviewed. SDOH factors including race, ethnicity, language, and COI calculated based on home address and zip code were analyzed. GIC of >3.25 years were identified in 32% (2709) of patients. GIC were associated with ages 14 to 29 years (P<0.001), Black race or Hispanic ethnicity (P<0.001), living ≥150 miles from the hospital (P=0.017), public health insurance (P<0.001), a maternal education level of high school or less (P<0.001), and a low COI (P<0.001). Multivariable analysis showed that GIC were associated with age ≥14 years, Black race or Hispanic ethnicity, documenting <3 caregivers as contacts, mother's education level being high school or less, a very low/low COI, and insurance status (C statistic 0.66). CONCLUSIONS One-third of patients followed in a regional referral center with significant CHD experienced a substantial GIC (>3.25 years). Several SDOH, including a low COI, were associated with GIC. Hospitals should adopt formal GIC improvement programs focusing on SDOH to improve continuity of care and ultimately overall outcomes for patients with CHD.
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Affiliation(s)
- Abbas H. Zaidi
- Department of CardiologyBoston Children’s HospitalBostonMA
- Department of PediatricsHarvard Medical SchoolBostonMA
- Present address:
Nemours Children's Hospital‐DelawareWilmingtonDE
| | - Susan F. Saleeb
- Department of CardiologyBoston Children’s HospitalBostonMA
- Department of PediatricsHarvard Medical SchoolBostonMA
| | - Michelle Gurvitz
- Department of CardiologyBoston Children’s HospitalBostonMA
- Department of PediatricsHarvard Medical SchoolBostonMA
| | - Emily Bucholz
- Department of CardiologyBoston Children’s HospitalBostonMA
- Department of PediatricsHarvard Medical SchoolBostonMA
- Present address:
University of Colorado DenverDenverCO
- Present address:
Children’s Hospital ColoradoAuroraCO
| | - Kimberlee Gauvreau
- Department of CardiologyBoston Children’s HospitalBostonMA
- Department of PediatricsHarvard Medical SchoolBostonMA
| | - Kathy J. Jenkins
- Department of CardiologyBoston Children’s HospitalBostonMA
- Department of PediatricsHarvard Medical SchoolBostonMA
| | - Sarah D. de Ferranti
- Department of CardiologyBoston Children’s HospitalBostonMA
- Department of PediatricsHarvard Medical SchoolBostonMA
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3
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Chandrasekar H, Sinclair-McBride K, Lee EH, Iqbal MB, Gauvreau K, Barkas I, Newburger JW, DeMaso DR, Saleeb SF. Feasibility and Caregiver Receptiveness to Anxiety Screening in Pediatric Cardiology Clinic: A Pilot Study. Clin Pediatr (Phila) 2023; 62:597-604. [PMID: 36461155 DOI: 10.1177/00099228221134559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Children with chronic medical conditions, including heart disease, have increased susceptibility to behavioral health concerns. We sought to evaluate the feasibility and parental opinion of anxiety screening in pediatric cardiology clinic. The PROMIS Pediatric Anxiety v2.0 Short Form 8a (PA2-S8) questionnaire was administered to 48 patients presenting to pediatric cardiology clinic for follow-up care. Parents/caregivers were asked their opinion on anxiety screening in cardiology clinic. The survey was completed by 47 out of 48 participants (median age 13, range 9-17). Fourteen (30%) participants had scores suggestive of increased anxiety symptomatology. No trends were identified between PA2-S8 score and age at diagnosis (P = .13), age at survey administration (P = .28), number of lifetime procedures (P = .89), number of noncardiac specialists (P = .13), or underlying cardiac diagnoses (P = .55). Most families (76%) were in favor of the screening effort. This study suggests that anxiety screening in cardiology clinic is both feasible and well-received by families.
