scholarly journals Retrospective Review of Limitations of Care for Inpatients at a Free-Standing, Tertiary Care Children’s Hospital

Children ◽  
2018 ◽  
Vol 5 (12) ◽  
pp. 164 ◽  
Author(s):  
Christopher J. Plymire ◽  
Elissa G. Miller ◽  
Meg Frizzola
Keyword(s):  
Chart Review ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Palliative Care Team ◽  
Do Not Resuscitate ◽  
Free Standing ◽  
Factors Influencing ◽  
Eol Care ◽  
Inpatient Units ◽  
Timing Of Death

Limited studies exist regarding the timing, location, or physicians involved in do-not-resuscitate (DNR) order placement in pediatrics. Prior pediatric studies have noted great variations in practice during end-of-life (EOL) care. This study aims to analyze the timing, location, physician specialties, and demographic factors influencing EOL care in pediatrics. We examined the time preceding and following the implementation of a pediatric palliative care team (PCT) via a 5-year, retrospective chart review of all deceased patients previously admitted to inpatient services. Thirty-five percent (167/471) of the patients in our study died with a DNR order in place. Sixty-two percent of patients died in an ICU following DNR order placement. A difference was noted in DNR order timing between patients on general inpatient units and those discharged to home compared with those in the ICUs (p = 0.02). The overall DNR order rate increased following the initiation of the PCT from 30.8% to 39.2% (p = 0.05), but no change was noted in the rate of death in the ICUs. Our study demonstrates a variation in the timing of death following DNR order placement when comparing ICUs and general pediatric floors. Following the initiation of the PCT, we saw increased DNR frequency but no change in the interval between a DNR order and death.

Comparative Morbidity Profile of Elective vs Therapeutic Neck Dissection

2021 ◽  
pp. 019459982110089
Author(s):  
Quinn Dunlap ◽  
James Reed Gardner ◽  
Amanda Ederle ◽  
Deanne King ◽  
Maya Merriweather ◽  
...  
Keyword(s):  
Neck Dissection ◽  
Surgical Complications ◽  
Chart Review ◽  
Care Center ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Neck Surgery ◽  
Continuous Variables ◽  
Significant Difference ◽  
History Of

Objective Neck dissection (ND) is one of the most commonly performed procedures in head and neck surgery. We sought to compare the morbidity of elective ND (END) versus therapeutic ND (TND). Study Design Retrospective chart review. Setting Academic tertiary care center. Methods Retrospective chart review of 373 NDs performed from January 2015 to December 2018. Patients with radical ND or inadequate chart documentation were excluded. Demographics, clinicopathologic data, complications, and sacrificed structures during ND were retrieved. Statistical analysis was performed with χ2 and analysis of variance for comparison of categorical and continuous variables, respectively, with statistical alpha set a 0.05. Results Patients examined consisted of 224 males (60%) with a mean age of 60 years. TND accounted for 79% (n = 296) as compared with 21% (n = 77) for END. Other than a significantly higher history of radiation (37% vs 7%, P < .001) and endocrine pathology (34% vs 2.6%, P < .001) in the TND group, no significant differences in demographics were found between the therapeutic and elective groups. A significantly higher rate of structure sacrifice and extranodal extension within the TND group was noted to hold in overall and subgroup comparisons. No significant difference in rate of surgical complications was appreciated between groups in overall or subgroup analysis. Conclusion While the significantly higher rate of structure sacrifice among the TND population represents an increased morbidity profile in these patients, no significant difference was found in the rate of surgical complications between groups. The significant difference seen between groups regarding history of radiation and endocrine pathology likely represents selection bias.

scholarly journals Post-operative fever in children undergoing mastoidectomy due to complicated acute mastoiditis

2021 ◽  
Author(s):  
Oren Ziv ◽  
Aviad Sapir ◽  
Eugene Leibowitz ◽  
Sofia Kordeluk ◽  
Daniel KAPLAN ◽  
...  
Keyword(s):  
Chart Review ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
University Hospital ◽  
Acute Mastoiditis ◽  
Benign Condition ◽  
Subperiosteal Abscess ◽  
Cortical Mastoidectomy ◽  
New Findings ◽  
Mastoid Surgery

