bluuebunny/crossref_metadata_2025_split huggingface dataset:
Analysis of Patient Characteristics and Risk Factors for Thrombosis After Surgery for Congenital Heart Disease
Authors: Murphy Lee D. , Benneyworth Brian D. , Moser Elizabeth A. S. , Hege Kerry M. , Valentine Kevin M. , Mastropietro Christopher W. 
Published: September 2018

Objectives:
Thrombosis is a cause of morbidity in 4–15% of children who undergo pediatric cardiac surgery. Data on how to prevent this complication are sorely needed. We aimed to identify risk factors for thrombosis following pediatric cardiac surgery and determine if use of low molecular weight heparin prophylaxis is associated with a reduction in thrombosis risk.

Design:
Retrospective cohort study.

Setting:
Tertiary pediatric cardiovascular ICU.

Patients:
Patients who underwent cardiac surgery between June 2014 and December 2015.

Interventions:
None.

Measurements and Main Results:
Data from patients with venous or arterial thrombosis confirmed by radiologic studies were matched two-to-one to controls based on age, Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery mortality category, and gender. Thrombosis was detected in 33 patients (6.2%): 25 patients (76%) had venous thromboses, five patients (15%) had arterial thromboses, and three patients (9%) had both. Median time to thrombosis detection was 13 days (25–75%; 7–31 d). On multivariate analysis, which included adjustment for postoperative disease severity, fresh frozen plasma exposure was independently associated with thrombosis (odds ratio, 3.7; 95% CI, 1.4–9.4). Twenty-eight patients (85%) had central venous catheter-related thromboses. Low molecular weight heparin prophylaxis use in this subset of patients was not statistically different from controls (50% vs 45%, respectively; p = 0.47). On multivariable analysis, fresh frozen plasma exposure was also independently associated with central venous catheter-related thrombosis (odds ratio, 3.6; 95% CI, 1.2–10.6).

Conclusions:
The occurrence of thrombosis after pediatric cardiac surgery at our institution was 6.2%, similar to what has been reported in other studies, despite frequent use of low molecular weight heparin. Further study is needed to determine the role of low molecular weight heparin for thromboprophylaxis and the relationship between fresh frozen plasma and thrombosis risk in children who undergo cardiac surgery.
Interhospital Transport of Pediatric Patients in Denmark
Authors: Brønnum Nystrup Kristin , Poorisrisak Porntiva , Breindahl Morten , Hallas Peter 
Published: September 2018

Objectives
No national guidelines exist in Denmark regarding interhospital transport of critically ill children. The aim of this study was to disclose which physicians actually accompany critically ill children during interhospital transports nationwide and whether the physicians have adequate clinical skills to perform interhospital transfers.

Methods
A questionnaire was sent to the youngest pediatrician on-call at every hospital in Denmark receiving pediatric emergencies except the tertiary Copenhagen University Hospital, Rigshospitalet.

Results
Seventeen pediatric departments were contacted (response rate, 100%). All departments indicated that they perform interhospital transport of pediatric patients. When presented with 5 cases, great heterogeneity in the choice of transport physician and accompanying staff was seen. With increasing severity, fewer pediatricians were willing to transport the children (24% vs 6%). Irrespective of the degree of severity, more transports were delegated to anesthesiologists than performed by pediatricians. Pediatricians who agreed to transport the infant and neonate had adequate competencies. In cases with older children, 0 to 75% of physicians who would do the transport had adequate clinical skills and experience in emergency pediatric respiratory and cardiovascular management. Training in interhospital transport was offered by 1 department; 6 departments (35%) had local guidelines describing the management of pediatric transports.