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Affiliation(s)
- Hamsika Chandrasekar
- Department of Pediatric Cardiology, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Keneisha Sinclair-McBride
- Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Erica H Lee
- Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Mudassera B Iqbal
- Massachusetts General Physician Organization Ambulatory Management, Massachusetts General Hospital, Boston, MA, USA
| | - Kimberlee Gauvreau
- Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Ioanna Barkas
- Department of Pediatrics, Hasbro Children's Hospital and Brown University, Providence, RI, USA
| | - Jane W Newburger
- Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - David R DeMaso
- Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Susan F Saleeb
- Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
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4
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Liddle D, Ibrahim B, Isibor C, Judge J, Orbach DB, Saleeb SF. Heart Failure Following Sinus Venosus Defect Closure in a Patient With Vein of Galen Malformation. JACC Case Rep 2023; 14:101831. [PMID: 37077875 PMCID: PMC10106996 DOI: 10.1016/j.jaccas.2023.101831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/11/2023] [Accepted: 03/20/2023] [Indexed: 04/21/2023]
Abstract
This case concerns an 18-month-old with masked congestive heart failure (CHF) from an unrepaired vein of Galen malformation and superior sinus venosus defect who progressed to severe, refractory CHF following superior sinus venosus defect repair. Partial transvenous coil embolization of a very-high-risk vein of Galen malformation resolved CHF symptoms. (Level of Difficulty: Advanced.).
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Affiliation(s)
- David Liddle
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Bishoy Ibrahim
- University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Christopher Isibor
- Department of Neurosurgery, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Jennifer Judge
- Department of Neurosurgery, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Darren B. Orbach
- Department of Neurosurgery, Boston Children’s Hospital, Boston, Massachusetts, USA
- Neurointerventional Radiology, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Susan F. Saleeb
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Address for correspondence: Dr Susan Saleeb, Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts 02115, USA.
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5
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Michelson A, Fulton DR, Saleeb SF. PATIENT AND PARENT ANXIETY AROUND CHEST PAIN EVALUATION. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02061-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Hummel K, Ramirez J, Zmora R, Davey B, Hom L, Saleeb SF, Martin GR, Jenkins KJ. IMPLEMENTATION OF LONGITUDINAL PATIENT REPORTED OUTCOMES IN CONGENITAL HEART DISEASE. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)04478-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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7
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Chandrasekar H, Hoganson DM, Lachenauer CS, Newburger JW, Sandora TJ, Saleeb SF. Mycobacterium chimaera Outbreak Management and Outcomes at a Large Pediatric Cardiac Surgery Center. Ann Thorac Surg 2021; 114:552-559. [PMID: 34454904 DOI: 10.1016/j.athoracsur.2021.07.074] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 07/15/2021] [Accepted: 07/20/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND In 2012, a global outbreak of invasive Mycobacterium chimaera (M. chimaera) infection was identified in patients post-cardiopulmonary bypass (CPB) surgery. Investigations revealed the source to be heater-cooler unit (HCU) exhaust, with point-source contamination discovered at the LivaNova HCU manufacturing plant. We report our experience with affected HCUs at a high-volume pediatric cardiac surgery center in the United States. METHODS A multi-disciplinary task force was established for outbreak management, including removing contaminated HCUs from service. Patients identified as exposed to affected HCUs were systematically contacted. A call center was created for patient/family inquiries, and symptomatic patients were assessed using an institutional triage protocol, including lab/culture data and infectious diseases consultation. RESULTS CPB surgeries were performed in 4,276 patients (median age 2.1 years, range 0-48.4) between October 2010 and October 2016. Call center volume was highest in the first 6 weeks following patient notification, totaling 307 calls and yielding 70 clinical patient assessments. Presenting symptoms included fatigue (60%), fever (49%), night sweats (46%), myalgias (34%), and weight loss (24%). Among the 70 assessed patients, echocardiogram (n=30), cardiac CT (n=2), cardiac MRI (n=1), and pulmonary CT (n=1) did not reveal abnormalities suggestive of active infection. Infectious diseases consultation occurred in 23 (33%) patients. Acid fast bacilli blood cultures were obtained in 30 patients; all were negative. CONCLUSIONS Through a highly coordinated outreach effort, no patients have been found to have M. chimaera infection in the six years after exposure to contaminated HCUs. Ongoing vigilance for cases that may yet manifest is needed.
