RESUMEN
BACKGROUND/OBJECTIVES: An elevated blood urea nitrogen (BUN) in known to be an important prognostic indicator in patients with end-stage heart or kidney disease or certain other life-threatening illnesses. However, it is less certain as to whether an elevated BUN is an independent predictor of long-term mortality risk in less seriously ill patients. To address this issue, we examined the relationship between BUN and long-term mortality after adjusting for potential confounders and other indicators of health status/disease severity, in a select population of older medically stable Veterans. DESIGN: Long-term prospective cohort study. SETTING: Outpatient follow-up of patients discharged from a recuperative care and rehabilitation unit (RCRU) of a Department of Veterans Affairs Community Living Center. PARTICIPANTS: 383 older Veterans (mean age = 78.6±7.6 years, 98% male, and 87% white) discharged alive and in stable medical condition. MEASUREMENTS: At discharge, each subject completed a comprehensive assessment and was then monitored as an outpatient for up to 9.3 years. Associations between blood urea nitrogen at RCRU discharge and mortality were identified utilizing Cox proportional hazards (PH) regression analyses adjusting for conditions known to confound this relationship. RESULTS: Within the follow-up period, 255 subjects (67%) died. In the unadjusted Cox PH model, a BUN ≥ 30 mg/dL was associated with a nearly 2-fold increased risk of mortality (hazard ratio 1.90, 95%CI 1.41 - 2.56). The association between BUN and long-term mortality remained highly significant after adjusting for potential confounders (hazard ratio 1.78, 95%CI 1.29 - 2.44). CONCLUSION: Our findings support BUN levels as an independent predictor of long-term mortality in older, medically stable Veterans. An elevated BUN may be reflective of global health status rather than solely an indicator of the severity of acute illness or unstable chronic disease.
Asunto(s)
Nitrógeno de la Urea Sanguínea , Insuficiencia Cardíaca/mortalidad , Fallo Renal Crónico/mortalidad , Alta del Paciente/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Biomarcadores/orina , Femenino , Estado de Salud , Insuficiencia Cardíaca/orina , Mortalidad Hospitalaria , Humanos , Fallo Renal Crónico/orina , Masculino , Persona de Mediana Edad , Pronóstico , Modelos de Riesgos Proporcionales , Estudios Prospectivos , VeteranosAsunto(s)
Anticuerpos Antivirales/sangre , Infecciones por VIH/inmunología , Vacuna Tetravalente Recombinante contra el Virus del Papiloma Humano Tipos 6, 11 , 16, 18/administración & dosificación , Vacuna Tetravalente Recombinante contra el Virus del Papiloma Humano Tipos 6, 11 , 16, 18/inmunología , Memoria Inmunológica , Infecciones por Papillomavirus/inmunología , Infecciones por Papillomavirus/prevención & control , Adulto , Anticuerpos Neutralizantes/sangre , Infecciones por VIH/complicaciones , Humanos , Masculino , Persona de Mediana EdadAsunto(s)
Fracturas por Compresión/cirugía , Fracturas Espontáneas/cirugía , Mieloma Múltiple/complicaciones , Columna Vertebral/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Fracturas por Compresión/complicaciones , Fracturas Espontáneas/complicaciones , Humanos , Persona de Mediana Edad , Adulto JovenAsunto(s)
Proteína de Unión a Elemento de Respuesta al AMP Cíclico/genética , Regulación Leucémica de la Expresión Génica , Leucemia Mielomonocítica Juvenil/genética , Leucemia Mielomonocítica Juvenil/metabolismo , MicroARNs/metabolismo , Preescolar , Proteína de Unión a Elemento de Respuesta al AMP Cíclico/deficiencia , Humanos , LactanteRESUMEN
