bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sedoanalgesia With Ketamine in the Emergency Department
Authors: Molina Gutiérrez Miguel Angel , Fernández Camuñas María , Ruíz Domínguez Jose Antonio , Bueno Barriocanal Marta , De Miguel Lavisier Begoña , López López Rosario , de Ceano-Vivas La Calle María 
Published: May 2024

Objective
Ketamine is a safe and widely used sedative and analgesic in children. The purpose of this study is to evaluate the response to sedoanalgesia for painful procedures in the pediatric emergency department.

Methods
A retrospective study was conducted in children younger than 16 years who underwent painful procedures with intravenous/intranasal ketamine between January 2016 and December 2022. We collected demographic variables, effectiveness, route of administration, indication, dose, sedation strategy, duration of procedure, and associated adverse effects.

Results
A total of 671 ketamine sedation procedures (411 males/260 females) were included, with a mean age of 7.2 years. Closed reduction was the most common painful procedure (53.8%), followed by burn healing (24.6%). Ketamine was administered intravenously in 93.4% of procedures and intranasally in 6.6%. The result of sedoanalgesia was satisfactory in 84.9% and unsatisfactory in 15.1%. The percentage of cases with unsatisfactory analgesia was higher with intranasal administration (36.4%; P < 0.001). In the intravenous group, the percentage of cases with unsatisfactory effectiveness (28.7%) was higher for patients younger than 2 years of age (P < 0.001). Arthrocentesis procedures were associated with the highest percentage of unsatisfactory sedoanalgesia failures among patients receiving intravenous ketamine (39.3%; P < 0.001). Intranasal ketamine patients who received a dose between 3.6 and 4 mg/kg had a significantly higher percentage of unsatisfactory sedoanalgesia (66.7%; P = 0.048). Patients receiving intravenous ketamine had significantly higher rates of unsatisfactory sedoanalgesia when the initial dose interval was 1.6 to 2 mg/kg (11.8%; P = 0.002) and when the final total dose was also 1.6 to 2 mg/kg (17.6%; P = 0.002).

Conclusions
This study concludes that intravenous/intranasal ketamine can provide safe and successful analgesia in pediatric patients in the ED. At intravenous doses of 1–1.5 mg/kg, good effectiveness was achieved in almost 90% of cases. Arthrocentesis had the highest percentage of unsatisfactory results. Repeat dosing should be considered for procedures longer than 20 minutes.
Point-of-Care Ultrasound for Pediatric Vaginal Obstruction in the Emergency Department
Authors: Sosa Philip , Tsung James W. , Firnberg Maytal 
Published: May 2024

Abstract
Point-of-care ultrasound can be an effective tool to facilitate the evaluation of abdominal and pelvic pain in children. We present a series of 3 pediatric patients with nonspecific abdominal and pelvic symptoms in whom point-of-care ultrasound expedited diagnosis, guided decision-making, prompted subspecialist consultation, and led to definitive management of vaginal obstruction.
The Development of a Combined Pediatric Emergency Medicine and Point-of-Care Ultrasound Curriculum
Authors: Budnik Elizabeth , Klekowski Nicole , Carney Michele , Tucker Ryan 
Published: May 2024

Abstract
Point-of-care ultrasound (POCUS) use has grown rapidly in the field of pediatric emergency medicine (PEM). Despite its growth, there continues to be a need for leaders in PEM POCUS to support ongoing education and advancement of providers within this field. We have developed a novel combined PEM POCUS fellowship that has successfully produced one graduate and a second will graduate in June 2023. We describe the implementation of this model as a potential option that institutions could use as a framework to support other trainees. This could alleviate some barriers for future trainees who seek advanced POCUS training and advance this growing field.
A Nomogram Prediction Model for Persistent Pulmonary Hypertension of the Newborn in Neonates Hospitalized for the First Time After Birth
Authors: Zhang Yan , Wen Juan , Zeng Min , Zhang Limei , Pang Yusheng 
Published: May 2024

Objective
Persistent pulmonary hypertension of the newborn (PPHN) is one of the critical neonatal diseases associated with high morbidity and mortality. This study attempted to conduct a nomogram prediction model for performing early identification of PPHN and providing effective information for clinical practice.

