Subject(s)
Pneumonia, Aspiration , Humans , Infant , Infant, Newborn , Pneumonia, Aspiration/diagnosisSubject(s)
Algorithms , Cervical Vertebrae/injuries , Clinical Decision-Making/methods , Emergency Medical Services/standards , Spinal Injuries/diagnosis , Wounds, Nonpenetrating/diagnosis , Cervical Vertebrae/diagnostic imaging , Child , Clinical Protocols , Delphi Technique , Diagnosis, Differential , Emergency Medical Services/methods , Emergency Service, Hospital/standards , Glasgow Coma Scale/standards , Humans , Magnetic Resonance Imaging/standards , Medical History Taking/methods , Medical History Taking/standards , Pediatrics/standards , Physical Examination/methods , Physical Examination/standards , Spinal Injuries/therapy , Tomography, X-Ray Computed/standards , Wounds, Nonpenetrating/therapyABSTRACT
In the assessment of septic arthritis of the hip in a pediatric population, ultrasound is a safe and easily conducted method to confirm an effusion. The need for MRI to further evaluate the patient for adjacent infection before treatment is debatable. Once an effusion is confirmed on ultrasonography, we have found that septic arthritis of the hip does not need advanced imaging before arthrotomy and debridement. Patients who fail to clinically respond to an initial hip arthrotomy and appropriate antibiotics may benefit from an MRI for the identification of concomitant infections that may require surgical intervention.
Subject(s)
Arthritis, Infectious/diagnostic imaging , C-Reactive Protein/analysis , Child , Disease Management , Hip Joint/diagnostic imaging , Hip Joint/surgery , Humans , Magnetic Resonance Imaging , UltrasonographyABSTRACT
PURPOSE: We identified preoperative parameters associated with increased risk of intraoperative Wilms tumor spill. MATERIALS AND METHODS: We retrospectively reviewed an institutional database of patients diagnosed with Wilms tumor between 2000 and 2008. Inclusion criteria consisted of available abdominal computerized tomogram and pathological stage I to IV disease. Patient characteristics and neoadjuvant chemotherapy use were noted. After blinding, a radiologist reviewed preoperative computerized tomogram parameters, calculating tumor volume and assigning a preoperative radiological stage. RESULTS: Of 67 patients diagnosed with Wilms tumor 41 (22 males, 19 females) met inclusion criteria, while 26 had incomplete imaging for analysis. Comparison of patients with and without intraoperative tumor spill demonstrated no significant differences in age (3.8 vs 3.6 years), sex (3 males and 3 females vs 19 males and 16 females), body weight or tumor capsule thickness. Preoperative radiological staging was unable to predict pathological stage I to III disease. Six intraoperative tumor spills (15%) were identified (left in 4, right in 2), of which 3 were stage III disease and 3 stage IV. Without neoadjuvant chemotherapy, patients with tumors greater than 1,000 cc had an increased risk of spill (2 of 2 [100%] vs 4 of 33 [12%], p = 0.03). Of 9 patients with stage IV disease 0% (0 of 4) receiving neoadjuvant chemotherapy experienced tumor spill, while lack of neoadjuvant chemotherapy was associated with a 60% (3 of 5 patients, 1 male and 2 females) risk of stage IV spill (p = 0.17). CONCLUSIONS: The sole significant tumor spill risk factor identifiable preoperatively was tumor volume greater than 1,000 cc. However, spill occurred at volumes less than 400 cc. Although not statistically significant, neoadjuvant chemotherapy for stage IV disease trended toward diminishing spill risk. Patients with Wilms tumors greater than 1,000 cc may benefit from neoadjuvant chemotherapy with less tumor spill, while stage IV tumors warrant further study in this regard.
Subject(s)
Intraoperative Complications/epidemiology , Kidney Neoplasms/surgery , Neoplasm Seeding , Nephrectomy , Wilms Tumor/surgery , Adolescent , Child , Child, Preschool , Female , Humans , Infant , Intraoperative Complications/etiology , Kidney Neoplasms/drug therapy , Kidney Neoplasms/pathology , Male , Preoperative Care , Retrospective Studies , Risk Assessment , Risk Factors , Wilms Tumor/drug therapy , Wilms Tumor/pathologyABSTRACT
BACKGROUND/PURPOSE: The aim of this study was to determine if the presence of "blush" (an indication of active bleeding) on abdominal CT in children with blunt liver injury adversely affected their clinical outcome as has been reported in adults. METHODS: The authors reviewed the records of 105 children ages 1 to 16 years with blunt liver injury seen on admission IV contrast CT seen over a 6-year period. Demographic characteristics measured were age, mechanism of injury, and injury severity score (ISS). Clinical outcomes included ICU stay, hospital length of stay (LOS), transfusion requirement (milliliters per kilogram), operations performed, and mortality rate. CT scans were evaluated retrospectively by a radiologist blinded to prior reports, for a "blush" and grade of liver injury. No patient underwent arterial embolization. The authors eliminated children with grade I-II injuries (30 patients), because only one had a blush, and analyzed the 75 patients with severe liver injuries (grades III-V). Those patients without a blush (n = 53) seen on CT were the control group, whereas patients with a blush (n = 22) were the study group. Data were analyzed using the Fisher's Exact and Mann-Whitney U test. The level of significance was set at.05. RESULTS: Patients with a blush had a significantly larger transfusion requirement (17.3 +/- 30.5 mL/kg v 5.0 +/- 10.9 mL/kg; P =.02) and mortality rate (23% v 4%; P =.02), but the ISS also was significantly greater (25.8 +/- 14.5 v 17.5 +/- 12.2; P =.019). All other data were similar between the 2 groups. CONCLUSIONS: Children with a blush seen on abdominal CT after blunt liver injury have higher transfusion requirements and greater risk of mortality than those without blush. Mortality is primarily related to the severity of their other injuries.
