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https://www.readbyqxmd.com/read/18091591/the-presentation-of-appendicitis-in-preadolescent-children
#1
Joshua M Colvin, Richard Bachur, Anupam Kharbanda
PURPOSE: We describe the clinical presentation of appendicitis in preadolescent children and differences in symptoms among age-stratified subgroups. METHODS: This is a retrospective analysis of a prospectively collected de-identified data set of patients 3 years or older and patients younger than 12 years presenting to a pediatric emergency department during a 21-month period with symptoms suspicious for appendicitis. The rates of appendicitis, perforation, negative appendectomy, as well as sensitivities, specificities, and positive likelihood ratios for historical and clinical variables associated with appendicitis were calculated for the entire cohort and for 3 age-stratified subgroups...
December 2007: Pediatric Emergency Care
https://www.readbyqxmd.com/read/24965659/effectiveness-of-the-head-ct-choice-decision-aid-in-parents-of-children-with-minor-head-trauma-study-protocol-for-a-multicenter-randomized-trial
#2
RANDOMIZED CONTROLLED TRIAL
Erik P Hess, Kirk D Wyatt, Anupam B Kharbanda, Jeffrey P Louie, Peter S Dayan, Leah Tzimenatos, Sandra L Wootton-Gorges, James L Homme, Laurie Pencille R N, Annie LeBlanc, Jessica J Westphal, Kathy Shepel, Nilay D Shah, Megan Branda, Jeph Herrin, Victor M Montori, Nathan Kuppermann
BACKGROUND: Blunt head trauma is a common cause of death and disability in children worldwide. Cranial computed tomography (CT), the reference standard for the diagnosis of traumatic brain injury (TBI), exposes children to ionizing radiation which has been linked to the development of brain tumors, leukemia, and other cancers. We describe the methods used to develop and test the effectiveness of a decision aid to facilitate shared decision-making with parents regarding whether to obtain a head CT scan or to further observe their child at home...
June 25, 2014: Trials
https://www.readbyqxmd.com/read/17600095/discovering-how-to-think-about-a-hospital-patient-information-system-by-struggling-to-evaluate-it-a-committee-s-journal
#3
Joseph Schulman, Gilad J Kuperman, Anupam Kharbanda, Rainu Kaushal
Parallel to the monumental problem of replacing paper-and-pen-based patient information management systems with electronic ones is the problem of evaluating the extent to which the change represents an improvement. All clinicians must grapple with this daunting challenge; those with little or no informatics expertise may be particularly surprised by the attendant difficulties. To do so successfully, they must be able to explicitly conceptualize the daily clinical work-a prerequisite for appreciating and reasonably evaluating it...
September 2007: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/17456874/suspected-appendicitis-in-children-rectal-and-intravenous-contrast-enhanced-versus-intravenous-contrast-enhanced-ct
#4
COMPARATIVE STUDY
Anupam B Kharbanda, George A Taylor, Richard G Bachur
PURPOSE: To retrospectively compare the diagnostic performance of intravenous contrast material-enhanced computed tomography (CT) with that of intravenous and rectal contrast-enhanced CT in the evaluation of children suspected of having appendicitis by using pathologic findings, surgical findings, or a follow-up telephone call as the reference standard. MATERIALS AND METHODS: This HIPAA-compliant study was approved by the committee on clinical investigations. As part of a larger study, informed consent was obtained from all parents and from all children older than 7 years...
May 2007: Radiology
https://www.readbyqxmd.com/read/24566613/impact-of-increasing-ondansetron-use-on-clinical-outcomes-in-children-with-gastroenteritis
#5
MULTICENTER STUDY
Stephen B Freedman, Matt Hall, Samir S Shah, Anupam B Kharbanda, Paul L Aronson, Todd A Florin, Rakesh D Mistry, Charles G Macias, Mark I Neuman
IMPORTANCE: Ondansetron hydrochloride use in children with gastroenteritis is increasing rapidly; however, little is known about its impact on outcomes. OBJECTIVE: To determine whether increasing emergency department ondansetron use has resulted in a reduction in intravenous rehydration rates. DESIGN, SETTING, AND PARTICIPANTS: Retrospective observational analysis of eligible visits included in the Pediatric Health Information System administrative database...
