Wheezing in Infancy: An Overview of Recent Literature.

PURPOSE OF REVIEW: Wheezing in infancy is a common presentation with many potential causes. In writing this review, we sought to summarize the newest recommendations and testing available for the more common etiologies of wheezing. RECENT FINDINGS: Regarding the diagnosis of asthma, the modified asthma predictive index has recently been established as a useful predictive tool. Non-breath held multidetector CT with 3D volume rendering airway images is also a newer helpful diagnostic tool for tracheomalacia due to ease of use and its 100% positive predictive value. We found vaccines have greatly reduced the prevalence of epiglottitis, while advances in surgery are improving outcomes in infants with vascular rings. Wheezing in infants is a common problem with an extensive differential diagnosis from relatively benign to life threatening. To prevent over-looking a diagnosis that potentially requires surgical correction or emergent care, we recommend a structured approach to the history and physical exam with targeted testing directed towards the most likely diagnoses as outlined in this review.

Questioning the specificity and sensitivity of ELISA for bullous pemphigoid diagnosis.

The reported sensitivity and specificity of enzyme-linked immunosorbent assay (ELISA) for bullous pemphigoid (BP) diagnosis is approximately 87% and 98%, respectively. These statistics suggest that ELISA is a reliable diagnostic test; therefore, the use of ELISA for BP diagnosis has increased. We report the case of a man who was diagnosed with BP and was treated for 3 years based on a positive ELISA for IgG against BP180. After reevaluation, his revised diagnosis was not consistent with BP based on clinical presentation, histopathology, and direct immunofluorescence (DIF). Reviewing reports of ELISA for BP diagnosis in the literature revealed several issues including dissimilar diagnostic procedures and patient populations, multiple reports of positive ELISA in patients without BP, and lack of explanation for these false-positives. This case report and review of the literature is a cautionary tale regarding the use of ELISA as an independently reliable test for BP diagnosis.

Information handoff and outcomes of critically ill patients transferred between hospitals.

PURPOSE: Patients transferred between hospitals are at high risk of adverse events and mortality. This study aims to identify which components of the transfer handoff process are important predictors of adverse events and mortality. MATERIALS AND METHODS: We conducted a retrospective, observational study of 335 consecutive patient transfers to 3 intensive care units at an academic tertiary referral center. We assessed the relationship between handoff documentation completeness and patient outcomes. The primary outcome was in-hospital mortality. Secondary outcomes included adverse events, duplication of labor, disposition error, and length of stay. RESULTS: Transfer documentation was frequently absent with overall completeness of 58.3%. Adverse events occurred in 42% of patients within 24 hours of arrival, with an overall in-hospital mortality of 17.3%. Higher documentation completeness was associated with reduced in-hospital mortality (odds ratio [OR], 0.07; 95% confidence interval [CI], 0.02 to 0.38; P = .002), reduced adverse events (coefficient, -2.08; 95% CI, -2.76 to -1.390; P < .001), and reduced duplication of labor (OR, 0.19; 95% CI, 0.04 to 0.88; P = .033) when controlling for severity of illness. CONCLUSIONS: Documentation completeness is associated with improved outcomes and resource utilization in patients transferred between hospitals.