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3.
São Paulo; s.n; 2021. 78 p. ilus, tab, graf.
Thesis in Portuguese | Inca | ID: biblio-1353640

ABSTRACT

INTRODUÇÃO: O tratamento das neoplasias da base craniana evoluiu grandemente desde as primeiras tentativas de abordagem destas lesões no final do século XIX. OBJETIVO: Analisar fatores prognósticos em pacientes com neoplasias da base do crânio submetidos à tratamentocirúrgico no período de 1990 a 2016 no A. C. Camargo Cancer Center. MATERIAL E MÉTODOS: Análise retrospectiva de prontuários. RESULTADOS: Foram avaliados prontuários de 601 pacientes submetidos a 742 cirurgias. Localizações tumorais mais frequentes foram fossas média e anterior. Histologia tumoral benigna mais frequente foi adenoma hipofisário e maligna o carcinoma de células escamosas. Cirurgias abertas apresentaram taxas de complicações mais altas do que as endoscópicas. Complicações mais prevalentes foram déficit de nervo craniano e fístula liquórica. Fator prognóstico de sobrevida das neoplasias malignas foi margens cirúrgicas negativas. CONCLUSÃO: Foi observada a transição de abordagens abertas para endoscópicas, com redução progressiva das taxas de complicações e resultados oncológicos mantidos.


INTRODUCTION: The treatment of skull base tumors has evolved greatly since the first attempts to approach these lesions at the end of the XIX century. PURPOSE: Analise prognostic factors in patients with skull base tumors operated on from 1990 until 2016 at A. C. Camargo Cancer Center. MATERIAL AND METHODS: Retrospective analysis of medical records. RESULTS: Medical records for 601 patients were evaluated, who were submitted to 742 surgeries. Most common tumor locations were the medial and anterior fossae. The most common benign histology was pituitary adenoma and malignant histology was squamous cell carcinoma. Open approaches presented with higher complication rates than endoscopic approaches. The most common complications were cranial nerve deficit and cerebrospinal fluid fistula. A prognostic factor of survival for malignant neoplasms was negative surgical margins. CONCLUSION: We observed the transition of open approaches to endoscopic and combined approaches, with progressive reduction in complication rates with sustained oncologic results.


Subject(s)
Humans , Male , Female , Skull Base Neoplasms/surgery , Prognosis , Surgical Procedures, Operative , Survival Analysis , Skull Base Neoplasms/therapy
4.
Medicina (Ribeirao Preto, Online) ; 54(3)dez. 2021. ilus
Article in Portuguese | LILACS (Americas) | ID: biblio-1353108

ABSTRACT

Planejamento pré-operatório de correção de deformidades supramaleolares através de impressão 3DRELATO DE CASOModelos impressos em 3D têm sido explorados profundamente no campo médico, destacando-se como importante ferramenta de auxílio para planejamento cirúrgico. Os autores apresentam relato de caso de um paciente, com artrose pós-traumática do tornozelo direito, submetido a osteotomia supramaleolar, em cunha de fechamento medial. Esta cirurgia foi realizada após planejamento operatório por impressão 3D, o que pode demonstrar reprodutibilidade deste método. (AU)


3D printed models have been explored deeply in the medical field, standing out as an important aid tool for surgical planning. The authors present a case report of a patient with post-traumatic arthrosis of the right ankle, who underwent supramaleolar osteotomy, using a medial closure wedge. This surgery was performed after operative planning by 3D printing, which can demonstrate the reproducibility of this method. (AU)


Subject(s)
Humans , Osteoarthritis , Osteotomy , Surgical Procedures, Operative , Congenital Abnormalities , Planning , Printing, Three-Dimensional
5.
Clin. biomed. res ; 41(4): 306-312, 20210000. tab, graf
Article in Portuguese | LILACS (Americas) | ID: biblio-1349512

