RESUMEN
STUDY OBJECTIVE: To determine whether clinical variables accurately identify children with radiographically proven constipation. METHODS: Prospective, cross sectional case series of children 2-12 years of age with abdominal pain (AP) requiring radiographic evaluation. Constipation was defined radiographically as the presence of fecal material throughout the colon. The presence of other pathology was noted. The pediatric emergency department (ED) physicians recorded a comprehensive history and physical examination and a provisional diagnosis was made. Radiographs were initially interpreted by the pediatric ED attending physicians; the official interpretation was later provided by a single board certified pediatric radiologist who was blinded to the ED interpretation. A discriminant analysis was performed to identify variables that could best discriminate between patients with, and without, radiographically proven constipation. RESULTS: In total 251 patients were enrolled over a 12 month period. Four variables were noted to be more common in constipated patients: a history of normal or hard stools, absence of rebound tenderness, presence of tenderness in the left lower quadrant and stool in the rectal vault on exam. Stool present on rectal exam was the best discriminator between patients with and without constipation. The discriminant analysis model had a sensitivity of 77%, specificity of 35% and a negative predictive value of 55%. CONCLUSION: No clinical variable, either as a single variable or in a model, accurately identified patients with abdominal pain and radiographically proven constipation.
Asunto(s)
Estreñimiento/diagnóstico , Examen Físico , Niño , Preescolar , Estudios Transversales , Análisis Discriminante , Femenino , Humanos , Masculino , Estudios Prospectivos , Sensibilidad y EspecificidadRESUMEN
Eighty-one pediatric patients had nuclear bone-imaging studies confirmatory of osteomyelitis during the past 10 years. Seven (8.6%) of 81 had "cold" osteomyelitis. These seven patients were all toxic [mean temperature (T), 39.9 degrees C; heart rate (HR), 145 beats/min], all had markedly elevated erythrocyte sedimentation rates (mean ESR, 76 mm/h), and six of seven had both confirmatory bone and blood cultures. All patients required surgical intervention. The average length of hospital stay for these seven patients was 32 days (range, 8-65 days). A control group of matched patients with "hot" osteomyelitis was constructed for statistical evaluation. This analysis confirmed significantly increased temperature, resting pulse rate, ESR, length of hospital stay, and rate of surgical intervention in patients with cold versus hot osteomyelitis. Patients with osteomyelitis presenting as a cold defect on bone imaging appeared to have a more aggressive type of bone infection, often requiring aggressive medical and surgical intervention adequately to control this infectious process.
Asunto(s)
Huesos/diagnóstico por imagen , Infecciones por Haemophilus/diagnóstico , Osteomielitis/diagnóstico por imagen , Infecciones Estafilocócicas/diagnóstico , Estudios de Casos y Controles , Niño , Preescolar , Femenino , Infecciones por Haemophilus/terapia , Humanos , Tiempo de Internación , Masculino , Osteomielitis/terapia , Pronóstico , Cintigrafía , Valores de Referencia , Estudios Retrospectivos , Sensibilidad y Especificidad , Infecciones Estafilocócicas/terapia , WisconsinRESUMEN
An 11 year old Chinese boy developed a unilateral cervical mass associated with pronounced eosinophilia and a marked increase in IgE concentrations. A biopsy sample showed massive eosinophilic tissue infiltration consistent with Kimura's disease. This disorder should be suspected when the clinical triad of painless unilateral cervical adenopathy, hypereosinophilia, and hyper-IgE is present, particularly in male Asian patients.
Asunto(s)
Hiperplasia Angiolinfoide con Eosinofilia/complicaciones , Inmunoglobulina E/sangre , Enfermedades Linfáticas/etiología , Hiperplasia Angiolinfoide con Eosinofilia/inmunología , Asia/etnología , Niño , Humanos , Enfermedades Linfáticas/inmunología , Masculino , CuelloAsunto(s)
Neoplasias Encefálicas/diagnóstico , Recurrencia Local de Neoplasia/cirugía , Tumor Rabdoide/diagnóstico , Neoplasias Encefálicas/fisiopatología , Neoplasias Encefálicas/cirugía , Quimioterapia Adyuvante , Estudios de Seguimiento , Humanos , Lactante , Masculino , Reoperación , Tumor Rabdoide/fisiopatología , Tumor Rabdoide/cirugía , Tomografía Computarizada por Rayos XAsunto(s)
Luxación de la Cadera/diagnóstico por imagen , Músculo Esquelético/diagnóstico por imagen , Anomalías Múltiples , Fisura del Paladar/patología , Cara/anomalías , Humanos , Hipertelorismo/patología , Luxaciones Articulares/patología , Inestabilidad de la Articulación/patología , Imagen por Resonancia Magnética , Cintigrafía , Recurrencia , SíndromeAsunto(s)
Huesos/diagnóstico por imagen , Pielonefritis/diagnóstico por imagen , Anemia de Células Falciformes/complicaciones , Preescolar , Femenino , Humanos , Osteomielitis/diagnóstico por imagen , Cintigrafía , Enfermedades de la Columna Vertebral/diagnóstico por imagen , Bazo/diagnóstico por imagenAsunto(s)
Neoplasias Óseas/secundario , Neoplasias Encefálicas/secundario , Neoplasias Renales/patología , Tumor de Wilms/secundario , Neoplasias Óseas/diagnóstico por imagen , Neoplasias Encefálicas/diagnóstico por imagen , Niño , Humanos , Masculino , Hueso Parietal/diagnóstico por imagen , Cintigrafía , Tumor de Wilms/diagnóstico por imagenRESUMEN
A wire stent was used successfully to treat life-threatening tracheomalacia in a 5-year-old girl. Wire stents placed bronchoscopically are nonobstructing and have the potential for balloon expansion to accommodate growth.
