25 research outputs found
Research priorities for European paediatric emergency medicine
Objective Research in European Paediatric Emergency Medicine (REPEM) network is a collaborative group of 69 paediatric emergency medicine (PEM) physicians from 20 countries in Europe, initiated in 2006. To further improve paediatric emergency care in Europe, the aim of this study was to define research priorities for PEM in Europe to guide the development of future research projects. Design and Setting We carried out an online survey in a modified three-stage Delphi study. Eligible participants were members of the REPEM network. In stage 1, the REPEM steering committee prepared a list of research topics. In stage 2, REPEM members rated on a 6-point scale research topics and they could add research topics and comment on the list for further refinement. Stage 3 included further prioritisation using the Hanlon Process of Prioritisation (HPP) to give more emphasis to the feasibility of a research topic. Results Based on 52 respondents (response rates per stage varying from 41% to 57%), we identified the conditions 'fever', 'sepsis' and 'respiratory infections', and the processes/interventions 'biomarkers', 'risk stratification' and 'practice variation' as common themes of research interest. The HPP identified highest priority for 4 of the 5 highest prioritised items by the Delphi process, incorporating prevalence and severity of each condition and feasibility of undertaking such research. Conclusions While the high diversity in emergency department (ED) populations, cultures, healthcare systems and healthcare delivery in European PEM prompts to focus on practice variation of ED conditions, our defined research priority list will help guide further collaborative research efforts within the REPEM network to improve PEM care in Europe.publishersversionPeer reviewe
Presentations of children to emergency departments across Europe and the COVID-19 pandemic: A multinational observational study
BACKGROUND: During the initial phase of the Coronavirus Disease 2019 (COVID-19) pandemic, reduced numbers of acutely ill or injured children presented to emergency departments (EDs). Concerns were raised about the potential for delayed and more severe presentations and an increase in diagnoses such as diabetic ketoacidosis and mental health issues. This multinational observational study aimed to study the number of children presenting to EDs across Europe during the early COVID-19 pandemic and factors influencing this and to investigate changes in severity of illness and diagnoses. METHODS AND FINDINGS: Routine health data were extracted retrospectively from electronic patient records of children aged 18 years and under, presenting to 38 EDs in 16 European countries for the period January 2018 to May 2020, using predefined and standardized data domains. Observed and predicted numbers of ED attendances were calculated for the period February 2020 to May 2020. Poisson models and incidence rate ratios (IRRs), using predicted counts for each site as offset to adjust for case-mix differences, were used to compare age groups, diagnoses, and outcomes. Reductions in pediatric ED attendances, hospital admissions, and high triage urgencies were seen in all participating sites. ED attendances were relatively higher in countries with lower SARS-CoV-2 prevalence (IRR 2.26, 95% CI 1.90 to 2.70, p < 0.001) and in children aged <12 months (12 to <24 months IRR 0.86, 95% CI 0.84 to 0.89; 2 to <5 years IRR 0.80, 95% CI 0.78 to 0.82; 5 to <12 years IRR 0.68, 95% CI 0.67 to 0.70; 12 to 18 years IRR 0.72, 95% CI 0.70 to 0.74; versus age <12 months as reference group, p < 0.001). The lowering of pediatric intensive care admissions was not as great as that of general admissions (IRR 1.30, 95% CI 1.16 to 1.45, p < 0.001). Lower triage urgencies were reduced more than higher triage urgencies (urgent triage IRR 1.10, 95% CI 1.08 to 1.12; emergent and very urgent triage IRR 1.53, 95% CI 1.49 to 1.57; versus nonurgent triage category, p < 0.001). Reductions were highest and sustained throughout the study period for children with communicable infectious diseases. The main limitation was the retrospective nature of the study, using routine clinical data from a wide range of European hospitals and health systems. CONCLUSIONS: Reductions in ED attendances were seen across Europe during the first COVID-19 lockdown period. More severely ill children continued to attend hospital more frequently compared to those with minor injuries and illnesses, although absolute numbers fell. TRIAL REGISTRATION: ISRCTN91495258 https://www.isrctn.com/ISRCTN91495258
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Gadolinium enhancement of spinal subdural collection on magnetic resonance imaging after lumbar puncture
We report a 35-year-old male with an unusual contrast-enhancing sterile spinal subdural collection on magnetic resonance imaging (MRI), apparently occurring as a complication of lumbar puncture. Follow-up MRI after 4 weeks demonstrated spontaneous resolution of the collection without intervening treatment
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CT perfusion imaging in the management of posterior reversible encephalopathy
Thrombocytopenia and emperipolesis in a patient with hepatitis A infection
Immune thrombocytopenia is a benign, self-limiting disease in children, responding well to treatment and generally associated with viral infections. A 13-year-old girl was admitted to a hospital with the epistaxis and propura after an attack of jaundice 6 weeks before. The diagnosis of hepatitis A virus (HAV)-induced thrombocytopenia was made. Furthermore, erythrophagocytosis by megakaryocytes was demonstrated in the bone marrow of the patient. Although hematologic complications following hepatitis B and C viruses are commonly reported, the association of hepatitis A vir-us and thrombocytopenia has rarely been described
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Diffusion-Weighted Imaging in the Setting of Diffuse Cortical Laminar Necrosis and Hypoxic-Ischemic Encephalopathy
BACKGROUND AND PURPOSE:
As is the case for CT scans, MR images may occasionally appear deceptively normal unless proper windowing is used. We sought to illustrate the necessity for proper windowing and for assessing the gray–white matter differentiation on diffusion-weighted (DW) images in the setting of hypoxic-ischemic encephalopathy.