April 2014: JAMA Pediatrics
https://www.readbyqxmd.com/read/23425756/analysis-of-radiation-exposure-among-pediatric-trauma-patients-at-national-trauma-centers
#6
MULTICENTER STUDY
Anupam B Kharbanda, Andrew Flood, Karen Blumberg, Nathan S Kreykes
BACKGROUND: Injured children undergo radiologic studies as part of trauma evaluations. Children are more sensitive than adult patients to the effects of ionizing radiation. Few studies have described the radiation exposure to pediatric patients during trauma evaluations. We sought to describe the rate of use of radiology studies and to estimate the effective dose of radiation delivered to pediatric trauma patients presenting to trauma centers within the United States. METHODS: We performed an analysis of pediatric patients younger than 19 years who presented to an American College of Surgery-verified trauma center in 2010 (National Trauma Data Bank)...
March 2013: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/17192449/atypical-clinical-features-of-pediatric-appendicitis
#7
Theresa Becker, Anupam Kharbanda, Richard Bachur
BACKGROUND: The diagnosis of appendicitis remains challenging in children. Delays in diagnosis, or misdiagnosis, have important medical and legal implications. The typical, or classic, presentation of pediatric appendicitis has been modeled after adult disease; however, many children present atypically with subtle findings or unusual signs. OBJECTIVES: To determine the frequency of atypical clinical features among pediatric patients with appendicitis and to investigate which atypical features are the strongest negative predictors for appendicitis among patients being evaluated for appendicitis...
February 2007: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/22221321/novel-serum-and-urine-markers-for-pediatric-appendicitis
#8
Anupam B Kharbanda, Alex J Rai, Yohaimi Cosme, Khin Liu, Peter S Dayan
OBJECTIVES: The objective was to describe the association between two novel biomarkers, calprotectin and leucine-rich alpha glycoprotein-1 (LRG), and appendicitis in children. METHODS: This was a prospective, cross-sectional study of children 3 to 18 years old presenting to a pediatric emergency department (ED) with possible appendicitis. Blood and urine samples were assayed for calprotectin and LRG via enzyme-linked immunosorbent assay (ELISA). Final diagnosis was determined by histopathology or telephone follow-up...
January 2012: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/24882663/appendicitis-do-clinical-scores-matter
#9
EDITORIAL
Anupam B Kharbanda
No abstract text is available yet for this article.
October 2014: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/24249617/use-of-a-clinical-pathway-to-improve-the-acute-management-of-vaso-occlusive-crisis-pain-in-pediatric-sickle-cell-disease
#10
Katherine L Ender, Jennifer A Krajewski, John Babineau, Mary Tresgallo, William Schechter, John M Saroyan, Anupam Kharbanda
BACKGROUND: The most common, debilitating morbidity of sickle cell disease (SCD) is vaso-occlusive crisis (VOC) pain. Although guidelines exist for its management, they are generally not well-followed, and research in other pediatric diseases has shown that clinical pathways improve care. The purpose of our study was to determine whether a clinical pathway improves the acute management of sickle cell vaso-occlusive crisis (VOC) pain in the pediatric emergency department (PED). PROCEDURE: Pain management practices were prospectively investigated before and after the initiation of a clinical pathway in the PED of an urban, tertiary care center with 50,000 ED visits per year and approximately 200 active sickle cell patients...
April 2014: Pediatric Blood & Cancer
https://www.readbyqxmd.com/read/23332463/variation-in-resource-utilization-across-a-national-sample-of-pediatric-emergency-departments
#11
MULTICENTER STUDY
Anupam B Kharbanda, Matthew Hall, Samir S Shah, Stephen B Freedman, Rakesh D Mistry, Charles G Macias, Bema Bonsu, Peter S Dayan, Evaline A Alessandrini, Mark I Neuman
OBJECTIVE: To describe variations in emergency department (ED) quality measures and determine the association between ED costs and outcomes for 3 pediatric conditions: asthma, gastroenteritis, and simple febrile seizure. STUDY DESIGN: This cross-sectional analysis of ED visits used the Pediatric Health Information System database. Children aged ≤ 18 years who were evaluated in an ED between July 2009 and June 2011 and had a discharge diagnosis of asthma, gastroenteritis, or simple febrile seizure were included...
