Trauma injury, severity, and outcomes among pediatric American Indian/Alaska Natives in the North Central United States.

BACKGROUND: There is a disproportionately higher trauma morbidity between American Indian/Alaska Native (AI/AN) and non-AI/AN children. OBJECTIVE: To characterize and compare trauma in AI/AN and non-AI/AN children presenting to a Regional Pediatric Level II Trauma Center (Adult Level I Trauma Center). METHOD: A retrospective observational study of all children <20 years presenting from 2012-2018. Descriptive data were analyzed along with T-tests to determine if demographic and clinical characteristics were different for AI/AN and non-AI/AN children. RESULTS: AI/AN children are more likely to be referred from outside hospitals [OR 5.61, 95% CI 3.79, 8.29], to have penetrating injuries [OR 3.87, 95% CI 1.88, 7.99] and have higher likelihood of both minor [OR 1.48, 95% Cl 1.06, 2.07] and major [OR 1.99, 95% Cl 1.37, 2.87] trauma activation on arrival. More AI/AN children suffer violent injuries [OR 3.12, 95% CI 1.90, 5.01], utilized Intensive Care Unit (ICU) [OR 1.54 95% CI 1.10, 2.14], had prolonged length of stay (LOS) [OR 1.52, 95% Cl 1.28, 1.80], and were less likely discharged home [OR 0.65, 95% Cl 0.44, 0.96]. CONCLUSIONS: AI/AN pediatric trauma patients suffer higher morbidity compared to non-AI/AN pediatric trauma patients. This study provides data which supports the need for future interventions to decrease the burden of injury noted among AI/AN children. STUDY TYPE: Treatment STUDY TYPE AND LEVEL OF EVIDENCE: Retrospective comparative study; Level III.

Combined nocturnal pulse oximetry and questionnaire-based obstructive sleep apnea screening - A cohort study.

BACKGROUND: Screening for obstructive sleep apnea (OSA) in both inpatient and outpatient settings to pursue diagnostic testing is becoming increasingly relevant, particularly given the estimates of 85-90% of patients with OSA remaining undiagnosed. Although many questionnaires are available for OSA screening, the STOP-BANG questionnaire is becoming increasingly used due to ease of use and positive performance characteristics. The utility of nocturnal oximetry, in conjunction with standard questionnaire-based strategies to enhance OSA screening in adults, has yet to be systematically examined. RESEARCH OBJECTIVES: To evaluate the utility of nocturnal oximetry measures combined with the standard STOP-BANG questionnaire as a screening strategy for OSA in the hospital setting and outpatient clinics. STUDY DESIGN AND METHODS: We conducted a retrospective cohort study. We reviewed the electronic medical records of 130 patients who were referred to Sanford sleep center from both inpatient and outpatient settings over one year (August 1st, 2016 to August 1st, 2017). Nocturnal oximetry was conducted at home (in the outpatient group) and in the medical wards (in the inpatient group), and the following measures were obtained: Oxygen Desaturation Index (ODIPOx), mean SaO2POx and time spent below 88% SaO2 (T88Pox). Apnea-hypopnea index (AHI), mean SaO2PSG, and T88PSG from overnight polysomnography (PSG) and STOP-BANG score. RESULTS: Based upon likelihood ratio testing comparing discriminative ability, a model of (ODIPox + STOPBANG) was superior and more accurate than STOP-BANG alone in detecting mild OSA in the overall sample (AUC = 0.644 [0.549-0.739], p = 0.003) and inpatient sample (AUC = 0.710 [0.582-0.839], p = 0.001). This approach was also more accurate in detecting severe OSA in full sample (AUC = 0.839 [0.763-0.914], p < 0.0001), inpatient sample (AUC = 0.825 [0.711-0.939], p < 0.0001) and outpatient sample (AUC = 0.827 [0.699-0.955], p < 0.0001). The ODIPox alone was more accurate than STOP-BANG alone in detecting mild OSA in the overall sample (AUC = 0.620 [0.524-0.717], p = 0.014) and inpatient sample (AUC = 0.704 [0.574-0.835], p = 0.002) and severe OSA in full sample (AUC = 0.839 [0.764-0.915], p < 0.0001), inpatient sample (AUC = 0.827 [0.714-0.940], p < 0.0001) and outpatient sample (AUC = 0.861 [0.771-0.950], p < 0.0001). CONCLUSION: The use of nocturnal oximetry measures (ODIPOx) improved the accuracy of standard OSA screening with the STOP-BANG questionnaire as a screening tool in severe OSA in both inpatient and outpatient settings. CLINICAL IMPLICATION: Obstructive sleep apnea is a common sleep disorder that impacts many co-morbidities in different age groups. Enhancing affordable screening methods for OSA can facilitate early diagnosis and treatment and subsequently ameliorate morbidity and mortality related to sleep-disordered breathing.