First name
Summer
Middle name
L
Last name
Kaplan

Title

Prevalence of and Associations With Avascular Necrosis After Pediatric Sepsis: A Single-Center Retrospective Study.

Year of Publication

2022

Number of Pages

Date Published

2022 Jan 06

ISSN Number

1529-7535

Abstract

<p><strong>OBJECTIVES: </strong>Avascular necrosis (AVN) is a rare, but serious, complication after sepsis in adults. We sought to determine if sepsis is associated with postillness diagnosis of AVN, as well as potential-associated risk factors for AVN in children with sepsis.</p>

<p><strong>DESIGN: </strong>Retrospective observational study.</p>

<p><strong>SETTING: </strong>Single academic children's hospital.</p>

<p><strong>PATIENTS: </strong>Patients less than 18 years treated for sepsis or suspected bacterial infection from 2011 to 2017. Patients who developed AVN within 3 years after sepsis were compared with patients who developed AVN after suspected bacterial infection and with patients with sepsis who did not develop AVN.</p>

<p><strong>INTERVENTION: </strong>None.</p>

<p><strong>MEASUREMENTS AND MAIN RESULTS: </strong>AVN was determined using International Classification of Diseases, 9th Edition/10th Edition codes and confirmed by chart review. The prevalence of AVN after sepsis was 0.73% (21/2,883) and after suspected bacterial infection was 0.43% (53/12,276; risk difference, 0.30; 95% CI, 0.0-0.63; p = 0.05). Compared with 43 sepsis controls without AVN, AVN in the 21 sepsis cases was associated with being older, having sickle cell disease and malignancy, higher body mass index, unknown source of infection, and low platelet count in the first 7 days of sepsis. Half of sepsis patients were treated with corticosteroids, and higher median cumulative dose of steroids was associated with AVN (23.2 vs 5.4 mg/kg; p &lt; 0.01). Older age at infection (odds ratio [OR], 1.3; 95% CI, 1.1-1.4), malignancy (OR, 8.8; 95% CI, 2.6-32.9), unknown site of infection (OR, 12.7; 95% CI, 3.3-48.6), and minimal platelet count less than 100,000/µL in first 7 days of sepsis (OR, 5.0; 95% CI, 1.6-15.4) were identified as potential risk factors for AVN after sepsis following adjustment for multiple comparisons.</p>

<p><strong>CONCLUSIONS: </strong>Although rare, sepsis was associated with a higher risk of subsequent AVN than suspected bacterial infection in children. Older age, malignancy, unknown site of infection, and minimum platelet count were potential risk factors for AVN after sepsis.</p>

DOI

10.1097/PCC.0000000000002880

Alternate Title

Pediatr Crit Care Med

PMID

34991135
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Title

Ultrasound imaging of preterm brain injury: fundamentals and updates.

Year of Publication

2021

Number of Pages

Date Published

2021 Oct 14

ISSN Number

1432-1998

Abstract

<p>Neurosonography has become an essential tool for diagnosis and serial monitoring of preterm brain injury. Preterm infants are at significantly higher risk of hypoxic-ischemic injury, intraventricular hemorrhage, periventricular leukomalacia and post-hemorrhagic hydrocephalus. Neonatologists have become increasingly dependent on neurosonography to initiate medical and surgical interventions because it can be used at the bedside. While brain MRI is regarded as the gold standard for detecting preterm brain injury, neurosonography offers distinct advantages such as its cost-effectiveness, diagnostic utility and convenience. Neurosonographic signatures associated with poor long-term outcomes shape decisions regarding supportive care, medical or behavioral interventions, and family members' expectations. Within the last decade substantial progress has been made in neurosonography techniques, prompting an updated review of the topic. In addition to the up-to-date summary of neurosonography, this review discusses the potential roles of emerging neurosonography techniques that offer new functional insights into the brain, such as superb microvessel imaging, elastography, three-dimensional ventricular volume assessment, and contrast-enhanced US.</p>

DOI

10.1007/s00247-021-05191-9

Alternate Title

Pediatr Radiol

PMID

34648071
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Title

CTA utilization for evaluation of suspected pulmonary embolism in a tertiary pediatric emergency department.

Year of Publication

2021

Number of Pages

105-110

Date Published

2021 Jan 04

ISSN Number

1873-4499

Abstract

<p><strong>OBJECTIVE: </strong>To evaluate changes in the utilization of computed tomography angiography (CTA) for evaluating suspected pulmonary embolism (PE) and the positive rate of ancillary for those studies negative for PE in the last 13&nbsp;years.</p>

<p><strong>MATERIALS AND METHODS: </strong>A retrospective review of patient&nbsp;≤&nbsp;20&nbsp;years of age who underwent a chest CT angiography to rule out PE was performed in a 13-year-period. CT angiographies were grouped into three categories: Positive for PE, negative for PE and positive for ancillary findings, and negative for any pathology. From the exams with ancillary findings, we examined how many of these had a chest radiograph perform within 24&nbsp;h prior to the CTA and how many of them had an impression stating the same conclusion as the CTA.</p>

<p><strong>RESULTS: </strong>307 chest CT angiographies for suspected PE were included. 50 (16%) were reported as positive for PE and 91 (30%) were negative for PE but positive for ancillary findings. The most frequent ancillary findings were pneumonia (n = 26) and pleural effusion (n = 11). Out of 91, 73 patients had a previous chest radiograph and 28 of them reported a similar diagnosis than the CTA. The number of CT angiographies indicated for PE increased by 3.2 studies per year. The rate of CT angiographies positive for ancillary findings (slope = 1.5) and positive for PE (slope = 0.3) remained similar throughout the same period.</p>

<p><strong>CONCLUSIONS: </strong>CTA orders for PE have been increasing without any increased detection of PE or ancillary findings in children.</p>

DOI

10.1016/j.clinimag.2020.12.024

Alternate Title

Clin Imaging

PMID

33524937
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Title

Current and Future Applications of Thoracic Dual-Energy CT in Children: Pearls and Pitfalls of Technique and Interpretation.

Year of Publication

2020

Number of Pages

433-441

Date Published

2020 Oct

ISSN Number

1558-5034

Abstract

<p>Dual-energy computer tomography (DECT) technology has experienced rapid growth in recent years, now allowing for the collection of 2 CT data sets and opening the potential for functional data acquisition. Data from a single postcontrast phase are deconstructed and Iodine can be subtracted to create a virtual noncontrast image, or selectively represented as a contrast map that allows for the qualification and quantification of lung perfusion. Virtual monoenergetic images can also be used to reduce beam-hardening artifact from concentrated contrast or metal implants. In children, DECT is of particular interest because it has been shown to be dose neutral in most applications, dose-reducing in multiphase studies, and to increase the contrast to noise ratio in suboptimal studies. We review the basics of acquisition, postprocessing, and thoracic applications of DECT with a focus on pulmonary blood volumes as a surrogate for perfusion imaging. The discussed applications include pulmonary embolism, hypoplastic lung, pulmonary hypertension in bronchopulmonary dysplasia, and pediatric lung masses.</p>

DOI

10.1053/j.sult.2020.05.008

Alternate Title

Semin. Ultrasound CT MR

PMID

32980090
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Title

The Cost-Estimation Department: A Step Toward Cost Transparency in Radiology.

Year of Publication

2018

Number of Pages

Date Published

2018 Sep 15

ISSN Number

1558-349X

DOI

10.1016/j.jacr.2018.07.033

Alternate Title

J Am Coll Radiol

PMID

30227950
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