July 2013: Journal of Pediatrics
https://www.readbyqxmd.com/read/24565425/effect-of-hispanic-ethnicity-and-language-barriers-on-appendiceal-perforation-rates-and-imaging-in-children
#12
MULTICENTER STUDY
Michael N Levas, Peter S Dayan, Manoj K Mittal, Michelle D Stevenson, Richard G Bachur, Nanette C Dudley, Lalit Bajaj, Charles G Macias, Jonathan Bennett, M Denise Dowd, Avis J Thomas, Anupam B Kharbanda
OBJECTIVE: To determine the association between Hispanic ethnicity and limited English proficiency (LEP) and the rates of appendiceal perforation and advanced radiologic imaging (computed tomography and ultrasound) in children with abdominal pain. STUDY DESIGN: We performed a secondary analysis of a prospective, cross-sectional, multicenter study of children aged 3-18 years presenting with abdominal pain concerning for appendicitis between March 2009 and April 2010 at 10 tertiary care pediatric emergency departments in the US...
June 2014: Journal of Pediatrics
https://www.readbyqxmd.com/read/23859583/performance-of-ultrasound-in-the-diagnosis-of-appendicitis-in-children-in-a-multicenter-cohort
#13
MULTICENTER STUDY
Manoj K Mittal, Peter S Dayan, Charles G Macias, Richard G Bachur, Jonathan Bennett, Nanette C Dudley, Lalit Bajaj, Kelly Sinclair, Michelle D Stevenson, Anupam B Kharbanda
OBJECTIVES: The objectives were to assess the test characteristics of ultrasound (US) in diagnosing appendicitis in children and to evaluate site-related variations based on the frequency of its use. Additionally, the authors assessed the test characteristics of US when the appendix was clearly visualized. METHODS: This was a secondary analysis of a prospective, 10-center observational study. Children aged 3 to 18 years with acute abdominal pain concerning for appendicitis were enrolled...
July 2013: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/22869405/validation-and-refinement-of-a-prediction-rule-to-identify-children-at-low-risk-for-acute-appendicitis
#14
MULTICENTER STUDY
Anupam B Kharbanda, Nanette C Dudley, Lalit Bajaj, Michelle D Stevenson, Charles G Macias, Manoj K Mittal, Richard G Bachur, Jonathan E Bennett, Kelly Sinclair, Craig Huang, Peter S Dayan
OBJECTIVE: To validate and refine a clinical prediction rule to identify which children with acute abdominal pain are at low risk for appendicitis (Low-Risk Appendicitis Rule). DESIGN: Prospective, multicenter, cross-sectional study. SETTING: Ten pediatric emergency departments. PARTICIPANTS: Children and adolescents aged 3 to 18 years who presented with suspected appendicitis from March 1, 2009, through April 30, 2010...
August 2012: Archives of Pediatrics & Adolescent Medicine
https://www.readbyqxmd.com/read/22841176/the-effect-of-abdominal-pain-duration-on-the-accuracy-of-diagnostic-imaging-for-pediatric-appendicitis
#15
MULTICENTER STUDY
Richard G Bachur, Peter S Dayan, Lalit Bajaj, Charles G Macias, Manoj K Mittal, Michelle D Stevenson, Nanette C Dudley, Kelly Sinclair, Jonathan Bennett, Michael C Monuteaux, Anupam B Kharbanda
STUDY OBJECTIVE: Advanced imaging with computed tomography (CT) or ultrasonography is frequently used to evaluate for appendicitis. The duration of the abdominal pain may be related to the stage of disease and therefore the interpretability of radiologic studies. Here, we investigate the influence of the duration of pain on the diagnostic accuracy of advanced imaging in children being evaluated for acute appendicitis. METHODS: A secondary analysis of a prospective multicenter observational cohort of children aged 3 to 18 years with suspected appendicitis who underwent CT or ultrasonography was studied...