ABSTRACT

Introdução: A apendicectomia é o tratamento de escolha da apendicite aguda. Embora a preferência pelas técnicas minimamente invasivas seja tendência mundial, a cirurgia aberta ainda é realidade na maioria dos hospitais públicos. O índice de complicações pós-operatórias varia de acordo com a técnica cirúrgica empregada. O presente estudo objetiva comparar a incidência de complicações pós-operatórias entre a apendicectomia aberta e laparoscópica. Métodos: Coorte retrospectiva incluindo pacientes submetidos à apendicectomia no Hospital de Pronto Socorro de Porto Alegre entre novembro de 2015 a novembro de 2019. Foram avaliados dados demográficos, tempo de evolução dos sintomas, técnica cirúrgica, achados transoperatórios, necessidade de drenos ou ostomias, tempo cirúrgico, tempo de internação, experiência do cirurgião e desfechos. Resultados: Foram incluídos 358 pacientes, com idade de 32 ± 13,8 anos, e predomínio do sexo masculino (58,9%); 58,1% foram submetidos a cirurgia aberta, 41,9% a laparoscopia e 8% necessitaram conversão. As apendicites foram classificadas como complicadas em um terço dos casos. O tempo cirúrgico foi menor na cirurgia aberta (79,3 ± 38,8 vs. 104 ± 35,2 minutos; p < 0,001). O índice de complicações pós-operatórias foi de 21,2%, sendo significativamente maior na técnica aberta (26,4% vs. 13%; p = 0,003). O tempo de internação, a necessidade de reintervenção e mortalidade não apresentaram diferença entre as técnicas. Conclusão: Embora a apendicectomia aberta seja um procedimento seguro, com bons resultados e baixa morbimortalidade, a laparoscopia oferece potenciais vantagens em termos de evolução pós-operatória, inclusive em casos complicados. Deve ser indicada rotineiramente havendo disponibilidade de material e capacitação da equipe cirúrgica. (AU)


Introduction: Appendectomy is the treatment of choice for acute appendicitis. Although the preference for minimally invasive techniques is a worldwide trend, open surgery remains a reality in most public hospitals. The rate of postoperative complications varies according to the surgical technique employed. The present study aimed to compare the incidence of postoperative complications between open and laparoscopic appendectomy. Methods: This retrospective cohort study included patients undergoing appendectomy at the Hospital de Pronto Socorro de Porto Alegre between November 2015 and November 2019. Demographic and clinical data, duration of symptoms, surgical technique, intraoperative findings, use of abdominal drains or stomas, operative time, length of stay, surgeon's experience, and outcomes were assessed. Results: Three hundred and fifty-eight patients were included, predominantly male (58.9%), with a mean age of 32 ± 13.8 years; 58.1% underwent open surgery, 41.9% underwent laparoscopic surgery, and 8% required conversion. One third of the cases were classified as complicated. The mean operative time was shorter for open surgery (79.3 ± 38.8 vs. 104 ± 35.2 minutes; p < 0.001). The rate of postoperative complications was 21.2%, with a significantly higher incidence in the open technique (26.4% vs. 13%; p = 0.003). Length of stay, reoperation rate, and mortality did not differ between the techniques. Conclusions: Although open appendectomy is a safe and efficient procedure, associated with low morbidity and mortality rates, laparoscopy provides potential clinically beneficial advantages in terms of postoperative outcomes, even in complicated cases. Therefore, it should be routinely performed where laparoscopic equipment and skillful staff are available. (AU)


Subject(s)
Appendectomy/adverse effects , Surgical Procedures, Operative/statistics & numerical data , Laparoscopy , Postoperative Complications
7.
Ann Surg ; 275(1): 99-105, 2022 01 01.
Article in English | MEDLINE | ID: mdl-34914661

ABSTRACT

OBJECTIVE: To evaluate the effects of gaining access to Medicare on key financial outcomes for surgical patients. SUMMARY BACKGROUND DATA: Surgical care poses a significant financial burden, especially among patients with insufficient financial risk protection. Medicare may mitigate the risk of these adverse circumstances, but the impact of Medicare eligibility on surgical patients remains poorly understood. METHODS: Regression discontinuity analysis of national, cross-sectional survey and cost data from the 2008 to 2018 National Health Interview Survey and Medical Expenditure Panel Survey. Patients were between the ages of 57 to 72 with surgery in the past 12 months. The primary outcomes were the presence of medical debt, delay/deferment of care due to cost, total annual out-of-pocket costs, and experiencing catastrophic health expenditures. RESULTS: Among 45,982,243 National Health Interview Survey patients, Medicare eligibility was associated with a 6.6 percentage-point decrease (95% confidence interval [CI]: -9.0% to -4.3) in being uninsured (>99% relative reduction), 7.6 percentage-point decrease (24% relative reduction) in having medical debt (95%CI: -14.1% to -1.1%), and 4.9 percentage-point decrease (95%CI: -9.4% to -0.4%) in deferrals/delays in medical care due to cost (28% relative reduction). Among 33,084,967 Medical Expenditure Panel Survey patients, annual out-of-pocket spending decreased by $1199 per patient (95%CI: -$1633 to -$765), a 33% relative reduction, and catastrophic health expenditures decreased by 7.3 percentage points (95%CI: -13.6% to -0.1%), a 55% relative reduction. CONCLUSIONS: Medicare may reduce the economic burden of healthcare spending and delays in care for older adult surgical patients. These findings have important implications for policy discussions regarding changing insurance eligibility thresholds for the older adult population.