Abstract Objectives: To determine the immediate post-operative course and outcome of pediatric patients with complicated acute mastoiditis (CAM) following surgical treatment. Study Design: A retrospective chart review of children diagnosed with CAM who underwent mastoid surgery during 2012-2019. Setting: Tertiary care university hospital. Participants: the study includes 33 patients, divided into two groups: 17 patients with subperiosteal abscess (SPA) alone - single complication group (SCG) and 16 patients with SPA and additional intracranial or intratemporal complications -multiple complications group (MCG). Main Outcome Measures: post-operative fever course and pattern (POF). Results :33 patients belong to the SCG 17(51%) and 16(49%) belonged to the MCG, respectively. 6/17(35.3%) SCG patients experienced POF vs. 12/16(75%) in the MCG (P=0.012). At post-operative day 2 (POD2), 10/13(77%) febrile patients belonged to MCG and 3/13(23%) to SCG (P=0.013). POF was recorded until POD6 in both groups. Seven patients, all from MCG with POF, underwent second imaging with no new findings. Conclusion: Following a cortical mastoidectomy for CAM, POF is not unusual in the first 6 days and seem to be benign condition. POF is more common, higher, and persistent for a longer duration in MCG compared with SCG. At POD 6, fever is expected to normalize in both groups, so if fever persists further evaluation should be considered.

Crimean-Congo haemorrhagic fever outbreak in Middle Anatolia: a multicentre study of clinical features and outcome measures

2005 ◽  
Vol 54 (4) ◽  
pp. 385-389 ◽  
Author(s):  
Mehmet Bakir ◽  
Mehmet Ugurlu ◽  
Basak Dokuzoguz ◽  
Hurrem Bodur ◽  
Mehmet A Tasyaran ◽  
...  
Keyword(s):  
Chart Review ◽  
Tertiary Care ◽  
Fatal Outcome ◽  
Hospital Costs ◽  
Retrospective Chart Review ◽  
Haemorrhagic Fever ◽  
Related Data ◽  
Cchf Virus ◽  
Crimean Congo Haemorrhagic Fever ◽  
Tertiary Care Hospitals

A Crimean-Congo haemorrhagic fever (CCHF) outbreak emerged from 2001 to 2003 in the Middle Anatolia region of Turkey. This study describes the clinical characteristics and outcome features of CCHF patients admitted to four tertiary care hospitals in Turkey. Definitive diagnosis was based on the detection of CCHF virus-specific IgM by ELISA or of genomic segments of the CCHF virus by RT-PCR. Related data were collected by a retrospective chart review. Hospital costs were extracted from the final discharge bills. Univariate and multivariate analyses were conducted to determine the independent predictors of mortality. CCHF virus-specific antibodies or genomic segments were detected in the sera of 99 cases. Seven cases that were treated with ribavirin were excluded from the study. Cases were mostly farmers (83 cases, 90 %), and 60 % had a tick-bite history before the onset of fever. Impaired consciousness and splenomegaly were independent predictors of a fatal outcome.

scholarly journals Trichotillomania in Children and the Different Approaches between Dermatological and Behavioral Health Professionals at an Urban Tertiary Care Center

2020 ◽  
pp. 1-7
Author(s):  
Sneha Rangu ◽  
Leslie Castelo-Soccio
Keyword(s):  
Behavioral Health ◽  
Chart Review ◽  
Complex Disease ◽  
Behavioral Therapy ◽  
Care Center ◽  
Treatment Options ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Psychosocial Impairment ◽  
Epidemiologic Features

<b><i>Background:</i></b> Trichotillomania (TTM) is a complex disease with varying clinical characteristics, and psychosocial impairment is noted in many TTM patients. Despite its prevalence in childhood, there is limited research on pediatric TTM. <b><i>Objective:</i></b> To analyze the clinical and epidemiologic features of TTM in children evaluated by dermatologists and behavioral health specialists. <b><i>Method:</i></b> We performed a retrospective chart review of 137 pediatric patients seen at the Children’s Hospital of Philadelphia with initial presentation of TTM at age 17 or younger. Patients were treated by dermatology or behavioral health. <b><i>Results:</i></b> The majority of the patients were females, with an average diagnosis age around 8 years. Over half had a psychiatric comorbidity, and over a quarter had a skin disorder. Skin disorders were more commonly present in those evaluated by dermatology, and psychiatric comorbidities were more commonly present in those evaluated by behavioral health. The most common form of treatment was behavioral therapy, with medications prescribed more often by dermatologists. <b><i>Conclusions:</i></b> TTM patients choose to present to behavioral health or dermatology; however, there are distinctive differences between the two cohorts. With behavioral and pharmacologic treatment options, a relationship between dermatologists and behavioral health specialists is necessary for multifactorial management of TTM.