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Affiliation(s)
- Hamsika Chandrasekar
- Department of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California.
| | - David M Hoganson
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Catherine S Lachenauer
- Division of Infectious Diseases, Departments of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Jane W Newburger
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Thomas J Sandora
- Division of Infectious Diseases, Departments of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Susan F Saleeb
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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8
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Dionne A, Sperotto F, Chamberlain S, Baker AL, Powell AJ, Prakash A, Castellanos DA, Saleeb SF, de Ferranti SD, Newburger JW, Friedman KG. Association of Myocarditis With BNT162b2 Messenger RNA COVID-19 Vaccine in a Case Series of Children. JAMA Cardiol 2021; 6:1446-1450. [PMID: 34374740 DOI: 10.1001/jamacardio.2021.3471] [Citation(s) in RCA: 118] [Impact Index Per Article: 39.3] [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: 12/20/2022]
Abstract
Importance The BNT162b2 (Pfizer-BioNTech) messenger RNA COVID-19 vaccine was authorized on May 10, 2021, for emergency use in children aged 12 years and older. Initial reports showed that the vaccine was well tolerated without serious adverse events; however, cases of myocarditis have been reported since approval. Objective To review results of comprehensive cardiac imaging in children with myocarditis after COVID-19 vaccine. Design, Setting, and Participants This study was a case series of children younger than 19 years hospitalized with myocarditis within 30 days of BNT162b2 messenger RNA COVID-19 vaccine. The setting was a single-center pediatric referral facility, and admissions occurred between May 1 and July 15, 2021. Main Outcomes and Measures All patients underwent cardiac evaluation including an electrocardiogram, echocardiogram, and cardiac magnetic resonance imaging. Results Fifteen patients (14 male patients [93%]; median age, 15 years [range, 12-18 years]) were hospitalized for management of myocarditis after receiving the BNT162b2 (Pfizer) vaccine. Symptoms started 1 to 6 days after receipt of the vaccine and included chest pain in 15 patients (100%), fever in 10 patients (67%), myalgia in 8 patients (53%), and headache in 6 patients (40%). Troponin levels were elevated in all patients at admission (median, 0.25 ng/mL [range, 0.08-3.15 ng/mL]) and peaked 0.1 to 2.3 days after admission. By echocardiographic examination, decreased left ventricular (LV) ejection fraction (EF) was present in 3 patients (20%), and abnormal global longitudinal or circumferential strain was present in 5 patients (33%). No patient had a pericardial effusion. Cardiac magnetic resonance imaging findings were consistent with myocarditis in 13 patients (87%) including late gadolinium enhancement in 12 patients (80%), regional hyperintensity on T2-weighted imaging in 2 patients (13%), elevated extracellular volume fraction in 3 patients (20%), and elevated LV global native T1 in 2 patients (20%). No patient required intensive care unit admission, and median hospital length of stay was 2 days (range 1-5). At follow-up 1 to 13 days after hospital discharge, 11 patients (73%) had resolution of symptoms. One patient (7%) had persistent borderline low LV systolic function on echocardiogram (EF 54%). Troponin levels remained mildly elevated in 3 patients (20%). One patient (7%) had nonsustained ventricular tachycardia on ambulatory monitor. Conclusions and Relevance In this small case series study, myocarditis was diagnosed in children after COVID-19 vaccination, most commonly in boys after the second dose. In this case series, in short-term follow-up, patients were mildly affected. The long-term risks associated with postvaccination myocarditis remain unknown. Larger studies with longer follow-up are needed to inform recommendations for COVID-19 vaccination in this population.