Methods
A total of 456 newborns who first admitted to the hospital after birth were included in the analysis, including 138 newborns with PPHN and 318 newborns without PPHN (as controls). The optimal predictive variables selection was performed based on LASSO (least absolute shrinkage and selection operator) regression and multivariate logistic regression. Using the selected variables, a nomogram prediction model was developed. To validate the model, the model was assessed using the receiver operating characteristic curve, calibration plot, and clinical impact curve.

Results
Six predictors, namely, gestational age, neonatal respiratory distress syndrome, the levels of hemoglobin and creatine kinase-MB, gestational thyroid dysfunction, and Pao
2, were identified by LASSO and multivariate logistic regression analysis from the original 30 variables studied. The constructed model, using these predictors, exhibited favorable predictive ability for PPHN, with an area under the receiver operating characteristic of 0.897 (sensitivity = 0.876, specificity = 0.785) in the training set and 0.871 (sensitivity = 0.902, specificity = 0.695) in the validation set, and was well calibrated, as indicated by the P
Hosmer-Lemeshow test values of 0.233 and 0.876 for the training and validation sets, respectively.

Conclusions
The model included gestational age, neonatal respiratory distress syndrome, the levels of hemoglobin and creatine kinase-MB, gestational thyroid dysfunction, and Pao
2 had good prediction performance for predicting PPHN among newborns first admitted to the hospital after birth.
Unveiling the Dark Side of Datura in Pediatric Poisoning With Insights From Jordanian Experience
Authors: Tarawneh Amjad , Nafi Omar , Abdelfattah Abedulrhman S. , Al-Tawarah Nafe M. 
Published: May 2024

Objectives

Datura stramonium, jimsonweed, is a toxic plant with hallucinogenic properties. Although there are many studies on Datura poisoning, none reported cases in Jordan. This study offers a comprehensive review on D. stramonium ingestion, covering its epidemiology, clinical presentation, and treatment. We aimed to provide better understanding of the factors for Datura ingestion, identify prevention and management strategies, and address research challenges.

Methods
This study adopted a retrospective review design to evaluate the cases of Datura poisoning in Al Karak, province of Jordan during the spring of 2022. Data collected from medical records, toxicology databases, and consultation records were analyzed using descriptive statistics.

Results
The common symptoms of Datura poisoning included agitation, mydriasis, and tachycardia. The management approaches comprised supportive care, administration of Diazepam for agitation, and, in some cases, neostigmine to counteract anticholinergic effects.

Conclusions
Understanding the risks associated with D. stramonium poisoning and implementing effective prevention and management strategies are crucial. This study highlights the importance of recognizing Datura poisoning as a potential diagnosis in children presenting with unexplained anticholinergic symptoms or agitation to the emergency room.
The Association Between Early Initiation of Systemic Corticosteroids and the Hospital Length of Stay in Patients With Multisystem Inflammatory Syndrome in Children
Authors: Reynolds-Herbst Torrie , Lowe David , Lozano Juan M. , Maniaci Vincenzo 
Published: May 2024

Objective
Patients with multisystem inflammatory syndrome in children (MIS-C) often require hospital admission. Treatment of MIS-C has included intravenous immunoglobulin, systemic corticosteroids, and/or immunomodulators. There is no standardized approach to when steroids should be initiated during treatment. The study objective was to determine whether early initiation of steroids in patients with MIS-C is associated with the duration of hospital length of stay (LOS).

Methods
This is a single-center retrospective cohort study of patients younger than 21 years who were hospitalized with MIS-C between March 2020 and September 2021 and received steroids. Cases were obtained from an institutional MIS-C log. Patients with culture proven sepsis and/or those who received intravenous immunoglobulin or steroids within the previous 30 days were excluded. We used a multivariable linear regression model, controlling for potential confounders, to assess the association between early steroids and LOS.

Results
A total of 56 patients hospitalized with MIS-C were identified; 38 received systemic corticosteroids and were included in the study. The mean time from admission to steroid administration was 9.8 hours (SD = 7.7) in the early group and 44.6 hours (SD = 14.2) in the late group. There was a statistically significant difference in baseline characteristics of patients receiving early versus late steroids in initial C-reactive peptide, procalcitonin, brain natriuretic peptide, and cardiac dysfunction. After controlling for confounders, initiating steroids within 24 hours of admission for MIS-C was associated with a decreased hospital LOS: in patients treated with early steroids, LOS was 58.3 hours less (95% confidence interval, −100.0 to −16.6; P = 0.007) than in those who received late steroids.