BACKGROUND: Nongonococcal urethritis (NGU) is a common chlamydia-associated syndrome in men; however, Trichomonas vaginalis and Mycoplasma genitalium are associated with its etiology and should be considered in approaches to therapy. We sought to determine whether the addition of tinidazole, an anti-trichomonal agent, to the treatment regimen would result in higher cure rates than those achieved with treatment with doxycycline or azithromycin alone. A secondary aim was to compare the efficacy of doxycycline therapy and with that of azithromycin therapy. METHODS: Randomized, controlled, double-blinded phase IIB trial of men with NGU. Participants were randomized to receive doxycycline plus or minus tinidazole or azithromycin plus or minus tinidazole and were observed for up to 45 days. RESULTS: The prevalences of Chlamydia trachomatis, M. genitalium, and T. vaginalis were 43%, 31%, and 13%, respectively. No pathogens were identified in 29% of participants. Clinical cure rates at the first follow-up visit were 74.5% (111 of 149 patients) for doxycycline-containing regimens and 68.6% (107 of 156 patients) for azithromycin-containing regimens. By the final visit, cure rates were 49% (73 of 149 patients) for doxycycline-containing regimens and 43.6% (68 of 156 patients) for azithromycin-containing regimens. There were no significant differences in clinical response rates among the treatment arms. However, the chlamydia clearance rate was 94.8% (55 of 58 patients) for the doxycycline arm and 77.4% (41 of 53 patients) for the azithromycin arm (P = .011), and the M. genitalium clearance rate was 30.8% (12 of 39 patients) for the doxycycline arm and 66.7% (30 of 45 patients) for the azithromycin arm (P = .002). CONCLUSIONS: Addition of tinidazole to the treatment regimen did not result in higher cure rates but effectively eradicated trichomonas. Clinical cure rates were not significantly different between patients treated with doxycycline and those treated with azithromycin; however, doxycycline had significantly better efficacy against Chlamydia, whereas azithromycin was superior to doxycycline for the treatment of M. genitalium.
Asunto(s)
Antibacterianos/administración & dosificación , Antiprotozoarios/administración & dosificación , Azitromicina/administración & dosificación , Doxiciclina/administración & dosificación , Tinidazol/administración & dosificación , Uretritis/tratamiento farmacológico , Adolescente , Adulto , Infecciones por Chlamydia/tratamiento farmacológico , Chlamydia trachomatis/aislamiento & purificación , Método Doble Ciego , Quimioterapia Combinada/métodos , Humanos , Masculino , Persona de Mediana Edad , Infecciones por Mycoplasma/tratamiento farmacológico , Mycoplasma genitalium/aislamiento & purificación , Resultado del Tratamiento , Tricomoniasis/tratamiento farmacológico , Trichomonas vaginalis/aislamiento & purificación , Uretritis/microbiología , Uretritis/parasitología , Adulto JovenRESUMEN
Quality-of-life instruments have provided important advances in measuring the quality of life of pediatric patients receiving treatment for cancer. However, the bases of these instruments have not included first-hand reports from the patients; thus, these instruments may be conceptually incomplete. We directly solicited from pediatric patients their perspectives regarding their quality of life during treatment for cancer. We conducted two pilot studies: 23 patients (aged 8-15 years) participated in the first, a cross-sectional study; and 13 patients (aged 10-18 years) participated in the second, a 2-year longitudinal study. Data were analyzed by using a semantic-content method, and the following six domains were recognized in data from both of the studies: symptoms, usual activities, social/family interactions, health status, mood, and the meaning of being ill. These domains were compared with those of seven established pediatric oncology quality-of-life instruments, none of which included all six of these domains; the domain most frequently missing was the meaning of being ill domain. Here we present a new definition of the quality of life of pediatric oncology patients that is based on six domains; this definition may ensure the completeness and sensitivity of these important instruments.
