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Platelet Transfusion Practice and Related Outcomes in Pediatric Extracorporeal Membrane Oxygenation.Pediatric Critical Care Medicine : a... Feb 2020To describe factors associated with platelet transfusion during pediatric extracorporeal membrane oxygenation and the relationships among platelet transfusion,...
OBJECTIVE
To describe factors associated with platelet transfusion during pediatric extracorporeal membrane oxygenation and the relationships among platelet transfusion, complications, and mortality.
DESIGN
Secondary analysis of data collected prospectively by the Collaborative Pediatric Critical Care Research Network between December 2012 and September 2014.
SETTING
Eight Collaborative Pediatric Critical Care Research Network-affiliated hospitals.
PATIENTS
Age less than 19 years old and treated with extracorporeal membrane oxygenation.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
Of 511 children, 496 (97.1%) received at least one platelet transfusion during extracorporeal membrane oxygenation. Neonatal age, venoarterial extracorporeal membrane oxygenation, and various acute and chronic diagnoses were associated with increased average daily platelet transfusion volume (milliliters per kilogram body weight). On multivariable analysis, average daily platelet transfusion volume was independently associated with mortality (per 1 mL/kg; odds ratio, 1.05; CI, 1.03-1.08; p < 0.001), whereas average daily platelet count was not (per 1 × 10/L up to 115 × 10/L; odds ratio, 1.00; CI, 0.98-1.01; p = 0.49). Variables independently associated with increased daily bleeding risk included increased platelet transfusion volume on the previous extracorporeal membrane oxygenation day, a primary cardiac indication for extracorporeal membrane oxygenation, adolescent age, and an acute diagnosis of congenital cardiovascular disease. Variables independently associated with increased daily thrombotic risk included increased platelet transfusion volume on the previous extracorporeal membrane oxygenation day and venoarterial extracorporeal membrane oxygenation. Variables independently associated with decreased daily thrombotic risk included full-term neonatal age and an acute diagnosis of airway abnormality.
CONCLUSIONS
Platelet transfusion was common in this multisite pediatric extracorporeal membrane oxygenation cohort. Platelet transfusion volume was associated with increased risk of mortality, bleeding, and thrombosis.
Topics: Acute Disease; Adolescent; Age Factors; Child; Child, Preschool; Chronic Disease; Extracorporeal Membrane Oxygenation; Hemorrhage; Hospital Mortality; Humans; Infant; Infant, Newborn; Logistic Models; Odds Ratio; Platelet Count; Platelet Transfusion; Prospective Studies; Risk Factors; Treatment Outcome
PubMed: 31568245
DOI: 10.1097/PCC.0000000000002102 -
Clinical Journal of the American... Nov 2018
Topics: Acute Disease; Acute Kidney Injury; Biopsy; Humans
PubMed: 30348811
DOI: 10.2215/CJN.11400918 -
Neurology India 2023
Topics: Humans; Brain Diseases; Diffusion Magnetic Resonance Imaging; Acute Disease
PubMed: 37929483
DOI: 10.4103/0028-3886.388072 -
The Korean Journal of Internal Medicine Jul 2023
Topics: Humans; Echocardiography; Pulmonary Embolism; Acute Disease
PubMed: 37291837
DOI: 10.3904/kjim.2023.006 -
Arquivos Brasileiros de Oftalmologia 2021Acute retinal pigment epitheliitis (ARPE) is an idiopathic, self-limiting inflammatory retinal disorder that particularly affects healthy young individuals. The... (Review)
Review
Acute retinal pigment epitheliitis (ARPE) is an idiopathic, self-limiting inflammatory retinal disorder that particularly affects healthy young individuals. The characteristic fundoscopic appearance of the acute retinal pigment epitheliitis includes a fine pigment stippling surrounded by a yellow-white hypopigmented halos in the macula. Although the exact pathogenesis of the disease remains unknown, some reports have suggested a relationship between a viral infection and acute retinal pigment epitheliitis. Acute retinal pigment epitheliitis is a rare disorder, and only single case reports or case series are found in the literature. The clinical and demographic characteristics of patients with this disease are not fully understood because of its rarity. In this study, we searched the literature to collect clinical and demographic features of the reported cases. We detail the characteristics of acute retinal pigment epitheliitis were pointed and discuss the pathogenesis of the disease.