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Affiliation(s)
- Audrey Dionne
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Francesca Sperotto
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Stephanie Chamberlain
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Annette L Baker
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Andrew J Powell
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Ashwin Prakash
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Daniel A Castellanos
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Susan F Saleeb
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Sarah D de Ferranti
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Jane W Newburger
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Kevin G Friedman
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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9
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Saleeb SF, McLaughlin SR, Graham DA, Friedman KG, Fulton DR. Resource reduction in pediatric chest pain: Standardized clinical assessment and management plan. CONGENIT HEART DIS 2017; 13:46-51. [DOI: 10.1111/chd.12539] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 08/08/2017] [Accepted: 09/01/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Susan F. Saleeb
- Department of Cardiology; Boston Children's Hospital; Boston Massachusetts, USA
| | - Sarah R. McLaughlin
- Clinical Research Program; Boston Children's Hospital; Boston Massachusetts, USA
| | - Dionne A. Graham
- Clinical Research Program; Boston Children's Hospital; Boston Massachusetts, USA
| | - Kevin G. Friedman
- Department of Cardiology; Boston Children's Hospital; Boston Massachusetts, USA
| | - David R. Fulton
- Department of Cardiology; Boston Children's Hospital; Boston Massachusetts, USA
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10
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Kane DA, Friedman KG, Fulton DR, Geggel RL, Saleeb SF. Needles in Hay II: Detecting Cardiac Pathology by the Pediatric Chest Pain Standardized Clinical Assessment and Management Plan. CONGENIT HEART DIS 2016; 11:396-402. [PMID: 26918410 DOI: 10.1111/chd.12335] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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] [Accepted: 12/26/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine if patients evaluated using the pediatric chest pain standardized clinical assessment and management plan (SCAMP) in cardiology clinic were later diagnosed with unrecognized cardiac pathology, and to determine if other patients with cardiac pathology not enrolled in the SCAMP would have been identified using the algorithm. STUDY DESIGN Patients 7-21 years of age, newly diagnosed with hypertrophic or dilated cardiomyopathy, coronary anomalies, pulmonary embolus, pulmonary hypertension, pericarditis, or myocarditis were identified from the Boston Children's Hospital (BCH) cardiac database between July 1, 2010 and December 31, 2012. Patients were cross-referenced to the SCAMP database or retrospectively assessed with the SCAMP algorithm. RESULTS Among 98 patients with cardiac pathology, 34 (35%) reported chest pain, of whom 10 were diagnosed as outpatients. None of these patients were enrolled in the SCAMP because of alternate chief complaints (n = 4) or referral to BCH for management of the new diagnosis (n = 6). Each of these patients would have had an echocardiogram recommended by retrospective application of the SCAMP algorithm. Two other patients with cardiac pathology were among the 1124 patients assessed by the SCAMP. One patient initially diagnosed with noncardiac chest pain presented 18 months later and was diagnosed with myocarditis as an inpatient. One patient seen initially in the emergency department was subsequently diagnosed with pericarditis as an outpatient. CONCLUSIONS Patients assessed by the chest pain SCAMP at BCH were not later diagnosed with cardiac pathology that was missed at the initial encounter. Nonenrolled outpatients with cardiac pathology and chest pain would have been successfully identified with the SCAMP algorithm.
