Correlation Between Intolerance of Uncertainty and Post-Operative Regret in Otolaryngology Patients.

OBJECTIVE: To determine if intolerance of uncertainty, depression, anxiety, worry, or stress are related to post-op regret in otolaryngology patients. METHODS: Adult patients or parents giving consent for pediatric patients meeting criteria for otolaryngologic surgery were recruited and completed the Intolerance of Uncertainty Scale (IUS-12), Penn State Worry Questionnaire (PSWQ), and Depression, Anxiety and Stress Scale-21 (DASS-21) preop and the Decisional Regret (DR) scale 1-month post-op. Pearson correlations were calculated. RESULTS: The cohort included 109 patients, 73 (67%) males and 36 (33.3%) females. 43 (39.5%) were college graduates and 66 (60.9%) were not. Mean IUS-12 score was 22.9 (95% CI 21.0-24.8), mean PSWQ score was 46.9 (95% CI 44.5-49.3). DASS-21 mean score was 11.9 (95% CI 9.6-14.3). Mean DR score was 11.1 (95% CI 8.6-13.6). IUS-12 subscales Prospective Anxiety mean score was 14.2 (95% CI 12.8-15.5) and Inhibitory Anxiety mean score was 16.5 (95% CI 14.5-18.6). The Pearson correlation coefficient for post-op DR and total preop IUS was .188 (P = .027) and the correlation coefficient for post-op DR and preop Prospective Anxiety subscale of IUS score was .174 (P = .037). Correlations with PSWQ and DASS-21 scores and DR were not statistically significant. CONCLUSION: Intolerance of uncertainty is a psychological construct that is associated with post-op DR. More work is needed to determine whether screening for IU and behavior modification directed at IU for those with high levels would improve post-op decisional regret.

Depression and Intolerance of Uncertainty: Association with Decisional Conflict in Otolaryngology Patients.

OBJECTIVE: To determine if anxiety, stress, depression, worry, and intolerance of uncertainty were related to pre-operative decisional conflict (DC), shared decision making (SDM), or demographic variables in adult otolaryngology surgical patients. METHODS: Consecutive adult patients meeting criteria for otolaryngological surgery were recruited and completed DC and SDM scales, Penn State Worry Questionnaire (PSWQ), Intolerance of Uncertainty Scale (IUS-12), and Depression, Anxiety and Stress Scale-21 (DASS-21). RESULTS: The cohort included 118 patients, 61 (51.7%) males and 57 (48.3%) females. Surgery was planned for a benign process in 90 (76.3%) and 46 (39.3%) had previous otolaryngologic surgery. SDM and DC scores did not significantly differ across gender, age, education level, previous otolaryngologic surgery or whether or not surgery was for malignancy. Patients with no malignancy had significantly higher DASS-21 Stress scores (mean 12.94 vs 8.15, P < .05) and total IUS-12 scores (mean 28.63 vs 25.56, P = .004). Women had lower PSWQ scores (41.56 vs 50.87 for men, P = .006). IUS-12 and PSWQ declined with age. DC scores correlated positively with DASS-21 Depression (r = .256, P = .008) and IUS-12 scores (r = .214, P = .024). SDM correlated negatively with DASS-21 Depression (r = -.208, P = .030). Linear regression model for DC scores revealed a significant relationship with DASS depression (B = 0.674, P = .048). CONCLUSION: Preoperative decisional conflict is associated with increased depression and intolerance of uncertainty in adults undergoing otolaryngologic surgery. Screening for and management of depression, anxiety, and related concerns may improve surgical outcomes in this group.

Maxillofacial trauma in children: Association between age and mandibular fracture site.

PURPOSE: To describe the association between age and location of facial fractures in the pediatric population. MATERIALS AND METHODS: A retrospective analysis of the Healthcare Cost and Utilization Project (HCUP) from the 2016 Kids' Inpatient Database (KID) in children aged ≤18 years was conducted. International Statistical Classification of Diseases, 10th Revision (ICD-10) codes were used to extract facial fracture diagnoses. Logistic regression was used to evaluate and compare the contribution of various demographic factors among patients who had different types of facial fractures. RESULTS: A total of 5568 admitted patients were identified who sustained any type of facial bone fracture. Patients who had facial fractures were significantly more likely to be male (68.2% versus 31.8%; p<0.001) and were older with a mean age of 12.86 years (95% confidence interval [CI]: 12.72-12.99). Approximately one-third of patients with a facial fracture had a concomitant skull base or vault fracture. Maxillary fractures were seen in 30.9% of the cohort while mandibular fractures occurred in 36.9% of patients. The most common mandibular fracture site was the symphysis (N=574, 27.9% of all mandibular fractures). Condylar fractures were more common in younger children while angle fractures were more common in teenagers. Regression analysis found that age was the only significant contributor to the presence of a mandibular fracture (ß=0.027, p<0.001) and race was the only significant contributor to maxillary fractures (ß=-0.090, p<0.001). CONCLUSIONS: Facial fractures increase in frequency with increasing age in children. The mandible was the most commonly fractured facial bone, with an age-related pattern in fracture location.

Airbag Burns: An Unfortunate Consequence of Motor Vehicle Safety.