Asunto(s)
Neoplasias/psicología , Psicología del Adolescente , Psicología Infantil , Psicometría/métodos , Calidad de Vida/psicología , Perfil de Impacto de Enfermedad , Adolescente , Instituciones Oncológicas , Niño , Femenino , Humanos , Entrevistas como Asunto , Masculino , Neoplasias/fisiopatología , Neoplasias/terapia , Pediatría , Proyectos Piloto , Psicometría/instrumentación , Autoevaluación (Psicología) , Encuestas y Cuestionarios , TennesseeRESUMEN
There has been little empirical documentation of the acute effects of bone marrow or stem cell transplant (BMT) on children. In the present study, the responses of 153 children undergoing BMT were assessed in a prospective, longitudinal design. Children were assessed at the time of admission for transplant, then underwent weekly assessments to week +6, followed by monthly assessment to month +6. Data were obtained both by parent report and patient report (for patients age 5 and up) using the BASES scales. The major findings are: (1) children undergoing BMT enter the hospital with an already heightened level of distress (defined by high levels of somatic symptoms and mood disturbance, and low levels of activity) that increases dramatically following conditioning, reaching a peak approximately 1 week following transplant; (2) this increased distress is transient, declining rapidly back to admission levels by week +4 to week +5, followed by a further decline to presumed basal levels by months 4-6; and (3) the trajectories of distress depicted by both parent and child report are remarkably similar, each providing confirmatory support for the validity of the findings. These findings confirm a number of widely held clinical impressions that had not previously been documented empirically, and point to the need for new interventions or more intensive approaches to supportive care aimed at reducing levels of distress during the acute phase of transplant.
Asunto(s)
Calidad de Vida , Trasplante de Células Madre/psicología , Adolescente , Adulto , Trasplante de Médula Ósea/efectos adversos , Trasplante de Médula Ósea/psicología , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Trastornos del Humor/etiología , Neoplasias/terapia , Padres , Cooperación del Paciente , Estudios Prospectivos , Trasplante de Células Madre/efectos adversos , Resultado del TratamientoRESUMEN
Medical and demographic variables were examined as predictors of acute health-related quality of life (HRQL), specifically, somatic distress, mood disturbance and activity levels, during the period of bone marrow transplant (BMT) hospitalization, and the transition phase in the months following hospital discharge. The responses of 153 children undergoing BMT were assessed by both parent report and patient self-report in a prospective longitudinal design. Type of transplant, diagnosis, age, gender, and socio-economic status (SES) were examined as predictor variables of patient outcome. Type of transplant, patient age, and SES emerged as significant determinants of patient response. Children undergoing unrelated donor (MUD) transplants experiencing the highest levels of distress, followed by those undergoing matched-sibling BMT, while those undergoing autologous transplant experienced the lowest levels of distress. Younger patients experienced lower levels of distress and better HRQL than older children and adolescents. Although patients from different SES backgrounds appeared very similar at the time of hospital admission, those from lower SES backgrounds demonstrated greater distress and disturbance in HRQL subsequently, and throughout the first 6 months post BMT. These findings help to target specific subgroups of patients that may be in greater need of preventive interventions or more aggressive supportive care.