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Affiliation(s)
- David A Kane
- Department of Pediatrics, University of Massachusetts Medical School, Worcester, Mass.
| | - Kevin G Friedman
- Department of Cardiology, Boston Children's Hospital, Boston, Mass.,Department of Pediatrics, Harvard Medical School, Boston, Mass, USA
| | - David R Fulton
- Department of Cardiology, Boston Children's Hospital, Boston, Mass.,Department of Pediatrics, Harvard Medical School, Boston, Mass, USA
| | - Robert L Geggel
- Department of Cardiology, Boston Children's Hospital, Boston, Mass.,Department of Pediatrics, Harvard Medical School, Boston, Mass, USA
| | - Susan F Saleeb
- Department of Cardiology, Boston Children's Hospital, Boston, Mass.,Department of Pediatrics, Harvard Medical School, Boston, Mass, USA
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11
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Saleeb SF, Newburger JW, Geva T, Baird CW, Gauvreau K, Padera RF, del Nido PJ, Borisuk MJ, Sanders SP, Mayer JE. Accelerated Degeneration of a Bovine Pericardial Bioprosthetic Aortic Valve in Children and Young Adults. Circulation 2014; 130:51-60. [DOI: 10.1161/circulationaha.114.009835] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Susan F. Saleeb
- From the Departments of Cardiology (S.F.S., J.W.N., T.G., K.G., S.P.S.) and Cardiac Surgery (C.W.B., P.J.d.N., M.J.B., J.E.M.), Boston Children’s Hospital, Boston, MA; Departments of Pediatrics (S.F.S., J.W.N., T.G., K.G., S.P.S.), Surgery (C.W.B., P.J.d.N., M.J.B., J.E.M.), and Pathology (R.F.P.), Harvard Medical School, Boston, MA; and Department of Pathology, Brigham and Women’s Hospital, Boston, MA (R.F.P)
| | - Jane W. Newburger
- From the Departments of Cardiology (S.F.S., J.W.N., T.G., K.G., S.P.S.) and Cardiac Surgery (C.W.B., P.J.d.N., M.J.B., J.E.M.), Boston Children’s Hospital, Boston, MA; Departments of Pediatrics (S.F.S., J.W.N., T.G., K.G., S.P.S.), Surgery (C.W.B., P.J.d.N., M.J.B., J.E.M.), and Pathology (R.F.P.), Harvard Medical School, Boston, MA; and Department of Pathology, Brigham and Women’s Hospital, Boston, MA (R.F.P)
| | - Tal Geva
- From the Departments of Cardiology (S.F.S., J.W.N., T.G., K.G., S.P.S.) and Cardiac Surgery (C.W.B., P.J.d.N., M.J.B., J.E.M.), Boston Children’s Hospital, Boston, MA; Departments of Pediatrics (S.F.S., J.W.N., T.G., K.G., S.P.S.), Surgery (C.W.B., P.J.d.N., M.J.B., J.E.M.), and Pathology (R.F.P.), Harvard Medical School, Boston, MA; and Department of Pathology, Brigham and Women’s Hospital, Boston, MA (R.F.P)
| | - Christopher W. Baird
- From the Departments of Cardiology (S.F.S., J.W.N., T.G., K.G., S.P.S.) and Cardiac Surgery (C.W.B., P.J.d.N., M.J.B., J.E.M.), Boston Children’s Hospital, Boston, MA; Departments of Pediatrics (S.F.S., J.W.N., T.G., K.G., S.P.S.), Surgery (C.W.B., P.J.d.N., M.J.B., J.E.M.), and Pathology (R.F.P.), Harvard Medical School, Boston, MA; and Department of Pathology, Brigham and Women’s Hospital, Boston, MA (R.F.P)
| | - Kimberlee Gauvreau
- From the Departments of Cardiology (S.F.S., J.W.N., T.G., K.G., S.P.S.) and Cardiac Surgery (C.W.B., P.J.d.N., M.J.B., J.E.M.), Boston Children’s Hospital, Boston, MA; Departments of Pediatrics (S.F.S., J.W.N., T.G., K.G., S.P.S.), Surgery (C.W.B., P.J.d.N., M.J.B., J.E.M.), and Pathology (R.F.P.), Harvard Medical School, Boston, MA; and Department of Pathology, Brigham and Women’s Hospital, Boston, MA (R.F.P)
| | - Robert F. Padera
- From the Departments of Cardiology (S.F.S., J.W.N., T.G., K.G., S.P.S.) and Cardiac Surgery (C.W.B., P.J.d.N., M.J.B., J.E.M.), Boston Children’s Hospital, Boston, MA; Departments of Pediatrics (S.F.S., J.W.N., T.G., K.G., S.P.S.), Surgery (C.W.B., P.J.d.N., M.J.B., J.E.M.), and Pathology (R.F.P.), Harvard Medical School, Boston, MA; and Department of Pathology, Brigham and Women’s Hospital, Boston, MA (R.F.P)
| | - Pedro J. del Nido