Subject(s)
Health Expenditures/statistics & numerical data , Insurance Coverage/economics , Medicare/economics , Surgical Procedures, Operative/economics , Aged , Cost of Illness , Cross-Sectional Studies , Health Care Surveys , Humans , Medically Uninsured , Middle Aged , Time-to-Treatment/economics , United States
8.
BMJ ; 371: m4381, 2020 12 10.
Article in English | MEDLINE | ID: mdl-34913872

ABSTRACT

OBJECTIVE: To determine whether patient mortality after surgery differs between surgeries performed on surgeons' birthdays compared with other days of the year. DESIGN: Retrospective observational study. SETTING: US acute care and critical access hospitals. PARTICIPANTS: 100% fee-for-service Medicare beneficiaries aged 65 to 99 years who underwent one of 17 common emergency surgical procedures in 2011-14. MAIN OUTCOME MEASURES: Patient postoperative 30 day mortality, defined as death within 30 days after surgery, with adjustment for patient characteristics and surgeon fixed effects. RESULTS: 980 876 procedures performed by 47 489 surgeons were analyzed. 2064 (0.2%) of the procedures were performed on surgeons' birthdays. Patient characteristics, including severity of illness, were similar between patients who underwent surgery on a surgeon's birthday and those who underwent surgery on other days. The overall unadjusted 30 day mortality on the operating surgeon's birthday was 7.0% (145/2064) and that on other days was 5.6% (54 824/978 812). After adjusting for patient characteristics and surgeon fixed effects (effectively comparing outcomes of patients treated by the same surgeon on different days), patients who underwent surgery on a surgeon's birthday exhibited higher mortality compared with patients who underwent surgery on other days (adjusted mortality rate, 6.9% v 5.6%; adjusted difference 1.3%, 95% confidence interval 0.1% to 2.5%; P=0.03). Event study analysis of patient mortality by day of surgery relative to a surgeon's birthday found similar results. CONCLUSIONS: Among Medicare beneficiaries who underwent common emergency surgeries, those who received surgery on the surgeon's birthday experienced higher mortality compared with patients who underwent surgery on other days. These findings suggest that surgeons might be distracted by life events that are not directly related to work.


Subject(s)
Holidays , Postoperative Complications/mortality , Surgeons/statistics & numerical data , Surgical Procedures, Operative/mortality , Aged , Aged, 80 and over , Critical Care/methods , Fee-for-Service Plans , Female , Humans , Male , Medicare , Postoperative Period , Retrospective Studies , United States/epidemiology
9.
Anesth Analg ; 134(1): 102-113, 2022 01 01.
Article in English | MEDLINE | ID: mdl-34908548