METHODS:
Six comatose patients (age range, 34–56 years) underwent MR imaging in the early phase (range, 1–5 days) after severe anoxic insult. T2-weighted, turbo fluid-attenuated inversion-recovery, and DW images were obtained in all six patients, with contrast-enhanced T1-weighted images obtained in four and apparent diffusion coefficient (ADC) maps in five of the six patients.
RESULTS:
At presentation, each of the six patients had symmetric, uniform hyperintensity in the cortex (mean ADC, 0.35 × 10
−3
mm
2
/s) relative to the white matter (mean ADC, 0.91 × 10
−3
mm
2
/s) on DW images. Each also had a poor outcome: brain death in four patients and a permanent vegetative state in two patients.
CONCLUSION:
The appearance of the MR images in the setting of diffuse cortical laminar necrosis can be deceptive to the unwary radiologist. The key to correct interpretation is proper windowing and the marked gray–white matter differentiation on spin-echo images but best seen on properly windowed DW images in the early subacute phase. This appearance also implies an extremely poor outcome, either a permanent vegetative state or brain death
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Carotid bifurcation calcium and correlation with percent stenosis of the internal carotid artery on CT angiography
The aim of this paper was to determine the correlation between calcium burden (expressed as a volume) and extent of stenosis of the origin of the internal carotid artery (ICA) by CT angiography (CTA). Previous studies have shown that calcification in the coronary arteries correlates with significant vessel stenosis, and severe calcification (measured by CT) in the carotid siphon correlates with significant (greater than 50% stenosis) as determined angiographically. Sixty-one patients (age range 50–85 years) underwent CT of the neck with intravenous administration of iodinated contrast for a variety of conditions. Images were obtained with a helical multidetector array CT scanner and reviewed on a three-dimensional workstation. A single observer manipulated window and level to segment calcified plaque from vascular enhancement in order to quantify vascular calcium volume (cc) in the region of the bifurcation of the common carotid artery/ICA origin, and to measure the extent of ICA stenosis near the origin. A total of 117 common carotid artery bifurcations were reviewed. A significant stenosis was defined arbitrarily as >40% (to detect lesions before they become hemodynamically significant) of luminal diameter on CTA using NASCET-like criteria. All significant stenoses (21 out of 117 carotid bifurcations) had measurable calcium. We found a relatively strong correlation between percent stenosis and the calcium volume (Pearsons r = 0.65, P<0.0001). We also found that there was an even stronger correlation between the square root of the calcium volume and the percent stenosis as measured by CTA (r= 0.77, P<0.0001). Calcium volumes of 0.01, 0.03, 0.06, 0.09 and 0.12 cc were used as thresholds to evaluate for a significant stenosis. A receiver operating characteristic (ROC) curve demonstrated that thresholds of 0.06 cc (sensitivity 88%, specificity 87%) and 0.03 cc (sensitivity 94%, specificity 76%) generated the best combinations of sensitivity and specificity. Hence, this preliminary study demonstrates a relatively strong relationship between volume of calcium at the carotid bifurcation in the neck (measured by CT) and percent stenosis of the ICA below the skull base (as measured by CTA). Use of calcium volume measurements as a threshold may be both sensitive and specific for the detection of significant ICA stenosis. The significance of the correlation between calcium volume and ICA stenosis is that potentially a score can be obtained that will identify those at risk for high grade carotid stenosis.Engineering and Applied Science