scholarly journals Combined Topical and Oral Antimicrobial Therapy for the Eradication of Methicillin-ResistantStaphylococcus aureus(Mrsa) Colonization in Hospitalized Patients

2002 ◽  
Vol 13 (5) ◽  
pp. 287-292 ◽  
Author(s):  
Scott K Fung ◽  
Marie Louie ◽  
Andrew E Simor
Keyword(s):  
Medical Devices ◽  
Antimicrobial Therapy ◽  
Chart Review ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Hospitalized Patients ◽  
Urinary Catheters ◽  
Mupirocin Ointment ◽  
Mrsa Colonization

OBJECTIVE: How to eradicate methicillin-resistantStaphylo-coccus aureus(MRSA) colonization in hospitalized patients is uncertain. We reviewed our experience with MRSA decolonization therapy in hospitalized patients.SETTING: An 1100-bed, university-affiliated tertiary care teaching hospital in Toronto, Ontario.DESIGN: Retrospective chart review of 207 adult inpatients with MRSA colonization hospitalized between February 1996 and March 1999.INTERVENTIONS: All patients with MRSA colonization were assessed for possible decolonization therapy with a combination of 4% chlorhexidine soap for bathing and washing, 2% mupirocin ointment applied to the anterior nares three times/day, rifampin (300 mg twice daily) and either trimethoprim/sulfamethoxazole (160 mg/800 mg twice daily) or doxycycline (100 mg twice daily). This treatment was given for seven days.RESULTS: A total of 207 hospitalized patients with MRSA colonization were identified and 103 (50%) received decolonization therapy. Patients who received decolonization therapy were less likely than untreated patientsto have intravenous (P=0.004) or urinary catheters (P<0.001), or extranasal sites of colonization (P=0.001). Successful decolonization was achieved in 90% of the 43 patients who were available for at least three months of follow-up.CONCLUSIONS: Combined topical and oral antimicrobial therapy was found to be effective in eradicating MRSA colonization in selected hospitalized patients, especially those without indwelling medical devices or extranasal sites of colonization.

A 10-Year Review of Necrotizing Fasciitis in the Pediatric Population: Delays to Diagnosis and Management

2016 ◽  
Vol 56 (7) ◽  
pp. 627-633 ◽  
Author(s):  
Heather VanderMeulen ◽  
Jeffrey M. Pernica ◽  
Madan Roy ◽  
April J. Kam
Keyword(s):  
Necrotizing Fasciitis ◽  
Chart Review ◽  
Pediatric Population ◽  
Care Center ◽  
Tertiary Care ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
Causative Organism ◽  
Antibiotic Administration ◽  
Large Variability

Objective. To assess the promptness and appropriateness of management in pediatric cases of necrotizing fasciitis (NF). Methods. A retrospective chart review examined cases of pediatric NF treated at a pediatric tertiary care center over a 10-year period. Results. Twelve patients were identified over the 10-year period. The median (25th to 75th centile) times to appropriate antibiotic administration, infectious disease consults, surgical consults and debridement surgeries were 2.6 (2.1-3.2), 7.7 (3.4-24.4), 4.6 (1.7-21.0), and 22.1 (10.3-28.4) hours following assessment at triage. The initial antibiotic(s) administered covered the causative organism in 9 of 12 cases. The median (25th to 75th centile) length of hospital stay was 21 (14.0-35.5) days. Conclusions. The large variability in the care of these patients speaks to the range of their presenting symptomatology. The lack of a standardized approach to the pediatric patient with suspected NF results in delays in management and suboptimal antibiotic choice.

