bluuebunny/crossref_metadata_2025_split huggingface dataset:
Plasma and Platelet Transfusion Strategies in Critically Ill Children Following Noncardiac Surgery and Critically Ill Children Undergoing Invasive Procedures Outside the Operating Room: From the Transfusion and Anemia EXpertise Initiative–Control/Avoidance of Bleeding
Authors: Tucci Marisa , Crighton Gemma , Goobie Susan M. , Russell Robert T. , Parker Robert I. , Haas Thorsten , Nellis Marianne E. , Vogel Adam M. , Lacroix Jacques , Stricker Paul A. ,   for the Pediatric Critical Care Transfusion and Anemia EXpertise Initiative–Control/Avoidance of Bleeding (TAXI-CAB), in collaboration with the Pediatric Critical Care Blood Research Network (BloodNet), and the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network
Published: January 2022

Objectives:
To present consensus statements and supporting literature for plasma and platelet transfusions in critically ill children following noncardiac surgery and critically ill children undergoing invasive procedures outside the operating room from the Transfusion and Anemia EXpertise Initiative - Control/Avoidance of Bleeding.

Design:
Systematic review and consensus conference of international, multidisciplinary experts in platelet and plasma transfusion management of critically ill children.

Setting:
Not applicable.

Patients:
Critically ill children undergoing invasive procedures outside of the operating room or noncardiac surgery.

Interventions:
None

Measurements and Main Results:
A panel of 10 experts developed evidence-based and, when evidence was insufficient, expert-based statements for plasma and platelet transfusions in critically ill children following noncardiac surgery or undergoing invasive procedures outside of the operating room. These statements were reviewed and ratified by the 29 Transfusion and Anemia EXpertise Initiative–Control/Avoidance of Bleeding experts. A systematic review was conducted using MEDLINE, EMBASE, and Cochrane Library databases, from inception to December 2020. Consensus was obtained using the Research and Development/University of California, Los Angeles Appropriateness Method. Results were summarized using the Grading of Recommendations Assessment, Development, and Evaluation method. We developed eight expert consensus statements focused on the critically ill child following noncardiac surgery and 10 expert consensus statements on the critically ill child undergoing invasive procedures outside the operating room.

Conclusions:
Evidence regarding plasma and platelet transfusion in critically ill children in this area is very limited. The Transfusion and Anemia EXpertise Initiative–Control/Avoidance of Bleeding Consensus Conference developed 18 pediatric specific consensus statements regarding plasma and platelet transfusion management in these critically ill pediatric populations.
Virtual Developmental Screening After Invasive Mechanical Ventilation in Children: A Prospective Cohort Pilot Study
Authors: Bartel Nicholas J. , Boyle David W. , Hines Abbey C. , Tomlin Angela M. , Nitu Mara E. , Szczepaniak Dorota , Abu-Sultaneh Samer M. A. 
Published: January 2022

OBJECTIVES:
With decreasing PICU mortality, survivor morbidity has increased. This study aims to evaluate feasibility of virtual PICU-led follow-up of patients at risk for pediatric postintensive care syndrome.

DESIGN:
Prospective cohort study.

SETTING:
Single-center, quaternary children’s hospital.

PATIENTS:
Children less than or equal to 4 years without known preexisting neurodevelopmental deficits requiring greater than or equal to 12 hours mechanical ventilation.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
Age-appropriate Ages and Stages Questionnaires, Third Edition (ASQ-3) were administered via a web-based system at 3, 6, and 12 months following PICU discharge. Primary-care physicians were notified of results; at-risk patients were referred to early developmental intervention. Forty-eight patients enrolled with median age 11.5 months (interquartile range [IQR], 2–19.5 mo) and median mechanical ventilation duration 92.5 hours (IQR, 40.5–147 hr). Fifty-eight percent completed greater than or equal to 1 ASQ-3. Lower caregiver educational achievement, lower income, and single-caregiver status were associated with lower ASQ-3 completion rates. Of those completing any ASQ-3, 50% flagged as at-risk for developmental delay and referred to early developmental intervention. There was no association between patient characteristics and abnormal ASQ-3.

