Limited Efficacy of Empiric Antibiotics for Pediatric Facial Fractures.

BACKGROUND: Controversies exist regarding the role of perioperative antibiotic use in pediatric craniomaxillofacial fracture repair. PURPOSE: This study aims to identify factors associated with antibiotic prescribing patterns and measures the association between antibiotic exposure and postoperative infections. STUDY DESIGN, SETTING, SAMPLE: In this retrospective cohort study, TriNetX, a research database, was used to gather data on patients under 18 years of age who underwent repair of facial fractures. The records were obtained from 2003 to 2021. Current Procedural Terminology codes for facial fracture procedures were used to identify patients. PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE: Antibiotic use, defined as a binary categorical variable of whether or not patients received perioperative antibiotics. The secondary predictor variable was timing of antibiotic administration, categorized by pre, intra, and postoperative administration. MAIN OUTCOME VARIABLES: Postoperative infection, determined by International Classification of Diseases, 9th and 10th Revision codes within patient charts. COVARIATES: Covariates included demographic variables such as age, sex, race, ethnicity, geographic location, and fracture characteristics, such as number of fractures and location of fracture. ANALYSES: χ2 analyses were used for categorical variables and two sample t tests for quantitative variables. Multivariable logistic regression was used to evaluate patient infection and antibiotic use with adjustment for covariates. P-values were 2-tailed and statistical significance was defined as P < .05. RESULTS: This cohort included 5,413 patients of which 70.4% were male, 74.4% identified as white, and 83.3% identified as non-Hispanic or Latino. There were no differences in postoperative infections in patients who received antibiotics compared to those who did not (0.9 vs 0.5%, respectively, P = .12). Nevertheless, antibiotic prescriptions have increased over the years. After controlling for relevant covariates, antibiotic use did not decrease the odds of infection (adjusted odds ratio 1.1, 95% CI 0.53 to 2.34, P = .79). There was a significant association between the timing of antibiotic use and infection (P = .044), with increased odds of infection when antibiotics were given postoperatively (adjusted odds ratio 3.8, 95% CI 1.2 to 12.07, P = .023). CONCLUSION AND RELEVANCE: While antibiotic prescriptions have increased over the years, this study demonstrates there is no difference in postoperative infection rates for pediatric patients prescribed antibiotics and those where were not.

Presence of social media mentions for vascular surgery publications is associated with an increased number of literature citations.

OBJECTIVE: The past two decades have seen a vast expansion of social media in all aspects of our lives. Scholars and journals are steadily increasing their social media presence to reach a wider audience. We compared the social media mentions (SMs) of vascular surgery publications and their effect on the literature citations (LCs) for them. METHODS: A total of 169 articles from three renowned vascular surgery journals (Journal of Vascular Surgery [JVS], Annals of Vascular Surgery, and European Journal of Vascular and Endovascular Surgery) in October 2016 were collected. All three journals are published by the same publisher (Elsevier). SMs were tracked using Altmetric Bookmarklet for Twitter and Facebook mentions. The LCs were evaluated using Scopus and Google Scholar. The number of citations was compared between those with and without any SMs and among the three journals using nonparametric Kruskal-Wallis tests. The proportion of articles with SMs was compared among the three journals using a χ2 test. The relationship between the numbers of SMs and LCs was assessed using the Spearman rank correlation coefficient and reported as 95% confidence intervals. Statistical significance was assigned at P < .05. RESULTS: Of the 169 articles examined, 51 (30.2%) had a presence regarding social media usage. JVS has both Twitter and Facebook presence. The Annals of Vascular Surgery and European Journal of Vascular and Endovascular Surgery only have Twitter accounts. JVS had the highest total number of citations, number of LCs per manuscript, and SMs per manuscript. A significant difference was found in the median, Q1 (median of the lower half of the data), and Q3 (median of the upper half of the data) number of total Google citations between those articles with and without SMs (median, 8.0; Q1, 3.0; Q3, 17.0; vs median, 3.0; Q1, 0.0; Q3, 8.0, respectively; Kruskal-Wallis P < .001). Similarly, a significant difference was found in the median number of total Scopus citations between those articles with and without SMs (median, 5.0; Q1, 2.0; Q3, 13.0 vs median, 2.0; Q1, 0.0; Q3, 6.0, respectively; Kruskal-Wallis P < .001). Articles with a SM showed a 2.7- fold increase in median total citations in Google and a 2.5-fold increase in median total citations in Scopus. The Spearman correlation coefficients to determine the relationship between the absolute number of SMs and LCs revealed a positive, but weak, correlation, largely driven by the majority of articles with no SMs. The difference in the median number of citations among the three journals was not statistically significant, either by Google (P = .22) or Scopus (P = .08), nor was the difference in the proportion of articles with SMs among the journals statistically significant (P = .36). CONCLUSIONS: The presence of SMs for vascular surgery publications, especially clinical science articles, was associated with a significantly increased number of median LCs during the 3 years after publication. The three journals did not differ with respect to the median number of citations or proportion of articles with SMs.

