Early Sepsis Response System Does Not Correlate with Pediatric Early Warning Score in Sepsis Recognition.

Sepsis is a leading cause of pediatric morbidity and mortality worldwide with early recognition and management improving patient outcomes. Early recognition warning systems, utilizing the electronic medical record (EMR), are recommended for children's hospitals. Validated pediatric early warning score (PEWS) recognize hospitalized children at risk for worsening and need for higher level of care. The goal of this study was to develop a novel pediatric sepsis early response warning system and compare this tool with the existing generic PEWS system in recognizing sepsis. A novel early sepsis warning system was integrated into the EMR of a tertiary pediatric children's hospital. In patients meeting criteria a best practice alert (BPA) triggers and children with a sepsis BPA trigger were evaluated from December, 2018 through May, 2020. BPA data was analyzed and identified children meeting sepsis criteria. Subjects identified as having sepsis were then correlated with PEWS scores at the time of the BPA. The BPA triggered in 736 pediatric subjects, with 181 in the emergency department, 275 in the pediatric inpatient floor and 280 in the pediatric intensive care unit. Pediatric sepsis criteria identified 524 of 736 (71%) as having sepsis. PEWS scores identified only 66 (13%) of the 524 subjects who had sepsis. Implementation of a sepsis trigger tool into EMR is feasible. Best practice alerts identify subjects with early sepsis and can be implemented to electronic medical record.

Assessment of Swallowing Function in Patients with Head and Neck Squamous Cell Carcinoma in High vs. Low Dose Cisplatin.

Cisplatin-based therapies are standard-of-care for advanced-stage head and neck squamous cell carcinoma (HNSCC). Treatment regimens include 3 weeks of high-dose bolus cisplatin or 6-7 weeks of low-dose weekly cisplatin, both with concurrent radiation. The effects of cisplatin dosage on swallowing function warrant further study. A 237-patient cohort treated for HNSCC at a single center were studied retrospectively. Gastrostomy tube dependence served as the primary endpoint. Secondary endpoints included weight changes, esophageal stricture, and lymphedema. The primary/secondary outcomes were not statistically significant; however, ototoxicity and renal toxicity were significantly higher in the high-dose group. These findings add insight into cisplatin dose-based functional outcomes.

Documentation of Sepsis in Patients Meeting Pediatric Sepsis Criteria: An Area for Improvement.

OBJECTIVE: Documentation is a critical aspect for properly evaluating a patient's medical status. In order to accurately diagnose sepsis promptly, the need for proper documentation becomes even more necessary. We conducted a retrospective chart review to assess accuracy and frequency of sepsis documentation by electronic medical records (EMR) review. The patients are children aged 0 to 18 years of age in whom the sepsis trigger tool fired in the EMR and were admitted on the inpatient floor or pediatric intensive care unit. METHODS: An EMR sepsis notification alert is currently utilized by our institution. Two pediatric intensivists reviewed the EMR charts of hospitalized, pediatric patients in whom the notification fired. The primary outcome was to identify the patients who met criteria for sepsis according to the 2005 International Pediatric Consensus Conference Guidelines. In patients who met the criteria, physician charting was inspected manually to evaluate documentation of sepsis and/or septic shock within 24 hours of meeting sepsis criteria. RESULTS: Using the 2005 International Pediatric Consensus Conference Guidelines, 359 patients met sepsis criteria. Of those, 24 (7 percent) were documented to have sepsis and/or septic shock in the EMR. Sixteen of those patients had septic shock, while the remaining eight had sepsis. CONCLUSION: Although sepsis is not uncommon, it is often not documented appropriately in electronic medical records. Hypothesized explanations include difficulty in diagnosing sepsis and using alternative diagnoses. This study demonstrates the ambiguity of the current pediatric sepsis criteria and difficulty capturing this diagnosis in the EMR.

Differentiation of Peripheral Nerve Tumors in the Brachial Plexus.

Schwannomas are benign extracranial nerve sheath tumors that can rarely affect the brachial plexus. Due to the relative rarity of these tumors and the complexity of the anatomy of the neck and shoulder, these tumors are a challenging diagnosis for clinicians. We present a case report of a 51-year-old male with a brachial plexus schwannoma definitively treated with surgical resection. It is our hope that this case serves as a reminder to consider schwannomas in the differential diagnosis for infraclavicular tumors.

In vivo modeling of docosahexaenoic acid and eicosapentaenoic acid-mediated inhibition of both platelet function and accumulation in arterial thrombi.

Omega-3 polyunsaturated fatty acids (n-3 PUFAs) are associated with a variety of cellular alterations that mitigate cardiovascular disease. However, pinpointing the positive therapeutic effects is challenging due to inconsistent clinical trial results and overly simplistic in vitro studies. Here we aimed to develop realistic models of n-3 PUFA effects on platelet function so that preclinical results can better align with and predict clinical outcomes. Human platelets incubated with the n-3 PUFAs docosahexaenoic acid and eicosapentaenoic acid were stimulated with agonist combinations mirroring distinct regions of a growing thrombus. Platelet responses were then monitored in a number of ex-vivo functional assays. Furthermore, intravital microscopy was used to monitor arterial thrombosis and fibrin deposition in mice fed an n-3 PUFA-enriched diet. We found that n-3 PUFA treatment had minimal effects on many basic ex-vivo measures of platelet function using agonist combinations. However, n-3 PUFA treatment delayed platelet-derived thrombin generation in both humans and mice. This impaired thrombin production paralleled a reduced platelet accumulation within thrombi formed in either small arterioles or larger arteries of mice fed an n-3 PUFA-enriched diet, without impacting P-selectin exposure. Despite an apparent lack of robust effects in many ex-vivo assays of platelet function, increased exposure to n-3 PUFAs reduces platelet-mediated thrombin generation and attenuates elements of thrombus formation. These data support the cardioprotective value of-3 PUFAs and strongly suggest that they modify elements of platelet function in vivo.