- From the Departments of Cardiology (S.F.S., J.W.N., T.G., K.G., S.P.S.) and Cardiac Surgery (C.W.B., P.J.d.N., M.J.B., J.E.M.), Boston Children’s Hospital, Boston, MA; Departments of Pediatrics (S.F.S., J.W.N., T.G., K.G., S.P.S.), Surgery (C.W.B., P.J.d.N., M.J.B., J.E.M.), and Pathology (R.F.P.), Harvard Medical School, Boston, MA; and Department of Pathology, Brigham and Women’s Hospital, Boston, MA (R.F.P)
| | - Michele J. Borisuk
- From the Departments of Cardiology (S.F.S., J.W.N., T.G., K.G., S.P.S.) and Cardiac Surgery (C.W.B., P.J.d.N., M.J.B., J.E.M.), Boston Children’s Hospital, Boston, MA; Departments of Pediatrics (S.F.S., J.W.N., T.G., K.G., S.P.S.), Surgery (C.W.B., P.J.d.N., M.J.B., J.E.M.), and Pathology (R.F.P.), Harvard Medical School, Boston, MA; and Department of Pathology, Brigham and Women’s Hospital, Boston, MA (R.F.P)
| | - Stephen P. Sanders
- From the Departments of Cardiology (S.F.S., J.W.N., T.G., K.G., S.P.S.) and Cardiac Surgery (C.W.B., P.J.d.N., M.J.B., J.E.M.), Boston Children’s Hospital, Boston, MA; Departments of Pediatrics (S.F.S., J.W.N., T.G., K.G., S.P.S.), Surgery (C.W.B., P.J.d.N., M.J.B., J.E.M.), and Pathology (R.F.P.), Harvard Medical School, Boston, MA; and Department of Pathology, Brigham and Women’s Hospital, Boston, MA (R.F.P)
| | - John E. Mayer
- From the Departments of Cardiology (S.F.S., J.W.N., T.G., K.G., S.P.S.) and Cardiac Surgery (C.W.B., P.J.d.N., M.J.B., J.E.M.), Boston Children’s Hospital, Boston, MA; Departments of Pediatrics (S.F.S., J.W.N., T.G., K.G., S.P.S.), Surgery (C.W.B., P.J.d.N., M.J.B., J.E.M.), and Pathology (R.F.P.), Harvard Medical School, Boston, MA; and Department of Pathology, Brigham and Women’s Hospital, Boston, MA (R.F.P)
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Saleeb SF, Thaver D, Gauvreau K, Marshall A, Fulton D. EVALUATION OF MID-TERM OUTCOMES IN COARCTATION OF THE AORTA MANAGED IN THE RECENT ERA. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)60513-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Verghese GR, Friedman KG, Rathod RH, Meiri A, Saleeb SF, Graham DA, Geggel RL, Fulton DR. Resource Utilization Reduction for Evaluation of Chest Pain in Pediatrics Using a Novel Standardized Clinical Assessment and Management Plan (SCAMP). J Am Heart Assoc 2012; 1:jah39. [PMID: 23130120 PMCID: PMC3487367 DOI: 10.1161/jaha.111.000349] [Citation(s) in RCA: 34] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Accepted: 01/26/2012] [Indexed: 11/16/2022]
Abstract
Background Chest pain is a common reason for referral to pediatric cardiologists. Although pediatric chest pain is rarely attributable to serious cardiac pathology, extensive and costly evaluation is often performed. We have implemented a standardized approach to pediatric chest pain in our pediatric cardiology clinics as part of a broader quality improvement initiative termed Standardized Clinical Assessment and Management Plans (SCAMPs). In this study, we evaluate the impact of a SCAMP for chest pain on practice variation and resource utilization. Methods and Results We compared demographic variables, clinical characteristics, and cardiac testing in a historical cohort (n=406) of patients presenting to our outpatient division for initial evaluation of chest pain in the most recent pre-SCAMP calendar year (2009) to patients enrolled in the chest pain SCAMP (n=364). Demographic variables including age at presentation, sex, and clinical characteristics were similar between groups. Adherence to the SCAMP algorithm for echocardiography was 84%. Practice variation decreased significantly after implementation of the SCAMP (P<0.001). The number of exercise stress tests obtained was significantly lower in the SCAMP-enrolled patients compared with the historic cohort (∼3% of patients versus 29%, respectively; P<0.001). Similarly, there was a 66% decrease in utilization of Holter monitors and 75% decrease in the use of long-term event monitors after implementation of the chest pain SCAMP (P=0.003 and P<0.001, respectively). The number of echocardiograms obtained was similar between groups. Conclusions Implementation of a SCAMP for evaluation of pediatric chest pain has lead to a decrease in practice variation and resource utilization. (J Am Heart Assoc. 2012;1:jah3-e000349 doi: 10.1161/JAHA.111.000349.)