Conclusions
Among patients with MIS-C, initiating systemic corticosteroids within 24 hours of admission was associated with decreased hospital LOS.
Diphenhydramine and Migraine Treatment Failure in Pediatric Patients Receiving Prochlorperazine
Authors: Naeem Sobia , Lozano Juan M. , Ruiz Castaneda Ana Maria , Lowe David 
Published: May 2024

Objectives
The objectives are to determine whether diphenhydramine coadministered with prochlorperazine versus prochlorperazine only is associated with a difference in the risk of migraine treatment failure, as measured by the need for additional therapy, hospitalization rates, and 72-hour return rates, and to compare extrapyramidal adverse effects between groups.

Methods
Retrospective cohort of patients aged 7 to 18 years treated in the emergency department for migraines using prochlorperazine with or without diphenhydramine between 2013 and 2019. Patients were included if they had International Classification of Diseases, Ninth or Tenth Revision, codes for migraine or unspecified headache and were treated with prochlorperazine as part of their initial migraine therapy. Data collected included demographics, medications administered, pain scores, neuroimaging, disposition, return visits, and documentation of extrapyramidal adverse effects. Multivariable logistic regression was used to estimate the association between diphenhydramine coadministration and each of the outcomes.

Results
A total of 1683 patients were included. Overall, 13% required additional therapy with a 16.7% admission rate and a 72-hour return rate of 5.3%. There was no association between initial treatment with diphenhydramine and the odds of additional therapy (adjusted odds ratio [aOR], 0.74 [95% confidence interval {CI}, 0.53–1.03]), admission rates (aOR, 1.22 [95% CI, 0.89–1.67]), or return visit rates (aOR, 0.91 [95% CI, 0.55–1.51]). Extrapyramidal adverse effects occurred in 2.4% of patients in the prochlorperazine group and 0% in the prochlorperazine with diphenhydramine group.

Conclusions
There was no association between diphenhydramine coadministration and the need for additional therapy, 72-hour return visit rates or admission rates. Extrapyramidal effects did not occur in patients treated with diphenhydramine.
Primary Care Enhanced Access Services and the Association With Nonurgent Pediatric Emergency Department Utilization and Child Opportunity Index
Authors: Hincapie Mark Ryan , Corbera-Hincapie Montserrat A. , Suresh Srinivasan , Alston Kaila , Butler Gabriella , Fabio Anthony , Ray Kristin N. 
Published: May 2024

Objectives
This study aims to examine the association between primary care practice characteristics (enhanced access services) and practice-level rates of nonurgent emergency department (ED) visits using ED and practice-level data. Survey data suggest that enhanced access services within a child's primary care practice may be associated with reduced nonurgent ED visits.

Methods
We performed a cross-sectional analysis of nonurgent ED visits to a tertiary pediatric hospital in Western Pennsylvania with nearly 85,000 annual ED visits. We obtained patient encounter data of all nonurgent pediatric ED (PED) visits between January 2018 and December 2019. We identified the primary care provider at the time of the study period. For each of the 42 included offices, we determined the number of unique children in the office with a nonurgent PED visit, allowing us to determine the percentage of children in the practice with such a visit during the study period. We then stratified the 42 offices into low, intermediate, and high tertiles of nonurgent PED use. Using Kruskal-Wallis tests, logistic regression, and Pearson χ2 tests, we compared practice characteristics, enhanced access services, practice location Child Opportunity Index 2.0, and PED visit diagnoses across tertiles.

Results
We examined 52,459 nonurgent PED encounters by 33,209 unique patients across 42 outpatient offices. Primary care practices in the lowest ED visit tertile were more likely to have 4 or more evenings with office hours (36% vs 14%, P = 0.04), 4 or more evenings of weekday extended hours (43% vs 14%, P = 0.05), and at least 1 day of any weekend hours (86% vs 29%, P = 0.01), compared with practices in other tertiles. High PED use tertile offices were also associated with lower Child Opportunity Index scores.