Current office-based hearing screening questions fail to identify adolescents at risk for hearing loss.

OBJECTIVE: There is a rising prevalence of hearing loss among adolescents in the United States. Current paediatric preventive care recommendations by the Bright Futures guidelines and the American Academy of Pediatrics suggest that clinicians should ask adolescents ten hearing screening questions to identify those who are at high risk of hearing loss for further objective hearing testing. We assessed the utility of these subjective risk assessment questions to distinguish those adolescents with objectively documented hearing loss. SETTING: A single public high school in Pennsylvania. METHODS: We compared results from a prospective study evaluating objective hearing assessments with the use of the ten Bright Futures hearing screening questions plus additional adolescent-specific questions to predict adolescent hearing loss. RESULTS: In relation to the questions used in this study, adolescents who were referred following objective hearing screens were more likely to report "trouble following the conversation when two or more people are talking at the same time" and a "past experience of slight hearing loss". Referrals from sound treated booth testing were more likely to report "trouble hearing over the phone" and have a diagnosis or history of hearing loss. CONCLUSIONS: Most Bright Futures questions were not associated with adolescent hearing loss. An objective adolescent hearing screen should be considered in the recommended schedule of preventive care, instead of the current risk-based subjective assessment.

Pilot study of a high-frequency school-based hearing screen to detect adolescent hearing loss.

OBJECTIVE: Like most of the United States, school-based hearing screening in Pennsylvania focuses on low-frequency, conductive hearing losses typical for young children, rather than the high-frequency, noise-induced hearing loss more prevalent among adolescents. The objective of this study was to compare the sensitivity and specificity of current school hearing screening in Pennsylvania with hearing screening including high frequencies, designed to detect adolescent hearing loss. SETTING: A single public high school. METHODS: In the Autumn of 2011 the high-frequency screen was delivered alongside the Pennsylvania school screen for students in the 11(th) grade. Screening referrals and a subset of passes returned for "gold standard" testing with audiology in a sound treated booth, in order to determine the sensitivity and specificity of the screening tests. RESULTS: Of 282 participants, five (2%) were referred on the Pennsylvania school screen, and 85 (30%) were referred on the high-frequency screen. Of the 48 who returned for gold standard testing with audiology, hearing loss was diagnosed in 9/48 (19%). Sensitivity of the Pennsylvania and high-frequency screens were 13% (95% confidence interval [CI] 0-53%) and 100% (95% CI 66-100%) respectively. Specificity of the Pennsylvania and high-frequency screens were 97% (95% CI 87-100%) and 49% (95% CI 32-65%) respectively. CONCLUSIONS: Current school hearing screens have low sensitivity for detection of adolescent hearing loss. Modifying school-based protocols may be warranted to best screen adolescents, and make optimal use of school nurse time and effort.