Thousands of people are injured in motor vehicle collisions daily and the mandated installation of airbags protects passengers but can also cause injuries from deployment including cutaneous burns. We sought to characterize the patterns and outcomes of burns resulting from airbag deployment by performing a retrospective review of all patients evaluated by the burn service from May 1, 2015 to April 30, 2019. Inclusion criteria were patients of all ages with burn injuries related to airbag deployment. Demographic data, burn characteristics, and outcomes were reviewed. Seventeen patients met the inclusion criteria: 82.4% female and 17.6% male. The average age was 40.4 years. Fifteen patients had second-degree and two had third-degree burns. The average TBSA was 0.45%. The hands or upper extremity (88%) were most often injured, but there were two chest, one neck, and one anterior thigh burns. Eight patients suffered multiple burns. Burn etiology (chemical vs thermal) was often not specified. No patients required hospitalization or surgical intervention, and all wounds healed with wound care. The average time to re-epithelialization was 11 days. Although airbags prevent mortality and serious injury, the exothermic chemical reaction that inflates the airbag is responsible for deployment-related burns. Since there is a chemical and thermal component, all airbag-related burns should undergo chemical decontamination on the initial presentation. Burns related to airbag deployment tend to be small and do not require grafting; however, patients suffer from associated pain, scarring, and burn management can be a financial and time burden to the patient.

Relationship Between Parental Intolerance of Uncertainty and Decisional Conflict in Pediatric Otolaryngologic Surgery.

OBJECTIVE: To assess the relationship between depression, anxiety, stress, worry, intolerance of uncertainty (IU), and shared decision making (SDM) in parents of pediatric otolaryngology surgical patients with their perceptions of decisional conflict (DC). STUDY DESIGN: Cross-sectional. SETTING: Academic pediatric otolaryngology outpatient clinic. METHODS: Participants were legal guardians of pediatric patients who met criteria for otolaryngologic surgery. Participants completed a demographic survey as well as validated Decisional Conflict Scale (DCS); Shared Decision-Making Scale (SDMS); Depression, Anxiety and Stress Scale-21 (DASS-21); Penn State Worry Questionnaire (PSWQ); and short form of the Intolerance of Uncertainty Scale (IUS-12). RESULTS: A total of 114 participants were enrolled. Respondents were predominantly female (93.0%) and married (60.5%). Most guardians had not consented previously for otolaryngologic surgery for their child (69.3%). Participants reported low levels of DC and depression as well as moderate levels of anxiety and stress. DC scores were not significantly correlated to DASS-21, PSWQ, or SDM. IUS-12 Total and subscale IUS-12 prospective negatively correlated with Total DC. DC was not related to age, sex, education level, previous otolaryngologic surgery, or type of surgery recommended. CONCLUSION: In this group, an association was found between IU and DC. Clinicians should be aware that DC is not modified by previous surgical experience. Interventions aimed at addressing parental IU related to surgery may reduce DC. Further research efforts could help us understand how mental health relates to surgical decision making.

Educational Animations to Inform Transplant Candidates About Deceased Donor Kidney Options: An Efficacy Randomized Trial.

BACKGROUND: Transplant candidates struggle making decisions about accepting kidneys with variable kidney donor profile index (KDPI) and increased risk donor (IRD) status. METHODS: This single site, pilot randomized controlled trial evaluated the efficacy of 2 animations to improve KDPI/IRD knowledge, decisional self-efficacy, and willingness. Kidney candidates were randomly assigned to animation viewing plus standard nurse discussion (intervention) or standard nurse discussion alone (control). Linear regression was used to test the significance of animation exposure after controlling for covariates (α < 0.1). RESULTS: Mean age was 60 years, and 27% were African American. Both intervention (n = 42) and control (n = 38) groups received similar education at similar duration (12.8 versus 11.8 min, respectively), usually by the same dedicated nurse educator (85% versus 75%, respectively). On multivariate analysis, the intervention group (versus control) exhibited significantly increased knowledge (ß = 0.23; 95% confidence interval, 0.66-1.77) and IRD willingness (ß = 0.22; 95% confidence interval, 0.05-0.86). There were no between-group differences in KDPI >85% willingness or distribution of KDPI/IRD decisional self-efficacy. Over 90% of participants provided positive ratings on each of 11 acceptability items. CONCLUSIONS: Supporting conventional IRD and KDPI education with educational animations can improve knowledge and IRD willingness compared with standard methods.

Paradoxical Vocal Cord Motion Presaging Bilateral Vocal Cord Paresis in an Infant.

Paradoxical vocal cord motion (PVCM) is a condition characterized by inappropriate adduction of the vocal cords during respiration. Usually seen in children and adolescents, PVCM presentation in infants is uncommon. Once thought to be a product of psychiatric disease, there are now several other proposed etiologies including irritant-induced and secondary to neurologic disease. Previous studies showed that the treatment of gastric reflux in this age group leads to a resolution of symptoms. We present a case of PVCM in an infant with hydrocephalus and Chiari II malformation. She received reflux therapy and ventriculoperitoneal (VP) shunting with two revisions. Despite these interventions, she continued with symptoms and eventually progressed to bilateral vocal cord paralysis (VCP). There is a paucity of literature describing PVCM as a precursor to VCP. Clinicians should be aware that in this population, refractory PVCM may serve as a warning sign for further vocal cord function decline.