Context: Despite evidence that more than 90%of children with traumatic injuri es to the spleen can be successfully managed nonoperatively, there is significan tvariation in the use of splenectomy. As asplenic children...Context: Despite evidence that more than 90%of children with traumatic injuri es to the spleen can be successfully managed nonoperatively, there is significan tvariation in the use of splenectomy. As asplenic children are at increased ris k of overwhelming postsplenectomy infection, nonoperative management may be cons idered a quality of care indicator. Objective: To test the hypothesis that child ren are more likely to undergo splenectomy in general hospitals than in children ’s hospitals. Design: Retrospective cohort study using data from the Kid’s Inp atient Database (KID) for the year 2000. Multivariable regression was used to control for patient and hospital characteristics. Setting and Participants: All ch ildren aged 0 to 16 years who were hospitalized with a traumatic (noniatro- genic) spleen injury in nonfederal short-stay hospitals in any of the 27 stat es participating in KID (N=2851). Main Outcome Measure: Splenectomy performed wi thin 1 day of arrival. Results: A total of 11 children (3%) with splenic injuri es receiving care at children’s hospitals underwent splenectomy compared with 3 83 children (15.4%) cared for at general hospitals (P < .001). After adjusting for patient characteristics, injury severity, and hospital characteristics, sple nectomy was more likely among children treated at general hospitals (odds ratio, 5.01; 95%confidence interval, 2.21-11.36) than among children treated at chil dren’s hospitals. Conclusions: There is considerable variation in the managemen t of pediatric splenic injuries, with significantly lower rates of splenectomy a t designated children’s hospitals. Quality improvement interventions, including increased education and training for physicians in general hospitals, may be ne eded to increase the use of spleen-conserving management practices.展开更多
This study examined the incidence of cardiac conduction abnormalities and ventricular arrhythmias after the transcatheter closure of muscular ventricular septal defects(MVSDs) using the Amplatzer device occluder. From...This study examined the incidence of cardiac conduction abnormalities and ventricular arrhythmias after the transcatheter closure of muscular ventricular septal defects(MVSDs) using the Amplatzer device occluder. From the records of 27 patients who underwent 33 consecutive MVSD device closures, a low incidence of permanent and transient cardiac conduction disturbances was observed. Heart rate variability was less after the closure of multiple MVSDs compared with single MVSDs.展开更多
文摘Context: Despite evidence that more than 90%of children with traumatic injuri es to the spleen can be successfully managed nonoperatively, there is significan tvariation in the use of splenectomy. As asplenic children are at increased ris k of overwhelming postsplenectomy infection, nonoperative management may be cons idered a quality of care indicator. Objective: To test the hypothesis that child ren are more likely to undergo splenectomy in general hospitals than in children ’s hospitals. Design: Retrospective cohort study using data from the Kid’s Inp atient Database (KID) for the year 2000. Multivariable regression was used to control for patient and hospital characteristics. Setting and Participants: All ch ildren aged 0 to 16 years who were hospitalized with a traumatic (noniatro- genic) spleen injury in nonfederal short-stay hospitals in any of the 27 stat es participating in KID (N=2851). Main Outcome Measure: Splenectomy performed wi thin 1 day of arrival. Results: A total of 11 children (3%) with splenic injuri es receiving care at children’s hospitals underwent splenectomy compared with 3 83 children (15.4%) cared for at general hospitals (P < .001). After adjusting for patient characteristics, injury severity, and hospital characteristics, sple nectomy was more likely among children treated at general hospitals (odds ratio, 5.01; 95%confidence interval, 2.21-11.36) than among children treated at chil dren’s hospitals. Conclusions: There is considerable variation in the managemen t of pediatric splenic injuries, with significantly lower rates of splenectomy a t designated children’s hospitals. Quality improvement interventions, including increased education and training for physicians in general hospitals, may be ne eded to increase the use of spleen-conserving management practices.
文摘This study examined the incidence of cardiac conduction abnormalities and ventricular arrhythmias after the transcatheter closure of muscular ventricular septal defects(MVSDs) using the Amplatzer device occluder. From the records of 27 patients who underwent 33 consecutive MVSD device closures, a low incidence of permanent and transient cardiac conduction disturbances was observed. Heart rate variability was less after the closure of multiple MVSDs compared with single MVSDs.