Predictors of mortality, hospital utilization, and the role of race in outcomes in head and neck trauma.

OBJECTIVE: A retrospective cross-sectional analysis was undertaken to determine the impact of race and insurance status on trauma outcomes in patients admitted to a Level I trauma center following head and neck fractures. STUDY DESIGN: Putative predictive factors, including injury mechanism, hemorrhagic shock, injury severity score (ISS), race, gender, and insurance status, were used in a multivariate outcome analysis to determine their influence on length of hospital stay, number of procedures performed, discharge status, and mortality; P < .05 was significant. RESULTS: Proportionately more male patients (76.5%) sustained head and neck fractures compared with females (23.5%). Blacks and Hispanics sustained proportionately more gunshot wounds (GSWs) compared with Whites, 16:1 and 7:1, respectively. There were no significant differences in length of hospital stay and mortality based on race or insurance status. Mortality was related to age, GSW as a mechanism of injury, increasing ISS, and shock on admission. CONCLUSIONS: Minority race and insurance status did not correlate with worse outcomes. Treatment biases in the acutely injured patient with head and neck injuries may be less prevalent than thought, if we consider mortality and utilization of care as primary outcome measures.

Autoimmune Neutropenia as a Cause of Periodontal Disease in Preschool Children.

In autoimmune neutropenia, autoantibodies attack neutrophils resulting in their destruction or alteration of their function. Since neutrophils have important immunologic functions, aberrations in their homeostasis lead to increased susceptibility to diseases, such as periodontitis. Periodontitis as a manifestation of neutropenia can affect adults and children. In this paper, we describe the treatment of periodontal disease in a 2-year-old female with autoimmune neutropenia. The importance of an interdisciplinary approach, frequent recalls, and meticulous mechanical therapy in stabilizing her periodontal condition, despite ongoing systemic infections is emphasized.

Anesthetic and dental management of a child with IMAGe syndrome.

IMAGe syndrome (OMIM 300290) is a rare multisystem disorder that has a broad phenotypic presentation. Though variable, this disorder mainly consists of Intrauterine growth retardation, Metaphyseal dysplasia, Adrenal hypoplasia congenita, and Genital abnormalities. Patients with IMAGe syndrome present as an uncommon yet important challenge for dentists and anesthesiologists due to their wide range of dysmorphic facial features, adrenal insufficiency, electrolyte imbalances, and need for steroid replacement. The purpose of this case report is to describe the successful anesthetic management of a pediatric patient diagnosed with IMAGe syndrome who presented for full mouth dental rehabilitation.

Time and cost analysis: pediatric dental rehabilitation with general anesthesia in the office and the hospital settings.

Pediatric dental patients who cannot receive dental care in the clinic due to uncooperative behavior are often referred to receive dental care under general anesthesia (GA). At Stony Brook Medicine, dental patients requiring treatment with GA receive dental care in our outpatient facility at the Stony Brook School of Dental Medicine (SDM) or in the Stony Brook University Hospital ambulatory setting (SBUH). This study investigates the time and cost for ambulatory American Society of Anesthesiologists (ASA) Class I pediatric patients receiving full-mouth dental rehabilitation using GA in these 2 locations, along with a descriptive analysis of the patients and dental services provided. In this institutional review board-approved cross-sectional retrospective study, ICD-9 codes for dental caries (521.00) were used to collect patient records between July 2009 and May 2011. Participants were limited to ASA I patients aged 36-60 months. Complete records from 96 patients were reviewed. There were significant differences in cost, total anesthesia time, and recovery room time (P < .001). The average total time (anesthesia end time minus anesthesia start time) to treat a child at SBUH under GA was 222 ± 62.7 minutes, and recovery time (time of discharge minus anesthesia end time) was 157 ± 97.2 minutes; the average total cost was $7,303. At the SDM, the average total time was 175 ± 36.8 minutes, and recovery time was 25 ± 12.7 minutes; the average total cost was $414. After controlling for anesthesia time and procedures, we found that SBUH cost 13.2 times more than SDM. This study provides evidence that ASA I pediatric patients can receive full-mouth dental rehabilitation utilizing GA under the direction of dentist anesthesiologists in an office-based dental setting more quickly and at a lower cost. This is very promising for patients with the least access to care, including patients with special needs and lack of insurance.