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Affiliation(s)
- George R Verghese
- Department of Cardiology, Children's Hospital Boston and the Department of Pediatrics, Harvard Medical School Boston, MA
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14
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Abstract
OBJECTIVE We sought to determine the incidence of sudden cardiac death among patients discharged from the cardiology clinic with presumed noncardiac chest pain (CP). METHODS The records of children >6 years of age who presented to Children's Hospital Boston between January 1, 2000, and December 31, 2009, with a complaint of CP were reviewed for demographic features, clinical characteristics, resource utilization, and presumed diagnosis. Patients were searched for in the US National Death Index and Social Security Death Index. RESULTS Data for a total of 3700 patients with CP (median age at evaluation: 13.4 years [range: 7-22.3 years]) were reviewed. The median follow-up period was 4.4 years (range: 0.5-10.4 years), for total of 17 886 patient-years of follow-up data. CP with exertion occurred in 1222 cases (33%), including 15 with associated syncope. A cardiac cause was determined in 37 cases; the remaining 3663 patients (99%) had CP of unknown (n = 1928), musculoskeletal (n = 1345), pulmonary (n = 242), gastrointestinal (n = 108), anxiety-related (n = 34), or drug-related (n = 4) origin. Emergency department visits for CP were documented for 670 patients (18%), and 263 patients (7%) had cardiology follow-up visits related to CP. There were 3 deaths, including 2 suicides and 1 spontaneous retroperitoneal hemorrhage. CONCLUSION CP in children is a common complaint and rarely has a cardiac cause. Review of 1 decade of cardiology visits (nearly 18 000 patient years) revealed that no patient discharged from the clinic died as a result of a cardiac condition.
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Affiliation(s)
- Susan F Saleeb
- Department of Cardiology, Children's Hospital Boston and Harvard Medical School, Harvard University, Boston, MA 02115, USA.
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15
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Friedman KG, Kane DA, Rathod RH, Renaud A, Farias M, Geggel R, Fulton DR, Lock JE, Saleeb SF. Management of pediatric chest pain using a standardized assessment and management plan. Pediatrics 2011; 128:239-45. [PMID: 21746719 PMCID: PMC9923781 DOI: 10.1542/peds.2011-0141] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [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] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Chest pain is a common reason for referral to pediatric cardiologists and often leads to an extensive cardiac evaluation. The objective of this study is to describe current management practices in the assessment of pediatric chest pain and to determine whether a standardized care approach could reduce unnecessary testing. PATIENTS AND METHODS We reviewed all patients, aged 7 to 21 years, presenting to our outpatient pediatric cardiology division in 2009 for evaluation of chest pain. Demographics, clinical characteristics, patient outcomes, and resource use were analyzed. RESULTS Testing included electrocardiography (ECG) in all 406 patients, echocardiography in 175 (43%), exercise stress testing in 114 (28%), event monitoring in 40 (10%), and Holter monitoring in 30 (7%). A total of 44 (11%) patients had a clinically significant medical or family history, an abnormal cardiac examination, and/or an abnormal ECG. Exertional chest pain was present in 150 (37%) patients. In the entire cohort, a cardiac etiology for chest pain was found in only 5 of 406 (1.2%) patients. Two patients had pericarditits, and 3 had arrhythmias. We developed an algorithm using pertinent history, physical examination, and ECG findings to suggest when additional testing is indicated. Applying the algorithm to this cohort could lead to an ∼20% reduction in echocardiogram and outpatient rhythm monitor use and elimination of exercise stress testing while still capturing all cardiac diagnoses. CONCLUSIONS Evaluation of pediatric chest pain is often extensive and rarely yields a cardiac etiology. Practice variation and unnecessary resource use remain concerns. Targeted testing can reduce resource use and lead to more cost-effective care.