Topics: Acute Disease; Fluorescein Angiography; Humans; Retinal Diseases; Retinal Pigments; Retinitis; Visual Acuity
PubMed: 33567017
DOI: 10.5935/0004-2749.20210028 -
The American Journal of Case Reports Feb 2019BACKGROUND Auricular hematomas are well-known among wrestlers and other contact sports participants, but spontaneous auricular hematomas are rare. The differential...
BACKGROUND Auricular hematomas are well-known among wrestlers and other contact sports participants, but spontaneous auricular hematomas are rare. The differential diagnosis for acute spontaneous auricular swelling is limited. In addition to infectious causes, antecedent trauma, and bleeding complications, angioedema should also be considered. Although rare, acute non-traumatic auricular hematomas need urgent surgical intervention if they are large. CASE REPORT A 37-year-old male presented to the Emergency Department (ED) with the complaint of acute pain and swelling to his left ear 30 minutes prior to arrival. He denied any recent or preceding trauma, insect bites, or allergies. He denied any anticoagulant use. Initial treatment was for possible allergic reaction, but an expanding hematoma was subsequently noted. This was incised and drained. CONCLUSIONS We report a rare case of spontaneous auricular hematoma. By highlighting the clinical features and treatments, the provider can be more alert to recognize and promptly treat this clinical entity.
Topics: Acute Disease; Adult; Ear Diseases; Hematoma; Humans; Male
PubMed: 30770527
DOI: 10.12659/AJCR.913464 -
Implementation Science : IS Nov 2014The application of complexity science to understanding healthcare system improvement highlights the need to consider interdependencies within the system. One important... (Review)
Review
BACKGROUND
The application of complexity science to understanding healthcare system improvement highlights the need to consider interdependencies within the system. One important aspect of the interdependencies in healthcare delivery systems is how individuals relate to each other. However, results from our observational and interventional studies focusing on relationships to understand and improve outcomes in a variety of healthcare settings have been inconsistent. We sought to better understand and explain these inconsistencies by analyzing our findings across studies and building new theory.
METHODS
We analyzed eight observational and interventional studies in which our author team was involved as the basis of our analysis, using a set theoretical qualitative comparative analytic approach. Over 16 investigative meetings spanning 11 months, we iteratively analyzed our studies, identifying patterns of characteristics that could explain our set of results. Our initial focus on differences in setting did not explain our mixed results. We then turned to differences in patient care activities and tasks being studied and the attributes of the disease being treated. Finally, we examined the interdependence between task and disease.
RESULTS
We identified system-level uncertainty as a defining characteristic of complex systems through which we interpreted our results. We identified several characteristics of healthcare tasks and diseases that impact the ways uncertainty is manifest across diverse care delivery activities. These include disease-related uncertainty (pace of evolution of disease and patient control over outcomes) and task-related uncertainty (standardized versus customized, routine versus non-routine, and interdependencies required for task completion).
CONCLUSIONS
Uncertainty is an important aspect of clinical systems that must be considered in designing approaches to improve healthcare system function. The uncertainty inherent in tasks and diseases, and how they come together in specific clinical settings, will influence the type of improvement strategies that are most likely to be successful. Process-based efforts appear best-suited for low-uncertainty contexts, while relationship-based approaches may be most effective for high-uncertainty situations.
Topics: Acute Disease; Delivery of Health Care; Humans; Observational Studies as Topic; Patient Participation; Professional Practice; Quality Improvement; Uncertainty
PubMed: 25407138
DOI: 10.1186/s13012-014-0165-1 -
Global Health Research and Policy Apr 2021In 2016, diarrhea killed around 7 children aged under 5 years per 1000 live births in Burundi. The objective of this study was to estimate the economic burden associated...
BACKGROUND
In 2016, diarrhea killed around 7 children aged under 5 years per 1000 live births in Burundi. The objective of this study was to estimate the economic burden associated with diarrhea in Burundi and to examine factors affecting the cost to provide economic evidence useful for the policymaking about clinical management of diarrhea.
METHODS
The study was designed as a prospective cost-of-illness study using an incidence-based approach from the societal perspective. The study included patients aged under 5 years with acute non-bloody diarrhea who visited Buyenzi health center and Prince Regent Charles hospital from November to December 2019. Data were collected through interviews with patients' caregivers and review of patients' medical and financial records. Multiple linear regression was performed to identify factors affecting cost, and a cost model was used to generate predictions of various clinical and care management costs. All costs were converted into international dollars for the year 2019.