CONCLUSIONS:
Virtual caregiver-completed surveillance is a promising method to screen children for neurodevelopmental abnormalities following PICU hospitalization and facilitate early referral for developmental intervention, but special attention must be dedicated to families with limited resources for follow-up.
Weaning Dexmedetomidine in Non-ICU Areas: An Implementation Effort
Authors: Solodiuk Jean C. , Sweet Erin , Greco Christine , Manzi Shannon F. , Giangregorio Maeve , Homoki Adam , Li Liza , Mansfield Laura , Mahoney Judy , Kleinman Monica E. 
Published: January 2022

OBJECTIVES:
To develop and implement clinical practice guidelines for safely weaning dexmedetomidine infusions in non-ICU areas.

DESIGN:
Development, implementation, and analysis of effectiveness of clinical practice guidelines.

SETTING:
Quaternary care academic free-standing pediatric hospital.

PATIENTS:
Children, otherwise medically ready for transfer to non-ICU areas, who were undergoing a planned wean of a dexmedetomidine infusion.

INTERVENTIONS:
Subject matter experts developed evidence-based guidelines for weaning dexmedetomidine in patients whose critical phase of illness had resolved.

MEASUREMENTS AND MAIN RESULTS:
Searches identified no prospective studies of dexmedetomidine weaning. We identified two retrospective reviews of withdrawal symptoms and one on the use of clonidine. There were case studies on withdrawal symptoms. Guidelines were piloted on a cohort of 24 patients while in the ICU. The guidelines were then implemented in non-ICU areas for patients undergoing dexmedetomidine weaning after ICU transfer. Over a 2-year period (October 1, 2018, to September 30, 2020), 63 patients (1 mo to 18 yr old) successfully weaned dexmedetomidine in non-ICU areas. The median time to discontinuation of dexmedetomidine after transfer to non-ICU areas was 5.8 days (interquartile range, 4.75–15 d). Fifty-eight percent (n = 41) of all patients were considered high risk for dexmedetomidine withdrawal based on the dose, duration of exposure, and the risk of experiencing physiologic detriment with more than mild withdrawal. Twenty-nine patients (46%) exhibited no signs or symptoms of withdrawal while weaning per guidelines. For those with signs and symptoms of withdrawal, the most common were tachycardia (n = 26, 40%), agitation (n = 9, 14%), and hypertension (n = 9, 11%).

CONCLUSIONS:
Weaning dexmedetomidine in non-ICU areas is feasible and can be accomplished safely even among pediatric patients at high risk for withdrawal using standardized weaning guidelines. At our institution, implementation was associated with reduced ICU length of stay for patients recovering from critical illness.
Balanced Versus Unbalanced Fluid in Critically Ill Children: Systematic Review and Meta-Analysis*
Authors: Lehr Anab Rebecca , Rached-d’Astous Soha , Barrowman Nick , Tsampalieros Anne , Parker Melissa , McIntyre Lauralyn , Sampson Margaret , Menon Kusum 
Published: January 2022

OBJECTIVES:
The ideal crystalloid fluid bolus therapy for fluid resuscitation in children remains unclear, but pediatric data are limited. Administration of 0.9% saline has been associated with hyperchloremic metabolic acidosis and acute kidney injury. The primary objective of this systematic review was to compare the effect of balanced versus unbalanced fluid bolus therapy on the mean change in serum bicarbonate or pH within 24 hours in critically ill children.

DATA SOURCES:
We searched MEDLINE including Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Embase, CENTRAL Trials Registry of the Cochrane Collaboration, ClinicalTrials.gov, and World Health Organization International Clinical Trials Registry Platform.

STUDY SELECTION:
Using the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols guidelines, we retrieved all controlled trials and observational cohort studies comparing balanced and unbalanced resuscitative fluids in critically ill children. The primary outcome was the change in serum bicarbonate or blood pH. Secondary outcomes included the prevalence of hyperchloremia, acute kidney injury, renal replacement therapy, and mortality.

DATA EXTRACTION:
Study screening, inclusion, data extraction, and risk of bias assessments were performed independently by two authors.

DATA SYNTHESIS:
Among 481 references identified, 13 met inclusion criteria. In the meta-analysis of three randomized controlled trials with a population of 162 patients, we found a greater mean change in serum bicarbonate level (pooled estimate 1.60 mmol/L; 95% CI, 0.04–3.16; p = 0.04) and pH level (pooled mean difference 0.03; 95% CI, 0.00–0.06; p = 0.03) after 4–12 hours of rehydration with balanced versus unbalanced fluids. No differences were found in chloride serum level, acute kidney injury, renal replacement therapy, or mortality.