ABSTRACT

BACKGROUND: Risk prediction models for postoperative mortality after intra-abdominal surgery have typically been developed using preoperative variables. It is unclear if intraoperative data add significant value to these risk prediction models. METHODS: With IRB approval, an institutional retrospective cohort of intra-abdominal surgery patients in the 2005 to 2015 American College of Surgeons National Surgical Quality Improvement Program was identified. Intraoperative data were obtained from the electronic health record. The primary outcome was 30-day mortality. We evaluated the performance of machine learning algorithms to predict 30-day mortality using: 1) baseline variables and 2) baseline + intraoperative variables. Algorithms evaluated were: 1) logistic regression with elastic net selection, 2) random forest (RF), 3) gradient boosting machine (GBM), 4) support vector machine (SVM), and 5) convolutional neural networks (CNNs). Model performance was evaluated using the area under the receiver operator characteristic curve (AUROC). The sample was randomly divided into a training/testing split with 80%/20% probabilities. Repeated 10-fold cross-validation identified the optimal model hyperparameters in the training dataset for each model, which were then applied to the entire training dataset to train the model. Trained models were applied to the test cohort to evaluate model performance. Statistical significance was evaluated using P < .05. RESULTS: The training and testing cohorts contained 4322 and 1079 patients, respectively, with 62 (1.4%) and 15 (1.4%) experiencing 30-day mortality, respectively. When using only baseline variables to predict mortality, all algorithms except SVM (area under the receiver operator characteristic curve [AUROC], 0.83 [95% confidence interval {CI}, 0.69-0.97]) had AUROC >0.9: GBM (AUROC, 0.96 [0.94-1.0]), RF (AUROC, 0.96 [0.92-1.0]), CNN (AUROC, 0.96 [0.92-0.99]), and logistic regression (AUROC, 0.95 [0.91-0.99]). AUROC significantly increased with intraoperative variables with CNN (AUROC, 0.97 [0.96-0.99]; P = .047 versus baseline), but there was no improvement with GBM (AUROC, 0.97 [0.95-0.99]; P = .3 versus baseline), RF (AUROC, 0.96 [0.93-1.0]; P = .5 versus baseline), and logistic regression (AUROC, 0.94 [0.90-0.99]; P = .6 versus baseline). CONCLUSIONS: Postoperative mortality is predicted with excellent discrimination in intra-abdominal surgery patients using only preoperative variables in various machine learning algorithms. The addition of intraoperative data to preoperative data also resulted in models with excellent discrimination, but model performance did not improve.


Subject(s)
Abdomen/surgery , Postoperative Complications/mortality , Risk Assessment/methods , Surgical Procedures, Operative/mortality , Algorithms , Area Under Curve , Data Collection/methods , Humans , Intraoperative Period , Logistic Models , Machine Learning , ROC Curve , Retrospective Studies , Risk , Risk Factors , Support Vector Machine
11.
Surg Clin North Am ; 102(1): 53-63, 2022 Feb.
Article in English | MEDLINE | ID: mdl-34800389

ABSTRACT

An increasing number of patients are on anticoagulation for a variety of indications. Patients on anticoagulation who present to the hospital with life-threatening hemorrhage, whether trauma related or not, must be assessed for the reversal of anticoagulation. Identification of the type of anticoagulation, the timing of the most recent usage of anticoagulation, and the efficacy of the anticoagulation all have an impact on whether reversal agents should be used. There are a variety of reversal agents, both nonspecific and specific, that could be used for reversal; however, not all reversal agents work for all anticoagulation medication. As more anticoagulation medications are used and indications expand, providers must be aware of the reversal agents available and the efficacy and indications for these reversal agents.


Subject(s)
Anticoagulants/adverse effects , Coagulants/therapeutic use , Critical Care/methods , Emergency Medical Services/methods , Hemorrhage/drug therapy , Hemorrhage/prevention & control , Perioperative Care/methods , Critical Illness , Drug Administration Schedule , Emergencies , Hemorrhage/etiology , Humans , Surgical Procedures, Operative , Wounds and Injuries/complications , Wounds and Injuries/therapy
14.
Can J Surg ; 64(6): E594-E602, 2021.
Article in English | MEDLINE | ID: mdl-34759044

ABSTRACT

Randomized controlled trials (RCTs) are the most robust study design for evaluating the safety and efficacy of a therapeutic intervention. However, their internal validity are at risk when evaluating surgical interventions. This review summarizes existing expertise- based trials in surgery and related methodological concepts to guide surgeons performing this work. We provide caseloads required to reach the learning curve for various surgical interventions and report criteria for expertise from published and unpublished expertise-based trials. In addition, we review design and implementation concepts of expertise-based trials, including recruitment of surgeons, crossover, ethics, generalizability, sample size and definitions for learning curve. Several RCTs have used an expertise-based design. We found that the majority of definitions used for expertise were vague, heterogeneous, and inconsistent across trials evaluating the same surgical intervention. Statistical methods exist to adjust for the learning curve; however, there is limited guidance. We developed the following criteria for surgical expertise for future trials: 1) decide on the proxy to be used for the learning curve, and 2) assess eligible surgeons by comparing their performance to the previously defined expertise criteria.