Asunto(s)
Calidad de Vida , Trasplante de Células Madre/psicología , Adolescente , Adulto , Factores de Edad , Niño , Preescolar , Estudios de Evaluación como Asunto , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Trastornos del Humor/etiología , Padres , Pronóstico , Estudios Prospectivos , Estudios Retrospectivos , Factores de Riesgo , Clase Social , Trasplante de Células Madre/efectos adversos , Estrés Fisiológico/etiología , Factores de TiempoRESUMEN
OBJECTIVE: To examine characteristics of US children living in food-insufficient households and to compare food and nutrient intakes, physical inactivity, and overweight and underweight status of children in food-insufficient households with those in food-sufficient households. DESIGN: Cross-sectional, nationally representative sample of children and households from the Continuing Survey of Food Intakes by Individuals, from 1994 to 1996. PARTICIPANTS: A group of 3790 households, including 5669 children (ages 0-17 years). MAIN OUTCOME MEASURE(S): Estimates of food insufficiency for children were based on the reported adequacy of their households, described as "often don't have enough to eat" or "sometimes don't have enough to eat." Nutrient consumption was based on two 24-hour dietary recalls from in-person interviews. RESULTS: Three percent of all households with children, and 7.5% of low-income families with children experienced food insufficiency. Several demographic and characteristic differences were observed between the food-sufficient and food-insufficient low-income groups. Children of low-income families, either food-sufficient or food-insufficient, had similar macronutrient and micronutrient intake, reported exercise, television watching, and percentage of overweight and underweight. When compared with the higher-income food-sufficient households, children in the low-income food-insufficient households consumed fewer calories (P =.05) and total carbohydrates (P =.004), but had a higher cholesterol intake (P =.02). The low-income food-insufficient group included more overweight children (P =.04), consumed less fruits (P =.04), and spent more time watching television (P =.02). CONCLUSIONS: While not different from low-income families who do not report food insufficiency, low-income families with food insufficiency had children who differed from high-income families in several nutrition and anthropometric measures. Clinicians should be aware of the possible effects of poverty and lack of access to food on child health and nutrition status. The long-term effects of these are not yet known.
Asunto(s)
Estado de Salud , Hambre , Pobreza , Adolescente , Índice de Masa Corporal , Niño , Preescolar , Estudios Transversales , Ingestión de Energía , Ejercicio Físico , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Factores de Riesgo , Estados UnidosRESUMEN
OBJECTIVE: This study was undertaken to examine variation in therapies and outcome for pediatric head trauma patients by patient characteristics and by pediatric intensive care unit. Specifically, the study was designed to examine severity of illness on admission to the pediatric intensive care unit, the therapies used during the pediatric intensive care unit stay, and patient outcomes. DATA SOURCES AND SETTING: Consecutive admissions from three pediatric intensive care units were recorded prospectively (n = 5,749). For this study, all patients with an admitting diagnosis of head trauma were included (n = 477). Data collection occurred during an 18-month period beginning in June 1996. All of the pediatric intensive care units were located in children's hospitals, had residency and fellowship training programs, and were headed by a pediatric intensivist. METHODS: Admission severity was measured as the worst recorded physiological derangement during the period
Asunto(s)
Traumatismos Craneocerebrales/mortalidad , Traumatismos Craneocerebrales/terapia , Cuidados Críticos , Preescolar , Traumatismos Craneocerebrales/clasificación , Femenino , Humanos , Lactante , Seguro de Salud , Unidades de Cuidado Intensivo Pediátrico , Presión Intracraneal , Modelos Logísticos , Masculino , Estudios Prospectivos , Respiración Artificial , Factores de Riesgo , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
OBJECTIVE: To understand better the effectiveness of routine treatment for emotional and behavioral problems experienced by adolescents, methods are needed to control for between-provider differences in the distribution of factors that adversely affect treatment success. Such methods are necessary to fairly compare providers' outcomes and to aid clinicians in identifying adolescents for whom routine care may need to be altered. As a preliminary step toward developing a model to adjust treatment outcomes to account for predictive factors, findings from studies of treated samples of adolescents were reviewed to identify the factors that influence the likelihood of treatment success for this population. METHOD: Medline and PSYCInfo databases were searched for studies of treated adolescents that reported the association between expert-nominated predictive factors and outcomes. Thirty-four studies met inclusion criteria. RESULTS: Significant predictors identified in these studies include diagnosis, baseline severity of symptoms and functional impairment, family dysfunction, and previous treatment. Several expert-nominated factors have not been adequately studied in treated samples. CONCLUSIONS: Much basic work is needed before a convincing body of empirical evidence can explain predictive factors for adolescent mental health treatment outcomes. Future efforts should determine a reduced set of predictive factors that can be measured with minimal burden to providers.