Conclusions
Great heterogeneity was found in the local transport strategies and practical skill sets of accompanying physicians. Overall, there is room for improvement in the management of interhospital transport of critically ill children in Denmark, perhaps by increasing the availability of specialized pediatric transport services for critically ill children nationwide.
Influenza A–Associated Epiglottitis and Compensatory Pursed Lip Breathing in an Infant
Authors: O'Bryant Shelease C. , Lewis Jonathan D. , Cruz Andrea T. , Mothner Brent A. 
Published: September 2018

AbstractThe last 3 decades have seen a shift in the epidemiology of epiglottitis. Epiglottitis was once most commonly associated withHaemophilus influenzaetype B. However, with the implementation of theH. influenzaetype B vaccine in 1985, the incidence has drastically declined. There are now new emerging pathogens—bacteria, viruses, and fungi—causing epiglottitis. Here, we report the first case of epiglottitis secondary to influenza A in a former full-term, vaccinated infant who presented with cough, fever, stridor, pursed lip breathing, and progressive respiratory distress and eventual respiratory failure. This case highlights the presentation and clinical course of epiglottitis and describes a rare clinical feature, pursed lip breathing, in an infant.
Parental Attitudes and Knowledge About Lumbar Puncture in Children
Authors: Acoglu Esma Altinel , Oguz Melahat Melek , Sari Eyup , Yucel Husniye , Akcaboy Meltem , Zorlu Pelin , Sahin Sanliay , Senel Saliha 
Published: September 2018

Objectives
Lumbar puncture (LP) is fundamental for diagnosis and treatment; however, some parents do not provide consent for their children to undergo the procedure, which can make diagnosis and determination of the optimal treatment difficult. The present study aimed to describe the level of knowledge and attitudes toward LP of parents whose children were scheduled to undergo the procedure.

Methods
A prospective cross-sectional descriptive study of a convenience sample of parents of 84 children aged 2 months to 17 years scheduled for LP at a single academic children's hospital between 2015 and 2017. Parents were administered a written survey and interviewed by a physician other than the person who did the LP. Data on parental level of knowledge and attitudes regarding LP, in addition to reasons for refusal, were collected.
The parents of 84 patients scheduled for LP due to various indications were administered a face-to-face survey interview. The survey was used to collect parental demographic data, as well as opinions and knowledge about LP and postinterventional complications.

Results
The mean age of the 84 patients (57% male and 43% female) was 6.4 ± 5.17 years. Lumbar puncture was planned for the presumptive diagnosis of neurological disease in 45.25% of the patients, central nervous system infection in 45.25%, and acute encephalopathy in 9.5%. Among the parents, 65% (n = 55) had no knowledge or attitude about LP prior to the survey interview. The most common parental concern related to LP was paralysis (25%), followed by infertility (2%), mental retardation (1%), and disease progression (1%). Only 4.7% of the parents did not provide consent for their child to undergo LP.

Conclusions
We found that most parents had little knowledge about LP, and the most common parental concern was paralysis. Despite this, in our study, only 5% of parents did not consent to LP.
Pediatric Malpractice Claims in the Emergency Department and Urgent Care Settings From 2001 to 2015
Authors: Glerum Kimberly M. , Selbst Steven M. , Parikh P. Divya , Zonfrillo Mark R. 
Published: September 2018

Objectives
This study aimed to provide an assessment of medical malpractice claims involving pediatric patients cared for in emergency department and urgent care settings.

Methods
We performed a retrospective review of all closed malpractice claims involving children (0–17 years old) originating from emergency department or urgent care centers from the Physician Insurers Association of America's Data Sharing Project database for a 15-year period (2001–2015). Reported data collected include medical specialty involved, medical diagnoses, chief medical factors, severity of resulting injury, claim disposition, average indemnity, and average defense costs.

Results
A total of 728 closed claims in pediatric emergency care settings were reviewed. Money was paid to the claimant in 30% of cases (220/728), with a total of US $70.3 million (average $319,513) paid to patients or families during the 15-year period. The most common resulting medical conditions were cardiac or cardiorespiratory arrest, appendicitis, and disorder of male genital organs. Error in diagnosis was the most common chief medical factor (41%), whereas those that involved failure or delay in admission to the hospital, which was the eighth most common chief medical factor, resulted in the highest average indemnity. Of the 728 closed claims, 220 involved a patient death (30%), but claims involving major permanent injury more often resulted in a payment. Of the 57 cases that went to trial, verdicts favored the physician in 47 cases (82%).