Subject(s)
Clinical Competence , Clinical Trials as Topic , Learning Curve , Research Design , Surgeons , Surgical Procedures, Operative , Clinical Competence/standards , Clinical Trials as Topic/standards , Humans , Research Design/standards , Surgeons/standards
15.
Can J Surg ; 64(6): E588-E593, 2021.
Article in English | MEDLINE | ID: mdl-34728524

ABSTRACT

BACKGROUND: Given the rising prevalence of subways in combination with an increasing incidence of subway-related injuries, understanding subway-related trauma is becoming ever more relevant. The aim of this study was to characterize the potential causes, injury characteristics and outcomes of subway-related trauma at a level 1 adult trauma centre in Toronto, Ontario. METHODS: We conducted a retrospective cohort study to identify patients who presented to the emergency department a level 1 adult trauma centre with a subway-related injury between Jan. 1, 2010, and Dec. 31, 2018. Patients were identified via International Statistical Classification of Diseases and Related Health Problems, 10th Revision E-codes (X81, Y02, V050, V051 and W17). We then further screened for descriptions of subway-related injuries. Patients whose injuries did not involve a moving subway train were excluded. RESULTS: We identified 51 patients who presented to the emergency department after being hit by a moving subway train. The majority of incidents (39 [76%]) were due to self-harm, 10 (20%) were unintentional injuries, and 2 (4%) were due to assault. The presence of alcohol was detected in 8 patients (80%) with unintentional injuries and 3 (8%) of those with self-inflicted injuries. Thirteen patients (25%) had a systolic blood pressure less than 90 mm Hg. The median Injury Severity Score was 17 (interquartile range 9-29). Seventeen patients (33%) presented with severe injuries (Abbreviated Injury Scale score ≥ 3) in 1 body region, and 19 (37%) had severe injuries in 2 or more body regions. The most common isolated severe injury was in the lower extremity, and the most common combinations of severe injuries were in the head and lower extremity, and head and thorax. Ten patients (20%) were declared dead in the emergency department. Of the 41 patients who survived their initial presentation, 12 (29%) went directly to the operating room, and 17 (41%) were transferred to the intensive care unit. The overall mortality rate was 29%. CONCLUSION: Patients with subway-related injuries experienced high mortality rates and severe injuries. Most incidents were due to self-harm or alcohol-related. Further research into early identification of those at risk and optimal prevention strategies is necessary to curb further incidents.


Subject(s)
Accidents/statistics & numerical data , Alcohol Drinking/epidemiology , Physical Abuse/statistics & numerical data , Railroads , Self-Injurious Behavior/epidemiology , Trauma Severity Indices , Wounds and Injuries/epidemiology , Wounds and Injuries/etiology , Adolescent , Adult , Aged , Blood Pressure/physiology , Craniocerebral Trauma/epidemiology , Craniocerebral Trauma/etiology , Craniocerebral Trauma/therapy , Critical Care/statistics & numerical data , Emergency Service, Hospital/statistics & numerical data , Female , Glasgow Coma Scale , Humans , Injury Severity Score , Lower Extremity/injuries , Male , Middle Aged , Ontario/epidemiology , Retrospective Studies , Self-Injurious Behavior/complications , Self-Injurious Behavior/mortality , Self-Injurious Behavior/therapy , Surgical Procedures, Operative/statistics & numerical data , Trauma Centers/statistics & numerical data , Wounds and Injuries/mortality , Wounds and Injuries/therapy , Young Adult
16.
Medicine (Baltimore) ; 100(43): e27668, 2021 Oct 29.
Article in English | MEDLINE | ID: mdl-34713863

ABSTRACT

BACKGROUND: Postoperative cognitive dysfunction (POCD) is a very common event in elderly noncardiac surgical patients. The effects of inhalational anaesthetics and propofol on the incidence of POCD and postoperative cognitive status at different time points after surgery are currently unclear. METHODS: We searched the Embase, Medline, Cochrane Library, and Web of Science databases for randomized controlled trials (RCTs), in which inhalation anaesthesia and propofol anaesthesia were compared. The incidence of POCD or postoperative cognitive status was assessed in elderly patients undergoing noncardiac surgery. RESULTS: Fifteen RCTs with 1854 patients were included in this meta-analysis. The incidence of POCD on postoperative Days 2-6 after propofol anaesthesia was markedly lower than that after inhalation anaesthesia (risk ratio (RR): 0.37, 95% confidence interval (CI): 0.15-0.88, P = .025), and Mini-Mental State Examination (MMSE) scores after propofol anaesthesia were substantially higher than those after inhalation anaesthesia (standard mean difference (SMD): 0.59, 95% CI: 0.07-1.11, P = .026). The levels of interleukin-6 (IL-6) and tumour necrosis factor-α (TNF-α) were much lower after propofol anaesthesia than after inhalation anaesthesia (SMD: -2.027, 95% CI: -3.748- -0.307, P = .021; SMD: -0.68, 95% CI: -0.93- -0.43, P < .001). CONCLUSIONS: The moderate evidence from this meta-analysis shows that, in elderly noncardiac surgical patients, propofol anaesthesia is superior to inhalation anaesthesia for attenuating of early POCD incidence, and low-level evidence shows that cognitive status is higher and systemic inflammation is less severe after propofol anaesthesia in the early days after surgery. LIMITATIONS: The sample size was not sufficiently large for systemic inflammation, and the tools to identify POCD were not uniform in the included studies.