Asunto(s)
Trastornos Mentales/terapia , Evaluación de Resultado en la Atención de Salud/métodos , Ajuste de Riesgo/métodos , Adolescente , Grupos Diagnósticos Relacionados , Femenino , Humanos , Masculino , Trastornos Mentales/diagnóstico , Pronóstico , Factores de RiesgoRESUMEN
High response rates in surveys of physicians are difficult to achieve. One possible strategy to improve physicians' survey participation is to offer the option of receiving and returning the survey by fax. This study describes the success of the option of fax communication in a survey of general practitioners, family physicians, and pediatricians in Arkansas with regard to pediatric asthma. Eligible physicians were given the choice of receiving the survey by telephone, mail, or fax. In this observational study, physicians' preferences, response rates, and biases for surveys administered by fax were compared with mail and telephone surveys. The overall survey response rate was 59%. For the 96 physicians completing an eligibility screener survey, the largest percentage requested to be surveyed by fax (47%) rather than by telephone (28%) or mail (25%). Faxing may be one strategy to add to the arsenal of tools to increase response rates in surveying physicians.
Asunto(s)
Actitud del Personal de Salud , Recolección de Datos , Médicos , Telefacsímil , Medicina Familiar y Comunitaria , Humanos , PediatríaRESUMEN
CONTEXT: Pediatric intensive care units (PICUs) have expanded nationally, yet few studies have examined the potential impact of regionalization and no study has demonstrated whether a relationship between patient volume and outcome exists in these units. Documentation of an inverse relationship between volume and outcome has important implications for regionalization of care. OBJECTIVES: This study examines relationships between the volume of patients and other unit characteristics on patient outcomes in PICUs. Specifically, we investigate whether an increase in patient volume improves mortality risk and reduces length of stay. DESIGN AND SETTING: A prospective multicenter cohort design was used with 16 PICUs. All of the units participated in the Pediatric Critical Care Study Group. Participants. Data were collected on 11 106 consecutive admissions to the 16 units over a 12-month period beginning in January 1993. MAIN OUTCOME MEASURES: Risk-adjusted mortality and length of stay were examined in multivariate analyses. The multivariate models used the Pediatric Risk of Mortality score and other clinical measures as independent variables to risk-adjust for illness severity and case-mix differences. RESULTS: The average patient volume across the 16 PICUs was 863 with a standard deviation of 341. We found significant effects of patient volume on both risk-adjusted mortality and patient length of stay. A 100-patient increase in PICU volume decreased risk-adjusted mortality (adjusted odds ratio:.95; 95% confidence interval:.91-.99), and reduced length of stay (incident rate ratio:.98; 95% confidence interval:.975-.985). Other PICU characteristics, such as fellowship training program, university hospital affiliation, number of PICU beds, and children's hospital affiliation, had no effect on risk-adjusted mortality or patient length of stay. CONCLUSIONS: The volume of patients in PICUs is inversely related to risk-adjusted mortality and patient length of stay. A further understanding of this relationship is needed to develop effective regionalization and referral policies for critically ill children.
Asunto(s)
Mortalidad Hospitalaria , Unidades de Cuidado Intensivo Pediátrico/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Niño , Preescolar , Estudios de Cohortes , Grupos Diagnósticos Relacionados/estadística & datos numéricos , Femenino , Capacidad de Camas en Hospitales/estadística & datos numéricos , Planificación Hospitalaria/estadística & datos numéricos , Humanos , Lactante , Masculino , Estudios Prospectivos , Calidad de la Atención de Salud/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Índice de Severidad de la Enfermedad , Estados UnidosRESUMEN
We have used dual-energy x-ray absorptiometry (DXA) in evaluation and follow-up of a patient with osteopetrosis, before and after cord blood transplantation. Other methods of follow-up in such cases have been described, but the use of DXA has not previously been reported. We have shown that DXA offers a safe means of assessing disease progression, the timing of treatment, and response after therapy for osteopetrosis.
