The Journal of Pediatrics Volume 160 Issue 6 2012 [Doi 10.1016_j.jpeds.2012.04.026] Alan H. Jobe --...
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Imaging studies for evaluation of acute appendicitis in children — Sarah S. Long, MD B achur et al performed a retrospective study of utilization of imaging and outcomes in children evaluated in Emergency Departments for acute appendicitis using an administrative database that included 38 freestanding United States children’s hospi- tals. The study spanned 5 years (2005 through 2009) and permitted several interesting observations about the use of ultrasonography (US), computed tomography (CT), or both. Overall, the median instituti onal rate of using either modalit y was 48% (inter- quartile range 37% to 57%). Thirty-four percent of patients had CT and 6% had US performed, also with marked variability between modalities across institutions. Rates and modes of imaging varied by age and sex — females and patients younger than 5 years were more likely to have imaging performed. Following a known rise in CT per- formance early in the decade, use peaked in 2007 and fell 6% from 2007 through 2009, while use of US increased almost 8% over the study years. Other than the rate of neg- ative appendectomy (ie, finding no appendicitis at surgery) being slightly lower in in- stitutions usi ng more US, var iation in adv anced diagnostic ima ging bet wee n ins tit uti ons did notcorrel ate wit h major out comes, including rates of app endiceal per- foration or hospital return for “missed” appendicitis. The study packs the weight of inclusion of 35 238 children with appendicitis, but also accentuates the leanness of an administrative database, which lacks patient-level clinical data (eg, duration and degree of illness/findings at the time of evaluation) and physician-level reasoning for diagnosis, imaging, and management. Article page 1034< Capnography to detect endotracheal tube dislodgement — Robert W. Wilmott, MD P ediatric residents were trained in intubation and resuscitation in a simulation lab at Yale University, and a randomized control study was performed to see whether standard monitoring plus capnography increased the ability to recognize dislodge- ment of the endotracheal tube. This study of 27 pediatric residents showed that those who had received training in capnography and had capnography available, in addition to standard monitoring, corrected endotracheal tube dislodgement significantly faster than the control group. The authors suggest that capnography should be considered as essential for intubated patients to enhance patients’ safety. Article page 1009< Iron and hepcidin in the preterm — Alan H. Jobe, MD, PhD I ron metabolism is problematic in the very preterm infant because of low iron stores at birth and the multiple effects of inflammation, blood loss for testing, nutritional deficits, and transfusion. The optimal amounts of iron supplementation and the tim- ing and levels of hemoglobin requiring transfusion remain uncertain. In this issue of The Journal , M€ uller et al report that urine hepcidin levels may be a good biomarker for iron and hematologic status in these infants. The 25 amino-acid form of hepcidin is synthesized by the liver and excreted in urine. It is a key regulator of iron homeo- stasis, acting through the iron exporter, ferropostin. A single biomarker in urine would be welcome as a replacement for multiple measurements of iron status using blood. Article page 949< Obesity treatment: putting guidelines to work — St ephen R. Da ni el s, MD, PhD T here has been substantial research on the treatment of obesity in children and ad- olescents. These results have been incorporated in the American Medical Associa- tion/Centers for Disease Control and Prevention recommendations for the prevention and treatment of obesity. Although these recommendations are relatively straightfor- ward, it is not clear how best to implement them in a clinical practice to get the best outcomes. In this issue of The Journal , Coleman et al report on the use of computer- assisted decision tools to implement the guidelines in an integrated health care system. The decision tools included alerts that were based on body mass index percentile and remind ed the primary-ca re physic ian about screeni ng for relat ed condit ions and A2 Vol. 160, No. 6
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Transcript of The Journal of Pediatrics Volume 160 Issue 6 2012 [Doi 10.1016_j.jpeds.2012.04.026] Alan H. Jobe --...
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Imaging studies forevaluation of acute
Capnography todetect endotracheal
Iron and hepcidin inthe preterm
Alan H. Jobe, MD, PhD
Obesity treatment:
A2putting guidelinesto work
Stephen R. Daniels, MD, PhDIron metabolism is problematic in the very preterm infant because of low iron storesat birth and the multiple effects of inflammation, blood loss for testing, nutritionaldeficits, and transfusion. The optimal amounts of iron supplementation and the tim-ing and levels of hemoglobin requiring transfusion remain uncertain. In this issue ofThe Journal, Muller et al report that urine hepcidin levels may be a good biomarkerfor iron and hematologic status in these infants. The 25 amino-acid form of hepcidinis synthesized by the liver and excreted in urine. It is a key regulator of iron homeo-stasis, acting through the iron exporter, ferropostin. A single biomarker in urinewould be welcome as a replacement for multiple measurements of iron status usingblood.
Article page 949