CONCLUSIONS:
Our systematic review found some evidence of improvement in blood pH and bicarbonate values in critically ill children after 4–12 hours of fluid bolus therapy with balanced fluid compared with the unbalanced fluid. However, a randomized controlled trial is needed to establish whether these findings have an impact on clinical outcomes before recommendations can be generated.
Inpatient Early Intervention for Serious Mental Illnesses Is Associated With Fewer Rehospitalizations Compared With Treatment as Usual in a High-volume Public Psychiatric Hospital Setting
Authors: Warner Alia R. , Lavagnino Luca , Glazier Stephen , Hamilton Jane E. , Lane Scott D. 
Published: January 2022

Objective:
High-acuity publicly funded inpatient psychiatric settings usually feature short lengths of stay and high readmission rates. This study examined the influence of an early intervention program for serious mental illnesses (SMI) on readmissions at 6 and 12 months postdischarge at a high-volume, urban public inpatient psychiatric hospital.

Methods:
The Early Onset Treatment Program (EOTP) is a cost-free, 90-day inpatient multidisciplinary service intervention program for uninsured patients who are within 5 years of SMI onset, funded as a pilot program by the Texas state legislature. Rehospitalization rates at 6 and 12 months were extracted from electronic medical records for EOTP participants (n=165) and comparison patients matched on demographics and diagnosis (n=155). The comparison group received treatment as usual at the same psychiatric hospital. Group re-admission rates were compared using logistic and Poisson regression analyses.

Results:
Group membership was a significant predictor of rehospitalization (P<0.0001) at both 6 and 12 months. Expressed as 1/odds ratio (OR), the EOTP group was less likely to readmit once and more than once at 6 months postdischarge (1/OR=3.82 and 4.74, respectively) compared with the non-EOTP group. The EOTP group was also less likely to readmit once and more than once at 12 months postdischarge (1/OR=2.96 and 3.51, respectively).

Conclusions:
The results suggest that participation in the EOTP service in this high-acuity setting was significantly related to reduced likelihood of rehospitalization at 6 and 12 months. Several variables may account for this observation, including length of stay, longer medication adherence, environmental stability, and more individualized and extensive psychotherapy treatment.
Utility of Nipple Markers in the Era of Digital Imaging
Authors: Lee Elizabeth , Sayyouh Mohamed , Aslam Anum , Sella Edith , Kazerooni Ella , Agarwal Prachi 
Published: January 2022

Purpose:
Nipple markers maybe used to decrease the recall of patients undergoing chest radiography by aiding in distinguishing between a nipple shadow and lung nodule. We evaluated the use of digital chest radiographs in clinical practice including accuracy of placement and markers that do not contribute to interpretation (ie, projected outside the lung fields). We also evaluated the recall rate for additional imaging in patients who received nipple markers compared to those who did not.

Material and Methods:
In this Institutional Review Board approved retrospective study, 1000 consecutive outpatient frontal and lateral chest radiographs performed in 2018 for which nipple markers were provided to patients formed the study group. Three cardiothoracic radiologists evaluated the images for the presence of markers and accuracy of placement. The recall rate was calculated over a 3-year period from March 21, 2016 and March 21, 2019.

Results:
One or both markers were missing without an explanation (such as mastectomy), misplaced or outside the lung fields in 57.8% (578/1000) of studies. The 3-year recall rate for all chest radiographs was very low (0.03%; 42/135,792) and was lower for patients provided nipple markers (0.007%; 5/62,587) than those who were not (0.05%; 37/73,205) (P<0.001).

Conclusions:
The low overall recall rate and high prevalence of inaccurate marker placement or markers that do not contribute to interpretation (ie, outside the lung fields) does not justify the routine use of nipple markers for chest radiography.
Significance of Right-to-Left Ventricular Ratio as a Quantitative Computed Tomography Biomarker in Patients With Negative Computed Tomography Pulmonary Angiograms
Authors: Tang Anji , Hunsaker Andetta , Hammer Mark 
Published: January 2022

Purpose:
The purpose of our study was to determine if the ratio of right–to-left ventricular diameter (RV/LV ratio) on computed tomography (CT) pulmonary angiograms (CTPA) is predictive of 90-day mortality in patients without pulmonary embolism (PE).