Asunto(s)
Absorciometría de Fotón , Osteopetrosis/diagnóstico , Adyuvantes Inmunológicos/uso terapéutico , Transfusión Sanguínea , Progresión de la Enfermedad , Ergocalciferoles/uso terapéutico , Sangre Fetal , Estudios de Seguimiento , Humanos , Lactante , Interferón gamma/uso terapéutico , Masculino , Osteopetrosis/tratamiento farmacológico , Osteopetrosis/terapia , Factores de Tiempo , Resultado del TratamientoAsunto(s)
Recolección de Datos/métodos , Interpretación Estadística de Datos , Investigación sobre Servicios de Salud/métodos , Unidades de Cuidado Intensivo Pediátrico/normas , Evaluación de Resultado en la Atención de Salud/organización & administración , Sesgo , Mortalidad Hospitalaria , Humanos , Modelos Logísticos , Reproducibilidad de los ResultadosRESUMEN
A study was conducted to determine the protective effects of two common dietary proteins, soy protein isolate (soy) and bovine whey, against chemically induced mammary tumors in female Sprague Dawley rats. Rats were fed AIN-93G diets having casein, soy, or whey as the sole protein source. Rats within the same dietary groups were mated to obtain the F1 and F2 generations. At age 50 days, F1 (experiment A) or F2 (experiment B) female offspring (> or =19 rats/group) were p.o. gavaged with 80 mg/kg 7,12-dimethylbenz(a)anthracene, and mammary glands were evaluated when 100% of the casein-fed group developed at least one palpable tumor. Rats grew well on all three diets, but casein-fed rats gained slightly more body weight than soy- or whey-fed rats (P < 0.05). Vaginal opening occurred 1 day earlier in soy-fed rats than in casein- or whey-fed rats, but no other differences in reproductive and developmental parameters were observed between groups. When 50% of the casein-fed rats had at least one mammary tumor, lower tumor incidences (24-34%) were observed in the soy-fed (P < 0.009) and whey-fed groups (P < 0.001). When 100% of the casein-fed rats had at least one tumor, soy-fed rats had a lower tumor incidence (77%) in experiment B (P < 0.002), but not in experiment A (P < 0.12), and there were no differences in tumor multiplicity. Whey-fed rats had lower mammary tumor incidence (54-62%; P < 0.002) and multiplicity (P < 0.007) than casein-fed rats in both experiments. Our results indicate that diets rich in soy reduce the incidence of chemically induced mammary tumors by approximately 20%. Furthermore, whey appears to be at least twice as effective as soy in reducing both tumor incidence and multiplicity.
Asunto(s)
9,10-Dimetil-1,2-benzantraceno/efectos adversos , Anticarcinógenos/administración & dosificación , Carcinógenos/efectos adversos , Proteínas en la Dieta/administración & dosificación , Neoplasias Mamarias Experimentales/prevención & control , Proteínas de la Leche/administración & dosificación , Proteínas de Soja/administración & dosificación , Adenocarcinoma/inducido químicamente , Adenocarcinoma/prevención & control , Análisis de Varianza , Animales , Caseínas/administración & dosificación , Bovinos , Quimioprevención , Femenino , Incidencia , Neoplasias Mamarias Experimentales/inducido químicamente , Ratas , Ratas Sprague-Dawley , Factores de Tiempo , Vagina/crecimiento & desarrollo , Aumento de Peso , Proteína de Suero de LecheRESUMEN
OBJECTIVE: To compare 24-hour dietary recalls collected over the telephone to in-person recalls collected in the 1994-1996 Continuing Survey of Food Intakes by Individuals (CSFII). DESIGN: Trained interviewers collected 24-hour dietary recalls over the telephone using the multiple-pass approach. These results were compared to in-person interviews from a pooled subsample of CSFII respondents. SUBJECTS/SETTING: List-assisted random-digit dialing was used to identify 700 women between the ages of 20 and 49 years. One eligible woman per household was selected to participate. STATISTICAL ANALYSES: Approximate t tests to examine differences in average nutrient and energy intakes were conducted on weighted data. RESULTS: The reported intakes of most nutrients in the current 24-hour dietary recalls collected over the telephone were significantly higher than those reported in the 1994 and 1995 CSFII, but there were no significant differences between the telephone survey and 1996 CSFII results. The 24-hour dietary recalls collected over the telephone yielded consistently greater mean nutrient intake per respondent compared with a comparable pooled subsample from the 1994, 1995, and 1996 CSFII. Generally, no significant differences were found in the food group data between the telephone survey and the CSFII survey. Mean dietary intakes reported by the comparable CSFII subsample increased from 1994 to 1996. APPLICATIONS: Collecting 24-hour dietary recalls over the telephone is a practical and valid data collection tool for use in national food consumption surveys.