Asunto(s)
Stents , Enfermedades de la Tráquea/terapia , Broncoscopía , Preescolar , Deleción Cromosómica , Cromosomas Humanos Par 7 , Femenino , Humanos , Tráquea , Enfermedades de la Tráquea/diagnósticoAsunto(s)
Aneurisma de la Aorta Abdominal/etiología , Aneurisma de la Aorta Torácica/etiología , Disección Aórtica/etiología , Síndrome de Marfan/diagnóstico , Disección Aórtica/diagnóstico , Disección Aórtica/cirugía , Aneurisma de la Aorta Abdominal/diagnóstico , Aneurisma de la Aorta Abdominal/cirugía , Aneurisma de la Aorta Torácica/diagnóstico , Aneurisma de la Aorta Torácica/cirugía , Preescolar , Femenino , Humanos , Síndrome de Marfan/complicacionesAsunto(s)
Maltrato a los Niños/diagnóstico , Diafragma/diagnóstico por imagen , Diafragma/lesiones , Espacio Retroperitoneal/diagnóstico por imagen , Resultado Fatal , Humanos , Lactante , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/lesiones , Masculino , Cintigrafía , Medronato de Tecnecio Tc 99mAsunto(s)
Riñón/diagnóstico por imagen , Pielonefritis/diagnóstico por imagen , Sepsis/diagnóstico por imagen , Infecciones Estreptocócicas/diagnóstico por imagen , Niño , Humanos , Masculino , Pielonefritis/microbiología , Cintigrafía , Choque Séptico/diagnóstico por imagen , Medronato de Tecnecio Tc 99mRESUMEN
Radiograph interpretation in the pediatric emergency department (ED) is commonly performed by pediatric emergency medicine (PEM) attendings or physicians-in-training. This study examines the effect of physician training level on radiograph interpretation and the clinical impact of false-negative radiograph interpretations. Data were collected on 1,471 radiographs of the chest, abdomen, extremity, lateral neck, and cervical spine interpreted by PEM attendings, one PEM fellow, one physician assistant, and emergency medicine, pediatric and family practice residents. Two hundred radiographs (14%) were misinterpreted, including 141 chest (16%), 24 extremity (8%), 20 abdomen (12%), 14 lateral neck (18%), and 1 cervical spine radiograph (2%). Physicians-in-training misinterpreted 16% of their radiographs versus 11% for PEM attendings (P = .01). Twenty (1.4%) radiographs had clinically significant (false-negative) misinterpretations, including 1.7% of physician-in-training and 0.8% of attending interpretations (P = 0.15). No morbidity resulted from the delay in correct interpretation. Radiograph misinterpretation by ED physicians occurs but is unlikely to result in significant morbidity.
Asunto(s)
Errores Diagnósticos , Medicina de Emergencia/educación , Servicio de Urgencia en Hospital/normas , Cuerpo Médico de Hospitales/normas , Pediatría/educación , Radiología/educación , Escolaridad , Medicina de Emergencia/normas , Reacciones Falso Negativas , Humanos , Cuerpo Médico de Hospitales/educación , Evaluación de Resultado en la Atención de Salud , Estudios ProspectivosAsunto(s)
Granuloma de Células Plasmáticas/diagnóstico , Enfermedades de la Vejiga Urinaria/diagnóstico , Niño , Diagnóstico Diferencial , Granuloma de Células Plasmáticas/complicaciones , Granuloma de Células Plasmáticas/cirugía , Hematuria/etiología , Humanos , Masculino , Tomografía Computarizada por Rayos X , Enfermedades de la Vejiga Urinaria/complicaciones , Enfermedades de la Vejiga Urinaria/cirugía , Neoplasias de la Vejiga Urinaria/diagnósticoRESUMEN
A 13-month-old patient with autoimmune deficiency syndrome had renal candidiasis. An abnormal renal sonographic pattern of hyperechoic renal pyramids was demonstrated. This abnormal sonographic finding should suggest renal candidiasis in an immune suppressed child. In the normal kidney of children, the pyramids are hypoechoic. This pattern has not been noted in previous publications. We report this case.