Conclusions
Primary care offices with higher nonurgent PED utilization had fewer enhanced access services and were located in neighborhood with fewer child-focused resources.
Reliability and Safety of the Superthin Anterolateral Thigh Flap: Evaluating Perfusion-Related Complications and Donor Morbidity
Authors: Yoo Kyung-Eun , Kim Da Eun , Lee Kyeong-Tae 
Published: May 2024

Background:
With an increasing need for thin flaps, the use of superthin anterolateral thigh (ALT) flaps, raised above the supra-superficial fascia, has drawn great attention. Controversy remains regarding whether such thin-flap elevation could affect postoperative outcomes, encompassing perfusion-related complications (PRCs) and donor-site morbidity. This study aimed to evaluate the outcomes of superthin ALT flap–based reconstruction compared with those of suprafascially elevated flaps.

Methods:
Patients who underwent free ALT flap–based reconstruction between March of 2017 and June of 2023 were reviewed and categorized into 2 groups based on flap elevation plane: superthin or suprafascial. Development of PRC and donor-site morbidity, including paresthesia, was compared. Independent associations of the elevation plane with complication profiles were evaluated. Further analyses were conducted using propensity score matching.

Results:
In total, 208 cases were analyzed: 80 superthin and 128 suprafascial ALT flaps. Nineteen cases (9.1%) experienced PRC, including 4 total and 14 partial necrosis. The incidence of overall and each type of PRC did not differ based on flap elevation plane even after adjusting for other variables. The superthin group exhibited significantly lower donor-site complications compared with the others, which was upheld in multivariable analyses. Elevating the flaps in a superthin fashion allowed for a higher rate of preservation of the lateral femoral cutaneous nerve, resulting in a significantly lower rate of postoperative paresthesia. Similar associations were observed in the propensity score matching analysis.

Conclusion:
Superthin ALT flap elevation does not appear to increase PRC risk and reduces donor-site complications, compared with suprafascial elevation.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Long-Term Outcomes of Regional Morphology in Spring-Assisted Surgery and Cranial Vault Remodeling
Authors: Dunson Blake T. , Bins Griffin P. , Layton Ryan G. , Zhou Larry , Kogan Samuel , Zeng Eric , Couture Daniel E. , David Lisa R. , Runyan Christopher M. 
Published: May 2024

Background:
Spring-assisted surgery (SAS) and cranial vault remodeling (CVR) are widely used surgical techniques to correct sagittal craniosynostosis (SC). The authors evaluated changes in regional morphology of patients with SC who had undergone SAS or CVR, using the frontal bossing index (FBI), occipital bulleting index, vertex narrowing index (VNI), and scaphocephalic severity index (SCI) to capture differences in anterior protrusion, posterior protrusion, width restriction, and global dysmorphology, respectively.

Methods:
Indices were measured on computed tomography and 3-dimensional photographs (n = 788) of 257 patients with SC from 2001 through 2022 who underwent SAS (n = 177) or CVR (n = 80). Short-term and long-term outcomes were evaluated.

Results:
Mean age at time of surgery was older in the CVR cohort (CVR, 22.55 ± 16.00 years; SAS, 4.56 ± 2.24 years) (P < 0.05). Before surgery, the SAS cohort had more severe regional dysmorphology in FBI, VNI, and SCI (P < 0.05) relative to the CVR cohort. Frontal bossing consistently improved over time in both cohorts. Head width improved as soon as 0 to 6 months postoperatively (P < 0.05), but it consistently regressed after the initial improvement in both cohorts. Global head shape initially improved in the CVR cohort but regressed over time. In contrast, patients in the SAS group maintained improvements in SCI over time, with significantly better percentage change in every age interval (P < 0.05).

Conclusions:
The FBI, occipital bulleting index, VNI, and SCI are useful tools for monitoring head shape and growth. SAS and CVR achieve similar morphologic outcomes, despite more severe preoperative morphology in the SAS group. Trending index changes with growth between the 2 cohorts suggest improved longevity of correction in the SAS group.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
An Interdisciplinary Multimodal Integrative Healthcare Program for Chronic Spinal Pain and Comorbid Mental Disorders
Authors: Wijnen Jaap , Geijselaers Marciano Wilhelmina Henricus , Pont Marc Lucas , van‘t Hullenaar Geert , Van Oosterwijck Jessica , de Jong Jeroen 
Published: May 2024

ABSTRACT

Objective
Previous studies evaluating interdisciplinary multimodal interventions for chronic spinal pain often excluded patients with comorbid mental disorders. This study aims to assess the effectiveness of an outpatient secondary care interdisciplinary multimodal integrative healthcare program for individuals experiencing co-occurring chronic spinal pain and mental disorders.