Subject(s)
Anesthesia, Inhalation/adverse effects , Anesthetics, Inhalation/adverse effects , Anesthetics, Intravenous/adverse effects , Postoperative Cognitive Complications/chemically induced , Propofol/adverse effects , Anesthetics, Inhalation/therapeutic use , Anesthetics, Intravenous/therapeutic use , Humans , Mental Status and Dementia Tests , Propofol/therapeutic use , Randomized Controlled Trials as Topic , Surgical Procedures, Operative/adverse effects , Surgical Procedures, Operative/methods
17.
Can J Surg ; 64(5): E540, 2021.
Article in English | MEDLINE | ID: mdl-34702757
18.
In. Barbato, Marcelo; Blanco, Raúl; Godino, Mario; Olivera Pertusso, Eduardo; Rodríguez, Ana María. Seguridad del paciente en áreas críticas. Montevideo, Cuadrado, 2019. p.109-121.
Monography in Spanish | LILACS (Americas), BNUY, UY-BNMED | ID: biblio-1342576
19.
In. Barbato, Marcelo; Blanco, Raúl; Godino, Mario; Olivera Pertusso, Eduardo; Rodríguez, Ana María. Seguridad del paciente en áreas críticas. Montevideo, Cuadrado, 2019. p.137-146.
Monography in Spanish | LILACS (Americas), BNUY, UY-BNMED | ID: biblio-1342580
20.
Pediatrics ; 148(5)2021 11.
Article in English | MEDLINE | ID: mdl-34697218

ABSTRACT

OBJECTIVES: Standard treatment of children hospitalized for acute orbital cellulitis includes systemic antibiotics. Recent data from single-center studies suggest the addition of systemic corticosteroids may hasten clinical improvement and reduce hospital length of stay (LOS). We investigate the potential relationship between corticosteroid exposure and duration of hospitalization for pediatric orbital cellulitis. METHODS: Using Pediatric Health Information System registry data from 51 children's facilities, we performed a retrospective cohort study of children hospitalized for orbital cellulitis <18 years of age from 2007 to 2018. The primary study outcome was hospital LOS. Secondary outcomes included frequency of surgical interventions, PICU admission, and 30-day related-cause readmission. RESULTS: Of the 5645 children included for study, 1347 (24%) were prescribed corticosteroids within 2 days of admission. Corticosteroid prescription was not associated with LOS in analyses adjusted for age; presence of meningitis, abscess, or vision issues; and operative episode and PICU admission within 2 days (e ß = 1.01, 95% confidence interval [CI]: 0.97-1.06). Corticosteroid exposure was associated with operative episodes after 2 days of hospitalization (odds ratio = 2.05, 95% CI: 1.29-3.27) and 30-day readmission (odds ratio = 2.40, 95% CI: 1.52-3.78) among patients with a primary diagnosis of orbital cellulitis. CONCLUSIONS: In this database query, we were not able to detect a reduction in LOS associated with corticosteroid exposure during hospitalization for orbital cellulitis. Corticosteroid prescription was associated with PICU admission and operative episodes after 2 days of hospitalization. Before the adoption of routine corticosteroid use, prospective, randomized control trials are needed.


Subject(s)
Adrenal Cortex Hormones/therapeutic use , Length of Stay , Orbital Cellulitis/drug therapy , Acute Disease , Adolescent , Child , Child, Preschool , Confidence Intervals , Humans , Infant , Infant, Newborn , Intensive Care Units, Pediatric/statistics & numerical data , Odds Ratio , Patient Readmission/statistics & numerical data , Registries , Retrospective Studies , Surgical Procedures, Operative/statistics & numerical data
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