RESULTS
One hundred thirty-eight patients with an average age of 14.45 months were included in this study. Twenty-one percent of the total patients included were admitted. The average total cost per episode of diarrhea was Int$109.01. Outpatient visit and hospitalization costs per episode of diarrhea were Int$59.87 and Int$292, respectively. The costs were significantly affected by the health facility type, patient type, health insurance scheme, complications with dehydration, and duration of the episode before consultation. Our model indicates that the prevention of one case of dehydration results in savings of Int$16.81, accounting for approximately 11 times of the primary treatment cost of one case of diarrhea in the community-based management program for diarrhea in Burundi.
CONCLUSION
Diarrhea is associated with a substantial economic burden to society. Evidence from this study provides useful information to support health interventions aimed at prevention of diarrhea and dehydration related to diarrhea in Burundi. Appropriate and timely care provided to patients with diarrhea in their communities and primary health centers can significantly reduce the economic burden of diarrhea. Implementing a health policy to provide inexpensive treatment to prevent dehydration can save significant amount of health expenditure.
Topics: Acute Disease; Burundi; Child Health; Child, Preschool; Cost of Illness; Diarrhea; Female; Humans; Incidence; Infant; Infant, Newborn; Male; Prospective Studies
PubMed: 33845920
DOI: 10.1186/s41256-021-00194-3 -
Indian Pediatrics Jan 2016Kawasaki disease is an acute vasculitis of unknown etiology that predominantly affects children <5 years of age. The incidence and the severity of myocarditis in this...
Kawasaki disease is an acute vasculitis of unknown etiology that predominantly affects children <5 years of age. The incidence and the severity of myocarditis in this disease is variable and depends upon the stage of the disease, acute or chronic. Acute-stage Kawasaki disease shows relatively high incidence of myocarditis, but almost all cases are clinically mild. We describe teenage boy presenting with atypical/incomplete manifestations of Kawasaki disease and developing fulminant myocarditis within a week of illness resulting in death. The case underscores the importance of suspecting Kawasaki disease in a young child presenting with features of myocardial ischemia.
Topics: Acute Disease; Adolescent; Fatal Outcome; Humans; Male; Mucocutaneous Lymph Node Syndrome; Myocarditis
PubMed: 26840674
DOI: 10.1007/s13312-016-0791-6 -
Romanian Journal of Ophthalmology 2023This report aims to discuss and review the diagnosis and management of acute acquired comitant esotropia (AACE) in children and to add several cases to the limited...
This report aims to discuss and review the diagnosis and management of acute acquired comitant esotropia (AACE) in children and to add several cases to the limited literature available on this unusual condition in the pediatric population. We present two cases of AACE with large-angle deviations that were investigated and followed-up according to current recommendations. Both cases required strabismus surgery for AACE, but different procedures were chosen, with good postoperative results. Unilateral recession of the medial rectus and resection of the lateral rectus (R&R) were performed in one case and bilateral medial rectus (MR) recession in the other, with resolution of the diplopia and full recovery of binocular vision. Although isolated AACE is usually benign, studies have reported the presence of intracranial disease in up to 10% of cases, making it a potential first sign of an underlying serious pathology. Therefore, AACE should be investigated as a medical emergency and neuroimaging should be performed in all patients with unclear onset of AACE, as well as in those with associated neurological symptoms, such as headache, cerebellar imbalance, weakness, or nystagmus. Acute acquired comitant esotropia (AACE) is an infrequent type of esotropia that usually appears in older children. It is characterized by esotropia and diplopia with acute onset. Neurological examinations and neuroimaging should be performed to exclude any potential intracranial disease. Treatment of AACE without underlying neurological disease is focused on managing the diplopia and resolving the esotropia. Strabismus surgery has good motor and sensory results and can successfully restore good binocular function. AACE = Acute acquired comitant esotropia, LR = lateral rectus, MR = medial rectus, PD = prism diopters, R&R = recession and resection, BSV = binocular single vision, PAT = prism adaptation test.
Topics: Humans; Male; Female; Child; Adolescent; Acute Disease; Esotropia; Vision, Binocular; Diplopia; Treatment Outcome; Oculomotor Muscles
PubMed: 37089805
DOI: 10.22336/rjo.2023.16