Conclusions
Cardiac conditions, appendicitis, and disorder of the male genital organs are the most common medical conditions, and error in diagnosis is the most common chief medical factor in pediatric emergency care malpractice suits. It is important for providers practicing in these settings to be familiar with the common diagnoses and chief medical factors involved in these claims.
Dental Abscess in Pediatric Patients
Authors: Jenkins Glyndwr W. , Bresnen Darren , Jenkins Elizabeth , Mullen Niall 
Published: September 2018

Objectives
Neglect is defined as the persistent failure to meet a child or young person's basic physical or psychological needs. Dental caries is explicitly mentioned in guidance on child maltreatment. We discuss the link between dental caries and child abuse in patients presenting to the emergency department.

Methods
A review of patient medical records was undertaken within the Paediatric Emergency Department at Sunderland Royal Hospital, with the aim to determine whether neglect was considered as a possible contributory factor when a child or young person presented at triage with an “oral cavity” problem.

Results
Of the applicable cases with inferences of possible safeguarding concerns, 13% had these concerns documented.

Conclusions
Child abuse recognition has become a prominent issue in recent years due to high profile cases. It is clear from this work, which resonates with the reported literature, that there is a lack of recognition of dental neglect being a possible indicator of more systemic abuse.
There is likely underreporting of these cases to the relevant authorities.
Utility of Chest Radiographs in Children Presenting to a Pediatric Emergency Department With Acute Asthma Exacerbation and Chest Pain
Authors: Majerus Chelsea R. , Tredway Trevor L. , Yun Nicole K. , Gerard James M. 
Published: September 2018

Objectives
Previous studies have not evaluated the utility of obtaining chest radiographs (CXR) in patients with acute asthma exacerbation reporting chest pain. The aims of this study were to evaluate the symptom of chest pain as a predictor for clinicians obtaining a CXR in these patients and to evaluate chest pain as a predictor of a positive CXR finding.

Methods
This was a retrospective chart review of patients, ages 2 to 18 years, presenting for acute asthma exacerbation to the emergency department from August 1, 2014, to March 31, 2016. Data collected included demographics, clinical data, provider type, and CXR results. Chest radiographs were classified as positive if they showed evidence of pneumonia, pneumothorax, or pneumomediastinum. Multivariate logistic regression models were developed with dependent variables of “obtaining a CXR” and “a positive CXR finding.”

Results
Seven hundred ninety-three subjects were included in the study. Two hundred thirty-one (29.1%) reported chest pain. Chest radiographs were obtained in 184 patients (23.2%). Of those, 74 patients (40.2%) had chest pain and 21 (11.4%) had a positive CXR. Providers were more likely to obtain CXRs in patients who reported chest pain (odds ratio = 2.2 [95% confidence interval = 1.5–3.2]). Patients reporting chest pain were more likely to have a positive CXR although this difference was not statistically significant (odds ratio = 2.0 [95% confidence interval = 0.7–5.6]).

Conclusions
Providers are more likely to obtain CXRs in asthmatic patients complaining of chest pain; however, these CXRs infrequently yield positive findings. This further supports limiting the use of chest radiography in patients with acute asthma exacerbation.
Trends in Head Computed Tomography Utilization in Children Presenting to Emergency Departments After Traumatic Head Injury
Authors: Ukwuoma Onyinyechi I. , Allareddy Veerajalandhar , Allareddy Veerasathpurush , Rampa Sankeerth , Rose Jerri A. , Shein Steven L. , Rotta Alexandre T. 
Published: September 2018

Objectives
Although closed head injuries occur commonly in children, most do not have a clinically important traumatic brain injury (ciTBI) and do not require neuroimaging. We sought to determine whether the utilization of computed tomography of the head (CT-H) in children presenting to an emergency department (ED) with a closed head injury changed after publication of validated clinical prediction rules to identify children at risk of ciTBI by the Pediatric Emergency Care Applied Research Network (PECARN).