Materials and Methods:
This Institutional Review Board-approved single-institution retrospective study was performed on patients who underwent CTPA in the emergency or inpatient setting over a 1-year period. Right and left ventricular diameters were measured and RV/LV ratios calculated for patients without acute PE. Ratios greater than or equal to 0.9 were considered abnormal. Univariate analysis was performed for the outcome of death within 90 days of CT. Multivariable analysis was also performed to control for age, sex, and lung disease.

Results:
Of the 423 patients included in the study, 55 patients died within 90 days of CT. An RV/LV ratio ≥0.9 was predictive of 90-day mortality: of the 226 patients with RV/LV ≥0.9, 42 (18.6%) died within 90 days, compared with 13 of 197 patients without abnormal ratio (6.6%), with odds ratio (OR) of 3.23 (95% confidence interval [CI]: 1.68-6.22; P<0.01). In multivariate analysis, RV/LV ratio had an OR of 5.19 per unit increase (95%CI: 1.06-25.42; P=0.04); age had an OR of 1.04 per year increase (95% CI: 1.01-1.06; P<0.01).

Conclusion:
Increased RV/LV ratio is a negative prognostic factor even in patients without acute PE and may be a useful CT biomarker to include in radiology reports for all patients undergoing CTPA.
Computed Tomography-derived Characterization of Pericoronary, Epicardial, and Paracardial Adipose Tissue and Its Association With Myocardial Ischemia as Assessed by Computed Fractional Flow Reserve
Authors: Duncker Hendrik , Achenbach Stephan , Moshage Maximilian , Dey Damini , Bittner Daniel O. , Ammon Fabian , Marwan Mohamed , Goeller Markus 
Published: January 2022

Background:
Increased pericoronary adipose tissue (PCAT) attenuation derived from coronary computed tomography (CT) angiography (CTA) relates to coronary inflammation and cardiac mortality. We aimed to investigate the association between CT-derived characterization of different cardiac fat compartments and myocardial ischemia as assessed by computed fractional flow reserve (FFRCT).

Methods:
In all, 133 patients (median 64 y, 74% male) with coronary artery disease (CAD) underwent CTA including FFRCT measurement followed by invasive FFR assessment (FFRINVASIVE). CT attenuation and volume of PCAT were quantified around the proximal right coronary artery (RCA), left anterior descending artery (LAD), and left circumflex artery (LCX). Epicardial adipose tissue (EAT) and paracardial adipose tissue (PAT; all intrathoracic adipose tissue outside the pericardium) were quantified in noncontrast cardiac CT datasets.

Results:
Median FFRCT was 0.86 [0.79, 0.91] and median FFRINVASIVE was 0.87 [0.81, 0.93]. Subjects with the presence of myocardial ischemia (n=26) defined by an FFRCT-threshold of ≤0.75 showed significantly higher RCA PCAT attenuation than individuals without myocardial ischemia (n=107) (−75.1±10.8 vs. −81.1±10.6 HU, P=0.011). In multivariable analysis adjusted for age, body mass index, sex and risk factors, increased RCA PCAT attenuation remained a significant predictor of myocardial ischemia. Between individuals with myocardial ischemia compared with individuals without myocardial ischemia, there was no significant difference in the volume and CT attenuation of EAT and PAT or in the PCAT volume of RCA, LAD, and LCX.

Conclusions:
Increased RCA PCAT attenuation is associated with the presence of myocardial ischemia as assessed by FFR, while PCAT volume, EAT, and PAT are not.
Urine leaks in children sustaining blunt renal trauma
Authors: Ghani Muhammad Owais Abdul , Snyder Elizabeth , Xu Mark C. , McKay Katlyn G. , Foster Jarrett , Tong Carmen , Clayton Douglas B. , Greeno Amber , Azam Bassil , Zhao Shilin , Hernanz-Schulman Marta , Lovvorn Harold N. 
Published: January 2022

BACKGROUND
Few consensus statements exist to guide the timely diagnosis and management of urine leaks in children sustaining blunt renal trauma (BRT). The aims of this study were to characterize kidney injuries among children who sustain BRT, evaluate risk factors for urine leaks, and describe the negative impact of urinoma on patient outcomes and resource consumption.