November 2012: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/22392173/interrater-reliability-of-clinical-findings-in-children-with-possible-appendicitis
#16
MULTICENTER STUDY
Anupam B Kharbanda, Michelle D Stevenson, Charles G Macias, Kelly Sinclair, Nanette C Dudley, Jonathan Bennett, Lalit Bajaj, Manoj K Mittal, Craig Huang, Richard G Bachur, Peter S Dayan
OBJECTIVE: Our objective was to determine the interrater reliability of clinical history and physical examination findings in children undergoing evaluation for possible appendicitis in a large, multicenter cohort. METHODS: We conducted a prospective, multicenter, cross-sectional study of children aged 3-18 years with possible appendicitis. Two clinicians independently evaluated patients and completed structured case report forms within 60 minutes of each other and without knowing the results of diagnostic imaging...
April 2012: Pediatrics
https://www.readbyqxmd.com/read/21676053/discriminative-accuracy-of-novel-and-traditional-biomarkers-in-children-with-suspected-appendicitis-adjusted-for-duration-of-abdominal-pain
#17
Anupam B Kharbanda, Yohaimi Cosme, Khin Liu, Steven L Spitalnik, Peter S Dayan
OBJECTIVES: The objective was to assess the accuracy of novel and traditional biomarkers in patients with suspected appendicitis as a function of duration of symptoms. METHODS: This was a prospective cohort study, conducted in a tertiary care emergency department (ED). The authors enrolled children 3 to 18 years old with acute abdominal pain of less than 96 hours and measured serum levels of interleukin-6 (IL-6), interleukin-8 (IL-8), C-reactive protein (CRP), white blood cell (WBC) count, and absolute neutrophil count (ANC)...
June 2011: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/18275440/comparison-of-pediatric-emergency-physicians-and-surgeons-evaluation-and-diagnosis-of-appendicitis
#18
COMPARATIVE STUDY
Anupam B Kharbanda, Steven J Fishman, Richard G Bachur
OBJECTIVES: To compare the interexaminer reliability and ability to predict appendicitis between pediatric emergency physicians (EPs) and senior surgical residents. METHODS: The authors conducted a prospective cohort study of children aged 3 to 18 years of age with signs and symptoms suspicious for appendicitis. Patients were initially examined by a pediatric EP attending and then by a consulting senior surgical resident. Physicians reported the presence or absence of specific historical and physical exam findings and predicted the likelihood the patient had appendicitis...
February 2008: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/17383771/evaluating-appendicitis-scoring-systems-using-a-prospective-pediatric-cohort
#19
Carisa Schneider, Anupam Kharbanda, Richard Bachur
STUDY OBJECTIVE: This article evaluates the performance of the previously published Alvarado and Samuel appendicitis scoring systems in a prospectively identified pediatric cohort. METHODS: A prospective cohort of patients, aged 3 to 21 years, being evaluated for appendicitis was enrolled during 20 consecutive months at a large, urban, pediatric hospital. Study forms were completed by pediatric emergency medicine attending physicians before imaging or surgery. Final diagnosis was determined by pathology or follow-up telephone call...
June 2007: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/16140712/a-clinical-decision-rule-to-identify-children-at-low-risk-for-appendicitis
#20
Anupam B Kharbanda, George A Taylor, Steven J Fishman, Richard G Bachur
OBJECTIVE: Computed tomography (CT) has gained widespread acceptance in the evaluation of children with suspected appendicitis. Concern has been raised regarding the long-term effects of ionizing radiation. Other means of diagnosing appendicitis, such as clinical scores, are lacking in children. We sought to develop a clinical decision rule to predict which children with acute abdominal pain do not have appendicitis. METHODS: Prospective cohort study was conducted of children and adolescents who aged 3 to 18 years, had signs and symptoms suspicious for appendicitis, and presented to the emergency department between April 2003 and July 2004...
September 2005: Pediatrics
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