ABSTRACT
Background: Liver size can be physically evaluated by means of percussion, but measurement remains only gross-estimation. Ultrasonography is a non-invasive and accurate method for measurement of liver size. However, there are few ultrasonic data available for assessment of liver span in Thai children under two years old. Objective: Determine liver sizes in healthy Thai children aged zero to two years and compare physical and ultrasonographic estimations. Subject and method: Two hundred eighty one children (148 boys and 133 girls) were enrolled in this study. The age, weight, and height were assessed, and the body surface area was calculated. The liver size or liver span was estimated by percussion and compared to ultrasonography. Result: The liver span (mean?SD) was 5.4?1.0 cm, 5.1?1.1 cm by physical and ultrasonographic examination, respectively. The measurement of liver span by physical examination had high reliability. The liver span correlated with body surface area rather than height, age, and weight. Conclusion: Physical examination of liver span provided reliable data in Thai children under two years old.
ABSTRACT
BACKGROUND: Catheter-related bloodstream infections (CRBSI) are an important cause of patient morbidity, mortality, and increased health care costs. Use of an antiseptic solution for skin disinfection at the catheter insertion site helps prevent catheter-related infections. In Thailand, povidone-iodine solution is the most commonly used agent for this purpose. However, the results of several studies including a meta-analysis indicated that the use of chlorhexidine gluconate is more effective than the use of povidone-iodine as an antiseptic for preventing CRBSI. This study evaluated the cost-effectiveness of chlorhexidine gluconate versus povidone-iodine for catheter-site care using the Siriraj Hospital perspective. MATERIAL AND METHOD: We used a decision analytic modeling for estimating the cost-effectiveness of antiseptic solutions. The CRBSI rate was obtained from the Center for Nosocomial Infection Control at Siriraj Hospital, while the efficacy of cholorhexidine compared to povidone-idone was based on a meta-analysis. The cost of managing infections was derived from the Thai Drug Related Group (DRG). A series of sensitivity analyses were performed. Since the time horizon of the analysis was less than 1 year, there was no need for discounting. RESULTS: We found that the use of chlorhexidine, rather than povidone iodine, for central catheter site care resulted in a 1.61% decrease in the incidence of CRBSI, a 0.32 % decrease in the incidence of death, and savings of 304 baht per catheter used. For peripheral catheter site care, the results were similar although the differences were smaller. CONCLUSION: Use of chlorhexidine gluconate in place of the current standard solution for vascular catheter site care is a cost-effective method of improving patient safety in Siriraj Hospital.