METHODS
A retrospective review was performed of 347 patients, younger than 19 years, who presented with BRT to a single American College of Surgeons–verified Level I Pediatric Trauma Center between 2005 and 2020. Frequency of and risk factors for urine leak after BRT were evaluated, and impact on patient outcomes and resource utilization were analyzed.

RESULTS
In total, 44 (12.7%) patients developed urine leaks, which exclusively presented among injury Grade 3 (n = 5; 11.4%), Grade 4 (n = 27; 61.4%), and Grade 5 (n = 12; 27.3%). A minority of urine leaks (n = 20; 45.5%) were discovered on presenting CT scan but all within 3 days. Kidney-specific operative procedures (nephrectomy, cystoscopy with J/ureteral stent, percutaneous nephrostomy) were more common among urine leak patients (n = 17; 38.6%) compared with patients without urine leaks (n = 3; 1.0%; p = 0.001). Patients with urine leak had more frequent febrile episodes during hospital stay (n = 24; 54.5%; p = 0.001) and showed increased overall 90-day readmission rates (n = 14; 33.3%; p < 0.001). Independent risk factors that associated with urine leak were higher grade (odds ratio [OR], 7.9; 95% confidence interval [CI], 2.6–24.3; p < 0.001), upper-lateral quadrant injuries (OR, 2.9; 95% CI, 1.2–7.1; p = 0.02), and isolated BRT (OR, 2.6; 95% CI, 1.0–6.5; p = 0.04).

CONCLUSION
In a large cohort of children sustaining BRT, urine leaks result in considerable morbidity, including more febrile episodes, greater 90-day readmission rates, and increased operative or image-guided procedures. This study is the first to examine the relationship between kidney quadrant injury and urine leaks. Higher grade (Grade 4–5) injury, upper lateral quadrant location, and isolated BRT were independently predictive of urine leaks.

LEVEL OF EVIDENCE
Therapeutic/Care Management; Level III.
Task-Induced Mental Fatigue and Motivation Influence Listening Effort as Measured by the Pupil Dilation in a Speech-in-Noise Task
Authors: Menase Defne Alfandari , Richter Michael , Wendt Dorothea , Fiedler Lorenz , Naylor Graham 
Published: January 2022

ObjectivesListening effort and fatigue are common complaints among individuals with hearing impairment (HI); however, the underlying mechanisms, and relationships between listening effort and fatigue are not well understood. Recent quantitative research suggests that the peak pupil dilation (PPD), which is commonly measured concurrent to the performance of a speech-in-noise task as an index of listening effort, may be informative of daily-life fatigue, but it remains unknown whether the same is true for task-induce fatigue. As fatigue effects are known to manifest differently depending on motivation, the main aim of the present study was to experimentally investigate the interactive effects of task-induced fatigue and motivation on the PPD.DesignIn a pre-/post-fatigue within-subject design, 18 participants with normal hearing (NH) engaged in a 98-trial-long speech-in-noise task (the ‘load sequence’, approximately 40 min. long), which either excluded or included additional memory demands (light vs. heavy load sequence). Before and after the load sequence, baseline pupil diameter (BPD) and PPD were measured during shorter ‘probe’ blocks of speech-in-noise tasks. In these probe blocks, if participants correctly repeated more than 60% of the keywords, they could win vouchers of either 20 or 160 Danish krones worth (low incentive vs. high incentive). After each probe block, participants reported their invested effort, tendency for quitting, and perceived performance.ResultsThe BPD in anticipation of listening declined from pre-to post-load sequence, suggesting an overall decrease in arousal, but the decline did not scale with the magnitude of the load sequence, nor with the amount of monetary incentive. Overall, there was larger pre-to post-load sequence decline in PPD when the load sequence was heavy and when the monetary incentives were low. Post-hoc analyses showed that the decline in PPD was only significant in the heavy-load sequence-low reward condition. The speech-in-noise task performance, self-reported effort, and self-reported tendency to quit listening did not change with the experimental conditions.ConclusionsThis is the first study to investigate the influence of task-induced fatigue on BPD and PPD. Whereas BPD was not sensitive to the magnitude of previous load sequence and monetary incentives, the decline in PPD from pre-to post-load sequence was significant after the heavy load sequence when the offered monetary incentives were low. This result supports the understanding that fatigue and motivation interactively influence listening effort.