Methods
Participants were 944 patients with chronic spinal pain and comorbid mental disorders. Primary outcomes were health-related quality of life, assessed using the Research and Development-36 (RAND-36), and pain-related disability, assessed using the Quebec Back Pain Disability Scale (QBPDS). Secondary outcomes included pain intensity, pain catastrophizing, kinesiophobia, fatigue, lumbar mobility, and isometric strength. Data were collected during the healthcare program at four time points: pretreatment (T0), midway through 20-week treatment (T1), end of 20-week treatment (T2), and at completion of 12-month relapse prevention program (T3). Multilevel regression analyses were conducted to examine the effects of the healthcare program on primary outcomes over time.

Results
The 20-week treatment period yielded significant improvements in both mental (B = 0.44, t(943) = 19.42, p < .001) and physical component summary scores (B = 0.45, t(943) = 18.24, p < .001) of the RAND-36, as well as in QBPDS total score (B = −0.77, t(943) = −26.16 p < .001). Pretreatment scores indicated the presence of problematic fatigue, kinesiophobia, and clinical levels of pain catastrophizing, all of which resolved by the end of the 12-month relapse prevention program.

Conclusions
An interdisciplinary multimodal integrative healthcare program seems effective for patients with chronic spinal pain and comorbid mental disorders.
Paucity of Online Information About Gender-Affirming Surgery Fellowships in the United States
Authors: Lin Elaine , Tian William M. , Harris Raiven , Patel Ashit , Rezak Kristen M. 
Published: May 2024

Background
Despite growing demand for gender-affirming surgery (GAS), there are few formal GAS fellowships in the United States. Paucity of online information about GAS fellowships may discourage potential applicants and decrease the visibility of the field. Thus, it is important to analyze the existing online information about GAS fellowships to improve fellow recruitment and patient outcomes.

Objective
To identify the number of GAS fellowship websites (GASFWs) and evaluate their robustness. Second, to report the social media presence of GAS fellowships.

Methods
To identify GASFWs, existing databases sponsored by plastic surgery associations and Google query were used between April and May 2023. Thirty-five independent variables based on previously published data were evaluated for presence in a bivariate fashion on GASFWs. Accounts on popular social media websites were also identified by Google query. Website and social media analysis were also done for GAS fellowships that were offered by departments/specialties other than plastic surgery.

Results
In total, only 6 GASFWs associated with plastic surgery departments were identified and analyzed. Eight nonplastic surgery GASFWs were included for analysis. Overall, both categories of GASFWs were not robust; key information such as previous fellow listing and selection criteria was often missing. Furthermore, important topics specifically related to GAS such as community engagement and programmatic building are often not found on GASFWs either. In addition, none of the fellowships had any independent Facebook, Instagram, or Twitter.

Conclusions
To ensure patient safety and quality outcomes, it is important to promote GAS by recruiting more applicants for specialized training beyond residency. With increased Internet use, improving GASFWs and social media presence as well as considering the use of a centralized database or match system can foster the growth of the field.
Timing of Autologous Tissue Breast Reconstruction Does Not Affect Free Flap Failure
Authors: Kalmar Christopher L. , Montorfano Lisandro , Thayer Wesley P. , Kassis Salam , Higdon Kent K. , Perdikis Galen 
Published: May 2024

Abstract
This study aimed to determine whether there is a difference in free flap failure based on the decision to undergo immediate versus delayed autologous tissue breast reconstruction after mastectomy. The National Surgical Quality Improvement Program database was queried for breast free flap procedures performed between 2015 and 2020. This study demonstrates that the decision to undergo immediate versus delayed autologous tissue breast reconstruction does not have a significant association with free flap failure. This remains true regardless of whether patients undergo unilateral mastectomy with reconstruction or whether patients choose to also undergo contralateral prophylactic mastectomy with reconstruction.