Methods
We used the nationwide ED sample (2008–2013) to examine children visiting an ED after a mild closed head injury. Multiple patient and hospital characteristics were assessed.

Results
Of the 4,552,071 children presenting to an ED with a mild closed head injury, 1,181,659 (26.0%) underwent CT-H. Care was most commonly received at metropolitan teaching hospitals (43.5%) and varied markedly by geographic region. Overall, there were no significant changes in the nationwide rates of CT-H utilization in the period immediately after publication of the PECARN prediction rules. However, compared with metropolitan teaching hospitals, CT-H utilization increased significantly for patients treated at nonteaching hospitals and at nonmetropolitan hospitals.

Conclusions
There was no overall reduction in CT-H utilization after publication of the 2009 PECARN prediction rules. However, patients treated at metropolitan teaching hospitals were significantly less likely to undergo CT-H after 2009, suggesting some penetration of the PECARN tool in that setting. Further research should study patterns of CT-H utilization in nonteaching hospitals and nonmetropolitan hospitals to assess challenges for adoption of validated pediatric ciTBI prediction rules.
Priorities for Investing in Community Health Improvement: A Comparison of Decision Makers in Public Health, Nonprofit Hospitals, and Community Nonprofits
Authors: Rozier Michael D. , Singh Simone R. , Jacobson Peter D. , Prosser Lisa A. 
Published: September 2018

Context:
As a result of additional requirements for tax exemption, many nonprofit hospitals have become more actively involved in community health improvement. There is an open question, however, as to how decision makers in hospitals decide which kind of improvement projects should receive priority and how hospital managers' priorities compare with those of decision makers in public health agencies and community-based nonprofits.

Objective:
To understand the priorities that guide decision makers in public health, nonprofit hospitals, and community nonprofits when allocating resources to community health projects.

Design:
We conducted an online survey with a discrete choice experiment, asking respondents to choose between different types of community health projects, which varied along several project characteristics. Respondents included managers of community health and community benefit at nonprofit hospitals (n = 225), managers at local public health departments (n = 200), and leaders of community nonprofits (n = 136). Respondents were located in 47 of 50 US states. A conditional logit model was used to estimate how various project characteristics led to greater or lesser support of a given health project. Open-ended questions aided in interpretation of results.

Results:
Respondents from all 3 groups showed strong agreement on community health priorities. Projects were more likely to be selected when they addressed a health issue identified on community health needs assessment, involved cross-sector collaboration, or were supported by evidence. Project characteristics that mattered less included the time needed to measure the project's impact and the project's target population.

Conclusion:
Elements often considered central to community health, such as long-term investment and prioritizing vulnerable populations, may not be considered by decision makers as important as other aspects of resource allocation. If we want greater priority for ideas such as health equity and social determinants of health, it will take a concerted effort from practitioners and policy makers to reshape expectations.
The Public Face of Rhinoplasty: Impact on Perceived Attractiveness and Personality
Authors: Lu Stephen M. , Hsu David T. , Perry Adam D. , Leipziger Lyle S. , Kasabian Armen K. , Bartlett Scott P. , Thorne Charles H. , Broer P. Niclas , Tanna Neil 
Published: September 2018

Background:
The authors assess the impact of rhinoplasty on public perception of a patient’s appearance and personality.

Methods:
A survey was created using standardized before-and-after photographs of 10 Caucasian women who had undergone primary rhinoplasty. Photographs of two additional women who had not undergone facial surgery were randomly included as controls, for a total of 12 survey items. Preoperative and postoperative photographs were placed side by side. The survey was administered by means of crowd-sourcing. Respondents were asked to evaluate which photograph better represented 11 traits of appearance or personality, according to a seven-point Likert scale. A score of 1 meant the preoperative photograph was much better, 7 meant the postoperative photograph was much better, and 4 meant no difference. T tests and analyses of variance were used to evaluate rating changes for each trait and differences between demographic groups.

