RESUMO
New-onset psychosis in the pediatric population poses many diagnostic challenges. Given the diversity of underlying causes, which fall under the purview of multiple medical specialties, a timely, targeted, yet thorough workup requires a systematic and coordinated approach. A committee of expert pediatric physicians from the divisions of emergency medicine, psychiatry, neurology, hospitalist medicine, and radiology convened to create and implement a novel clinical pathway and approach to the pediatric patient presenting with new-onset psychosis. Here we provide background and review the evidence supporting the investigations recommended in our pathway to screen for a comprehensive range of etiologies of pediatric psychosis.
Assuntos
Neurologia , Pediatria , Transtornos Psicóticos , Humanos , Criança , Procedimentos Clínicos , Consenso , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/etiologia , Transtornos Psicóticos/terapiaAssuntos
Doenças do Nervo Abducente/etiologia , COVID-19/complicações , Diplopia/etiologia , Hipertensão Intracraniana/etiologia , SARS-CoV-2/imunologia , Síndrome de Resposta Inflamatória Sistêmica/fisiopatologia , Dor Abdominal/etiologia , Anticorpos Antivirais/sangue , COVID-19/diagnóstico , COVID-19/fisiopatologia , Teste de Ácido Nucleico para COVID-19 , Teste Sorológico para COVID-19 , Líquido Cefalorraquidiano/virologia , Criança , Diagnóstico Tardio , Reações Falso-Negativas , Cefaleia/etiologia , Humanos , Hipertensão Intracraniana/líquido cefalorraquidiano , Hipertensão Intracraniana/fisiopatologia , Nasofaringe/virologia , Papiledema/etiologia , Reação em Cadeia da Polimerase Via Transcriptase Reversa , SARS-CoV-2/isolamento & purificação , Síndrome de Resposta Inflamatória Sistêmica/complicaçõesRESUMO
Surgical-site infections (SSIs) account for 20% of all healthcare-associated infections, are the most common nosocomial infection among surgical patients, and are a focus of quality improvement initiatives. Despite implementation of many quality care measures (e.g. prophylactic antibiotics), SSIs remain a significant cause of morbidity, mortality, and economic burden, particularly in the field of neurosurgery. Topical vancomycin is increasingly utilized in instrumented spinal and cardiothoracic procedures, where it has been shown to reduce the risk of SSIs. However, a randomized controlled trial assessing its efficacy in the general neurosurgical population has yet to be done. The principle aim of "Topical Vancomycin for Neurosurgery Wound Prophylaxis" (NCT02284126) is to determine whether prophylactic, topical vancomycin reduces the risk of SSIs in the adult neurosurgical population. This prospective, multicenter, patient-blinded, randomized controlled trial will enroll patients to receive the standard of care plus topical vancomycin, or the standard of care alone. The primary endpoint of this study is a SSI by postoperative day (POD) 30. Patients must be over 18years of age. Patients are excluded for renal insufficiency, vancomycin allergy, and some ineligible procedures. Univariate analysis and logistic regression will determine the effect of topical vancomycin on SSIs at 30days. A randomized controlled trial is needed to determine the efficacy of this treatment. Results of this trial are expected to directly influence the standard of care and prevention of SSIs in neurosurgical patients.