Asunto(s)
Encuestas sobre Dietas , Entrevistas como Asunto/métodos , Teléfono , Adulto , Ingestión de Energía , Femenino , Humanos , Persona de Mediana EdadRESUMEN
OBJECTIVES: The purpose of this study was to assess demographic and geographic differences in prevalence of self-reported nutrition-related health problems in Arkansas, Louisiana, and Mississippi. METHODS: The authors analyzed 1991 and 1993 Behavioral Risk Factor Surveillance System data for adults 18 years or older. RESULTS: Less educated African American women and women of other minority groups who were aged 35 to 64 years reported the highest prevalence of health problems. Geographic differences involved prevalence of hypertension, health status, and insurance status. CONCLUSIONS: Specific demographic subgroups and geographic areas with a high risk of health problems are in particular need of targeted interventions.
Asunto(s)
Trastornos Nutricionales/epidemiología , Trastornos Nutricionales/etiología , Adulto , Distribución por Edad , Anciano , Escolaridad , Femenino , Conductas Relacionadas con la Salud , Estado de Salud , Humanos , Hipertensión/complicaciones , Seguro de Salud/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Grupos Minoritarios/estadística & datos numéricos , Mississippi/epidemiología , Encuestas Nutricionales , Vigilancia de la Población , Prevalencia , Características de la Residencia , Factores de Riesgo , Distribución por Sexo , Factores SocioeconómicosAsunto(s)
Logro , Recién Nacido de muy Bajo Peso , Factores de Edad , Niño , Humanos , Recién Nacido , PronósticoRESUMEN
Flexible bronchoscopy (FB) and bronchoalveolar lavage (BAL) have been applied increasingly to the evaluation of pulmonary disease in children. Although several complications have been reported following FB and BAL, high fever after BAL in immunocompetent children has not previously been reported. To determine the frequency, clinical characteristics, and outcome of these complications in children who developed high fever post-BAL, we retrospectively reviewed all bronchoscopic procedures done on an outpatient basis between August 1995 and July 1997. We identified 78 immunocompetent noncritically ill children who had undergone FB and BAL as an outpatient procedure for evaluation of underlying pulmonary disease, of whom 13 (17%) developed temperature (T) higher than or equal to 39 degrees C (fever group). The 13 patients in the fever group had a median age of 10 (range, 4-48) months and a reported T of 39.4 degrees C (39.1-40.6 degrees C) occurring 7.5 (4-12) hr after BAL. To determine if there were differences in clinical or BAL fluid (BALF) characteristics, we compared each child in the fever group to two children in the nonfever group, based upon primary indications and age. There were no differences in demographic or clinical characteristics between the two groups. Lymphocyte concentrations in BALF were significantly reduced in the fever group (P = 0.03). An abnormal BALF cell differential (defined as one or more of the following: neutrophils >10%, lymphocytes >30%, or eosinophils >1%) was significantly more common in the fever group (P = 0.008, odds ratio 3.6). We conclude that high fever is a frequent adverse event following BAL in noncritically ill immunocompetent children with underlying pulmonary disease. Pre-BAL clinical characteristics are not associated with development of high fever. However, the finding of an abnormal BALF cell differential is strongly associated with development of high fever post-BAL.