Therapy of Ulcerated Hemangiomas

2013 ◽  
Vol 17 (4) ◽  
pp. 233-242 ◽  
Author(s):  
Catherine C. McCuaig ◽  
Lynn Cohen ◽  
Julie Powell ◽  
Afshin Hatami ◽  
Danielle Marcoux ◽  
...  
Keyword(s):  
Systemic Therapy ◽  
Chart Review ◽  
Wound Care ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Dye Laser ◽  
Pulsed Dye Laser ◽  
Pediatric Dermatology ◽  
Tertiary Referral Center ◽  
Control Study

Background: Cutaneous ulceration is the most common complication of infantile hemangiomas (IHs) seen in a pediatric dermatology practice. Objective: The most effective treatments in our experience are compared to those in the current literature. Methods: The study was a retrospective chart review of therapy of 169 ulcerated IHs at a tertiary care pediatric hospital and a literature review. Results: Combination therapy was the rule. Local wound care was required in all, pain management in 72%, pulsed dye laser in 42%, infection control in 38%, diminution of the hemangioma through systemic therapy in 36%, and suppression of bleeding in 2%. Limitations: A retrospective review compared to a case-control study has inherent bias. In addition, our cases were all at a tertiary referral center. Conclusion: All ulcerated IHs benefit from local barrier creams or dressings. Pulsed dye laser, antibiotics, topical morphine 0.1% in hydrogel, topical becaplermin, and, most importantly, systemic therapy (especially propranolol) to reduce the hemangioma may be useful.

scholarly journals Current Practices of Adjunctive Therapy for Pertussis at Six Canadian Tertiary Care Pediatric Hospitals

1998 ◽  
Vol 9 (2) ◽  
pp. 83-86
Author(s):  
Christopher T Naugler ◽  
Scott A Halperin
Keyword(s):  
Adjunctive Therapy ◽  
Chart Review ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Exclusion Criterion ◽  
Recommended Dosage ◽  
Lengths Of Stay ◽  
Pediatric Hospitals ◽  
National Perspective ◽  
Reactive Airways

OBJECTIVE: To document initial investigations and treatment used in the management of children hospitalized with pertussis.DESIGN: Retrospective chart review encompassing admissions from January 1, 1991 to June 1, 1995.SETTING: Six Canadian pediatric hospitals representing about 39% of the pediatric tertiary care beds in Canada.PATIENTS: Four hundred and forty children who met the inclusion criterion of a primary admitting diagnosis of pertussis and who did not meet the exclusion criterion of nosocomially acquired pertussis or a prior admission for pertussis during the study period.MAIN RESULTS: Most patients had cultures positive forBordetella pertussis, although the proportion of positive tests varied widely among hospitals. Erythromycin was the most commonly used medication; however, only 47% of children received the recommended dosage. Salbutamol and corticosteroids were used most often in patients with reactive airways disease. Younger children and those with reactive airways disease had longer lengths of stay in hospital.CONCLUSIONS: Pertussis treatment varied widely among the six hospitals studied, and was often not consistent with current Canadian recommendations. The results will allow practitioners to place their practices in a national perspective and provide a baseline for further studies.

scholarly journals Safety Assessment of a Noninvasive Respiratory Protocol for Adults with COVID-19

2020 ◽  
Vol 15 (12) ◽  
pp. 734-738
Author(s):  
William E Soares III ◽  
Elizabeth M Schoenfeld ◽  
Paul Visintainer ◽  
Tala Elia ◽  
Venkatrao Medarametla ◽  
...  
Keyword(s):  
Patient Safety ◽  
Respiratory Distress ◽  
Healthcare System ◽  
Safety Assessment ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
High Flow ◽  
Adult Patients ◽  
Do Not Resuscitate ◽  
High Flow Nasal Cannula

As evidence emerged supporting noninvasive strategies for coronavirus disease 2019 (COVID-19)–related respiratory distress, we implemented a noninvasive COVID-19 respiratory protocol (NCRP) that encouraged high-flow nasal cannula (HFNC) and self-proning across our healthcare system. To assess safety, we conducted a retrospective chart review evaluating mortality and other patient safety outcomes after implementation of the NCRP protocol (April 3, 2020, to April 15, 2020) for adult patients hospitalized with COVID-19, compared with preimplementation outcomes (March 15, 2020, to April 2, 2020). During the study, there were 469 COVID-19 admissions. Fewer patients underwent intubation after implementation (10.7% [23 of 215]), compared with before implementation (25.2% [64 of 254]) (P < .01). Overall, 26.2% of patients died (24% before implementation vs 28.8% after implementation; P = .14). In patients without a do not resuscitate/do not intubate order prior to admission, mortality was 21.8% before implementation vs 21.9% after implementation. Overall, we found no significant increase in mortality following implementation of a noninvasive respiratory protocol that decreased intubations in patients with COVID-19.

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