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Affiliation(s)
- Kevin G. Friedman
- Department of Cardiology, Children's Hospital Boston, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts,Address correspondence to Kevin G. Friedman, MD, Department of Cardiology, Children's Hospital Boston, Boston, MA 02115. E-mail:
| | - David A. Kane
- Department of Cardiology, Children's Hospital Boston, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Rahul H. Rathod
- Department of Cardiology, Children's Hospital Boston, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Ashley Renaud
- Department of Cardiology, Children's Hospital Boston, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Michael Farias
- Department of Cardiology, Children's Hospital Boston, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Robert Geggel
- Department of Cardiology, Children's Hospital Boston, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - David R. Fulton
- Department of Cardiology, Children's Hospital Boston, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - James E. Lock
- Department of Cardiology, Children's Hospital Boston, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Susan F. Saleeb
- Department of Cardiology, Children's Hospital Boston, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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Saleeb SF, Solowiejczyk DE, Glickstein JS, Korsin R, Gersony WM, Hsu DT. Frequency of development of aortic cuspal prolapse and aortic regurgitation in patients with subaortic ventricular septal defect diagnosed at <1 year of age. Am J Cardiol 2007; 99:1588-92. [PMID: 17531586 DOI: 10.1016/j.amjcard.2007.01.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2006] [Revised: 01/10/2007] [Accepted: 01/10/2007] [Indexed: 10/23/2022]
Abstract
The natural history of aortic cuspal prolapse and aortic regurgitation (AR), studied most commonly in subpulmonic ventricular septal defect (VSD), has not been well defined in isolated, unrepaired VSD diagnosed during infancy. This study aimed to define the incidence and progression of aortic cuspal prolapse and AR in patients with subaortic VSDs diagnosed at <1 year of age who had no aortic cuspal prolapse or AR at presentation and did not require surgery within the first year of life. Patients had yearly follow-up, and data regarding clinical course, physical examination, and echocardiography were obtained. Comparisons were made between patients who developed aortic cuspal prolapse and AR and those who did not. One hundred patients, with a mean age at VSD diagnosis of 0.1 +/- 0.5 years, followed for a mean of 7.1 +/- 10.1 years, were studied. Aortic cuspal prolapse developed in 14 patients (14%) at a mean age of 7.1 +/- 6 years (range 0.4 to 18.4). AR murmurs were heard in 6 patients (6%) at a mean age of 5.1 +/- 3.1 years, all of whom had aortic cuspal prolapse and underwent VSD closure and aortic valvuloplasty. In conclusion, aortic cuspal prolapse and clinical AR are not uncommon in patients with subaortic VSDs. Long-term follow-up of patients with subaortic VSDs should include the serial evaluation of aortic valve anatomy and function.
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Affiliation(s)
- Susan F Saleeb
- Department of Cardiology, Children's Hospital of Boston, Massachusetts, USA.
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Saleeb SF, Gersony WM, Korsin R, Solowiejczyk DE, Hsu DT. Aortic valve prolapse and aortic insufficiency in subaortic ventricular septal defects. J Am Coll Cardiol 2003. [DOI: 10.1016/s0735-1097(03)82618-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
Real time ultrasonography, according to the method of Graf, was performed on 113 infant hips because of abnormal physical findings (ranging from hip clicks to frank dislocation). Three parameters were measured on the standard coronal images: alpha and beta angles of Graf and the d/D ratio of Morin. Results indicated that the presence of hip clicks (88 hips) in general is a benign condition and not associated with abnormal anatomy. Hips that were reduced at birth but dislocatable (Barlow hip) showed no significantly abnormal acetabular anatomy. Hips that were dislocated at rest but were reducible (Ortolani hip) showed definite abnormal acetabular anatomy and femoral head coverage. Ultrasonography is beneficial in the management of developmental dysplasia of the hip (DDH); it confirms the clinical findings and eliminates radiation exposure to the infant's pelvis, especially in the first 4-6 months of life when standard radiography is not always reliable in diagnosing DDH.
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Affiliation(s)
- P Nimityongskul
- Department of Orthopaedic Surgery, University of South Alabama, Mobile 36617-2293, USA
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Affiliation(s)
- S M Khader
- Department of Radiology, University of South Alabama College of Medicine, Mobile 36617, USA
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Affiliation(s)
- D Takhtani
- Department of Radiology, University of South Alabama College of Medicine, Mobile 36617, USA
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Patel N, Saleeb SF, Teplick SK. General case of the day. Mesenteric panniculitis with extensive inflammatory involvement of the peritoneum and intraperitoneal structures. Radiographics 1999; 19:1083-5. [PMID: 10464811 DOI: 10.1148/radiographics.19.4.g99jl221083] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- N Patel
- Department of Radiology, University of South Alabama College of Medicine, Mobile 36617, USA
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Affiliation(s)
- S F Saleeb
- Department of Radiology, University of South Alabama College of Medicine, Mobile 36617, USA
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Affiliation(s)
- S A Kuestermann
- Department of Radiology, University of South Alabama, College of Medicine, Mobile 36617, USA
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Affiliation(s)
- D Takhtani
- Department of Radiology, University of South Alabama College of Medicine, Mobile 36617, USA
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Affiliation(s)
- W Green
- Department of Radiology, University of South Alabama Medical Center, Mobile 36617
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