Results:
There were 264 responses received. Averaged scores across the 10 survey patients produced a value for each appearance or personality trait. In 10 of 11 categories (i.e., symmetry, youthfulness, facial harmony, likeability, trustworthiness, confidence, femininity, attractiveness, approachability, and intelligence), the postoperative photograph was significantly favorable compared with the preoperative photograph (p < 0.00001). The preoperative photograph was rated higher only in aggressiveness (p < 0.001). The same scores were calculated for the controls; no significant difference in any category was seen except confidence, where the right image was viewed as more confident (mean, 4.19; p < 0.005).

Conclusion:
Aesthetic rhinoplasty improves the public perception of a person’s appearance and personality in multiple aspects.
Current Approaches to Prepectoral Breast Reconstruction
Authors: Nahabedian Maurice Y. 
Published: September 2018

Summary:
Prepectoral prosthetic breast reconstruction has become an acceptable option for women following mastectomy. Benefits include no animation deformity, absence of pectoralis major muscle spasm, and less pain and discomfort. Important aspects of prepectoral reconstruction include working with breast surgeons that are adept at performing an optimal mastectomy. Tissue perfusion and reasonable thickness of the mastectomy are critical components of success. Tissue necrosis, infection, and delayed healing can lead to reconstructive failure. Given the risks and benefits of this procedure, questions regarding indications, patient selection, and specific details related to technique remain because there is no consensus. Whether it is safe to perform prepectoral reconstruction in obese or previously irradiated patients is controversial. The use of acellular dermal matrix is common but not universal. The amount of acellular dermal matrix used is variable, with success being demonstrated with the partial and total wrap techniques. Device selection can vary but is critical in the prepectoral setting. Postoperative care and the management of adverse events are important to understand and can impact surgical and aesthetic outcomes. This article provides current approaches, recommendations, and an algorithm for prepectoral breast reconstruction with an emphasis on patient selection, immediate versus delayed prepectoral reconstruction, specific technical details, and postoperative management.
Postoperative Ketorolac in Breast and Body Contouring Procedures: A Nationwide Claims Analysis
Authors: Kelley Brian P. , Chung Kevin C. , Chung Ting-Ting , Bennett Katelyn G. , Sacks Gina , Sears Erika D. , Waljee Jennifer F. 
Published: September 2018

Background:
Nonsteroidal antiinflammatory drugs are useful alternatives to narcotics for analgesia. However, concerns remain regarding their safety. The authors evaluated ketorolac use and complications. We hypothesized that no association between ketorolac and morbidity exists in patients undergoing body contouring.

Methods:
Truven MarketScan claims database was analyzed for patients undergoing breast and body contouring surgery. Patients selected received ketorolac and were enrolled a minimum of 90 days. The authors performed a multivariable logistic regression to calculate risk of morbidity, adjusting for clinical and sociodemographic factors.

Results:
Among the 106,279 patients enrolled, 4924 (4.6 percent) received postoperative ketorolac. In multivariable regression analysis, ketorolac was not associated with hematoma (OR, 1.20; 95 percent CI, 0.99 to 1.46; p > 0.05). There was an increased rate of reoperation within 72 hours (OR, 1.22; 95 percent CI, 1.00 to 1.49; p < 0.05; number needed to harm, 262 patients). Ketorolac was associated with fewer readmissions (OR, 0.76; 95 percent CI, 0.62 to 0.93; p < 0.05; number needed to treat, 87 patients), with a reduction in the rate of pain as a readmission diagnosis (0.6 percent versus 4.3 percent; p = 0.021). Ketorolac was associated with seroma, but this association may not be causal (OR, 1.28; 95 percent CI, 1.05 to 1.57; p < 0.05; number needed to harm, 247 patients). Ketorolac provided an estimated savings of $157 per patient.

Conclusions:
The benefits of ketorolac likely outweigh the risks after surgery. Absolute differences in reoperation rates were low, and improved rates of hospital admission impact cost savings. The authors advocate postoperative ketorolac once the wound is hemostatic.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.