Atypical posterior reversible encephalopathy syndrome (PRES): is peritoneal dialysis a risk factor?

A patient with diabetes mellitus who had recently been started on peritoneal dialysis presented with headaches, confusion, falling episodes, and multiple white matter abnormalities affecting the frontal, temporal, parietal, and occipital lobes on MRI of the brain. He developed stupor and frequent seizures despite control of hypertension with intravenous nicardipine. Diagnosis of atypical PRES and institution of successful empiric therapy was based on electronic searches (Google and MEDLINE) facilitated by verbal communication between and among the specialists involved in his care.

Mortality before and after initiation of a computerized physician order entry system in a critically ill pediatric population.

OBJECTIVE: A worrisome increase in mortality has been reported recently following the initiation of a computerized physician order entry (CPOE) system in a critically ill pediatric transport population. We tested the hypothesis that such a mortality increase did not occur after the initiation of CPOE in a pediatric population that was directly admitted to the neonatal and pediatric intensive care units at Montefiore Medical Center during two 6-month periods before CPOE and one 6-month period immediately after CPOE was initiated. Mortality in the pre- and post-CPOE time periods was compared, and adjustment for potentially confounding covariates was performed. SETTING: The pediatric and neonatal intensive care units at Montefiore Medical Center. PATIENTS: All patients admitted from the emergency room or operating room or as transfers from other institutions directly to the pediatric and neonatal intensive care units at Montefiore Medical Center. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Overall, 29 (3.16%) of the 917 patients in the pre-CPOE period and nine (2.41%) of the 374 patients in the post-CPOE period died during their hospital stay (p = .466). The power to detect the hypothesized mortality increase was 81.7%. The variables that remained significant risk factors for mortality after adjustment were shock (odds ratio, 9.41; 95% confidence interval, 2.90-30.49), prematurity (odds ratio, 3.57; 95% confidence interval, 1.74-7.30), male gender (odds ratio, 3.31; 95% confidence interval, 1.47-7.69), or a hematologic/oncologic diagnosis (odds ratio, 3.14; 95% confidence interval, 1.44-6.86). Post-CPOE initiation status remained unassociated with mortality after adjusting for all covariates (odds ratio, 0.71; 95% confidence interval, 0.32-1.57). CONCLUSION: Mortality did not increase during CPOE initiation.